Koić Elvira, Filaković Pavo, Djordjević Veljko, Nadj Sanea
Psychiatric Department, General Hospital "Virovitica", Virovitica, Croatia.
Coll Antropol. 2009 Sep;33(3):961-71.
Gambling or gaming is a common term for a group of various games, activities and behavior that involve wagering money on an event with an uncertain outcome with the primary intent of winning additional money, i.e., a player risks and hopes to get back what he/she had gambled, or to win more. When the player is unable to resist impulses to gamble, and gambling behavior harmfully affects him or the others, then he/she is suffering from the so called "pathological gambling", which is one of six categories of the "Impulse control disorders" in the International Classification of Diseases. Since, at present, there is no standardized program and approach to the problem of gambling in Croatia, and having in mind the arising accessibility and popularity of the "games of chance", the authors are presenting seven cases of problem and pathological gambling and call for broad public discussion on the problem from medical-psychiatric and forensic-point of view. The first patient was treated on an outpatient basis with cognitive-behavioral and family therapy for problem gambling; for the second patient was treated for impulse control disorders; for the third patient gambling was a symptom of psychotic form of depressive disorder; the fourth had primary diagnosis of personality disorder; and the fifth patient was prosecuted for armed robbery and evaluated by a psychiatric expert. The sixth and the seventh patients were women suffering from primary bipolar affective and major depressive disorder, respectively. The authors conclude that, due to the size of the problem and its consequences, the prevention of pathological gambling is very important. The prevention can be carried out primarily through screening at the school level and primary health care services, whereas secondary screening may be conducted through the system of psychiatric care. It is recommended to invest into research, education of a wider population, and development of preventive programs.
赌博是一个统称，涵盖了一系列不同的游戏、活动和行为，这些活动涉及在结果不确定的事件上投注金钱，其主要目的是赢取额外的钱财，即玩家冒险并希望赢回其所投注的金额，或者赢得更多。当玩家无法抗拒赌博冲动，且赌博行为对其自身或他人造成有害影响时，那么他/她就患有所谓的“病态赌博”，这是《国际疾病分类》中“冲动控制障碍”的六个类别之一。由于目前克罗地亚尚无针对赌博问题的标准化方案和方法，并且考虑到“博彩游戏”的易获取性和普及程度不断提高，作者在此呈现七例问题赌博和病态赌博案例，并呼吁从医学 - 精神病学和法医学角度就该问题展开广泛的公众讨论。第一位患者作为门诊病人接受了针对问题赌博的认知行为疗法和家庭疗法；第二位患者接受了冲动控制障碍治疗；第三位患者的赌博行为是抑郁障碍精神病形式的一种症状；第四位患者的初步诊断为人格障碍；第五位患者因持械抢劫被起诉并接受了精神病专家的评估。第六位和第七位患者分别患有原发性双相情感障碍和重度抑郁症。作者得出结论，鉴于该问题的规模及其后果，预防病态赌博非常重要。预防主要可通过学校层面和初级卫生保健服务进行筛查来开展，而二级筛查可通过精神科护理系统进行。建议投入研究、对更广泛人群进行教育并制定预防方案。
