Department of Psychiatry, Mount Sinai School of Medicine, New York, NY 10029, USA.
World J Biol Psychiatry. 2013 Mar;14(2):121-8. doi: 10.3109/15622975.2011.560964. Epub 2011 Apr 12.
Pathological gambling (PG) is an impulse control disorder characterized by recurrent gambling thoughts and behaviours that impair social functioning. Earlier studies suggested that topiramate may be effective in treating some impulse control disorders. We conducted the first randomized, controlled trial of topiramate in PG.
PG patients were randomized to topiramate (N = 20) or placebo (N = 22) in this 14-week, double-blind, placebo-controlled, parallel-group trial. The primary outcome measure was change in the obsessions subscale of the Yale-Brown Obsessive-Compulsive Scale Modified for Pathological Gambling.
Mixed regression models (time [weeks] × treatment) revealed no significant treatment effect of topiramate on the primary or secondary outcome measures. The most statistically robust findings involved reducing the Barratt Impulsiveness Scale (BIS) total score and Motor and Non-Planning subscale scores, for which topiramate outperformed placebo at merely a trend level (P < 0.1).
The observed trend in BIS score reductions may warrant further investigation to study whether topiramate reduces clinically important impulsivity in PG. Treatment studies with larger samples and less stringent exclusion criteria are needed to produce results that can be generalized to pathological gamblers in the community.
病理性赌博（PG）是一种冲动控制障碍，其特征是反复出现的赌博想法和行为，损害了社会功能。早期研究表明，托吡酯可能对治疗某些冲动控制障碍有效。我们进行了托吡酯治疗 PG 的首次随机对照试验。
在这项为期 14 周的双盲、安慰剂对照、平行组试验中，PG 患者被随机分配至托吡酯（N=20）或安慰剂（N=22）组。主要结局指标是耶鲁-布朗强迫量表病理性赌博修订版（Yale-Brown Obsessive-Compulsive Scale Modified for Pathological Gambling）中强迫观念分量表的变化。
混合回归模型（时间[周]×治疗）显示托吡酯对主要或次要结局指标均无显著治疗作用。最具统计学意义的发现涉及降低巴瑞特冲动量表（Barratt Impulsiveness Scale，BIS）总分和运动及非计划分量表分数，托吡酯在这方面的表现仅略优于安慰剂（P<0.1）。
BIS 评分降低的观察趋势可能需要进一步研究，以研究托吡酯是否能降低 PG 患者的临床重要冲动性。需要进行更大样本量和更少严格排除标准的治疗研究，以产生可推广至社区病理性赌博者的结果。
