Jones Henrietta Bowden, George Sanju
Department of Neurosciences and Mental Health, Imperial College, London, UK.
BMJ Case Rep. 2011 Aug 24;2011:bcr0720114459. doi: 10.1136/bcr.07.2011.4459.
Dopaminergic agents are commonly used and effective treatments for restless legs syndrome (RLS), a disabling sensorimotor disorder. Less known are some of the potentially disabling side effects of these treatments, particularly iatrogenic gambling addiction, as is described here. Here the authors present a 62-year-old man, with a 20-year history of RLS, who developed gambling addiction while on dopaminergic treatment. He was not forewarned of this side effect, nor was he ever screened for gambling behaviours prior to or during treatment. Eight months after discontinuation of dopaminergic treatment and after 10 sessions of cognitive-behavioural therapy for gambling addiction, his gambling behaviours have partially resolved. To our knowledge, this is the first ever first person account of this condition. To prevent the devastating consequences of gambling addiction or to minimise its impact by early intervention, the authors call for clinicians involved in treatment of RLS to follow these simple measures: screen patients for gambling behaviours prior to the onset and during dopaminergic treatment; forewarn patients of this potential side effect; and if patients screen positive, refer them to specialist gambling treatment services, in addition to making necessary changes to their medication regime.
多巴胺能药物是治疗不安腿综合征(RLS)这种致残性感觉运动障碍的常用且有效的方法。这些治疗的一些潜在致残副作用却鲜为人知,尤其是医源性赌博成瘾,本文对此进行了描述。本文作者介绍了一名62岁男性,患有不安腿综合征20年,在接受多巴胺能治疗期间染上了赌博成瘾。他未被告知这种副作用,在治疗前或治疗期间也从未接受过赌博行为筛查。在停用多巴胺能治疗8个月后,以及在接受了10次针对赌博成瘾的认知行为治疗后,他的赌博行为部分得到缓解。据我们所知,这是关于这种情况的首例第一人称叙述。为防止赌博成瘾的毁灭性后果或通过早期干预将其影响降至最低,作者呼吁参与不安腿综合征治疗的临床医生采取以下简单措施:在开始多巴胺能治疗前及治疗期间对患者进行赌博行为筛查;预先告知患者这种潜在副作用;如果患者筛查呈阳性,除了对其用药方案进行必要调整外,还应将他们转介至专门的赌博治疗服务机构。