Bullock Scott A, Potenza Marc N
Department of Psychiatry, Yale University School of Medicine, 1 Church Street 7 floor, New Haven, CT, 06510, USA.
Department of Psychiatry, Yale University School of Medicine, 1 Church Street 7 floor, New Haven, CT, 06510, USA ; Departments of Psychiatry and Child Study Center, Yale University School of Medicine, Connecticut Mental Health Center, 34 Park Street, New Haven, CT, 06519, USA.
Curr Psychopharmacol. 2012 Feb 1;1(1). doi: 10.2174/2211556011201010067.
Pathological gambling (PG) affects about 0.2-2% of adults and the impact extends to family members, employers and society as a whole. Recent research has identified similarities in the pathophysiologies of PG and substance use disorders (SUDs). As such, findings regarding SUDs provide a framework for investigating PG. The aims of the manuscript are two-fold. First, we will briefly revivew neural systems implicated in PG. Cortico-limbic circuitry involving the ventral striatum, ventromedial prefrontal cortex, anterior cingulate cortex, and dorsolateral prefrontal cortex are discussed as are the neurotransmitters norepinephrine, serotonin, dopamine, opioids, glutamate, and gamma-aminobutyric acid (GABA). This background will provide a framework for reviewing the psychopharmacological treatments that have been tested for efficacy and safety in treating PG. Of medications, the strongest data suggest the efficacy and tolerability of opioid antagonists in the treatment of PG, and other agents have varying degree of empirical support. As behavioral therapies have also shown efficacy, they will be briefly considered as well. Future research is needed to understand how treatments work in PG and for whom specific treatments might work best.
病理性赌博（PG）影响约0.2%至2%的成年人，其影响波及家庭成员、雇主乃至整个社会。最近的研究已确定PG与物质使用障碍（SUDs）在病理生理学上存在相似之处。因此，关于SUDs的研究结果为调查PG提供了一个框架。本文的目的有两个。首先，我们将简要回顾与PG相关的神经系统。涉及腹侧纹状体、腹内侧前额叶皮质、前扣带回皮质和背外侧前额叶皮质的皮质-边缘回路将被讨论，去甲肾上腺素、血清素、多巴胺、阿片类物质、谷氨酸和γ-氨基丁酸（GABA）等神经递质也将被讨论。这一背景将为回顾已在治疗PG中测试过疗效和安全性的心理药物治疗提供一个框架。在药物方面，最有力的数据表明阿片类拮抗剂在治疗PG方面的疗效和耐受性，其他药物也有不同程度的经验支持。由于行为疗法也已显示出疗效，它们也将被简要考虑。需要未来的研究来了解治疗方法在PG中如何起作用以及特定治疗方法可能对哪些人效果最佳。
