Yip Sarah W, Potenza Marc N
Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.
Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA ; Department of Neurobiology, Yale University School of Medicine, New Haven, CT, USA ; Yale Child Study Center, Yale University School of Medicine, New Haven, CT, USA.
Curr Treat Options Psychiatry. 2014 Jun 1;1(2):189-203. doi: 10.1007/s40501-014-0014-5.
Preclinical and clinical research implicate several neurotransmitter systems in the pathophysiology of gambling disorder (GD). In particular, neurobiological research suggests alterations in serotonergic, dopaminergic, glutamatergic and opioidergic functioning. The relative efficacy of medications targeting these systems remains a topic of ongoing research, and there is currently no Food and Drug Administration (FDA) approved medication with an indication for GD. Considering co-occurring disorders may be particularly important when devising a treatment plan for GD: extant data suggest that the opioid antagonist naltrexone may by the most effective form of current pharmacotherapy for GD, particularly for individuals with a co-occurring substance-use disorder (SUD) or with a family history of alcoholism. In contrast, lithium or other mood stabilizers may be most effective for GD for patients presenting with a co-occurring bipolar-spectrum disorder (BSD). Further, serotonin reuptake inhibitors (SRIs) may be efficacious in reducing GD symptoms for individuals also presenting with a (non-BSD) mood or anxiety disorder. Finally, elevated rates of GD (and other Impulse Control Disorders; ICDs) have been noted among individuals with Parkinson's Disease (PD), and clinicians should assess for vulnerability to GD when considering treatment options for PD. Reducing levodopa or dopamine agonist (DA) dosages may partially reduce GD symptoms among patients with co-occurring PD. For GD patients not willing to consider drug treatment, n-acetyl cysteine or behavioral therapies may be effective. Ongoing research into the effectiveness of combined behavioral and pharmacotherapies is being conducted; thus combined treatments should also be considered.
临床前和临床研究表明，几种神经递质系统与赌博障碍（GD）的病理生理学有关。特别是，神经生物学研究表明血清素能、多巴胺能、谷氨酸能和阿片样物质能功能存在改变。针对这些系统的药物的相对疗效仍是一个正在进行研究的课题，目前美国食品药品监督管理局（FDA）尚未批准有治疗GD适应症的药物。在为GD制定治疗计划时，考虑共病可能尤为重要：现有数据表明，阿片类拮抗剂纳曲酮可能是目前治疗GD最有效的药物形式，特别是对于患有共病物质使用障碍（SUD）或有酗酒家族史的个体。相比之下，锂盐或其他心境稳定剂可能对伴有双相谱障碍（BSD）的GD患者最有效。此外，5-羟色胺再摄取抑制剂（SRIs）可能对同时患有（非BSD）心境或焦虑障碍的个体减轻GD症状有效。最后，帕金森病（PD）患者中GD（及其他冲动控制障碍；ICDs）的发生率较高，临床医生在考虑PD的治疗方案时应评估患者患GD的易感性。减少左旋多巴或多巴胺激动剂（DA）的剂量可能会部分减轻共病PD患者的GD症状。对于不愿考虑药物治疗的GD患者，N-乙酰半胱氨酸或行为疗法可能有效。目前正在对联合行为疗法和药物疗法的有效性进行研究；因此也应考虑联合治疗。
