Romanczuk-Seiferth Nina, van den Brink Wim, Goudriaan Anna E
Department of Psychiatry and Psychotherapy, Campus Mitte, Charité Universitätsmedizin Berlin, Berlin, Germany.
Neuropsychobiology. 2014;70(2):95-102. doi: 10.1159/000362839. Epub 2014 Oct 30.
Pathological gambling (PG), as defined until recently in the DSM-IV, shares many clinical characteristics with substance use disorders (SUDs), such as craving and loss of control. Moreover, an increasing body of literature also revealed neurobiological similarities between PG and substance-related addictions. Further, specific treatments for SUD are also effective in pathological gamblers. These observations resulted in a recent change in the diagnostic classification of PG in DSM-5: maladaptive gambling behavior is now subsumed as 'gambling disorder' (GD) under the category 'substance-related and addictive disorders'. On the basis of similarities in clinical characteristics between GD and SUDs, this article proposes 3 main clusters of diagnostic criteria: 'loss of control', 'craving/withdrawal' and 'neglect of other areas in life'. These symptom clusters can then be related to the experimental paradigms commonly used in the neuroscience of addiction, including neuropsychological, neurophysiological and neuroimaging studies. In this paper, we present the neurobiological evidence for PG by focusing on key functional magnetic resonance imaging studies related to these 3 symptom clusters. It is concluded that these symptom clusters provide a useful framework for systematic comparisons of new evidence in GD and SUDs in the future.
直到最近，《精神疾病诊断与统计手册》第四版（DSM-IV）所定义的病理性赌博（PG）与物质使用障碍（SUDs）具有许多临床特征，如渴望和失控。此外，越来越多的文献也揭示了PG与物质相关成瘾之间的神经生物学相似性。此外，针对SUD的特定治疗方法对病理性赌徒也有效。这些观察结果导致了最近《精神疾病诊断与统计手册》第五版（DSM-5）中PG诊断分类的变化：适应不良的赌博行为现在被归入“物质相关及成瘾性障碍”类别下的“赌博障碍”（GD）。基于GD与SUDs在临床特征上的相似性，本文提出了3个主要的诊断标准类别：“失控”、“渴望/戒断”和“忽视生活中的其他方面”。然后，这些症状类别可以与成瘾神经科学中常用的实验范式相关联，包括神经心理学、神经生理学和神经影像学研究。在本文中，我们通过关注与这3个症状类别相关的关键功能磁共振成像研究，展示了PG的神经生物学证据。得出的结论是，这些症状类别为未来系统比较GD和SUDs中的新证据提供了一个有用的框架。
