de Brito Antonio Marcelo Cabrita, de Almeida Pinto Moema Galindo, Bronstein Gabriel, Carneiro Elizabeth, Faertes Daniela, Fukugawa Viviane, Duque Angela, Vasconcellos Fatima, Tavares Hermano
Outpatient Clinic for Impulse Control Disorders, Institute and Department of Psychiatry, University of São Paulo School of Medicine Hospital das Clínicas, Rua Dr. Ovídio Pires de Campos, 785, Jardim Paulista, São Paulo, SP, CEP 05403-010, Brazil.
Impulse Control Disorders Clinic, Department of Psychiatry, Santa Casa de Misericórdia Hospital, Rio de Janeiro, Brazil.
J Gambl Stud. 2017 Mar;33(1):249-263. doi: 10.1007/s10899-016-9620-z.
Gambling disorder (GD) is a prevalent condition for which no pharmacological treatment has yet been approved, although there is evidence that topiramate can reduce impulsivity in GD and craving in various addictive behaviors. The goal of this study was to investigate the effectiveness of topiramate combined with cognitive restructuring for GD in a two-center, randomized, double-blind clinical trial. Participants were individuals seeking outpatient treatment for GD (n = 30), treated with either topiramate or placebo combined with a brief cognitive intervention, over a 12-week period, the dose of topiramate being tapered up during the first 8 weeks. The main outcome measures were gambling craving, behavior, and cognitive distortions; impulsivity; depression and social adjustment. Topiramate proved superior to placebo in reducing gambling craving (P = 0.017); time and money spent gambling (P = 0.007 and P = 0.047, respectively); cognitive distortions related to gambling (P = 0.003); and social adjustment (P = 0.040). We found no significant effects on impulsivity or depression. These findings are in contrast with data from a previous clinical trial with topiramate for GD. In the current study, we found that topiramate affects features specifically related to gambling addiction and had no significant effect on associated phenomena such as impulsiveness and depression. We believe that this response could be due to synergistic interaction between topiramate and the cognitive intervention.
赌博障碍（GD）是一种普遍存在的疾病，目前尚无获批的药物治疗方法，尽管有证据表明托吡酯可以降低GD患者的冲动性以及减少各种成瘾行为中的渴望感。本研究的目的是在一项双中心、随机、双盲临床试验中，调查托吡酯联合认知重构对GD的有效性。参与者为寻求GD门诊治疗的个体（n = 30），在12周的时间里，接受托吡酯或安慰剂联合简短认知干预的治疗，托吡酯的剂量在前8周逐渐增加。主要结局指标为赌博渴望、行为和认知扭曲；冲动性；抑郁和社会适应。结果显示，托吡酯在降低赌博渴望（P = 0.017）、赌博花费的时间和金钱（分别为P = 0.007和P = 0.047）、与赌博相关的认知扭曲（P = 0.003）以及社会适应方面（P = 0.040）均优于安慰剂。我们发现托吡酯对冲动性或抑郁没有显著影响。这些发现与之前一项使用托吡酯治疗GD的临床试验数据相反。在本研究中，我们发现托吡酯对与赌博成瘾特别相关的特征有影响，而对冲动性和抑郁等相关现象没有显著影响。我们认为这种反应可能是由于托吡酯与认知干预之间的协同相互作用。
