Grant Jon E, Chamberlain Samuel R
Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Pritzker School of Medicine, Chicago, IL, USA E-mail:
Ann Clin Psychiatry. 2017 Aug;29(3):167-172.
Although gambling disorder is prevalent and functionally impairing, no FDA-approved medications exist for its treatment. The ability of clinical trials to detect the benefits of active treatment has been hindered by an unusually high placebo response. Virtually nothing is known about baseline clinical characteristics that might predict placebo response in those with gambling disorder.
Participants (N = 152) assigned to placebo were pooled from multiple double-blind trials of gambling disorder. Participants were classified as placebo responders or non-responders based on a cut-off of 35% reduction in symptom severity on the Gambling Symptom Assessment Scale. Baseline group differences were characterized using t tests and equivalent non-parametric tests as appropriate.
Fifty-one percent of individuals assigned to placebo showed a significant clinical response. Compared with non-responders, placebo responders remained in treatment for significantly longer, were more likely to report "enjoyment" as a trigger for gambling, and were less likely to state that "boredom" or "loneliness" triggered their gambling. Placebo responders and non-responders did not differ significantly in age, sex, age at symptom onset, baseline symptom severity, comorbidities, or likelihood of having received a previous treatment.
Predictors of placebo response for gambling disorder appear markedly different from those reported for other mental illnesses.
尽管赌博障碍很常见且会造成功能损害，但尚无美国食品药品监督管理局（FDA）批准用于治疗该疾病的药物。临床试验检测积极治疗益处的能力受到异常高的安慰剂反应的阻碍。对于可能预测赌博障碍患者安慰剂反应的基线临床特征，人们几乎一无所知。
从多项赌博障碍双盲试验中汇总分配到安慰剂组的参与者（N = 152）。根据赌博症状评估量表上症状严重程度降低35%的临界值，将参与者分为安慰剂反应者或无反应者。使用t检验和适当的等效非参数检验来描述基线组间差异。
分配到安慰剂组的个体中有51%显示出显著的临床反应。与无反应者相比，安慰剂反应者接受治疗的时间明显更长，更有可能报告“享受”是赌博的触发因素，而不太可能表示“无聊”或“孤独”是其赌博的触发因素。安慰剂反应者和无反应者在年龄、性别、症状发作年龄、基线症状严重程度、合并症或既往接受治疗的可能性方面没有显著差异。
赌博障碍安慰剂反应的预测因素似乎与其他精神疾病所报告的预测因素明显不同。
