Department of Psychiatry & Behavioral Neuroscience, University of Chicago, Chicago, IL, USA.
Department of Psychiatry, University of Cambridge; & Cambridge and Peterborough NHS Foundation Trust (CPFT), UK.
CNS Spectr. 2019 Dec;24(6):609-615. doi: 10.1017/S1092852918001645.
The clinical phenotype of gambling disorder (GD) is suggestive of changes in brain regions involved in reward and impulse suppression, notably the striatum. Studies have yet to characterize striatal morphology (shape) in GD and whether this may be a vulnerability marker.
To characterize the morphology of the striatum in those with disordered gambling (at-risk gambling and GD) versus controls.
Individuals aged 18-29 years were classified a priori into those with some degree of GD symptoms (at-risk gambling and GD) or controls. Exclusion criteria were a current mental disorder (apart from GD), history of brain injury, or taking psychoactive medication within 6 weeks of enrollment. History of any substance use disorder was exclusionary. Participants completed an impulsivity questionnaire and structural brain scan. Group differences in volumes and morphology were characterized in subcortical regions of interest, focusing on the striatum.
Thirty-two people with GD symptoms (14 at-risk and 18 GD participants) and 22 controls completed the study. GD symptoms were significantly associated with higher impulsivity and morphological alterations in the bilateral pallidum and left putamen. Localized contraction in the right pallidum strongly correlated with trait impulsivity in those with GD symptoms.
Morphologic abnormalities of the striatum appear to exist early in the disease trajectory from subsyndromal gambling to GD and thus constitute candidate biological vulnerability markers, which may reflect differences in brain development associated with trait impulsivity. Striatal morphology and associated impulsivity might predispose to a range of problematic repetitive behaviors.
赌博障碍（GD）的临床表型表明，与奖励和冲动抑制相关的脑区，尤其是纹状体，发生了变化。目前尚未有研究对 GD 患者的纹状体形态（形状）进行特征描述，也不知道这是否是一个易损性标志物。
描述有赌博障碍（有风险的赌博和 GD）和对照组个体的纹状体形态。
根据预先设定的标准，将年龄在 18-29 岁的个体分为有一定 GD 症状（有风险的赌博和 GD）或对照组。排除标准为当前患有精神障碍（GD 除外）、脑损伤史或入组前 6 周内服用精神活性药物。有任何物质使用障碍史的个体被排除在外。参与者完成了冲动性问卷和结构脑扫描。在皮质下感兴趣区域，重点是纹状体，对体积和形态进行了亚组差异特征描述。
32 名有 GD 症状的个体（14 名有风险的赌博和 18 名 GD 参与者）和 22 名对照组完成了研究。GD 症状与双侧苍白球和左侧壳核的更高冲动性和形态改变显著相关。在有 GD 症状的个体中，右侧苍白球的局灶性收缩与特质冲动性强烈相关。
纹状体的形态异常似乎在亚综合征赌博向 GD 发展的疾病轨迹早期就存在，因此构成了候选的生物易损性标志物，这可能反映了与特质冲动性相关的大脑发育差异。纹状体的形态和相关的冲动性可能导致一系列有问题的重复性行为。
