Department of Clinical Sciences Lund, Psychiatry, Faculty of Medicine, Lund University, Lund, Sweden.
Malmö Addiction Center, Clinical Research Unit, Malmö, Sweden.
PLoS One. 2021 Jun 1;16(6):e0252516. doi: 10.1371/journal.pone.0252516. eCollection 2021.
Gambling Disorder (GD) has recently been reclassified from an impulse-control disorder to a behavioural addiction and, as in other addictive disorders, the dopaminergic reward system is involved. According to neuroimaging studies, alterations within the striatal dopaminergic signalling can occur in GD. However, the findings to date are controversial and there has been no agreement yet on how the reward system is affected on a molecular basis. Within the last 20 years, there has been growing evidence for a higher risk to develop GD in response to certain dopaminergic medication. Especially the dopamine agonists pramipexole and ropinirole, and the dopamine modulator aripiprazole seem to increase the likelihood for GD. The goal of this study was to examine the association between a prescription for either of the three pharmaceuticals and a GD diagnosis in a large cross-sectional study of the Swedish population. Compared to patients with any other dopaminergic drug prescription (38.7% with GD), the diagnosis was more common in patients with a dopamine agonist prescription (69.8% with GD), resulting in an odds ratio of 3.2. A similar association was found between aripiprazole prescriptions and GD diagnoses, which were analysed within the subgroup of all patients with schizophrenia or a schizotypal, delusional, or another non-mood psychotic disorder. An aripiprazole prescription increased the likelihood of GD (88.8%) in comparison to patients without an aripiprazole prescription (71.2%) with an odds ratio of 3.4. This study contributes to the increasingly reliable evidence for an association between several dopaminergic drugs and a higher risk for developing GD. Therefore, one future research goal should be a better understanding of the neurobiology in GD to be able to design more selective dopaminergic medication with less severe side effects. Additionally, this knowledge could enable the development of pharmacotherapy in GD and other addictive disorders.
赌博障碍 (GD) 最近已从冲动控制障碍重新分类为行为成瘾，与其他成瘾障碍一样，多巴胺奖赏系统也参与其中。根据神经影像学研究，GD 患者的纹状体多巴胺信号可能会发生改变。然而，迄今为止的研究结果存在争议，尚未就奖赏系统如何在分子基础上受到影响达成共识。在过去的 20 年中，越来越多的证据表明，某些多巴胺能药物的使用会增加 GD 的发病风险。特别是多巴胺激动剂普拉克索和罗匹尼罗，以及多巴胺调节剂阿立哌唑似乎会增加 GD 的可能性。本研究的目的是在对瑞典人群进行的一项大型横断面研究中，检查三种药物处方与 GD 诊断之间的关联。与其他任何多巴胺能药物处方的患者相比（有 GD 的患者占 38.7%），有多巴胺激动剂处方的患者（有 GD 的患者占 69.8%）的诊断更为常见，比值比为 3.2。在所有患有精神分裂症或精神分裂样、妄想性、或其他非情感性精神病障碍的患者亚组中，阿立哌唑处方与 GD 诊断之间也存在类似的关联。与没有阿立哌唑处方的患者相比，阿立哌唑处方增加了 GD 的可能性（88.8%对 71.2%），比值比为 3.4。这项研究为几种多巴胺能药物与更高的 GD 发病风险之间的关联提供了越来越可靠的证据。因此，未来的研究目标之一应该是更好地了解 GD 中的神经生物学，以便能够设计出副作用较小、选择性更强的多巴胺能药物。此外，这方面的知识可以促进 GD 和其他成瘾障碍的药物治疗发展。
