Yamada Risa, Miyashita Kumi, Hashimoto Taka-Mitsu, Hironaka Naoyuki, Takada Kohji, Shigeta Masahiro, Miyata Hisatsugu
From the Department of Psychiatry, The Jikei University School of Medicine, Nishi-shimbashi, Minato-ku, Tokyo, Japan (RY, NH, KT, MS, HM); Department of Preventive Intervention for Psychiatric Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, Ogawahigashi, Kodaira, Tokyo, Japan (RY); Social Welfare Corporation Taiyosha, Omori-minami Ota-ku Tokyo, Japan (KM); The National Center for University Entrance Examinations, Komaba, Meguro-ku, Tokyo, Japan (T-MH); Department of Psychology, Teikyo University, Otsuka, Hachioji, Tokyo, Japan (KT); and Hirakawa Hospital, Miyama-cho, Hachioji-shi, Tokyo, Japan (HM).
J Addict Med. 2023;17(2):140-146. doi: 10.1097/ADM.0000000000001054. Epub 2022 Sep 3.
This study investigated the occurrence rate of psychiatric disorders comorbid with gambling disorder, and their clinical significance in the severity of gambling disorder using a retrospective cross-sectional design.
The medical records of 359 patients (men/women, 326/33; median age, 37.0 years) with gambling disorder as the primary disorder from 12 treatment facilities specializing in addiction (9 clinics and 3 hospitals) in Japan were studied. We investigated patients' comorbid psychiatric disorders, demographic and clinical characteristics, and the severity of gambling disorder based on criteria from the Diagnostic and Statistical Manual of Mental Disorders, fifth edition.
Of all patients, 58.3% had comorbidities (tobacco use disorder, 20.9%; alcohol use disorder, 13.9%; major depressive disorder, 13.1%; behavioral addictions, 13.1%; attention-deficit hyperactivity disorder, 6.1%; etc.). Statistical analysis indicated that as the number of comorbid psychiatric disorders increased, psychosocial problems also increased (e.g., proportion of adverse childhood experiences [ P < 0.001], and history of suicide attempts [ P = 0.009]). In the multivariable analysis, behavioral addictions ( β = 0.666; t = 3.151) were significantly associated with gambling disorder severity. Specifically, individuals with gambling disorder comorbid with behavioral addictions including kleptomania, excessive buying, and excessive sex-related behavior may present more severe gambling problems than those without behavioral addictions.
Patients with gambling disorder should be carefully assessed for psychiatric comorbidities and interventions should reflect the individual diagnosis.
本研究采用回顾性横断面设计，调查与赌博障碍共病的精神障碍发生率及其在赌博障碍严重程度方面的临床意义。
对来自日本12家专门治疗成瘾问题的医疗机构（9家诊所和3家医院）的359例以赌博障碍为主要疾病的患者（男性/女性，326/33；中位年龄37.0岁）的病历进行研究。我们根据《精神障碍诊断与统计手册》第五版的标准，调查了患者共病的精神障碍、人口统计学和临床特征以及赌博障碍的严重程度。
在所有患者中，58.3%患有共病（烟草使用障碍，20.9%；酒精使用障碍，13.9%；重度抑郁症，13.1%；行为成瘾，13.1%；注意力缺陷多动障碍，6.1%等）。统计分析表明，随着共病精神障碍数量的增加，心理社会问题也增加（例如，儿童期不良经历的比例[P<0.001]和自杀未遂史[P = 0.009]）。在多变量分析中，行为成瘾（β = 0.666；t = 3.151）与赌博障碍严重程度显著相关。具体而言，患有赌博障碍且共病包括盗窃癖、过度购物和过度性行为等行为成瘾的个体，可能比没有行为成瘾的个体存在更严重的赌博问题。
应对患有赌博障碍的患者进行仔细的精神共病评估，干预措施应反映个体诊断。
