药物引起的赌博障碍:流行病学、神经生物学和管理。

IF 3.1 Q2 PHARMACOLOGY & PHARMACY
Mirjam Wolfschlag, Anders Håkansson
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引用次数: 3

摘要

有问题的赌博被认为是主要用于神经系统疾病的多巴胺能药物的可能后果,即普拉克索和罗匹尼罗,也可能是一种抗精神病化合物阿立哌唑。帕金森氏症、不宁腿综合征和其他可能用多巴胺激动剂治疗的病症患者,以及治疗精神病的患者,都是易受伤害的患者群体,理论上,他们患赌博障碍(GD)的风险更高,例如,由于这些群体的精神疾病发病率较高。本文的目的是回顾流行病学、临床和神经生物学证据的多巴胺能药物和GD之间的关联,并描述风险群体和治疗方案。GD的神经生物学涉及奖励和强化系统,主要基于中皮质边缘多巴胺的投射,伏隔核是对物质和行为产生成瘾的关键区域。赌博的成瘾性也许可以用奖励的不确定性来解释,这种不确定性以一种病态的方式激活了多巴胺信号。由于奖励相关学习是由多巴胺介导的,它可以被多巴胺能药物改变,可能导致赌博行为增加和冲动控制下降。药物与GD之间似乎存在因果关系,但这种关联背后的分子机制尚未得到充分描述。需要进行更多的研究,以全面概述在使用多巴胺能药物的患者组中发生GD的临床情况,并需要关于不同化合物的风险分化的数据。此外,关于多巴胺类药物引起的GD治疗的介入研究很少。虽然GD总体上是可以治疗的,但有必要进行治疗研究,测试在这些患者群体中逐渐减少药物治疗或其他针对赌博的治疗方式的有效性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Drug-Induced Gambling Disorder: Epidemiology, Neurobiology, and Management.

Problematic gambling has been suggested to be a possible consequence of dopaminergic medications used mainly in neurological conditions, i.e. pramipexole and ropinirole, and possibly by one antipsychotic compound, aripiprazole. Patients with Parkinson's disease, restless legs syndrome and other conditions potentially treated with dopamine agonists, as well as patients treated for psychotic disorders, are vulnerable patient groups with theoretically increased risk of developing gambling disorder (GD), for example due to higher rates of mental ill-health in these groups. The aim of the present paper is to review the epidemiological, clinical, and neurobiological evidence of the association between dopaminergic medications and GD, and to describe risk groups and treatment options. The neurobiology of GD involves the reward and reinforcement system, based mainly on mesocorticolimbic dopamine projections, with the nucleus accumbens being a crucial area for developing addictions to substances and behaviors. The addictive properties of gambling can perhaps be explained by the reward uncertainty that activates dopamine signaling in a pathological manner. Since reward-related learning is mediated by dopamine, it can be altered by dopaminergic medications, possibly leading to increased gambling behavior and a decreased impulse control. A causal relationship between the medications and GD seems likely, but the molecular mechanisms behind this association have not been fully described yet. More research is needed in order to fully outline the clinical picture of GD developing in patient groups with dopaminergic medications, and data are needed on the differentiation of risk in different compounds. In addition, very few interventional studies are available on the management of GD induced by dopaminergic medications. While GD overall can be treated, there is need for treatment studies testing the effectiveness of tapering of the medication or other gambling-specific treatment modalities in these patient groups.

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来源期刊
Pharmaceutical Medicine
Pharmaceutical Medicine PHARMACOLOGY & PHARMACY-
CiteScore
5.10
自引率
4.00%
发文量
36
期刊介绍: Pharmaceutical Medicine is a specialist discipline concerned with medical aspects of the discovery, development, evaluation, registration, regulation, monitoring, marketing, distribution and pricing of medicines, drug-device and drug-diagnostic combinations. The Journal disseminates information to support the community of professionals working in these highly inter-related functions. Key areas include translational medicine, clinical trial design, pharmacovigilance, clinical toxicology, drug regulation, clinical pharmacology, biostatistics and pharmacoeconomics. The Journal includes:Overviews of contentious or emerging issues.Comprehensive narrative reviews that provide an authoritative source of information on topical issues.Systematic reviews that collate empirical evidence to answer a specific research question, using explicit, systematic methods as outlined by PRISMA statement.Original research articles reporting the results of well-designed studies with a strong link to wider areas of clinical research.Additional digital features (including animated abstracts, video abstracts, slide decks, audio slides, instructional videos, infographics, podcasts and animations) can be published with articles; these are designed to increase the visibility, readership and educational value of the journal’s content. In addition, articles published in Pharmaceutical Medicine may be accompanied by plain language summaries to assist readers who have some knowledge of, but not in-depth expertise in, the area to understand important medical advances.All manuscripts are subject to peer review by international experts. Letters to the Editor are welcomed and will be considered for publication.
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