بررسی آزمایشی تکانشگری در قمار پاتولوژی

We examined the relationship between gambling severity, impulsivity and obsessionality/compulsivity in 38 pathological gamblers, representing the complete Minnesota sample of a randomized, placebo-controlled clinical trial of paroxetine for the treatment of pathological gambling (PG), using Pearson correlations and linear regression models at baseline and treatment endpoint. At baseline, Pathological Gambling Modification of the Yale–Brown Obsessive–Compulsive Scale (PG-YBOCS) scores correlated significantly with those of the Eysenck Impulsiveness Questionnaire (EIQ) Impulsiveness subscale and Padua Inventory (PI) factors I and IV (corresponding to impaired control over mental and motor activities, respectively). None of the associations between PI factors and the PG-YBOCS were significant after adjusting for Impulsiveness scores. There were no differences in changes in the PG-YBOCS between the paroxetine and placebo group. Changes in PG-YBOCS scores after treatment correlated with changes in Impulsiveness scores. These changes appeared independent of paroxetine treatment. The results suggest that, although PG exhibits features of both obsessionality/compulsivity and impulsivity and elements of both decrease with treatment, impulsivity predominates and changes in gambling severity are most associated with changes in impulsivity.

Impulsivity transcends multiple psychiatric disorders (Moeller et al., 2001) and is thought to be central to impulse control disorders such as pathological gambling (PG) (Blaszczynski et al., 1997, Petry and Casarella, 1999, Petry, 2001a and Potenza et al., 2001). The relationship between impulsivity and obsessionality/compulsivity is relatively poorly understood, particularly as related to specific psychiatric disorders and their treatments. Multiple studies have reported that pathological gamblers score higher than healthy volunteers on measures of impulsivity (Blaszczynski et al., 1986 and Blanco et al., 1996), and one report observed pathological gamblers scoring higher than social gamblers on obsessionality/compulsivity (Blaszczynski, 1999). Although pharmacological approaches to PG have been based on the postulate that the studied medications target features of impulsivity or compulsivity, such hypotheses have not been formally tested. A more precise knowledge of the clinical features targeted by these medications may help improve our understanding of the neurobiology of pathological gambling and guide future treatment research. Rationales for the study of serotonin reuptake inhibitors (SSRIs) in the treatment of PG have been based on their efficacy in treating obsessive–compulsive disorder and/or the relationship between serotonin and impulsivity (Grant et al., 2003a). SSRIs are considered first-line treatments for obsessive–compulsive disorder. At the same time, a number of studies have documented the relationship between abnormalities in the serotonergic system and different disorders related to impulsivity. Prior to the conduct of this study, several clinical trials had suggested that SSRIs, including paroxetine (Hollander et al., 1998, Blanco et al., 2002 and Kim et al., 2002) might be useful in the treatment of PG, although they had also documented high placebo response rates. We sought to examine the extent to which PG symptom severity correlated with obsessionality/compulsivity and impulsivity at baseline, and whether changes in PG symptomatology during treatment with paroxetine were associated with changes in obsessionality/compulsivity and impulsivity. We hypothesized that: 1) consistent with its diagnostic classification as an impulse control disorder, PG severity would correlate with impulsivity rather than with obsessionality/compulsivity; 2) decreases in gambling behavior would correlate with decreases in impulsivity; and 3) patients treated with paroxetine would have greater decreases in impulsivity and gambling behavior than those treated with placebo.