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Mestre-Bach G, Potenza MN. Current Understanding of Compulsive Sexual Behavior Disorder and Co-occurring Conditions: What Clinicians Should Know about Pharmacological Options. CNS Drugs 2024; 38:255-265. [PMID: 38485889 DOI: 10.1007/s40263-024-01075-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/15/2024] [Indexed: 04/02/2024]
Abstract
Compulsive sexual behavior disorder (CSBD) has recently been recognized as a psychiatric disorder. Pharmacological treatments for CSBD have received little study and thus have limited empirical support. The main objective of the present work is to review existing literature on the efficacy of different drugs on the symptomatology of CSBD, including the subtype of problematic pornography use (PPU). The main pharmacological approaches to treating CSBD have included opioid antagonists (naltrexone and nalmefene), selective serotonin reuptake inhibitors (paroxetine, citalopram, fluoxetine, and sertraline), mood stabilizers (topiramate), tricyclic antidepressants (clomipramine), serotonin antagonist and reuptake inhibitors (nefazodone), and N-acetylcysteine. Since people with CSBD may experience different co-occurring disorders, these should be considered when choosing the best pharmacological treatment. Pharmacological therapy for CSBD/PPU has been suggested as an adjunct to psychological therapies, which, for the moment, have the most empirical evidence. However, to evaluate the efficacy of most of the drugs presented in this narrative review, data to date have only been available from case studies. Thus, empirical support is scant and generalizability of results is limited, highlighting the need for more research in this area.
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Affiliation(s)
- Gemma Mestre-Bach
- Instituto de Investigación, Transferencia e Innovación, Universidad Internacional de La Rioja, La Rioja, Spain
| | - Marc N Potenza
- Department of Psychiatry, Yale University School of Medicine, One Church Street, Rm 726, New Haven, CT, 06510, USA.
- Connecticut Mental Health Center, New Haven, CT, USA.
- Connecticut Council on Problem Gambling, Wethersfield, CT, USA.
- Wu Tsai Institute, Yale University, New Haven, CT, USA.
- Yale Child Study Center, Yale University School of Medicine, New Haven, CT, USA.
- Department of Neuroscience, Yale University School of Medicine, New Haven, CT, USA.
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Mestre-Bach G, Potenza MN. Pharmacological management of gambling disorder: an update of the literature. Expert Rev Neurother 2024; 24:391-407. [PMID: 38357896 DOI: 10.1080/14737175.2024.2316833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 02/05/2024] [Indexed: 02/16/2024]
Abstract
INTRODUCTION Gambling disorder (GD) is a mental health condition characterized by persistent and problematic betting behavior. GD generates distress and impairment, and treatment options include psychological and pharmacological interventions. AREAS COVERED This narrative review explores existing pharmacological treatments for GD. The following classes of medications were considered: opioid-receptor antagonists (e.g. naltrexone and nalmefene), serotonin reuptake inhibitors (e.g. fluvoxamine, paroxetine, sertraline, escitalopram, and citalopram), glutamatergic agents (e.g. N-acetylcysteine (NAC), acamprosate, and memantine), mood stabilizers (e.g. topiramate, carbamazepine, lithium), and other medications (e.g. modafinil, nefazodone, olanzapine, haloperidol, tolcapone, and bupropion). EXPERT OPINION Due to the limitations of the studies reviewed, solid conclusions regarding the optimal choice of pharmacotherapy for individuals with GD are challenging to draw at this time. Despite some medications, such as naltrexone and nalmefene, showing promising results, efficacy has varied across studies. The review highlights current gaps/limitations, including small sample sizes, limited diversity in participant demographics, the need for exploring different gambling subtypes and treatment responses, high placebo response rates, lack of longer-term longitudinal information, limited investigation of neurobiological correlates and co-occurring disorders, and the importance of implementation research. Further research is needed to address these gaps and explore additional medications, as well as interventions like neuromodulation.
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Affiliation(s)
- Gemma Mestre-Bach
- Instituto de Investigación, Transferencia e Innovación, Universidad Internacional de La Rioja, La Rioja, Spain
| | - Marc N Potenza
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Child Study Center, Yale University School of Medicine, New Haven, CT, USA
- Connecticut Mental Health Center, New Haven, CT, USA
- Connecticut Council On Problem Gambling, Wethersfield, CT, USA
- Department of Neuroscience, Yale University, New Haven, CT, USA
- Wu Tsai Institute, Yale University, New Haven, CT, USA
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Dowling N, Merkouris S, Lubman D, Thomas S, Bowden-Jones H, Cowlishaw S. Pharmacological interventions for the treatment of disordered and problem gambling. Cochrane Database Syst Rev 2022; 9:CD008936. [PMID: 36130734 PMCID: PMC9492444 DOI: 10.1002/14651858.cd008936.pub2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Pharmacological interventions for disordered and problem gambling have been employed in clinical practice. Despite the availability of several reviews of the efficacy of pharmacological interventions for disordered or problem gambling, few have employed systematic search strategies or compared different categories of pharmacological interventions. Systematic reviews of high-quality evidence are therefore essential to provide guidance regarding the efficacy of different pharmacological interventions for disordered or problem gambling. OBJECTIVES The primary aims of the review were to: (1) examine the efficacy of major categories of pharmacological-only interventions (antidepressants, opioid antagonists, mood stabilisers, atypical antipsychotics) for disordered or problem gambling, relative to placebo control conditions; and (2) examine the efficacy of these major categories relative to each other. SEARCH METHODS: We searched the Cochrane Common Mental Disorders Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), Ovid MEDLINE, Embase, and PsycINFO (all years to 11 January 2022). SELECTION CRITERIA We included randomised trials evaluating a pharmacological intervention for the treatment of disordered or problem gambling. Eligible control conditions included placebo control groups or comparisons with another category of pharmacological intervention. DATA COLLECTION AND ANALYSIS We used standard methodological procedures, including systematic extraction of included study characteristics and results and risk of bias assessment. Our primary outcome was reduction in gambling symptom severity. Our secondary outcomes were reduction in gambling expenditure, gambling frequency, time spent gambling, depressive symptoms, anxiety symptoms, and functional impairment; and responder status. We evaluated treatment effects for continuous and dichotomous outcomes using standardised mean difference (SMD) and risk ratios (RR), respectively, employing random-effects meta-analyses. A minimum of two independent treatment effects were required for a meta-analysis to be conducted (with only meta-analytic findings reported in this abstract). MAIN RESULTS We included 17 studies in the review (n = 1193 randomised) that reported outcome data scheduled for end of treatment. Length of treatment ranged from 7 to 96 weeks. Antidepressants: Six studies (n = 268) evaluated antidepressants, with very low to low certainty evidence suggesting that antidepressants were no more effective than placebo at post-treatment: gambling symptom severity (SMD -0.32, 95% CI -0.74 to 0.09, n = 225), gambling expenditure (SMD -0.27, 95% CI -0.60 to 0.06, n = 144), depressive symptoms (SMD -0.19, 95% CI -0.60 to 0.23, n = 90), functional impairment (SMD -0.15, 95% CI -0.53 to 0.22, n = 110), and responder status (RR 1.24, 95% CI 0.93 to 1.66, n = 268). Opioid antagonists: Four studies (n = 562) evaluated opioid antagonists, with very low to low certainty evidence showing a medium beneficial effect of treatment on gambling symptom severity relative to placebo at post-treatment (SMD -0.46, 95% CI -0.74 to -0.19, n = 259), but no difference between groups in responder status (RR 1.65, 95% CI 0.86 to 3.14, n = 562). Mood stabilisers: Two studies (n = 71) evaluated mood stabilisers (including anticonvulsants), with very low certainty evidence suggesting that mood stabilisers were no more effective than placebo at post-treatment: gambling symptom severity (SMD -0.92, 95% CI -2.24 to 0.39, n = 71), depressive symptoms (SMD -0.15, 95% CI -1.14 to 0.83, n = 71), and anxiety symptoms (SMD -0.17, 95% CI -0.64 to 0.30, n = 71). Atypical antipsychotics:Two studies (n = 63) evaluated the atypical antipsychotic olanzapine, with very low certainty evidence showing a medium beneficial effect of treatment on gambling symptom severity relative to placebo at post-treatment (SMD -0.59, 95% CI -1.10 to -0.08, n = 63). Comparative effectiveness: Two studies (n = 62) compared antidepressants with opioid antagonists, with very low certainty evidence indicating that antidepressants were no more effective than opioid antagonists on depressive symptoms (SMD 0.22, 95% CI -0.29 to 0.72, n = 62) or anxiety symptoms (SMD 0.21, 95% CI -0.29 to 0.72, n = 62) at post-treatment. Two studies (n = 58) compared antidepressants with mood stabilisers (including anticonvulsants), with very low certainty evidence indicating that antidepressants were no more effective than mood stabilisers on depressive symptoms (SMD 0.02, 95% CI -0.53 to 0.56, n = 58) or anxiety symptoms (SMD 0.16, 95% CI -0.39 to 0.70, n = 58) at post-treatment. Tolerability and adverse events: Several common adverse effects were reported by participants receiving antidepressants (e.g. headaches, nausea, diarrhoea/gastrointestinal issues) and opioid antagonists (e.g. nausea, dry mouth, constipation). There was little consistency in the types of adverse effects experienced by participants receiving mood stabilisers (e.g. tiredness, headaches, concentration difficulties) or atypical antipsychotics (e.g. pneumonia, sedation, increased hypomania). Discontinuation of treatment due to these adverse events was highest for opioid antagonists (10% to 32%), followed by antidepressants (4% to 31%), atypical antipsychotics (14%), and mood stabilisers (13%). AUTHORS' CONCLUSIONS This review provides preliminary support for the use of opioid antagonists (naltrexone, nalmefene) and atypical antipsychotics (olanzapine) to produce short-term improvements in gambling symptom severity, although a lack of available evidence precludes a conclusion regarding the degree to which these pharmacological agents can improve other gambling or psychological functioning indices. In contrast, the findings are inconclusive with regard to the effects of mood stabilisers (including anticonvulsants) in the treatment of disordered or problem gambling, and there is limited evidence to support the efficacy of antidepressants. However, these conclusions are based on very low to low certainty evidence characterised by a small number of included studies, high risk of bias, modest pooled sample sizes, imprecise estimates, moderate between-study heterogeneity, and exclusion of participants with psychiatric comorbidities. Moreover, there were insufficient studies to conduct meta-analyses on many outcome measures; to compare efficacy across and within major categories of interventions; to explore dosage effects; or to examine effects beyond post-treatment. These limitations suggest that, despite recommendations related to the administration of opioid antagonists in the treatment of disordered or problem gambling, pharmacological interventions should be administered with caution and with careful consideration of patient needs. A larger and more methodologically rigorous evidence base with longer-term evaluation periods is required before definitive conclusions can be drawn about the effectiveness and durability of pharmacological treatments for disordered or problem gambling.
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Affiliation(s)
- Nicki Dowling
- School of Psychology, Deakin University, Geelong, Australia
- Melbourne Graduate School of Education, University of Melbourne, Melbourne, Australia
| | | | - Dan Lubman
- Turning Point, Eastern Health, Melbourne, Australia
- Eastern Health Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Shane Thomas
- School of Health, Federation University, Melbourne, Australia
- Research School of Population Health, Australian National University, Melbourne, Australia
- Peking University, Beijing, China
| | - Henrietta Bowden-Jones
- National Problem Gambling Clinic UK, Faculty of Brain Sciences, UCL, London, UK
- Department of Psychiatry, Cambridge University, Cambridge, UK
| | - Sean Cowlishaw
- Department of Psychiatry, University of Melbourne, Melbourne, Australia
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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Abstract
Gambling disorder (GD) is estimated to be experienced by about 0.5% of the adult population in the United States. The etiology of GD is complex and includes genetic and environmental factors. Specific populations appear particularly vulnerable to GD. GD often goes unrecognized and untreated. GD often co-occurs with other conditions, particularly psychiatric disorders. Behavioral interventions are supported in the treatment of GD. No medications have a formal indication for the GD, although clinical trials suggest some may be helpful. Noninvasive neuromodulation is being explored as a possible treatment. Improved identification, prevention, and treatment of GD are warranted.
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Affiliation(s)
- Elina A Stefanovics
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA; U.S. Department of Veterans Affairs New England Mental Illness Research and Education Clinical Center (MIRECC), West Haven, CT, USA
| | - Marc N Potenza
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA; Yale Child Study Center, Yale University, New Haven, CT, USA; Connecticut Mental Health Center, New Haven, CT, USA; Connecticut Council on Problem Gambling, Wethersfield, CT, USA; Department of Neuroscience, Yale University, New Haven, CT, USA; Wu Tsai Institute, Yale University, New Haven, CT, USA; Division on Addictions Research at Yale, Yale Impulsivity Research Program, Yale Center of Excellence in Gambling Research, Women and Addictions Core of Women's Health Research at Yale, Neuroscience and Child Study, Yale University School of Medicine, 1 Church Street, Room 726, New Haven, CT 06510, USA.
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Intranasal as needed naloxone in the treatment of gambling disorder: A randomised controlled trial. Addict Behav 2022; 125:107127. [PMID: 34634640 DOI: 10.1016/j.addbeh.2021.107127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 09/23/2021] [Accepted: 09/27/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Gambling disorder (GD) is a global phenomenon affecting millions of people. GD can result in severe social and financial difficulties and efficacious treatments are warranted. Psychosocial treatments form the basis of treatment. Opioid antagonists (OAs) have however shown promise in previous studies. In a recent imaging study intranasal naloxone was found to rapidly and fully occupy brain μ-opioid receptors. This trial investigates the effect and safety of as needed naloxone in the treatment of gambling disorder. METHODS This was a 12-week double blind, randomised control trial comparing intranasal naloxone to placebo. The primary endpoint was gambling urge measured by the Gambling symptom Assessment Scale (G-SAS). Secondary outcome measures were gambling severity measures (PGSI) as well as quality of life (WHO:EUROHIS-8), alcohol consumption (AUDIT), depression (MARDS) and internet use (IDS-9SF). In addition, safety of treatment was assessed. Both treatment groups received psychosocial support. RESULTS 126 participants were randomised to treatment groups in a 1:1 ratio. 106 patients completed the study. Gambling urge (GSAS) and other gambling related measured improved in both groups, but no statistically significant difference could be found. Intranasal naloxone was well tolerated, no subjects discontinued the study due to adverse events. No serious adverse drug reactions were observed. CONCLUSIONS This study found no difference between the as-needed administration of intranasal naloxone and placebo in reducing gambling urge in persons with GD. Intranasal naloxone was safe and well tolerated.
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Tjernström N, Roman E. Individual strategies in the rat gambling task are related to voluntary alcohol intake, but not sexual behavior, and can be modulated by naltrexone. Front Psychiatry 2022; 13:931241. [PMID: 36569617 PMCID: PMC9772284 DOI: 10.3389/fpsyt.2022.931241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 11/07/2022] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Gambling disorder (GD) is the first non-substance or behavioral addiction to be included in substance-related and addictive disorders in DSM-5. Since GD is a younger phenomenon relative to alcohol and substance use disorders, little is known about potential unique features in GD and to what extent characteristics are shared with alcohol and substance use disorders. The rat gambling task (rGT) is used to study decision-making in rats. This study aimed to identify individual differences in rGT strategies and explore the stability of these strategies over time. Moreover, motor impulsivity, sexual behavior, and voluntary alcohol intake were examined in rats with different rGT strategies. Finally, the response to naltrexone on performance in rats with different rGT strategies was investigated. METHODS Male Lister hooded rats (n = 40) underwent repeated testing in the rGT, repeated copulatory behavioral tests, and 7 weeks of voluntary alcohol intake through a modified intermittent two-bottle free-choice paradigm. Finally, rats were treated with naltrexone prior to testing in the rGT. RESULTS The results revealed individual choice strategies in the rGT that were stable over time, even after multiple interruptions and other behavioral testing. The rats with a risky choice strategy displayed higher motor impulsivity and voluntary alcohol intake than the other groups. No difference in sexual behavior was found between the different rGT groups. Finally, in all rats irrespectively of rGT strategy, treatment with naltrexone decreased the number of completed trials and premature responses, and increased omissions, which indicates an overall lowered motivation. DISCUSSION In conclusion, rats with risky rGT strategies had higher voluntary alcohol intake but not elevated sexual behavior, indicating shared underlying mechanisms between rGT strategies and alcohol intake but not natural rewards in terms of sexual behavior. Finally, naltrexone treatment resulted in an overall lowered motivation in the rGT.
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Affiliation(s)
- Nikita Tjernström
- Neuropharmacology and Addiction, Department of Pharmaceutical Biosciences, Uppsala University, Uppsala, Sweden
| | - Erika Roman
- Neuropharmacology and Addiction, Department of Pharmaceutical Biosciences, Uppsala University, Uppsala, Sweden.,Department of Anatomy, Physiology and Biochemistry, Swedish University of Agricultural Sciences, Uppsala, Sweden
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Stancil SL, Abdel-Rahman S, Wagner J. Developmental Considerations for the Use of Naltrexone in Children and Adolescents. J Pediatr Pharmacol Ther 2021; 26:675-695. [PMID: 34588931 DOI: 10.5863/1551-6776-26.7.675] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 01/27/2021] [Indexed: 11/11/2022]
Abstract
Naltrexone (NTX) is a well-tolerated drug with a wide safety margin and mechanism of action that affords use across a wide variety of indications in adults and children. By antagonizing the opioid reward system, NTX can modulate behaviors that involve compulsivity or impulsivity, such as substance use, obesity, and eating disorders. Evidence regarding the disposition and efficacy of NTX is mainly derived from adult studies of substance use disorders and considerable variability exists. Developmental changes, plausible disease-specific alterations and genetic polymorphisms in NTX disposition, and pharmacodynamic pathways should be taken into consideration when optimizing the use of NTX in the pediatric population. This review highlights the current state of the evidence and gaps in knowledge regarding NTX to facilitate evidence-based pharmacotherapy of mental health conditions, for which few pharmacologic options exist.
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Validation of the Japanese Version of the Pathological Gambling Adaptation of the Yale-Brown Obsessive-Compulsive Scale (PG-YBOCS-J) Among Subclinical Japanese Gamblers. Int J Ment Health Addict 2021. [DOI: 10.1007/s11469-020-00258-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
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Perez-Macia V, Martinez- Cortes M, Mesones J, Segura-Trepichio M, Garcia-Fernandez L. Monitoring and Improving Naltrexone Adherence in Patients with Substance Use Disorder. Patient Prefer Adherence 2021; 15:999-1015. [PMID: 34040354 PMCID: PMC8140930 DOI: 10.2147/ppa.s277861] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 04/09/2021] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE Naltrexone is an opioid antagonist used for the treatment of patients with opioid use disorder and alcohol use disorder. This population often presents problems of follow-up and therapeutic efficacy related to adherence to treatment. The purpose of our study is to provide an exhaustive summary of the current evidence regarding naltrexone adherence in people with substance use disorders and to identify possible variables that may influence adherence to naltrexone. METHODS Two searches were performed in bibliographic databases (PubMed, Embase), and studies included in the systematic review were those published from January 1, 2011 to September 2020, with participants over 18 years of age, evaluating treatment with naltrexone in alcohol use disorder and opioid use disorder. From the total of 133 articles initially selected, 36 were included and analyzed in the systematic review. RESULTS Naltrexone has not demonstrated superiority over other available treatments in terms of adherence and abstinence, although reinforcement systems have obtained favorable results as an additional strategy to improve adherence. CONCLUSION It is necessary to study other psychosocial variables involved in improving adherence, in addition to taking patient preferences into account in order to improve the external validity of the results.
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Affiliation(s)
- Virginia Perez-Macia
- Vinalopó University Hospital, Elche, Spain
- Psychology and Psychiatry Department, Catholic University of Murcia, Murcia, Spain
- Correspondence: Virginia Perez-Macia 36 Vicente Fuentes Sansano Road, Elche (Alicante), 03205, SpainTel +34 675550722 Email
| | | | - Jesus Mesones
- Vinalopó University Hospital, Elche, Spain
- Psychology and Psychiatry Department, Catholic University of Murcia, Murcia, Spain
| | | | - Lorena Garcia-Fernandez
- University Hospital of San Juan, Alicante, Spain
- Clinical Medicine Department, Miguel Hernández University, Alicante, Spain
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Antons S, Brand M, Potenza MN. Neurobiology of cue-reactivity, craving, and inhibitory control in non-substance addictive behaviors. J Neurol Sci 2020; 415:116952. [DOI: 10.1016/j.jns.2020.116952] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 04/19/2020] [Accepted: 05/26/2020] [Indexed: 12/13/2022]
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Verholleman A, Victorri-Vigneau C, Laforgue E, Derkinderen P, Verstuyft C, Grall-Bronnec M. Naltrexone Use in Treating Hypersexuality Induced by Dopamine Replacement Therapy: Impact of OPRM1 A/G Polymorphism on Its Effectiveness. Int J Mol Sci 2020; 21:ijms21083002. [PMID: 32344532 PMCID: PMC7215378 DOI: 10.3390/ijms21083002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 04/20/2020] [Accepted: 04/21/2020] [Indexed: 01/15/2023] Open
Abstract
Hypersexuality is a well-known adverse side effect of dopamine replacement therapy (DRT), and anti-craving drugs could be an effective therapeutic option. Our aim was to update the knowledge on this issue, particularly on the influence of an Opioid Receptor Mu 1 (OPRM1) genetic polymorphism. A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. We also analyzed a case of iatrogenic hypersexuality that occurred in a patient treated with DRT. An analysis of the OPRM1 gene was performed on said patient. Our search identified 597 publications, of which only 7 were included in the final data synthesis. All seven publications involved naltrexone use. Five of them were case reports. None of the publications mentioned DRT side effects, nor did they report genetic data. Regarding our case report, the introduction of naltrexone corresponded with the resolution of the patient’s hypersexuality. Moreover, the patient carried the A/G genotype, which has been reported to be associated with a stronger response to naltrexone for patients with an alcohol use disorder. Although studies are inconclusive so far, naltrexone could be an interesting therapeutic option for resistant hypersexuality due to DRT. Carrying the A/G genotype could help explain a good response to treatment.
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Affiliation(s)
- Audrey Verholleman
- Addictology and Psychiatry Department, CHU Nantes, 44093 Nantes, France; (A.V.); (E.L.)
| | - Caroline Victorri-Vigneau
- Inserm UMR-1246, Université de Nantes, Université de Tours, 44200 Nantes, France;
- Pharmacology Department, CHU Nantes, 44093 Nantes, France
| | - Edouard Laforgue
- Addictology and Psychiatry Department, CHU Nantes, 44093 Nantes, France; (A.V.); (E.L.)
- Inserm UMR-1246, Université de Nantes, Université de Tours, 44200 Nantes, France;
- Pharmacology Department, CHU Nantes, 44093 Nantes, France
| | - Pascal Derkinderen
- Neurology Department, CHU Nantes, 44093 Nantes, France;
- Inserm UMR-1235, Université de Nantes, 44035 Nantes, France
| | - Celine Verstuyft
- Inserm UMR-1178, CESP, Université Paris-Sud, 94276 Le Kremlin Bicêtre, France;
- Assistance Publique-Hôpitaux de Paris, Service de Génétique moléculaire, Pharmacogénétique et Hormonologie, Hôpitaux Universitaires Paris-Sud, Hôpital de Bicêtre, 94275 Le Kremlin Bicêtre, France
| | - Marie Grall-Bronnec
- Addictology and Psychiatry Department, CHU Nantes, 44093 Nantes, France; (A.V.); (E.L.)
- Inserm UMR-1246, Université de Nantes, Université de Tours, 44200 Nantes, France;
- Correspondence: ; Tel.: +33-(0)2-40846116; Fax: +33-(0)2-40846118
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12
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Grant JE, Chamberlain SR. Gambling and substance use: Comorbidity and treatment implications. Prog Neuropsychopharmacol Biol Psychiatry 2020; 99:109852. [PMID: 31881248 DOI: 10.1016/j.pnpbp.2019.109852] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 12/12/2019] [Accepted: 12/20/2019] [Indexed: 10/25/2022]
Abstract
Gambling disorder is a common condition that was previously listed as an impulse control disorder, but is now considered a substance-related and addictive disorder. Gambling disorder has been associated with various untoward long-term outcomes including impaired quality of life, relationship break-ups, debt and mortgage foreclosure, and elevated risk of suicidality. This paper provides a concise primer on gambling disorder, with a special focus on its parallels with substance use disorders. We consider clinical presentations, comorbid expression, heritability, and treatment approaches (psychological and pharmacological). Lastly, we highlight new treatment directions suggested by the literature.
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Affiliation(s)
- Jon E Grant
- Department of Psychiatry & Behavioral Neuroscience, University of Chicago, Chicago, IL, USA.
| | - Samuel R Chamberlain
- Department of Psychiatry, University of Cambridge; & Cambridge and Peterborough NHS Foundation Trust (CPFT), UK
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Kraus SW, Etuk R, Potenza MN. Current pharmacotherapy for gambling disorder: a systematic review. Expert Opin Pharmacother 2020; 21:287-296. [PMID: 31928246 DOI: 10.1080/14656566.2019.1702969] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Introduction: Gambling disorder is classified as an addictive disorder and is associated with significant distress and impairment in personal, social, occupational or other important areas of functioning. Although no pharmacotherapy has a formal indication for gambling disorder, data suggest potential benefits of specific medications.Area covered: This systematic review evaluated findings from 19 randomized controlled trials testing pharmacotherapies for the treatment of gambling disorder.Expert opinion: Few randomized controlled trials have studied pharmacotherapies for gambling disorder. Though results are limited, opioid antagonists like naltrexone showed promise in the pharmacological treatment of gambling disorder. Pharmacotherapy combined with psychotherapy treatments for gambling disorder may provide better rates of patient retention in comparison to pharmacology-only treatments, though further research is needed in this area. Future studies should address gaps relating to considerations of racial, ethnic, gender and other individual differences in clinical studies. Because gambling disorder often co-occurs with other psychiatric disorders, additional research is needed to test treatments for dually diagnosed patients.
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Affiliation(s)
- Shane W Kraus
- Department of Psychology, University of Nevada, Las Vegas, NV, USA
| | - Repairer Etuk
- Department of Psychology, University of Nevada, Las Vegas, NV, USA
| | - Marc N Potenza
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.,Department of Neuroscience, Yale University School of Medicine, New Haven, CT, USA.,Yale Child Study Center, Yale University School of Medicine, New Haven, CT, USA.,The Connecticut Council on Problem Gambling, Wethersfield, CT, USA.,The Connecticut Mental Health Center, New Haven, CT, USA
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Kim KM, Choi SW, Kim D, Lee J, Kim JW. Associations among the opioid receptor gene ( OPRM1) A118G polymorphism, psychiatric symptoms, and quantitative EEG in Korean males with gambling disorder: A pilot study. J Behav Addict 2019; 8:463-470. [PMID: 31553235 PMCID: PMC7044614 DOI: 10.1556/2006.8.2019.41] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND AND AIMS A single nucleotide polymorphism of A118G (SNP; rs1799971) in the opioid receptor μ-1 (OPRM1) gene is a missense variant that influences the affinity of μ-opioid receptors. This study aimed to investigate the associations among the A118G polymorphism in the OPRM1 gene, psychiatric symptoms, and quantitative electroencephalography (qEEG) findings in patients with gambling disorder. METHODS Fifty-five male patients with gambling disorder aged between 18 and 65 years old participated in the study. The A118G polymorphism was genotyped into the AA, GA, and GG groups by the polymerase chain reaction/restriction fragment length polymorphism method. Resting-state qEEG was recorded with the eyes closed, and the absolute power of the delta (1-4 Hz), theta (4-8 Hz), alpha (8-12 Hz), and beta (12-30 Hz) frequency bands was analyzed. Psychiatric symptoms, including depression, anxiety, impulsivity and severity of gambling, were assessed by a self-rating scale. RESULTS There were no significant differences in psychiatric symptoms among the three genotype groups (AA, GA, and GG). However, the frequency band power of qEEG showed significant differences among the three genotype groups. The absolute power of the beta and theta bands in the frontal lobe was higher in G allele carriers. DISCUSSION AND CONCLUSION Based on the findings of this study, the polymorphism in the OPRM1 gene might affect the neurophysiological process in patients with gambling disorder.
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Affiliation(s)
- Kyoung Min Kim
- Department of Psychiatry, Dankook University Hospital, Cheonan, Republic of Korea,Department of Psychiatry, Dankook University College of Medicine, Seoul, Republic of Korea
| | - Sam-Wook Choi
- Department of Psychiatry, True Mind Mental Health Clinic, Korea Institute of Behavioral Addictions, Seoul, Republic of Korea
| | - Dohyun Kim
- Department of Psychiatry, Dankook University Hospital, Cheonan, Republic of Korea
| | - Jaewon Lee
- Department of Psychiatry, Korea Institute of Neuromodulation, Easybrain Center, Seoul, Republic of Korea,Corresponding authors: Jaewon Lee, MD, PhD; Department of Psychiatry, Korea Institute of Neuromodulation, EasyBrain Center, 1330-9 Seocho-dong, Seocho-gu, Seoul, Republic of Korea; Phone: +82 2 583 9081; Fax: +82 2 583 9082; E-mail: ; Jun Won Kim, MD, PhD; Department of Psychiatry, Catholic University of Daegu School of Medicine, 33 Duryugongwon-ro 17-gil, Nam-Gu, Daegu 42472, Republic of Korea; Phone: +82 53 650 4332; Fax: +82 53 623 1694; E-mail:
| | - Jun Won Kim
- Department of Psychiatry, Catholic University of Daegu School of Medicine, Daegu, Republic of Korea,Corresponding authors: Jaewon Lee, MD, PhD; Department of Psychiatry, Korea Institute of Neuromodulation, EasyBrain Center, 1330-9 Seocho-dong, Seocho-gu, Seoul, Republic of Korea; Phone: +82 2 583 9081; Fax: +82 2 583 9082; E-mail: ; Jun Won Kim, MD, PhD; Department of Psychiatry, Catholic University of Daegu School of Medicine, 33 Duryugongwon-ro 17-gil, Nam-Gu, Daegu 42472, Republic of Korea; Phone: +82 53 650 4332; Fax: +82 53 623 1694; E-mail:
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15
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Castrén S, Mäkelä N, Haikola J, Salonen AH, Crystal R, Scheinin M, Alho H. Treating gambling disorder with as needed administration of intranasal naloxone: a pilot study to evaluate acceptability, feasibility and outcomes. BMJ Open 2019; 9:e023728. [PMID: 31439593 PMCID: PMC6707653 DOI: 10.1136/bmjopen-2018-023728] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND AND AIM There is growing interest in the use of medication-assisted treatments for gambling disorder (GD). Opioid receptor antagonists are hypothesised to blunt the craving associated with gambling. This study was designed to assess the feasibility of using an intranasal naloxone spray to treat GD. DESIGN An 8-week, open-label, uncontrolled pilot study. SETTING A single study site in the capital region of Finland. SUBJECTS Twenty problem gamblers (nine men) were randomised into two groups. Group A (n=10) took one dose into one nostril (2 mg naloxone), as needed, with a maximum of 4 doses/day (max. 8 mg/day). Group B (n=10) took one dose into each nostril (4 mg naloxone) as needed, with a maximum of 4 doses/day (max. 16 mg/day). INTERVENTION Naloxone hydrochloride nasal spray. MEASURES Acceptability and feasibility of the intervention were assessed. Use of study medication, adverse events, gambling frequency and gambling expenditure were recorded in a mobile diary. Problem gambling: South Oaks Gambling Screen (SOGS), depressive symptoms: Beck Depression Inventory (BDI) and alcohol use: Alcohol Use Disorders Identification Test were recorded. RESULTS Study completion rate was 90%. Acceptability and feasibility scores were high. Group B used intranasal naloxone more frequently than group A, and consequently used more naloxone. No serious adverse events were reported. The postintervention SOGS scores were lower (median=4 (IQR=3.75) versus preintervention scores (median=12 (IQR=4.75)). Depressive symptoms were reduced during the trial (preintervention BDI median=9, IQR=9 vs postintervention BDI median=6, IQR=6). CONCLUSIONS The acceptability and feasibility of using intranasal naloxone were high, and no serious adverse events were reported. Preliminary results suggest mixed results in terms of gambling behaviour (ie, reduced frequency but not expenditure) and decreased depressive symptoms. TRIAL REGISTRATION NUMBER EudraCT2016-001828-56.
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Affiliation(s)
- Sari Castrén
- Department of Public Health Solutions, Terveyden ja hyvinvoinnin laitos, Helsinki, Finland
- Faculty of Social Science, Department of Psychology and Speech Language Pathology, Turun Yliopisto, Turku, Finland
| | - Niklas Mäkelä
- Alcohol, Drugs and Addictions Unit, Terveyden ja hyvinvoinnin laitos, Helsinki, Finland
- Clinicum, University of Helsinki, Helsinki, Finland
| | - Janne Haikola
- Faculty of Natural Sciences, University of Tampere, Tampere, Finland
| | - Anne H Salonen
- Alcohol, Drugs and Addictions Unit, Terveyden ja hyvinvoinnin laitos, Helsinki, Finland
- Ita-Suomen yliopisto Terveystieteiden tiedekunta, Kuopio, Finland
| | | | - Mika Scheinin
- Institute of Biomedicine, University of Turku, Turku, Finland
| | - Hannu Alho
- Alcohol, Drugs and Addictions Unit, Terveyden ja hyvinvoinnin laitos, Helsinki, Finland
- Abdominal Center, University and University of Helsinki, Helsinki, Finland
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16
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Intranasal naloxone rapidly occupies brain mu-opioid receptors in human subjects. Neuropsychopharmacology 2019; 44:1667-1673. [PMID: 30867551 PMCID: PMC6785104 DOI: 10.1038/s41386-019-0368-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 03/03/2019] [Accepted: 03/06/2019] [Indexed: 12/14/2022]
Abstract
Nasal spray formulations of naloxone, a mu-opioid receptor (MOR) antagonist, are currently used for the treatment of opioid overdose. They may have additional therapeutic utility also in the absence of opioid agonist drugs, but the onset and duration of action at brain MORs have been inadequately characterized to allow such projections. This study provides initial characterization of brain MOR availability at high temporal resolution following intranasal (IN) naloxone administration to healthy volunteers in the absence of a competing opioid agonist. Fourteen participants were scanned twice using positron emission tomography (PET) and [11C]carfentanil, a selective MOR agonist radioligand. Concentrations of naloxone in plasma and MOR availability (relative to placebo) were monitored from 0 to 60 min and at 300-360 min post naloxone. Naloxone plasma concentrations peaked at ~20 min post naloxone, associated with slightly delayed development of brain MOR occupancy (half of peak occupancy reached at ~10 min). Estimated peak occupancies were 67 and 85% following 2 and 4 mg IN doses, respectively. The estimated half-life of occupancy disappearance was ~100 min. The rapid onset of brain MOR occupancy by IN naloxone, evidenced by the rapid onset of its action in opioid overdose victims, was directly documented in humans for the first time. The employed high temporal-resolution PET method establishes a model that can be used to predict brain MOR occupancy from plasma naloxone concentrations. IN naloxone may have therapeutic utility in various addictions where brain opioid receptors are implicated, such as gambling disorder and alcohol use disorder.
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17
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Abstract
Gambling disorder is characterized by a persistent, recurrent pattern of gambling that is associated with substantial distress or impairment. The prevalence of gambling disorder has been estimated at 0.5% of the adult population in the United States, with comparable or slightly higher estimates in other countries. The aetiology of gambling disorder is complex, with implicated genetic and environmental factors. Neurobiological studies have implicated cortico-striato-limbic structures and circuits in the pathophysiology of this disorder. Individuals with gambling disorder often go unrecognized and untreated, including within clinical settings. Gambling disorder frequently co-occurs with other conditions, particularly other psychiatric disorders. Behavioural interventions, particularly cognitive-behavioural therapy but also motivational interviewing and Gamblers Anonymous, are supported in the treatment of gambling disorder. No pharmacological therapy has a formal indication for the treatment of gambling disorder, although placebo-controlled trials suggest that some medications, such as opioid-receptor antagonists, may be helpful. Given the associations with poor quality of life and suicide, improved identification, prevention, policy and treatment efforts are needed to help people with gambling disorder.
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18
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Goslar M, Leibetseder M, Muench HM, Hofmann SG, Laireiter AR. Pharmacological Treatments for Disordered Gambling: A Meta-analysis. J Gambl Stud 2019; 35:415-445. [PMID: 30570700 PMCID: PMC6517351 DOI: 10.1007/s10899-018-09815-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Disordered gambling is a public health concern associated with detrimental consequences for affected individuals and social costs. Currently, opioid antagonists are considered the first-line treatments to reduce symptoms of uncontrolled gambling. Only recently, glutamatergic agents and combined pharmacological and psychological treatments have been examined appearing promising options for the management of gambling disorder. A multilevel literature search yielded 34 studies including open-label and placebo-controlled trials totaling 1340 participants to provide a comprehensive evaluation of the short- and long-term efficacies of pharmacological and combined treatments. Pharmacological treatments were associated with large and medium pre-post reductions in global severity, frequency, and financial loss (Hedges’s g: 1.35, 1.22, 0.80, respectively). The controlled effect sizes for the outcome variables were significantly smaller (Hedges’s g: 0.41, 0.11, 0.22), but robust for the reduction of global severity at short-term. In general, medication classes yielded comparable effect sizes independent of predictors of treatment outcome. Of the placebo controlled studies, results showed that opioid antagonists and mood stabilizers, particularly the glutamatergic agent topiramate combined with a cognitive intervention and lithium for gamblers with bipolar disorders demonstrated promising results. However, more rigorously designed, large-scale randomized controlled trials with extended placebo lead-in periods are necessary. Moreover, future studies need to monitor concurrent psychosocial treatments, the type of comorbidity, use equivalent measurement tools, include outcome variables according to the Banff, Alberta Consensus, and provide follow-up data in order to broaden the knowledge about the efficacy of pharmacological treatments for this disabling condition.
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Affiliation(s)
- Martina Goslar
- Department of Psychology, University of Salzburg, Hellbrunnerstrasse 34, 5020, Salzburg, Austria.
| | - Max Leibetseder
- Department of Psychology, University of Salzburg, Hellbrunnerstrasse 34, 5020, Salzburg, Austria
| | - Hannah M Muench
- Department of Clinical Psychology and Psychotherapy, Eberhard Karls University of Tuebingen, Schleichstraße 4, 72076, Tuebingen, Germany
| | - Stefan G Hofmann
- Department of Psychological and Brain Sciences, Boston University, 900 Commonwealth Avenue, 2nd Fl., Boston, MA, 02215, USA
| | - Anton-Rupert Laireiter
- Department of Psychology, University of Salzburg, Hellbrunnerstrasse 34, 5020, Salzburg, Austria.,Faculty of Psychology, University of Vienna, Liebiggasse 5, 1010, Vienna, Austria
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19
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Victorri-Vigneau C, Spiers A, Caillet P, Bruneau M, Ignace-Consortium, Challet-Bouju G, Grall-Bronnec M. Opioid Antagonists for Pharmacological Treatment of Gambling Disorder: Are they Relevant? Curr Neuropharmacol 2018; 16:1418-1432. [PMID: 28721822 PMCID: PMC6295935 DOI: 10.2174/1570159x15666170718144058] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 05/05/2017] [Accepted: 07/12/2017] [Indexed: 12/21/2022] Open
Abstract
Background: To date, no drugs have been approved for gambling disorder. Numerous publications have described the value of opioid antagonists. Indeed, the mesocorticolimbic dopaminergic pathway has been suggested as the underlying cause of reward-seeking behaviour, and it is modulated by the opioid system. Objective: This study aims to evaluate the relevance of opioid antagonists for treating GD. Method: A systematic literature review was conducted. A search of the PubMed electronic database, PsycINFO and the Cochrane Systematic Review Database without any limits was performed. Results: There is little information concerning the effects of opioid antagonists on GD. The total search with “nalmefene and gambling” without any limits revealed only 11 articles. The search with “naltrexone and gambling” without any limits gener-ated 47 articles. Nevertheless, the best available data support the use of opioid antagonists, particularly in individuals with a history of alcohol use disorder or strong gambling urges. Conclusion: Future trials are still needed. Indeed, opioid antagonists effectiveness has been investigated in only a limited number of patients, clinical trials do not reflect the heterogeneity of GD and there is little knowledge of the predictive factors of response to treatments. Moreover, differential affinity to nalmefene for kappa receptors may be associated with a particular effect in a yet to be defined addiction phenotype. Head to head comparisons between naltrexone and nalmefene would be helpful in combining other medication or psychotherapy. The identification of subgroups of patients that are more likely to benefit from opioid antagonists should be a goal
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Affiliation(s)
- Caroline Victorri-Vigneau
- Pharmacology Department, Nantes University Hospital, Nantes, France.,INSERM UMR1246 SPHERE Methods in Patients-centered outcomes and Health Research, University of Nantes and Tours, Nantes, France
| | - Andrew Spiers
- Pharmacology Department, Nantes University Hospital, Nantes, France
| | - Pascal Caillet
- Pharmacology Department, Nantes University Hospital, Nantes, France
| | - Mélanie Bruneau
- Addictology and Psychiatry Department, Nantes University Hospital, Nantes, France
| | - Ignace-Consortium
- Service de Pharmacologie Clinique, Institut de Biologie, 9 quai moncousu, 44093 Nantes cedex, France
| | - Gaëlle Challet-Bouju
- INSERM UMR1246 SPHERE Methods in Patients-centered outcomes and Health Research, University of Nantes and Tours, Nantes, France.,Addictology and Psychiatry Department, Nantes University Hospital, Nantes, France
| | - Marie Grall-Bronnec
- INSERM UMR1246 SPHERE Methods in Patients-centered outcomes and Health Research, University of Nantes and Tours, Nantes, France.,Addictology and Psychiatry Department, Nantes University Hospital, Nantes, France
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20
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Potenza MN. Clinical neuropsychiatric considerations regarding nonsubstance or behavioral addictions. DIALOGUES IN CLINICAL NEUROSCIENCE 2018. [PMID: 29302225 PMCID: PMC5741111 DOI: 10.31887/dcns.2017.19.3/mpotenza] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Over the past several decades, non-substance-use behaviors like gambling, gaming, and sex have received greater consideration as possible foci of addictions. In this article, I will review the recent history and current status of non-substance or behavioral addictions. A main focus will involve gambling and gambling disorder, given that the latter is currently the sole non-substance addictive disorder described in the main text of the current (fifth) edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Internet gaming disorder, currently in the DSM-5 section addressing conditions that may need additional research, will also be considered, as will the concept of Internet addiction. Compulsive sexual behaviors (including problematic pornography use) will be considered, particularly with respect to how behavioral addictions may be considered in the forthcoming 11th edition of the International Classification of Diseases (ICD-11).
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Affiliation(s)
- Marc N Potenza
- Department of Psychiatry, Child Study Center, the National Center on Addiction and Substance Abuse, Yale University School of Medicine and the Connecticut Mental Health Center, Connecticut, USA
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21
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Abstract
BACKGROUND AND AIMS To investigate the potential indications and adverse effects of using the opioid antagonist naltrexone to treat problem gamblers. CASE PRESENTATION The files of the 1,192 patients who were referred to the National Problem Gambling Clinic between January 2015 and June 2016 were audited. Seventeen patients were considered appropriate for treatment with naltrexone, having attended and failed to respond to psychological therapies at the clinic. Fourteen patients were placed on a regimen of 50 mg/day naltrexone. DISCUSSION Of the 14 patients who were treated with naltrexone, there were 10 for whom sufficient follow-up existed to analyze the treatment efficacy and side effects of naltrexone. Patients showed significant decreases in their craving to gamble and the majority (60%) were able to abstain completely from gambling in the treatment period, with a further 20% reducing their gambling to almost nothing. The reported side effects from the naltrexone included: loss of appetite, gastrointestinal pain, headaches, sedation, dizziness, and vivid dreams. Two patients with concurrent alcohol-use disorder relapsed during the treatment. One patient relapsed after the treatment period. CONCLUSIONS The study showed significant outcomes in reducing gambling cravings for the sample set. Given the design of the study as a case series, there was no control group, and a number of patients were on other psychotropic medications. We recommend care when prescribing to those suffering from concurrent alcohol-use disorder.
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Affiliation(s)
- Sophie Ward
- National Problem Gambling Clinic, Central and North West London NHS Foundation Trust, London, UK,Institute of Medical and Biomedical Education, St. George’s University of London, London, UK,Corresponding author: Sophie Ward; National Problem Gambling Clinic, Central and North West London NHS Foundation Trust, Cranmer Terrace, London SW17 0RE, UK; E-mail:
| | - Neil Smith
- National Problem Gambling Clinic, Central and North West London NHS Foundation Trust, London, UK
| | - Henrietta Bowden-Jones
- National Problem Gambling Clinic, Central and North West London NHS Foundation Trust, London, UK,Faculty of Medicine, Imperial College London, London, UK
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22
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Christensen DR. A review of opioid-based treatments for gambling disorder: an examination of treatment outcomes, cravings, and individual differences. INTERNATIONAL GAMBLING STUDIES 2018. [DOI: 10.1080/14459795.2018.1470662] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Darren R. Christensen
- Faculty of Health Sciences, University of Lethbridge, Alberta Gambling Research Institute , Lethbridge, Canada
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23
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Abstract
Should excessive and problematic engagement in nonsubstance use behaviors be mental disorders? The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) repositioned gambling disorder in the substance use disorders section and introduced Internet gaming disorder in the research appendix; the International Classification of Diseases (ICD-11) is also considering it. This article outlines pros and cons of considering behavioral addictions as mental disorders and also reviews the DSM-5 decision-making processes. It focuses on three conditions: gambling disorder, Internet gaming disorder (IGD), and Internet addiction (IA). We detail assessment methods and prevalence rates for these conditions and outline psychiatric comorbidities, demographic and biological risk factors, and promising treatment approaches. We also briefly discuss other putative behavioral addictions: eating/food, sex, exercise, shopping, and tanning "addictions." Overall, data are inconclusive, and consistent terminology and methodology are needed to define and evaluate these conditions more fully prior to considering them mental disorders.
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MESH Headings
- Behavior, Addictive/epidemiology
- Behavior, Addictive/etiology
- Behavior, Addictive/genetics
- Behavior, Addictive/therapy
- Disruptive, Impulse Control, and Conduct Disorders/epidemiology
- Disruptive, Impulse Control, and Conduct Disorders/etiology
- Disruptive, Impulse Control, and Conduct Disorders/genetics
- Disruptive, Impulse Control, and Conduct Disorders/therapy
- Gambling/epidemiology
- Gambling/etiology
- Gambling/genetics
- Gambling/therapy
- Humans
- Internet
- Video Games
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Affiliation(s)
- Nancy M Petry
- Department of Medicine, University of Connecticut School of Medicine, Farmington, Connecticut 16032-3944, USA; , ,
| | - Kristyn Zajac
- Department of Medicine, University of Connecticut School of Medicine, Farmington, Connecticut 16032-3944, USA; , ,
| | - Meredith K Ginley
- Department of Medicine, University of Connecticut School of Medicine, Farmington, Connecticut 16032-3944, USA; , ,
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24
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Abstract
This paper is the thirty-ninth consecutive installment of the annual review of research concerning the endogenous opioid system. It summarizes papers published during 2016 that studied the behavioral effects of molecular, pharmacological and genetic manipulation of opioid peptides, opioid receptors, opioid agonists and opioid antagonists. The particular topics that continue to be covered include the molecular-biochemical effects and neurochemical localization studies of endogenous opioids and their receptors related to behavior, and the roles of these opioid peptides and receptors in pain and analgesia, stress and social status, tolerance and dependence, learning and memory, eating and drinking, drug abuse and alcohol, sexual activity and hormones, pregnancy, development and endocrinology, mental illness and mood, seizures and neurologic disorders, electrical-related activity and neurophysiology, general activity and locomotion, gastrointestinal, renal and hepatic functions, cardiovascular responses, respiration and thermoregulation, and immunological responses.
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Affiliation(s)
- Richard J Bodnar
- Department of Psychology and CUNY Neuroscience Collaborative, Queens College, City University of New York, Flushing, NY 11367, United States.
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25
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26
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Hloch K, Mladěnka P, Doseděl M, Adriani W, Zoratto F. The current clinical knowledge on the treatment of gambling disorder: A summary. Synapse 2017; 71. [DOI: 10.1002/syn.21976] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 03/14/2017] [Accepted: 03/14/2017] [Indexed: 02/04/2023]
Affiliation(s)
- Karel Hloch
- Department of Social and Clinical Pharmacy; Faculty of Pharmacy, Charles University; Heyrovskeho 1203 Hradec Kralove 500 05 Czech Republic
| | - Přemysl Mladěnka
- Department of Pharmacology and Toxicology; Faculty of Pharmacy, Charles University; Heyrovskeho 1203 Hradec Kralove 500 05 Czech Republic
| | - Martin Doseděl
- Department of Social and Clinical Pharmacy; Faculty of Pharmacy, Charles University; Heyrovskeho 1203 Hradec Kralove 500 05 Czech Republic
| | - Walter Adriani
- Centre for Behavioural Sciences and Mental Health; Istituto Superiore di Sanità; Viale Regina Elena 299 Rome I-00161 Italy
| | - Francesca Zoratto
- Unit of Cognitive Primatology and Primate Centre; Institute of Cognitive Sciences and Technologies of the National Research Council of Italy; Via Ulisse Aldrovandi 16/B Rome I-00197 Italy
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27
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Majuri J, Joutsa J, Johansson J, Voon V, Alakurtti K, Parkkola R, Lahti T, Alho H, Hirvonen J, Arponen E, Forsback S, Kaasinen V. Dopamine and Opioid Neurotransmission in Behavioral Addictions: A Comparative PET Study in Pathological Gambling and Binge Eating. Neuropsychopharmacology 2017; 42:1169-1177. [PMID: 27882998 PMCID: PMC5357051 DOI: 10.1038/npp.2016.265] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2016] [Revised: 11/12/2016] [Accepted: 11/16/2016] [Indexed: 12/20/2022]
Abstract
Although behavioral addictions share many clinical features with drug addictions, they show strikingly large variation in their behavioral phenotypes (such as in uncontrollable gambling or eating). Neurotransmitter function in behavioral addictions is poorly understood, but has important implications in understanding its relationship with substance use disorders and underlying mechanisms of therapeutic efficacy. Here, we compare opioid and dopamine function between two behavioral addiction phenotypes: pathological gambling (PG) and binge eating disorder (BED). Thirty-nine participants (15 PG, 7 BED, and 17 controls) were scanned with [11C]carfentanil and [18F]fluorodopa positron emission tomography using a high-resolution scanner. Binding potentials relative to non-displaceable binding (BPND) for [11C]carfentanil and influx rate constant (Ki) values for [18F]fluorodopa were analyzed with region-of-interest and whole-brain voxel-by-voxel analyses. BED subjects showed widespread reductions in [11C]carfentanil BPND in multiple subcortical and cortical brain regions and in striatal [18F]fluorodopa Ki compared with controls. In PG patients, [11C]carfentanil BPND was reduced in the anterior cingulate with no differences in [18F]fluorodopa Ki compared with controls. In the nucleus accumbens, a key region involved in reward processing, [11C]Carfentanil BPND was 30-34% lower and [18F]fluorodopa Ki was 20% lower in BED compared with PG and controls (p<0.002). BED and PG are thus dissociable as a function of dopaminergic and opioidergic neurotransmission. Compared with PG, BED patients show widespread losses of mu-opioid receptor availability together with presynaptic dopaminergic defects. These findings highlight the heterogeneity underlying the subtypes of addiction and indicate differential mechanisms in the expression of pathological behaviors and responses to treatment.
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Affiliation(s)
- Joonas Majuri
- Division of Clinical Neurosciences, Turku University Hospital, Turku, Finland,Department of Neurology, University of Turku, Turku, Finland,Turku PET Centre, University of Turku, Turku, Finland,Turku PET Centre, University of Turku, POB 52, Turku 20521, Finland, Tel: +358-2-3130000, Fax: +358-2-2318191, E-mail:
| | - Juho Joutsa
- Division of Clinical Neurosciences, Turku University Hospital, Turku, Finland,Department of Neurology, University of Turku, Turku, Finland,Turku PET Centre, University of Turku, Turku, Finland
| | | | - Valerie Voon
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Kati Alakurtti
- Turku PET Centre, University of Turku, Turku, Finland,Department of Radiology, University of Turku and Turku University Hospital, Turku, Finland
| | - Riitta Parkkola
- Department of Radiology, University of Turku and Turku University Hospital, Turku, Finland
| | - Tuuli Lahti
- Department of Health, Unit of Tobacco, Alcohol and Gambling, National Institute of Health and Welfare, Helsinki, Finland
| | - Hannu Alho
- Department of Health, Unit of Tobacco, Alcohol and Gambling, National Institute of Health and Welfare, Helsinki, Finland
| | - Jussi Hirvonen
- Turku PET Centre, University of Turku, Turku, Finland,Department of Radiology, University of Turku and Turku University Hospital, Turku, Finland
| | - Eveliina Arponen
- Turku PET Centre, University of Turku, Turku, Finland,Turku PET Centre, Åbo Akademi University, Turku, Finland
| | - Sarita Forsback
- Turku PET Centre, University of Turku, Turku, Finland,Turku PET Centre, Åbo Akademi University, Turku, Finland
| | - Valtteri Kaasinen
- Division of Clinical Neurosciences, Turku University Hospital, Turku, Finland,Department of Neurology, University of Turku, Turku, Finland,Turku PET Centre, University of Turku, Turku, Finland
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28
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Mouaffak F, Leite C, Hamzaoui S, Benyamina A, Laqueille X, Kebir O. Naltrexone in the Treatment of Broadly Defined Behavioral Addictions: A Review and Meta-Analysis of Randomized Controlled Trials. Eur Addict Res 2017; 23:204-210. [PMID: 28877518 DOI: 10.1159/000480539] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 08/14/2017] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Broadly defined behavioral addiction is a conceptual framework including behaviors characterized by loss of control and continuation despite significant negative consequences. Broadly defined behavioral addictions share many similarities with substance use disorders. As naltrexone is one of the most studied treatment for substance use disorders, we conducted a meta-analysis of randomized placebo-controlled trials (RCT) assessing the effectiveness of naltrexone in the treatment of broadly defined behavioral addictions. METHOD We conducted a literature search and selection, up to January 1, 2017, according to previously set inclusion criteria. The selected trials underwent a quality assessment before data extraction and statistical analysis, which used fixed and random effects models. Standardized mean differences (SMD) were calculated using Hedge's adjusted g. RESULTS A total of 6 RCTs (n = 356) were included. Of these, 3 assessed naltrexone effectiveness in the treatment of pathological gambling, and 3 tested its benefits in broadly defined behavioral addictions other than pathological gambling (kleptomania, trichotillomania, and impulsive compulsive disorders). The meta-analysis of the whole sample resulted in a statistically significant score improvement under naltrexone versus placebo (fixed effect model: SMD = -0.27, 95% CI [-0.51 to -0.03], z = 2.23; p = 0.025). CONCLUSION The results of our meta-analysis suggest a beneficial effect of naltrexone in the treatment of broadly defined behavioral addictions.
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Affiliation(s)
- Fayçal Mouaffak
- Unité de Psychiatrie d'Urgence, de Liaison et de Recherche, Pôle 93G04, EPS Ville Evrard, Saint Denis, France
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Choi SW, Shin YC, Kim DJ, Choi JS, Kim S, Kim SH, Youn H. Treatment modalities for patients with gambling disorder. Ann Gen Psychiatry 2017; 16:23. [PMID: 28465711 PMCID: PMC5410060 DOI: 10.1186/s12991-017-0146-2] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 04/18/2017] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Gambling disorder (GD) is defined as persistent and recurrent problematic gambling behavior leading to clinically significant impairment or distress. The prevalence of GD has been shown to be 1.2-7.1% in the general population. GD can severely impact on personal and vocational wellbeing as well as lead to financial problems, and has been known to be difficult to treat. This review describes the available pharmacotherapy/psychosocial treatments for GD patients, and summarizes data on the effectiveness of these GD treatments. METHODS This review refers to newly as well as previously published studies and guidelines. RESULTS The description of pharmacotherapy mainly focuses on opioid receptor antagonists, selective serotonin reuptake inhibitors, and mood stabilizers. Psychosocial treatments/strategies mainly include cognitive behavioral therapy, motivational interviewing, and Gamblers Anonymous. We also introduce relatively novel treatment modalities. CONCLUSIONS This review can help clinicians to decide treatment plans for their GD patients. In addition, it can be used as a reference for designing future research.
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Affiliation(s)
- Sam-Wook Choi
- Korea Institute on Behavioral Addictions, True Mind Clinic, F7, KR tower, 1 141, Teheran-ro, Gangnam-gu, Seoul, 06132 South Korea.,Healthcare & Information Research Institute, Namseoul University, 91 Daehak-ro, Seonghwan-eup, Seobuk-gu, Cheonan-Si, Chungcheongnam-do 31021 South Korea
| | - Young-Chul Shin
- Department of Psychiatry, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 29 Saemunan-ro, Jongno-gu, Seoul, 03181 South Korea
| | - Dai-Jin Kim
- Department of Psychiatry, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpodae-ro, Seocho-gu, Seoul, 06591 South Korea
| | - Jung-Seok Choi
- Department of Psychiatry, SMG-SNU Bora-mae Medical Center, 20 Boramae-ro 5-gil, Dongjak-gu, Seoul, 07061 South Korea
| | - Seohee Kim
- Korea Institute on Behavioral Addictions, True Mind Clinic, F7, KR tower, 1 141, Teheran-ro, Gangnam-gu, Seoul, 06132 South Korea
| | - Seung-Hyun Kim
- Department of Psychiatry, Korea University Guro Hospital, Korea University College of Medicine, 148 Gurodong-ro, Guro-gu, Seoul, 08308 South Korea
| | - HyunChul Youn
- Department of Psychiatry, Korea University Guro Hospital, Korea University College of Medicine, 148 Gurodong-ro, Guro-gu, Seoul, 08308 South Korea
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Tolchard B. Cognitive-behavior therapy for problem gambling: a critique of current treatments and proposed new unified approach. J Ment Health 2016; 26:283-290. [DOI: 10.1080/09638237.2016.1207235] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Barry Tolchard
- School of Health, University of New England, Armidale, NSW, Australia
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31
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Latest Developments in Treatment for Disordered Gambling: Review and Critical Evaluation of Outcome Studies. CURRENT ADDICTION REPORTS 2016. [DOI: 10.1007/s40429-016-0110-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Piquet-Pessôa M, Fontenelle LF. Opioid antagonists in broadly defined behavioral addictions: a narrative review. Expert Opin Pharmacother 2016; 17:835-44. [PMID: 26798982 DOI: 10.1517/14656566.2016.1145660] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Naltrexone (NTX), a mu-opioid receptor antagonist, has been approved for the treatment of alcoholism and opioid dependence. More recently, however, NTX and a related drug, nalmefene (NMF), have also shown positive results for the treatment of gambling disorders. AREAS COVERED In this study, we reviewed the trials testing the effect of opioid antagonists (OA) in gambling disorders and in other broadly defined behavioral addictions, including selected DSM-5 disruptive, impulse-control, and conduct disorders, obsessive-compulsive and related disorders, eating disorders, and other conditions not currently recognized by official classification schemes. We found six randomized controlled trials (RCTs) of OA in gambling disorder, two RCTs of OA in trichotillomania (hair pulling disorder), two RCTs of OA in binge eating disorder, and one RCT of OA for kleptomania. We also reviewed case reports on hypersexual disorder, compulsive buying and skin picking disorders. EXPERT OPINION The reviewed data supported the use of OA, namely NTX and NMF, in gambling disorder (both) and kleptomania (NTX). We did not find enough evidence to support the use of NTX or NMF in trichotillomania (hair pulling disorder), excoriation (skin-picking) disorder, compulsive buying disorder, hypersexual disorder, or binge eating disorder.
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Affiliation(s)
- Marcelo Piquet-Pessôa
- a Obsessive, Compulsive, and Anxiety Spectrum Disorders Research Program, Institute of Psychiatry , Federal University of Rio de Janeiro (UFRJ) , Rio de Janeiro , Brasil
| | - Leonardo F Fontenelle
- a Obsessive, Compulsive, and Anxiety Spectrum Disorders Research Program, Institute of Psychiatry , Federal University of Rio de Janeiro (UFRJ) , Rio de Janeiro , Brasil.,b D'Or Institute for Research and Education (IDOR) , Rio de Janeiro , Brasil.,c Monash Institute of Cognitive and Clinical Neurosciences (MICCN), School of Psychological Sciences & Monash Biomedical Imaging (MBI) Facility , Monash University , Victoria , Australia
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