Psychological assessment in pathological gamblers treated with escitalopram

Abstract

Pathological Gambling (PG) is classified as a "Disorder of Impulse Control", but due to similarities with drug addiction is frequently described as a drug-free addiction (Potenza et al., 2012). PG is conceptualized as a behavioural addiction because of its neurobiologic, neurophysiologic and psychological features. Current therapeutical approaches seem unsatisfactory as they do not achieve definitive positive outcomes. Considering the well known psycopathological comorbidities, PG represents both a social (impact on relatives money/life) and a sanitary cost, in terms of pharmacological and psychological support. The compulsive behaviour detectable in PG, is a disease with neurophysiopathological basis now fairly well-defined which affects particularly vulnerable people. PG is linked to important changes in brain systems such as the prefrontal cortex, the nucleus accumbens, the endogenous opioid system and the extended amygdale. Recent fMRI studies associate PG with blunted mesolimbic activation to non-specific rewards, whereas increased prefrontal cortex, anterior cingulate and ventral striatum activation is observed during gambling-related cue-exposure paradigms. Several neuropsychological studies show higher impulsivity in PG (Odlaug BL. et al., 2013) that, together with specific psychopathological symptoms, such as anxiety and depressed mood, characterize different PG subtypes (Blaszczynski A, Nower L. 2002). Impulsivity transcends multiple psychiatric disorders and is thought to be central to impulse control disorders such as PG. Furthermore, many PGs suffers from depression and decreased mood.