Treatment of pathological gambling with Clomipramine
Available from: Lut Tamam
- "Both disorders start in adolescence or early adulthood and subsequently follow episodic and/or chronic courses  . Similar comorbidity patterns, abnormalities of central serotonin and noradrenaline neurotransmission , and positive response to mood stabilizers         and antidepressant drugs          are the other common features. Another finding supporting a possible ICD-BD relationship is the increased prevalence of mood disorders in patients with ICDs and the increased prevalence of ICDs in patients with BD . "
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ABSTRACT: Impulsivity is associated with mood instability, behavioral problems, and action without planning in patients with bipolar disorder. Increased impulsivity levels are reported at all types of mood episodes. This association suggests a high comorbidity between impulse control disorders (ICDs) and bipolar disorder. The aim of this study is to compare the prevalence of ICDs and associated clinical and sociodemographic variables in euthymic bipolar I patients.
A total of 124 consecutive bipolar I patients who were recruited from regular attendees from the outpatient clinic of our Bipolar Disorder Unit were included in the study. All patients were symptomatically in remission. Diagnosis of bipolar disorder was confirmed using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Impulse control disorders were investigated using the modified version of the Minnesota Impulsive Disorders Interview. Impulsivity was measured with the Barratt Impulsiveness Scale Version 11. Furthermore, all patients completed the Zuckerman Sensation-Seeking Scale Form V.
The prevalence rate of all comorbid ICDs in our sample was 27.4% (n = 34). The most common ICD subtype was pathologic skin picking, followed by compulsive buying, intermittent explosive disorder, and trichotillomania. There were no instances of pyromania or compulsive sexual behavior. There was no statistically significant difference between the sociodemographic characteristics of bipolar patients with and without ICDs with regard to age, sex, education level, or marital status. Comorbidity of alcohol/substance abuse and number of suicide attempts were higher in the ICD(+) group than the ICD(-) group. Length of time between mood episodes was higher in the ICD(-) group than the ICD(+) group. There was a statistically significant difference between the total number of mood episodes between the 2 groups, but the number of depressive episodes was higher in the ICD(+) patients as compared with the ICD(-) patients. There was no statistically significant difference between the age of first episode, seasonality, presence of psychotic features, and chronicity of illness. A statistically significant difference was observed between the ICD(+) and ICD(-) groups in terms of total impulsivity, attention, nonplanning, and motor impulsivity scores as determined by the Barratt Impulsiveness Scale Version 11.
The present study revealed that there is a high comorbidity rate between bipolar disorder and ICDs based on Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, criteria. Alcohol/substance use disorders, a high number of previous suicide attempts, and depressive episodes should alert the physician to the presence of comorbid ICDs among bipolar patients that could affect the course and treatment of the disorder.
Available from: Heather A Berlin
- "While SSRIs may be effective for some patients with PG    , those with comorbid conditions, like bipolar "
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ABSTRACT: Evidence is reviewed here which suggests that antiepileptic drugs (AEDs) may be effective for the treatment of impulsivity across a range of psychiatric disorders and for impulse control and cluster B personality disorders in particular. AEDs may be effective for the treatment of the brain circuitry related to impulsivity, by modulating GABA, glutamate, serotonin, and norepinephrine. It is suggested that interventions should be directed at the brain circuitry which modulates core symptoms like impulsivity that may be shared across disorders, rather than the disorder itself. In addition to these core symptom domains, clinicians should identify comorbid conditions and associated symptoms related to brain systems as they can also influence overall treatment response. The increasing experience of psychiatrists in treating impulse control disorders, cluster B personality disorders, and impulsivity across disorders should complement the knowledge obtained from research. This will lead to a better understanding of the brain mechanisms underlying impulsive symptom domains within disorders and to more targeted treatments with improved outcomes.
Available from: Alex Blaszczynski
- "J. Stein et al., 1992), kleptomania and bulimia (McElroy, Keck, Pope, & Hudson, 1989), body dysmorphic disorder (Hollander & Wong, 1995), and trichotillomania (Winchel, Jones, Stanley, Molcho, & Stanley, 1992). The Hollander et al. (1992) study was one of the first studies to use this approach as a treatment for problem gambling. Clomipramine was administered to a 31-year-old female poly-gambler with a 12-year history of excessive gambling. "
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ABSTRACT: This article provides a brief overview of the development of pharmacological approaches in the treatment of problem or pathological gambling. The rationale for pharmacological approaches during those early stages of this form of intervention was based on attempts to simply block reinforcing affective “thrill” components inherent in gambling or on clinical judgment that drew analogies between the manifestations of repetitive gambling behavior and compulsions. Speculation that pathological gambling may be related to a dimension of impulsivity and obsessive-compulsive disorders prompted trials of medications shown to be efficacious with obsessive-compulsive disorder, such as the selective serotonin reuptake inhibitors. Other classes of medications such as opioid antagonists, mood stabilizers, and other antidepressants, have also shown promise in the treatment of pathological gambling. We conclude that pathological gambling may be a syndrome that includes features of affect instability, impaired cognitive control of impulses, and addiction.
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