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CASE REPORT |
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Volume 23 |
April - June 2007 (Part-I) |
Number 2 |
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Published by : PROFESSIONAL MEDICAL PUBLICATIONS |
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ISSN 1681-715X |
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CASE REPORT |
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Volume 23 |
April - June 2007 (Part-I) |
Number 2 |
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Obstinate gambling addiction
Leszek Tomasz Ros’ABSTRACT
Some authors regard gambling as an addiction. Detailed psychiatric examination revealed obsessive-compulsive syndrome in this patient. He was treated systematically with individual psychotherapy and sertraline from low doses up to the maximal dose (i.e. about 200 mg daily). A complete remission of the obsessive-compulsive syndrome was achieved. A number of indirect proofs demonstrate a significant role of sertraline in the aetiology of obsessive-compulsive syndrome. The most important evidence is the effectiveness of the drug from the group of selective inhibitors of serotonin central reuptake (SI-5HT) in the treatment of obsessive compulsive syndrome. Sertraline is safe and effective in the treatment of obsessive-compulsive syndrome. Drug doses ranged from 50 to 200 mg daily.
KEY WORDS: Gambling, Addiction, Obsessive-Compulsive Syndrome, Sertraline.
Pak J Med Sci April 2007 Vol. 23 No. 2 293-295
1. Dr. Leszek Tomasz Ros’ MD
Central University Teaching Hospital with Polyclinic,
Armed Forces School of Medicine
Independent Public Health Care Institution
Department of Neurosurgery with Outpatient Clinic
Private Practice.
Correspondence
Leszek Tomasz Ros’ MD
ul. Zablocinska 6 m. 55
01-697 Warszawa
POLAND.
E-mail: leszek.ros@wp.pl
* Received for Publication: September 7, 2006
* Accepted: October 15, 2006
INTRODUCTION
Gambling is one of the very well known habit among some people. Some authors regard gambling as an addiction. It leads in most cases to slow deterioration of a human being, to loss of money, not infrequently to selling of house furniture necessary for living and even to selling of whole apartments and houses. Gambling is not infrequently the cause of bankruptcy, leading whole family to poverty and extreme destitution. It is commonly known that men succumb to gambling far more frequently than women. Gambling often draws people for very long periods of life - these periods may frequently last for several years. Gambling takes various forms worldwide, from card playing for money to various gambles, e.g. roulette. A characteristic feature of gambling addiction is the fact that it is always connected with playing for money. At the beginning of the addiction, particularly dangerous for the possible future gambler is frequent winning in consecutive plays and rapid gathering of money. In such cases, gambling draws in a victim, that is gambling addiction develops rapidly and permanently. Rapidly growing sum of won money excites, encourages, intrigues, tempts, improves mood and frequently brings euphoria. Then other important matters in life become less interesting and slowly cease to count. Frequently, family, occupational work, various lofty aims in life become completely unimportant for a beginner gambler.
Case Report
Male patient K.K, aged 50 years never received any psychiatric treatment. The patient was born after normal pregnancy and labour. His childhood was moderately successful. The patient’s mother was tender, considerate, warm, affective and caring. The father was extremely busy with his occupational work and, therefore, had very little time for his family. Besides that he was rather peremptory, stand-offish, emotionally cold, resolutely imposing his will, with irascible moods, frequently verbally aggressive. Very frequently he used to make small rows over trifles. The patient has two younger sisters with whom, similarly as with his mother, he has very good and heartfelt contacts. His mother is alive, the father died two years ago. In primary school and secondary technical school the patient achieved medium results but he never repeated years. He got married at the age of 24. Presently the patient has one adult daughter who has a decent husband and a child. He has no family history of mental illness. The patient gave no history of head trauma and loss of consciousness. He was never abusing alcohol. Out of serious somatic diseases, the patient has received medical treatment for chronic coronary artery disease. He was having good married life. His wife was very hard working, affective, warm, conscientious, and caring. For the first three-four years the patient had no secrets from his wife. He worked hard as technician mechanic and spent much time with his wife and daughter. Then, patient’s gambling became the curse of further life of the couple. After his colleagues’ invitation he went to a club to play roulette. The initial series of consecutive winnings and quite great sum of money gathered became the cause of unhappiness of the patient and his family. For the first several months he managed to conceal his addiction from his wife.
The patient, since that time, has been feeling a strong obsessive compulsion to go to the club to play roulette. The temptation was much stronger than logical, reasonable thinking. The patient for all these years has had a critical attitude towards his addiction. He has always thought that his gambling is without any sense. Soon his wife learned the truth. The patient no longer concealed his addiction. Several times a day he had obsessive thoughts to go to the club to play roulette. His compulsory going to the club for roulette was regarded by the author as compulsion, i.e. realization of obsessive thoughts. The whole of these manifestations formed chronic obsessive-compulsive syndrome. The patient was losing money more often. He sold his car and expensive furniture from his apartment. He was fired from his job since he stole his firm’s money to pay debts assumed for paying consecutive roulette losses. He gave his wife no money. His wife’s earnings were insufficient to make the ends meet. The patient moved then to his still young parents who supported him and watched that he was not going to play roulette, but this situation humiliated the patient very much. He was guarded by his parents but obsessive thoughts and strong temptation caused that he was clandestinely going out to the club where he continued to play roulette. The formal and emotional contacts with the patient were very good, affective. His current thought was logical, normal. The mood was slightly depressed adequately to patient’s living situation. He denied any suicidal ideation. He had numerous obsessive tought changing into compulsion. Detailed psychiatric examination revealed obsessive-compulsive syndrome. This diagnosis was confirmed by the following scales.1-5
* ICD-10 scale
* Yale-Brown Obsession Scale
* Obsession and Compulsion Scale of the National Institute of Mental Health
* NIMH Global Scale of Obsession and Compulsion
* MAUDSLEY Obsession and Compulsion Inventory
Laboratory tests: Basic laboratory blood and urine analyses gave normal results chest radiogram was normal. ECG record: medium-degree anteroinferior wall ischaemia in the form of T-wave flattening. EEG record was normal, eye fundus examination was also normal. No focal and meningeal symptoms were seen on Neurological examination. Physical examination. And cranial computed tomography was normal.
The author treated the patient systematically with individual psychotherapy and Sertraline starting with a low dose which was gradually increased to about 200 mg daily. A complete remission of the obsessive-compulsive syndrome was achieved.DISCUSSION
Setraline5 is a selective serotonin central reuptake inhibitor. A number of indirect proofs1 demonstrate a significant role of sertraline in the aetiology of obsessive-compulsive syndrome. The most important evidence1 is the effectiveness of the drug from the group of selective inhibitors of serotonin central reuptake (SI-5HT) in the treatment of obsessive-compulsive syndrome and it is safe and effective1 in the treatment of obsessive-compulsive syndrome and it has also been confirmed in many studies.1-5 Drug doses ranged from 50 to 200mg daily.
However, most authors think that sertraline doses in the treatment of obsessive-compulsive syndrome should be significantly higher than the doses of the drug administered in the treatment of “major depression”. Some authors6 believe that 50 mg daily is sometimes the optimal dose in the treatment of major depression. Others7,8 prefer doses of about 100-150 mg daily in the treatment of major depression.
However, many authors1-5 think that for effective treatment of obsessive-compulsive syndrome higher sertraline doses are needed, about 150-200 mg daily. It is a safe drug5 and is well tolerated by patients. It proved useful in this patient who has been suffering from chronic coronary artery disease.REFERENCES
1. Chouinard G. Sertraline in the treatment of obsessive-compulsive disorder: two double-blind, placebo-controlled studies. Inter Clin Psychopharmacology 1992;2:37-4.
2. Griest J, Chouinard B, DuBoff B. Double-blind parallel comparison of three dosages of sertraline and placebo in outpatients with obsessive-compulsive disorder. Arch Gen Psych 1995;52(4):289-96.
3. Greist JH, Jefferson JW, Kobak KA. A one year double-blind placebo-controlled fixed dose study of sertraline in the treatment of obsessive-compulsive disorder. Inter Clin Psychopharmacology 1995;10(2):57-65.
4. Kroning MH, Apter J, Asnis G. Placebo-controlled, multicenter study of sertraline treatment for obsessive-compulsive disorder. J Clin Psychopharmacology 1999;19(2):172-6.
5. Murdoch D, McTavish D. Sertraline: A review of its pharmacodynamic and pharmacokinetic properties, and therapeutic potential in depression and obsessive compulsive disorder. Drugs 1992;44(4):604-24.
6. Preskorn SH, Lane RM. Sertraline 50 mg daily: the optimal dose in the treatment of depression. Inter Clin Psychopharmacology 1996;10(3):129-41.
7. Luketsos GG, Taragano F, Freisman GJ. Major depression and its response to sertraline in primary care vs. Psychiatric office practice patients, results of an open-label trial in Argentina. Neuropsychiatry and Memory Group, John Hopkins University, Baltimore, MD, USA.
8. Moller HJ, Gallinat J, Hegerl U. Double-blind, multicenter comparative study of sertraline and amitriptyline in hospitalized patients with major depression. Pharmacopsychiatry 1998;31(6):170-7.
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