SYMPOSIA

Pathological gambling: review of recent data
Ömer Şenormancı
Bakirkoy Research and Training Hospital for Psychiatry, Neurology and Neurosurgery, İstanbul, Turkey
E-mail: senorman_7@hotmail.com
Bulletin of Clinical Psychopharmacology, Vol: 21, Supplement: 2, 2011 - www.psikofarmakoloji.org
Abstracts of the Invited Speakers
Gambling, which could also be defined as risking one’s chances for a possible outcome, is a cultural phenomenon as old as humanity. While
gambling is a form of entertainment without any drawbacks for the great majority, pathological gambling develops in a small minority.
The prevalence (0.2%- 5.3%) in the adult population is gradually increasing due to the ease of accessibility such as Internet gambling. This
increase and the accessibility of gambling becoming easier, have led to some sociodemographic changes in the population who have
trouble with gambling. Recent studies have shown pathological gambling to be higher in the psychiatric patient population compared
to the normal population (with no assigned psychiatric diagnosis) and that it is necessary to be included as part of the questioning in a
psychiatric evaluation.
Some drugs once thought to be a new hope in the pharmacological treatment of pathological gambling, have been proven ineffective
in recent randomized, double-blind, and placebo-controlled studies. Current studies are testing GABAergic and antiglutamatergic drugs,
that are thought to be effective in chemical and behavioral addictions, in the treatment of pathological gambling.
Two large meta-analysis studies have reported that non-pharmacological therapy approaches are more effective in the treatment
of pathological gambling. Behavioral therapy, cognitive behavioral therapy and short, motivational, individualized approaches are
demonstrated to be effective. Although it is suggested that behaviorial therapy + cognitive behavioral therapy and short, motivational,
and individualized approaches are equally effective, combining the two may improve the efficacy of the treatment. This presentation aims
to describe pathological gambling accompanied by contemporary information with respect to treatment.
Key words: Pathological gambling, impulse control disorder, pharmacotherapy, psychotherapy
Bulletin of Clinical Psychopharmacology 2011;21(Suppl. 2):S53
Is binge eating a type of addiction?
Fulya Maner
Bakirkoy Research and Training Hospital for Psychiatry, Neurology and Neurosurgery, İstanbul, Turkey
E-mail: fmaner@ttmail.com
Binge eating is characterized by recurrent episodes of eating, in a discrete period of time, an amount of food that is much larger than most
people would eat in a similar time period under similar circumstances. There is a sense of lack of control over eating during the episode.
Eating is much more rapid than normal and one eats until feeling uncomfortably full. After overeating one feels disgusted, depressed or
guilty. Binge eating disorder is included in eating disorders not elsewhere specified in the DSM-IV and is a symptom of bulimia nervosa
and anorexia nervosa.
Research has shown that patients with eating disorders have high rates of co-occuring substance use disorders. The substance of abuse
and food appear to compete for sites in the brain and abstinence from substance use causes craving for the substance and also for food.
Addictions involving food and substances share similar etiologies and behavioral symptoms. Individuals suffering from binge eating
disorder are more likely to have first degree relatives with a substance abuse disorder. According to retrospective reports of patients,
the initiation of disordered eating usually began before substance abuse. The general reward pathway includes the ventral tegmental
area and basal forebrain. Substance abuse has been shown to change the neural processes around these connections. The mesolimbic
dopamine system connects the ventral tegmental area to the basal forebrain and is critical for the self-administration of psychomotor
stimulants. Dopamine deficiency has been suggested to be a common characteristic of individuals who are prone to substance or food
addiction. Striatal dopamine receptor (DRD2) availability is significantly lower in obese individuals than in controls. Body mass index is
shown to correlate inversely with measures of D2 receptors.
Functional neuroimaging studies have revealed that pleasant smelling, looking, and tasting food has reinforcing characteristics similar
to drugs of abuse. Many of the brain changes reported for hedonistic eating are also seen in various types of addiction. Overeating may
have an acquired drive similar to drug addiction with respect to motivation and incentive craving. In both cases, the desire and continued
satisfaction occur after early and repeated exposure to stimuli.
Addictive behavior manifests itself in permanent preoccupation with food and eating, withdrawal symptoms, continuation of disturbed
S53