Epidemiology, pathophysiology and treatment of pathological gambling

Pathological gambling is a prevalent disorder that is gaining attention from patients, clinicians and policy makers. Aetiological factors that have been related to pathological gambling include: (i) abnormalities in the serotonergic, dopaminergic and noradrenergic systems; (ii) cognitive distortions; and (iii) a reinforcement of the gambling activity by either episodic gains or the excitement that accompanies gambling. Male gender, urban residence, lower income and the presence of a comorbid psychiatric disorder (particularly substance abuse) appear to constitute risk factors for the presence of the disorder. A number of treatments have been suggested as potentially effective: Gamblers Anonymous, behavioural therapy, manualised cognitive therapy and several medications. At present, only manualised cognitive therapy and the selective serotonin (5- hydroxytryptamine; 5-HT) reuptake inhibitor fluvoxamine have shown efficacy in systematic (albeit small) studies. However, much research remains to be done to better understand the psychophysiology of pathological gambling, to firmly demonstrate the efficacy of the different proposed treatment approaches, and to establish criteria for treatment selection for individual patients.