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      Amantadine in the Treatment of Pathological Gambling: A Case Report

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          Abstract

          Despite almost a decade of intense research, effective treatment strategies for Pathological Gambling (PG) remain very challenging. This paper details a case report suggesting that the treatment of PG may benefit from the use of the non-specific glutamate blocker amantadine. The drug was well-tolerated and effective, leading to a 43–64% reduction in severity of gambling symptoms (as measured with G-SAS). Our result is discussed in the context of the glutamatergic hypothesis of addiction and in light of previous observations on the potential impact of glutamatergic agents in the treatment of PG. The role of the dopaminergic system, and its interaction with the glutamatergic system, is also explored. Further studies are required to define the true benefits of amantadine for the treatment of PG.

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          A rating scale for mania: reliability, validity and sensitivity.

          Fenja Ziegler, Paul R Young, Patrick J. Biggs … (1978)
          An eleven item clinician-administered Mania Rating Scale (MRS) is introduced, and its reliability, validity and sensitivity are examined. There was a high correlation between the scores of two independent clinicians on both the total score (0.93) and the individual item scores (0.66 to 0.92). The MRS score correlated highly with an independent global rating, and with scores of two other mania rating scales administered concurrently. The score also correlated with the number of days of subsequent stay in hospital. It was able to differentiate statistically patients before and after two weeks of treatment and to distinguish levels of severity based on the global rating.
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            The glutamate homeostasis hypothesis of addiction.

            Peter Kalivas (2009)
            Addiction is associated with neuroplasticity in the corticostriatal brain circuitry that is important for guiding adaptive behaviour. The hierarchy of corticostriatal information processing that normally permits the prefrontal cortex to regulate reinforcement-seeking behaviours is impaired by chronic drug use. A failure of the prefrontal cortex to control drug-seeking behaviours can be linked to an enduring imbalance between synaptic and non-synaptic glutamate, termed glutamate homeostasis. The imbalance in glutamate homeostasis engenders changes in neuroplasticity that impair communication between the prefrontal cortex and the nucleus accumbens. Some of these pathological changes are amenable to new glutamate- and neuroplasticity-based pharmacotherapies for treating addiction.
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              Pathological gambling is linked to reduced activation of the mesolimbic reward system.

              Michael Rose, Thomas J. Raedler, Iver Hand … (2005)
              By analogy to drug dependence, it has been speculated that the underlying pathology in pathological gambling is a reduction in the sensitivity of the reward system. Studying pathological gamblers and controls during a guessing game using functional magnetic resonance imaging, we observed a reduction of ventral striatal and ventromedial prefrontal activation in the pathological gamblers that was negatively correlated with gambling severity, linking hypoactivation of these areas to disease severity.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Front Psychiatry
                Journal ID (iso-abbrev): Front Psychiatry
                Journal ID (publisher-id): Front. Psychiatry
                Title: Frontiers in Psychiatry
                Publisher: Frontiers Media S.A.
                ISSN (Electronic): 1664-0640
                Publication date (Electronic): 27 November 2012
                Publication date Collection: 2012
                Volume: 3
                Electronic Location Identifier: 102
                Affiliations
                [1] 1Department of Psychiatry, Drug Addiction Unit, Catholic University Medical School Rome, Italy
                [2] 2Department of Neuroscience and Imaging, University G. d’Annunzio Chieti, Italy
                [3] 3Department of Neurology, University G. d’Annunzio Chieti and Pescara, Italy
                Author notes

                Edited by: Marco Diana, University of Sassari, Italy

                Reviewed by: Roberta Agabio, University of Cagliari, Italy; George Kenna, Brown University, USA; Marco Diana, University of Sassari, Italy; Primavera A. Spagnolo, National Institutes of Health, USA

                *Correspondence: Giovanni Martinotti, Clinica Villa Maria Pia, Via del Forte Trionfale 36, 00135 Rome, Italy. e-mail: giovanni.martinotti@ 123456gmail.com

                This article was submitted to Frontiers in Addictive Disorders & Behavioral Dyscontrol, a specialty of Frontiers in Psychiatry.

                Article
                DOI: 10.3389/fpsyt.2012.00102
                PMC ID: 3506782
                PubMed ID: 23205015
                SO-VID: e19cbe53-35ed-4b2f-93cf-2d6f50eefbbf
                Copyright © Copyright © 2012 Pettorruso, Martinotti, Di Nicola, Onofrj, Di Giannantonio, Conte and Janiri.
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in other forums, provided the original authors and source are credited and subject to any copyright notices concerning any third-party graphics etc.

                History
                Date received : 27 September 2012
                Date accepted : 07 November 2012
                Page count
                Figures: 1, Tables: 1, Equations: 0, References: 47, Pages: 5, Words: 4149
                Categories
                Subject: Psychiatry
                Subject: Clinical Case Study

                ScienceOpen disciplines: Clinical Psychology & Psychiatry
                Keywords: dopamine,addiction,glutamate,pathological gambling,treatment,glutamatergic drugs,amantadine
                Data availability:
                ScienceOpen disciplines: Clinical Psychology & Psychiatry
                Keywords: dopamine, addiction, glutamate, pathological gambling, treatment, glutamatergic drugs, amantadine

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