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2017, Número 6

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Salud Mental 2017; 40 (6)


Current psychological therapeutic approaches for gambling disorder with psychiatric comorbidities: A narrative review

Echeburúa E, Amor PJ, Gómez M

Idioma: Español
Referencias bibliográficas: 41
Paginas: 299-305
Archivo PDF: 167.99 Kb.


FRAGMENTO

Antecedentes. La presencia comórbida del juego patológico (JP) con otro trastorno mental plantea diversos desafíos al tratamiento, como las recaídas, las repercusiones negativas para los pacientes y sus familias y un mayor número de hospitalizaciones. Objetivo. Revisar la evidencia empírica existente sobre el papel que cumplen las terapias psicológicas en el tratamiento de estos trastornos duales. Método. Se realizó una revisión narrativa de la bibliografía relevante sobre este tema. Se llevó a cabo una búsqueda sistemática de artículos originales (2010-octubre 2017) en MEDLINE y PsycInfo con las palabras clave: 1. gambling or gamblers, 2. Treatment, intervention, therapy or therapeutics, y 3. dual diagnosis or comorbidity. Resultados. Hay diversas terapias para el JP: tratamiento hospitalario, terapia intensiva ambulatoria, terapia cognitivo-conductual (TCC) individual y en grupo, Jugadores Anónimos y farmacoterapia. La hospitalización se limita a los pacientes con una crisis aguda, fracasos terapéuticos previos y trastornos comórbidos graves, como la depresión y los intentos de suicidio. El tratamiento para el JP comórbido con otro trastorno (depresión, abuso de sustancias o esquizofrenia) requiere más investigación. Las terapias más efectivas en estos casos son al parecer la TCC, la entrevista motivacional y los grupos de autoayuda. Los programas que combinan farmacoterapia con tratamientos psicológicos parecen aumentar la retención del tratamiento. Discusión y conclusión. La intervención debe adaptarse a las necesidades específicas de cada paciente y la investigación debe mejorar las estrategias motivacionales cuando los pacientes muestran una deficiente adherencia a la medicación, así como diseñar medidas para mejorar la fidelidad al tratamiento psicológico.


REFERENCIAS (EN ESTE ARTÍCULO)

  1. Abou-Saleh, M. T. (2004). Dual diagnosis: management within a psychosocial context. Advances in Psychiatric Treatment, 10(5), 352-360. doi: 10.1192/ apt.10.5.352

  2. Borras, L., & Huguelet, P. (2007). Schizophrenia and pathological gambling. The American Journal on Addictions, 16(4), 269-271. doi:10.1080/10550490701389765

  3. Carlbring, P., & Smit, F. (2008). Randomized trial of internet-delivered self-help with telephone support for pathological gamblers. Journal of Consulting and Clinical Psychology, 76(6), 1090-1094. doi:10.1037/a0013603

  4. Chaim, C. H., Nazar, B. P., Hollander, E., & Lessa, J. M. (2014). Pathological gambling treated with lithium: The role of assessing temperament. Addictive Behaviors, 39(12), 1911-1913. doi: 10.1016/j.addbeh.2014.05.016

  5. Chen, S., Barnett, P. G., Sempel, J. M., & Timko, C. (2006). Outcomes and costs of matching the intensity of dual-diagnosis treatment to patients’ symptom severity. Journal of Substance Abuse Treatment, 31(1), 95-105. doi: 10.1016/j. jsat.2006.03.015

  6. Diskin, K. M., & Hodgins, D. C. (2009). A randomized controlled trial of a single session motivational intervention for concerned gamblers. Behaviour Research and Therapy, 47(5), 382-388. doi: 10.1016/j.brat.2009.01.018

  7. Dowling, N. A., Cowlishaw, S., Jackson, A. C., Merkouris, S. S., Francis, K. L., & Christensen, D. R. (2015). Prevalence of psychiatric co-morbidity in treatment- seeking problem gamblers: A systematic review and meta-analysis. Australian and New Zealand Journal of Psychiatry, 49(6), 519-539. doi: 10.1177/0004867415575774

  8. Dowling, N. A., Merkouris, S. S., & Lorains, F. K. (2016). Interventions for comorbid problem gambling and psychiatric disorders: Advancing a developing field of research. Addictive Behaviors, 58, 21-30. doi: 10.1016/j.addbeh.2016.02.012

  9. Echeburúa, E., Báez, C., & Fernández-Montalvo, J. (1996). Comparative effectiveness of three therapeutic modalities in the psychological treatment of pathological gambling: Long-term outcome. Behavioural and Cognitive Psychotherapy, 24(1), 51-72. doi: 10.1017/S1352465800016830

  10. Echeburúa, E., & Fernández-Montalvo, J. (2005). Psychological Treatment of Slot-Machine Pathological Gambling: New Perspectives. Journal of Gambling Studies, 21(1), 21-26. doi: 10.1007/s10899-004-1918-6

  11. Echeburúa, E., Gómez, M., & Freixa, M. (2011). Cognitive-behavioural treatment of pathological gambling in individuals with chronic schizophrenia: A pilot study. Behaviour Research and Therapy, 49(11), 808-814. doi: 10.1016/j. brat.2011.08.009

  12. Echeburúa, E. (2015). Clinical management of gambling disorder. In N. Guebaly, G. Carra, & M. Galanter (Eds.), Textbook of Addiction Treatment: International Perspective (vol. 3, pp. 1475-1490). Milan: Springer.

  13. Echeburúa, E., Gómez, M., & Freixa, M. (2017). Prediction of relapse after cognitive- behavioral treatment of gambling disorder in individuals with chronic schizophrenia: A survival analysis. Behavior Therapy, 48(1), 69-75. doi: 10.1016/j.beth.2016.09.008

  14. González-Ortega, I., Echeburúa, E., Corral, P., Polo-López, R., & Alberich, S. (2013). Predictors of pathological gambling severity taking gender differences into account. European Addiction Research, 19(3), 146-154. doi: 10.1159/000342311

  15. Gooding, P., & Tarrier, N. (2009). A systematic review and meta-analysis of cognitive- behavioural interventions to reduce problem gambling: Hedging our bets?. Behaviour Research and Therapy, 47(7), 592-607. doi: 10.1016/j. brat.2009.04.002

  16. Grant, J. E., Kim, S. W., Hollander, E., & Potenza, M. N. (2008). Predicting response to opiate antagonists and placebo in the treatment of pathological gambling. Psychopharmacology, 200(4), 521-527. doi: 10.1007/s00213-008-1235-3

  17. Grant, J. E., Chamberlain, S. R., Odlaug, B. L., Potenza, M. N., & Kim, S. W. (2010). Memantine shows promise in reducing gambling severity and cognitive inflexibility in pathological gambling: A pilot study. Psychopharmacology, 212(4), 603-612. doi: 10.1007/s00213-010-1994-5

  18. Grant, J. E., & Odlaug, B. L. (2012). Psychosocial interventions for gambling disorders. In Increasing the odds. What Clinicians Need to Know About Gambling Disorders (vol. 7, pp. 38-51). Washington, DC: National Center for Responsible Gaming.

  19. Green, A. I., Drake, R. E., Brunette, M. F., & Noordsy, D. L. (2007). Schizophrenia and co-occurring substance use disorder. The American Journal of Psychiatry, 164(3), 402-408.

  20. Haydock, M., Cowlishaw, S., Harvey, C., & Castle, D. (2015). Prevalence and correlates of problem gambling in people with psychotic disorders. Comprehensive Psychiatry, 58, 122-129. doi: 10.1016/j.comppsych.2015.01.003

  21. Hodgins, D. C., & Holub, A. (2007). Treatment of Problem Gambling. In G. Smith, D. C. Hodgins, & R. J. Williams (Eds.), Research and Measurement Issues in Gambling Studies (pp. 372-397). Amsterdam: Elsevier.

  22. Hodgins, D. C., Currie, S. R., Currie, G., &, Fick, G. H. (2009). Randomized trial of brief motivational treatments for pathological gamblers: More is not necessarily better. Journal of Consulting and Clinical Psychology, 77(5), 950-960. doi: 10.1037/a0016318

  23. Hollander, E., Pallanti, S., Allen, A., Sood, E., & Rossi, N. B. (2005). Does sustained- release lithium reduce impulsive gambling and affective instability versus placebo in pathological gamblers with bipolar spectrum disorders? The American Journal of Psychiatry, 162(1), 137-145. doi: 10.1176/appi.ajp.162.1.137

  24. Jiménez-Murcia, S., Bove, F. I., lsrael, M., Steiger, H., Fernández-Aranda, F., Álvarez- Moya, E., … & Menchón, J. M. (2012). Cognitive-behavioral therapy for pathological gambling in Parkinson’s disease: A pilot controlled study. European Addiction Research, 18(6), 265-274. doi: 10.1159/000337442

  25. Kassani, A., Niazi, M., Hassanzadeh, J., & Menati, R. (2015). Survival analysis of drug abuse relapse in addiction treatment centers. International Journal of High Risk Behaviors and Addiction, 4(3), e23402. doi: 10.5812/ijhrba.23402

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