N-acetyl cysteine, a glutamate-modulating agent, in the treatment of pathological gambling: A pilot study
N-acetyl cysteine, a glutamate-modulating agent, in the treatment of pathological gambling: A pilot study
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DOI：
10.1016/j.biopsych.2006.11.021
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发表时间：
2007-09-15
影响因子：
10.6
通讯作者：
Odlaug, Brian L.
中科院分区：
文献类型：
--
作者：
Grant, Jon E.;Kim, Suck Won;Odlaug, Brian L.
背景：虽然病理性赌博（PG）是相对常见的，药物治疗PG的研究是有限的。N-乙酰半胱氨酸（NAC），一种氨基酸，似乎可以恢复细胞外谷氨酸在神经核中的浓度，因此在减少成瘾行为方面提供了希望。27个科目在为期8周的NAC开放标签试验中，对112名患有DSM-1V PG的女性进行治疗，（定义为在终点时耶鲁布朗强迫症量表病理性赌博[PG-YBOCS]总分降低>= 30%）随机分配至6周的双盲NAC或安慰剂组。PG-YBOCS评分从基线时的平均20.3 ± 4.1下降到开放期结束时的11.8 ± 9.8（P <0.001）。27例受试者中有16例（59.3%）符合应答者标准。NAC的平均有效关闭为1476.9 +/- 311.3 mg/天。在16例应答者中，13例进入双盲期。那些分配到NAC，83.3%仍然符合反应标准，在双盲阶段结束时，只有28.6%的那些分配到安慰剂Conclusions：NAC的疗效支持的假设，药理学操纵的谷氨酸系统可能针对核心症状的奖励寻求成瘾行为，如赌博。更大、更长、安慰剂对照的双盲研究是必要的。
Background: Although pathological gambling (PG) is relatively common, pharmacotherapy research for PG is limited. N-acetyl cysteine (NAC), an amino acid, seems to restore extracellular glutamate concentration in the nucleus accumbens and therefore offers promise in reducing addictive behavior.Methods: Twenty-seven subjects (112 women) with DSM-lV PG were treated in an 8-week open-label trial of NAC with responders (defined as a >= 30% reduction in Yale Brown Obsessive Compulsive Scale Modified for Pathological Gambling [PG-YBOCS] total score at end point) randomized to 6 weeks of double-blind NAC or placebo.Results: The PG-YBOCS scores decreased from a mean of 20.3 +/- 4.1 at baseline to 11.8 +/- 9.8 at the end of the open-label phase (P < .001). Sixteen of 27 subjects (59.3%) met responder criteria. The mean effective close of NAC was 1476.9 +/- 311.3 mg/day. Of 16 responders, 13 entered the double-blind phase. Of those assigned to NAC, 83.3% still met responder criteria at the end of the double-blind phase, compared with only 28.6% of those assigned to placebo.Conclusions: The efficacy of NAC lends support to the hypothesis that pharmacological manipulation of the glutamate system might target core symptoms of reward-seeking addictive behaviors such as gambling. Larger, longer, placebo-controlled double-blind studies are warranted.