Epidemiology, pathophysiology and treatment of pathological gambling

Pathological gambling is a prevalent disorder that is gaining attention fro m patients, clinicians and policy makers. Aetiological factors that have be en related to pathological gambling include: (i) abnormalities in the serot onergic, dopaminergic and noradrenergic systems; (ii) cognitive distortions ; and (iii) a reinforcement of the gambling activity by either episodic gai ns or the excitement that accompanies gambling. Male gender, urban residenc e, lower income and the presence of a comorbid psychiatric disorder (partic ularly substance abuse) appear to constitute risk factors for the presence of the disorder. A number of treatments have been suggested as potentially effective: Gamble rs Anonymous, behavioural therapy, manualised cognitive therapy and several medications. At present, only manualised cognitive therapy and the selecti ve serotonin (5-hvdroxytryptamine: 5-HT) reuptake inhibitor flwuvoxamine ha ve shown efficacy in systematic (albeit small) studies. However, much resea rch remains to be done to better understand the psychophysiology of patholo gical gambling, to firmly demonstrate the efficacy of the different propose d treatment approaches, and to establish criteria for treatment selection f ur individual patients.