Background

Aripiprazole has been linked to cases of problem gambling (PBG), but evidence supporting this association remains preliminary. Additionally, data specific to PBG in individuals with first-episode psychosis (FEP) receiving aripiprazole are limited to a few case reports, even though aripiprazole is widely used among this population that might be especially vulnerable to PBG.

Methods

To examine this association, a nested case-control study was conducted in a cohort of 219 patients followed at a FEP program located in the Quebec City, Quebec, Canada, metropolitan area. Fourteen cases meeting the PBG criteria according to the Problem Gambling Severity Index were identified and matched for gender and index date to 56 control subjects.

Results

In the univariable conditional logistic regression analysis, the use of aripiprazole was associated with an increased risk of PBG (odds ratio [OR] 15.2; 95% confidence interval [CI] 2.1–670.5). Cases were more likely to have a prior gambling history (either recreational or problematic) than controls at admittance in the program; they were also more frequently in a relationship and employed. After adjustment for age, relationship status, employment and Cluster B personality disorders, the use of aripiprazole remained associated with an increased risk of PBG (OR 8.6 [95% CI 1.5–227.2]).

Conclusions

Findings from this study suggest that FEP patients with a gambling history, problematic or not, may be at increased risk of developing PBG when receiving aripiprazole. They also highlight the importance of systematically screening for PBG all individuals with psychotic disorders, as this comorbidity hinders recovery. While the results also add credence to a causal association between aripiprazole and PBG, further prospective studies are needed to address some of the limitations of this present study.

中文翻译：

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与阿立哌唑相关的赌博问题：首发精神病项目中的嵌套病例对照研究

背景

阿立哌唑与问题赌博 (PBG) 案件有关，但支持这种关联的证据仍然是初步的。此外，接受阿立哌唑治疗的首发精神病 (FEP) 患者的 PBG 数据仅限于少数病例报告，尽管阿立哌唑在可能特别易受 PBG 影响的人群中广泛使用。

方法

为了检验这种关联，在加拿大魁北克大都会地区魁北克市的 FEP 项目中，对一组 219 名患者进行了嵌套病例对照研究。根据问题赌博严重程度指数确定了 14 个符合 PBG 标准的案例，并将其性别和指数日期与 56 名对照受试者相匹配。

结果

在单变量条件逻辑回归分析中，使用阿立哌唑与 PBG 风险增加相关（优势比 [OR] 15.2；95% 置信区间 [CI] 2.1-670.5）。与项目准入时的对照相比，病例更有可能有先前的赌博历史（娱乐或有问题的）；他们也更频繁地建立关系和就业。在对年龄、关系状况、就业和 B 类人格障碍进行调整后，阿立哌唑的使用仍然与 PBG 风险增加相关（OR 8.6 [95% CI 1.5-227.2]）。

结论

这项研究的结果表明，有赌博史的 FEP 患者，无论是否有问题，在接受阿立哌唑治疗时可能会增加发生 PBG 的风险。他们还强调了对所有患有精神病的个体进行系统筛查 PBG 的重要性，因为这种合并症会阻碍康复。虽然结果也增加了阿立哌唑和 PBG 之间因果关系的可信度，但需要进一步的前瞻性研究来解决本研究的一些局限性。