Kumar Oynama Bozukluğu
Özet
Kumar oynama bozukluğu (KOB), olumsuz sonuçlarına rağmen yineleyici ve kontrolsüz bir şekilde kumar oynama eylemiyle karakterize, DSM-5 ile birlikte dürtü kontrol bozukluklarından maddeyle ilişkili ve bağımlılık bozuklukları kategorisine taşınan davranışsal bir bağımlılıktır. Yıllık yaygınlığı %0.2-0.3 olan ve psikiyatrik komorbiditelerin sıklıkla eşlik ettiği bu heterojen bozukluğun etiyolojisini açıklamak amacıyla klinik görünümlerine göre davranışsal olarak koşullanmış, duygusal olarak hassas ve antisosyal-dürtüsel gibi çeşitli alt tipler ile tipolojiler önerilmiştir. Patofizyolojisinde dopaminerjik, serotoninerjik ve noradrenerjik sistemlerdeki nörokimyasal disfonksiyonların yanı sıra prefrontal korteks, striatum ve insula gibi ödül ve bilişsel kontrol süreçleriyle ilişkili beyin bölgelerindeki yapısal veya işlevsel değişikliklerin rol oynadığı, ayrıca ikiz çalışmalarının %35-54 oranında kalıtabillik göstererek genetik yatkınlığa işaret ettiği bildirilmektedir. KOB olan bireylerde kontrolün yanılsaması, kumarbazın yanılgısı ve kayıpların peşinden koşma gibi belirgin bilişsel çarpıtmalar ve disinhibisyon sorunları izlenmektedir. Tedavi arayışının oldukça düşük (%10) olduğu bu bozukluğun yönetiminde farmakoterapi kapsamında opioid antagonistleri, monoaminerjik ve glutamaterjik ilaçlar araştırılırken; psikososyal müdahalelerde ise bilişsel yeniden yapılandırma ve relaps önlemeyi içeren BDT süreçleri ile Adsız Kumarbazlar grupları ve motivasyonel görüşmeler öne çıkmaktadır.
Gambling disorder (GD) is a behavioral addiction characterized by repetitive and uncontrolled gambling despite negative consequences, which has been moved from impulse control disorders to substance-related and addictive disorders in DSM-5. This heterogeneous disorder, which has an annual prevalence of 0.2-0.3% and is frequently accompanied by psychiatric comorbidities, has been classified into various subtypes and typologies such as behaviorally conditioned, emotionally vulnerable, and antisocial-impulsive to explain its clinical presentations. In its pathophysiology, neurochemical dysfunctions in dopaminergic, serotonergic, and noradrenergic systems, as well as structural or functional alterations in brain regions associated with reward and cognitive control processes such as the prefrontal cortex, striatum, and insula play a role, and twin studies also indicate a genetic predisposition, demonstrating a heritability rate of 35-54%. Distinct cognitive distortions and disinhibition issues, such as the illusion of control, gambler's fallacy, and chasing losses, are observed in individuals with GD. While opioid antagonists, monoaminergic, and glutamatergic medications are investigated within the scope of pharmacotherapy for the management of this disorder, which has a very low treatment-seeking rate (10%), psychosocial interventions prominently feature motivational interviewing, Gamblers Anonymous groups, and CBT processes that include cognitive restructuring and relapse prevention.
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