Frontal lobe dysfunction in pathological gambling patients.
BACKGROUND
Limited data are available about the validity of the diagnosis of pathological gambling (PG) and about the etiology and the efficacy of different treatment strategies of this disorder; however, similarities in decision-making behavior between PG patients and patients with ventromedial prefrontal cortex lesions suggest a possible implication of these areas in the pathophysiology of this disorder, as in obsessive-compulsive disorder, in which the decision-making impairment is significantly associated with response to serotonin reuptake inhibitor treatment. Nevertheless, several studies have shown that decision-making functioning is also impaired in drug-addicted patients who have shown abnormalities in ventromedial prefrontal cortex during functional neuroimaging studies.


METHODS
We assessed the decision-making function mediated by the ventromedial prefrontal cortex in 20 PG patients and 40 healthy control (HC) subjects using the Gambling Task, which simulates real-life decision-making, testing the ability to balance immediate rewards against long-term negative consequence.


RESULTS
Significant differences were found in Gambling Task performance between HC subjects and PG patients, who showed a specific decision-making profile across the sequence of the game. The dissimilarity does not appear to depend on the basic cognitive function deficit of the PG group.


CONCLUSIONS
These data seem to suggest the existence of a link between PG and other disorders (i.e., obsessive-compulsive disorder and drug addiction) all having diminished ability to evaluate future consequences, which may be explained at least in part by an abnormal functioning of the orbitofrontal cortex.
Cavedini
Paolo
P
Department of Neuropsychiatric Sciences, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, 20 Via Stamira D'Ancona, Milan 20127, Italy.
Riboldi
Giovanna
G
Keller
Roberto
R
D'Annucci
Arcangela
A
Bellodi
Laura
L
D000328:Adult; D000704:Analysis of Variance; D003657:Decision Making / Q000502:physiology; D005260:Female; D005625:Frontal Lobe / Q000503:physiopathology*; D005715:Gambling / Q000523:psychology*; D006801:Humans; D008297:Male; D009483:Neuropsychological Tests; D012701:Serotonin / Q000378:metabolism
D012701:Serotonin