FDG-PET study in pathological gamblers. 1. Lithium increases orbitofrontal, dorsolateral and cingulate metabolism.
BACKGROUND
Pathological gambling affects 1-3% of the adult population, and has high comorbidity. Although mood stabilizers and serotonin reuptake inhibitors have shown some efficacy in the treatment of this condition, there is little known about how these pharmacological interventions work.


METHODS
Twenty-one patients with pathological gambling, who met lifetime comorbid bipolar spectrum diagnoses, received baseline PET scans. Sixteen of these patients were entered into a randomized double-blind placebo-controlled parallel group design trial of lithium, and received follow-up PET scans at 10 weeks. A comparison group of 32 age- and sex-matched controls was also available. Anatomical MRIs were obtained as a structural template.


RESULTS
In patients with pathological gambling, relative glucose metabolic rates (rGMR) in the orbitofrontal cortex and medial frontal cortex were significantly increased at baseline compared to normal controls. Lithium increased rGMR further in the orbitofrontal cortex, heightening normal/patient differences, but it also increased the rGMR of the posterior cingulate and the dorsolateral frontal cortex normalizing the metabolic rate in these regions.


CONCLUSIONS
Cortical areas implicated in impulse control disorders show increased rGMR in pathological gambling at baseline. Lithium treatment, while alleviating the symptoms, further increases rGMR in these areas.
Hollander
Eric
E
Department of Psychiatry, Mount Sinai School of Medicine, New York, NY 10029, USA. eric.hollander@mssm.edu
Buchsbaum
Monte S
MS
Haznedar
M Mehmet
MM
Berenguer
Jessica
J
Berlin
Heather A
HA
Chaplin
William
W
Goodman
Chelain R
CR
LiCalzi
Elizabeth M
EM
Newmark
Randall
R
Pallanti
Stefano
S
D000328:Adult; D018692:Antimanic Agents / Q000627:therapeutic use; D007174:Disruptive, Impulse Control, and Conduct Disorders / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000378:metabolism*; D004311:Double-Blind Method; D005260:Female; D019788:Fluorodeoxyglucose F18; D005625:Frontal Lobe / Q000000981:diagnostic imaging / Q000187:drug effects / Q000378:metabolism*; D007839:Functional Laterality; D005715:Gambling; D006179:Gyrus Cinguli / Q000000981:diagnostic imaging / Q000187:drug effects / Q000378:metabolism*; D006801:Humans; D018020:Lithium Compounds / Q000627:therapeutic use*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010919:Placebos; D049268:Positron-Emission Tomography; D011581:Psychological Tests; D016896:Treatment Outcome
D018692:Antimanic Agents; D018020:Lithium Compounds; D010919:Placebos; D019788:Fluorodeoxyglucose F18