title: Pathological gambling treated with lithium: the role of assessing temperament.
abstract: OBJECTIVE
  Pathological gambling is a condition for which there is still no FDA-approved treatment although some medications seem to be effective at reducing its symptoms. In DSM-V, it is now classified as an addiction disorder. Data show that baseline comorbidities in patients with gambling and substance misuse behavior are frequent. These might include not only major syndromes but also subclinical ones. Bipolar spectrum conditions are often among these comorbidities. Lithium has been showed to be effective in PG subjects with bipolar spectrum comorbidity, and we present a case where assessment of temperament was helpful in treatment selection.
  
  
  CONCLUSIONS
  This case illustrates the clinical benefits of how the assessment of temperament and comorbidities in pathological gambling patients may guide the clinician to a successful treatment choice. The case presented also corroborates previous evidence on the efficacy of lithium in patients with pathological gambling and comorbid bipolar spectrum conditions and euphoric temperament. Future clinical trials on pathological gambling pharmacotherapy should include temperament assessment to evaluate its influence on different outcomes.
authors.affiliation: Psychiatry Residency Program, Federal University of Rio de Janeiro (UFRJ), Institute of Psychiatry (IPUB), Rio de Janeiro, Brazil. Electronic address: carolina.hanna@gmail.com.
authors.forename: Carolina Hanna
authors.initials: CH
authors.lastname: Chaim
authors.affiliation: Federal University of Rio de Janeiro (UFRJ), Institute of Psychiatry (IPUB), Rio de Janeiro, Brazil; Rua Visconde de Pirajá 547, Sala 610, Rio de Janeiro, RJ 22415-900, Brazil. Electronic address: bruno.nazar@ufrj.br.
authors.forename: Bruno Palazzo
authors.initials: BP
authors.lastname: Nazar
authors.affiliation: Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, United States; Child Psychiatry Annex, 3340 Bainbridge Avenue, Bronx, NY 10467-2490, United States. Electronic address: eholland@montefiore.org.
authors.forename: Eric
authors.initials: E
authors.lastname: Hollander
authors.affiliation: Federal University of Rio de Janeiro (UFRJ), Institute of Psychiatry (IPUB), Rio de Janeiro, Brazil; Rua Venceslau Brás 71, Fundos, Rio de Janeiro, RJ 22290-140, Brazil. Electronic address: lessa.md@gmx.com.
authors.forename: José Luiz Martins
authors.initials: JL
authors.lastname: Lessa
mesh_terms: D000328:Adult; D018692:Antimanic Agents / Q000627:therapeutic use*; D005715:Gambling / Q000188:drug therapy*; D006801:Humans; D018020:Lithium Compounds / Q000627:therapeutic use*; D008297:Male; D013694:Temperament / Q000187:drug effects*; D016896:Treatment Outcome
chemical_list: D018692:Antimanic Agents; D018020:Lithium Compounds
keywords: Addiction; Bipolar disorder; Euphoric temperament; Lithium; Pathological gambling; Pharmacological treatment