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Intervenções terapêuticas na perturbação de jogo : uma revisão narrativa
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Introdução: O jogo a dinheiro é uma atividade cada vez mais popular mundialmente, incluindo várias modalidades, desde casinos a formas mais recentes como apostas desportivas e raspadinhas. Adicionalmente, estas formas de jogo são cada vez mais publicitadas e estão cada vez mais disponíveis online, aumentando assim a sua promoção e acessibilidade. Estas atividades, comummente de lazer, podem levar a um maior envolvimento do indivíduo, tornando-se prejudiciais e afetando a sua vida pessoal, familiar, laboral ou financeira.
Objetivo: Avaliar quais as opções terapêuticas mais eficazes na perturbação de jogo, através de uma revisão da literatura.
Métodos: Realizou-se uma pesquisa nas bases de dados eletrónicas Pubmed e ScienceDirect, selecionando-se os estudos randomizados com controlo, em língua inglesa, que abordassem o tratamento da perturbação de jogo através de intervenções farmacológicas e/ou não farmacológicas.
Resultados: Foram selecionados dezassete estudos, dos quais oito avaliaram intervenções farmacológicas e os restantes nove avaliaram intervenções não farmacológicas. De entre as intervenções farmacológicas, dois estudos verificaram melhorias em indivíduos tratados com antagonistas opióides e um estudo demonstrou eficácia do carbonato de lítio em doentes com perturbação de jogo e perturbação bipolar concomitante. Relativamente às intervenções não farmacológicas, as intervenções breves foram eficazes na melhoria dos sintomas dos indivíduos em todos os artigos inseridos nesta revisão, obtendo-se resultados semelhantes nos estudos incluídos que abordaram as terapias cognitivo-comportamentais.
Conclusões: As intervenções não farmacológicas, nomeadamente as intervenções breves e as intervenções cognitivo-comportamentais, demonstraram ser eficazes na melhoria dos sintomas dos indivíduos com perturbação de jogo. Os antagonistas opióides demonstraram também efeitos na redução de sintomas, nomeadamente nas áreas do desejo e das compulsões, podendo assumir um papel importante na complementação das intervenções comportamentais. Deste modo, as intervenções não farmacológicas apresentam-se como principal opção de tratamento nestes indivíduos, podendo vir a ser complementadas por intervenções farmacológicas futuramente.
Introduction: Gambling is becoming more and more popular worldwide and it includes various forms, from casinos to the more recent ways such as sports betting or scratching cards. Furthermore, these activities have been increasingly advertised and settled on the online space, becoming accessible to the wider population. While gambling is commonly a leisure activity, it can become harmful, and negatively impact a range of life´s aspects, such as financial, personal or relational. Objective: Analyze the most effective methods available to treat gambling disorder, doing so by conducting a narrative review. Methods: To conduct this narrative review, a bibliographical search was made on Pubmed and ScienceDirect. Randomized controlled trials which analyzed gambling disorder treatments through pharmacological or non-pharmacological interventions were selected. Their publication in english was mandatory. Results: Seventeen trials were included, eight of which analyzed pharmacological interventions and the other nine analyzed non-pharmacological interventions. Two of the included pharmacological trials concluded that opioid antagonists were effective improving individuals with gambling disorder whilst another study concluded that lithium was effective on individuals with concomitant gambling disorder and bipolar disorder. On the other hand, brief interventions and cognitive behavioural therapies were effective reducing gambling symptoms in all included trials. Conclusions: Regarding the included trials, brief and cognitive-behavioural interventions showed the best results when improving patiens with gambling disorder. Moreover, opioid antagonists were effective reducing some of the patients´ symptoms, such as craving and urge. To summarize, motivational interviews and cognitive behavioural interventions present as the first line of treatment for individuals with gambling disorder and hereafter may be complemented with pharmacological treatment such as opioid antagonists.
Introduction: Gambling is becoming more and more popular worldwide and it includes various forms, from casinos to the more recent ways such as sports betting or scratching cards. Furthermore, these activities have been increasingly advertised and settled on the online space, becoming accessible to the wider population. While gambling is commonly a leisure activity, it can become harmful, and negatively impact a range of life´s aspects, such as financial, personal or relational. Objective: Analyze the most effective methods available to treat gambling disorder, doing so by conducting a narrative review. Methods: To conduct this narrative review, a bibliographical search was made on Pubmed and ScienceDirect. Randomized controlled trials which analyzed gambling disorder treatments through pharmacological or non-pharmacological interventions were selected. Their publication in english was mandatory. Results: Seventeen trials were included, eight of which analyzed pharmacological interventions and the other nine analyzed non-pharmacological interventions. Two of the included pharmacological trials concluded that opioid antagonists were effective improving individuals with gambling disorder whilst another study concluded that lithium was effective on individuals with concomitant gambling disorder and bipolar disorder. On the other hand, brief interventions and cognitive behavioural therapies were effective reducing gambling symptoms in all included trials. Conclusions: Regarding the included trials, brief and cognitive-behavioural interventions showed the best results when improving patiens with gambling disorder. Moreover, opioid antagonists were effective reducing some of the patients´ symptoms, such as craving and urge. To summarize, motivational interviews and cognitive behavioural interventions present as the first line of treatment for individuals with gambling disorder and hereafter may be complemented with pharmacological treatment such as opioid antagonists.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2024
Palavras-chave
Perturbação de jogo Terapêutica Psiquiatria