Repetitive trans cranial Magnetic Stimulation (rTMS) for treating addictive behaviours in Pathological Gambling
Gambling is a pleasant social activity for most individuals however, it can advance to a pathologic state (pathological gambling, PG) when individuals get preoccupied and progress to an impulsive and compulsive state, investing more time and money despite adverse effects. Gambling disorder is recognised as a subcategory under “substance related and addictive disorder” in DSM-V and has prevalence of 0.2-5.3% worldwide. In Singapore, 44% of the residents engaged in at least one form of gambling in the past 1 year and 0.03-0.4% of the respondents were probable pathological gamblers, according to the 2014 national survey (National Council …show more content…
However, we have the options to explore a looming non-invasive procedure which might offer serendipity in the realm of gambling addiction therapy. Repetitive transcranial magnetic stimulation is a potential intervention which stimulates the neurons through magnetic pulses that modulate the excitability of neurons (Benali et al., 2011; Tan et al., 2013). rTMS has been studied in the treatment of psychiatric conditions such as depression (Fitzgerald, Hoy, Anderson, & Daskalakis, 2016), schizophrenia (Barr et al., 2013) and autism spectrum disorders (Enticott et al., 2014) which yielded promising results. It is an emerging tool in addiction treatment as well. rTMS of prefrontal cortex enhances dopamine release (Keck et al., 2002; Ohnishi et al., 2004; Strafella, Paus, Barrett, & Dagher, 2001) and glutamine transmission (Michael et al., 2003; Zangen & Hyodo, 2002) in the subcortical regions, which are compromised in addiction and in other psychiatric diseases. Substantial scientific evidence supports rTMS as a promising tool for reducing psychological symptoms of addiction such as craving in substance use disorders (Gorelick, Zangen, & George, 2014). High frequency rTMS has been shown to be effective in treating nicotine addiction (Amiaz, Levy, Vainiger, Grunhaus, & Zangen, 2009), cocaine addiction (Camprodon, Martinez-Raga, Alonso-Alonso, Shih, & Pascual-Leone, 2007; Politi, Fauci, Santoro, & Smeraldi, 2008) and …show more content…
Patients with pathological gambling (DSM-V score > 6) diagnosis will be recruited from the outpatient clinic. The study will be a randomised, open label, single site, parallel study which will recruit 80 patients (40 in treatment, 40 in control) for this pilot study rTMS parameters
20 sessions (1 hour each) of rTMS will be delivered over a period of 2 months at a frequency of 20 Hz, 20 trains per 2 s with 10 sec interval, with a follow up period of 2 weeks. The intensity will be maintained as per optimised standards (can we specify?). The sessions will be administered by trained psychiatrists using Magpro rTMS machine located at the Institute of Mental Health.
Timeline
The project is expected to commence by end of 2016 and recruit participants through 2017. The analysis will be planned towards the last quarter of FY17 followed by the report and publication.
Gambling is a pleasant social activity for most individuals however, it can advance to a pathologic state (pathological gambling, PG) when individuals get preoccupied and progress to an impulsive and compulsive state, investing more time and money despite adverse effects. Gambling disorder is recognised as a subcategory under “substance related and addictive disorder” in DSM-V and has prevalence of 0.2-5.3% worldwide. In Singapore, 44% of the residents engaged in at least one form of gambling in the past 1 year and 0.03-0.4% of the respondents were probable pathological gamblers, according to the 2014 national survey (National Council …show more content…
However, we have the options to explore a looming non-invasive procedure which might offer serendipity in the realm of gambling addiction therapy. Repetitive transcranial magnetic stimulation is a potential intervention which stimulates the neurons through magnetic pulses that modulate the excitability of neurons (Benali et al., 2011; Tan et al., 2013). rTMS has been studied in the treatment of psychiatric conditions such as depression (Fitzgerald, Hoy, Anderson, & Daskalakis, 2016), schizophrenia (Barr et al., 2013) and autism spectrum disorders (Enticott et al., 2014) which yielded promising results. It is an emerging tool in addiction treatment as well. rTMS of prefrontal cortex enhances dopamine release (Keck et al., 2002; Ohnishi et al., 2004; Strafella, Paus, Barrett, & Dagher, 2001) and glutamine transmission (Michael et al., 2003; Zangen & Hyodo, 2002) in the subcortical regions, which are compromised in addiction and in other psychiatric diseases. Substantial scientific evidence supports rTMS as a promising tool for reducing psychological symptoms of addiction such as craving in substance use disorders (Gorelick, Zangen, & George, 2014). High frequency rTMS has been shown to be effective in treating nicotine addiction (Amiaz, Levy, Vainiger, Grunhaus, & Zangen, 2009), cocaine addiction (Camprodon, Martinez-Raga, Alonso-Alonso, Shih, & Pascual-Leone, 2007; Politi, Fauci, Santoro, & Smeraldi, 2008) and …show more content…
Patients with pathological gambling (DSM-V score > 6) diagnosis will be recruited from the outpatient clinic. The study will be a randomised, open label, single site, parallel study which will recruit 80 patients (40 in treatment, 40 in control) for this pilot study rTMS parameters
20 sessions (1 hour each) of rTMS will be delivered over a period of 2 months at a frequency of 20 Hz, 20 trains per 2 s with 10 sec interval, with a follow up period of 2 weeks. The intensity will be maintained as per optimised standards (can we specify?). The sessions will be administered by trained psychiatrists using Magpro rTMS machine located at the Institute of Mental Health.
Timeline
The project is expected to commence by end of 2016 and recruit participants through 2017. The analysis will be planned towards the last quarter of FY17 followed by the report and publication.