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A Case of Gambling Disorder

A Case of Gambling Disorder

  • “Mrs Kim” is brought to the emergency department by her daughter for bizarre behavior and symptoms of mania. For the past month, she has been gambling more than usual and today she returned from the casino after gambling for 48 continuous hours. She had maxed out her credit cards and emptied her savings account. A family friend saw her at the casino acting provocatively toward random strangers. Apparently, she has not slept for the past 3 days. Her family has never seen her act this way.

  • Mrs Kim has no psychiatric history. A month earlier, she complained of boredom and lack of motivation to her PCP last month. She was prescribed an antidepressant. Gambling has been a significant part of her life for years. She has been going to the local casino at least once a week for the past 16 years and playing for 5 to 8 hours each time. Before this past incident, she has never gambled more money than she could afford or chased her bets. She has also never experienced gambling-related repercussions.

  • The patient is restless but alert and oriented. She is talkative with rapid speech. She reports that she feels “amazing.” Additionally, her affect is labile—she cries when discussing her deceased husband and then suddenly starts making jokes. She is fixated on leaving the hospital and returning to Thailand to see her deceased mother (whom she believes is still alive).

  • Mrs Kim is admitted to the inpatient unit after a negative medical workup. Medication-induced bipolar and related disorder are suspected. Her antidepressant is discontinued and a low-dose antipsychotic is started. Fourteen days later, she is discharged: her delusions and manic symptoms have resolved, including her urges to gamble uncontrollably.
  • This fictional case vignette of a patient with gambling problems represents a scenario that any practicing psychiatrist may encounter. Although the patient suffered gambling-related problems, treatment was unique and personalized. It is not uncommon to include significant others to help control finances, professionals (eg, accountants, lawyers), and health care workers (eg, counselors, therapists) in treatment plans.
     

  • For more on this topic, see “A Brief Review of Gambling Disorder,” on which this case was based.

Comments

Better education on self knowledge, intrapersonal education, would be valuable in schools, eg, understanding our personal triggers, hypersensitivities, hyposensitivities, also understanding neurotypes, eg, people with attention deficit, get bored easily, on autistic spectrum, prefer not to engage socially, hyperactive, need to be busy constantly...understanding basic beeds and drivers...drugs can only be countered by drugs, self knowledge has to be a better way forwards...not saying there is no place for medication BUT so many young people feel impaired, faulty, yet actually they are simply unique, and every weakness is a strength, just as every strength is a weakness...curriculum overloaded, so highly unlikely to get any space allocated, except wedged into PSHE, Personal, Social and Health Education.

Kokila @

Bipolar disorder and poor impulse cotrol with addiction to drugs,, Alcohol ( another DRUG) ,sexual addiction, gambling adddiction , speeding, hypersexuality, overspending , etc., have long been observed together esp in rapid cyclers. Any member of GA will be willing to tell you many stories like this one.
Many experts warned about use of Anti depressants in Bipolar patients because of unleashing hypomania or Mania,,. Mood stabilizers are better choice and well tested with less problems.

Choudhary @

This does appear to be a case of antidepressent-induced bipolar disorder, but I don't see the advantage of having the patient take antipsychotics. Discontinuing the antidepressants or possibly switching the patient to another type of antidepressant might be a better choice. The psychosis most likely would have resolved on its own once the antidepressant was dealt with. I am not a big fan of using antipsychotics to deal with side-effects of other drugs.

Victoria @

Likely bipolar type I would be an appropriate diagnosis. Gambling DO as well. Curious, what antidepressant was initially prescibed?

Karen @

Machines with lights and electricity can hypnotize a vulnerable person , especially if this has never happened before. I think there is going to be big psychiatric fallout from virtual reality, internet , and technology without careful awareness of self and how it affects you. I think there should be no diagnosis until careful observation and awareness increases .

Brenda E @

This case sounds very similar to what some Parkinson patients experience with dopamine agonist medications.....I am speaking from personal experience as our family was devastated by the effects of the drug Mirapex.

teresa @

Additionally, but rarely alcohol and/or lights (more rarely in adults) can induce seizures and even at times frequent intermittent or status epilepticus. This can result in altered mental status and severe change in affect, as well.

Linda @

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