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[Aripiprazole, gambling disorder and compulsive sexuality].
Encephale. 2016 Jun; 42(3):281-3.E

Abstract

INTRODUCTION

Aripiprazole, an atypical or second-generation antipsychotic, is usually well tolerated. It is an approved treatment for schizophrenia and mania in bipolar disorder type 1. Unlike the other antipsychotics, it has high affinity agonist properties for dopamine D2 and D3 receptors. It has also 5-HT1A partial agonist and 5-HT2A antagonist properties. Aripiprazole is a first or second line treatment frequently used because it has reduced side effects such as weight gain, sleepiness, dyslipidemia, insulin resistance, hyperprolactinemia and extrapyramidal symptoms.

CASE-REPORT

We report the case of a 28-year-old male patient diagnosed with schizoid personality disorder. He was a moderate smoker with occasional social gambling habits. After several psychotic episodes, he was first treated with risperidone, but he experienced excessive sedation, decreased libido, erectile dysfunction and was switched to 15 mg aripiprazole. He developed an addiction habit for gambling at casino slot machines. Due to large gambling debts, he requested placement on a voluntary self-exclusion list. Thereafter, he turned his attention towards scratch card gambling. The patient described his experience of gambling as a "hypnotic state". He got several personal loans to obtain money to continue gambling. He was then referred to an addiction unit. Before being treated with aripiprazole, he was an exclusive heterosexual with a poor sexual activity. Under treatment, he switched to a homosexual behavior with hypersexuality, unprotected sex and sadomasochistic practices. The craving for gambling and compulsive sexual behavior ceased two weeks after aripiprazole was discontinued and he was switched to amisulpride. Thereafter, he reported a return to a heterosexual orientation.

DISCUSSION

Compulsive behaviors such as gambling, hypersexuality and new sexual orientation are common in patients with Parkinson's disease treated with dopaminergic agonists. These behaviors involve the reward system, with an enhanced dopaminergic activity in the mesolimbic pathways and occur more frequently in young subjects, males with previous gambling habits and tobacco use. A few cases of aripiprazole-induced pathological gambling as well as aripiprazole-induced hypersexuality have been reported. To our knowledge, we are the first to report a case of gambling disorder associated with hypersexuality and change of sexuality orientation. Aripiprazole is the only antipsychotic with agonist properties for the D2 dopamine receptor. It may also act as an enhancer in the mesolimbic dopaminergic pathways. Aripiprazole also has 5-HT1A partial agonist and 5-HT2A antagonist properties that may promote sexual activity.

CONCLUSION

Aripiprazole is an antipsychotic associated with reduced side effects compared to other antipsychotics. We report the case of a patient who experienced gambling disorder, hypersexuality and a new sexual orientation under treatment. These side effects are little known. They are usually difficult for patients to mention due to feelings of guilt. The consequences on social life, family and health may be serious. Clinicians and patients should be aware about the possible issue of these behavior disorders with aripiprazole.

Authors+Show Affiliations

Service d'addictologie, CHU Félix-Guyon, route de Bellepierre, 97405 Saint-Denis cedex, Réunion. Electronic address: david.mete@chu-reunion.fr.Service d'addictologie, CHU Félix-Guyon, route de Bellepierre, 97405 Saint-Denis cedex, Réunion.Service d'addictologie, CHU Félix-Guyon, route de Bellepierre, 97405 Saint-Denis cedex, Réunion.Service d'addictologie, CHU Félix-Guyon, route de Bellepierre, 97405 Saint-Denis cedex, Réunion.

Pub Type(s)

Case Reports
Journal Article

Language

fre

PubMed ID

26923999

Citation

Mété, D, et al. "[Aripiprazole, Gambling Disorder and Compulsive Sexuality]." L'Encephale, vol. 42, no. 3, 2016, pp. 281-3.
Mété D, Dafreville C, Paitel V, et al. [Aripiprazole, gambling disorder and compulsive sexuality]. Encephale. 2016;42(3):281-3.
Mété, D., Dafreville, C., Paitel, V., & Wind, P. (2016). [Aripiprazole, gambling disorder and compulsive sexuality]. L'Encephale, 42(3), 281-3. https://doi.org/10.1016/j.encep.2016.01.003
Mété D, et al. [Aripiprazole, Gambling Disorder and Compulsive Sexuality]. Encephale. 2016;42(3):281-3. PubMed PMID: 26923999.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - [Aripiprazole, gambling disorder and compulsive sexuality]. AU - Mété,D, AU - Dafreville,C, AU - Paitel,V, AU - Wind,P, Y1 - 2016/02/26/ PY - 2014/01/20/received PY - 2014/12/18/accepted PY - 2016/3/1/entrez PY - 2016/3/1/pubmed PY - 2017/9/21/medline KW - Agonistes dopaminergiques KW - Aripipazole KW - Aripiprazole KW - Dopamine KW - Gambling disorder KW - Hypersexuality KW - Jeu pathologique KW - Orientation sexuelle KW - Partial agonist KW - Sexual orientation KW - Sexualité compulsive SP - 281 EP - 3 JF - L'Encephale JO - Encephale VL - 42 IS - 3 N2 - INTRODUCTION: Aripiprazole, an atypical or second-generation antipsychotic, is usually well tolerated. It is an approved treatment for schizophrenia and mania in bipolar disorder type 1. Unlike the other antipsychotics, it has high affinity agonist properties for dopamine D2 and D3 receptors. It has also 5-HT1A partial agonist and 5-HT2A antagonist properties. Aripiprazole is a first or second line treatment frequently used because it has reduced side effects such as weight gain, sleepiness, dyslipidemia, insulin resistance, hyperprolactinemia and extrapyramidal symptoms. CASE-REPORT: We report the case of a 28-year-old male patient diagnosed with schizoid personality disorder. He was a moderate smoker with occasional social gambling habits. After several psychotic episodes, he was first treated with risperidone, but he experienced excessive sedation, decreased libido, erectile dysfunction and was switched to 15 mg aripiprazole. He developed an addiction habit for gambling at casino slot machines. Due to large gambling debts, he requested placement on a voluntary self-exclusion list. Thereafter, he turned his attention towards scratch card gambling. The patient described his experience of gambling as a "hypnotic state". He got several personal loans to obtain money to continue gambling. He was then referred to an addiction unit. Before being treated with aripiprazole, he was an exclusive heterosexual with a poor sexual activity. Under treatment, he switched to a homosexual behavior with hypersexuality, unprotected sex and sadomasochistic practices. The craving for gambling and compulsive sexual behavior ceased two weeks after aripiprazole was discontinued and he was switched to amisulpride. Thereafter, he reported a return to a heterosexual orientation. DISCUSSION: Compulsive behaviors such as gambling, hypersexuality and new sexual orientation are common in patients with Parkinson's disease treated with dopaminergic agonists. These behaviors involve the reward system, with an enhanced dopaminergic activity in the mesolimbic pathways and occur more frequently in young subjects, males with previous gambling habits and tobacco use. A few cases of aripiprazole-induced pathological gambling as well as aripiprazole-induced hypersexuality have been reported. To our knowledge, we are the first to report a case of gambling disorder associated with hypersexuality and change of sexuality orientation. Aripiprazole is the only antipsychotic with agonist properties for the D2 dopamine receptor. It may also act as an enhancer in the mesolimbic dopaminergic pathways. Aripiprazole also has 5-HT1A partial agonist and 5-HT2A antagonist properties that may promote sexual activity. CONCLUSION: Aripiprazole is an antipsychotic associated with reduced side effects compared to other antipsychotics. We report the case of a patient who experienced gambling disorder, hypersexuality and a new sexual orientation under treatment. These side effects are little known. They are usually difficult for patients to mention due to feelings of guilt. The consequences on social life, family and health may be serious. Clinicians and patients should be aware about the possible issue of these behavior disorders with aripiprazole. SN - 0013-7006 UR - https://www.unboundmedicine.com/medline/citation/26923999/[Aripiprazole_gambling_disorder_and_compulsive_sexuality]_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0013-7006(16)00004-X DB - PRIME DP - Unbound Medicine ER -