PubMed · 2444841
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1987-10-24. Serotonin, suicidal behaviour, and impulsivity.. https://pubmed.ncbi.nlm.nih.gov/2444841/
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This paper provides a "how to" guide for designing an effective treatment outcome study. Three areas addressed are (1) a description of the three stages: treatment development, efficacy testing, and effectiveness testing; (2) suggestions for writing a grant proposal; and (3) optimal study design. The latter includes considerations of comorbidity, standard design features, treatment, assessment, patients, therapists, and replication. These are discussed with regard to the testing of psychosocial treatments, with examples from the area of pathological gambling. Finally, general questions applicable to any study are provided, including: Is there a rationale for all design decisions? Is the investigator aware of what can and cannot be inferred from the data, based on the design? Does the study design address research questions that are important and genuinely of benefit to the field?
In recent years, attention focused on compulsive gambling(1), and its causes and cures, has increased at a notable rate. Among the measures taken to help the compulsive gambler is the voluntary(2) self-exclusion program which is either in place or being considered in various states.(3) Although the programs differ from jurisdiction to jurisdiction, the basic premise is that the gambler requests that he be banned from the gaming establishment and/or removed from its mailing list. This article examines this new concept primarily from a legal perspective. The self-exclusion program represents a state-created legal entity constructed upon a clinical foundation. It prominently includes several clinical references to mental health principles. Of necessity, there appear some analogies to the field of substance abuse; these have provided at least a starting point for more particularized study and research in the fledgling field of compulsive gambling treatment.
According to most diagnostic manuals such as ICD-10 and DSM-IV, kleptomania is classified as an impulse-control disorder. With regard to comorbidity, kleptomania is related to the obsessive- compulsive disorder spectrum and to the broader spectrum of affective disorders. Accordingly a psychopharmacological intervention with anti-depressant drugs or mood stabilizers may be possible, even though there are to date no known results from controlled therapy studies. Nevertheless the successful administration of such medication has been reported in several cases. Assuming a disturbed central serotonin reuptake, the use of selective serotonin reuptake inhibitors (SSRI) seems to be indicated. But also naltrexone could be of use in kleptomania.