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Problem Gambling Associated with Aripiprazole: A Nested Case-Control Study in a First-Episode Psychosis Program

Abstract

Background

Aripiprazole has been linked to cases of problem gambling (PBG), but evidence supporting this association remains preliminary. Additionally, data specific to PBG in individuals with first-episode psychosis (FEP) receiving aripiprazole are limited to a few case reports, even though aripiprazole is widely used among this population that might be especially vulnerable to PBG.

Methods

To examine this association, a nested case-control study was conducted in a cohort of 219 patients followed at a FEP program located in the Quebec City, Quebec, Canada, metropolitan area. Fourteen cases meeting the PBG criteria according to the Problem Gambling Severity Index were identified and matched for gender and index date to 56 control subjects.

Results

In the univariable conditional logistic regression analysis, the use of aripiprazole was associated with an increased risk of PBG (odds ratio [OR] 15.2; 95% confidence interval [CI] 2.1–670.5). Cases were more likely to have a prior gambling history (either recreational or problematic) than controls at admittance in the program; they were also more frequently in a relationship and employed. After adjustment for age, relationship status, employment and Cluster B personality disorders, the use of aripiprazole remained associated with an increased risk of PBG (OR 8.6 [95% CI 1.5–227.2]).

Conclusions

Findings from this study suggest that FEP patients with a gambling history, problematic or not, may be at increased risk of developing PBG when receiving aripiprazole. They also highlight the importance of systematically screening for PBG all individuals with psychotic disorders, as this comorbidity hinders recovery. While the results also add credence to a causal association between aripiprazole and PBG, further prospective studies are needed to address some of the limitations of this present study.

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Correspondence to Olivier Corbeil.

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Funding

The authors did not receive any funding for the research, authorship and publication of this article.

Competing interest

Olivier Corbeil has received an honorarium from Janssen and Otsuka-Lundbeck Alliance and is currently receiving a grant from the Fonds de Recherche du Québec-Santé. Marie-France Demers has received grants from Janssen and Otsuka-Lundbeck Alliance. Marc-André Roy has received grants from Otsuka-Lundbeck Alliance, Janssen, Sunovion and Mylan. All other authors have no conflicts of interest that are directly relevant to the content of this study.

Availability of data and material

All data generated or analysed during this study are available from the corresponding author on reasonable request.

Code availability

Not applicable.

Author contributions

Olivier Corbeil and Stéphanie Corbeil conceptualized the research question and study design, collected the data, interpreted the results and wrote the first draft of the manuscript. Pierre-Hugues Carmichael conducted the analyses and interpreted the results. Michel Dorval, Isabelle Giroux and Christian Jacques conceptualized the research question and study design. Marie-France Demers and Marc-André Roy interpreted the results and supervised the project. All authors critically revised the manuscript and approved the final manuscript that was submitted.

Ethics approval

Study protocol was reviewed and approved by the institution’s ethics board and access to patients’ medical files was granted by the professional services’ director. No signed consent was requested, as data collection did not require contact with patients. All research data were anonymized.

Consent to participate

Not applicable.

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Not applicable.

Acknowledgements

The authors would like to thank Guillaume Chalifour and Ann-Sophie Breault for their support in designing the study as well as Marie-Pier Ducas, Anne-Marie Essiambre, Alexandre Lachance and Chantal Vallières for their help during data collection. Authors also wish to thank Catherine Boudreault for her contribution in the case identification procedure as well as the entire staff at the Clinique Notre-Dame des Victoires for their precious collaboration and their unwavering dedication to patients’ recovery.

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Corbeil, O., Corbeil, S., Dorval, M. et al. Problem Gambling Associated with Aripiprazole: A Nested Case-Control Study in a First-Episode Psychosis Program. CNS Drugs 35, 461–468 (2021). https://doi.org/10.1007/s40263-021-00801-4

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