ADICCIONES NO CONVENCIONALES

Alumno: Jota Orellana Cuellar

Docente: Dr. Carlos Lizrraga Stucci
Adiccin. Definicin RAE
Hbito de quien se deja dominar por el uso de
alguna o algunas drogas txicas, o por la aficin
desmedida a ciertos juegos
DEPENDENCIA VS IMPULSIVIDAD VS COMPULSIVIDAD
CARACTERSTICA DE LAS ADICCIONES
CONDUCTUALES
1. Conducta anormal en un perodo de 1 ao.
2. Prdida del control al inicio de la conducta.
3. Efecto de recompensa.
4. Desarrollo de tolerancia.
5. Cambio de la percepcin de la conducta.
6. Impulsividad y deseo de ejecutar la conducta.
7. Funcin de la adiccin para regular el humor.
8. Expectativa del efecto.
9. Patrn limitado de la conducta.
10. Ocupacin cognitiva en la realizacin de la
conducta.
11. Percepcin distorsionada e irracional de
diferentes aspectos de la conducta.
12. Sndrome de retirada.
13. Continuacin de la conducta a pesar de los
efectos negativos.
14. Reacciones aprendidas/condicionadas.
15. Sufrimiento.

F63 Trastornos de los hbitos y de los
impulsos
Esta categora abarca ciertos trastornos de la conducta que no son clasificables bajo
otros cdigos. Consisten en acciones iterativas que no tienen una
clara motivacin racional, que no pueden ser
controladas y que generalmente atentan contra los propios intereses de la
persona o los de otras. El paciente suele indicar que esta conducta se asocia con
impulsos para la accin. La causa de estos trastornos no ha sido dilucidada y se los
agrupa debido a sus amplias similitudes descriptivas y no porque se sepa que
compartan alguna otra caracterstica importante entre s.

F63.0 Juego patolgico (ludomana)
Y en el DSM V?
In psychiatry, the only disorders that have been considered addictions are those involving
alcohol or other drugs. Now, proposed revisions for the American Psychiatric
Association's Diagnostic and Statistical Manual of Mental Disorders include for the first
time "behavioral addictions"a change some say is long overdue and others say is still
premature. So far, only one behavior has made the cut: gambling, which under the
new proposal would join substance-use disorders as a full-fledged addiction.
Y en el DSM V?
In addition to the substance-related disorders, this chapter also includes
gambling disorder, reflecting evidence that gambling behaviors activate
reward systems similar to those activated by drugs of abuse and produce some
behavioral symptoms that appear comparable to those produced by the substance use
disorders. Other excessive behavioral patterns, such as Internet gaming, have
also been described, but the research on these and other behavioral syndromes is less
clear. Thus, groups of repetitive behaviors, which some term behavioral addictions,
with such subcategories as "sex addiction", "exercise addiction,
or "shopping addiction, are not included because at this time there
is insufficient peer-reviewed evidence to establish the
diagnostic criteria and course descriptions needed to
identify these behaviors as mental disorders.
ADICCIN AL JUEGO (LUDOPATA)
ADICCIN AL INTERNET
5 criterios
The DAT images of the
bilateral corpus striatum
in the control group
showed a panda-eye
shape and DATs were
distributed uniformly and
symmetrically in the
corpus striatum.
The DAT
images of the IAD
subjects displayed
different levels of
abnormity, in which the
corpus stratums were
much smaller
and showed different
shapes, dumbbell, thin
strip, lunate
shape, or sporadic spot.
ADICCIN AL SEXO
ADICCIN AL SEXO
ADICCIN A LOS EJERCICIOS
ADICCIN A LAS COMPRAS
FACTORES DE RIESGO
No existe una personalidad pre mrbida del
adicto
.
Individuals with behavioral addictions and those with substance use disorders both score
high on self-report measures of impulsivity and sensation-seeking and
generally low on measures of harm avoidance (1620). However, individuals with some
behavioral addictions, such as internet addiction or pathological gambling, may also report
high levels of harm avoidance (21; see also Weinstein and Lejoyeux, this issue).
Other research has suggested that aspects of psychoticism,
interpersonal conflict, and self-directedness may all play a role in
internet addiction (see Weinstein and Lejoyeux, this issue). In contrast, individuals with
obsessive compulsive disorder generally score high on measures of harm avoidance
and low on impulsivity (17,21). Individuals with behavioral addictions also score
high on measures of compulsivity, but these may be limited to impaired control over
mental activities and worries about losing control over motor behaviors (22). Impaired
inhibition of motor responses (impulsivity) has been found in individuals with
obsessive compulsive disorder and pathologic skin picking (a behavioral addiction with
arguably closer phenomenological links to obsessive compulsive disorder), whereas cognitive
inflexibility (thought to contribute to compulsivity) was limited to obsessive
compulsivity disorder (23,24).
FACTORES DE RIESGO
Sin embargo, existir un genotipo pre
mrbido?
Due to the lack of
genetic studies on
compulsive buying,
compulsive sexual
behavior and
compulsive
computer use, it is
early to speculate
whether genetic
findings in these
behavioral
addictions would be
similar to the
findings on
pathological
gambling.
FISIOPATOLOGA
The Dopamine Reinforcement Pathway
MS NEUROTRASMISORES
Noradrenalina: Arousal y excitacin, elevada.
Serotonina: Iniciacin del comportamiento
(modulador del impulso) y cese. Disminuida.
Dopamina: Recompensa y refuerzo, resultados
ambiguos.
Opiodes: Placer y urgencia. Elevados? Tx con
naltrexona.
Glutamato: Procesos motivacionales. Excitador.
Disminuidos? Tx glutamatrgico en PG.
Primero la adiccin y despus el
dao cerebral o viceversa?
BACKGROUND:
Gambling is a form of nonsubstance addiction classified as an impulse control disorder. Pathologic gamblers are considered healthy with
respect to their cognitive status. Lesions of the frontolimbic systems, mostly of the
right hemisphere, are associated with addictive behavior. Because gamblers are
not regarded as "brain-lesioned" and gambling is nontoxic, gambling is a model to test whether addicted "healthy" people are relatively
impaired in frontolimbic neuropsychological functions.
METHODS:
Twenty-one nonsubstance dependent gamblers and nineteen healthy subjects underwent a behavioral neurologic interview centered on
incidence, origin, and symptoms of possible brain damage, a neuropsychological examination, and an electroencephalogram.
RESULTS:
Seventeen gamblers (81%) had a positive medical history for brain damage (mainly traumatic head
injury, pre- or perinatal complications). The gamblers, compared with the controls, were significantly
more impaired in concentration, memory, and executive functions, and evidenced a higher prevalence of non-right-handedness (43%) and,
non-left-hemisphere language dominance (52%). Electroencephalogram (EEG) revealed dysfunctional activity in 65% of the gamblers,
compared with 26% of controls.
CONCLUSIONS:
This study shows that the "healthy" gamblers are indeed brain-damaged. Compared with a matched control population, pathologic gamblers
evidenced more brain injuries, more fronto-temporo-limbic neuropsychological dysfunctions and more EEG abnormalities. The authors thus
conjecture that addictive gambling may be a consequence of brain damage,
especially of the frontolimbic systems, a finding that may well have medicolegal consequences.
Abstract
INTRODUCTION:
In Parkinson's disease, the degeneration of the dopaminergic system and the
longstanding exposure to dopamine replacement therapy (DRT) may
cause, in a group of vulnerable patients, dysregulation of the brain reward system.
STATE OF THE ARTS:
These patients develop DRT-related compulsions, which include addiction to levodopa or dopamine dysregulation
syndrome (DDS), punding, and impulse control disorders (ICDs). ICDs or behavioral addiction
reported in Parkinson's disease include pathological gambling,
hypersexuality, compulsive buying and binge eating. Although the underlying
pathophysiology is still poorly understood, these behaviors are linked by their reward-based and repetitive nature.
Such behaviors may result in devastating psychosocial impairment for the patients and are often hidden.
PERSPECTIVE AND CONCLUSIONS:
The recognition of these behaviors is important and allows a better clinical management. Although the limited data do
not permit particular therapeutic strategies, some approaches are worth considering: DRT reduction, trials of non-
dopaminergic medications and subthalamic chronic stimulation.

TRATAMIENTO
RECOMENDACIONES AUSTRALIA
Terapia de grupo deberan ser utilizados en
reducir la severidad del juego patolgico en
personas slo con dicha enfermedad (B).
Antidepresivos no deberan ser utilizados en
reducir la severidad del juego patolgico en
personas slo con dicha enfermedad (B).
Naltrexona puede ser utilizado en reducir la
severidad del juego patolgico (C).
Estabilizadores del nimo/anticonvulsivantes, N-
acetilcistena y olanzapina: se recomienda
investigando con ECR.

RECOMENDACIONES SINGAPUR
Terapia de grupo deberan ser utilizados en
reducir la severidad del juego patolgico en
personas slo con dicha enfermedad (B).
Fluvoxamina y paroxetina podran ser
considerados en reducir la severidad del juego
patolgico (B).
Naltrexona puede ser utilizado en reducir la
severidad del juego patolgico (A).



ADICCIN AL SEXO
ADICCIN A LAS COMPRAS
GRACIAS