GAMBLING DISORDER: CASE REPORT AND REVIEW OF CLINICAL AND PSYCHOSOCIAL ASPECTS

Abstract

Introduction: Gambling is defined as activities involving the wagering of money in an attempt to predict the outcome of a future event, the outcome of which is largely independent of the bettor's actions. Among the most popular forms of this practice are casino games, lotteries, and Internet gambling, including poker and sports betting. Gambling disorder is the term adopted by the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) to describe a persistent and recurrent pattern of gambling behavior associated with significant distress or substantial impairment in various areas of life. The lifetime prevalence is 1%, making it the third most common behavior after tobacco and alcohol. Treatment is complex, with an emphasis on psychosocial interventions. Objective: To report a case of a patient referred to the psychiatry service by primary care in her city of origin due to dysfunctional behavior related to gambling on various digital platforms and to discuss the therapeutic interventions adopted, considering the main clinical, social, and psychopathological aspects associated with the condition and discussing the difficulties faced in the multidisciplinary management of gambling disorder. Methodology: This is a clinical case report, complemented by a narrative review of the literature, based on a retrospective analysis of the electronic medical records of a patient treated at the Psychiatry Outpatient Clinic of the Base Hospital of the São José do Rio Preto Medical School, linked to the Department of Neurological Sciences, Psychiatry, and Medical Psychology of FAMERP. Results: A 24-year-old female patient with persistent and maladaptive online gambling behavior, associated with significant financial, social, and emotional losses. Initial treatment included psychotropic drugs (fluoxetine, naltrexone, valproate, and risperidone), blocking accounts on digital platforms, and referral for psychotherapy, resulting in partial improvement. However, the patient did not have effective access to psychotherapy during follow-up, which contributed to relapse, discontinuation of follow-up, and maintenance of functional impairments. Conclusion: The management of gambling disorder requires a multidisciplinary approach, combining psychosocial and pharmacological interventions and ongoing support, with attention to psychiatric comorbidities. The difficulty of accessing specialized therapies, the high relapse rate, and the psychosocial impacts of gambling behavior highlight the need for more effective public policies, in addition to individualized therapeutic strategies to promote comprehensive rehabilitation and prevent new episodes.