[Aripiprazole, gambling disorder and compulsive sexuality]. / Aripiprazole, jeu pathologique et sexualité compulsive.

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.

[Internet and video games among students of Reunion Island in 2010: uses, misuses, perceptions and associated factors]. / Internet et jeux vidéo chez les étudiants de La Réunion en 2010 : usages, mésusages, perceptions et facteurs associés.

BACKGROUND: Describe the uses of Internet and video games and quantify associated problematic uses. METHODS: Information on student practices concerning the use of the Internet and video games was collected with a self-administered questionnaire. Problematic uses were identified with specific tools (Young criteria and Tejeiro criteria) and with self-evaluative questions. Information on life events with traumatic potential and use of psychoactive substances was also collected. Logistic regression models were applied to identify possible associated factors. RESULTS: Based on a sample of 1119 subjects, this study showed that students in Reunion Island are very concerned by the uses of the Internet and video games (98% and 46% of respondents). The prevalence of problematic use of the Internet accounted for 6% of respondents. Problematic uses of video games involved 8% of students (18% of gamers). Young people seemed unaware of their problematic practices and were seeking informations. The public respondent was also characterized by vulnerable situations (traumatic events induring their lives, consumption of psychoactive substances). Significant associations (with no identified causality) were examined, in particular between problematic uses of Internet and video games, and life events with traumatic potential. CONCLUSION: These first estimates of the prevalence of problematic use of Internet and video games on Reunion Island are important to promote locally collective awareness about these modern addictions. These results will be used to guide local actions of prevention and care, especially among younger generations. But it is necessary to conduct further work to better identify the factors associated with these problematic uses (determinants, comorbidities addictive…).