Dimensions and disorder specificity of impulsivity in pathological gambling

Executive Function in Gambling Disorder: A Meta-analysis on Neuropsychological Evidence

Gambling disorder (GD) is associated with deficits in various cognitive functions. Specifically for executive function (EF), previous findings are inconsistent, despite deficits being reported for shifting, inhibition, planning, and working memory domains. Although a worse performance in EF measures related to GD severity is often reported, there is a need to clarify current evidence. This study aims to systematically review and perform a meta-analysis to clarify the association between EF deficits and GD. The current study followed the preferred reporting items for systematic reviews and meta-analyses protocols. The meta-analysis used a random effects model and robust variance estimation to analyze the data, using Hedge's g to report effect sizes. A total of 21 studies were systematically reviewed, of which 17 were included for meta-analysis. Meta-analysis was performed for shifting, inhibition, planning, and verbal fluency. Due to a lower number of studies, working memory data was systematically reviewed, but no meta-analysis was performed. Significant effect sizes were found for shifting and inhibition, indicative of deficits in participants with GD. No significant deficits were found for the other EF domains. Working memory results revealed inconsistent evidence, even when divided into verbal and visuospatial modalities. There is enough evidence of deficits in shifting and inhibition in participants with GD. However, better sample characterization should be considered in future studies to better understand the sources of potential heterogeneity. Consideration of gambling severity as a continuous variable could allow for a more detailed analysis of EF alterations across the various degrees of GD.

Neurophysiological Correlates of Near-Wins in Gambling: A Systematic Literature Review

Identification of specific patterns of brain activity related to problem gambling may provide a deeper understanding of its underlying mechanisms, highlighting the importance of neurophysiological studies to better understand development and persistence of gambling behavior. The patterns of cognitive functioning have been investigated through electroencephalography (EEG) studies based on the near-win/near-miss (NW) effect. The main goal of the present study was to evaluate the neurophysiological basis of NWs and their modulation by gambling problems through a systematic review of event-related potentials (ERP) studies elicited by feedback events. The review followed the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols (PRISMA). A total of 15 studies were included, 12 comprising non-problem gamblers (NPGs) and three comparing problem gamblers (PGs) with matched controls. For the P300 component, the win outcome elicited a larger amplitude than the other outcomes (NW and loss), followed by the NW outcome, which elicited a larger amplitude than loss in some studies. For feedback-related negativity (FRN), the loss outcome evoked a more negative amplitude in several studies, despite eliciting a similar amplitude to NW outcomes in others. For PGs, the NW outcome evoked a higher amplitude of P300 than loss, while NPGs showed a similar amplitude to both outcomes. The present review gathered information from different sources and provides a consistent view of the different studies. However, studies lack systematic and robust methodologies, leading to inconsistent results and making it difficult to reach any definitive conclusions.

The Iowa Gambling Task: Men and Women Perform Differently. A Meta-analysis

The Iowa Gambling Task (IGT) was designed to assess decision-making under conditions of complexity and uncertainty; it is currently one of the most widely used tests to assess decision-making in both experimental and clinical settings. In the original version of the task, participants are given a loan of play money and four decks of cards and are asked to maximize profits. Although any single card unpredictably yields wins/losses, variations in frequency and size of gains/losses ultimately make two decks more advantageous in the long term. Several studies have previously suggested that there may be a sex-related difference in IGT performance. Thus, the present study aimed to explore and quantify sex differences in IGT performance by pooling the results of 110 studies. The meta-analysis revealed that males tend to perform better than females on the classic 100-trial IGT (UMD = 3.381; p < 0.001). Furthermore, the significant heterogeneity observed suggests high variability in the results obtained by individual studies. Results were not affected by publication bias or other moderators. Factors that may contribute to differences in male and female performance are discussed, such as functional sex-related asymmetries in the ventromedial prefrontal cortex and amygdala, as well as differences in sensitivity to wins/losses.

How We Lost 90% of Participants on a Bad Bet: Results from a Pilot Randomized Controlled Trial on Cognitive Bias Modification in Problem Gamblers

Whilst opportunities to participate in gambling have increased, access to support for problem gamblers is lacking behind. This lack of balance calls for improved and accessible intervention methods. The present double-blind randomized controlled trial (RCT) explored the effectiveness of two interventions targeting automatic cognitive processes, known as Attentional Bias Modification (AtBM) and Approach Bias Modification (ApBM). It was hypothesized these interventions would reduce gambling behavior and reduce or reverse targeted biases. Participants (N = 331) were community-recruited Flemish (35%) and Dutch (65%) adult problem gamblers motivated to reduce or stop their gambling who received either six sessions of active training (AtBM or ApBM) or of the corresponding sham-training (sham-AtBM or sham-ApBM). Due to high attrition rates (90.1% up to the intervention phase) the study was terminated before completion, since it would greatly limit the validity of any results. A post hoc qualitative study was performed on a subset of participants to gain insight into contributing factors for the high attrition rate. Issues negatively impacting participants' motivation to complete the program were identified, as well as elements of the program that received approval. The results from this study provide a first insight into the potential of the use of online cognitive bias modification (CBM) interventions in problem gambling (PG). Suggestions and directions for future studies are discussed.

Examining the role of urgency in predicting binge size in bulimia nervosa

Greater binge size within bulimia nervosa is associated with elevated distress and impairment. Theoretical models posit that emotion dysregulation predicts binge eating, but little research has investigated the potential for dispositional traits that reflect difficulty in emotion regulation to predict binge size among women with bulimia nervosa. Research supports that negative urgency, the tendency to act rashly when feeling distressed, is associated with binge eating behavior among individuals with bulimia nervosa. Relatively fewer studies have explored associations between binge eating and positive urgency, the tendency to act rashly when feeling extreme positive affect. The urgency traits may predict greater binge size within bulimia nervosa. The current study sought to examine negative urgency and positive urgency as predictors of test meal intake in a sample of 50 women, n = 21 with bulimia nervosa and n = 29 healthy controls. Dispositional levels of positive urgency, negative urgency, positive affect, and negative affect were measured prior to a laboratory binge eating paradigm. Participants in the bulimia nervosa group scored higher on negative urgency, positive urgency, and negative affect than participants in the control group. Across participants, lower levels of negative affect were associated with greater test meal intake. Elevated levels of positive urgency predicted significantly greater test meal intake, but only for participants with bulimia nervosa. No other dispositional traits predicted test meal intake when the interaction of positive urgency and group was included in the model. Findings suggest positive urgency is an underappreciated, but potentially important, risk factor for greater binge size in bulimia nervosa.

Impulsivity and Attention in Obsessive Compulsive and Tic Disorders: Mismatch in Self-Report and Behavioural Data

Impulsivity is a multidimensional, cross-diagnostic behavioural construct that has been described in various psychiatric disorders including obsessive-compulsive disorder (OCD) and Tourette syndrome (TS). Different interpretations of results in the past have raised the question of heightened impulsivity as an explanatory model for self-described impulsive behaviour, especially in OCD. Our study included 16 patients with OCD, 14 patients with TS, and 28 healthy control subjects (HC). Self-assessed impulsivity was examined by the Barratt Impulsiveness Scale-11 (BIS-11), and the behavioural test used was the immediate and delayed memory task (IMT/DMT). Significantly heightened self-assessed impulsivity of the patient collective compared to HC could be observed in in only one dimension: lack of attention (χ2 (2) = 24.910, p < 0.001). Post-hoc tests were performed using Bonferroni adjusted alpha levels of 0.0167 per test (0.05/3) and revealed significantly higher scores in patients with OCD (M = 19.57, SD = 2.82), z = 4.292, p < 0.001 as with TS (M = 19.38, SD = 3.62), z = 3.832, p < 0.001 compared to HC (M = 13.78, SD = 3.18). In patients with OCD, correlations between the dimension of obsessive thoughts with a lack of attention in the form of first-order factor cognitive instability could be shown (n = 14, p = 0.024, rs = 0.599) while in patients with TS, tic symptomatology correlated significantly with second-order factor attentional impulsivity (n = 12, p = 0.027, rs = 0.635). In behavioural testing, no significant group differences could be observed either in impulsive behaviour (IMT: χ2 (2) = 4.709, p = 0.824; DMT: χ2 (2) = 0.126, p = 0.939) or in sustained attention (IMT: χ2 (2) = 0.388, p = 0.095; DMT: χ2 (2) = 0.663, p = 0.718). Heightened impulsivity as an explanatory model for the observed lack of attention, especially in patients with OCD, should be questioned and interpretation biases considered in the future. The necessity of a multidimensional approach to the research of impulsivity is underscored by our results.

Network Analysis of the Structure of the Core Symptoms and Clinical Correlates in Comorbid Schizophrenia and Gambling Disorder

Few studies have analyzed the clinical profile of treatment-seeking patients with the comorbid presence of schizophrenia (SCZ) and gambling disorder (GD), which warrants new research to assess the network structure of this complex mental condition. The aim of this study was to explore the organization of the symptoms and other clinical correlates of SCZ with GD. Network analysis was applied to a sample of N = 179 SCZ patients (age range: 19-70 years, mean=39.5, SD=9.9) who met clinical criteria for gambling disorder-related problems. Variables included in the network were the core GD symptoms according to the DSM-5, psychotic and paranoid ideation levels, global psychological distress, GD severity measures (debts and illegal behavior related with gambling), substances (tobacco, alcohol, and illegal drugs), and personality profile. The nodes with the highest authority in the network (variables of highest relevance) were personality traits and psychological distress. Four empirical modules/clusters were identified, and linkage analysis identified the nodes with the highest closeness (bridge nodes) to be novelty seeking and reward dependence (these traits facilitate the transition between the modules). Identification of the variables with the highest centrality/linkage can be particularly useful for developing precise management plans to prevent and treat SCZ with GD.

Supplementary Information

The online version contains supplementary material available at 10.1007/s11469-022-00983-y.

e-Estesia: A Serious Game for Reducing Arousal, Improving Emotional Regulation and Increasing Wellbeing in Individuals with Gambling Disorder

Gambling disorder (GD) is associated with deficits in emotion regulation and impulsivity-related personality traits. In recent years there has been an increase in the use of serious games (SG) to address these factors with positive results. The aim of this study was to analyze the efficacy of the intervention with a new SG (e-Estesia), as an adjunct to a CBT intervention for GD. The sample comprised two groups (experimental group (n = 40) and control group (n = 64)) of patients with GD diagnosis. Both groups received 16 weekly CBT sessions and, concurrently, only the experimental group received 15 additional sessions with e-Estesia. Pre-post treatment with e-Estesia administered in both groups were: DSM-5 Criteria, South Oaks Gambling Screen, Symptom Checklist-Revised and measure of relapses, dropout and compliance of treatment. As regards the experimental group were also administered: Difficulties in Emotion Regulation Scale, Emotion Regulation Questionnaire, and Impulsive Behavior Scale. No statistically significant differences in the general psychopathological state, emotion regulation or impulsivity were found when comparing the groups. However, patients enrolled in the e-Estesia intervention had significantly less relapses and better indicators of treatment compliance than the control group. Considering these results, the use of complementary tools such as SG are useful for addressing GD.

Factors related to the dual condition of gambling and gaming disorders: A path analysis model

BACKGROUND AND AIMS

Gaming disorder has experienced rapid growth in the last decade among youth and adult populations, in parallel to the expansion of the videogame industry. The objective of this study was to explore the underlying process to explain the dual diagnosis of gaming with gambling disorder.

METHODS

The sample included n = 117 patients who met clinical criteria for gaming disorder, recruited from a tertiary care unit specialized in the treatment of behavioral addictions. Path analysis (implemented through structural equation modeling) assessed the direct and mediational mechanisms between the dual condition of gaming + gambling disorder and sociodemographic variables and personality traits.

RESULTS

The comorbid gaming + gambling disorder was met for 14.5% of the participants (additionally, 6.0% of the sample also met criteria for problematic gambling). The dual diagnosis was directly related to an older age at onset of the addiction problems, a higher level of the novelty seeking trait and being in active work. Employment status also mediated the relationship between persistence levels and chronological age. Greater psychopathological distress was related to females, higher levels of harm avoidance and persistence and lower levels of self-directedness.

CONCLUSIONS

The results of this study provide empirical evidence for the specific factors that increase the likelihood of the dual gaming + gambling disorder. Clinical settings should consider these features to improve gaming diagnosis and treatment. Preventive programs should also be focused on the most vulnerable groups to prevent onset and progression of this comorbid condition.

Impulsivity, Emotion Regulation, Cognitive Distortions and Attentional Bias in a Spanish Sample of Gambling Disorder Patients: Comparison between Online and Land-Based Gambling

Several risk factors have been related to the onset and maintenance of gambling disorder (GD). The aim of this study was to explore the differences in emotion dysregulation, impulsivity, cognitive distortions, and attentional bias between online and land-based gamblers. The sample consisted of 88 treatment-seeking patients from the Behavioral Addictions Unit at the Hospital de la Santa Creu i Sant Pau, Barcelona (Spain). Patients were divided into two groups by considering their main type of gambling, i.e., online (n = 26) and land-based gambling (n = 62). Online gamblers were younger, more often employed, with a higher educational level than land-based gamblers. Regarding the rest of the variables, statistically significant differences were only found in Positive Urgency, one of the UPPS-P subscales, in which the land-based gambling group scored higher than the online gambling group. In this exploratory study, individuals with online and land-based GD phenotypes did not differ either in difficulties in emotion regulation or in attentional and cognitive biases. However, land-based GD patients showed a higher tendency to succumb to strong impulses under the influence of positive emotions. These preliminary findings warrant the need to continue investigating GD phenotypes in larger patient samples.

The prevalence and features of schizophrenia among individuals with gambling disorder

BACKGROUND-OBJECTIVES

Few studies have analyzed the comorbid presence of gambling disorder (GD) with schizophrenia, its sociodemographic correlates and clinical implications. This study estimated the prevalence of the dual diagnosis (GD with schizophrenia) and the differences in the profiles of patients with and without the dual condition.

METHOD

The sample included n = 3,754 patients consecutively accepted for treatment for GD. Sociodemographics, gambling-related variables, psychopathological state and personality traits were assessed and compared between the groups.

RESULTS

The prevalence of schizophrenia within patients who met clinical criteria for GD was 4.4% (95% confidence interval: 3.8%-5.1%). Variables related to the dual presence of GD with schizophrenia were single marital status, lower education level, inactive working status, socioeconomic disadvantage, younger age, earlier onset of gambling problems, worse global psychopathological state and more dysfunctional personality profile (higher level in harm avoidance and lower level in cooperativeness, reward dependence, persistence and self-directedness).

CONCLUSION

The presence of schizophrenia among patients with GD was around 4 times higher than the prevalence rate estimated in the reference general population. The differences in the profiles of GD patients with and without schizophrenia suggest that individuals with the dual diagnosis condition require unique assessment considerations and tailored treatment interventions specifically designed for the clinical and functioning higher risk.

Neurochemistry of response inhibition and interference in gambling disorder: a preliminary study of γ-aminobutyric acid (GABA+) and glutamate-glutamine (Glx)

BACKGROUND

Neurobehavioral research on the role of impulsivity in gambling disorder (GD) has produced heterogeneous findings. Impulsivity is multifaceted with different experimental tasks measuring different subprocesses, such as response inhibition and distractor interference. Little is known about the neurochemistry of inhibition and interference in GD.

METHODS

We investigated inhibition with the stop signal task (SST) and interference with the Eriksen Flanker task, and related performance to metabolite levels in individuals with and without GD. We employed magnetic resonance spectroscopy (MRS) to record glutamate-glutamine (Glx/Cr) and inhibitory, γ-aminobutyric acid (GABA+/Cr) levels in the dorsal ACC (dACC), right dorsolateral prefrontal cortex (dlPFC), and an occipital control voxel.

RESULTS

We found slower processing of complex stimuli in the Flanker task in GD (P < .001, η2p = 0.78), and no group differences in SST performance. Levels of dACC Glx/Cr and frequency of incongruent errors were correlated positively in GD only (r = 0.92, P = .001). Larger positive correlations were found for those with GD between dACC GABA+/Cr and SST Go error response times (z = 2.83, P = .004), as well as between dACC Glx/Cr and frequency of Go errors (z = 2.23, P = .03), indicating general Glx-related error processing deficits. Both groups expressed equivalent positive correlations between posterror slowing and Glx/Cr in the right dlPFC (GD: r = 0.74, P = .02; non-GD: r = .71, P = .01).

CONCLUSION

Inhibition and interference impairments are reflected in dACC baseline metabolite levels and error processing deficits in GD.

A Serious Game to Improve Emotion Regulation in Treatment-Seeking Individuals With Gambling Disorder: A Usability Study

Background: Serious games have shown positive results in increasing motivation, adherence to treatment and strengthening the therapeutic alliance in multiple psychiatric disorders. In particular, patients with impulse control disorders and other disorders in which the patient suffers from inhibitory control deficits (e.g., behavioral addictions) have been shown to benefit from serious games. Aim: The aim of this study was to describe the characteristics and to evaluate the usability of a new serious videogame, e-Estesia. This serious videogame was designed to improve emotion regulation in patients with gambling disorder (GD). Preliminary results from a pilot sample are also reported. Method: A pilot sample of 26 patients undergoing treatment for GD was recruited (ranging from 22 to 74 years, mean = 41.2 and SD = 12.9; 80.8% men). Participants used e-Estesia on a tablet, which was connected to a thoracic band that sent heart rate (HR) and heart rate variability (HRV) data to the videogame platform in order to provide biofeedback. The System Usability Scale was completed by patients to determine the usability of e-Estesia. Results and Discussion: e-Estesia performed comparatively well for all the explored groups (i.e., sex, age, and online vs. offline gambling: mean usability score = 83.8, SD = 13.1). Around 84.6% of the patients endorsed that it was easy to use. Female patients with GD presented higher HRV during the use of the serious videogame compared to men.

Considering Motor Excitability During Action Preparation in Gambling Disorder: A Transcranial Magnetic Stimulation Study

A lack of inhibitory control appears to contribute to the development and maintenance of addictive disorders. Among the mechanisms thought to assist inhibitory control, an increasing focus has been drawn on the so-called preparatory suppression, which refers to the drastic suppression observed in the motor system during action preparation. Interestingly, deficient preparatory suppression has been reported in alcohol use disorders. However, it is currently unknown whether this deficit also concerns behavioral, substance-free, addictions, and thus whether it might represent a vulnerability factor common to both substance and behavioral addictive disorders. To address this question, neural measures of preparatory suppression were obtained in gambling disorder patients (GDPs) and matched healthy control subjects. To do so, single-pulse transcranial magnetic stimulation was applied over the left and the right motor cortex to elicit motor-evoked potentials (MEPs) in both hands when participants were performing a choice reaction time task. In addition, choice and rapid response impulsivity were evaluated in all participants, using self-report measures and neuropsychological tasks. Consistent with a large body of literature, the MEP data revealed that the activity of the motor system was drastically reduced during action preparation in healthy subjects. Surprisingly, though, a similar MEP suppression was observed in GDPs, indicating that those subjects do not globally suffer from a deficit in preparatory suppression. By contrast, choice impulsivity was higher in GDPs than healthy subjects, and a higher rapid response impulsivity was found in the more severe forms of GD. Altogether, those results demonstrated that although some aspects of inhibitory control are impaired in GDPs, these alterations do not seem to concern preparatory suppression. Yet, the profile of individuals suffering of a GD is very heterogeneous, with only part of them presenting an impulsive disposition, such as in patients with alcohol use disorders. Hence, a lack of preparatory suppression may be only shared by this sub-type of addicts, an interesting issue for future investigation.

The influence of chronological age on cognitive biases and impulsivity levels in male patients with gambling disorder

BACKGROUND AND AIMS

Due to the contribution of age to the etiology of gambling disorder (GD), there is a need to assess the moderator effect of the aging process with other features that are highly related with the clinical profile. The objective of this study is to examine the role of the chronological age into the relationships between cognitive biases, impulsivity levels and gambling preference with the GD profile during adulthood.

METHODS

Sample included n = 209 patients aged 18-77 years-old recruited from a Pathological Gambling Outpatients Unit. Orthogonal contrasts explored polynomial patterns in data, and path analysis implemented through structural equation modeling assessed the underlying mechanisms between the study variables.

RESULTS

Compared to middle-age patients, younger and older age groups reported more impairing irrational beliefs (P = 0.005 for interpretative control and P = 0.043 for interpretative bias). A linear trend showed that as people get older sensation seeking (P = 0.006) and inability to stop gambling (P = 0.018) increase. Path analysis showed a direct effect between the cognitive bias and measures of gambling severity (standardized effects [SE] between 0.12 and 0.17) and a direct effect between impulsivity levels and cumulated debts due to gambling (SE = 0.22).

CONCLUSION

Screening tools and intervention plans should consider the aging process. Specific programs should be developed for younger and older age groups, since these are highly vulnerable to the consequences of gambling activities and impairment levels of impulsivity and cognitive biases.

Comorbidity, family history and personality traits in pathological gamblers compared with healthy controls

Background

While DSM-5 classified pathological gambling as an addictive disorder, there is debate as to whether ICD-11 should follow suit. The debate hinges on scientific evidence such as neurobiological findings, family history of psychiatric disorders, psychiatric comorbidity, and personality variables.

Methods

In the “Baden-Württemberg Study of Pathological Gambling”, we compared a group of 515 male pathological gamblers receiving treatment with 269 matched healthy controls. We studied differences in sociodemographic characteristics, gambling-related variables, psychiatric comorbidity (lifetime), family history of psychiatric conditions, as well as personality traits such as impulsivity (Barratt Impulsiveness Scale), sensation seeking (Zuckerman's Sensation Seeking Scale) and the NEO-FFI big five. Personality traits were validated in an age- and ethnicity-matched subsample of “pure” gamblers without any psychiatric comorbidity (including nicotine dependence). Data were analyzed using two-sample t-tests, Chi2 analyses, Fisher's exact test and Pearson correlation analysis, as appropriate. Bonferroni correction was applied to correct for multiple comparisons.

Results

Only 1% of the gamblers had been diagnosed with an impulse control disorder other than gambling (ICD-10). Notably, 88% of the gamblers in our sample had a comorbid diagnosis of substance dependence. The highest axis I comorbidity rate was for nicotine dependence (80%), followed by alcohol dependence (28%). Early age of first gambling experience was correlated with gambling severity. Compared to first-degree relatives of controls, first-degree relatives of pathological gamblers were more likely to suffer from alcohol dependence (27.0% vs. 7.4%), pathological gambling (8.3% vs. 0.7%) and suicide attempts (2.7% vs. 0.4%). Significant group differences were observed for the NEO-FFI factors neuroticism, agreeableness and conscientiousness. Gamblers were also more impulsive than controls, but did not differ from controls in terms of sensation seeking.

Conclusions

Our findings support classifying pathological gambling as a behavioural addiction in the ICD-11. This decision will have a significant impact on the approaches available for prevention (e.g. age limits) and treatment.

Impulsivity, Lack of Premeditation, and Debts in Online Gambling Disorder

Background and Objectives: Gambling disorder (GD) is a recurrent and persistent problematic gambling behavior that impairs multiple areas of an individual's life. GD can persist through two modes: online or offline. This study aims to compare sociodemographic, clinical, and psychological characteristics between treatment-seeking online and offline gamblers and analyze the effect of the gambling mode (online or offline) on anxiety, depression, impulsivity, and debts. Methods: Seventy-nine treatment-seeking gamblers (96.2% males), who were simultaneously receiving treatment at a specialized Pathological Gambling and Behavioral Addictions Unit, participated in this study. The sample was divided into two subsamples: online (n = 29, 100% males) and offline (n = 50, 94% males); the characteristics of these two groups were compared and analyzed using Chi-Square test (χ²), t-Test or Mann-Whitney U-test (p < 0.05). Multiple linear regression analyses were performed to determine the effects of gambling mode on significant variables (lack of premeditation and debts). Results: The online sample with a mean age of 29.4 years mainly chose to engage in sports betting (45%, p < 0.05) and showed a higher lack of premeditation levels (25.8 points, p < 0.05) than the offline sample. In addition, the online sample was younger with respect to their onset to gambling (20.2 years, p < 0.05) and the beginning of their gambling problems (25 years, p < 0.05) compared to the offline sample. Online gambling increased the levels of lack of premeditation by an average of 5.43 points compared to offline gambling (p < 0.05). Accumulated debts of the online sample were lower (€11,000) than those of the offline sample (€12,000). However, the interaction between age and gambling mode revealed that online gamblers increased their debt amounts with age at an average increase of €2,726.33 per year compared to offline gamblers (p < 0.05). No significant influence of gambling mode was found on GD severity, anxiety, and depression levels. Conclusions: Gambling mode has a significant relationship with lack of premeditation-a component of impulsivity-and accumulation of debts in treatment-seeking people with GD; however, no relationship was found with the rest of the variables analyzed. Future research with larger samples is needed to confirm these findings.

Sequential exploration in the Iowa gambling task: Validation of a new computational model in a large dataset of young and old healthy participants

The Iowa Gambling Task (IGT) is one of the most common paradigms used to assess decision-making and executive functioning in neurological and psychiatric disorders. Several reinforcement-learning (RL) models were recently proposed to refine the qualitative and quantitative inferences that can be made about these processes based on IGT data. Yet, these models do not account for the complex exploratory patterns which characterize participants' behavior in the task. Using a dataset of more than 500 subjects, we demonstrate the existence of sequential exploration in the IGT and we describe a new computational architecture disentangling exploitation, random exploration and sequential exploration in this large population of participants. The new Value plus Sequential Exploration (VSE) architecture provided a better fit than previous models. Parameter recovery, model recovery and simulation analyses confirmed the superiority of the VSE scheme. Furthermore, using the VSE model, we confirmed the existence of a significant reduction in directed exploration across lifespan in the IGT, as previously reported with other paradigms. Finally, we provide a user-friendly toolbox enabling researchers to easily and flexibly fit computational models on the IGT data, hence promoting reanalysis of the numerous datasets acquired in various populations of patients and contributing to the development of computational psychiatry.

Heterogeneity in Disordered Gambling: Decision-Making and Impulsivity in Gamblers Grouped by Preferred Form

Background: Previous research has indicated that disordered gamblers display deficits in impulsivity and risky decision-making, compared to healthy control groups. However, disordered gamblers are not a homogenous group, and differences in performance on neurocognitive tasks may be related to the form of gambling in which an individual chooses to engage. The present study used neurocognitive tasks and questionnaire measures to ascertain group differences in gamblers grouped by preferred form of gambling. Method: Treatment-seeking pathological gamblers from the National Problem Gambling Clinic, London (n = 101), completed a neurocognitive assessment comprising the Cambridge gamble task (CGT), the stop-signal task (SST), a probabilistic reversal learning task (PRL), and the Kirby Monetary Choice Questionnaire, as well as questionnaire measures of gambling severity, impulsivity, depression, and anxiety. Analyses compared gamblers who favored fixed-odds betting terminals (FOBTs) (the modal form) to gamblers who preferred other forms of gambling (non-FOBT). Results: The FOBT group showed impaired decision-making under risk on the CGT compared to the non-FOBT group, choosing the likely option less on more uncertain decisions. The FOBT group made fewer perseverative errors on the PRL task, had lower depression and anxiety scores, and were less likely to have a family history of problem gambling than the non-FOBT group. Discussion: Decision-making and cognitive flexibility differences between gamblers grouped by gambling type supports preferred form as an important source of heterogeneity in gambling disorder. Decision-making strategies and risk attitudes should be considered when approaching cognition-focused treatment strategies, allowing interventions to be targeted at specific cognitive deficits.

Suicidal ideation and history of suicide attempts in treatment-seeking patients with gambling disorder: The role of emotion dysregulation and high trait impulsivity

BACKGROUND AND AIMS

Gambling disorder (GD) presents high rates of suicidality. The combined influences of emotion dysregulation and trait impulsivity are crucially important (albeit understudied) for developing strategies to treat GD and prevent suicide attempts. The aim of this study is to investigate the association between trait impulsivity, emotion dysregulation, and the dispositional use of emotion regulation (ER) strategies with suicidal ideation and psychopathological symptom severity in GD.

METHODS

The sample composed of 249 patients with GD (166 with suicidal ideation) who underwent face-to-face clinical interviews and completed questionnaires to assess psychopathological symptoms, impulsive traits, and ER.

RESULTS

Patients with GD who presented suicidal ideation were older and had a later age of GD onset and higher GD severity. Analyses of variance showed higher comorbid symptoms, emotion dysregulation, and trait impulsivity in patients with suicidal ideation. Still, no significant differences were found in the use of ER strategies. SEM analysis revealed that a worse psychopathological state directly predicted suicidal ideation and that both emotion dysregulation and GD severity indirectly increased the risk of suicidal ideation through this state. High trait impulsivity predicted GD severity. Finally, a history of suicide attempts was directly predicted by suicidal ideation.

CONCLUSIONS

Patients with GD are at risk of presenting suicidal behaviors. The results of this study revealed the importance of comorbid psychopathology in the occurrence of suicidal ideation and the indirect effect of trait impulsivity and emotion dysregulation on suicidality. Thus, suicidal rates in GD could possibly be reduced by specifically targeting these domains during treatment.

Assessing the Relationship between Disordered Gamblers with Psychosis and Increased Gambling Severity: The Mediating Role of Impulsivity

OBJECTIVE

Recent research suggests that disordered gambling and psychosis co-occur at higher rates than expected in the general population. Gamblers with psychosis also report greater psychological distress and increased gambling severity. However, the mechanism by which psychosis leads to greater gambling symptomology remains unknown. The objective of the present research was to test whether impulsivity mediated the relationship between comorbid psychosis and gambling severity.

METHOD

The sample consisted of 394 disordered gamblers voluntarily seeking treatment at a large university hospital in São Paulo, Brazil. A semistructured clinical interview (Mini-International Neuropsychiatric Interview) was used to diagnosis the presence of psychosis by registered psychiatrists. Severity of gambling symptoms was assessed using the Gambling Symptom Assessment Scale, and the Barratt Impulsiveness Scale-11 provided a measure of impulsivity.

RESULTS

Of the sample, 7.2% met diagnostic criteria for psychosis. Individuals with a dual diagnosis of psychosis did not report greater gambling severity. Conversely, dual diagnoses of psychosis were associated with greater levels of impulsivity. Higher levels of impulsivity were also associated with greater gambling severity. Importantly, support for our hypothesised mediation model was found such that impulsivity mediated the association between disordered gambling and psychosis and gambling severity.

CONCLUSION

Impulsivity appears to be a transdiagnostic process that may be targeted in treatment among disordered gamblers with a dual diagnosis of psychosis to reduce problematic gambling behaviours.

[Testing a Model to Predict Problem Gambling in Speculative Game Users]

PURPOSE

The purpose of the study was to develop and test a model for predicting problem gambling in speculative game users based on Blaszczynski and Nower's pathways model of problem and pathological gambling.

METHODS

The participants were 262 speculative game users recruited from seven speculative gambling places located in Seoul, Gangwon, and Gyeonggi, Korea. They completed a structured self-report questionnaire comprising measures of problem gambling, negative emotions, attentional impulsivity, motor impulsivity, non-planning impulsivity, gambler's fallacy, and gambling self-efficacy. Structural Equation Modeling was used to test the hypothesized model and to examine the direct and indirect effects on problem gambling in speculative game users using SPSS 22.0 and AMOS 20.0 programs.

RESULTS

The hypothetical research model provided a reasonable fit to the data. Negative emotions, motor impulsivity, gambler's fallacy, and gambling self-efficacy had direct effects on problem gambling in speculative game users, while indirect effects were reported for negative emotions, motor impulsivity, and gambler's fallacy. These predictors explained 75.2% problem gambling in speculative game users.

CONCLUSION

The findings suggest that developing intervention programs to reduce negative emotions, motor impulsivity, and gambler's fallacy, and to increase gambling self-efficacy in speculative game users are needed to prevent their problem gambling.

No evidence for common processes of cognitive control and self-control

Cognitive control and self-control are often used as interchangeable terms. Both terms refer to the ability to pursue long-term goals, but the types of controlled behavior that are typically associated with these terms differ, at least superficially. Cognitive control is observed in the control of attention and the overcoming of habitual responses, while self-control is observed in resistance to short-term impulses and temptations. Evidence from clinical studies and neuroimaging studies suggests that below these superficial differences, common control process (e.g., inhibition) might guide both types of controlled behavior. Here, we study this hypothesis in a behavioral experiment, which interlaced trials of a Simon task with trials of an intertemporal decision task. If cognitive control and self-control depend on a common control process, we expected conflict adaptation from Simon task trials to lead to increased self-control in the intertemporal decision trials. However, despite successful manipulations of conflict and conflict adaptation, we found no evidence for this hypothesis. We investigate a number of alternative explanations of this result and conclude that the differences between cognitive control and self-control are not superficial, but rather reflect differences at the process level.

Alterations in the Emotional Regulation Process in Gambling Addiction: The Role of Anger and Alexithymia

This study aims at the assessment of alexithymia and anger levels in 100 treatment-seeking pathological gamblers compared with controls, who were matched for age, gender and education. Furthermore a positive correlation between alexithymia, anger and severity of gambling disorder and a relationship between gambling behaviour and anger after controlling for alexithymia, are investigated. Finally the role that gender plays in anger in pathological gamblers was also evaluated. Psychological assessment includes the South Oaks Gambling Screen, State-Trait Anger Expression Inventory-2 and the twenty-item Toronto Alexithymia Scale. Statistical analysis of the results shows a higher level of anger in pathological gamblers than in controls, together with alterations in emotional processing. Severity of gambling behaviour positively correlates with alexithymia scores, state-anger and trait-anger. Moreover, a significant contribution of anger in predicting gambling behaviour was suggested after controlling for alexithymia. In conclusion, anger and alexithymia must be regarded as relevant components of the assessment of pathological gamblers, in order to select the best therapeutical strategies to prevent self-defeating behaviours and to reduce drop-out from treatments.

Decision making measured by the Iowa Gambling Task in alcohol use disorder and gambling disorder: a systematic review and meta-analysis

BACKGROUND AND AIMS

Gambling disorder (GD) and alcohol use disorder (AD) have similar features, such as elevated impulsivity and decision-making deficits, which are directly linked to relapse and poor therapeutic outcomes. Our aim was to assess decision-making characteristics in GD and AD patients compared to healthy controls (HC) based on one of the most frequently used measures of decision-making: the Iowa Gambling Task (IGT).

METHODS

In our systematic literature search of three databases, we identified 1198 empirical articles that mentioned decision-making deficits with the use of the IGT in patients diagnosed with either AD or GD. Possible effects were calculated using meta-analysis. In the end, 17 studies (including 1360 participants) were suitable for inclusion in the meta-analysis reporting data for 23 group contrasts.

RESULTS

The random effects estimate indicated impaired IGT performance in both AD patients (N=500; d=-0.581, CI:-89.5<δ<-26.6%) and an even greater deficit in GD patients (N=292; d=-1.034, CI:-156.1<δ<50.7%) compared to HCs. Sampling variances were calculated for both AD (v₁=0.0056) and GD groups (v₂=0.0061), from which the z-score was calculated (z=-21.0785; p<0.05), which indicates a statistically significant difference between AD and GD groups. No significant moderating effects of age, gender or education were found.

CONCLUSIONS

There is enough evidence to support that decision-making deficit associated with addictive disorders, and that the deficit is more expressed in gambling disorder than in alcohol use disorder. Impaired decision-making plays an important part in poor therapeutic outcomes, thus provides a promising opportunity for cognitive intervention.

Effectiveness of two web-based cognitive bias modification interventions targeting approach and attentional bias in gambling problems: study protocol for a pilot randomised controlled trial

BACKGROUND

Disordered gamblers have phenotypical and pathological similarities to those with substance use disorders (SUD), including exaggerated automatic cognitive processing of motivationally salient gambling cues in the environment (i.e., attentional and approach bias). Cognitive bias modification (CBM) is a family of computerised interventions that have proved effective in successfully re-training these automatic cognitive biases in SUD. CBM interventions can, in principle, be administered online, thus showing potential of being a low-cost, low-threshold addition to conventional treatments. This paper presents the design of a pilot randomised controlled trial exploring the effectiveness of two web-based CBM interventions targeting attentional and approach bias towards gambling cues in a sample of Dutch and Belgian problematic and pathological gamblers.

METHODS/DESIGN

Participants (N = 182) are community-recruited adults experiencing gambling problems, who have gambled at least twice in the past 6 months and are motivated to change their gambling behaviour. After a baseline assessment session, participants are randomly assigned to one of four experimental conditions (attentional or approach bias training, or the placebo version of the two trainings) and complete six sessions of training. At baseline and before each training session, participants receive automated personalised feedback on their gambling motives and reasons to quit or reduce gambling. The post-intervention, 1-month, and 3-month follow-up assessments will examine changes in gambling behaviour, with frequency and expenditure as primary outcomes, and depressive symptoms and gambling-related attentional and approach biases as secondary outcomes. Secondary analyses will explore possible moderators (interference control capacity and trait impulsivity) and mediators (change in cognitive bias) of training effects on the primary outcomes.

DISCUSSION

This study is the first to explore the effectiveness of an online CBM intervention for gambling problems. The results of this study can be extremely valuable for developing e-health interventions for gambling problems and further understanding the role of motivational implicit cognitive processes underlying problematic gambling behaviour.

TRIAL REGISTRATION

Netherlands Trial Register, NTR5096 . Registered on 11 March 2015.

Prefrontal Glx and GABA concentrations and impulsivity in cigarette smokers and smoking polysubstance users

Glutamate and GABA play an important role in substance dependence. However, it remains unclear whether this holds true for different substance use disorders and how this is related to risk-related traits such as impulsivity. We, therefore, compared Glx (as a proxy measure for glutamate) and GABA concentrations in the dorsal anterior cingulate cortex (dACC) of 48 male cigarette smokers, 61 male smoking polysubstance users, and 90 male healthy controls, and investigated the relationship with self-reported impulsivity and substance use. Glx and GABA concentrations were measured using proton Magnetic Resonance Spectroscopy. Impulsivity, smoking, alcohol and cocaine use severity and cannabis use were measured using self-report instruments. Results indicate a trend towards group differences in Glx. Post-hoc analyses showed a difference between smokers and healthy controls (p=0.04) and a trend towards higher concentrations in smoking polysubstance users and healthy controls (p=0.09), but no differences between smokers and smoking polysubstance users. dACC GABA concentrations were not significantly different between groups. Smoking polysubstance users were more impulsive than smokers, and both groups were more impulsive than controls. No significant associations were observed between dACC neurotransmitter concentrations and impulsivity and level and severity of smoking, alcohol or cocaine use or the presence of cannabis use. The results indicate that differences in dACC Glx are unrelated to type and level of substance use. No final conclusion can be drawn on the lack of GABA differences due to assessment difficulties. The relationship between dACC neurotransmitter concentrations and cognitive impairments other than self-reported impulsivity should be further investigated.

Delay discounting and impulsivity traits in young and older gambling disorder patients

BACKGROUND

Impulsivity is understood to be a multidimensional construct involving aspects such as impulsive choice and impulsive traits. Delay discounting, the tendency to place greater value in immediate rewards over larger, long-term rewards, has been associated with maladaptive choices in gambling disorder (GD). Delay discounting is known to evolve with age; though no study to date has evaluated the interactions between impulsivity, GD severity and age in treatment-seeking patients.

OBJECTIVES

We aimed to examine whether associations between delay discounting and impulsivity traits differed between younger and older-aged GD patients. Secondly, we sought to untangle the mediating role of impulsivity in determining gambling behavior in these two age groups.

METHODS

GD patients (N=335) were evaluated using the UPPS-P Impulsive Behavior Scale and a delay discounting task. Structural Equation Modeling (SEM) was used to explore associations between impulsivity measures and gambling severity in young (18-30years) and old (31-70) GD patients.

RESULTS

No differences in delay discounting were found between young and old GD patients. Significant correlations between delay discounting and urgency levels (the tendency to act rashly under emotional states) were identified only in the young GD group. Path analyses also revealed both positive and negative urgency to be a mediator of GD severity levels in young GD patients.

DISCUSSION AND CONCLUSIONS

Significant associations between impulsive choice and positive urgency are only present in young gamblers, suggesting that positive urgency influence choice behavior to a greater degree at younger ages. Implications for targeted interventions are discussed.

Impulsivity and Stress Response in Pathological Gamblers During the Trier Social Stress Test

Gambling has been associated with increased sympathetic nervous system output and stimulation of the hypothalamic–pituitary–adrenal axis. However it is unclear how these systems are affected in pathological gambling. This study aimed to investigate the effect of the Trier Social Stress Test (TSST) on cortisol and on cardiac interbeat intervals in relation to impulsivity, in a sample of male pathological gamblers compared to healthy controls. In addition, we investigated the correlation between the TSST, duration of the disorder and impulsivity. A total of 35 pathological gamblers and 30 healthy controls, ranging from 19 to 58 years old and all male, participated in this study. Stress response was measured during and after the TSST by salivary cortisol and cardiac interbeat intervals; impulsivity was assessed with the Barratt Impulsiveness Scale (BIS-11). Exposure to the TSST produced a significant increase in salivary cortisol and interbeat intervals in both groups, without differences between groups. We found a negative correlation between baseline cortisol and duration of pathological gambling indicating that the longer the duration of the disorder the lower the baseline cortisol levels. Additionally, we found a main effect of impulsivity across groups on interbeat interval during the TSST, indicating an association between impulsivity and the intensity of the neurovegetative stress response during the TSST. Involvement of the hypothalamic–pituitary–adrenal axis in pathological gambling was confirmed together with evidence of a correlation between length of the disorder and diminished baseline cortisol levels. Impulsivity emerged as a personality trait expressed by pathological gamblers; however the neurovegetative response to the TSST, although associated with impulsivity, appeared to be independent of the presence of pathological gambling.

Is gambling disorder associated with impulsivity traits measured by the UPPS-P and is this association moderated by sex and age?

OBJECTIVES

Impulsivity is a construct that is strongly associated with Gambling Disorder (GD). The main objectives in the present study are: 1) to explore the role of sex and age on impulsivity levels in GD patients; 2) to identify the relationship of the different impulsivity facets with comorbid psychopathology and other personality traits in GD patients; and (3) to assess whether impulsivity is a predictor for the severity of GD.

METHOD

The final sample consisted of 406 consecutive participants. All of them were seeking treatment for GD (88.4% male and 11.6% female) and completed the South Oaks Gambling Screen (SOGS), the UPPS-P Impulsive Behavior Scale, the Symptom Checklist (SCL-90-R), the Temperament and Character Inventory-R (TCI-R) as well as other clinical and psychopathological measures.

RESULTS

Results show a negative linear trend between age and lower sensation seeking levels as well as lack of premeditation (the higher the age the lower the UPPS-P scores), and a positive linear trend between age and positive urgency (UR) (the higher the age the higher the UPPS-P score). However, no sex differences were found for the assessed impulsivity dimensions. Lack of perseverance was positively associated with obsessive-compulsive symptoms and harm avoidance trait, and negatively related to persistence and self-directedness traits. Positive UR and negative UR were positively correlated with general psychopathology and the total number of DSM-IV criteria, and negatively associated to the following personality traits: self-directedness and cooperativeness. Finally, only the sensation seeking and negative UR of the UPPS-P showed predictive capacity on the severity of the disorder (the higher the impulsivity scores the higher the illness severity).

CONCLUSIONS

These findings highlight the association between impulsivity traits (measured by the UPPS-P) and GD in a large and consecutively recruited clinical sample with GD, taking into account the variables sex and age.

Impulsivity, alexithymia and dissociation among pathological gamblers in different therapeutic settings: A multisample comparison study

Since many psychopathological traits seem to be related to Gambling Disorder (GD), impulsivity, alexithymia and dissociation could play a central role in gambling behaviors, particularly in pathological gambling. We test this hypothesis in four distinct samples of gamblers, three undergoing different types of treatments and a control group. The study sample consists of 204 subjects (males 87.3%, mean age=47.75 years, SD=12.08) divided into four groups: (1) 59 subjects belonging to an Outpatients Treatment Program in the National Health System (NHS); (2) 60 subjects of an Outpatients Self-Help Group Program; (3) 35 subjects belonging to a Residential Treatment Program (Inpatients Program); and (4) 50 subjects without gambling problems (Control Group). Results show a positive relationship between gambling behaviors, impulsivity and alexithymia, and a negligible link between gambling behaviors and dissociation. Findings also display the presence of higher levels of all these features in pathological gamblers with higher scores on the SOGS, and particularly, in participants attending a Residential Treatment Program (Inpatients Program). This study confirms the hypothesis of the presence of higher levels of impulsivity, alexithymia and dissociation in pathological gamblers with a greater severity and seems to indicate a significant importance of impulsivity and alexithymia in predicting gambling behaviors.

Comparison of impulsivity in non-problem, at-risk and problem gamblers

As a non-substance addiction, gambling disorder represents the model for studying the neurobiology of addiction without toxic consequences of chronic drug use. From a neuropsychological perspective, impulsivity is deemed as a potential construct responsible in the onset and development of drug addiction. The objective of this study was to investigate the associations between impulsivity and gambling status in young adults with varying severity of gambling. A sample of 1120 college students, equally divided into non-problem, at-risk and problem gamblers, were administered multiple measures of impulsivity including the UPPSP Impulsive Behaviors Scale (UPPSP), the Barratt Impulsiveness Scale-11 (BIS-11), and the Delay-discounting Test (DDT). Compared with non-problem gamblers, both at-risk gamblers and problem gamblers displayed elevated scores on Negative Urgency, Positive Urgency, Motor Impulsiveness, and Attentional Impulsiveness. Problem gamblers showed higher scores than at-risk gamblers on Positive Urgency. Logistic regression models revealed that only Negative Urgency positively predicted both at-risk gambling and problem gambling compared to non-problem gambling. These results suggest that dimensions of impulsivity may be differentially linked to gambling behavior in young adults, with Negative Urgency putatively identified as an important impulsivity-related marker for the development of gambling disorder, which may provide a better understanding of the pathogenesis.

Working memory, executive function and impulsivity in Internet-addictive disorders: a comparison with pathological gambling

OBJECTIVE

The purpose of the present study was to test whether individuals with Internet addiction disorder (IAD) presented analogous characteristics of working memory, executive function and impulsivity compared with pathological gambling (PG) patients.

METHODS

The subjects included 23 individuals with IAD, 23 PG patients and 23 controls. All of the participants were measured with the digit span task, Wisconsin Card Sorting Test, go/no-go task and Barratt Impulsiveness Scale-11 (BIS-11) under the same experimental conditions.

RESULTS

The results of this study showed that the false alarm rate, total response errors, perseverative errors, failure to maintain set and BIS-11 scores of both the IAD and PG groups were significantly higher than that of the control group. In addition, the forward scores and backwards scores, percentage of conceptual level responses, number of categories completed and hit rate of the IAD and PG groups were significantly lower than that of the control group. Furthermore, the false alarm rate and BIS-11 scores of the IAD group were significantly higher than those of PG patients, and the hit rate was significantly lower than that of the PG patients.

CONCLUSIONS

Individuals with IAD and PG patients present deficiencies in working memory, executive dysfunction and impulsivity, and individuals with IAD are more impulsive than PG patients.

Serum BDNF levels in patients with gambling disorder are associated with the severity of gambling disorder and Iowa Gambling Task indices

Background and aims Gambling disorder (GD) shares many similarities with substance use disorders (SUDs) in clinical, neurobiological, and neurocognitive features, including decision-making. We evaluated the relationships among, GD, decision-making, and brain-derived neurotrophic factor (BDNF), as measured by serum BDNF levels. Methods Twenty-one male patients with GD and 21 healthy sex- and age-matched control subjects were evaluated for associations between serum BDNF levels and the Problem Gambling Severity Index (PGSI), as well as between serum BDNF levels and Iowa Gambling Task (IGT) indices. Results The mean serum BDNF levels were significantly increased in patients with GD compared to healthy controls. A significant correlation between serum BDNF levels and PGSI scores was found when controlling for age, depression, and duration of GD. A significant negative correlation was obtained between serum BDNF levels and IGT improvement scores. Discussion These findings support the hypothesis that serum BDNF levels constitute a dual biomarker for the neuroendocrine changes and the severity of GD in patients. Serum BDNF level may serve as an indicator of poor decision-making performance and learning processes in GD and help to identify the common physiological underpinnings between GD and SUDs.

Impulsivity and gambling: A complex clinical association across three measures

BACKGROUND AND OBJECTIVES

Gambling disorder (GD) is often characterized as an impulsive condition, but results to date have varied substantially by the measure used to assess impulsivity and the modality of the assessment. The purpose of this analysis was to assess the clinical associations between three measures of impulsivity (Eysenck impulsiveness questionnaire [EIQ], Barratt impulsiveness scale [BIS], and stop-signal task [SST]) and GD symptom severity.

METHODS

One hundred and fifty-four participants with a current GD diagnosis were assessed on at least one of the three measures of impulsivity and additional clinical measures of gambling severity. Groups within each domain of the measures were divided using a mean split to compare high and low impulsivity (HI and LI) across clinical and demographic variables.

RESULTS

Of the included domains, the motor impulsivity domain of the BIS showed multiple clinical differences between the HI and LI groups. The attentional impulsivity domain of the BIS showed limited clinical associations. Surprisingly, HI and LI groups from the SST and EIQ domains did not show any differences in symptom severity.

DISCUSSION AND CONCLUSIONS

These findings emphasize the complex nature of impulsivity, particularly as it relates to GD. With disparate results between different measures, it will be important to clarify the specific features assessed by each measure, and their optimal use clinically.

SCIENTIFIC SIGNIFICANCE

This analysis suggests that the motor impulsivity feature of the BIS shows the strongest clinical utility for predicting gambling severity. It also emphasizes the importance of sub-typing impulsivity, rather than considering it a single neurocognitive feature.

Abnormal brain activation in excoriation (skin-picking) disorder: evidence from an executive planning fMRI study

BACKGROUND

Excoriation (skin-picking) disorder (SPD) is a relatively common psychiatric condition whose neurobiological basis is unknown.

AIMS

To probe the function of fronto-striatal circuitry in SPD.

METHOD

Eighteen participants with SPD and 15 matched healthy controls undertook an executive planning task (Tower of London) during functional magnetic resonance imaging (fMRI). Activation during planning was compared between groups using region of interest and whole-brain permutation cluster approaches.

RESULTS

The SPD group exhibited significant functional underactivation in a cluster encompassing bilateral dorsal striatum (maximal in right caudate), bilateral anterior cingulate and right medial frontal regions. These abnormalities were, for the most part, outside the dorsal planning network typically activated by executive planning tasks.

CONCLUSIONS

Abnormalities of neural regions involved in habit formation, action monitoring and inhibition appear involved in the pathophysiology of SPD. Implications exist for understanding the basis of excessive grooming and the relationship of SPD with putative obsessive-compulsive spectrum disorders.

Variety of gambling activities from adolescence to age 30 and association with gambling problems: a 15-year longitudinal study of a general population sample

AIMS

To estimate trajectories of gambling variety from mid-adolescence to age 30 years, and compare the different trajectory groups with regard to the type and the frequency of gambling activities practiced and gambling-related problems.

DESIGN

Prospective longitudinal cohort study.

SETTING

Province of Quebec, Canada.

PARTICIPANTS

A mixed-gender general population cohort assessed at ages 15 (n=1882), 22 (n=1785) and 30 (n=1358).

MEASUREMENTS

Adolescent and adult versions of the South Oaks Gambling Screen (SOGS).

FINDINGS

Group-based trajectory analysis identified three distinct trajectories: a late-onset low trajectory (26.7% of sample) initiating gambling at age 22, an early-onset low trajectory (64.8% of sample), characterized by one to two different activities from age 15 onwards and a high trajectory (8.4% of sample), with an average of four to five different activities from age 15 to 30. Males (14.2%) were four times more likely to be on a high trajectory than females (3.5%) (P<0.001). Preferred types of gambling activities were similar across the three trajectories. Participants on a high trajectory reported higher gambling frequency at ages 15 and 30, and were more likely to experience problem gambling at age 30: 3.09 [95% confidence interval (CI)=1.66, 5.75] and 2.26 (95% CI=1.27, 4.04) times more, respectively, than late-onset low and early-onset low participants, even when socio-economic status (SES), frequency of gambling and problem gambling in adolescence, gender, age 30 education, SES and frequency of gambling were controlled.

CONCLUSIONS

Engaging in several different types of gambling in early adulthood appears to be a risk factor for emergence of problem gambling.

Personality traits of problem gamblers with and without alcohol dependence

INTRODUCTION

A large proportion of individuals with gambling disorder also present with a history of alcohol dependence, but few studies have directly examined the relationship between these two conditions. This study's primary and secondary aims were to 1) examine the relationship of personality traits to co-occurring lifetime (current/past) alcohol dependence status, while 2) accounting for differences in gambling characteristics and co-occurring psychiatric disorders among problem/pathological gamblers recruited from the community.

METHODS

Problem/pathological gamblers (N=150) completed measures of personality traits and gambling characteristics (e.g., gambling severity, gambling involvement, delayed discounting of monetary rewards), and were clinically interviewed for co-occurring psychiatric disorders.

RESULTS

A co-occurring lifetime diagnosis of alcohol dependence (n=61, 40.7%) was associated with lower personality scores for Control, Well-Being, Achievement, Traditionalism, and Harm Avoidance, as well as higher scores for Alienation (Tellegen & Waller, 1994) in bivariate analyses. Problem/pathological gamblers with lifetime alcohol dependence reported greater lifetime gambling severity, greater past-year gambling involvement, steeper delayed discounting, and a greater likelihood of current and lifetime substance dependence, lifetime antisocial personality disorder, and current unipolar mood disorders. Multivariate analyses indicated that lower Control, Traditionalism, and Well-Being and a co-occurring lifetime substance dependence diagnosis best accounted for a co-occurring lifetime alcohol dependence diagnosis in problem/pathological gamblers.

CONCLUSIONS

Problem/pathological gamblers with co-occurring lifetime alcohol dependence demonstrate addictive behavior across multiple domains and report a personality style characterized by hopelessness, impaired control, and resistance to externally-motivated treatment approaches. Implications for the treatment of these complex cases are discussed.