Sex differences in addictive disorders

Prefrontal activity during IOWA Gambling Task in young adult women

This study aims to investigate the relationships between personality traits of impulsivity, using the UPPS-P Impulsive Behaviour Scales shortened version, and prefrontal cortex (PFC) activity during the IOWA Gambling Task (IGT) in young adult women. The study included a sample of 83 young, healthy females (19.8 ± 1.4 years), who voluntarily took part in the study. Repeated measures analysis during the IGT revealed a significant increase in HbO (all p <.001; ηp2 >.31) and a decrease in Hbr (all p <.003; ηp2 >.08) in all prefrontal quadrants. This increase in oxygenation occurs primarily during the choice period under ambiguity (r =.23; p =.039). Additionally, there was a significant linear decrease in selecting the decks associated with a high frequency of losses (p <.001), while the favorable deck with low losses showed a linear increase (F = 12.96; p <.001). Notably, discrepancies were found between UPPS-P and IGT impulsivity ratings. The Lack of Perseverance and Lack of Premeditation scales from the UPPS-P were identified as significant predictors of HbO levels, mainly in the two quadrants of the left hemisphere's, lateral (adjusted R2 =.23; p <.001; f2 =.34) and rostral (adjusted R2 =.13; p <.002; f2 =.17). These findings suggest that young adult women predominantly adopt a punishment-avoidance strategy during IGT, exhibiting increased activation in the left hemisphere, especially during the task's initial phase characterized by ambiguity.

A gut (microbiome) feeling about addiction: Interactions with stress and social systems

In recent years, an increasing attention has given to the intricate and diverse connection of microorganisms residing in our gut and their impact on brain health and central nervous system disease. There has been a shift in mindset to understand that drug addiction is not merely a condition that affects the brain, it is now being recognized as a disorder that also involves external factors such as the intestinal microbiota, which could influence vulnerability and the development of addictive behaviors. Furthermore, stress and social interactions, which are closely linked to the intestinal microbiota, are powerful modulators of addiction. This review delves into the mechanisms through which the microbiota-stress-immune axis may shape drug addiction and social behaviors. This work integrates preclinical and clinical evidence that demonstrate the bidirectional communication between stress, social behaviors, substance use disorders and the gut microbiota, suggesting that gut microbes might modulate social stress having a significance in drug addiction.

Sensitivity to the initial rewarding effects of alcohol: Influence of age, sex, and β-endorphin

BACKGROUND

Alcohol use disorders (AUDs) are widespread, devastating and complex. About 20% of people who consume alcohol develop problem use, accounting for over 5% of worldwide deaths. While numerous animal models have facilitated understanding of the consequences of excessive drinking, translational models allow for experimental manipulation of factors thought to contribute to AUD liability.

METHODS

We employ a single-exposure conditioned place preference assay (SE-CPP) to investigate the influence of age, sex and the opioid peptide β-endorphin (bE) on the initial rewarding effects of ethanol, a strong predictor of AUDs. Adolescent (PND28-35) and adult (PND70-90) male and female, control C57BL/6J and bE-deficient mice were tested following a single injection of 1.5 g/kg of ethanol. Following the SE-CPP test, animals were deeply anesthetized, sacrificed, and perfused, and the brains were subsequently sectioned at 40 microns and processed for immunohistochemical localization of c-fos. One-sample, two-tailed t-tests were used to assess drug preference or aversion and the locomotor effects of alcohol.

RESULTS

In general, adults were more sensitive to the effects of alcohol than adolescents, and outcomes depended on sex and bE. For example, among females, adolescents were stimulated by the drug, but insensitive to locomotor effects as adults, while among males, adolescents were insensitive and adults sedated. Wild-type adolescents of both sexes failed to evince initial subjective reward from the drug, but bE-deficient adolescents, and all adult subjects, preferred a context once associated with ethanol over one that had been paired with saline. c-fos immunoreactivity in multiple brain regions was attenuated in bE-deficient animals, though influences of both sex and bE grew stronger with age.

CONCLUSIONS

This study demonstrates the utility of the SE-CPP paradigm for elucidating factors that contribute to the liability for AUDs, and supports the growing body of research that shows that sensitivity to the rewarding effects of alcohol changes during the course of development. Our results also suggest that developmental contributions are sex-dependent, and may also depend on the influence of endogenous opioid signaling.

Substance use patterns, quantities, and associated risk factors in women with polysubstance misuse

Polysubstance use (PSU), the use of two or more substances proximally, is highly prevalent and has amplified the risk for morbidity and mortality. However, PSU patterns and associated risk factors are not well characterized. This may be especially relevant to women who are known to be vulnerable to stress/trauma, craving, pain, and anxious and depressive symptoms as associated risk factors for PSU. A cross-sectional observational study was conducted to characterize substance use patterns in women who regularly used cocaine, opioids, marijuana, alcohol, benzodiazepines and/or nicotine and were being assessed for a placebo-controlled study of guanfacine treatment (n = 94; ages 19-65). Data on stress/traumatic life events, drug cravings for each substance, pain ratings, and anxiety and depressive symptoms were also obtained using standardized well-validated surveys. High use per day of two or more drugs was observed (72.7% ± 33.3%) and opioid amounts were high relative to other drug amounts (p's < 0.001). Notably, higher stress/trauma events and higher cravings are each associated with cumulative PSU days, amounts and probability of an individual PSU day (p's < 0.02). This remained when PSU versus single substance use was compared. Pain, anxiety and depressive symptoms were not associated with PSU metrics. These findings characterize specific patterns of PSU in women and show that average drug craving and stress/trauma events are associated with PSU. Interventions that focus on stress/trauma and craving management could be of benefit in reducing PSU risk in women.

Sex steroid hormones, the estrous cycle, and rapid modulation of glutamatergic synapse properties in the striatal brain regions with a focus on 17β-estradiol and the nucleus accumbens

The striatal brain regions encompassing the nucleus accumbens core (NAcc), shell (NAcs) and caudate-putamen (CPu) regulate cognitive functions including motivated behaviors, habit, learning, and sensorimotor action, among others. Sex steroid hormone sensitivity and sex differences have been documented in all of these functions in both normative and pathological contexts, including anxiety, depression and addiction. The neurotransmitter glutamate has been implicated in regulating these behaviors as well as striatal physiology, and there are likewise documented sex differences in glutamate action upon the striatal output neurons, the medium spiny neurons (MSNs). Here we review the available data regarding the role of steroid sex hormones such as 17β-estradiol (estradiol), progesterone, and testosterone in rapidly modulating MSN glutamatergic synapse properties, presented in the context of the estrous cycle as appropriate. Estradiol action upon glutamatergic synapse properties in female NAcc MSNs is most comprehensively discussed. In the female NAcc, MSNs exhibit development period-specific sex differences and estrous cycle variations in glutamatergic synapse properties as shown by multiple analyses, including that of miniature excitatory postsynaptic currents (mEPSCs). Estrous cycle-differences in NAcc MSN mEPSCs can be mimicked by acute exposure to estradiol or an ERα agonist. The available evidence, or lack thereof, is also discussed concerning estrogen action upon MSN glutamatergic synapse in the other striatal regions as well as the underexplored roles of progesterone and testosterone. We conclude that there is strong evidence regarding estradiol action upon glutamatergic synapse function in female NAcs MSNs and call for more research regarding other hormones and striatal regions.

Impulsivity and compulsivity in gambling disorder and bulimic spectrum eating disorders: Analysis of neuropsychological profiles and sex differences

BACKGROUND

Gambling disorder (GD) and bulimic spectrum eating disorders (BSDs) not only share numerous psychopathological, neurobiological, and comorbidity features but also are distinguished by the presence of inappropriate behaviours related to impulsivity and compulsivity. This study aimed to emphasise the differences and similarities in the main impulsivity and compulsivity features between GD and BSD patients, and to analyse the potential influence of sex in these domains.

METHODS

Using self-reported and neurocognitive measures, we assessed different impulsive-compulsive components in a sample of 218 female and male patients (59 with BSD and 159 with GD) and 150 healthy controls.

RESULTS

We observed that GD and BSDs exhibited elevated levels of impulsivity and compulsivity in all the dimensions compared to healthy controls. Moreover, these disorders showed differences in several personality traits, such as high novelty seeking in GD, and low persistence and high harm avoidance in BSDs. In addition, patients with BSDs also displayed a trend towards greater impulsive choice than GD patients. Regarding sex effects, GD women presented higher overall impulsivity and compulsivity than GD men. Nevertheless, no sex differences were found in BSDs.

CONCLUSIONS

Clinical interventions should consider these deficits to enhance their effectiveness, including adjunctive treatment to target these difficulties. Our findings also provide support to the relevance of sex in GD, which should also be considered in clinical interventions.

Depression mediates the relationship of experiential avoidance and internet addiction: a cross-lagged mediation analysis

Previous research has identified the contemporaneous association between experiential avoidance, depression, and Internet addiction. However, the mechanisms underlying this association are not well acknowledged. The present study aimed to use cross-lagged panel modeling to examine whether depression mediates the relation between experiential avoidance and Internet addiction and whether gender plays a role in the relation. A total of 2731 participants (934 male, Meanage=18.03) were recruited from a university at the baseline study (December 2019). Data was collected at all 3 time points across one year (2019?2020), using 6-month intervals. Experiential avoidance, depression and Internet addiction were assessed using the Acceptance and Action Questionnaire-II (AAQ-II), the Beck Depression Inventory-II (BDI-II) questionnaire, and Young?s Internet Addiction Test (IAT), respectively. Cross-lagged panel models were used to evaluate the longitudinal association and the mediating effect. Multigroup analyses were conducted to examine gender differences in the models.Cross-lagged models indicated that experiential avoidance significantly predicted subsequent depression, and depression significantly predicted subsequent Internet addiction. Furthermore, mediation analyses showed that depression has a mediating effect in the relation between experiential avoidance and Internet addiction (? = 0.010, 95%CI[0.003, 0.018], p>0.001). Multigroup analyses demonstrated that the pattern of structural relations stayed consistent across gender. The findings indicated that experiential avoidance is indirectly related to Internet addiction through depression, suggesting that treatments targeted at reducing experiential avoidance could help relieve depression and thus decrease the risk of Internet addiction.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12144-023-04511-6.

No association of the dopamine D2 receptor genetic bilocus score (rs1800497/rs1799732) on food addiction and food reinforcement in Chilean adults

Purpose: Different systems regulate food intake. In the reward system, dopamine (DA) is the main neurotransmitter, and a variety of genetic variants (rs1799732 and rs1800497) are associated with addiction. Addiction is a highly polygenic disease, where each allelic variant adds a small amount of vulnerability. Polymorphisms rs1799732 and rs1800497 are associated with eating behavior and hedonic hunger, but links to food addiction remain unclear.

Aim: To evaluate the association between the bilocus profile (rs1799732-rs1800497) of the dopaminergic pathway with food reinforcement and food addiction in Chilean adults.

Methods: A cross-sectional study recruited a convenience sample of 97 obese, 25 overweight, and 99 normal-weight adults (18–35 years). Anthropometric measurements were performed by standard procedures and eating behavior was assessed using the: Food Reinforcement Value Questionnaire (FRVQ) and Yale Food Addiction scale (YFAS). The DRD2 genotypes were determined by TaqMan assays (rs1800497 and rs1799732). A bilocus composite score was calculated.

Results: In the normal weight group, individuals who were heterozygous for the rs1977932 variant (G/del) showed higher body weight (p-value 0.01) and abdominal circumference (p-value 0.01) compared to those who were homozygous (G/G). When analyzing rs1800497, a significant difference in BMI was observed for the normal weight group (p-value 0.02) where heterozygous showed higher BMI. In the obese group, homozygous A1/A1 showed higher BMI in comparison to A1/A2 and A2/A2 (p-value 0.03). Also, a significant difference in food reinforcement was observed in the rs1800497, where homozygous for the variant (A1A1) show less reinforcement (p-value 0.01).In relation to the bilocus score in the total sample, 11% showed “very low dopaminergic signaling”, 24.4% were “under”, 49.7% showed “intermediate signaling”, 12.7% showed “high” and 1.4% showed “very high”. No significant genotypic differences were observed in food reinforcement and food addiction by bilocus score.

Conclusions: The results indicate that the genetic variants rs1799732 and rs1800497 (Taq1A) were associated with anthropometric measurements but not with food addiction or food reinforcement in Chilean university students. These results suggest that other genotypes, such as rs4680 and rs6277, which affect DA signaling capacity through a multilocus composite score, should be studied. Level V: Evidence obtained from a cross-sectional descriptive study.

ERα Stimulation Rapidly Modulates Excitatory Synapse Properties in Female Rat Nucleus Accumbens Core

INTRODUCTION

The nucleus accumbens core (NAcc) is a sexually differentiated brain region that is modulated by steroid hormones such as 17β-estradiol (estradiol), with consequential impacts on relevant motivated behaviors and disorders such as addiction, anxiety, and depression. NAcc estradiol levels naturally fluctuate, including during the estrous cycle in adult female rats, which is analogous to the menstrual cycle in adult humans. Across the estrous cycle, excitatory synapse properties of medium spiny neurons rapidly change, as indicated by analysis of miniature excitatory postsynaptic currents (mEPSCs). mEPSC frequency decreases during estrous cycle phases associated with high estradiol levels. This decrease in mEPSC frequency is mimicked by acute topical exposure to estradiol. The identity of the estrogen receptor (ER) underlying this estradiol action is unknown. Adult rat NAcc expresses three ERs, all extranuclear: membrane ERα, membrane ERβ, and GPER1.

METHODS

In this brief report, we take a first step toward addressing this challenge by testing whether activation of ERs via acute topical agonist application is sufficient for inducing changes in mEPSC properties recorded via whole-cell patch clamp.

RESULTS

An agonist of ERα induced large decreases in mEPSC frequency, while agonists of ERβ and GPER1 did not robustly modulate mEPSC properties.

CONCLUSIONS

These data provide evidence that activation of ERα is sufficient for inducing changes in mEPSC frequency and is a likely candidate underlying the estradiol-induced changes observed during the estrous cycle. Overall, these findings extend our understanding of the neuroendocrinology of the NAcc and implicate ERα as a primary target for future studies.

Is there such a thing as gambling dual disorder? Preliminary evidence and clinical profiles

Patients with gambling disorder (GD) frequently present other mental disorders, such as substance use disorder (SUDs), attention deficit/hyperactivity disorder (ADHD), mood disorders, and impulse-control disorders. We propose that GD should not be conceptualized as a single nosological entity, but rather as a gambling dual disorder (GDD). This study aims to provide further evidence of the co-occurrence of GD and other mental disorders in routine clinical practice and to identify different clinical profiles of severity. This descriptive, cross-sectional, and observational study included 116 patients with GD who were undergoing treatment in a specialized center. The MULTICAGE-CAD 4 and South Oaks gambling screen questionnaires confirmed the presence of GD in 97.4% and 100% of the patients, respectively. Other addictive behaviors such as compulsive spending, Internet, video games, or SUD (59.5%, 27.6%, 11.2%, and 13.8%, respectively) were also identified. The most used substances were tobacco (42.2%) and alcohol (5.2%). Half of the patients suffered from ADHD, 30.2% showed moderate or severe depression, and 17.2% suffered from a social anxiety problem. The majority (76.7%) also presented a phenotype with high impulsiveness. The cluster analysis identified two different clinical profiles of severity in patients with GDD. One profile showed higher severity of other mental disorders (ADHD, depression, anxiety, SUD, or insomnia), impulsivity, general psychopathological burden, and disability. In conclusion, our study provides further evidence on the co-occurrence of GD and other mental disorders supporting the GDD existence, shows impulsiveness as a vulnerability factor for GD, and identifies two clinical severity profiles.

Attitudes and beliefs of medical students on cannabis in Hong Kong

BACKGROUND

To assess Hong Kong medical students' knowledge, attitudes and beliefs on cannabis and its future legal reform.

METHODS

A cross-sectional anonymous online survey were sent from 1st December 2018 to 31st August 2020 to all medical students from the Li Ka Shing Faculty of Medicine, the University of Hong Kong (HKU).

RESULTS

187 students (13.6 %) responded the survey. Overall, students perceived cannabis possessed significant physical and mental health risks, but they were more neutral to its physical and mental benefits. They also supported legalizing cannabis more so for medical use than recreational use. Females perceived higher risks than males. Those who used cannabis before were more acceptable to recommend cannabis as medical treatments, perceived cannabis use with greater benefits and less risks, and were more likely to support legal reform for cannabis in Hong Kong than their counterparts. Students were also more likely to recommend medical cannabis than non-licensed cannabis to patients if they were legally available.

CONCLUSION

Medical students in Hong Kong supported legalization of cannabis for medical use despite perceiving significant risks from cannabis use. Future research should investigate public acceptance on medical cannabis in Hong Kong and other Asian countries.

The Protective Role of Resilience in the Development of Social Media Addiction in Tertiary Students and Psychometric Properties of the Slovenian Bergen Social Media Addiction Scale (BSMAS)

With the onset of the COVID-19 pandemic, social media became one of the most utilized sources of information relating to the disease. With the increased reliance on social media, the risk of excessive use and the development of social media addiction emerges. The aim of the present study was to explore the psychometric properties of the Slovenian version of the Bergen Social Media Addiction Scale, and to explore how psychological resilience affects social media addiction symptoms directly and indirectly through symptoms of depression, anxiety and mental distress. A large online cross-sectional study was conducted in March 2021 among Slovenian tertiary students (N = 4868). The results showed the high reliability, unidimensionality and criterion validity of the Slovenian Bergen Social Media Addiction Scale. The proposed structural model fit the data well and showed a significant direct positive effect of depression and stress on social media addiction. Moreover, the majority of the negative effects of psychological resilience on social media addiction (87.2%) were indirect, through depression and stress symptoms, whereas resilience had a significantly smaller impact on social media addiction by reducing anxiety symptoms. The overall prevalence of social media addiction symptoms was 4.6%, with females exhibiting higher proportions than men. Additionally, female social media users reported a complete absence of social media addiction symptoms less often compared to males. Future research should further explore the mechanisms behind social media addiction, in order to gain a better understanding of the apparently different risk levels for both genders.

The Modified Yale Food Addiction Scale May Be Simplified and Diagnostically Improved: The Same Prevalence but Different Severity and Risk Factors of Food Addiction among Female and Male Students

The Yale Food Addiction Scale (YFAS) is the most commonly used scale for measuring food addiction (FA). The previous approach to the YFAS and its subsequent versions assumed dichotomization of items, separating addiction symptoms and clinical significance items, and factorial validity testing on a subset of items. In this paper, we discuss the drawbacks associated with these procedures. In addition, we present a different analytical approach to investigate the validity of the modified YFAS (mYFAS) along with an alternative scoring method that overcomes limitations related to the previous approach. After establishing the structure of the mYFAS, we investigated the potential antecedents and consequences of FA separately for men and women. The sample consisted of 1182 Polish undergraduate students (613 women, 559 men, 10 missing values on gender) with a mean age of 20.33 years (SD = 1.68; range: 18–36). They were asked to complete self-report questionnaires measuring FA, personality traits (Big Five), self-esteem, narcissism, self-efficacy, social anxiety, loneliness, and well-being indicators. Due to the low content, factorial, and clinical validity, the first three items were excluded from the Polish version of the mYFAS. The six-item mYFAS demonstrated measurement invariance, allowing for meaningful comparisons between genders and yielded almost identical prevalence rates for men and women. The hierarchical multiple regression analysis showed that, narcissism, and social anxiety predicted FA in both genders, whereas important gender differences in antecedents were also noted. In addition, FA was associated with body mass index (BMI) and most of the well-being indicators, even after controlling for relevant variables. The findings suggest that our modified analytical approach allows researchers to measure FA using a valid, useful, and simple tool.

Effects of the Phenethylamine 2-Cl-4,5-MDMA and the Synthetic Cathinone 3,4-MDPHP in Adolescent Rats: Focus on Sex Differences

The illicit drug market of novel psychoactive substances (NPSs) is expanding, becoming an alarming threat due to increasing intoxication cases and insufficient (if any) knowledge of their effects. Phenethylamine 2-chloro-4,5-methylenedioxymethamphetamine (2-Cl-4,5-MDMA) and synthetic cathinone 3,4-methylenedioxy-α-pyrrolidinohexanophenone (3,4-MDPHP) are new, emerging NPSs suggested to be particularly dangerous. This study verified whether these two new drugs (i) possess abuse liability, (ii) alter plasma corticosterone levels, and (iii) interfere with dopaminergic transmission; male and female adolescent rats were included to evaluate potential sex differences in the drug-induced effects. Findings show that the two NPSs are not able to sustain reliable self-administration behavior in rats, with cumulatively earned injections of drugs being not significantly different from cumulatively earned injections of saline in control groups. Yet, at the end of the self-administration training, females (but not males) exhibited higher plasma corticosterone levels after chronic exposure to low levels of 3,4-MDPHP (but not of 2-Cl-4,5-MDMA). Finally, electrophysiological patch-clamp recordings in the rostral ventral tegmental area (rVTA) showed that both drugs are able to increase the firing rate of rVTA dopaminergic neurons in males but not in females, confirming the sex dimorphic effects of these two NPSs. Altogether, this study demonstrates that 3,4-MDPHP and 2-Cl-4,5-MDMA are unlikely to induce dependence in occasional users but can induce other effects at both central and peripheral levels that may significantly differ between males and females.

Sex differences in neural substrates of risk taking: Implications for sex-specific vulnerabilities to internet gaming disorder

BACKGROUND AND AIMS

Sex differences in internet gaming disorder (IGD) remain unknown. Investigating sex-specific neural features that underlie the core risk factor (i.e., risk-taking) of IGD would help in understanding sex-specific vulnerabilities to IGD and advance sex-specific treatments and prevention for IGD.

METHODS

111 participants (28 IGD males, 27 IGD females, 26 recreational game user (RGU) males, 30 RGU females) completed a probability discounting task during fMRI scanning.

RESULTS

First, among RGUs, males showed a higher risk-taking tendency and greater neural activation associated with risk/value evaluation for reward (the ventromedial prefrontal cortex (vmPFC), anterior cingulate cortex (ACC), left putamen) and smaller activation associated with cognitive control (the inferior frontal gyrus) than females during the contrast of risky-safe choices. Moreover, males showed a greater modulatory effect of risky choices on the connection from the vmPFC/ACC to the left putamen than females. Second, IGD males showed decreased activation in the vmPFC/ACC and left putamen compared to RGU males, whereas this decrease did not exist in IGD females.

DISCUSSION

Males show a higher risk-taking tendency than females. Altered neural substrates associated with risky decision-making exist in IGD males but not in IGD females.

CONCLUSIONS

The present findings fill the gap in information on the behavioral and neural substrates underlying IGD among females and demonstrate that a high risk-taking tendency is a risk factor and core symptom only in IGD males but not in IGD females. It is necessary to design and adopt distinct treatments and prevention strategies for IGD in males and females.

The estrous cycle and 17β-estradiol modulate the electrophysiological properties of rat nucleus accumbens core medium spiny neurons

The nucleus accumbens core is a key nexus within the mammalian brain for integrating the premotor and limbic systems and regulating important cognitive functions such as motivated behaviors. Nucleus accumbens core functions show sex differences and are sensitive to the presence of hormones such as 17β-estradiol (estradiol) in normal and pathological contexts. The primary neuron type of the nucleus accumbens core, the medium spiny neuron (MSN), exhibits sex differences in both intrinsic excitability and glutamatergic excitatory synapse electrophysiological properties. Here, we provide a review of recent literature showing how estradiol modulates rat nucleus accumbens core MSN electrophysiology within the context of the estrous cycle. We review the changes in MSN electrophysiological properties across the estrous cycle and how these changes can be mimicked in response to exogenous estradiol exposure. We discuss in detail recent findings regarding how acute estradiol exposure rapidly modulates excitatory synapse properties in nucleus accumbens core but not caudate-putamen MSNs, which mirror the natural changes seen across estrous cycle phases. These recent insights demonstrate the strong impact of sex-specific estradiol action upon nucleus accumbens core neuron electrophysiology.

Benefits, Risks and Gender Differences in Sport, and Exercise Dependence: Key Role of Alexithymia

The literature has long highlighted the benefits of sport, but too much sport could indicate a dependence without a substance, namely exercise dependence. The literature has only recently investigated this issue and therefore several questions are open, particularly with regard to psychopathological significance and gender differences. The aim of this paper is to investigate whether young subjects (M = 20 years) with a risk of exercise dependency and non-dependent symptomatic display other behavioural and psychological suffering and discomforts, or whether such an investment in physical activity is compatible with a framework of relative well-being; and if there are differences related to gender. A total of 396 subjects were involved in this study. Exercise Dependence Scale, Toronto Alexithymia Scale, Subjective Happiness Scale, Satisfaction with Life Scale and an ad hoc questionnaire with information relating to the consumption of alcohol, soft and hard drugs, quality of sleep and nutrition, affective and friendship relationships, hobbies, presence of psychological or physical disorders, motivations for sporting activity, and any traumatic experiences were used. With regard to the Exercise Dependence Scale (EDS), the prevalence of subjects at risk of exercise dependence was 1.5% and that of non-dependents symptomatic was 31.3%. Considering only men, the percentage of subjects at risk of exercise dependence rose to 3% and that of non-dependents symptomatic to 47.9%. Our data support the hypothesis that the risk of exercise dependence and the symptomatic condition without dependence can occur in situations of relative well-being (happiness, satisfaction, relationships) without significant associations with other problematic behaviours. Modest consumption of soft drugs is reported in non-dependent symptomatic subjects. The hypothesis of increased levels of alexithymia is confirmed but limited to the male gender. Gender differences are confirmed in the frequency and motivation to practice sport and in the risk of dependence. It is important that the assessment of addiction risk is integrated with the assessment of alexithymia and personal and social resources over time.

Motivational Factors Are Varying across Age Groups and Gender

The aim of the current study was to explore differences in passion for achievement, grit, and mindset across age and gender, by using a cross-sectional design. The sample consisted of 1548 participants including 931 females and 617 males aged from 13 to 77 years (Mage 26.53 years, SD = 11.77). The eight-item Passion for Achievement Scale was used to assess general passion and the Grit-S scale was used to assess grit. Mindset was assessed using the eight-item Theories of Intelligence Scale (TIS). The results indicated significant differences between the three factors related to age, age groups, and gender. For the total sample, there was a significant gender difference in passion, where males score higher, and growth mindset, where females score higher. With age, passion decreases until the age of 50–59, and slightly increases for the remaining age groups. After a decrease in grit between the first (13–19 years) and the second (20–29 years) age group, grit increases with age. Mindset scores decline strongly after the age of 40–49. Generally, the patterns show that mindset and passion decrease across the life-span, while grit increases. Indeed, these attributes seems to be different from each other, and how they change varies across age groups.

Relationship between sex hormones, reproductive stages and ADHD: a systematic review

OBJECTIVE

This systematic review aims to summarize current available evidence for the relationship between sex hormones or reproductive life stages (adrenarche in males and females, menarche, pregnancy, postpartum and menopause) and ADHD.

METHODS

We systematically reviewed studies investigating the relationship between sex hormones and symptoms of inattention and/or hyperactivity in individuals with an ADHD diagnosis or equivalent assessment of symptoms with validated scales. Articles were screened sequentially by two reviewers who were clinically and academically familiar with ADHD. Studies were rated according to Oxford Levels of Evidence (CEBM 2009).

RESULTS

Four studies matched inclusion criteria. One article was a case report of a female with ADHD and premenstrual syndrome experiencing worsening symptoms prior to each period (Quinn, J Clin Psychol 61:579-587, 2005). Another was a review article analysing literature relating to the effect of hormones on ADHD symptoms and supporting that a relationship exists between ADHD symptoms and sex hormone levels, without further characterization (Haimov-Kochman and Berger, Front Hum Neurosci 8, 2014). Giotakos and colleagues found no relationship between Wender Utah scores and sex hormone levels (Giotakos et al., J Forensic Psychiatry Psychol 16:423-433, 2005). An exploratory study by Ostojic and Miller found evidence for an association between early pubertal onset, inattention and risk-taking behaviour (Ostojic and Miller, J Atten Disord 20:782-791, 2016).

CONCLUSION

The literature on the relationship between sex hormones and ADHD is limited. Available studies present contradicting information. It is not known how this lack of evidence affects the treatment of ADHD during the lifespan. Further research is required to correctly characterize the mechanisms behind ADHD symptoms and its potential association with sex hormones.

Sex is a defining feature of neuroimaging phenotypes in major brain disorders

Sex is a biological variable that contributes to individual variability in brain structure and behavior. Neuroimaging studies of population-based samples have identified normative differences in brain structure between males and females, many of which are exacerbated in psychiatric and neurological conditions. Still, sex differences in MRI outcomes are understudied, particularly in clinical samples with known sex differences in disease risk, prevalence, and expression of clinical symptoms. Here we review the existing literature on sex differences in adult brain structure in normative samples and in 14 distinct psychiatric and neurological disorders. We discuss commonalities and sources of variance in study designs, analysis procedures, disease subtype effects, and the impact of these factors on MRI interpretation. Lastly, we identify key problems in the neuroimaging literature on sex differences and offer potential recommendations to address current barriers and optimize rigor and reproducibility. In particular, we emphasize the importance of large-scale neuroimaging initiatives such as the Enhancing NeuroImaging Genetics through Meta-Analyses consortium, the UK Biobank, Human Connectome Project, and others to provide unprecedented power to evaluate sex-specific phenotypes in major brain diseases.

Clustering Treatment Outcomes in Women with Gambling Disorder

The rising prevalence of gambling disorder (GD) among women has awakened considerable interest in the study of therapeutic outcomes in females. This study aimed to explore profiles of women seeking treatment for GD based on a set of indicators including sociodemographic features, personality traits, clinical state at baseline, and cognitive behavioral therapy (CBT) outcomes. Two-step clustering, an agglomerative hierarchical classification system, was applied to a sample of n = 163 women of ages ranging from 20 to 73 years-old, consecutively attended to by a clinical unit specialized in the treatment of G. Three mutually exclusive clusters were identified. Cluster C1 (n = 67, 41.1%) included the highest proportion of married, occupationally active patients within the highest social status index. This cluster was characterized by medium GD severity levels, the best psychopathological functioning, and the highest mean in the self-directedness trait. C1 registered 0% dropouts and only 14.9% relapse. Cluster C2 (n = 63; 38.7%) was characterized by the lowest GD severity, medium scores for psychopathological measures and a high risk of dropout during CBT. Cluster C3 (n = 33; 20.2%) registered the highest GD severity, the worst psychopathological state, the lowest self-directedness level and the highest harm-avoidance level, as well as the highest risk of relapse. These results provide new evidence regarding the heterogeneity of women diagnosed with GD and treated with CBT, based on the profile at pre- and post-treatment. Person-centered treatments should include specific strategies aimed at increasing self-esteem, emotional regulation capacities and self-control of GD women.

Sex Differences and Exogenous Estrogen Influence Learning and Brain Responses to Prediction Errors

Animal studies show marked sex differences as well as effects of estrogen (E2) in the mesocorticolimbic dopaminergic (DA) pathways, which play a critical role in reward processing and reinforcement learning and are also implicated in drug addiction. In this computational pharmacological fMRI study, we investigate the effects of both factors, sex and estrogen, on reinforcement learning and the dopaminergic system in humans; 67 male and 64 naturally cycling female volunteers, the latter in their low-hormone phase, were randomly assigned, double-blind, to take E2 or placebo. They completed a reinforcement learning task in the MRI scanner for which we have previously shown reward prediction error (RPE)-related activity to be dopaminergic. We found RPE-related brain activity to be enhanced in women compared with men and to a greater extent when E2 levels were elevated in both sexes. However, both factors, female sex and E2, slowed adaptation to RPEs (smaller learning rate). This discrepancy of larger RPE-related activity yet smaller learning rates can be explained by organizational sex differences and activational effects of circulating E2, which both affect DA release differently to DA receptor binding capacities.

Comparing axon regeneration in male and female mice after peripheral nerve injury

Axons in the adult mammalian central nervous system fail to regenerate after injury. By contrast, spontaneous axon regeneration occurs in the peripheral nervous system (PNS) due to a supportive PNS environment and an increase in the intrinsic growth potential induced by injury via cooperative activation of multifaceted biological pathways. This study compared axon regeneration and injury responses in C57BL/6 male and female mice after sciatic nerve crush (SNC) injury. The extent of axon regeneration in vivo was indistinguishable in male and female mice when observed at 3 days after SNC injury, and primary dorsal root ganglion (DRG) neurons from injured, male and female mice extended axons to a similar length. Moreover, the induction of selected regeneration-associated genes (RAGs), such as Atf3, Sprr1a, Gap43, Sox11, Jun, Gadd45a, and Smad1 were comparable in male and female DRGs when assessed by quantitative real-time reverse transcription polymerase chain reaction. Furthermore, the RNA-seq analysis of male and female DRGs revealed that differentially expressed genes (DEGs) in SNC groups compared to sham-operated groups included many common genes associated with neurite outgrowth. However, we also found that a large number of genes in the DEGs were sex dependent, implicating the involvement of distinct gene regulatory network in the two sexes following peripheral nerve injury. In conclusion, we found that male and female mice mounted a comparable axon regeneration response and many RAGs were commonly induced in response to SNC. However, given that many DEGs were sex-dependently expressed, future studies are needed to investigate whether they contribute to peripheral axon regeneration, and if so, to what extent.

Doctor shopping among chronic noncancer pain patients treated with opioids in the province of Quebec (Canada): incidence, risk factors, and association with the occurrence of opioid overdoses

Opioid doctor shopping was a rare phenomenon among people living with chronic noncancer pain but was associated with the occurrence of opioid overdoses.

Introduction:

Prescription opioids continue to be involved in the opioid crisis, and a better understanding of factors associated with problematic opioid use is needed.

Objectives:

The aim of this study was to assess the incidence of opioid doctor shopping, a proxy for problematic opioid use, to identify associated risk factors, and to assess its association with the occurrence of opioid overdoses.

Methods:

This was a retrospective cohort study of people living with chronic noncancer pain (CNCP) and treated with opioids for at least 6 months between 2006 and 2017 in the province of Quebec (Canada). Data were drawn from the Quebec health administrative databases. Doctor shopping was defined as overlapping prescriptions written by ≥ 2 prescribers and filled in ≥3 pharmacies.

Results:

A total of 8,398 persons with CNCP were included. The median age was 68.0 (Q1: 54; Q3: 82) years, and 37.1% were male. The 1-year incidence of opioid doctor shopping was 7.8%, 95% confidence interval (CI): 7.2–8.5. Doctor shopping was associated with younger age (hazard ratio [HR] 18–44 vs ≥65 years: 2.22, 95% CI: 1.77–2.79; HR 45–64 vs ≥65 years: 1.34, 95% CI: 1.11–1.63), male sex (HR = 1.20, 95% CI: 1.01–1.43), history of substance use disorder (HR = 1.32, 95% CI: 1.01–1.72), and anxiety (HR = 1.41, 95% CI: 1.13–1.77). People who exhibited doctor shopping were 5 times more likely to experience opioid overdoses (HR = 5.25, 95% CI: 1.44–19.13).

Conclusion:

Opioid doctor shopping is a marginal phenomenon among people with CNCP, but which is associated with the occurrence of opioid overdoses. Better monitoring of persons at high risk to develop doctor shopping could help prevent opioid overdoses.

Subpopulations of Addictive Behaviors in Different Sample Types and Their Relationships with Gender, Personality, and Well-Being: Latent Profile vs. Latent Class Analysis

BACKGROUND

Relatively strong theoretical assumptions and previous studies concerning co-occurring addictive behaviors suggest a subpopulation representing general proclivity to behavioral addictions (BAs), and there are gender-specific subpopulations. This study aimed to compare latent profile analysis (LPA) and latent class analysis (LCA) as the methods of investigating different clusters of BAs in the general student population and among students positively screened for at least one BA. Participants and procedure: Analyses of six BAs (study, shopping, gaming, Facebook, pornography, and food) and their potential antecedents (personality) and consequences (well-being) were conducted on a full sample of Polish undergraduate students (N = 1182) and a subsample (n = 327) of students including individuals fulfilling cutoff for at least one BA.

RESULTS

LPA on the subsample mostly replicated the previous four profiles found in the full sample. However, LCA on a full sample did not replicate previous findings using LPA and showed only two classes: those with relatively high probabilities on all BAs and low probabilities. LCA on the subsample conflated profiles identified with LPA and classes found with LCA in the full sample.

CONCLUSIONS

LCA on dichotomized scores (screened positively vs. negatively) were less effective in identifying clear patterns of interrelationships between BAs based on relatively strong theoretical assumptions and found in previous research. BAs can be investigated on the whole spectrum of behavior, and person-centered analyses might be more useful when they are based on continuous scores. This paper provides more detailed analyses of the four basic clusters of BAs, prevalence, and co-occurrence of particular BAs within and between them, their gender and personality risk factors, relationships to well-being, and their interrelationships as emerging from the results of this and previous studies.

Profiles of potential behavioral addictions' severity and their associations with gender, personality, and well-being: A person-centered approach

BACKGROUND

Addictions share common etiological factors associated with personality vulnerabilities such as narcissism or emotional instability. Also, there are gender differences in the type of and risk for addiction (e.g., men may be more prone to addictions, overall). These are considerably less understood in relation to behavioral addictions (BAs) than in substance use disorders. This study aimed to investigate associations between profiles of six potential BAs (study, shopping, gaming, Facebook, pornography, and food) and gender, personality, and well-being among Polish emerging adults, as a partial replication and extension of previous work.

PARTICIPANTS AND PROCEDURE

In a paper-and-pencil cross-sectional study, 1182 Polish undergraduate students (mean age = 20.33 years; SD = 1.68) completed questionnaires measuring six potential BAs alongside questions on demographic variables, personality traits (Big Five, narcissism), and well-being indicators (general quality of life, health quality, sleep quality, perceived stress, anxiety, and hopelessness).

RESULTS

Using latent profile analysis, four profiles were identified: (1) elevated levels of study, Facebook, shopping, and food addictions; (2) elevated levels of gaming and pornography addictions; (3) low or average levels of all potential BAs, and (4) highest levels of all potential BAs. The second and fourth profiles included men predominantly, and the first profile included almost exclusively women. The fourth profile, in comparison to all other profiles, demonstrated significantly higher scores on all potential BAs, narcissism, lowest conscientiousness and emotional stability, and lowest well-being.

CONCLUSIONS

The results suggest that there is a general proclivity to potential BAs. Furthermore, there are gender-specific profiles of potential BAs, which at present are poorly understood.

Measurement of shopping addiction and its relationship with personality traits and well-being among Polish undergraduate students

There is still a scarcity of studies showing the relative contribution of different personality characteristics differentiating various behavioral addictions within an integrated model. In comparison to other addictions, fairly little is known about the role of specific personality traits in compulsive shopping. In addition, few studies have investigated the unique contribution of shopping addiction in terms of explaining different facets of well-being above and beyond personality characteristics previously shown to be related to psychosocial functioning. The present study shows validation of the Bergen Shopping Addiction Scale (BSAS) and a tentative integrated model of potential shopping addiction personality risk factors. BSAS was administered to 1156 Polish students. In addition, demographic variables, and personality traits (Big Five), self-esteem, self-efficacy, perceived narcissism, loneliness, social anxiety, and well-being indicators were measured. BSAS had acceptable fit with the data and demonstrated good reliability. The investigated model showed that shopping addiction was related to higher extraversion, perceived narcissism, and social anxiety, and lower agreeableness and general self-efficacy. Woman and older participants scored higher on BSAS. Shopping addiction was further related to all facets of impaired well-being and explained worse general health, and decreased sleep quality above and beyond other variables in the model. The results support the notion that shopping addiction may have specific personality risk factors with low agreeableness as an outstanding characteristic. This has implications for the development of early prevention and intervention programs.

Food addiction comorbid to mental disorders: A nationwide survey and register-based study

OBJECTIVE

Substance use disorder is highly prevalent among individuals with mental disorders. However, it remains largely unknown whether this is also the case for "food addiction"-a phenotype characterized by an addiction-like attraction to predominantly highly processed foods with a high content of refined carbohydrates and fat. Therefore, the primary aim of this study was to estimate the weighted prevalence of food addiction among individuals with mental disorders.

METHOD

A total of 5,000 individuals aged 18-62 were randomly drawn from eight categories of major mental disorders from the Danish Psychiatric Central Research Register and invited to participate in an online questionnaire-based survey, which included the Yale Food Addiction Scale 2.0. Data on health care and sociodemographics from the Danish registers were linked to all invitees-enabling comprehensive attrition analysis and calculation of the weighted prevalence of food addiction.

RESULTS

A total of 1,394 (27.9%) invitees participated in the survey. Across all diagnostic categories, 23.7% met the criteria for food addiction. The weighted prevalence of food addiction was highest among individuals with eating disorders (47.7%, 95%CI: 41.2-54.2), followed by affective disorders (29.4%, 95%CI: 22.9-36.0) and personality disorders (29.0%, 95%CI: 22.2-35.9). When stratifying on sex, the prevalence of food addiction was higher among women in most diagnostic categories.

DISCUSSION

Food addiction is highly prevalent among individuals with mental disorders, especially in those with eating disorders, affective disorders and personality disorders. Food addiction may be an important target for efforts aimed at reducing obesity among individuals with mental disorders.

The Mediating Role of Impulsivity and the Moderating Role of Gender Between Fear of Missing Out and Gaming Disorder Among a Sample of Chinese University Students

The role of fear of missing out (FoMO) in addictive behaviors has recently attracted growing attention. In view of negative effects of gaming disorder (GD) among adolescents and emerging adults, research examining the relationship between FoMO and GD is needed, alongside the roles of impulsivity and gender in the relationship between FoMO and GD. This study examined whether impulsivity as a mediator and gender as a moderator impacted on the relationship between FoMO and GD among a sample of Chinese university students. A sample of 1,288 Chinese university students from three universities completed an online survey through the Wenjuanxing platform. The Chinese Trait-State Fear of Missing Out Scale, the Barratt Impulsiveness Scale-Brief, and the Chinese Gaming Disorder Scale were used in this study. The model results indicated that impulsivity partially mediated the relationship between FoMO and GD, and that there was a larger effect size between impulsivity and GD among males. High levels of FoMO among individuals may impact on executive functions leading to more impulsivity, and are associated with GD. Gender may moderate the relationship between impulsivity and GD. This study deepens the understanding of the relationship between FoMO and GD, and provides new perspectives for practitioners to incorporate into health prevention programs to help regulate emotion, control impulsivity, and decrease GD.

Gender and gambling disorder: Differences in compulsivity-related neurocognitive domains

BACKGROUND AND AIMS

It has been suggested that compulsivity has an essential role in gambling disorder (GD), yet there is a lack of literature exploring the link between GD, compulsivity and gender. Our main aim was to explore gender differences between two of the neurocognitive domains of compulsivity (attentional set-shifting and attentional bias and disengagement) in patients with GD and compare them with healthy controls (HCs).

METHODS

The sample included 57 treatment-seeking adults with GD and 60 HCs recruited from the general population.

RESULTS

The pairwise comparisons showed a worse attentional set-shifting performance in women with GD than in men (total trials (p = 0.042, |d| = 0.56), perseverative responses (p = 0.001, |d| = 0.89), trails to complete the first category (p = 0.001, |d| = 0.78) and categories completed (p = 0.001, |d| = 0.98. Also, men with GD presented higher difficulties than HC men in the two assessed compulsivity domains (attentional bias and disengagement and attentional set-shifting; Stroop interference (p = 0.015, |d| = 0.11), TMT-B (p = 0.041, |d| = 1.96) and lower scores for the WCST perseverative responses (p = 0.007, |d| = 0.78), whereas the differences observed in women with GD and HCs were most significantly in attentional set-shifting.

CONCLUSIONS

This study provides the first evidence of gender compulsivity differences in GD. The results are relevant for improving current treatments by targeting specific compulsivity domains that can lead to more successful treatment options.

Sex differences in prevalence, risk factors and clinical correlates of internet addiction among chinese college students

BACKGROUND

Internet addiction(IA) is now very common. However, few studies have explored the sex differences in risk factors for IA, especially among Chinese college students. This study aimed to investigate the sex differences in prevalence, risk factors and clinical correlates of IA among Chinese college students.

METHODS

A total of 8098 college students from Hunan province were recruited using a cross-sectional design and a convenience sampling method. Each student filled out the survey online anonymously, which collected their information on their socio-demographics, internet addiction(Revised Chinese internet addiction scale;CIAS-R), ADHD(Wender Utah Rating Scale and World Health Organization (WHO) Adult ADHD Self-Report Scale v 1.1 Symptom Checklist), depression(Self-reporting Depression Scale;SDS), insomnia(Athens Insomnia Scale;AIS), anxiety(Self-Rating Anxiety Scale;SAS) and suicidal behaviors through WeChat.

RESULTS

Overall, the prevalence of IA in males and females was 7.21%(259/3592) and 8.17%(368/4506), respectively. Multivariate logistic regression analysis revealed that suicidal ideation[odds ratio (OR),1.557;95% confidence interval (CI),1.083-2.240], suicide attempts(OR,2.081;95%CI:1.271-3.409), ADHD(OR,6.487;95%CI,4.697-8.959) and insomnia(OR,2.596;95%CI,1.910-3.529) were independent risk factors for male IA after controlling for confounding variables. Nationality(OR,1.507;95%CI,1.058-2.145), suicidal ideation(OR,2.012;95%CI,1.532-2.641), depression(OR,1.771;95%CI:1.071-2.930), ADHD(OR,4.497; 95%CI,3.285-6.158) and insomnia(OR,2.356;95%CI,1.813-3.061) were independent risk factors for female IA.

LIMITATION

No causal relationships could be drawn due to the cross-sectional design.

CONCLUSIONS

This study shows IA is common among both sexes. IA is significantly associated with ADHD, insomnia and suicidal behaviors in both male and female students, indicating the importance of screening IA and addressing ADHD, insomnia and suicidal behaviors to improve the mental health of college students and better prevent suicide in both sexes.

Associations Between Internet Addiction and Gender, Anxiety, Coping Styles and Acceptance in University Freshmen in South China

Objective: Internet addiction (IA) has become a global public health issue. Although previous studies revealed several risk factors related to IA, most of them focused on the western societies. The present study assesses the relationships between gender and other factors with IA in university freshmen in the South China. Methods: A total of 3,380 first-year college students (1,995 males and 1,385 females) participated in an evaluation of their experiences surfing on the Internet. We investigated the severity of IA in the participants by considering their psychological characteristics, such as acceptance, anxiety levels, and coping styles. Then, we compared the results between males and females and between those in addiction group (Chinese Internet Addiction Scale, CIAS, scores≥64) and non-addiction group (CIAS scores ≤27). We also conducted a logistic regression analysis to detect the relationships between severity of IA and psychological characteristics and gender differences. Results: We observed that males showed significantly higher scores in CIAS than females. The addiction group exhibited significantly higher state anxiety and trait anxiety, and experienced less acceptance of self and others and acceptance by others, and adopted less positive coping style and preferred negative coping style than non-addiction group. The logistic regression analysis revealed that three factors (negative coping styles, acceptance of self and others, state anxiety levels) had a significant association with more severe IA. Conclusion: Gender differences affect the severity of IA in the first-year students in South China. Males with state anxiety and negative coping styles deserve attention because they are likely to be addicted to the Internet. Thus, health practitioners should perform efficient strategies while considering gender differences to precaution first-year college students with the risk factors for IA.

Gaming Disorder and Well-Being Among Emirati College Women

Background: The present study examined Internet Gaming Disorder (IGD) and depressive symptom levels among a predominantly female sample of college students from the United Arab Emirates (UAE). Methods: IGD was assessed among two successive cohorts of students at the beginning of the academic year in 2016 and 2019, respectively. All participants (n = 412) completed the Internet Gaming Disorder Scale - Short-Form (IGDS9-SF) and the WHO-5 Well-being Index (WHO-5), a tool widely used for the screening and assessment of depressive symptomatology. Results: Mean IGDS9-SF scores (15.85, SD = 6.40) were fairly similar to those observed in other nations. The prevalence of IGD was 1.45%, based on the stringent cut-off score (> = 40). Prevalence of IGD rose to 18.20% when using the less stringent cut-off (> = 21). There was an increase in the rate of IGD between 2016 and 2019, although not statistically significant. Higher IGDS9-SF scores were associated with greater depressive symptomatology; those scoring above the less stringent IGD cut-off had a greater likelihood of screening positive for depression OR = 2.28, 95% CI (1.176-4.428). Conclusions: This study provides insights about IGD among a predominantly female Arab population, finding a correlation with mood disorder symptomatology and suggesting an increase in problematic gaming over time. The results are discussed with reference to the mood repair hypothesis and the possibility of IGD being a dual disorder. The association with depressive symptoms is also discussed in light of the neurobiology of addictive behaviors and sexual dimorphism.

Exercise Addiction and Satisfaction of Fitness Center Users as Precursors to the Intention of Continuing to Engage in Physical Activity

Exercise addiction occurs when a person engages in excessive physical activity until they lose control. Among individuals attending fitness centers, the risk of developing exercise addiction has been estimated to be close to 10%. The objective of this study was to determine whether exercise addiction may be an antecedent of satisfaction with the service received and/or of the intention of continuing to partake in leisure-time physical activity at fitness centers in a direct or indirect manner. A total of 361 individuals (29.05 ± 11.40 years old) who were physically active at Spanish fitness centers were asked to respond to a questionnaire on exercise addiction, satisfaction with the sports service, and their intention to continue to engage in physical activity. A multi-group analysis was conducted to check for differences in relationships by sex. The results show the relationships between addiction, satisfaction, and intention to continue physical activity. The standardized values display differences between men and women, with women exhibiting the highest values for the relationships between addiction and the rest of the constructs. Satisfaction with the sports service is a mediator in the relationship between exercise addiction and intention to engage in leisure-time physical activity.

Contribution of sex on the underlying mechanism of the gambling disorder severity

Significant increasing prevalences have been observed in gambling disorder (GD) in the last decades. This study analyzed the underlying mechanisms of the gambling severity with path analysis (implemented through Structural Equation Modeling, SEM), and assessed the potential moderator effect of the patients’ sex. A sample of n = 512 treatment-seeking patients was assessed for sociodemographics and clinical state previously to the treatment. Results obtained in two separate SEM (for men and women) revealed differences in the direct effects and the mediational links. Among the male subsample, higher GD severity was directly related to the higher cognitive bias and the younger age of onset of the problematic gambling, while impulsivity levels and age of onset achieved an indirect effect on the disordered gambling mediated by the cognitive bias. Among females, GD severity was directly increased by younger age of onset, higher cognitive bias and lower self-directedness, while lower socioeconomic positions, and higher levels in harm avoidance achieved an indirect effect on the gambling severity mediated also by the distortions related to the gambling activity. These results provide new empirical evidence for a better understanding of the GD etiology, suggesting that the underlying complex links mediating the GD severity are strongly related to the patients’ sex. The results can also contribute to design more effectiveness and precise therapy programs of patient-centered care.

Network Analysis of Internet Addiction Symptoms Among a Clinical Sample of Japanese Adolescents with Autism Spectrum Disorder

In the present study, we employed network analysis that conceptualizes internet addiction (IA) as a complex network of mutually influencing symptoms in 108 adolescents with autism spectrum disorder (ASD) to examine the network architecture of IA symptoms and identify central/influential symptoms. Our analysis revealed that defensive and secretive behaviors and concealment of internet use were identified as central symptoms in this population, suggesting that mitigating these symptoms potentially prevent the development and/or maintenance of IA in adolescents with ASD. Providing adolescents and their caregivers with psychoeducation on the role of central symptoms above in IA can be a salient intervention. Doing so may facilitate nonconflicting conversations between them about adolescents' internet use and promote more healthy adolescents' internet use behavior.

Sex differences in the human reward system: convergent behavioral, autonomic and neural evidence

Several studies have suggested that females and males differ in reward behaviors and their underlying neural circuitry. Whether human sex differences extend across neural and behavioral levels for both rewards and punishments remains unclear. We studied a community sample of 221 young women and men who performed a monetary incentive task known to engage the mesoaccumbal pathway and salience network. Both stimulus salience (behavioral relevance) and valence (win vs loss) varied during the task. In response to high- vs low-salience stimuli presented during the monetary incentive task, men showed greater subjective arousal ratings, behavioral accuracy and skin conductance responses (P < 0.006, Hedges' effect size g = 0.38 to 0.46). In a subsample studied with functional magnetic resonance imaging (n = 44), men exhibited greater responsiveness to stimulus salience in the nucleus accumbens, midbrain, anterior insula and dorsal anterior cingulate cortex (P < 0.02, g = 0.86 to 1.7). Behavioral, autonomic and neural sensitivity to the valence of stimuli did not differ by sex, indicating that responses to rewards vs punishments were similar in women and men. These results reveal novel and robust sex differences in reward- and punishment-related traits, behavior, autonomic activity and neural responses. These convergent results suggest a neurobehavioral basis for sexual dimorphism observed in the reward system, including reward-related disorders.

The relationship of smartphone addiction with psychological distress and neuroticism among university medical students

Background

Smartphone plays a vital role in higher education as it serves as a device with multiple functions. Smartphone addiction was reported on the rise among college and university students. The addiction may result in unwanted consequences on their academic performance and psychological health. One factor that consistently relates to psychological distress and smartphone addiction is the neurotic personality trait. This study explored the relationship of smartphone addiction with psychological health and neuroticism among USM medical students.

Methods

A cross-sectional study was carried out on medical students in a public medical school. DASS-21, the neuroticism-subscale of USMaP-i and SAS-SV were administered to measure psychological distress, neuroticism, and smartphone addiction of the medical students. Spearman correlation was performed to examine the correlation between smartphone addiction with psychological distress and neuroticism. Simple linear regression was performed to investigate relationship factors of smartphone addiction.

Results

A total of 574 medical students participated in this study. The prevalence of smartphone addiction was 40.6%. It was higher among male (49.2%) compared to female (36.6%) medical students. The result showed a fair positive correlation between smartphone addiction and psychological health (rdepression = 0.277, p-value < 0.001; ranxiety = 0.312, p-value < 0.001; rstress = 0.329, p-value < 0.001). However, there was a poor positive correlation between smartphone addiction and neuroticism (r = 0.173, p-value < 0.001). The simple linear regression showed a significant increase in the levels of depression, anxiety, stress and neuroticism upon one unit increase in smartphone addiction (bdepression = 0.101, p-value < 0.001; banxiety = 0.120, p-value < 0.001; bstress = 0.132, p-value < 0.001; bneuroticism = 0.404, p-value < 0.05). These results indicated significant relationships between smartphone addiction, psychological health and neuroticism.

Conclusion

This study suggested a high prevalence of smartphone addiction among medical students, particularly in male medical students. The smartphone addiction might lead to psychological problems and the most vulnerable group is the medical student with the neurotic personality trait.

Intergenerational Transmissions of Mother-Adolescent Smartphone Dependency: The Mediating Role of Negative Parenting and the Moderating Role of Gender

Given the prevalence and undesirable consequences of smartphone dependency among adolescents, it is necessary to explore the influencing factors of adolescent smartphone dependency. The aim of this study was to examine the intergenerational transmission of mother–adolescent smartphone dependency and the mediating role of negative parenting, moderated by adolescent gender. Data for 2541 middle school students (mean aged = 13 years)–mother dyads were obtained from the first wave of the Korean Children and Youth Panel Survey 2018 (KCYPS 2018). The moderated mediation model using Hayes PROCESS macro (Model 14) was employed to test the study hypothesis. The moderated mediation model revealed that maternal smartphone dependency was associated with adolescent smartphone dependency. Perceived negative parenting mediated this link and adolescent gender moderated the relationship between negative parenting and adolescent smartphone dependency, especially for adolescent girls. Our findings showed that both maternal smartphone dependency and negative parenting were determinants of adolescent smartphone dependency, suggesting that both factors were important for understanding these issues. Moreover, the mediating role of negative parenting (between maternal and adolescent smartphone dependency) implies that parental education programs designed to improve negative parenting may reduce adolescent smartphone dependency, especially for adolescent girls.

Sex-Specific Transcriptome Differences in Human Adipose Mesenchymal Stem Cells

In humans, sexual dimorphism can manifest in many ways and it is widely studied in several knowledge fields. It is increasing the evidence that also cells differ according to sex, a correlation still little studied and poorly considered when cells are used in scientific research. Specifically, our interest is on the sex-related dimorphism on the human mesenchymal stem cells (hMSCs) transcriptome. A systematic meta-analysis of hMSC microarrays was performed by using the Transcriptome Mapper (TRAM) software. This bioinformatic tool was used to integrate and normalize datasets from multiple sources and allowed us to highlight chromosomal segments and genes differently expressed in hMSCs derived from adipose tissue (hADSCs) of male and female donors. Chromosomal segments and differentially expressed genes in male and female hADSCs resulted to be related to several processes as inflammation, adipogenic and neurogenic differentiation and cell communication. Obtained results lead us to hypothesize that the donor sex of hADSCs is a variable influencing a wide range of stem cell biologic processes. We believe that it should be considered in biologic research and stem cell therapy.

Cannabis Use as a Risk Factor for Depression, Anxiety, and Suicidality: Epidemiological Associations and Implications for Nurses

Psychiatric disorders and substance use disorders commonly co-occur and are major public health concerns given the morbidity and mortality associated with them. Globally, cannabis is among the most commonly used drugs, and cannabis use frequently begins in adolescence or emerging adulthood, both important periods of development and periods in which psychiatric symptoms and disorders frequently emerge. Thus, the relationships between cannabis use and mental illnesses are essential for nurses and other healthcare professionals and researchers to explore and understand. This literature review examines the relationships between cannabis use and depression, anxiety, and suicide. It includes a primer on the neurobiology of cannabis effects; an overview on the epidemiological evidence on the associations between cannabis use and depression, anxiety, and suicide; and a discussion of implications for nurses, particularly important given changes in the medical and recreational cannabis legislation in North America. Overall, this review found consistent evidence showing a cross-sectional association between recreational cannabis use and depression, anxiety, and suicide, despite some limitations and conflicts in the literature. In addition, most evidence from longitudinal or case control studies suggested cannabis use preceded the development of depressive symptoms and suicidal behaviors, although the quality of this evidence was mixed. Implications for future research and nursing practice are discussed.

Effects of Drugs of Abuse on the Blood-Brain Barrier: A Brief Overview

The use of psychostimulants and alcohol disrupts blood-brain barrier (BBB) integrity, resulting in alterations to cellular function, and contributes to neurotoxicity. The BBB is the critical boundary of the central nervous system (CNS) where it maintains intracellular homeostasis and facilitates communication with the peripheral circulation. The BBB is regulated by tight junction (TJ) proteins that closely interact with endothelial cells (EC). The complex TJ protein network consists of transmembrane proteins, including claudins, occludins, and junction adhesion molecules (JAM), as well as cytoskeleton connected scaffolding proteins, zonula occludentes (ZO-1, 2, and 3). The use of psychostimulants and alcohol is known to affect the CNS and is implicated in various neurological disorders through neurotoxicity that partly results from increased BBB permeability. The present mini review primarily focuses on BBB structure and permeability. Moreover, we assess TJ protein and cytoskeletal changes induced by cocaine, methamphetamine, morphine, heroin, nicotine, and alcohol. These changes promote glial activation, enzyme potentiation, and BBB remodeling, which affect neuroinflammatory pathways. Although the effect of drugs of abuse on BBB integrity and the underlying mechanisms are well studied, the present review enhances the understanding of the underlying mechanisms through which substance abuse disorders cause BBB dysfunction.

Associations between adjustment disorder and hospital-based infections in the Danish population

OBJECTIVE

There is some evidence that posttraumatic stress disorder (PTSD) is associated with increased risk of infections, and it is unknown whether adjustment disorder is as well. We assessed the association between adjustment disorder and subsequent infections, and assessed additive interaction with sex.

METHODS

The study population included a nationwide cohort of all Danish-born residents of Denmark diagnosed with adjustment disorder between 1995 and 2011, and an age- and sex-matched general population comparison cohort. We compared rates of infections requiring inpatient or outpatient hospitalization in the two cohorts. We fit Cox proportional hazards models to compute adjusted hazard ratios (aHR) for the associations between adjustment disorder and 32 types of infections, and calculated interaction contrasts to assess interaction between adjustment disorder and sex.

RESULTS

Adjustment disorder was associated with increased rates of infections overall (n = 19,838 infections, aHR = 1.8, 95% confidence interval = 1.8. 1.9), and increased rates of each individual infection type (aHRs for 30 infections ranged from 1.5 to 2.3), adjusting for baseline psychiatric and somatic comorbidities and marital status. For many infection types (e.g., skin infections, pneumonia), interaction contrasts indicated rate differences were greater among men than women, while for two (urinary tract infections and sexually transmitted infections), rate differences were greater for women.

CONCLUSIONS

These findings are consistent with studies examining the relationship between psychological stress and infections, and between PTSD and infections. They may be explained by a combination of the triggering of unhealthy behaviors as well as immune responses to stress.

Sexual addiction, compulsivity, and impulsivity among a predominantly female sample of adults who use the internet for sex

BACKGROUND AND AIMS

Compulsive sexual behavior is characterized by extensive sexual behavior and unsuccessful efforts to control excessive sexual behavior. The aim of the studies was to investigate compulsivity, anxiety and depression and impulsivity and problematic online sexual activities among adult males and females who use the Internet for finding sexual partners and using online pornography.

METHODS

Study 1- 177 participants including 143 women M = 32.79 years (SD = 9.52), and 32 men M = 30.18 years (SD = 10.79). The Sexual Addiction Screening Test (SAST), the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), Spielberger Trait-State Anxiety Inventory (STAI-T STAI-S) and Beck Depression Inventory (BDI). Study 2- 139 participants including 98 women M = 24 years (SD = 5) and 41 men M = 25 years (SD = 4). The impulsivity questionnaire (BIS/BAS), Problematic online sexual activities (s-IAT-sex) and Sexual Addiction Screening Test (SAST).

RESULTS

Study 1- Multiple regression analysis has indicated that a model which included BDI, Y-BOCS, and STAI scores contributed to the variance of sexual addiction rates, and explained 33.3% of the variance. Study 2- Multiple regression analysis indicated that BIS/BAS and s-IAT scores contributed to the variance of sexual addiction rates, and explained 33% of the variance.

DISCUSSION AND CONCLUSIONS

Obsessive-compulsive symptoms contributed to sexual addiction among individuals who use the Internet for finding sexual partners. Impulsivity and problematic online sexual activity contributed to ratings of sex addiction. These studies support the argument that sex addiction lies on the impulsive-compulsive scale and could be classified as a behavioral addiction.

100 Cases of Exercise Addiction: More Evidence for a Widely Researched but Rarely Identified Dysfunction

Exercise addiction is an extensively studied topic in the sport science and psychology literature as reflected by the more than 1000 papers published in the field. However, only about 12 cases were published in the area, which may suggest that there is difficulty in reaching and studying affected individuals. Relying on the Components Model of Addiction, we performed an extensive search on non-scholar websites (i.e. popular media websites) and identified 100 cases that met the eligibility criteria. These cases reflect the several physical, psychological and social consequences that may accompany the dysfunction, as well as numerous exercise activities to which individuals may become addicted. The findings also raise the question whether women are more affected than men, or perhaps women are more open than men to disclose their problem, as based on the four to one ratio of the identified cases. The current work supports the large volume of research in the field of exercise addiction, because either the prevalence of the dysfunction is greater than expected, or people are more open to disclose their problem on Internet sites.