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Grant JE, Collins M, Chamberlain SR, Chesivoir E. Disorders of impulsivity in trichotillomania and skin picking disorder. J Psychiatr Res 2024; 170:42-46. [PMID: 38101209 DOI: 10.1016/j.jpsychires.2023.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 10/31/2023] [Accepted: 12/06/2023] [Indexed: 12/17/2023]
Abstract
Trichotillomania and skin picking disorder are often classified as body-focused repetitive behaviors (BFRBs) as they are characterized by repetitive hair-pulling and skin picking, respectively. They were initially considered to be impulse control disorders despite little research scrutiny. The objective of this study was to examine the relationship of these two conditions to other disorders with impulsive features. Adults with trichotillomania (n = 104) and skin picking (n = 178) or both (n = 96) were recruited from the general community using advertisements and online support groups and completed an online survey. Participants undertook a structured clinical interview and completion of self-report instruments to characterize clinical profiles and associated characteristics. In addition, each participant completed the Minnesota Impulse Disorders Interview to screen for disorders with impulsive features. Of the 378 adults with BFRBs, 134 (35.4%) screened positive for at least one disorder with features of impulsivity with the most common being compulsive buying (18.3%) and problematic use of the internet (17.5%). Participants with a co-occurring disorder of impulsivity reported significantly worse pulling and picking symptoms (p < .001), were more likely to have co-occurring alcohol problems (p < .001) and PTSD (p < .001), and scored higher regarding dissociative symptoms (p < .001). BFRBs are associated with a range of impulsive disorders and the comorbidity may have important treatment implications.
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Affiliation(s)
- Jon E Grant
- Department of Psychiatry & Behavioral Neuroscience, University of Chicago, Pritzker School of Medicine, Chicago, IL, USA.
| | - Madison Collins
- Department of Psychiatry & Behavioral Neuroscience, University of Chicago, Pritzker School of Medicine, Chicago, IL, USA
| | - Samuel R Chamberlain
- Department of Psychiatry, Faculty of Medicine, University of Southampton, UK; Southern Health NHS Foundation Trust, Southampton, UK
| | - Eve Chesivoir
- Department of Psychiatry & Behavioral Neuroscience, University of Chicago, Pritzker School of Medicine, Chicago, IL, USA
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Prevalence and Clinical Significance of Psychiatric Comorbidities With Gambling Disorder in 12 Clinical Settings in Japan. J Addict Med 2023; 17:140-146. [PMID: 36084180 DOI: 10.1097/adm.0000000000001054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This study investigated the occurrence rate of psychiatric disorders comorbid with gambling disorder, and their clinical significance in the severity of gambling disorder using a retrospective cross-sectional design. METHODS The medical records of 359 patients (men/women, 326/33; median age, 37.0 years) with gambling disorder as the primary disorder from 12 treatment facilities specializing in addiction (9 clinics and 3 hospitals) in Japan were studied. We investigated patients' comorbid psychiatric disorders, demographic and clinical characteristics, and the severity of gambling disorder based on criteria from the Diagnostic and Statistical Manual of Mental Disorders, fifth edition. RESULTS Of all patients, 58.3% had comorbidities (tobacco use disorder, 20.9%; alcohol use disorder, 13.9%; major depressive disorder, 13.1%; behavioral addictions, 13.1%; attention-deficit hyperactivity disorder, 6.1%; etc.). Statistical analysis indicated that as the number of comorbid psychiatric disorders increased, psychosocial problems also increased (e.g., proportion of adverse childhood experiences [ P < 0.001], and history of suicide attempts [ P = 0.009]). In the multivariable analysis, behavioral addictions ( β = 0.666; t = 3.151) were significantly associated with gambling disorder severity. Specifically, individuals with gambling disorder comorbid with behavioral addictions including kleptomania, excessive buying, and excessive sex-related behavior may present more severe gambling problems than those without behavioral addictions. CONCLUSIONS Patients with gambling disorder should be carefully assessed for psychiatric comorbidities and interventions should reflect the individual diagnosis.
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Scandroglio F, Ferrazzi G, Giacobazzi A, Vinci V, Marchi M, Galeazzi GM, Musetti A, Pingani L. Prevalence and Possible Predictors of Gambling Disorder in a Sample of Students in the Healthcare Professions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:452. [PMID: 36612781 PMCID: PMC9819379 DOI: 10.3390/ijerph20010452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/21/2022] [Accepted: 12/22/2022] [Indexed: 06/17/2023]
Abstract
The Italian version of the South Oaks Gambling Screen questionnaire (SOGS) and a socio-demographic questionnaire were administered to a sample of 275 healthcare professions students aged 19 to 58 years (mean age = 22.17; females = 81.1%) to address the research objectives: to examine the prevalence and correlates of problem gambling in a population of university healthcare professions students in Italy. Among the sample, 8.7% (n = 24) of participants showed problem gambling and 1.5% (n = 4) pathologic gambling. Lottery and scratch cards were the most frequent type of gambling in the sample, followed by cards and bingo. Compared to females, males tend to be more involved in problem gambling and pathological gambling. Males tend to be more involved than females in different types of gambling (such as cards, sports bets, gambling at the casino). Pathological gambling is positively associated with gender, being students lagging behind the regular schedule of exams and parents' level of education. These findings have important implications in terms of prevention and intervention on gambling and pathological gambling. Universities should make available educational programs and counselling services to address this issue.
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Affiliation(s)
- Francesca Scandroglio
- Department of Biomedical, Metabolic and Neural Sciences, Università degli Studi di Modena e Reggio Emilia, 41125 Modena, Italy
| | - Giulia Ferrazzi
- Department of Biomedical, Metabolic and Neural Sciences, Università degli Studi di Modena e Reggio Emilia, 41125 Modena, Italy
| | - Alessia Giacobazzi
- Department of Biomedical, Metabolic and Neural Sciences, Università degli Studi di Modena e Reggio Emilia, 41125 Modena, Italy
| | - Vera Vinci
- Dipartimento ad attività integrata di Salute Mentale e Dipendenze Patologiche, Azienda USL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy
| | - Mattia Marchi
- Department of Biomedical, Metabolic and Neural Sciences, Università degli Studi di Modena e Reggio Emilia, 41125 Modena, Italy
- Dipartimento ad attività integrata di Salute Mentale e Dipendenze Patologiche, Azienda USL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy
| | - Gian Maria Galeazzi
- Department of Biomedical, Metabolic and Neural Sciences, Università degli Studi di Modena e Reggio Emilia, 41125 Modena, Italy
- Dipartimento ad attività integrata di Salute Mentale e Dipendenze Patologiche, Azienda USL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy
| | - Alessandro Musetti
- Department of Humanities, Social Sciences and Cultural Industries, University of Parma, 43121 Parma, Italy
| | - Luca Pingani
- Department of Biomedical, Metabolic and Neural Sciences, Università degli Studi di Modena e Reggio Emilia, 41125 Modena, Italy
- Dipartimento ad attività integrata di Salute Mentale e Dipendenze Patologiche, Azienda USL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy
- Direzione delle Professioni Sanitarie, Azienda USL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy
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Tang KTY, Kim HS, Hodgins DC, McGrath DS, Tavares H. Gambling disorder and comorbid behavioral addictions: Demographic, clinical, and personality correlates. Psychiatry Res 2020; 284:112763. [PMID: 31951870 DOI: 10.1016/j.psychres.2020.112763] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 12/09/2019] [Accepted: 01/04/2020] [Indexed: 11/15/2022]
Abstract
Gambling disorder (GD) frequently co-occurs with substance use disorders. However, the extent to which GD co-occurs with behavioral addictions (BAs) and the demographic, clinical, and personality correlates of comorbid GD and BA is largely unknown. The aims of the present research were to address this gap among people seeking treatment for GD (N = 458) in São Paulo, Brazil. Structured clinical interviews diagnosed individuals with GD and other psychiatric disorders. The Shorter PROMIS questionnaire was used to identify BAs (work, exercise, food bingeing, sex, and shopping). Questionnaires assessed demographic characteristics, gambling behavior, and personality. Of the total sample, 206 (45.0%) participants met the criteria of having at least one behavioral addiction (GD+BA). The most common comorbid BA was food bingeing (8.1%) with the least common being exercise (3.6%). In a multivariate logistic regression, individuals with GD+BA tended to be younger, and had greater rates of comorbid post-traumatic stress disorder and bulimia nervosa compared to participants who did not present with a comorbid BA. Taken together, individuals with GD+BA present with increased psychopathology. These results may have important implications for the assessment and treatment of individuals with GD and comorbid BAs.
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Affiliation(s)
- Karen T Y Tang
- Department of Psychology & Neuroscience, Dalhousie University, Canada.
| | - Hyoun S Kim
- Department of Psychology, University of Calgary, Canada
| | | | | | - Hermano Tavares
- Impulse Control Disorders Outpatient Unit, Institute and Department of Psychiatry, University of São Paulo, São Paulo, Brazil
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Problem gambling, associations with comorbid health conditions, substance use, and behavioural addictions: Opportunities for pathways to treatment. PLoS One 2020; 15:e0227644. [PMID: 31923269 PMCID: PMC6953879 DOI: 10.1371/journal.pone.0227644] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 12/23/2019] [Indexed: 12/12/2022] Open
Abstract
Background Problem gambling is a public health issue and its comorbidity with other health conditions may provide an opportunity for screening in healthcare settings; however, a high level of uncertainty and a lack of research in the field remains. The objective of this study is to investigate potential associations between problem gambling and numerous other health conditions, including substance use, mental health problems, and behavioural addictions. Methods A cross-sectional web-survey was distributed by a market research company to an online panel of respondents in Sweden, which aimed to be representative of the general population. Chi-squared and Mann-Whitney U tests, followed by logistic regression analysis, were performed to determine associations between screening positive for lifetime problem gambling and potential comorbid conditions and behaviours. Results Among 2038 participants, 5.7 percent screened positive for lifetime problem gambling. Significant associations were found between problem gambling and male gender, education level, daily tobacco use, moderate psychological distress, problematic shopping, and problem gaming. Conclusion The association between screening for problem gambling and other health conditions, including psychological distress and behavioural addictions such as shopping and gaming, demonstrates the need to screen for problem gambling in the context of other health hazards, such as in different healthcare settings. Further research is required to identify the temporal relationship between these conditions and to investigate underlying etiological mechanisms.
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Cowie ME, Kim HS, Hodgins DC, McGrath DS, Scanavino MDT, Tavares H. Demographic and psychiatric correlates of compulsive sexual behaviors in gambling disorder. J Behav Addict 2019; 8:451-462. [PMID: 31416337 PMCID: PMC7044634 DOI: 10.1556/2006.8.2019.35] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND AND AIMS Gambling disorder (GD) and compulsive sexual behavior (CSB) may commonly co-occur. Yet, the psychiatric correlates of these co-occurring disorders are an untapped area of empirical scrutiny, limiting our understanding of appropriate treatment modalities for this dual-diagnosed population. This study examined the demographic and clinical correlates of CSB in a sample of treatment-seeking individuals with GD (N = 368) in São Paulo, Brazil. METHODS Psychiatrists and psychologists conducted semi-structured clinical interviews to identify rates of CSB and other comorbid psychiatric disorders. The Shorter PROMIS Questionnaire was administered to assess additional addictive behaviors. The TCI and BIS-11 were used to assess facets of personality. Demographic and gambling variables were also assessed. RESULTS Of the total sample, 24 (6.5%) met diagnostic criteria for comorbid CSB (GD + CSB). Compared to those without compulsive sexual behaviors (GD - CSB), individuals with GD + CSB were more likely to be younger and male. No differences in gambling involvement emerged. Individuals with GD + CSB tended to have higher rates of psychiatric disorders (depression, post-traumatic stress disorder, and bulimia nervosa) and engage in more addictive behaviors (problematic alcohol use, drug use, and exercise) compared to GD - CSB. Those with GD + CSB evidenced less self-directedness, cooperativeness, self-transcendence, and greater motor impulsivity. Logistic regression showed that the predictors of GD + CSB, which remained in the final model, were being male, a diagnosis of bulimia, greater gambling severity, and less self-transcendence. DISCUSSION AND CONCLUSION Given those with GD + CSB evidence greater psychopathology, greater attention should be allocated to this often under studied comorbid condition to ensure adequate treatment opportunities.
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Affiliation(s)
- Megan E. Cowie
- Addictive Behaviours Laboratory, Department of Psychology, University of Calgary, Calgary, AB, Canada,Corresponding author: Megan E. Cowie; Addictive Behaviours Laboratory, Department of Psychology, University of Calgary, Room AD 240, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada; Phone: +1 403 210 9580; E-mail:
| | - Hyoun S. Kim
- Addictive Behaviours Laboratory, Department of Psychology, University of Calgary, Calgary, AB, Canada
| | - David C. Hodgins
- Addictive Behaviours Laboratory, Department of Psychology, University of Calgary, Calgary, AB, Canada
| | - Daniel S. McGrath
- Addictive Behaviours Laboratory, Department of Psychology, University of Calgary, Calgary, AB, Canada
| | - Marco D. T. Scanavino
- Outpatient Unit for Excessive Sexual Drive and Prevention of Negative Outcomes Associated with Sexual Behavior, Institute of Psychiatry, Clinicas’ Hospital, University of São Paulo Medical School, São Paulo, Brazil,Department of Psychiatry, Medical School, University of São Paulo, São Paulo, Brazil,Experimental Pathophysiology, Post-Graduation Program, Medical School, University of São Paulo, São Paulo, Brazil
| | - Hermano Tavares
- Department of Psychiatry, Medical School, University of São Paulo, São Paulo, Brazil,Impulse Control Disorders and Behavioral Addictions Outpatient Unit, Institute and Department of Psychiatry, University of São Paulo, São Paulo, Brazil
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Overlapping dimensional phenotypes of impulsivity and compulsivity explain co-occurrence of addictive and related behaviors. CNS Spectr 2019; 24:426-440. [PMID: 30458896 DOI: 10.1017/s1092852918001244] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Impulsivity and compulsivity have been implicated as important transdiagnostic dimensional phenotypes with potential relevance to addiction. We aimed to develop a model that conceptualizes these constructs as overlapping dimensional phenotypes and test whether different components of this model explain the co-occurrence of addictive and related behaviors. METHODS A large sample of adults (N = 487) was recruited through Amazon's Mechanical Turk and completed self-report questionnaires measuring impulsivity, intolerance of uncertainty, obsessive beliefs, and the severity of 6 addictive and related behaviors. Hierarchical clustering was used to organize addictive behaviors into homogenous groups reflecting their co-occurrence. Structural equation modeling was used to evaluate fit of the hypothesized bifactor model of impulsivity and compulsivity and determine the proportion of variance explained in the co-occurrence of addictive and related behaviors by each component of the model. RESULTS Addictive and related behaviors clustered into 2 distinct groups: Impulse-Control Problems, consisting of harmful alcohol use, pathological gambling, and compulsive buying, and Obsessive-Compulsive-Related Problems, consisting of obsessive-compulsive symptoms, binge eating, and internet addiction. The hypothesized bifactor model of impulsivity and compulsivity provided the best empirical fit, with 3 uncorrelated factors corresponding to a general Disinhibition dimension, and specific Impulsivity and Compulsivity dimensions. These dimensional phenotypes uniquely and additively explained 39.9% and 68.7% of the total variance in Impulse-Control Problems and Obsessive-Compulsive-Related Problems. CONCLUSION A model of impulsivity and compulsivity that represents these constructs as overlapping dimensional phenotypes has important implications for understanding addictive and related behaviors in terms of shared etiology, comorbidity, and potential transdiagnostic treatments.
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Abstract
Gambling disorder is characterized by a persistent, recurrent pattern of gambling that is associated with substantial distress or impairment. The prevalence of gambling disorder has been estimated at 0.5% of the adult population in the United States, with comparable or slightly higher estimates in other countries. The aetiology of gambling disorder is complex, with implicated genetic and environmental factors. Neurobiological studies have implicated cortico-striato-limbic structures and circuits in the pathophysiology of this disorder. Individuals with gambling disorder often go unrecognized and untreated, including within clinical settings. Gambling disorder frequently co-occurs with other conditions, particularly other psychiatric disorders. Behavioural interventions, particularly cognitive-behavioural therapy but also motivational interviewing and Gamblers Anonymous, are supported in the treatment of gambling disorder. No pharmacological therapy has a formal indication for the treatment of gambling disorder, although placebo-controlled trials suggest that some medications, such as opioid-receptor antagonists, may be helpful. Given the associations with poor quality of life and suicide, improved identification, prevention, policy and treatment efforts are needed to help people with gambling disorder.
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9
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Yakovenko I, Hodgins DC. A scoping review of co-morbidity in individuals with disordered gambling. INTERNATIONAL GAMBLING STUDIES 2017. [DOI: 10.1080/14459795.2017.1364400] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Igor Yakovenko
- School of Public Health, University of Alberta, Edmonton, Canada
| | - David C. Hodgins
- School of Public Health, University of Alberta, Edmonton, Canada
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10
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Starcevic V, Khazaal Y. Relationships between Behavioural Addictions and Psychiatric Disorders: What Is Known and What Is Yet to Be Learned? Front Psychiatry 2017; 8:53. [PMID: 28439243 PMCID: PMC5383701 DOI: 10.3389/fpsyt.2017.00053] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 03/24/2017] [Indexed: 11/13/2022] Open
Abstract
This article provides a narrative review of the relationships between several behavioural addictions [pathological gambling, problematic Internet use (PIU), problematic online gaming, compulsive sexual behaviour disorder, compulsive buying, and exercise addiction] and psychiatric disorders. Associations between most behavioural addictions and depressive and anxiety disorders are strong and seem relatively non-specific. Strong links with substance use disorders may support the notion that some people are more prone to addictive behaviours, regardless of whether these involve substances or problematic activities. Other associations seem relatively specific, for example, those between PIU/online gaming and attention-deficit/hyperactivity disorder, between compulsive buying on the one hand and eating disorders and hoarding on the other hand and between exercise addiction and eating disorders. The quality of the research varies, but most studies suffer from methodological limitations, including a cross-sectional or correlational design, non-representative study populations, small sample sizes, reliance on self-report assessment instruments, diverse diagnostic criteria, and conceptual heterogeneity of most behavioural addictions. Due to these limitations, generalisability of the findings is questionable and the direction of causality, if any, is unknown in the relationships between behavioural addictions and psychiatric disorders. Regardless of the aetiological uncertainty, these relationships often call for a modified treatment approach. Prospective studies are needed to clarify the longitudinal relationships between behavioural addictions and psychiatric disorders.
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Affiliation(s)
- Vladan Starcevic
- Discipline of Psychiatry, Sydney Medical School Nepean, University of Sydney, Sydney, NSW, Australia
| | - Yasser Khazaal
- Department of Psychiatry, University of Geneva, Geneva, Switzerland.,Research Center, Montreal University Institute of Mental Health, Montreal, QC, Canada
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11
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Abstract
Aim To investigate impulsive behaviors in pathological buying (PB). Methods The study included three groups matched for age and gender: treatment seeking outpatients with PB (PB+), treatment seeking psychiatric inpatients without PB (PB-), and a healthy control group (HC). PB was assessed by means of the Compulsive Buying Scale and by the impulse control disorder (ICD) module of the research version of the Structured Clinical Interview for DSM-IV (SCID-ICD). All participants answered questionnaires concerning symptoms of borderline personality disorder, self-harming behaviors, binge eating and symptoms of attention deficit and hyperactivity disorder (ADHD). In addition, comorbid ICDs were assessed using the SCID-ICD. Results The PB+ and PB- groups did not differ with regard to borderline personality disorder or ADHD symptoms, but both groups reported significantly more symptoms than the HC group. Frequencies of self-harming behaviors did not differ between the three groups. Patients with PB were more often diagnosed with any current ICD (excluding PB) compared to those without PB and the HC group (38.7% vs. 12.9% vs. 12.9%, respectively, p=.017). Discussion Our findings confirm prior research suggesting more impulsive behaviors in patients with and without PB compared to healthy controls. The results of the questionnaire-based assessment indicate that outpatients with PB perceive themselves equally impulsive and self-harm as frequently as inpatients without PB; but they seem to suffer more often from an ICD as assessed by means of an interview.
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Affiliation(s)
- Heike Zander
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hannover, Germany,Corresponding author: Heike Zander, Psy.D.; Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany; Phone: +49 511 532 6696; Fax: +49 511 532 18579; E-mail:
| | - Laurence Claes
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium,Faculty of Medicine and Health Sciences (CAPRI), University of Antwerp, Antwerp, Belgium
| | - Eva M. Voth
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Martina de Zwaan
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Astrid Müller
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hannover, Germany
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12
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Welte JW, Barnes GM, Tidwell MCO, Wieczorek WF. Predictors of Problem Gambling in the U.S. J Gambl Stud 2016; 33:327-342. [DOI: 10.1007/s10899-016-9639-1] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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13
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Dowling N, Merkouris S, Lorains F. Interventions for comorbid problem gambling and psychiatric disorders: Advancing a developing field of research. Addict Behav 2016; 58:21-30. [PMID: 26900888 DOI: 10.1016/j.addbeh.2016.02.012] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2015] [Revised: 02/04/2016] [Accepted: 02/07/2016] [Indexed: 12/15/2022]
Abstract
Despite significant psychiatric comorbidity in problem gambling, there is little evidence on which to base treatment recommendations for subpopulations of problem gamblers with comorbid psychiatric disorders. This mini-review draws on two separate systematic searches to identify possible interventions for comorbid problem gambling and psychiatric disorders, highlight the gaps in the currently available evidence base, and stimulate further research in this area. In this mini-review, only 21 studies that have conducted post-hoc analyses to explore the influence of psychiatric disorders or problem gambling subtypes on gambling outcomes from different types of treatment were identified. The findings of these studies suggest that most gambling treatments are not contraindicated by psychiatric disorders. Moreover, only 6 randomized studies comparing the efficacy of interventions targeted towards specific comorbidity subgroups with a control/comparison group were identified. The results of these studies provide preliminary evidence for modified dialectical behavior therapy for comorbid substance use, the addition of naltrexone to cognitive-behavioral therapy (CBT) for comorbid alcohol use problems, and the addition of N-acetylcysteine to tobacco support programs and imaginal desensitisation/motivational interviewing for comorbid nicotine dependence. They also suggest that lithium for comorbid bipolar disorder, escitalopram for comorbid anxiety disorders, and the addition of CBT to standard drug treatment for comorbid schizophrenia may be effective. Future research evaluating interventions sequenced according to disorder severity or the functional relationship between the gambling behavior and comorbid symptomatology, identifying psychiatric disorders as moderators of the efficacy of problem gambling interventions, and evaluating interventions matched to client comorbidity could advance this immature field of study.
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14
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Chamberlain SR, Lochner C, Stein DJ, Goudriaan AE, van Holst RJ, Zohar J, Grant JE. Behavioural addiction-A rising tide? Eur Neuropsychopharmacol 2016; 26:841-55. [PMID: 26585600 DOI: 10.1016/j.euroneuro.2015.08.013] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2015] [Revised: 07/17/2015] [Accepted: 08/15/2015] [Indexed: 01/21/2023]
Abstract
The term 'addiction' was traditionally used in relation to centrally active substances, such as cocaine, alcohol, or nicotine. Addiction is not a unitary construct but rather incorporates a number of features, such as repetitive engagement in behaviours that are rewarding (at least initially), loss of control (spiralling engagement over time), persistence despite untoward functional consequences, and physical dependence (evidenced by withdrawal symptoms when intake of the substance diminishes). It has been suggested that certain psychiatric disorders characterized by maladaptive, repetitive behaviours share parallels with substance addiction and therefore represent 'behavioural addictions'. This perspective has influenced the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), which now has a category 'Substance Related and Addictive Disorders', including gambling disorder. Could other disorders characterised by repetitive behaviours, besides gambling disorder, also be considered 'addictions'? Potential examples include kleptomania, compulsive sexual behaviour, 'Internet addiction', trichotillomania (hair pulling disorder), and skin-picking disorder. This paper seeks to define what is meant by 'behavioural addiction', and critically considers the evidence for and against this conceptualisation in respect of the above conditions, from perspectives of aetiology, phenomenology, co-morbidity, neurobiology, and treatment. Research in this area has important implications for future diagnostic classification systems, neurobiological models, and novel treatment directions.
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Affiliation(s)
- Samuel R Chamberlain
- Department of Psychiatry, University of Cambridge, UK; Cambridge and Peterborough NHS Foundation Trust (CPFT), UK.
| | - Christine Lochner
- MRC Unit on Anxiety and Stress Disorders, Department of Psychiatry, Stellenbosch University, South Africa
| | - Dan J Stein
- MRC Unit on Anxiety and Stress Disorders, Department of Psychiatry and Mental Health, University of Cape Town, South Africa
| | - Anna E Goudriaan
- Amsterdam Institute for Addiction Research, Academic Medical Center, University of Amsterdam, The Netherlands and Arkin Mental Health, Amsterdam, The Netherlands
| | - Ruth Janke van Holst
- Amsterdam Institute for Addiction Research, Academic Medical Center, University of Amsterdam, The Netherlands and Arkin Mental Health, Amsterdam, The Netherlands
| | - Joseph Zohar
- Division of Psychiatry, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Jon E Grant
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Pritzker School of Medicine, Chicago, IL, USA
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15
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Granero R, Fernández-Aranda F, Steward T, Mestre-Bach G, Baño M, Del Pino-Gutiérrez A, Moragas L, Aymamí N, Gómez-Peña M, Mallorquí-Bagué N, Tárrega S, Menchón JM, Jiménez-Murcia S. Compulsive Buying Behavior: Characteristics of Comorbidity with Gambling Disorder. Front Psychol 2016; 7:625. [PMID: 27199853 PMCID: PMC4850691 DOI: 10.3389/fpsyg.2016.00625] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 04/14/2016] [Indexed: 01/03/2023] Open
Abstract
Compulsive buying behavior (CBB) has begun to be recognized as a condition worthy of attention by clinicians and researchers. Studies on the commonalities between CBB and other behavioral addictions such as gambling disorder (GD) exist in the literature, but additional research is needed to assess the frequency and clinical relevance of the comorbidity of CBB and GD. The aim of the study was to estimate the point-prevalence of CBB+GD in a clinical setting. Data corresponded to n = 3221 treatment-seeking patients who met criteria for CBB or GD at a public hospital unit specialized in treating behavioral addictions. Three groups were compared: only-CBB (n = 127), only-GD (n = 3118) and comorbid CBB+GD (n = 24). Prevalence for the co-occurrence of CBB+GD was 0.75%. In the stratum of patients with GD, GD+CBB comorbidity obtained relatively low point prevalence (0.77%), while in the subsample of CBB patients the estimated prevalence of comorbid GD was relatively high (18.9%). CBB+GD comorbidity was characterized by lower prevalence of single patients, higher risk of other behavioral addictions (sex, gaming or internet), older age and age of onset. CBB+GD registered a higher proportion of women compared to only-GD (37.5 vs. 10.0%) but a higher proportion of men compared to only-CBB (62.5 vs. 24.4%). Compared to only-GD patients, the simultaneous presence of CBB+GD was associated with increased psychopathology and dysfunctional levels of harm avoidance. This study provides empirical evidence to better understand CBB, GD and their co-occurrence. Future research should help delineate the processes through which people acquire and develop this comorbidity.
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Affiliation(s)
- Roser Granero
- Ciber Fisiopatología Obesidad y Nutrición, Instituto de Salud Carlos IIIBarcelona, Spain; Departament de Psicobiologia i Metodologia de les Ciències de la Salut, Universitat Autònoma de BarcelonaBarcelona, Spain
| | - Fernando Fernández-Aranda
- Ciber Fisiopatología Obesidad y Nutrición, Instituto de Salud Carlos IIIBarcelona, Spain; Pathological Gambling Unit, Department of Psychiatry, Bellvitge University Hospital-IDIBELLBarcelona, Spain
| | - Trevor Steward
- Ciber Fisiopatología Obesidad y Nutrición, Instituto de Salud Carlos IIIBarcelona, Spain; Pathological Gambling Unit, Department of Psychiatry, Bellvitge University Hospital-IDIBELLBarcelona, Spain
| | - Gemma Mestre-Bach
- Pathological Gambling Unit, Department of Psychiatry, Bellvitge University Hospital-IDIBELL Barcelona, Spain
| | - Marta Baño
- Ciber Fisiopatología Obesidad y Nutrición, Instituto de Salud Carlos IIIBarcelona, Spain; Pathological Gambling Unit, Department of Psychiatry, Bellvitge University Hospital-IDIBELLBarcelona, Spain
| | - Amparo Del Pino-Gutiérrez
- Nursing Department of Mental Health, Public Health, Maternal and Child Health, Nursing School, University of Barcelona Barcelona, Spain
| | - Laura Moragas
- Pathological Gambling Unit, Department of Psychiatry, Bellvitge University Hospital-IDIBELL Barcelona, Spain
| | - Neus Aymamí
- Pathological Gambling Unit, Department of Psychiatry, Bellvitge University Hospital-IDIBELL Barcelona, Spain
| | - Mónica Gómez-Peña
- Pathological Gambling Unit, Department of Psychiatry, Bellvitge University Hospital-IDIBELL Barcelona, Spain
| | - Núria Mallorquí-Bagué
- Ciber Fisiopatología Obesidad y Nutrición, Instituto de Salud Carlos IIIBarcelona, Spain; Pathological Gambling Unit, Department of Psychiatry, Bellvitge University Hospital-IDIBELLBarcelona, Spain
| | - Salomé Tárrega
- Departament de Psicobiologia i Metodologia de les Ciències de la Salut, Universitat Autònoma de Barcelona Barcelona, Spain
| | - José M Menchón
- Pathological Gambling Unit, Department of Psychiatry, Bellvitge University Hospital-IDIBELLBarcelona, Spain; Ciber de Salud Mental, Instituto de Salud Carlos IIIBarcelona, Spain
| | - Susana Jiménez-Murcia
- Ciber Fisiopatología Obesidad y Nutrición, Instituto de Salud Carlos IIIBarcelona, Spain; Pathological Gambling Unit, Department of Psychiatry, Bellvitge University Hospital-IDIBELLBarcelona, Spain
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Yip SW, Mei S, Pilver CE, Steinberg MA, Rugle LJ, Krishnan-Sarin S, Hoff RA, Potenza MN. At-Risk/Problematic Shopping and Gambling in Adolescence. J Gambl Stud 2015; 31:1431-1447. [PMID: 25117852 PMCID: PMC4827601 DOI: 10.1007/s10899-014-9494-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Elevated levels of both pathological gambling (PG) and problem shopping (PS) have been reported among adolescents, and each is associated with a range of other negative health/functioning measures. However, relationships between PS and PG, particularly during adolescence, are not well understood. In this study, we explored the relationship between different levels of problem-gambling severity and health/functioning characteristics, gambling-related social experiences, gambling behaviors and motivations among adolescents with and without at-risk/problematic shopping (ARPS). Survey data from Connecticut high school students (n = 2,100) were analyzed using bivariate analyses and logistic regression modeling. Although at-risk/problematic gambling (ARPG) was not increased among adolescents with ARPS, adolescents with ARPG (vs non-gamblers) were more likely to report having experienced a growing tension or anxiety that could only be relieved by shopping and missing other obligations due to shopping. In comparison to the non-ARPS group, a smaller proportion of respondents in the ARPS group reported paid part-time employment, whereas a greater proportion of respondents reported excessive gambling by peers and feeling concerned over the gambling of a close family member. In general, similar associations between problem-gambling severity and measures of health/functioning and gambling-related behaviors and motivations were observed across ARPS and non-ARPS adolescents. However, associations were weaker among ARPS adolescents for several variables: engagement in extracurricular activities, alcohol and caffeine use and gambling for financial reasons. These findings suggest a complex relationship between problem-gambling severity and ARPS. They highlight the importance of considering co-occurring risk behaviors such as ARPS when treating adolescents with at-risk/problem gambling.
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Affiliation(s)
- Sarah W Yip
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Songli Mei
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- School of Public Health, Jilin University, Changchun, China
| | - Corey E Pilver
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Department of Biostatistics, Yale School of Public Health, New Haven, CT, USA
| | | | | | | | - Rani A Hoff
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- VA CT Healthcare System, West Haven, CT, USA
| | - Marc N Potenza
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Department of Neurobiology, Yale University School of Medicine, New Haven, CT, USA
- Yale Child Study Center, Yale University School of Medicine, New Haven, CT, USA
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Dowling NA, Cowlishaw S, Jackson AC, Merkouris SS, Francis KL, Christensen DR. Prevalence of psychiatric co-morbidity in treatment-seeking problem gamblers: A systematic review and meta-analysis. Aust N Z J Psychiatry 2015; 49:519-39. [PMID: 25735959 PMCID: PMC4438101 DOI: 10.1177/0004867415575774] [Citation(s) in RCA: 200] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The aim of this paper was to systematically review and meta-analyse the prevalence of co-morbid psychiatric disorders (DSM-IV Axis I disorders) among treatment-seeking problem gamblers. METHODS A systematic search was conducted for peer-reviewed studies that provided prevalence estimates of Axis I psychiatric disorders in individuals seeking psychological or pharmacological treatment for problem gambling (including pathological gambling). Meta-analytic techniques were performed to estimate the weighted mean effect size and heterogeneity across studies. RESULTS Results from 36 studies identified high rates of co-morbid current (74.8%, 95% CI 36.5-93.9) and lifetime (75.5%, 95% CI 46.5-91.8) Axis I disorders. There were high rates of current mood disorders (23.1%, 95% CI 14.9-34.0), alcohol use disorders (21.2%, 95% CI 15.6-28.1), anxiety disorders (17.6%, 95% CI 10.8-27.3) and substance (non-alcohol) use disorders (7.0%, 95% CI 1.7-24.9). Specifically, the highest mean prevalence of current psychiatric disorders was for nicotine dependence (56.4%, 95% CI 35.7-75.2) and major depressive disorder (29.9%, 95% CI 20.5-41.3), with smaller estimates for alcohol abuse (18.2%, 95% CI 13.4-24.2), alcohol dependence (15.2%, 95% CI 10.2-22.0), social phobia (14.9%, 95% CI 2.0-59.8), generalised anxiety disorder (14.4%, 95% CI 3.9-40.8), panic disorder (13.7%, 95% CI 6.7-26.0), post-traumatic stress disorder (12.3%, 95% CI 3.4-35.7), cannabis use disorder (11.5%, 95% CI 4.8-25.0), attention-deficit hyperactivity disorder (9.3%, 95% CI 4.1-19.6), adjustment disorder (9.2%, 95% CI 4.8-17.2), bipolar disorder (8.8%, 95% CI 4.4-17.1) and obsessive-compulsive disorder (8.2%, 95% CI 3.4-18.6). There were no consistent patterns according to gambling problem severity, type of treatment facility and study jurisdiction. Although these estimates were robust to the inclusion of studies with non-representative sampling biases, they should be interpreted with caution as they were highly variable across studies. CONCLUSIONS The findings highlight the need for gambling treatment services to undertake routine screening and assessment of psychiatric co-morbidity and provide treatment approaches that adequately manage these co-morbid disorders. Further research is required to explore the reasons for the variability observed in the prevalence estimates.
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Affiliation(s)
- Nicki A Dowling
- School of Psychology, Deakin University, Burwood, VIC, Australia,Melbourne Graduate School of Education, University of Melbourne, Melbourne, VIC, Australia,School of Psychological Sciences, Monash University, Melbourne, VIC, Australia,Centre for Gambling Research, Australian National University, Canberra, ACT, Australia
| | - Sean Cowlishaw
- School of Social and Community Medicine, Bristol University, Bristol, UK
| | - Alun C Jackson
- Melbourne Graduate School of Education, University of Melbourne, Melbourne, VIC, Australia
| | - Stephanie S Merkouris
- School of Psychology, Deakin University, Burwood, VIC, Australia,Problem Gambling Research and Treatment Centre, Monash University, Melbourne, VIC, Australia
| | - Kate L Francis
- Melbourne Graduate School of Education, University of Melbourne, Melbourne, VIC, Australia
| | - Darren R Christensen
- Melbourne Graduate School of Education, University of Melbourne, Melbourne, VIC, Australia,Faculty of Health Sciences, University of Lethbridge, Lethbridge, AB, Canada
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Abstract
BACKGROUND AND AIMS Compulsive sexual behavior (CSB) is a common disorder featuring repetitive, intrusive and distressing sexual thoughts, urges and behaviors that negatively affect many aspects of an individual's life. This article reviews the clinical characteristics of CSB, cognitive aspects of the behaviors, and treatment options. METHODS We reviewed the literature regarding the clinical aspects of CSB and treatment approaches. RESULTS The literature review of the clinical aspects of CSB demonstrates that there is likely a substantial heterogeneity within the disorder. In addition, the treatment literature lacks sufficient evidence-based approaches to develop a clear treatment algorithm. CONCLUSIONS Although discussed in the psychological literature for years, CSB continues to defy easy categorization within mental health. Further research needs to be completed to understand where CSB falls within the psychiatric nosology.
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Affiliation(s)
- Katherine L. Derbyshire
- Department of Psychiatry & Behavioral Neuroscience, University of Chicago, Chicago, IL, USA,* Corresponding author: Katherine L. Derbyshire, BS; Department of Psychiatry & Behavioral Neuroscience, University of Chicago, 5841 S. Maryland Avenue, MC 3077, Chicago, IL 60637, USA; Phone: +1-773-702-9066; Fax: +1-773-834-6761; E-mail:
| | - Jon E. Grant
- Department of Psychiatry & Behavioral Neuroscience, University of Chicago, Chicago, IL, USA
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Grant JE, Derbyshire K, Leppink E, Chamberlain SR. Obesity and gambling: neurocognitive and clinical associations. Acta Psychiatr Scand 2015; 131:379-86. [PMID: 25346399 DOI: 10.1111/acps.12353] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/02/2014] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Research on health correlates in gamblers has found an association between gambling and obesity. The neurocognitive underpinnings of impulsivity may be useful targets for understanding and ultimately treating individuals with both gambling and obesity problems. METHOD 207 non-treatment seeking young adults (18-29 years) with subsyndromal gambling disorder were recruited from the community. Subjects were grouped according to weight ('normal weight' BMI<25, 'overweight' BMI≥25; or 'obese' BMI≥30). Measures relating to gambling behaviour and objective computerized neurocognitive measures were collected. RESULTS Of the 207 subjects, 22 (10.6%) were obese and 49 (23.7%) were overweight. The obese gamblers consumed more nicotine (packs per day equivalent) and reported losing more money per week to gambling. Obese gamblers exhibited significant impairments in terms of reaction times for go trials on the stop-signal test (SST), quality of decision making and risk adjustment on the Cambridge Gamble Test (CGT), and sustained attention on the rapid visual information processing task (RVP). CONCLUSION Obesity was associated with decision making and sustained attention impairments in gamblers, along with greater monetary loss due to gambling. Future work should use longitudinal designs to examine the temporal relationship between these deficits, weight, other impulsive behaviour, and functional impairment.
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Affiliation(s)
- J E Grant
- Department of Psychiatry & Behavioral Neuroscience, University of Chicago, Chicago, IL, USA
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20
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Single versus multiple impulse control disorders in Parkinson’s disease: an 11C-raclopride positron emission tomography study of reward cue-evoked striatal dopamine release. J Neurol 2015; 262:1504-14. [DOI: 10.1007/s00415-015-7722-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2015] [Revised: 03/24/2015] [Accepted: 03/25/2015] [Indexed: 01/16/2023]
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Müller A, Mitchell JE, de Zwaan M. Compulsive buying. Am J Addict 2015; 24:132-137. [DOI: 10.1111/ajad.12111] [Citation(s) in RCA: 161] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Revised: 06/15/2013] [Accepted: 07/13/2013] [Indexed: 11/26/2022] Open
Affiliation(s)
- Astrid Müller
- Department of Psychosomatic Medicine and Psychotherapy, Center for Addiction Research (CARe)Hannover Medical SchoolHannoverGermany
| | - James E. Mitchell
- Department of Clinical NeuroscienceUniversity of North Dakota, School of Medicine and Health SciencesFargoNorth Dakota
- Neuropsychiatric Research InstituteFargoNorth Dakota
| | - Martina de Zwaan
- Department of Psychosomatic Medicine and Psychotherapy, Center for Addiction Research (CARe)Hannover Medical SchoolHannoverGermany
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22
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Abstract
Preclinical and clinical research implicate several neurotransmitter systems in the pathophysiology of gambling disorder (GD). In particular, neurobiological research suggests alterations in serotonergic, dopaminergic, glutamatergic and opioidergic functioning. The relative efficacy of medications targeting these systems remains a topic of ongoing research, and there is currently no Food and Drug Administration (FDA) approved medication with an indication for GD. Considering co-occurring disorders may be particularly important when devising a treatment plan for GD: extant data suggest that the opioid antagonist naltrexone may by the most effective form of current pharmacotherapy for GD, particularly for individuals with a co-occurring substance-use disorder (SUD) or with a family history of alcoholism. In contrast, lithium or other mood stabilizers may be most effective for GD for patients presenting with a co-occurring bipolar-spectrum disorder (BSD). Further, serotonin reuptake inhibitors (SRIs) may be efficacious in reducing GD symptoms for individuals also presenting with a (non-BSD) mood or anxiety disorder. Finally, elevated rates of GD (and other Impulse Control Disorders; ICDs) have been noted among individuals with Parkinson's Disease (PD), and clinicians should assess for vulnerability to GD when considering treatment options for PD. Reducing levodopa or dopamine agonist (DA) dosages may partially reduce GD symptoms among patients with co-occurring PD. For GD patients not willing to consider drug treatment, n-acetyl cysteine or behavioral therapies may be effective. Ongoing research into the effectiveness of combined behavioral and pharmacotherapies is being conducted; thus combined treatments should also be considered.
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Affiliation(s)
- Sarah W. Yip
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Marc N. Potenza
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Department of Neurobiology, Yale University School of Medicine, New Haven, CT, USA
- Yale Child Study Center, Yale University School of Medicine, New Haven, CT, USA
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Łabuzek K, Beil S, Beil-Gawełczyk J, Gabryel B, Franik G, Okopień B. The latest achievements in the pharmacotherapy of gambling disorder. Pharmacol Rep 2014; 66:811-20. [PMID: 25149985 DOI: 10.1016/j.pharep.2014.05.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Revised: 04/28/2014] [Accepted: 05/06/2014] [Indexed: 12/16/2022]
Abstract
Gambling disorder (GD) is becoming increasingly prevalent both among adults and adolescents. Unfortunately, this disorder is largely underestimated, while it can still lead to serious social and personal consequences, including criminal behavior or suicide attempts. In the past, the only means of treating gambling were psychobehavioral therapies. Nowadays, this disorder could also respond to many drugs from different classes such as opioid antagonists, serotonin selective reuptake inhibitors, mood stabilizers, atypical antipsychotics or glutamatergic agents. This review presents current pharmacological strategies and the results of clinical trials evaluating the efficacy of pharmacotherapy for GD. It also discusses the importance of distinguishing different pathological gambler subtypes such as impulsive, obsessive-compulsive and addictive subtypes as this may have serious pharmacological implications.
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Affiliation(s)
- Krzysztof Łabuzek
- Department of Internal Medicine and Clinical Pharmacology, Medical University of Silesia, Katowice, Poland.
| | - Sonia Beil
- Department of Internal Medicine and Clinical Pharmacology, Medical University of Silesia, Katowice, Poland
| | | | - Bożena Gabryel
- Department of Pharmacology, Medical University of Silesia, Katowice, Poland
| | - Grzegorz Franik
- Department of Gynecological Endocrinology, Medical University of Silesia, Katowice, Poland
| | - Bogusław Okopień
- Department of Internal Medicine and Clinical Pharmacology, Medical University of Silesia, Katowice, Poland
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Lowengrub K, Iancu I, Aizer A, Kotler M, Dannon PN. Pharmacotherapy of pathological gambling: review of new treatment modalities. Expert Rev Neurother 2014; 6:1845-51. [PMID: 17181431 DOI: 10.1586/14737175.6.12.1845] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Pathological gambling is classified in the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition as an impulse-control disorder. In the International Classification of Diseases of the WHO, pathological gambling is coded under the heading of 'Habit and Impulse Disorders'. Pathological gambling is a chronic, progressive disorder, which has a prevalence of 1-3.4% among western civilizations. The enormous personal and social consequences of this disorder include a high rate of suicide attempts, job loss, marital and family problems, legal problems, and criminal behavior. Recent studies have demonstrated that pathological gambling patients respond well to treatment with selective serotonin reuptake inhibitors, mood stabilizers and opioid antagonists. These findings support the idea that pathological gambling and other disorders of impulse control may be conceptualized as part of the obsessive-compulsive spectrum disorders or addictive disorders. This article will discuss possible treatment strategies according to different behavior patterns in pathological gambling and also remind the physicians who intend to treat this disorder of the possible diagnosis of pathological gambling.
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Affiliation(s)
- Katherine Lowengrub
- Ness Ziona and Beer Ya'akov Medical Complex and Tel Aviv University, The Rehovot Community Mental Health & Rehabilitation Center, Remez Street 80, Rehovot, 76449, Israel.
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25
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Guertler D, Rumpf HJ, Bischof A, Kastirke N, Petersen KU, John U, Meyer C. Assessment of problematic internet use by the Compulsive Internet Use Scale and the Internet Addiction Test: a sample of problematic and pathological gamblers. Eur Addict Res 2014; 20:75-81. [PMID: 24080838 DOI: 10.1159/000355076] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2013] [Accepted: 08/13/2013] [Indexed: 11/19/2022]
Abstract
This study aims to analyze psychometric properties and validity of the Compulsive Internet Use Scale (CIUS) and the Internet Addiction Test (IAT) and, second, to determine a threshold for the CIUS which matches the IAT cut-off for detecting problematic Internet use. A total of 292 subjects with problematic or pathological gambling (237 men, 55 women) aged 14-63 years and with private Internet use for at least 1 h per working or weekend day were recruited via different recruitment channels. Results include that both scales were internally consistent (Cronbach's α=0.9) and had satisfactory convergent validity (r=0.75; 95% CI 0.70-0.80). The correlation with duration of private Internet use per week was significantly higher for the CIUS (r=0.54) compared to the IAT (r=0.40). Among all participants, 25.3% were classified as problematic Internet users based on the IAT with a cut-off≥40. The highest proportion of congruent classified cases results from a CIUS cut-off ≥18 (sensitivity 79.7%, specificity 79.4%). However, a higher cut-off (≥21) seems to be more appropriate for prevalence estimation of problematic Internet use.
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Affiliation(s)
- Diana Guertler
- Institute for Social Medicine and Prevention, University of Greifswald, Greifswald, Germany
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26
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Santangelo G, Barone P, Trojano L, Vitale C. Pathological gambling in Parkinson's disease. A comprehensive review. Parkinsonism Relat Disord 2013; 19:645-53. [DOI: 10.1016/j.parkreldis.2013.02.007] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2012] [Revised: 02/07/2013] [Accepted: 02/14/2013] [Indexed: 11/16/2022]
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Jiménez-Murcia S, Bove FI, Israel M, Steiger H, Fernández-Aranda F, Alvarez-Moya E, Granero R, Penelo E, Vergé B, Aymamí MN, Santamaría JJ, Gómez-Peña M, Moragas L, Savvidou LG, Menchón JM. Cognitive-behavioral therapy for pathological gambling in Parkinson's disease: a pilot controlled study. Eur Addict Res 2012; 18:265-74. [PMID: 22760081 DOI: 10.1159/000337442] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2011] [Accepted: 02/06/2012] [Indexed: 12/13/2022]
Abstract
OBJECTIVES The main objective of this study was to compare the clinical characteristics and differences in response to treatment of two groups of pathological gamblers: with comorbid Parkinson's disease (PG + PD) and without (PG - PD). METHODS Clinical and psychopathological profiles and response to cognitive-behavioral treatment were assessed in 15 PG + PD and 45 PG - PD individuals consulting a specialized hospital Unit. RESULTS Statistically significant differences were observed between the two groups on a series of clinical variables. PG + PD patients were older and presented later onset of problematic gambling behaviors, lower alcohol consumption and higher bingo playing than PG - PD patients. No significant differences were noted in psychopathology except for lower measures of hostility in the PG + PD group. No statistical differences were detected between groups in terms of response to treatment. CONCLUSION These results may provide guidance for obtaining accurate diagnostic information in pathological gamblers by properly identifying patients with specific needs that may be targeted with treatment.
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Affiliation(s)
- Susana Jiménez-Murcia
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain.
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28
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Dannon PN, Lowengrub K, Gonopolski Y, Musin E, Kotler M. Pathological gambling: a review of phenomenological models and treatment modalities for an underrecognized psychiatric disorder. PRIMARY CARE COMPANION TO THE JOURNAL OF CLINICAL PSYCHIATRY 2011; 8:334-9. [PMID: 17245454 PMCID: PMC1764524 DOI: 10.4088/pcc.v08n0603] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2006] [Accepted: 06/27/2006] [Indexed: 10/20/2022]
Abstract
Pathological gambling (PG) is a prevalent and highly disabling impulse-control disorder. Two dominant phenomenological models for PG have been presented in the literature. According to one model, PG is included as an obsessive-compulsive spectrum disorder, while according to the second model, PG represents a form of nonpharmacologic addiction. In this article, we present an expanded conceptualization of the phenomenology of PG. On the basis of our clinical research experience and a review of data in the field, we propose 3 subtypes of pathological gamblers: the "impulsive" subtype, the "obsessive-compulsive" subtype, and the "addictive" subtype. We also review the current pharmacologic and nonpharmacologic treatment strategies for PG. A further aim of this article is to encourage awareness of the importance of improved screening procedures for the early detection of PG.
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Affiliation(s)
- Pinhas N Dannon
- Rehovot Community Mental Health & Rehabilitation Center affililated with Ness Ziona Medical Center and Tel Aviv University, Rehovot, Israel.
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Bouju G, Grall-Bronnec M, Landreat-Guillou M, Venisse JL. Jeu pathologique : facteurs impliqués. Encephale 2011; 37:322-31. [DOI: 10.1016/j.encep.2011.01.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2009] [Accepted: 08/03/2010] [Indexed: 10/17/2022]
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31
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O'Sullivan SS, Wu K, Politis M, Lawrence AD, Evans AH, Bose SK, Djamshidian A, Lees AJ, Piccini P. Cue-induced striatal dopamine release in Parkinson's disease-associated impulsive-compulsive behaviours. Brain 2011; 134:969-78. [PMID: 21349901 DOI: 10.1093/brain/awr003] [Citation(s) in RCA: 247] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Impulsive-compulsive behaviours are a significant source of morbidity for patients with Parkinson's disease receiving dopaminergic therapy. The development of these behaviours may reflect sensitization of the neural response to non-drug rewards, similar to that proposed for sensitization to drug rewards in addiction. Here, by using (11)C-raclopride positron emission tomography imaging, we investigated the effects of reward-related cues and L-dopa challenge in patients with Parkinson's disease with and without impulsive-compulsive behaviours on striatal levels of synaptic dopamine. Eighteen patients (11 with and seven without impulsive-compulsive behaviours) underwent three (11)C-raclopride positron emission tomography scans. The impulsive-compulsive behaviours included hypersexuality, binge eating, punding, compulsive use of dopamine replacement therapy, compulsive buying and pathological gambling, with eight patients exhibiting more than one impulsive-compulsive behaviour. There were no significant differences in baseline dopamine D2 receptor availability between the Parkinson's disease groups. No differences were found when comparing the percentage change of raclopride binding potential between the two Parkinson's disease groups following L-dopa challenge with neutral cues. The group with Parkinson's disease with impulsive-compulsive behaviours had a greater reduction of ventral striatum (11)C-raclopride binding potential following reward-related cue exposure, relative to neutral cue exposure, following L-dopa challenge (16.3% compared with 5.8% in Parkinson's disease controls, P = 0.016). The heightened response of striatal reward circuitry to heterogeneous reward-related visual cues among a group of patients with different impulsive-compulsive behaviours is consistent with a global sensitization to appetitive behaviours with dopaminergic therapy in vulnerable individuals. Our findings are relevant for the broader debate on the relation between impulsive-compulsive behaviours and addictions and may have important implications with regards to advertisement legislation in an effort to prevent the onset of behavioural addictions.
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Affiliation(s)
- Sean S O'Sullivan
- Reta Lila Weston Institute of Neurological Studies, University College London, London WC1N 1PJ, UK.
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Grant JE, Odlaug BL, Kim SW. Kleptomania: Clinical Characteristics and Relationship to Substance Use Disorders. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2010; 36:291-5. [DOI: 10.3109/00952991003721100] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Stein DJ, Grant JE, Franklin ME, Keuthen N, Lochner C, Singer HS, Woods DW. Trichotillomania (hair pulling disorder), skin picking disorder, and stereotypic movement disorder: toward DSM-V. Depress Anxiety 2010; 27:611-26. [PMID: 20533371 DOI: 10.1002/da.20700] [Citation(s) in RCA: 141] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
In DSM-IV-TR, trichotillomania (TTM) is classified as an impulse control disorder (not classified elsewhere), skin picking lacks its own diagnostic category (but might be diagnosed as an impulse control disorder not otherwise specified), and stereotypic movement disorder is classified as a disorder usually first diagnosed in infancy, childhood, or adolescence. ICD-10 classifies TTM as a habit and impulse disorder, and includes stereotyped movement disorders in a section on other behavioral and emotional disorders with onset usually occurring in childhood and adolescence. This article provides a focused review of nosological issues relevant to DSM-V, given recent empirical findings. This review presents a number of options and preliminary recommendations to be considered for DSM-V: (1) Although TTM fits optimally into a category of body-focused repetitive behavioral disorders, in a nosology comprised of relatively few major categories it fits best within a category of motoric obsessive-compulsive spectrum disorders, (2) available evidence does not support continuing to include (current) diagnostic criteria B and C for TTM in DSM-V, (3) the text for TTM should be updated to describe subtypes and forms of hair pulling, (4) there are persuasive reasons for referring to TTM as "hair pulling disorder (trichotillomania)," (5) diagnostic criteria for skin picking disorder should be included in DSM-V or in DSM-Vs Appendix of Criteria Sets Provided for Further Study, and (6) the diagnostic criteria for stereotypic movement disorder should be clarified and simplified, bringing them in line with those for hair pulling and skin picking disorder.
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Affiliation(s)
- Dan J Stein
- Department of Psychiatry, University of Cape Town, Rondebosch, Cape Town, South Africa.
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Phillips KA, Stein DJ, Rauch SL, Hollander E, Fallon BA, Barsky A, Fineberg N, Mataix-Cols D, Ferrão YA, Saxena S, Wilhelm S, Kelly MM, Clark LA, Pinto A, Bienvenu OJ, Farrow J, Leckman J. Should an obsessive-compulsive spectrum grouping of disorders be included in DSM-V? Depress Anxiety 2010; 27:528-55. [PMID: 20533367 PMCID: PMC3985410 DOI: 10.1002/da.20705] [Citation(s) in RCA: 135] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The obsessive-compulsive (OC) spectrum has been discussed in the literature for two decades. Proponents of this concept propose that certain disorders characterized by repetitive thoughts and/or behaviors are related to obsessive-compulsive disorder (OCD), and suggest that such disorders be grouped together in the same category (i.e. grouping, or "chapter") in DSM. This article addresses this topic and presents options and preliminary recommendations to be considered for DSM-V. The article builds upon and extends prior reviews of this topic that were prepared for and discussed at a DSM-V Research Planning Conference on Obsessive-Compulsive Spectrum Disorders held in 2006. Our preliminary recommendation is that an OC-spectrum grouping of disorders be included in DSM-V. Furthermore, we preliminarily recommend that consideration be given to including this group of disorders within a larger supraordinate category of "Anxiety and Obsessive-Compulsive Spectrum Disorders." These preliminary recommendations must be evaluated in light of recommendations for, and constraints upon, the overall structure of DSM-V.
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Kaplan MS, Krueger RB. Diagnosis, assessment, and treatment of hypersexuality. JOURNAL OF SEX RESEARCH 2010; 47:181-98. [PMID: 20358460 DOI: 10.1080/00224491003592863] [Citation(s) in RCA: 133] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
This article reviews the current evidence base for the diagnosis, assessment, and treatment of hypersexual conditions. Controversy concerning this diagnosis is discussed. Terminology and diagnostic criteria, as well as psychological, psychopharmacological, and other treatment approaches, are presented.
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Affiliation(s)
- Meg S Kaplan
- College of Physicians and Surgeons, Columbia University, NY, USA
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Winslow M, Subramaniam M, Qiu S, Lee A. Socio-demographic Profile and Psychiatric Comorbidity of Subjects with Pathological Gambling. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2010. [DOI: 10.47102/annals-acadmedsg.v39n2p122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Introduction: Pathological gambling is defined as the failure to resist the impulse to gamble despite disruption to personal, family and vocational life. It appears to be highly comorbid with psychiatric disorders. This study aims to describe the socio-demographic profile and comorbidity of 40 pathological gamblers compared to controls. Materials and Methods: Questionnaires were administered to 40 cases (90% male, mean age = 38.3, SD = 10.0) scoring 5 or more in the South Oaks Gambling Screen (SOGS) and verified to be pathological gamblers based on DSM-IV criteria and 40 age-and-gender-matched controls. Results: Study results showed that the prevalence of lifetime DSM-IV diagnoses were significantly different between cases and controls (χ² = 16.4, P <0.001), with 67.5% of the cases and 22.5% of the controls meeting the criteria, respectively. Eighty percent of the cases had at least one personality disorder compared to 45% in the control (χ² = 10.5, P <0.005). The common lifetime disorders observed in the cases were substance abuse disorder and anxiety while common personality disorders were obsessive-compulsive, avoidant and paranoid. Conclusion: This study highlights the high rates of comorbidity in a largely Chinese sample in an Asian setting and the importance of assessing pathological gamblers for comorbidities.
Key words: Asian, Comorbidities, Demographics, Pathological Gambling
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Jiménez-Murcia S, Granero Pérez R, Fernández-Aranda F, Alvarez Moya E, Aymamí MN, Gómez-Peña M, Bueno B, Santamaría JJ, Moragas L, Penelo E, Jaurrieta N, Alonso MP, Segalàs C, Real E, Labad J, Bove F, Vallejo J, Menchón JM. Comorbidity in pathological gambling: clinical variables, personality and treatment response. REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2010; 2:178-89. [PMID: 23034347 DOI: 10.1016/s1888-9891(09)73236-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2009] [Accepted: 09/28/2009] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Pathological gambling shows high comorbidity rates, especially with substance use disorders, although affective, anxiety and other impulse control disorders, as well as personality disorders, are also frequently associated. OBJECTIVES To explore comorbidity in pathological gambling with other mental disorders in a consecutive sample of patients attending a unit specialized in pathological gambling, and specifically the relationship between substance-related disorders, on the one hand, and personality and clinical variables in pathological gamblers, on the other. METHOD A total of 498 patients with a DSM-IV-TR diagnosis of Pathological Gambling (11.8% women) were assessed with a semi-structured clinical interview and several clinical and personality scales. RESULTS Higher comorbidity with affective disorders was found in women (30.5%), while higher comorbidity with substance-related disorders was found in men (11.2%). A positive association was also detected between a history of psychiatric disorders and current comorbidity with substance-use disorders, as well as between alcohol abuse and age. Finally, some personality traits such as low reward dependence (OR=0.964) and high impulsivity (OR=1.02) predicted other substance abuse (not alcohol). High selftranscendence scores predicted both alcohol and other substance abuse (OR=1.06). CONCLUSIONS Our results suggest a high prevalence of comorbid disorders in pathologic gambling, mainly with affective and substance-related disorders. The results of the present study, conducted in a broad sample of consecutively admitted pathologic gamblers, may contribute to understanding of this complex disorder and treatment improvement.
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Affiliation(s)
- S Jiménez-Murcia
- Servicio de Psiquiatría, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España; Ciber Fisiopatologia de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Barcelona, España.
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Jiménez-Murcia S, Granero Pérez R, Fernández-Aranda F, Álvarez Moya E, Aymamí M, Gómez-Peña M, Bueno B, Santamaría J, Moragas L, Penelo E, Jaurrieta N, Alonso M, Segalàs C, Real E, Labad J, Bove F, Vallejo J, Menchón J. Comorbidity of Pathological Gambling: clinical variables, personality and response to treatment. ACTA ACUST UNITED AC 2009. [DOI: 10.1016/s2173-5050(09)70050-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Kuzma JM, Black DW. Epidemiology, prevalence, and natural history of compulsive sexual behavior. Psychiatr Clin North Am 2008; 31:603-11. [PMID: 18996301 DOI: 10.1016/j.psc.2008.06.005] [Citation(s) in RCA: 195] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Research into CSB is hindered by the lack of a generally accepted definition and reliable and valid assessment tools. Despite these limitations, evidence indicates that CSB is relatively common in the general adult population, causes substantial personal distress, and is a source of significant psychosocial disability. CSB appears to begin early in life, to have a male preponderance, and to run a chronic or episodic course. It is also commonly associated with psychiatric comorbidity, typically mood, anxiety, substance use, and personality disorders. Further research is needed to better our understanding of the disorder and improve our ability to develop specific interventions.
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Affiliation(s)
- John M Kuzma
- HealthPartners Regions Behavioral Health, 640 Jackson Street, St. Paul, MN 55110, USA
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Personality Traits and Disorders in Pathological Gamblers versus Normal Controls. J Addict Dis 2008; 27:33-40. [DOI: 10.1300/j069v27n01_04] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Källmén H, Andersson P, Andren A. Are Irrational Beliefs and Depressive Mood More Common Among Problem Gamblers than Non-Gamblers? A Survey Study of Swedish Problem Gamblers and Controls. J Gambl Stud 2008; 24:441-50. [DOI: 10.1007/s10899-008-9101-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2008] [Accepted: 06/02/2008] [Indexed: 10/22/2022]
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Iancu I, Lowengrub K, Dembinsky Y, Kotler M, Dannon PN. Pathological gambling: an update on neuropathophysiology and pharmacotherapy. CNS Drugs 2008; 22:123-38. [PMID: 18193924 DOI: 10.2165/00023210-200822020-00004] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Neurobiological research has shown the potential involvement of serotonergic, dopaminergic and opioid dysfunction in the pathophysiology of pathological gambling. In this review, we present current theories of the neuropathology of pathological gambling, paying particular attention to the role of the neural circuitry underlying motivation, reward, decision-making and impulsivity. This review also presents a literature review of current pharmacological treatment strategies for pathological gambling, such as selective serotonin reuptake inhibitors (SSRIs), opioid receptor antagonists, anti-addiction drugs and mood stabilizers, and also discusses the role of nonpharmacological interventions.A hypothetical model of the clinical subtypes of pathological gambling is presented, e.g. the impulsive subtype, the obsessive-compulsive subtype and the addictive subtype. This model attempts to integrate current knowledge in the field of pathological gambling regarding neuropathology, psychiatric co-morbidity, family history, genetics, course of illness, gender and response to pharmacological treatment. Finally, it is proposed that the existence of possible clinical subtypes of pathological gambling may provide a potential framework for matching the various subtypes with specific pharmacotherapies.
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Affiliation(s)
- Iulian Iancu
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Abstract
OBJECTIVE Understanding variations in disease presentation in men and women is clinically important as differences may reflect biological and sociocultural factors and have implications for prevention and treatment strategies. Few empirical investigations have been performed in kleptomania, particularly with respect to gender-related influences. METHODS From 2001--2007, 95 adult subjects (n=27 [28.4%] males) with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition-defined kleptomania were assessed on sociodemographics and clinical characteristics, including symptom severity, comorbidity, and functional impairment, to identify gender-related differences. RESULTS Men and women showed substantial symptom severity and functional impairment. Compared with affected men, women with kleptomania were more likely to be married (47.1% vs 25.9%; P=.039), have a later age at shoplifting onset (20.9 vs 14 years of age; P=.001), steal household items (P<.001), hoard stolen items (P=.020), and have an eating disorder (P=.017) and less likely to steal electronic goods (P<.001) and have another impulse-control disorder (P=.018). CONCLUSION Kleptomania is similarly associated with significant impairment in women and men. Gender-related differences in clinical features and co-occurring disorders suggest that prevention and treatment strategies incorporate gender considerations.
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The Structure of Pathological Gambling among Korean Gamblers: A Cluster and Factor Analysis of Clinical and Demographic Characteristics. Int J Ment Health Addict 2007. [DOI: 10.1007/s11469-007-9082-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Westphal JR, Johnson LJ. Multiple Co-occurring Behaviours among Gamblers in Treatment: Implications and Assessment. INTERNATIONAL GAMBLING STUDIES 2007. [DOI: 10.1080/14459790601157905] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Gulsun M, Gulcat Z, Aydin H. Treatment of Compulsive Sexual Behaviour with Clomipramine and Valproic Acid. Clin Drug Investig 2007; 27:219-23. [PMID: 17305416 DOI: 10.2165/00044011-200727030-00005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
The concepts of compulsive sexual behaviour or sexual addiction and treatment of the disorder have been argued over by many investigators. From a scientific point of view, both concepts are still not well established in psychiatric nomenclature. On the other hand, authors point out that compulsive sexual behaviour, obsessive-compulsive disorder and substance addiction show similarities in symptomatology and response to treatment. In this article, the case of a 21-year-old female exhibiting compulsive sexual behaviour since childhood who was treated with a combination of clomipramine and valproic acid is presented and discussed in the light of the relevant literature.
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Affiliation(s)
- Murat Gulsun
- Isparta Military Hospital, Isparta Asker Hastanesi Psikiyatri Servisi, Egridir Yolu, Isparta, Turkey.
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Kim SW, Grant JE, Eckert ED, Faris PL, Hartman BK. Pathological gambling and mood disorders: clinical associations and treatment implications. J Affect Disord 2006; 92:109-16. [PMID: 16443282 DOI: 10.1016/j.jad.2005.12.040] [Citation(s) in RCA: 120] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The rapidly expanding gambling business has resulted in an increasing number of gamblers, and the problem is likely to get worse in the future. Traditionally, mood and gambling symptoms have been known to overlap. In the present review we attempt to examine the diagnostic associations and implications for treatment. METHOD Selected published papers on the frequencies of mood disorders among patients who have gambling disorder or gambling disorder among patients who have mood disorder have been reviewed. Recently emerging new treatment methods for gambling disorder have been reviewed and a brief summary has been added. RESULTS SCID based study results show a close link between gambling and mood disorders. The prevalence of manic disorder reaches to approximately one fourth of the pathological gambling disorder population. The prevalence of depression is much higher, reaching to over half of the population in some studies. LIMITATIONS The studies included in the present paper involve inpatients, outpatients, subjects recruited through advertisements and prison populations. Thus the data need to be interpreted as such. Standardized assessment instruments are not used in all studies. Methodological issues such as primary or secondary nature of depression have not been addressed adequately in these studies. The findings, however, offer new insights for the assessment and treatment of complicated gambling disorder cases. CONCLUSIONS A high prevalence rate of manic and depressive disorders has been recorded among pathological gambling disorder patients. A rational treatment approach to each defined subset of complicated gambling disorder is discussed.
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Affiliation(s)
- Suck Won Kim
- Department of Psychiatry, University of Minnesota Medical School, F282/2A West, 2450 Riverside Avenue, Minneapolis, 55454, USA.
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Black DW, Monahan PO, Temkit M, Shaw M. A family study of pathological gambling. Psychiatry Res 2006; 141:295-303. [PMID: 16499975 DOI: 10.1016/j.psychres.2005.12.005] [Citation(s) in RCA: 93] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2005] [Revised: 12/05/2005] [Accepted: 12/13/2005] [Indexed: 10/25/2022]
Abstract
The cause of pathological gambling (PG) is unknown. The current study was conducted to determine whether PG is familial, and to examine patterns of familial aggregation of psychiatric disorder. To that end, 31 case probands with DSM-IV PG and 31 control probands were recruited and interviewed regarding their first degree relatives (FDRs). Available and willing FDRs were directly interviewed with structured instruments of known reliability, and best estimate final diagnoses were blindly assigned for 193 case and 142 control relatives over age 18 years. The results were analyzed using logistic regression by the method of generalized estimating equations. The lifetime rates of PG and "any gambling disorder" were significantly greater among the relatives of case probands (8.3% and 12.4%, respectively) than among the control relatives (2.1% and 3.5%, respectively) (OR=3.36 for "any gambling disorder"). PG relatives also had significantly higher lifetime rates of alcohol disorders, "any substance use disorder," antisocial personality disorder (ASPD), and "any mental disorder". "Any gambling disorder," alcohol disorder, and "any substance use disorder" remained significant after a conservative Bonferroni correction. Interestingly, PG families were significantly larger than control families. We conclude that gambling disorders are familial and co-aggregate with substance misuse. The data are also suggestive that PG co-aggregates with ASPD. Further research on the heritability of PG is warranted.
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Affiliation(s)
- Donald W Black
- Department of Psychiatry, Psychiatry Research / 2-126B MEB, University of Iowa, Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA 52242, USA.
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