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Baenas I, Mora-Maltas B, Etxandi M, Lucas I, Granero R, Fernández-Aranda F, Tovar S, Solé-Morata N, Gómez-Peña M, Moragas L, Del Pino-Gutiérrez A, Tapia J, Diéguez C, Goudriaan AE, Jiménez-Murcia S. Cluster analysis in gambling disorder based on sociodemographic, neuropsychological, and neuroendocrine features regulating energy homeostasis. Compr Psychiatry 2024; 128:152435. [PMID: 37976998 DOI: 10.1016/j.comppsych.2023.152435] [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: 07/26/2023] [Revised: 10/12/2023] [Accepted: 10/26/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND The heterogeneity of gambling disorder (GD) has led to the identification of different subtypes, mostly including phenotypic features, with distinctive implications on the GD severity and treatment outcome. However, clustering analyses based on potential endophenotypic features, such as neuropsychological and neuroendocrine factors, are scarce so far. AIMS This study firstly aimed to identify empirical clusters in individuals with GD based on sociodemographic (i.e., age and sex), neuropsychological (i.e., cognitive flexibility, inhibitory control, decision making, working memory, attention, and set-shifting), and neuroendocrine factors regulating energy homeostasis (i.e., leptin, ghrelin, adiponectin, and liver-expressed antimicrobial peptide 2, LEAP-2). The second objective was to compare the profiles between clusters, considering the variables used for the clustering procedure and other different sociodemographic, clinical, and psychological features. METHODS 297 seeking-treatment adult outpatients with GD (93.6% males, mean age of 39.58 years old) were evaluated through a semi-structured clinical interview, self-reported psychometric assessments, and a protocolized neuropsychological battery. Plasma concentrations of neuroendocrine factors were assessed in peripheral blood after an overnight fast. Agglomerative hierarchical clustering was applied using sociodemographic, neuropsychological, and neuroendocrine variables as indicators for the grouping procedure. Comparisons between the empirical groups were performed using Chi-square tests (χ2) for categorical variables, and analysis of variance (ANOVA) for quantitative measures. RESULTS Three-mutually-exclusive groups were obtained, being neuropsychological features those with the greatest weight in differentiating groups. The largest cluster (Cluster 1, 65.3%) was composed by younger males with strategic and online gambling preferences, scoring higher on self-reported impulsivity traits, but with a lower cognitive impairment. Cluster 2 (18.2%) and 3 (16.5%) were characterized by a significantly higher proportion of females and older patients with non-strategic gambling preferences and a worse neuropsychological performance. Particularly, Cluster 3 had the poorest neuropsychological performance, especially in cognitive flexibility, while Cluster 2 reported the poorest inhibitory control. This latter cluster was also distinguished by a poorer self-reported emotion regulation, the highest prevalence of food addiction, as well as a metabolic profile characterized by the highest mean concentrations of leptin, adiponectin, and LEAP-2. CONCLUSIONS To the best of our knowledge, this is the first study to identify well-differentiated GD clusters using neuropsychological and neuroendocrine features. Our findings reinforce the heterogeneous nature of the disorder and emphasize a role of potential endophenotypic features in GD subtyping. This more comprehensive characterization of GD profiles could contribute to optimize therapeutic interventions based on a medicine of precision.
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Affiliation(s)
- Isabel Baenas
- Clinical Psychology Department, Bellvitge University Hospital, Barcelona, Spain; Psychoneurobiology of Eating and Addictive Behaviors Group, Neurosciences Program, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain; Ciber Physiopathology of Obesity and Nutrition (CIBERObn), Instituto de Salud Carlos III, Barcelona, Spain; Doctoral Program in Medicine and Translational Research, University of Barcelona (UB), Barcelona, Spain
| | - Bernat Mora-Maltas
- Clinical Psychology Department, Bellvitge University Hospital, Barcelona, Spain; Ciber Physiopathology of Obesity and Nutrition (CIBERObn), Instituto de Salud Carlos III, Barcelona, Spain; Doctoral Program in Medicine and Translational Research, University of Barcelona (UB), Barcelona, Spain
| | - Mikel Etxandi
- Doctoral Program in Medicine and Translational Research, University of Barcelona (UB), Barcelona, Spain; Department of Psychiatry, Hospital Universitari Germans Trias i Pujol, IGTP Campus Can Ruti, Badalona, Spain
| | - Ignacio Lucas
- Clinical Psychology Department, Bellvitge University Hospital, Barcelona, Spain; Psychoneurobiology of Eating and Addictive Behaviors Group, Neurosciences Program, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain; Ciber Physiopathology of Obesity and Nutrition (CIBERObn), Instituto de Salud Carlos III, Barcelona, Spain
| | - Roser Granero
- Psychoneurobiology of Eating and Addictive Behaviors Group, Neurosciences Program, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain; Ciber Physiopathology of Obesity and Nutrition (CIBERObn), Instituto de Salud Carlos III, Barcelona, Spain; Department of Psychobiology and Methodology, Autonomous University of Barcelona, Barcelona, Spain
| | - Fernando Fernández-Aranda
- Clinical Psychology Department, Bellvitge University Hospital, Barcelona, Spain; Psychoneurobiology of Eating and Addictive Behaviors Group, Neurosciences Program, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain; Ciber Physiopathology of Obesity and Nutrition (CIBERObn), Instituto de Salud Carlos III, Barcelona, Spain; Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Sulay Tovar
- Ciber Physiopathology of Obesity and Nutrition (CIBERObn), Instituto de Salud Carlos III, Barcelona, Spain; Department of Physiology, CIMUS, University of Santiago de Compostela, Instituto de Investigación Sanitaria (IDIS), Santiago de Compostela, Spain
| | - Neus Solé-Morata
- Clinical Psychology Department, Bellvitge University Hospital, Barcelona, Spain
| | - Mónica Gómez-Peña
- Clinical Psychology Department, Bellvitge University Hospital, Barcelona, Spain; Psychoneurobiology of Eating and Addictive Behaviors Group, Neurosciences Program, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
| | - Laura Moragas
- Clinical Psychology Department, Bellvitge University Hospital, Barcelona, Spain; Psychoneurobiology of Eating and Addictive Behaviors Group, Neurosciences Program, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
| | - Amparo Del Pino-Gutiérrez
- Psychoneurobiology of Eating and Addictive Behaviors Group, Neurosciences Program, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain; Ciber Physiopathology of Obesity and Nutrition (CIBERObn), Instituto de Salud Carlos III, Barcelona, Spain; Department of Public Health, Mental Health and Perinatal Nursing, School of Nursing, University of Barcelona, Barcelona, Spain
| | - Javier Tapia
- Psychoneurobiology of Eating and Addictive Behaviors Group, Neurosciences Program, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain; Doctoral Program in Medicine and Translational Research, University of Barcelona (UB), Barcelona, Spain; Medical Direction of Ambulatory Processes, South Metropolitan Territorial Management, Bellvitge University Hospital, Barcelona, Spain
| | - Carlos Diéguez
- Ciber Physiopathology of Obesity and Nutrition (CIBERObn), Instituto de Salud Carlos III, Barcelona, Spain; Department of Physiology, CIMUS, University of Santiago de Compostela, Instituto de Investigación Sanitaria (IDIS), Santiago de Compostela, Spain
| | - Anna E Goudriaan
- Arkin Mental Health Care, Jellinek, Amsterdam Institute for Addiction Research, Amsterdam, The Netherlands; Amsterdam UMC, Department of Psychiatry, University of Amsterdam, Amsterdam, The Netherlands; Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Susana Jiménez-Murcia
- Clinical Psychology Department, Bellvitge University Hospital, Barcelona, Spain; Psychoneurobiology of Eating and Addictive Behaviors Group, Neurosciences Program, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain; Ciber Physiopathology of Obesity and Nutrition (CIBERObn), Instituto de Salud Carlos III, Barcelona, Spain; Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain.
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Phenotype of Gambling Disorder Patients with Lotteries as a Preferred Form of Gambling. Int J Ment Health Addict 2022. [DOI: 10.1007/s11469-022-00793-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Abstract
Lottery gambling can become an addictive behavior which can significantly interfere with daily functioning. The objectives of this work were to estimate the prevalence of lottery gambling, to assess the profile related to this gambling type in a large clinical sample of patients who met criteria for gambling disorder (GD), and to compare this profile with the other two non-strategic forms of gambling (slot-machines and bingo). Sample included n = 3,531 patients consecutively attended for treatment-seeking due to gambling-related problems. All the participants met criteria for GD and were into the range of 18 to 85 years old. Sociodemographic variables, GD severity, psychopathological state, and personality traits were assessed. Statistical comparisons between the groups defined by the patients’ gambling preference (lotteries versus other gambling activities) were conducted, with chi-square test and analysis of variance. The prevalence of lotteries as the only gambling activity was 2.5%, 8.9% for lottery gambling as primary activity with other secondary gambling types, and 20.6% for lotteries as primary or secondary gambling activity. Lottery gambling and bingo gambling were more prevalent among women (bingo included the highest percentage of women). Compared to slot machine gambling, lotteries and bingo grouped older patients and those with later age of onset of the gambling-related problems. Bingo gambling showed the highest psychological distress and the most dysfunctional personality traits. This study shows the high frequency of lottery gambling among treatment-seeking for GD patients, and it provides empirical evidence about the profile associated with this gambling activity compared to other non-strategic gambling forms. The likelihood of lottery gambling is higher for women, patients married or living with a stable partner, and those within higher social position indexes.
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Delay Discounting in Gambling Disorder: Implications in Treatment Outcome. J Clin Med 2022; 11:jcm11061611. [PMID: 35329937 PMCID: PMC8955705 DOI: 10.3390/jcm11061611] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 02/21/2022] [Accepted: 03/12/2022] [Indexed: 02/04/2023] Open
Abstract
Impulsive choice, measured by delay discounting (DD) tasks, has been shown in patients with gambling disorders (GD). However, the impact of DD and treatment outcome has been scarcely explored in GD patients. The aims of this study were: (1) to examine the baseline association between DD and clinical variables in GD patients depending on their age and gambling preferences (strategic vs. non-strategic); and (2) to estimate the predictive role of DD on poorer outcomes of cognitive-behavioral therapy (CBT) when considering also the effect of other clinical variables. 133 treatment-seeking male GD patients were evaluated at baseline with a DD task and measures of GD severity, personality traits and psychopathology. Treatment outcome was measured in terms of dropout from CBT and relapses. Results showed baseline associations between DD and GD severity (correlation coefficient R = 0.408 among strategic gamblers and R = 0.279 among mixed gamblers) and between DD and positive/negative urgency (R = 0.330 for the youngest patients, R = 0.244 for middle age, and around R = 0.35 for gamblers who reported preferences for strategic games). Other personality traits such as high harm avoidance and low cooperativeness were also related to DD at baseline (R = 0.606 among strategic gamblers). Regarding treatment outcome, a steeper discount rate predicted a higher risk of relapses in strategic gamblers (odds ratio OR = 3.01) and middle-age ones (OR = 1.59), and a higher risk of dropout in younger gamblers (OR = 1.89), non-strategic gamblers (OR = 1.70) and mixed gamblers (R = 4.74). GD severity mediated the associations between age, DD, personality traits and poor CBT outcome. In conclusion, impulsive choice affects treatment response in individuals with GD and may interfere with it to a significant extent. Considering DD in GD, patients seeking treatment could help control its impact on treatment adherence and relapses.
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Griffiths KR, Aparício L, Braund TA, Yang J, Harvie G, Harris A, Hay PJ, Touyz S, Kohn MR. Impulsivity and Its Relationship With Lisdexamfetamine Dimesylate Treatment in Binge Eating Disorder. Front Psychol 2021; 12:716010. [PMID: 34531798 PMCID: PMC8439192 DOI: 10.3389/fpsyg.2021.716010] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 07/27/2021] [Indexed: 11/13/2022] Open
Abstract
High trait impulsivity is thought to contribute to the sense of loss of control over eating and impulses to binge eat experienced by those with binge eating disorder (BED). Lisdexamfetamine dimesylate (LDX), a drug approved for treatment of moderate to severe BED, has been shown to decrease impulsive features of BED. However, the relationship between LDX-related reductions of binge eating (BE) episodes and impulsivity has not yet been explored. Forty-one adults aged 18-40years with moderate to severe BED completed questionnaires and tasks assessing impulsivity at baseline and after 8weeks of 50-70mg of LDX. Twenty age-matched healthy controls were also assessed at two timepoints for normative comparison. Data were analysed using linear mixed models. BED participants exhibited increased self-reported motor, non-planning, cognitive and food-related impulsivity relative to controls but no differences in objective task-based measures of impulsivity. Food-related and non-planning impulsivity was significantly reduced by LDX, but not to normative levels. Individuals with higher baseline levels of motor and non-planning impulsivity, and loss of control over eating scores experienced the greatest reduction in BE frequency after 8weeks of LDX. Further, there were significant associations between the degree to which subjective loss of control over eating, non-planning impulsivity and BE frequency reduced after 8weeks of LDX. These data suggest that specific subjective measures of impulsivity may be able to predict who will have the greatest benefit from LDX treatment and that reductions in BE frequency may be moderated by concurrent reductions in non-planning impulsivity.
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Affiliation(s)
- Kristi R Griffiths
- Brain Dynamics Centre, Westmead Institute for Medical Research, University of Sydney, Westmead, NSW, Australia
| | - Leonor Aparício
- Brain Dynamics Centre, Westmead Institute for Medical Research, University of Sydney, Westmead, NSW, Australia.,Faculty of Medicine, University of Porto, Porto, Portugal
| | - Taylor A Braund
- Brain Dynamics Centre, Westmead Institute for Medical Research, University of Sydney, Westmead, NSW, Australia.,BlackDog Institute, Sydney, NSW, Australia.,Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Jenny Yang
- Brain Dynamics Centre, Westmead Institute for Medical Research, University of Sydney, Westmead, NSW, Australia
| | - Grace Harvie
- Brain Dynamics Centre, Westmead Institute for Medical Research, University of Sydney, Westmead, NSW, Australia
| | - Anthony Harris
- Brain Dynamics Centre, Westmead Institute for Medical Research, University of Sydney, Westmead, NSW, Australia.,Discipline of Psychiatry, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Phillipa J Hay
- School of Medicine, Translational Health Research Institute, Western Sydney University, Sydney, NSW, Australia
| | - Stephen Touyz
- Clinical Psychology Unit, School of Psychology, University of Sydney, Sydney, NSW, Australia.,InsideOut Institute, Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia
| | - Michael R Kohn
- Centre for Research into Adolescents' Health (CRASH), University of Sydney, Sydney, NSW, Australia.,Adolescent and Young Adult Medicine, Westmead Hospital, Sydney, NSW, Australia
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Pettorruso M, Testa G, Granero R, Martinotti G, d'Andrea G, di Giannantonio M, Fernández-Aranda F, Mena-Moreno T, Gómez-Peña M, Moragas L, Baenas I, Del Pino-Gutierrez A, Codina E, Valenciano-Mendoza E, Mora-Maltas B, Zoratto F, Valero-Solís S, Guillen-Guzmán E, Menchón JM, Jiménez-Murcia S. The transition time to gambling disorder: The roles that age, gambling preference and personality traits play. Addict Behav 2021; 116:106813. [PMID: 33453584 DOI: 10.1016/j.addbeh.2020.106813] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 12/20/2020] [Accepted: 12/28/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND AND AIMS Gambling Disorder (GD) is considered a heterogeneous, multidimensional pathology with high personal and social consequences. The transition time (TT) between problematic gaming and pathological gambling, which varies significantly across patients, may predict the disorder's severity. As only limited studies have investigated the factors implicated in the TT, the current study set out to identify its predictors and their relationships with GD severity. METHODS Correlation were performed in 725 male GD patients to identify factors associated to TT and GD severity, including: age of onset of gambling behaviors, alcohol/drug use, personality traits and gambling preferences (i.e., strategic, non-strategic, and mixed). Then a regression analysis was performed to identify predictors of TT to GD. RESULTS Longer TT correlated with higher GD severity, early age of onset of problematic gambling, substance use and a non-strategic gambling preference. Personality traits including low self-directedness, high novelty seeking, and low cooperativeness were also related with longer TT. The strongest associations with GD severity were substance use, and some of the personality traits (i.e., low self-directedness and cooperativeness, high harm avoidance and self-transcendence). Factors significantly predicting longer transition to GD were older ages, low self-directedness, and non-strategic gambling. CONCLUSIONS A clinical profile characterized by a longer TT and more severe GD symptoms pertains to older patients with low self-directedness, and preference for non-strategic gambling. Other relevant factors associated with this profile of patients included early age of onset problematic gambling, substance consumption, high novelty seeking and low cooperativeness.
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Jiménez-Murcia S, Giménez M, Granero R, Masuet-Aumatell C, Ramón JM, Agüero F, Morchón S, Moragas L, Baenas I, del Pino-Gutierrez A, Codina E, Valenciano-Mendoza E, Mora-Maltas B, Valero-Solís S, Etxandi M, Guillen-Guzmán E, Menchón JM, Fernández-Aranda F. Gambling disorder seeking treatment patients and tobacco use in relation to clinical profiles. Addict Behav 2021; 114:106723. [PMID: 33203595 DOI: 10.1016/j.addbeh.2020.106723] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 10/05/2020] [Accepted: 10/24/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Tobacco smoking and gambling disorder (GD) often co-occur. However, few studies have assessed the extent to which cigarette smoking may serve to classify and/or better define GD behaviour profiles. METHODS Among a large sample of n = 3,652 consecutive treatment-seeking patients with GD (91% men). Smokers were compared to non-smokers across different sociodemographic, clinical, psychopathological and personality variables. The effect sizes for the means and the proportion differences between the groups were estimated. An evaluation of the smoking changes over the last 15 years was also performed. RESULTS From the total sample, 62.4% of gamblers reported tobacco use. A decreasing linear trend in tobacco use was observed within the studied period, women having a more irregular pattern. The use of tobacco was linked to the use of alcohol and other illegal drugs. Gamblers who smoke, as compared to those who don't, presented lower education levels, lower social position indexes and active employment. They were younger, with an earlier age of onset, shorter duration of the gambling behavior, higher GD severity, more psychological symptoms, higher scores in novelty seeking and lower scores in reward dependence, self-directedness and self-transcendence. CONCLUSIONS Gamblers seeking treatment who smoke display particular social, clinical, psychological, temperamental and character features different from non-smoking gamblers, suggesting that the presence or absence of comorbid smoking condition in GD should always be considered when developing an optimal treatment, as gamblers who smoke might need treatment strategies different from non-smoking gamblers.
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Kurilla A. Is Subtyping of Gamblers Based on the Pathways Model of Problem and Disordered Gambling Valid? A Systematic Review. J Gambl Stud 2021; 37:983-1006. [PMID: 33386516 DOI: 10.1007/s10899-020-09995-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2020] [Indexed: 02/07/2023]
Abstract
Gamblers are a heterogenous group in terms of the presence of comorbid psychopathology, maladaptive personality traits, and motivation to gamble. The Pathways Model, the most promising comprehensive framework to explain this heterogeneity, classifies gamblers into three subtypes. The aim of this review was to determine whether or not subtyping of gamblers based on the Pathways Model of problem and disordered gambling is valid. A literature review was conducted using the following online databases: Academic Search Complete, PubMed, Web of Science, and PsychINFO. Studies were selected or excluded based on meeting predetermined criteria. Fourteen studies examining subtyping of gamblers based on the Pathways Model were reviewed and evaluated. Results suggest that in the adult population there are three subtypes of gamblers that largely coincide with the subtypes defined in the Pathways Model. Of these, the emotionally vulnerable subtype is the most problematic and inconsistent. In contrast, for adolescents, at least four gambler subtypes have been identified. The extant literature on subtyping of gamblers suffers from some severe limitations. Further research is required to fully validate the Pathways Model.
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Affiliation(s)
- Adam Kurilla
- Psychology Department, College of Humanities and Sciences, Virginia Commonwealth University, 806 West Franklin Street, Richmond, VA, 23284-2018, USA.
- Center for Treatment of Drug Dependencies, Hranicna 2, 821 05, Bratislava, Slovak Republic.
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Jiménez-Murcia S, Granero R, Giménez M, Del Pino-Gutiérrez A, Mestre-Bach G, Mena-Moreno T, Moragas L, Baño M, Sánchez-González J, de Gracia M, Baenas-Soto I, Contaldo SF, Valenciano-Mendoza E, Mora-Maltas B, López-González H, Menchón JM, Fernández-Aranda F. Contribution of sex on the underlying mechanism of the gambling disorder severity. Sci Rep 2020; 10:18722. [PMID: 33127941 PMCID: PMC7599246 DOI: 10.1038/s41598-020-73806-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 09/22/2020] [Indexed: 12/19/2022] Open
Abstract
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.
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Affiliation(s)
- Susana Jiménez-Murcia
- Ciber Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Madrid, Spain. .,Department of Psychiatry, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, C/Feixa Llarga S/N, C.P. 08907, Barcelona, Spain. .,Department of Clinical Sciences, School of Medicine, Universitat de Barcelona - UB, L'Hospitalet de Llobregat, Barcelona, Spain. .,Psychiatry and Mental Health Group, Neuroscience Program, Institut D'Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Roser Granero
- Ciber Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Madrid, Spain.,Department of Psychiatry, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, C/Feixa Llarga S/N, C.P. 08907, Barcelona, Spain.,Department of Psychobiology and Methodology, Autonomous University of Barcelona, Barcelona, Spain
| | - Mónica Giménez
- Department of Psychiatry, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, C/Feixa Llarga S/N, C.P. 08907, Barcelona, Spain.,Ciber Salud Mental (CIBERsam), Instituto de Salud Carlos III, Madrid, Spain
| | - Amparo Del Pino-Gutiérrez
- Department of Psychiatry, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, C/Feixa Llarga S/N, C.P. 08907, Barcelona, Spain.,Department of Public Health, Mental Health and Perinatal Nursing, School of Nursing, University of Barcelona, Barcelona, Spain
| | - Gemma Mestre-Bach
- Ciber Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Madrid, Spain.,Department of Psychiatry, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, C/Feixa Llarga S/N, C.P. 08907, Barcelona, Spain
| | - Teresa Mena-Moreno
- Ciber Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Madrid, Spain.,Department of Psychiatry, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, C/Feixa Llarga S/N, C.P. 08907, Barcelona, Spain
| | - Laura Moragas
- Department of Psychiatry, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, C/Feixa Llarga S/N, C.P. 08907, Barcelona, Spain
| | - Marta Baño
- Department of Psychiatry, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, C/Feixa Llarga S/N, C.P. 08907, Barcelona, Spain
| | - Jéssica Sánchez-González
- Department of Psychiatry, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, C/Feixa Llarga S/N, C.P. 08907, Barcelona, Spain
| | - Marta de Gracia
- Department of Psychiatry, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, C/Feixa Llarga S/N, C.P. 08907, Barcelona, Spain
| | - Isabel Baenas-Soto
- Department of Psychiatry, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, C/Feixa Llarga S/N, C.P. 08907, Barcelona, Spain
| | - S Fabrizio Contaldo
- Department of Psychiatry, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, C/Feixa Llarga S/N, C.P. 08907, Barcelona, Spain
| | - Eduardo Valenciano-Mendoza
- Department of Psychiatry, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, C/Feixa Llarga S/N, C.P. 08907, Barcelona, Spain.,Ciber Salud Mental (CIBERsam), Instituto de Salud Carlos III, Madrid, Spain
| | - Bernat Mora-Maltas
- Department of Psychiatry, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, C/Feixa Llarga S/N, C.P. 08907, Barcelona, Spain
| | - Hibai López-González
- Department of Psychiatry, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, C/Feixa Llarga S/N, C.P. 08907, Barcelona, Spain
| | - José M Menchón
- Department of Psychiatry, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, C/Feixa Llarga S/N, C.P. 08907, Barcelona, Spain.,Department of Clinical Sciences, School of Medicine, Universitat de Barcelona - UB, L'Hospitalet de Llobregat, Barcelona, Spain.,Ciber Salud Mental (CIBERsam), Instituto de Salud Carlos III, Madrid, Spain
| | - Fernando Fernández-Aranda
- Ciber Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Madrid, Spain.,Department of Psychiatry, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, C/Feixa Llarga S/N, C.P. 08907, Barcelona, Spain.,Department of Clinical Sciences, School of Medicine, Universitat de Barcelona - UB, L'Hospitalet de Llobregat, Barcelona, Spain.,Psychiatry and Mental Health Group, Neuroscience Program, Institut D'Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
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9
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Marques DR, Gomes AA, Clemente V, Drake CL, Roth T, Morin CM, de Azevedo MHP. Typologies of individuals vulnerable to insomnia: a two-step cluster analysis. Sleep Biol Rhythms 2020. [DOI: 10.1007/s41105-020-00285-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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11
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Aloi M, Verrastro V, Rania M, Sacco R, Fernández-Aranda F, Jiménez-Murcia S, De Fazio P, Segura-Garcia C. The Potential Role of the Early Maladaptive Schema in Behavioral Addictions Among Late Adolescents and Young Adults. Front Psychol 2020; 10:3022. [PMID: 32038394 PMCID: PMC6985770 DOI: 10.3389/fpsyg.2019.03022] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 12/20/2019] [Indexed: 12/22/2022] Open
Abstract
Background Behavioral addiction (BA) is a recent concept in psychiatry. Few studies have investigated the relationship between BA and early maladaptive schemas (EMSs). EMS is the core of Schema Therapy (ST). According to the ST model, psychiatric disorders result from the development of EMSs in response to unmet emotional needs in childhood. Bach et al. (2018) grouped the 18 EMSs into four domains: (1) disconnection and rejection; (2) impaired autonomy and performance; (3) excessive responsibility and standards; and (4) impaired limits. This study aims to assess the possible association of the most frequent BAs with EMSs in a large group of late adolescents and young adults and to evaluate their self-perceived quality of life (QoL). Methods A battery of psychological tests assessing food addiction (FA), gambling disorder (GD), internet addiction (IA), and QoL was administered to 1,075 late adolescents and young adults (N = 637; 59.3% women). A forward-stepwise logistic regression model was run to identify which variables were associated with BAs. Results Food addiction was more frequent among women and GD among men, while IA was equally distributed. Regarding the EMSs, participants with FA or IA showed significantly higher scores on all four-schema domains, whereas those with GD exhibited higher scores on impaired autonomy and performance and impaired limits. Besides, average scores of all domains increased with the association of two or more comorbid BAs. Self-perceived QoL was lower for participants with FA and IA, but not for those with GD; the presence of comorbid BAs was associated with lower Physical Component Summary (PCS) and Mental Component Summary (MCS) scores. Finally, specific EMS domains and demographic variables were associated with each BA. Conclusion Late adolescents and young adults with FA or IA have a lower perception of their mental and physical health. The most striking result is that FA appears to be associated with the disconnection and rejection schema domain, IA with all the schema domains (except for impaired autonomy and performance), and GD with impaired autonomy and performance schema domain. In conclusion, our findings suggest that EMS should be systematically assessed during psychotherapy of patients with BAs.
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Affiliation(s)
- Matteo Aloi
- Department of Health Sciences, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
| | - Valeria Verrastro
- Department of Medical and Surgical Sciences, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
| | - Marianna Rania
- Department of Health Sciences, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
| | - Raffaella Sacco
- Department of Health Sciences, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
| | - Fernando Fernández-Aranda
- Department of Psychiatry, Bellvitge University Hospital, IDIBELL, Barcelona, Spain.,CIBER Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Barcelona, Spain.,Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Susana Jiménez-Murcia
- Department of Psychiatry, Bellvitge University Hospital, IDIBELL, Barcelona, Spain.,CIBER Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Barcelona, Spain.,Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Pasquale De Fazio
- Department of Health Sciences, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
| | - Cristina Segura-Garcia
- Department of Medical and Surgical Sciences, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
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12
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Sharman S, Clark L, Roberts A, Michalczuk R, Cocks R, Bowden-Jones H. Heterogeneity in Disordered Gambling: Decision-Making and Impulsivity in Gamblers Grouped by Preferred Form. Front Psychiatry 2019; 10:588. [PMID: 31481905 PMCID: PMC6709538 DOI: 10.3389/fpsyt.2019.00588] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Accepted: 07/25/2019] [Indexed: 11/13/2022] Open
Abstract
Background: Previous research has indicated that disordered gamblers display deficits in impulsivity and risky decision-making, compared to healthy control groups. However, disordered gamblers are not a homogenous group, and differences in performance on neurocognitive tasks may be related to the form of gambling in which an individual chooses to engage. The present study used neurocognitive tasks and questionnaire measures to ascertain group differences in gamblers grouped by preferred form of gambling. Method: Treatment-seeking pathological gamblers from the National Problem Gambling Clinic, London (n = 101), completed a neurocognitive assessment comprising the Cambridge gamble task (CGT), the stop-signal task (SST), a probabilistic reversal learning task (PRL), and the Kirby Monetary Choice Questionnaire, as well as questionnaire measures of gambling severity, impulsivity, depression, and anxiety. Analyses compared gamblers who favored fixed-odds betting terminals (FOBTs) (the modal form) to gamblers who preferred other forms of gambling (non-FOBT). Results: The FOBT group showed impaired decision-making under risk on the CGT compared to the non-FOBT group, choosing the likely option less on more uncertain decisions. The FOBT group made fewer perseverative errors on the PRL task, had lower depression and anxiety scores, and were less likely to have a family history of problem gambling than the non-FOBT group. Discussion: Decision-making and cognitive flexibility differences between gamblers grouped by gambling type supports preferred form as an important source of heterogeneity in gambling disorder. Decision-making strategies and risk attitudes should be considered when approaching cognition-focused treatment strategies, allowing interventions to be targeted at specific cognitive deficits.
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Affiliation(s)
- Steve Sharman
- School of Psychology, College of Applied Health and Communities, University of East London, London, United Kingdom.,Department of Psychology, University of Cambridge, Cambridge, United Kingdom
| | - Luke Clark
- Department of Psychology, University of Cambridge, Cambridge, United Kingdom.,Centre for Gambling Research at UBC, Department of Psychology, University of British Columbia, Vancouver, BC, Canada
| | - Amanda Roberts
- School of Psychology, College of Social Science, University of Lincoln, Lincoln, United Kingdom
| | - Rosanna Michalczuk
- Department of Psychology, University of Cambridge, Cambridge, United Kingdom.,South London and Maudsley Trust, Bethlem Royal Hospital, London, United Kingdom
| | - Rachel Cocks
- Department of Psychology, University of Cambridge, Cambridge, United Kingdom.,Royal Holloway, University of London, London, United Kingdom
| | - Henrietta Bowden-Jones
- National Problem Gambling Clinic, London, United Kingdom.,Faculty of Medicine, Faculty of Medicine Centre, Imperial College London, London, United Kingdom
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13
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Mallorquí-Bagué N, Tolosa-Sola I, Fernández-Aranda F, Granero R, Fagundo AB, Lozano-Madrid M, Mestre-Bach G, Gómez-Peña M, Aymamí N, Borrás-González I, Sánchez-González J, Baño M, Del Pino-Gutiérrez A, Menchón JM, Jiménez-Murcia S. Cognitive Deficits in Executive Functions and Decision-Making Impairments Cluster Gambling Disorder Sub-types. J Gambl Stud 2018; 34:209-223. [PMID: 29058168 DOI: 10.1007/s10899-017-9724-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
To identify Gambling Disorder (GD) subtypes, in a population of men seeking treatment for GD, according to specific executive function domains (i.e., cognitive flexibility, inhibition and working memory as well as decision making) which are usually impaired in addictive behaviors. A total of 145 males ranging from 18 to 65 years diagnosed with GD were included in this study. All participants completed: (a) a set of questionnaires to assess psychopathological symptoms, personality and impulsivity traits, and (b) a battery of neuropsychological measures to test different executive functioning domains. Two clusters were identified based on the individual performance on the neuropsychological assessment. Cluster 1 [n = 106; labeled as Low Impaired Executive Function (LIEF)] was composed by patients with poor results in the neuropsychological assessment; cluster 2 patients [n = 46; labeled as High Impaired Executive Function (HIEF)] presented significantly higher deficits on the assessed domains and performed worse than the ones of LIEF cluster. Regarding the characterization of these two clusters, patients in cluster 2 were significantly older, unemployed and registered higher mean age of GD onset than patients in cluster 1. Additionally, patients in cluster 2 also obtained higher psychopathological symptoms, impulsivity (in both positive and negative urgency as well as sensation seeking) and some specific personality traits (higher harm avoidance as well as lower self-directedness and cooperativeness) than patients in cluster 1. The results of this study describe two different GD subtypes based on different cognitive domains (i.e., executive function performance). These two GD subtypes display different impulsivity and personality traits as well as clinical symptoms. The results provide new insight into the etiology and characterization of GD and have the potential to help improving current treatments.
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Affiliation(s)
- Núria Mallorquí-Bagué
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain. .,Ciber Fisiopatologia Obesidad y Nutrición (CB 06/03), Instituto Salud Carlos III, Madrid, Spain.
| | - Iris Tolosa-Sola
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain.,Ciber Fisiopatologia Obesidad y Nutrición (CB 06/03), Instituto Salud Carlos III, Madrid, Spain
| | - Fernándo Fernández-Aranda
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain.,Ciber Fisiopatologia Obesidad y Nutrición (CB 06/03), Instituto Salud Carlos III, Madrid, Spain.,Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain
| | - Roser Granero
- Ciber Fisiopatologia Obesidad y Nutrición (CB 06/03), Instituto Salud Carlos III, Madrid, Spain.,Departament de Psicobiologia i Metodologia, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ana Beatriz Fagundo
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain.,Ciber Fisiopatologia Obesidad y Nutrición (CB 06/03), Instituto Salud Carlos III, Madrid, Spain
| | - María Lozano-Madrid
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain.,Ciber Fisiopatologia Obesidad y Nutrición (CB 06/03), Instituto Salud Carlos III, Madrid, Spain
| | - Gemma Mestre-Bach
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain.,Ciber Fisiopatologia Obesidad y Nutrición (CB 06/03), Instituto Salud Carlos III, Madrid, Spain
| | - Mónica Gómez-Peña
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain
| | - Neus Aymamí
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain
| | | | | | - Marta Baño
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain
| | | | - José M Menchón
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain
| | - Susana Jiménez-Murcia
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain. .,Ciber Fisiopatologia Obesidad y Nutrición (CB 06/03), Instituto Salud Carlos III, Madrid, Spain. .,Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain.
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14
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Sociodemographic and psychopathological predictors of criminal behavior in women with gambling disorder. Addict Behav 2018; 80:124-129. [PMID: 29407682 DOI: 10.1016/j.addbeh.2018.01.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 01/16/2018] [Accepted: 01/16/2018] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Women have been underrepresented in the empirical research of gambling disorder (GD), a psychiatric condition included in the Diagnostic and Statistical Manual of Mental Health Disorders (DSM-5). More specifically, no studies to date have been carried out exploring the clinical phenotype of women with GD who have committed gambling-related illegal acts. AIMS In this study, we sought to delineate the clinical, personality and psychopathological differences between treatment-seeking women with GD, with and without a criminal record. Furthermore, we aimed to identify the variables that best predict the presence of illegal acts in this clinical group. MATERIAL AND METHODS Data corresponded to n=273 treatment-seeking women who met criteria for GD. Two groups were compared: women with a history of criminal behavior (n=61, 22.34%) to those who did not (n=212, 77.66%) taking psychopathology, clinical and personality data into account. RESULTS Women who engaged in criminal acts were younger and endorsed higher psychopathology, GD severity, and novelty seeking levels than the other clinical group. Regarding the predictive model, women with higher levels of novelty seeking and lower levels of reward dependence were at higher risk of having a criminal record. DISCUSSION, CONCLUSIONS AND IMPLICATIONS FOR PRACTICE AND/OR POLICY: Our findings uphold that women with GD and a history of illegal acts are especially vulnerable in terms of comorbid psychopathology and dysfunctional personality traits. Therefore, this population could potentially benefit from public policies that target their mental health needs.
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15
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Menchon JM, Mestre-Bach G, Steward T, Fernández-Aranda F, Jiménez-Murcia S. An overview of gambling disorder: from treatment approaches to risk factors. F1000Res 2018; 7:434. [PMID: 30090625 PMCID: PMC5893944 DOI: 10.12688/f1000research.12784.1] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/03/2018] [Indexed: 12/26/2022] Open
Abstract
Gambling disorder (GD) has been reclassified recently into the "Substance-Related and Addictive Disorders" category of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), a landmark occurrence for a behavioral addiction. GD is characterized by recurrent, maladaptive gambling behavior that results in clinically significant distress. Although the number of randomized controlled trials assessing the effectiveness of pharmacological treatments is limited, some pharmacological treatments, notably opiate antagonists, have been employed in the treatment of GD. Patients with GD often present cognitive distortions and specific personality traits, making treatment more difficult. Cognitive behavioral therapy has become the most common psychological intervention for treating gambling problems, and it is effective in reducing gambling behavior. In this brief overview, we provide a report on the state of pharmacological and psychological treatments for gambling disorder. Risk factors and potential future lines of research are addressed.
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Affiliation(s)
- José M Menchon
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain.,Departament of Clinical Sciences, School of Medicine, University of Barcelona , Barcelona, Spain.,CIBER Salud Mental (CIBERSAM), Instituto Carlos III, Barcelona, Spain
| | - Gemma Mestre-Bach
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain.,Ciber Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Barcelona, Spain
| | - Trevor Steward
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain.,Ciber Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Barcelona, Spain
| | - Fernando Fernández-Aranda
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain.,Departament of Clinical Sciences, School of Medicine, University of Barcelona , Barcelona, Spain.,Ciber Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Barcelona, Spain
| | - Susana Jiménez-Murcia
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain.,Departament of Clinical Sciences, School of Medicine, University of Barcelona , Barcelona, Spain.,Ciber Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Barcelona, Spain
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16
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Jiménez-Murcia S, Fernández-Aranda F, Mestre-Bach G, Granero R, Tárrega S, Torrubia R, Aymamí N, Gómez-Peña M, Soriano-Mas C, Steward T, Moragas L, Baño M, Del Pino-Gutiérrez A, Menchón JM. Exploring the Relationship between Reward and Punishment Sensitivity and Gambling Disorder in a Clinical Sample: A Path Modeling Analysis. J Gambl Stud 2017; 33:579-597. [PMID: 27447184 DOI: 10.1007/s10899-016-9631-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Most individuals will gamble during their lifetime, yet only a select few will develop gambling disorder. Gray's Reinforcement Sensitivity Theory holds promise for providing insight into gambling disorder etiology and symptomatology as it ascertains that neurobiological differences in reward and punishment sensitivity play a crucial role in determining an individual's affect and motives. The aim of the study was to assess a mediational pathway, which included patients' sex, personality traits, reward and punishment sensitivity, and gambling-severity variables. The Sensitivity to Punishment and Sensitivity to Reward Questionnaire, the South Oaks Gambling Screen, the Symptom Checklist-Revised, and the Temperament and Character Inventory-Revised were administered to a sample of gambling disorder outpatients (N = 831), diagnosed according to DSM-5 criteria, attending a specialized outpatient unit. Sociodemographic variables were also recorded. A structural equation model found that both reward and punishment sensitivity were positively and directly associated with increased gambling severity, sociodemographic variables, and certain personality traits while also revealing a complex mediational role for these dimensions. To this end, our findings suggest that the Sensitivity to Punishment and Sensitivity to Reward Questionnaire could be a useful tool for gaining a better understanding of different gambling disorder phenotypes and developing tailored interventions.
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Affiliation(s)
- Susana Jiménez-Murcia
- Pathological Gambling Unit, Department of Psychiatry, Bellvitge University Hospital-IDIBELL, C/Feixa Llarga s/n, Hospitalet de Llobregat, 08907, Barcelona, Spain. .,Ciber Fisiopatología Obesidad y Nutrición (CB 06/03), Instituto Salud Carlos III, C/Monforte de Lemos, 3-5. Pabellón 11-Planta 0, 28029, Madrid, Spain. .,Department of Clinical Sciences, School of Medicine, University of Barcelona, Campus de Bellvitge - Pavelló de Govern, Feixa Llarga s/n, Hospitalet de Llobregat, 08907, Barcelona, Spain.
| | - Fernando Fernández-Aranda
- Pathological Gambling Unit, Department of Psychiatry, Bellvitge University Hospital-IDIBELL, C/Feixa Llarga s/n, Hospitalet de Llobregat, 08907, Barcelona, Spain.,Ciber Fisiopatología Obesidad y Nutrición (CB 06/03), Instituto Salud Carlos III, C/Monforte de Lemos, 3-5. Pabellón 11-Planta 0, 28029, Madrid, Spain.,Department of Clinical Sciences, School of Medicine, University of Barcelona, Campus de Bellvitge - Pavelló de Govern, Feixa Llarga s/n, Hospitalet de Llobregat, 08907, Barcelona, Spain
| | - Gemma Mestre-Bach
- Pathological Gambling Unit, Department of Psychiatry, Bellvitge University Hospital-IDIBELL, C/Feixa Llarga s/n, Hospitalet de Llobregat, 08907, Barcelona, Spain.,Ciber Fisiopatología Obesidad y Nutrición (CB 06/03), Instituto Salud Carlos III, C/Monforte de Lemos, 3-5. Pabellón 11-Planta 0, 28029, Madrid, Spain
| | - Roser Granero
- Ciber Fisiopatología Obesidad y Nutrición (CB 06/03), Instituto Salud Carlos III, C/Monforte de Lemos, 3-5. Pabellón 11-Planta 0, 28029, Madrid, Spain.,Departament de Psicobiologia i Metodologia de les Ciències de la Salut, Universitat Autònoma de Barcelona, C/Fortuna Edifici B, Bellaterra, Cerdanyola del Vallès, 08193, Barcelona, Spain
| | - Salomé Tárrega
- Departament de Psicobiologia i Metodologia de les Ciències de la Salut, Universitat Autònoma de Barcelona, C/Fortuna Edifici B, Bellaterra, Cerdanyola del Vallès, 08193, Barcelona, Spain
| | - Rafael Torrubia
- Department of Psychiatry and Forensic Medicine, Institute of Neurosciences, School of Medicine, Autonomous University of Barcelona, Av. de Can Domènech, 737, 08193, Cerdanyola, Barcelona, Spain
| | - Neus Aymamí
- Pathological Gambling Unit, Department of Psychiatry, Bellvitge University Hospital-IDIBELL, C/Feixa Llarga s/n, Hospitalet de Llobregat, 08907, Barcelona, Spain
| | - Mónica Gómez-Peña
- Pathological Gambling Unit, Department of Psychiatry, Bellvitge University Hospital-IDIBELL, C/Feixa Llarga s/n, Hospitalet de Llobregat, 08907, Barcelona, Spain
| | - Carles Soriano-Mas
- Pathological Gambling Unit, Department of Psychiatry, Bellvitge University Hospital-IDIBELL, C/Feixa Llarga s/n, Hospitalet de Llobregat, 08907, Barcelona, Spain.,Departament de Psicobiologia i Metodologia de les Ciències de la Salut, Universitat Autònoma de Barcelona, C/Fortuna Edifici B, Bellaterra, Cerdanyola del Vallès, 08193, Barcelona, Spain.,Ciber de Salud Mental (CIBERSAM), Instituto Salud Carlos III, C/Monforte de Lemos 3-5. Pabellón 11-Planta 0, 28029, Madrid, Spain
| | - Trevor Steward
- Pathological Gambling Unit, Department of Psychiatry, Bellvitge University Hospital-IDIBELL, C/Feixa Llarga s/n, Hospitalet de Llobregat, 08907, Barcelona, Spain.,Ciber Fisiopatología Obesidad y Nutrición (CB 06/03), Instituto Salud Carlos III, C/Monforte de Lemos, 3-5. Pabellón 11-Planta 0, 28029, Madrid, Spain
| | - Laura Moragas
- Pathological Gambling Unit, Department of Psychiatry, Bellvitge University Hospital-IDIBELL, C/Feixa Llarga s/n, Hospitalet de Llobregat, 08907, Barcelona, Spain
| | - Marta Baño
- Pathological Gambling Unit, Department of Psychiatry, Bellvitge University Hospital-IDIBELL, C/Feixa Llarga s/n, Hospitalet de Llobregat, 08907, Barcelona, Spain
| | - Amparo Del Pino-Gutiérrez
- Nursing Department of Mental Health, Public Health, Maternal and Child Health, Nursing School, University of Barcelona, Campus de Bellvitge - Pavelló de Govern, Feixa Llarga s/n, Hospitalet del Llobregat, 08907, Barcelona, Spain
| | - José M Menchón
- Pathological Gambling Unit, Department of Psychiatry, Bellvitge University Hospital-IDIBELL, C/Feixa Llarga s/n, Hospitalet de Llobregat, 08907, Barcelona, Spain.,Ciber Fisiopatología Obesidad y Nutrición (CB 06/03), Instituto Salud Carlos III, C/Monforte de Lemos, 3-5. Pabellón 11-Planta 0, 28029, Madrid, Spain.,Ciber de Salud Mental (CIBERSAM), Instituto Salud Carlos III, C/Monforte de Lemos 3-5. Pabellón 11-Planta 0, 28029, Madrid, Spain
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17
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Steward T, Mestre-Bach G, Fernández-Aranda F, Granero R, Perales JC, Navas JF, Soriano-Mas C, Baño M, Fernández-Formoso JA, Martín-Romera V, Menchón JM, Jiménez-Murcia S. Delay discounting and impulsivity traits in young and older gambling disorder patients. Addict Behav 2017; 71:96-103. [PMID: 28288442 DOI: 10.1016/j.addbeh.2017.03.001] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 02/23/2017] [Accepted: 03/04/2017] [Indexed: 01/12/2023]
Abstract
BACKGROUND Impulsivity is understood to be a multidimensional construct involving aspects such as impulsive choice and impulsive traits. Delay discounting, the tendency to place greater value in immediate rewards over larger, long-term rewards, has been associated with maladaptive choices in gambling disorder (GD). Delay discounting is known to evolve with age; though no study to date has evaluated the interactions between impulsivity, GD severity and age in treatment-seeking patients. OBJECTIVES We aimed to examine whether associations between delay discounting and impulsivity traits differed between younger and older-aged GD patients. Secondly, we sought to untangle the mediating role of impulsivity in determining gambling behavior in these two age groups. METHODS GD patients (N=335) were evaluated using the UPPS-P Impulsive Behavior Scale and a delay discounting task. Structural Equation Modeling (SEM) was used to explore associations between impulsivity measures and gambling severity in young (18-30years) and old (31-70) GD patients. RESULTS No differences in delay discounting were found between young and old GD patients. Significant correlations between delay discounting and urgency levels (the tendency to act rashly under emotional states) were identified only in the young GD group. Path analyses also revealed both positive and negative urgency to be a mediator of GD severity levels in young GD patients. DISCUSSION AND CONCLUSIONS Significant associations between impulsive choice and positive urgency are only present in young gamblers, suggesting that positive urgency influence choice behavior to a greater degree at younger ages. Implications for targeted interventions are discussed.
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18
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Granero R, Fernández-Aranda F, Aymamí N, Gómez-Peña M, Fagundo AB, Sauchelli S, Del Pino-Gutiérrez A, Moragas L, Savvidou LG, Islam MA, Tàrrega S, Menchón JM, Jiménez-Murcia S. Subtypes of Pathological Gambling with Concurrent Illegal Behaviors. J Gambl Stud 2016; 31:1161-78. [PMID: 25228407 DOI: 10.1007/s10899-014-9499-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The aims of this study are: to explore empirical clusters in a sample of individuals with a gambling disorder (GD) according to the presence of illegal behaviors, to describe the subgroups at a clinical level and to examine whether a temporal change has taken place across the last 9 years. The sample consisted of 378 patients with a GD who consecutively received outpatient treatment, and who reported the presence of the DSM-IV criteria "presence of illegal behavior". Two-step clustering procedure revealed the existence of four empirical groups, which differed in both sociodemographic and clinical profiles. The patients, who have committed illegal acts due to their gambling behavior, are a heterogeneous group in which it is possible to identify different subtypes, based on sociodemographic, psychopathological, clinical and personality characteristics.
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Affiliation(s)
- Roser Granero
- Departament de Psicobiologia i Metodologia de les Ciències de la Salut, Universitat Autònoma de Barcelona, Barcelona, Spain. .,CIBER Fisiopatologia Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Barcelona, Spain.
| | - Fernando Fernández-Aranda
- CIBER Fisiopatologia Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Barcelona, Spain. .,Pathological Gambling Unit, Department of Psychiatry, IDIBELL, University Hospital of Bellvitge, Feixa Llarga, s/n. 08907-L'Hospitalet de Llobregat, Barcelona, Spain. .,Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain.
| | - Neus Aymamí
- Pathological Gambling Unit, Department of Psychiatry, IDIBELL, University Hospital of Bellvitge, Feixa Llarga, s/n. 08907-L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Mónica Gómez-Peña
- Pathological Gambling Unit, Department of Psychiatry, IDIBELL, University Hospital of Bellvitge, Feixa Llarga, s/n. 08907-L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Ana Beatriz Fagundo
- CIBER Fisiopatologia Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Barcelona, Spain. .,Pathological Gambling Unit, Department of Psychiatry, IDIBELL, University Hospital of Bellvitge, Feixa Llarga, s/n. 08907-L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Sarah Sauchelli
- Pathological Gambling Unit, Department of Psychiatry, IDIBELL, University Hospital of Bellvitge, Feixa Llarga, s/n. 08907-L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Amparo Del Pino-Gutiérrez
- Pathological Gambling Unit, Department of Psychiatry, IDIBELL, University Hospital of Bellvitge, Feixa Llarga, s/n. 08907-L'Hospitalet de Llobregat, Barcelona, Spain. .,Department of Public Health, Mental Health and Mother-Infant Nursing, University School of Nursing, University of Barcelona, Barcelona, Spain.
| | - Laura Moragas
- Pathological Gambling Unit, Department of Psychiatry, IDIBELL, University Hospital of Bellvitge, Feixa Llarga, s/n. 08907-L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Lamprini G Savvidou
- Pathological Gambling Unit, Department of Psychiatry, IDIBELL, University Hospital of Bellvitge, Feixa Llarga, s/n. 08907-L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Mohammed A Islam
- CIBER Fisiopatologia Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Barcelona, Spain. .,Pathological Gambling Unit, Department of Psychiatry, IDIBELL, University Hospital of Bellvitge, Feixa Llarga, s/n. 08907-L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Salomé Tàrrega
- 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, IDIBELL, University Hospital of Bellvitge, Feixa Llarga, s/n. 08907-L'Hospitalet de Llobregat, Barcelona, Spain. .,Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain. .,CIBER Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Barcelona, Spain.
| | - Susana Jiménez-Murcia
- CIBER Fisiopatologia Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Barcelona, Spain. .,Pathological Gambling Unit, Department of Psychiatry, IDIBELL, University Hospital of Bellvitge, Feixa Llarga, s/n. 08907-L'Hospitalet de Llobregat, Barcelona, Spain. .,Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain.
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19
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Wolz I, Hilker I, Granero R, Jiménez-Murcia S, Gearhardt AN, Dieguez C, Casanueva FF, Crujeiras AB, Menchón JM, Fernández-Aranda F. "Food Addiction" in Patients with Eating Disorders is Associated with Negative Urgency and Difficulties to Focus on Long-Term Goals. Front Psychol 2016; 7:61. [PMID: 26869963 PMCID: PMC4735728 DOI: 10.3389/fpsyg.2016.00061] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 01/12/2016] [Indexed: 12/13/2022] Open
Abstract
Objectives: The present study aimed to investigate if eating disorder patients differ in specific personality traits depending on a positive screening of food addiction (FA) and to find a model to predict FA in eating disorder patients using measures of personality and impulsivity. Methods: Two hundred seventy eight patients, having an eating disorder, self-reported on FA, impulsivity, personality, eating and general psychopathology. Patients were then split into two groups, depending on a positive or negative result on the FA screening. Analysis of variance was used to compare means between the two groups. Stepwise binary logistic regression was used to obtain a predictive model for the presence of FA. Results: Patients with FA had lower self-directedness, and more negative urgency and lack of perseverance than patients not reporting addictive eating. The probability of FA can be predicted by high negative urgency, high reward dependence, and low lack of premeditation. Conclusion: Eating disorder patients who have more problems to pursue tasks to the end and to focus on long-term goals seem to be more likely to develop addictive eating patterns.
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Affiliation(s)
- Ines Wolz
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELLBarcelona, Spain; Ciber Fisiopatologia Obesidad y Nutrición, Instituto Salud Carlos IIIBarcelona, Spain
| | - Ines Hilker
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL Barcelona, Spain
| | - Roser Granero
- Ciber Fisiopatologia Obesidad y Nutrición, Instituto Salud Carlos IIIBarcelona, Spain; Department of Psychobiology and Methodology, Universitat Autònoma de BarcelonaBarcelona, Spain
| | - Susana Jiménez-Murcia
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELLBarcelona, Spain; Ciber Fisiopatologia Obesidad y Nutrición, Instituto Salud Carlos IIIBarcelona, Spain; Department of Psychobiology and Methodology, Universitat Autònoma de BarcelonaBarcelona, Spain
| | | | - Carlos Dieguez
- Ciber Fisiopatologia Obesidad y Nutrición, Instituto Salud Carlos IIIBarcelona, Spain; Department of Physiology, Centro Singular de Investigación en Medicina Molecular y Enfermedades Crónicas, University of Santiago de Compostela-Instituto de Investigación SanitariaSantiago de Compostela, Spain
| | - Felipe F Casanueva
- Ciber Fisiopatologia Obesidad y Nutrición, Instituto Salud Carlos IIIBarcelona, Spain; Laboratory of Molecular and Cellular Endocrinology, Research Area, Complejo Hospitalario Universitario de Santiago de CompostelaA Coruña, Spain
| | - Ana B Crujeiras
- Ciber Fisiopatologia Obesidad y Nutrición, Instituto Salud Carlos IIIBarcelona, Spain; Laboratory of Molecular and Cellular Endocrinology, Research Area, Complejo Hospitalario Universitario de Santiago de CompostelaA Coruña, Spain
| | - José M Menchón
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELLBarcelona, Spain; Department of Psychobiology and Methodology, Universitat Autònoma de BarcelonaBarcelona, Spain; Ciber Salud Mental, Instituto Salud Carlos IIIBarcelona, Spain
| | - Fernando Fernández-Aranda
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELLBarcelona, Spain; Ciber Fisiopatologia Obesidad y Nutrición, Instituto Salud Carlos IIIBarcelona, Spain; Department of Clinical Sciences, School of Medicine, University of BarcelonaBarcelona, Spain
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20
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Tárrega S, Castro-Carreras L, Fernández-Aranda F, Granero R, Giner-Bartolomé C, Aymamí N, Gómez-Peña M, Santamaría JJ, Forcano L, Steward T, Menchón JM, Jiménez-Murcia S. A Serious Videogame as an Additional Therapy Tool for Training Emotional Regulation and Impulsivity Control in Severe Gambling Disorder. Front Psychol 2015; 6:1721. [PMID: 26617550 PMCID: PMC4641919 DOI: 10.3389/fpsyg.2015.01721] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 10/26/2015] [Indexed: 01/01/2023] Open
Abstract
Background: Gambling disorder (GD) is characterized by a significant lack of self-control and is associated with impulsivity-related personality traits. It is also linked to deficits in emotional regulation and frequently co-occurs with anxiety and depression symptoms. There is also evidence that emotional dysregulation may play a mediatory role between GD and psychopathological symptomatology. Few studies have reported the outcomes of psychological interventions that specifically address these underlying processes. Objectives: To assess the utility of the Playmancer platform, a serious video game, as an additional therapy tool in a CBT intervention for GD, and to estimate pre-post changes in measures of impulsivity, anger expression and psychopathological symptomatology. Method: The sample comprised a single group of 16 male treatment-seeking individuals with severe GD diagnosis. Therapy intervention consisted of 16 group weekly CBT sessions and, concurrently, 10 additional weekly sessions of a serious video game. Pre-post treatment scores on South Oaks Gambling Screen (SOGS), Barratt Impulsiveness Scale (BIS-11), I7 Impulsiveness Questionnaire (I7), State-Trait Anger Expression Inventory 2 (STAXI-2), Symptom Checklist-Revised (SCL-90-R), State-Trait Anxiety Inventory (STAI-S-T), and Novelty Seeking from the Temperament and Character Inventory-Revised (TCI-R) were compared. Results: After the intervention, significant changes were observed in several measures of impulsivity, anger expression and other psychopathological symptoms. Dropout and relapse rates during treatment were similar to those described in the literature for CBT. Conclusion: Complementing CBT interventions for GD with a specific therapy approach like a serious video game might be helpful in addressing certain underlying factors which are usually difficult to change, including impulsivity and anger expression.
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Affiliation(s)
- Salomé Tárrega
- Department of Psychobiology and Methodology of Health Science, Universitat Autònoma de Barcelona Barcelona, Spain
| | - Laia Castro-Carreras
- Faculty of Health and Life Sciences, Universitat Pompeu Fabra de Barcelona Barcelona, Spain
| | - Fernando Fernández-Aranda
- Pathological Gambling Unit, Department of Psychiatry, Bellvitge University Hospital-IDIBELL Barcelona, Spain ; Ciber Fisiopatologia Obesidad y Nutrición, Instituto Salud Carlos III Barcelona, Spain ; Department of Clinical Sciences, School of Medicine, University of Barcelona Barcelona, Spain
| | - Roser Granero
- Department of Psychobiology and Methodology of Health Science, Universitat Autònoma de Barcelona Barcelona, Spain ; Ciber Fisiopatologia Obesidad y Nutrición, Instituto Salud Carlos III Barcelona, Spain
| | - Cristina Giner-Bartolomé
- Pathological Gambling Unit, Department of Psychiatry, Bellvitge University Hospital-IDIBELL Barcelona, Spain ; Ciber Fisiopatologia Obesidad y Nutrición, Instituto Salud Carlos III 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
| | - Juan J Santamaría
- Pathological Gambling Unit, Department of Psychiatry, Bellvitge University Hospital-IDIBELL Barcelona, Spain
| | - Laura Forcano
- Pathological Gambling Unit, Department of Psychiatry, Bellvitge University Hospital-IDIBELL Barcelona, Spain
| | - Trevor Steward
- Pathological Gambling Unit, Department of Psychiatry, Bellvitge University Hospital-IDIBELL Barcelona, Spain ; Ciber Fisiopatologia Obesidad y Nutrición, Instituto Salud Carlos III Barcelona, Spain
| | - José M Menchón
- Pathological Gambling Unit, Department of Psychiatry, Bellvitge University Hospital-IDIBELL Barcelona, Spain ; Department of Clinical Sciences, School of Medicine, University of Barcelona Barcelona, Spain ; CIBERSAM - CIBER Salud Mental, Instituto Salud Carlos III Barcelona, Spain
| | - Susana Jiménez-Murcia
- Pathological Gambling Unit, Department of Psychiatry, Bellvitge University Hospital-IDIBELL Barcelona, Spain ; Ciber Fisiopatologia Obesidad y Nutrición, Instituto Salud Carlos III Barcelona, Spain ; Department of Clinical Sciences, School of Medicine, University of Barcelona Barcelona, Spain
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Wiehler A, Bromberg U, Peters J. The Role of Prospection in Steep Temporal Reward Discounting in Gambling Addiction. Front Psychiatry 2015; 6:112. [PMID: 26379558 PMCID: PMC4548081 DOI: 10.3389/fpsyt.2015.00112] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Accepted: 07/24/2015] [Indexed: 12/18/2022] Open
Abstract
Addiction and pathological gambling (PG) have been consistently associated with high impulsivity and a steep devaluation of delayed rewards, a process that is known as temporal discounting (TD). Recent studies indicated that enhanced episodic future thinking (EFT) results in less impulsive TD in healthy controls (HCs). In a separate line of research, it has been suggested that non-linearities in time perception might contribute to reward devaluation during inter-temporal choice. Therefore, in addition to deficits in valuation processes and executive control, impairments in EFT and non-linearities in time perception have been hypothesized to contribute to steep TD in addiction. In this study, we explore such a potential association of impairments in EFT and time perception with steep TD in PG. We investigated 20 PGs and 20 matched HCs. TD was assessed via a standard computerized binary choice task. EFT was measured using a variation of the Autobiographical Memory Interview by Levine et al. (1). Time perception was assessed with a novel task, utilizing a non-linear rating procedure via circle-size adjustments. Groups did not differ in baseline EFT. In both groups, a power law accounted time perception best, and the degree of non-linearity in time perception correlated with discounting across groups. A multiple regression analysis across all predictors and covariates revealed that only group status (PG/HC) and depression were significantly associated with discounting behavior such that PG increased TD and depression attenuated TD. Our findings speak against the idea that steep TD in PG is due to a skewed perception of time or impairments in EFT, at least under the present task conditions. The lack of overall group differences in EFT does not rule out the possibility of more complex interactions of EFT and decision-making. These interactions might be diminished in pathological gambling or addiction more generally, when other task configurations are used.
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Affiliation(s)
- Antonius Wiehler
- Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Uli Bromberg
- Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jan Peters
- Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Clinical, Psychopathological, and Personality Characteristics Associated with ADHD among Individuals Seeking Treatment for Gambling Disorder. BIOMED RESEARCH INTERNATIONAL 2015; 2015:965303. [PMID: 26229967 PMCID: PMC4502275 DOI: 10.1155/2015/965303] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 06/08/2015] [Indexed: 12/29/2022]
Abstract
Objectives. (1) To assess the current presence of ADHD symptoms among patients seeking treatment for gambling disorder; (2) to explore clinical and sociodemographic differences between patients who score high and low on the measure of ADHD symptoms; (3) to analyze whether the presence of ADHD symptoms is associated with more severe psychopathology and with specific personality traits; (4) to analyze the mediating role of ADHD symptoms in the relationship between novelty seeking and gambling severity. Method. A total of 354 consecutive patients were administered an extensive battery assessing gambling behavior, psychopathology, and personality traits. Results. Male and female gamblers did not differ significantly in their mean scores on the ADHD measure. However, younger participants aged 18–35 scored higher. Higher ADHD scores were also associated with greater severity of gambling disorder and more general psychopathology. Regarding personality traits, high persistence and self-directedness were negatively related to ADHD scores, while in women alone a positive correlation was found between ADHD scores and scores on harm avoidance and self-transcendence. Conclusion. The presence of ADHD symptoms in both male and female gambling disorder patients may act as an indicator of the severity of gambling, general psychopathology, and dysfunctional personality traits.
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Sauvaget A, Jiménez-Murcia S, Fernández-Aranda F, Fagundo AB, Moragas L, Wolz I, Veciana De Las Heras M, Granero R, Del Pino-Gutiérrez A, Baño M, Real E, Aymamí MN, Grall-Bronnec M, Menchón JM. Unexpected online gambling disorder in late-life: a case report. Front Psychol 2015; 6:655. [PMID: 26074835 PMCID: PMC4444736 DOI: 10.3389/fpsyg.2015.00655] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 05/04/2015] [Indexed: 12/03/2022] Open
Abstract
Background: The lifetime prevalence of problem or Gambling disorder (GD) in the elderly (i.e., those over 60 years old) is reported to range from 0.01 to 10.9%. Research has identified several specific risk factors and vulnerabilities in the elderly. Since the late 1990s, an increase in online GD has been observed in the youth population, whereas casinos, slot machines, and bingo seem to be the activities of choice among the elderly. Interestingly, online GD has not been described in the elderly to date. Case Description: We report an 83-year-old man who started online casino gambling from the age of 80 years, leading to debts that exceeded €30,000. He underwent a full clinical and neuropsychological assessment, without any evidence of cognitive impairment or any associated neurodegenerative disease. However, he had risk factors for GD, including adjustment disorder, stressful life events, previous offline casino GD when 50 years old, and dysfunctional personality traits. The change to online GD may have been due to his isolation, movement difficulties, and his high level of education, which facilitated his access to the Internet. Care management focused on individual cognitive-behavioral therapy. Conclusion: The prevalence of online GD may be underestimated among the elderly, and may increase among isolated old people with movement difficulties and ready access to the Internet. However, late-life GD should be considered a diagnosis of elimination, requiring a full medical, psychiatric (including suicide risk), and cognitive assessment. Specific therapeutic approaches need to be proposed and developed.
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Affiliation(s)
- Anne Sauvaget
- Addictology and Liaison Psychiatry Department, Nantes University Hospital Nantes, France ; Department of Psychiatry, University Hospital of Bellvitge-IDIBELL Barcelona, Spain
| | - Susana Jiménez-Murcia
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL Barcelona, Spain ; CIBER Fisiopatología Obesidad y Nutrición, Instituto de Salud Carlos III Barcelona, Spain ; Department of Clinical Sciences, School of Medicine, University of Barcelona Barcelona, Spain
| | - Fernando Fernández-Aranda
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL Barcelona, Spain ; CIBER Fisiopatología Obesidad y Nutrición, Instituto de Salud Carlos III Barcelona, Spain ; Department of Clinical Sciences, School of Medicine, University of Barcelona Barcelona, Spain
| | - Ana B Fagundo
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL Barcelona, Spain ; CIBER Fisiopatología Obesidad y Nutrición, Instituto de Salud Carlos III Barcelona, Spain
| | - Laura Moragas
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL Barcelona, Spain
| | - Ines Wolz
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL Barcelona, Spain ; CIBER Fisiopatología Obesidad y Nutrición, Instituto de Salud Carlos III Barcelona, Spain
| | | | - Roser Granero
- CIBER Fisiopatología Obesidad y Nutrición, Instituto de Salud Carlos III Barcelona, Spain ; Departament de Psicobiologia i Metodologia de les Ciències de la Salut, Universitat Autònoma de Barcelona Barcelona, Spain
| | - Amparo Del Pino-Gutiérrez
- Department of Public Health, Mental Health and Perinatal Nursing, University School of Nursing, University of Barcelona Barcelona, Spain
| | - Marta Baño
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL Barcelona, Spain
| | - Eva Real
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL Barcelona, Spain
| | - Maria N Aymamí
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL Barcelona, Spain
| | - Marie Grall-Bronnec
- Addictology and Liaison Psychiatry Department, Nantes University Hospital Nantes, France
| | - José M Menchón
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL Barcelona, Spain ; Department of Clinical Sciences, School of Medicine, University of Barcelona Barcelona, Spain ; CIBER Salud Mental, Instituto de Salud Carlos III Barcelona, Spain
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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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Moragas L, Granero R, Stinchfield R, Fernández-Aranda F, Fröberg F, Aymamí N, Gómez-Peña M, Fagundo AB, Islam MA, del Pino-Gutiérrez A, Agüera Z, Savvidou LG, Arcelus J, Witcomb GL, Sauchelli S, Menchón JM, Jiménez-Murcia S. Comparative analysis of distinct phenotypes in gambling disorder based on gambling preferences. BMC Psychiatry 2015; 15:86. [PMID: 25886577 PMCID: PMC4406168 DOI: 10.1186/s12888-015-0459-0] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 03/26/2015] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Studies examining gambling preferences have identified the importance of the type of gambling practiced on distinct individual profiles. The objectives were to compare clinical, psychopathological and personality variables between two different groups of individuals with a gambling disorder (strategic and non-strategic gamblers) and to evaluate the statistical prediction capacity of these preferences with respect to the severity of the disorder. METHOD A total sample of 2010 treatment-seeking patients with a gambling disorder participated in this stand-alone study. All were recruited from a single Pathological Gambling Unit in Spain (1709 strategic and 301 non-strategic gamblers). The design of the study was cross-sectional and data were collected at the start of treatment. Data was analysed using logistic regression for binary outcomes and analysis of variance (ANOVA) for quantitative responses. RESULTS There were significant differences in several socio-demographic and clinical variables, as well as in personality traits (novelty seeking and cooperativeness). Multiple regression analysis showed harm avoidance and self-directedness were the main predictors of gambling severity and psychopathology, while age at assessment and age of onset of gambling behaviour were predictive of gambling severity. Strategic gambling (as opposed to non-strategic) was significantly associated with clinical outcomes, but the effect size of the relationships was small. CONCLUSIONS It is possible to identify distinct phenotypes depending on the preference of gambling. While these phenotypes differ in relation to the severity of the gambling disorder, psychopathology and personality traits, they can be useful from a clinical and therapeutic perspective in enabling risk factors to be identified and prevention programs targeting specific individual profiles to be developed.
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Affiliation(s)
- Laura Moragas
- Pathological Gambling Unit, Department of Psychiatry, Bellvitge University Hospital-IDIBELL, c/ Feixa Llarga s/n, 08907 L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Roser Granero
- Ciber Fisiopatología Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (Spain), Barcelona, Spain. .,Departament de Psicobiologia i Metodologia de les Ciències de la Salut, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - Randy Stinchfield
- Department of Psychiatry, University of Minnesota Medical School, Minnesota, USA.
| | - Fernando Fernández-Aranda
- Pathological Gambling Unit, Department of Psychiatry, Bellvitge University Hospital-IDIBELL, c/ Feixa Llarga s/n, 08907 L'Hospitalet de Llobregat, Barcelona, Spain. .,Ciber Fisiopatología Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (Spain), Barcelona, Spain. .,Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain.
| | - Frida Fröberg
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
| | - Neus Aymamí
- Pathological Gambling Unit, Department of Psychiatry, Bellvitge University Hospital-IDIBELL, c/ Feixa Llarga s/n, 08907 L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Mónica Gómez-Peña
- Pathological Gambling Unit, Department of Psychiatry, Bellvitge University Hospital-IDIBELL, c/ Feixa Llarga s/n, 08907 L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Ana B Fagundo
- Pathological Gambling Unit, Department of Psychiatry, Bellvitge University Hospital-IDIBELL, c/ Feixa Llarga s/n, 08907 L'Hospitalet de Llobregat, Barcelona, Spain. .,Ciber Fisiopatología Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (Spain), Barcelona, Spain.
| | - Mohammed A Islam
- Pathological Gambling Unit, Department of Psychiatry, Bellvitge University Hospital-IDIBELL, c/ Feixa Llarga s/n, 08907 L'Hospitalet de Llobregat, Barcelona, Spain. .,Ciber Fisiopatología Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (Spain), Barcelona, Spain.
| | - Amparo del Pino-Gutiérrez
- Pathological Gambling Unit, Department of Psychiatry, Bellvitge University Hospital-IDIBELL, c/ Feixa Llarga s/n, 08907 L’Hospitalet de Llobregat, Barcelona, Spain ,Departament d’Infermeria de Salut Pública, Salut Mental i Maternoinfantil, Escola Universitària d’Infermeria, Universitat de Barcelona, Barcelona, Spain
| | - Zaida Agüera
- Pathological Gambling Unit, Department of Psychiatry, Bellvitge University Hospital-IDIBELL, c/ Feixa Llarga s/n, 08907 L'Hospitalet de Llobregat, Barcelona, Spain. .,Ciber Fisiopatología Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (Spain), Barcelona, Spain.
| | - Lamprini G Savvidou
- Pathological Gambling Unit, Department of Psychiatry, Bellvitge University Hospital-IDIBELL, c/ Feixa Llarga s/n, 08907 L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Jon Arcelus
- Leicester Eating Disorders Service, Leicester General Hospital, Leicester, UK.
| | - Gemma L Witcomb
- Leicester Eating Disorders Service, Leicester General Hospital, Leicester, UK.
| | - Sarah Sauchelli
- Pathological Gambling Unit, Department of Psychiatry, Bellvitge University Hospital-IDIBELL, c/ Feixa Llarga s/n, 08907 L'Hospitalet de Llobregat, Barcelona, Spain.
| | - José M Menchón
- Pathological Gambling Unit, Department of Psychiatry, Bellvitge University Hospital-IDIBELL, c/ Feixa Llarga s/n, 08907 L'Hospitalet de Llobregat, Barcelona, Spain. .,Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain. .,CIBER Salud Mental (CIBERSAM), Instituto Carlos III, Barcelona, Spain.
| | - Susana Jiménez-Murcia
- Pathological Gambling Unit, Department of Psychiatry, Bellvitge University Hospital-IDIBELL, c/ Feixa Llarga s/n, 08907 L'Hospitalet de Llobregat, Barcelona, Spain. .,Ciber Fisiopatología Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (Spain), Barcelona, Spain. .,Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain.
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Jiménez-Murcia S, Granero R, Tárrega S, Angulo A, Fernández-Aranda F, Arcelus J, Fagundo AB, Aymamí N, Moragas L, Sauvaget A, Grall-Bronnec M, Gómez-Peña M, Menchón JM. Mediational Role of Age of Onset in Gambling Disorder, a Path Modeling Analysis. J Gambl Stud 2015; 32:327-40. [DOI: 10.1007/s10899-015-9537-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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