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Tanaka M, Cho T, Arai K, Iriki A, Hashimoto T, Horii S, Tsurumi K. The Paradoxical Clinical Course of Persons with Gambling Disorder and Comorbid Attention-Deficit/Hyperactivity Disorder (ADHD). J Gambl Stud 2023; 39:1723-1734. [PMID: 37402115 DOI: 10.1007/s10899-023-10233-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2023] [Indexed: 07/05/2023]
Abstract
The co-occurrence of gambling disorder (GD) and attention-deficit/hyperactivity disorder (ADHD) has been widely reported. In this study, we aimed to investigate the social background, clinical characteristics, and clinical course of initial-visit GD patients with and without ADHD in a Japanese psychiatric hospital. We recruited 40 initial-visit GD patients and collected comprehensive information by self-report questionnaires, direct interviews, and medical records. 27.5% of the GD patients had comorbid ADHD. Compared to the GD patients without ADHD, those with ADHD had significantly higher comorbidity rates of autism spectrum disorder (ASD), lower rates of marriage, slightly less years of education and marginally lower employment rates. On the other hand, the GD patients with ADHD showed higher treatment retention rates and participation rates in the mutual support group. Despite presenting with disadvantageous characteristics, GD patients with ADHD exhibited a more favourable clinical course. Therefore, clinicians should be mindful of the possibility of ADHD comorbidity and the potential for better clinical outcomes among GD patients with ADHD.
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Affiliation(s)
- Masuo Tanaka
- International Medical Center, Fujita Health University Hospital, 1-98, Dengakugakubo, Kutsukake-cho, Toyoake, 470-1192, Aichi, Japan
- Zikei Hospital, 100-2 Urayasu-honmachi, Minami, Okayama, 702-8508, Okayama, Japan
- Department of Psychiatry, Koryo Hospital, 187-2, Yoshiwa, Ube, Yamaguchi, 759-0134, Japan
| | - Tetsuji Cho
- Clinical Education Center, General Foundation of Shigisan Hospital, 4-13-1 Seyakita, Heartland Shigisan, Sango, Ikoma, 636-0815, Nara, Japan
| | - Kiyomi Arai
- School of Medicine and Health Sciences, Institute of Health Science, Shinshu University, 3-1-1, Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Akihisa Iriki
- Department of Psychiatry, Osaka Psychiatric Medical Center, 3-16-21, Miyanosaka, Hirakata, 573- 0022, Osaka, Japan
| | - Takashi Hashimoto
- Department of Psychiatry, Koryo Hospital, 187-2, Yoshiwa, Ube, Yamaguchi, 759-0134, Japan
| | - Shigeo Horii
- Zikei Hospital, 100-2 Urayasu-honmachi, Minami, Okayama, 702-8508, Okayama, Japan
| | - Kosuke Tsurumi
- Department of Psychiatry, Graduate School of Medicine, Kyoto University, 54, Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, Kyoto, 606-8507, Japan.
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El Archi S, Barrault S, Brunault P, Ribadier A, Varescon I. Co-occurrence of Adult ADHD Symptoms and Problematic Internet Use and Its Links With Impulsivity, Emotion Regulation, Anxiety, and Depression. Front Psychiatry 2022; 13:792206. [PMID: 35492700 PMCID: PMC9045584 DOI: 10.3389/fpsyt.2022.792206] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 02/28/2022] [Indexed: 12/24/2022] Open
Abstract
The co-occurrence of attention-deficit/hyperactivity disorder (ADHD) and problematic Internet use (PIU) is associated with increased severity of PIU and poorer treatment outcomes. The main objective of this study was to examine the association between PIU and adult ADHD symptoms and determine whether adult ADHD symptoms were a predictor of PIU in the general adult population. We also examined the potential mediating role of the dimensional psychopathological factors, including anxiety, depression, impulsivity, and emotion regulation, in this relationship. To achieve these aims, we recruited 532 regular Internet users online from the general adult population. The participants completed an online questionnaire assessing PIU (Internet Addiction Test), anxiety and depression symptoms (Hospital Anxiety and Depression Scale), adult ADHD symptoms (Adult ADHD Self-Report Scale-V1.1), emotion regulation (Emotion Regulation Questionnaire), and impulsivity (UPPS-P Impulsive Behavior Scale). We conducted a multiple regression analysis to determine the predictors of PIU and mediation analyses to identify the psychopathological mediators of the association between adult ADHD symptoms and PIU. PIU was observed in 17.9% of our sample. A significantly higher proportion of respondents with PIU screened positive for adult ADHD symptoms compared to respondents without PIU (50.5 vs. 21.7%; p < 0.001). Individuals with PIU reported significantly higher scores than those without PIU for anxiety and depressive symptoms, impulsivity, and the emotion regulation strategy of expressive suppression. Additionally, they had significantly lower scores than those without PIU on cognitive reappraisal than non-problematic Internet users. In addition to adult ADHD symptoms, the multiple regression analysis revealed that PIU was also positively predicted by depressive symptoms, positive urgency, lack of perseverance, and expressive suppression, and is negatively predicted by cognitive reappraisal and negative urgency. The mediation analysis showed that lack of perseverance, positive urgency, and depressive and anxiety symptoms were partial mediators of the relationship between adult ADHD symptoms and PIU. Our results highlight the significant co-occurrence of PIU and adult ADHD symptoms. This study also provides support for a theoretical model in which impulsivity dimensions, emotion regulation strategies, as well as the tendency to anxiety and depressive symptoms, may play a mediating role in this co-occurrence. In summary, the findings emphasize the need to assess these psychological characteristics in problematic Internet users, as they can be a factor of clinical complexity, as well as the importance of targeting them as part of integrated interventions for both adult ADHD symptoms and PIU.
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Affiliation(s)
- Sarah El Archi
- University of Tours, Laboratory QualiPsy, EE1901, Tours, France
| | - Servane Barrault
- University of Tours, Laboratory QualiPsy, EE1901, Tours, France.,CHRU of Tours, Centre de Soins d'Accompagnement et de Prévention en Addictologie (CSAPA 37), Tours, France.,Université Paris Cité, Laboratory of Psychopathology and Health Processes, Boulogne-Billancourt, France
| | - Paul Brunault
- University of Tours, Laboratory QualiPsy, EE1901, Tours, France.,CHRU of Tours, Service d'Addictologie Universitaire, Équipe de Liaison et de Soins en Addictologie, Tours, France.,University of Tours, UMR 1253, iBrain, INSERM, Tours, France
| | - Aurélien Ribadier
- University of Tours, Laboratory QualiPsy, EE1901, Tours, France.,Université Paris Cité, Laboratory of Psychopathology and Health Processes, Boulogne-Billancourt, France
| | - Isabelle Varescon
- Université Paris Cité, Laboratory of Psychopathology and Health Processes, Boulogne-Billancourt, France
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