A Comparison of Treatment-Seeking Behavioral Addiction Patients with and without Parkinson's Disease

Drug-Induced Gambling Disorder: Epidemiology, Neurobiology, and Management

Problematic gambling has been suggested to be a possible consequence of dopaminergic medications used mainly in neurological conditions, i.e. pramipexole and ropinirole, and possibly by one antipsychotic compound, aripiprazole. Patients with Parkinson's disease, restless legs syndrome and other conditions potentially treated with dopamine agonists, as well as patients treated for psychotic disorders, are vulnerable patient groups with theoretically increased risk of developing gambling disorder (GD), for example due to higher rates of mental ill-health in these groups. The aim of the present paper is to review the epidemiological, clinical, and neurobiological evidence of the association between dopaminergic medications and GD, and to describe risk groups and treatment options. The neurobiology of GD involves the reward and reinforcement system, based mainly on mesocorticolimbic dopamine projections, with the nucleus accumbens being a crucial area for developing addictions to substances and behaviors. The addictive properties of gambling can perhaps be explained by the reward uncertainty that activates dopamine signaling in a pathological manner. Since reward-related learning is mediated by dopamine, it can be altered by dopaminergic medications, possibly leading to increased gambling behavior and a decreased impulse control. A causal relationship between the medications and GD seems likely, but the molecular mechanisms behind this association have not been fully described yet. More research is needed in order to fully outline the clinical picture of GD developing in patient groups with dopaminergic medications, and data are needed on the differentiation of risk in different compounds. In addition, very few interventional studies are available on the management of GD induced by dopaminergic medications. While GD overall can be treated, there is need for treatment studies testing the effectiveness of tapering of the medication or other gambling-specific treatment modalities in these patient groups.

The Development of the Turkish Craving for Online Shopping Scale: A Validation Study

In the present study, the Turkish version of the Craving for Online Shopping Scale (TCOSS) was developed by modifying items on the Penn Alcohol Craving Scale (PACS). The sample comprised 475 adult volunteers (233 women and 242 men) from three different non-clinical samples recruited online. The structure validity of the TCOSS was examined utilizing exploratory factor analysis (EFA), confirmatory factor analysis (CFA), and criterion validity testing. The EFA showed that the TCOSS had a unidimensional structure that explained 80% of the total variance. The five-item unidimensional structure of the TCOSS then underwent further testing using two different samples. First, the structure of the TCOSS was tested using CFA, which confirmed the unidimensional factor structure. Second, measurement invariance of the TCOSS was conducted through structural invariance, metric invariance, and scalar invariance across different samples. This demonstrated the TCOSS had measurement invariance across different samples (CFA and criterion validity samples). Criterion validity of the TCOSS was tested using the Internet Addiction Test-Short Form, Brief Self-Control Scale, Compulsive Online Shopping Scale, Positive and Negative Affect Schedule, and self-reported personal information. According to the criterion validity results, the TCOSS assessed the structure it targets. Cronbach’s α internal consistency coefficients of the TCOSS were .94 in the EFA sample, .94 in the CFA sample, and .96 in the criterion validity sample. When validity and reliability analysis of the TCOSS are considered as a whole, it is concluded that the TCOSS is a valid and reliable scale for assessing craving for online shopping among online shoppers.

Self-reported rates of impulsivity in Parkinson's Disease

OBJECTIVE

Impulsive decision-making is characterized by actions taken without considering consequences. Patients with Parkinson's disease (PD) who receive dopaminergic treatment, especially dopamine agonists, are at risk of developing impulsive-compulsive behaviors (ICBs). We assessed impulse-related changes across a large heterogeneous PD population using the Barratt impulsivity scale (BIS-11) by evaluating BIS-11 first- and second-order factors.

METHODS

We assessed a total of 204 subjects: 93 healthy controls (HCs), and 68 ICB- and 43 ICB + PD patients who completed the BIS-11. Using a general linear model and a least absolute shrinkage and selection operation regression, we compared BIS-11 scores between the HC, ICB- PD, and ICB + PD groups.

RESULTS

Patients with PD rated themselves as more impulsive than HCs in the BIS-11 total score, second-order attention domain, and first-order attention and self-control domains. ICB + patients recorded higher total scores as well as higher scores in the second-order non-planning domain and in self-control and cognitive complexity than ICB- patients.

INTERPRETATION

These results indicate that the patients with PD show particular problems with attentional control, whereas ICB + patients show a distinct problem in cognitive control and complexity. Additionally, it appears that all patients with PD are more impulsive than their age- and sex-matched healthy peers. Increased impulsivity may be a result of the disease course, or attributed to dopaminergic medication use, but these results emphasize the importance of the cognitive components of impulsivity in patients with PD.