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Biomedical subjects

Jon E Grant

Publications and source records attributed to Jon E Grant.

At least 19 recordsLinked to original sources
PubMed2006

Neuropsychological functioning in kleptomania.

Kleptomania is characterized by the failure to resist impulses to steal objects not needed for personal use or their monetary value. The objective of this study was to examine cognitive and executive functioning in subjects with kleptomania. Fifteen women with a primary DSM-IV diagnosis of kleptomania underwent a detailed psychiatric examination, including measures of kleptomania severity, and a battery of neuropsychological tests that emphasized executive functions. Correlational analyses were computed between measures of kleptomania severity and tests of executive functioning. Kleptomania subjects reported a mean duration of illness of 17.9 years and shoplifting a mean of 1.7 times per week. All subjects reported an inability to resist urges to shoplift. Neuropsychological testing revealed group mean test scores within 0.5 standard deviations of normative standards for age. Five subjects (33.3%), however, had below-average performance on at least one measure of executive functioning, and 4 (26.7%) had below-average scores on two executive measures. Correlational analyses revealed a statistically significant correlation between kleptomania severity and Wisconsin Card Sorting Test performance (r=-0.693, p=0.004). As a group, subjects with kleptomania did not demonstrate deficits on neuropsychological testing. Greater kleptomania symptom severity, however, was correlated with impairment in executive functioning.

Adolescent↗
PubMed2006

White matter integrity in kleptomania: a pilot study.

This study's goal was to examine microstructural organization of frontal white matter in kleptomania. Ten females with DSM-IV kleptomania and 10 female controls underwent diffusion tensor imaging. Inferior frontal white matter was the a priori region of interest. Trace and fractional anisotropy (FA) were also calculated for frontal and posterior cortical regions in both subject groups. Kleptomania subjects had significantly higher mean frontal Trace, and significantly lower mean frontal FA than control subjects. Group differences remained significant when right and left frontal Trace and FA were analyzed. Groups did not differ significantly in posterior Trace or FA. Kleptomania may be associated with decreased white matter microstructural integrity in inferior frontal brain regions.

Adult↗
PubMed2006

Sexual obsessions and clinical correlates in adults with obsessive-compulsive disorder.

Because little is known about sexual obsessions in individuals with obsessive-compulsive disorder (OCD), we examined rates and clinical correlates of sexual obsessions in 293 consecutive subjects with primary lifetime Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, OCD (54.6% females; mean age, 40.5 +/- 12.9 years). Symptom severity was examined using the Yale-Brown Obsessive Compulsive Scale. Comorbidity, treatment response, insight, depression symptoms, quality of life, and social functioning were also assessed. All variables were compared in subjects who have OCD with and without sexual obsessions. Of the 293 subjects with primary OCD, 73 (24.9%) reported a history of sexual obsessions, and 39 (13.3%) of the subjects with OCD reported current sexual obsessions. Women were as likely as men to report sexual obsessions. As compared to those without these symptoms, subjects with current sexual obsessions were significantly more likely to report current aggressive (P < .001) and religious (P = .001) obsessions. Subjects with sexual obsessions also reported an earlier age of onset of OCD than subjects without these symptoms. Severity of OCD, comorbidity, treatment response, insight, depressive symptoms, quality of life, and social functioning did not differ between those with and without sexual obsessions. These preliminary results suggest that sexual obsessions are fairly common among individuals with OCD and may be associated with important clinical characteristics.

Adult↗
PubMed2006

Sexual orientation of men with pathological gambling: prevalence and psychiatric comorbidity in a treatment-seeking sample.

Although gay men represent a high-risk group for psychiatric illness and impairment, they are largely an understudied population. The purpose of the present study was to examine the sexual orientation and clinical correlates of men with pathological gambling (PG). Sexual orientation was assessed in 105 men presenting with PG. Gay and bisexual men with PG were compared with heterosexual men in terms of gambling symptoms, impairment, and co-occurring psychiatric disorders. Of 22 men (21.0%) with PG, 15 were gay (14.3%) and 7 were bisexual (6.7%). Gay and bisexual men vs heterosexual men were more likely to be single (81.8% vs 21.7%; chi(2)(2) = 28.2; P < .001), have a lifetime (81.8% vs 44.6%; chi(2)(1) = 9.7; P = .002) or current (68.2% vs 34.9%; chi(2)(1) = 7.9; P = .005) impulse control disorder, and have a lifetime substance use disorder (59.1% vs 31.3%; chi(2)(1) = 5.7; P < .05). Gay and bisexual men with PG also showed a trend toward greater impairment (P = .04). Psychiatric comorbidity and impairment are high in gay and bisexual men with PG. Research is needed to optimize patient care for gay and bisexual men with PG.

Adult↗
PubMed2006

Pathological gambling and mood disorders: clinical associations and treatment implications.

BACKGROUND: The rapidly expanding gambling business has resulted in an increasing number of gamblers, and the problem is likely to get worse in the future. Traditionally, mood and gambling symptoms have been known to overlap. In the present review we attempt to examine the diagnostic associations and implications for treatment. METHOD: Selected published papers on the frequencies of mood disorders among patients who have gambling disorder or gambling disorder among patients who have mood disorder have been reviewed. Recently emerging new treatment methods for gambling disorder have been reviewed and a brief summary has been added. RESULTS: SCID based study results show a close link between gambling and mood disorders. The prevalence of manic disorder reaches to approximately one fourth of the pathological gambling disorder population. The prevalence of depression is much higher, reaching to over half of the population in some studies. LIMITATIONS: The studies included in the present paper involve inpatients, outpatients, subjects recruited through advertisements and prison populations. Thus the data need to be interpreted as such. Standardized assessment instruments are not used in all studies. Methodological issues such as primary or secondary nature of depression have not been addressed adequately in these studies. The findings, however, offer new insights for the assessment and treatment of complicated gambling disorder cases. CONCLUSIONS: A high prevalence rate of manic and depressive disorders has been recorded among pathological gambling disorder patients. A rational treatment approach to each defined subset of complicated gambling disorder is discussed.

Bipolar Disorder↗
PubMed2006

Impulse control disorders in adults with obsessive compulsive disorder.

Little is known about impulse control disorders (ICDs) in individuals with obsessive compulsive disorder (OCD). Although studies have examined ICD comorbidity in OCD, no previous studies have examined clinical correlates of ICD comorbidity in a large sample of individuals with a primary diagnosis of OCD. We examined rates and clinical correlates of comorbid ICDs in 293 consecutive subjects with lifetime DSM-IV OCD (56.8% females; mean age=40.6+/-12.9 years). Comorbidity data were obtained with the Structured Clinical Interview for DSM-IV. ICDs were diagnosed with structured clinical interviews using DSM-IV criteria. OCD severity was assessed with the Yale-Brown Obsessive-Compulsive Scale. Quality of life and social/occupational functioning were examined using the Quality of Life Enjoyment and Satisfaction Questionnaire and the Social and Occupational Functioning Assessment Scale. All variables were compared in OCD subjects with and without lifetime and current ICDs. Forty-eight (16.4%) OCD subjects had a lifetime ICD, and 34 (11.6%) had a current ICD. Skin picking was the most common lifetime (10.4%) and current (7.8%) ICD, followed by nail biting with lifetime and current rates of 4.8% and 2.4%, respectively. OCD subjects with current ICDs had significantly worse OCD symptoms and poorer functioning and quality of life. These preliminary results suggest that there is a low prevalence of ICDs among individuals with OCD, although certain ICDs (skin picking) appear to be more common.

Adult↗
PubMed2006

Update on pathological gambling.

Pathological gambling (PG) is a significant public health concern associated with high rates of psychiatric comorbidity and mortality. Although research into the biology of PG is still in an early stage, recent advances in our understanding of motivation, reward, and addiction have provided substantial insight into the possible pathophysiology of this disorder. In addition, over the past 5 years, extraordinary progress has been made in the area of clinical research examining treatments for PG. Although PG is a disabling disorder that continues to represent a clinical challenge for the healthcare professional, our current knowledge of pharmacotherapy and psychosocial interventions offers potentially effective treatment options.

Behavior, Addictive↗
PubMed2006

Compulsive aspects of impulse-control disorders.

Impulsivity and compulsivity have been considered opposite poles of a continuous spectrum, but their relationship seems to be more complex. Disorders characterized by impulsivity often have features of compulsivity and vice-versa. Impulse-control disorders (ICDs) are characterized by repetitive behaviors and impaired inhibition of these behaviors, suggesting a similarity to the frequently excessive, unnecessary, and unwanted rituals of obsessive-compulsive disorder (OCD). There are, however, important differences be-tween ICDs and OCD. The construct of compulsivity as related to ICDs and OCD warrants additional investigation to identify the similarities and differences and to examine the implications for prevention and treatment strategies.

Compulsive Behavior↗
PubMed2006

The neurobiology of substance and behavioral addictions.

Behavioral addictions, such as pathological gambling, kleptomania, pyromania, compulsive buying, and compulsive sexual behavior, represent significant public health concerns and are associated with high rates of psychiatric comorbidity and mortality. Although research into the biology of these behaviors is still in the early stages, recent advances in the understanding of motivation, reward, and addiction have provided insight into the possible pathophysiology of these disorders. Biochemical, functional neuroimaging, genetic studies, and treatment research have suggested a strong neurobiological link between behavioral addictions and substance use disorders. Given the substantial co-occurrence of these groups of disorders, improved understanding of their relationship has important implications not only for further understanding the neurobiology of both categories of disorders but also for improving prevention and treatment strategies.

Arousal↗
PubMed2006

Escitalopram treatment of pathological gambling with co-occurring anxiety: an open-label pilot study with double-blind discontinuation.

Although co-occurring disorders are common in pathological gambling (PG), investigations of the response to pharmacotherapy in individuals with PG and co-occurring psychiatric symptomatology are limited. Thirteen subjects with DSM-IV PG and co-occurring anxiety were treated in a 12-week open-label trial of escitalopram. Subjects were assessed with the Yale-Brown Obsessive Compulsive Scale Modified for Pathological Gambling (PG-YBOCS; primary outcome measure), the Hamilton Anxiety Rating Scale (HAM-A), the Clinical Global Impressions scale (CGI), and measures of psychosocial functioning and quality of life. Those subjects who 'responded' (defined as a 30% or greater reduction in PG-YBOCS total score at endpoint) were offered inclusion in an 8-week double-blind discontinuation phase. PG-YBOCS scores decreased from a mean of 22.2+/-4.5 at baseline to 11.9+/-10.7 at endpoint (P=0.002) and 61.5% were responders. Scores on the HAM-A decreased by 82.8% over the 12-week period (mean of 15.9+/-3.2 at baseline to a mean of 2.8+/-3.6 at endpoint) (P<0.001). On the CGI, 38.5% of subjects (n=5) were 'very much improved' and 23.1% (n=3) were 'much improved' by study endpoint. The Sheehan Disability Scale, Perceive Stress Scale and Quality of Life Inventory all showed improvement (P< or = 0.001, P=0.002 and P=0.029, respectively). The mean end-of-study dose of escitalopram was 25.4+/-6.6 mg/day. Of three subjects assigned to escitalopram during the discontinuation phase, none reported statistically significant worsening of gambling symptoms. However, one subject assigned to placebo reported that gambling symptoms returned within 4 weeks. Open-label escitalopram treatment was associated with improvements in gambling and anxiety symptoms and measures of psychosocial functioning and quality of life. Larger, longer, placebo-controlled, double-blind studies are needed to evaluate further the safety and tolerability of escitalopram in the treatment of PG and co-occurring anxiety.

Adult↗
PubMed2006

Multicenter investigation of the opioid antagonist nalmefene in the treatment of pathological gambling.

OBJECTIVE: Pathological gambling is a disabling disorder experienced by approximately 1%-2% of adults and for which there are few empirically validated treatments. The authors examined the efficacy and tolerability of the opioid antagonist nalmefene in the treatment of adults with pathological gambling. METHOD: A 16-week, randomized, dose-ranging, double-blind, placebo-controlled trial was conducted at 15 outpatient treatment centers across the United States between March 2002 and April 2003. Two hundred seven persons with DSM-IV pathological gambling were randomly assigned to receive nalmefene (25 mg/day, 50 mg/day, or 100 mg/day) or placebo. Scores on the primary outcome measure (Yale-Brown Obsessive Compulsive Scale Modified for Pathological Gambling) were analyzed by using a linear mixed-effects model. RESULTS: Estimated regression coefficients showed that the 25 mg/day and 50 mg/day nalmefene groups had significantly different scores on the Yale-Brown Obsessive Compulsive Scale Modified for Pathological Gambling, compared to the placebo group. A total of 59.2% of the subjects who received 25 mg/day of nalmefene were rated as "much improved" or "very much improved" at the last evaluation, compared to 34.0% of those who received placebo. Adverse experiences included nausea, dizziness, and insomnia. CONCLUSIONS: Subjects who received nalmefene had a statistically significant reduction in severity of pathological gambling. Low-dose nalmefene (25 mg/day) appeared efficacious and was associated with few adverse events. Higher doses (50 mg/day and 100 mg/day) resulted in intolerable side effects.

Adult↗
PubMed2006

Alcohol craving in outpatients with alcohol dependence: rate and clinical correlates.

OBJECTIVE: The present study was undertaken to assess the rate and severity of alcohol craving symptoms among registered alcohol-dependent patients at a Veterans Affairs outpatient clinic. We also examined the relationship between alcohol craving and the clinical characteristics of alcohol-dependent patients. METHOD: Participants included 101 alcohol-dependent veterans enrolled in an outpatient addiction clinic. Alcohol craving was measured by the Penn Alcohol Craving Scale. Alcoholism severity and clinical characteristics were assessed with the Addiction Severity Index, Timeline Followback method, and other instruments. Three alcohol-craving groups (low, moderate, and high) were identified and compared using their demographic and clinical characteristics. Multiple regression analysis was performed to evaluate the relationship between the potential predictors and alcohol craving. RESULTS: The rate of alcohol craving was as follows: low craving (46%), moderate craving (29%), and high craving (25%). When these three craving groups were compared using univariate analyses, patients with higher alcohol craving had significantly higher alcohol composite scores (last 30 days) and severe alcohol dependence (last 1 year). In multiple regression analysis, the model explained 50% of the variance in alcohol craving, with alcoholism severity (42%), withdrawal symptoms (5%), and depression (3%) as significant predictors. CONCLUSIONS: Patients in an outpatient treatment setting had a wide range of alcohol cravings. Level of alcohol craving was directly associated with several increased indices of alcohol- and non-alcohol-related morbidity.

Alcoholism↗
PubMed2006

Understanding and treating kleptomania: new models and new treatments.

Kleptomania, characterized by repetitive, uncontrollable stealing of items not needed for personal use, is a disabling disorder that often goes unrecognized in clinical practice. Although originally conceptualized as an obsessive compulsive spectrum disorder, emerging evidence (clinical characteristics, familial transmission, and treatment response) suggests that kleptomania may have important similarities to both addictive and mood disorders. In particular, kleptomania frequently co-occurs with substance use disorders, and it is common for individuals with kleptomania to have first-degree relatives who suffer from a substance use disorder. Additionally, there is some suggestion that selective serotonin reuptake inhibitors, the treatment of choice for obsessive compulsive disorder, may lack efficacy for kleptomania. Instead, other medications (lithium, anti-epileptics, and opioid antagonists) have shown early promise in treating kleptomania. Evidence suggests that there may be subtypes of kleptomania that are more like OCD, whereas others have more similarities to addictive and mood disorders. Subtyping of individuals with kleptomania may be a useful way to better understand this behavior and decide on effective treatment interventions.

Algorithms↗
PubMed2006

Medication management of pathological gambling.

Pathological gambling has received little attention from clinicians and researchers despite prevalence rates similar to or greater than those of schizophrenia and bipolar disorder. This article summarizes the phenomenology and associated psychopathology of this public health problem and presents results of studies of 3 types of pharmacological agents used to treat this disorder: serotonin reuptake inhibitors, opioid antagonists, and mood stabilizers.

Disruptive, Impulse Control, and Conduct Disorders↗
PubMed2005

Reliability and validity of the pathological gambling adaptation of the Yale-Brown Obsessive-Compulsive Scale (PG-YBOCS).

The Yale Brown Obsessive Compulsive Scale adapted for Pathological Gambling (PG-YBOCS) was developed to measure the severity and change in severity of pathological gambling symptoms. The PG-YBOCS is a 10-item clinician-administered questionnaire that measures the severity of PG over a recent time interval (usually within the past one/two week(s)). In order to assess and validate the scale, it was administered to 337 subjects: 188 pathological gamblers and 149 healthy controls. Internal consistency and correlations between individual items and total score were assessed for various permutations of the sample. Other scales were administered to assess convergent, discriminant and content validity. Sensitivity to change was evaluated in treatment studies with fluovoxamine, lithium, and valproate. Each item was frequently endorsed across a range of severity. Good inter-rater reliability and internal consistency were obtained. The PG-YBOCS showed high validity and reliability for total score, item-total correlations, and for each subscale (Thoughts/Urges and Behavior). PG-YBOCS scores correlated with global severity and South Oaks Gambling Screen (SOGS) scores. The scale was also sensitive to change in pathological gambling severity. PG-YBOCS thus appears to be a reliable and valid measure of pathological gambling severity, and can be regarded as an important tool for clinicians and researchers treating pathological gamblers.

Adult↗
PubMed2005

Betting on dopamine.

Explore the source record for details and available documents.

Antipsychotic Agents↗
PubMed2005

Impulse control disorders in adult psychiatric inpatients.

OBJECTIVE: The authors' goal was to examine the prevalence of impulse control disorders in psychiatric inpatients. METHOD: They used the Minnesota Impulsive Disorders Interview, a semistructured clinical interview assessing pathological gambling, trichotillomania, kleptomania, pyromania, intermittent explosive disorder, compulsive buying, and compulsive sexual behavior, to screen 204 consecutively admitted psychiatric inpatients. One hundred twelve of the inpatients were women (54.9%), and the mean age of the 204 inpatients was 40.5 years (SD=13.2, range=18-83). Patients whose screen was positive for an impulse control disorder were evaluated with structured clinical interviews. RESULTS: Sixty-three patients (30.9%) were diagnosed with at least one current impulse control disorder. The most common impulse control disorders were compulsive buying (N=19 [9.3%]), kleptomania (N=16 [7.8%]), and pathological gambling (N=14 [6.9%]). Patients with and without co-occurring impulse control disorders did not differ significantly from each other on demographic measures or number or type of psychiatric diagnoses other than impulse control disorders. CONCLUSIONS: Impulse control disorders appear common among psychiatric inpatients. Additional, larger studies are needed to examine the prevalence of impulse control disorders in the general population and specific psychiatric groups.

Adolescent↗