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PubMed2004

Pathological gambling and personality disorders: an exploratory study with the IPDE.

This article describes the most frequent personality disorders related to pathological gambling. Participants included 50 pathological gamblers assessed with the IPDE, and 50 normative subjects from the general population with the same demographic features (age, sex, and socioeconomic level). Thirty-two percent of the clinical sample (vs. the 8% of the normative sample) showed at least one personality disorder. The most prevalent disorders were Borderline (16%), followed by Antisocial, Paranoid, Narcissistic, and Non-specified (8% each). Gamblers with personality disorders presented an average of 1.5 disorders and they reported higher gambling severity and more severe symptoms of anxiety, depression and alcohol abuse. The implications of this study for clinical practice and research are discussed.

Adult↗

PubMed2005

Effect of genes, environment, and lifetime co-occurring disorders on health-related quality of life in problem and pathological gamblers.

BACKGROUND: Problem and pathological gambling are associated with many impairments in quality of life, including financial, family, legal, and social problems. Gambling disorders commonly co-occur with other psychiatric disorders, such as alcoholism and depression. Although these consequences and correlates have been reported, little is known about the health-related functional impairment associated with gambling. OBJECTIVE: To model differences in the health-related quality of life (HRQoL) among non-problem gamblers, problem gamblers, and pathological gamblers after controlling for lifetime co-occurring substance use disorders, psychiatric disorders, sociodemographics, and genetic and family environmental influences. DESIGN: Cohort and co-twin studies. SETTING: Nationally distributed community sample. PATIENTS: Male twin members of the Vietnam Era Twin Registry: 53 pathological gamblers, 270 subclinical problem gamblers, and 1346 non-problem gamblers (controls). INTERVENTIONS: We obtained HRQoL data, via the 8-Item Short-Form Health Survey, from all participants. Data from a subset of twin pairs discordant for gambling behavior was used to control for genetic and family environmental effects on HRQoL and problem gambling. Main Outcome Measure Health-related quality of life. RESULTS: Results from adjusted logistic regression analyses suggest little difference across groups in the physical domains of the health survey; however, for each mental health domain, pathological gamblers had lower HRQoL scores than problem gamblers (P<.05), who in turn had lower scores than non-problem gamblers (P<.05). After controlling for genes and family environment, no significant differences existed between the non-problem gambling twins and their problem or pathological gambling brothers, but adjusted co-twin analyses resulted in statistically significant differences in 4 of 8 subscales. CONCLUSIONS: Pathological and problem gambling are associated with significant decrements in HRQoL. This association is partly explained by genetic and family environmental effects and by lifetime co-occurring substance use disorders. Implications for clinicians, health care utilization, and public health issues are discussed.

Cohort Studies↗

PubMed1993

Addiction disorders of New Jersey physicians.

The principles of treatment for addictive disorders are simple: Identify the disorder. Find skilled therapists to direct a treatment plan. Pursue the plan. Develop the skills to cope with life after addiction. Seek appropriate support from family and systems in the community.

Alcoholism↗

PubMed2001

Impulsive traits and 5-HT2A receptor promoter polymorphism in alcohol dependents: possible association but no influence of personality disorders.

OBJECTIVE: Impulsive behavior in alcoholics puts them at serious risk of severer course of disease and has been related to the serotonergic neurotransmission dysfunction. The aim of this study is to investigate the association between impulsive aggression in alcohol dependents with regard to the G-1438A polymorphism in the promoter region of the 5-HT2A receptor gene. Furthermore, we investigated the statistical interaction between 5-HT2A alleles, antisocial personality disorder (APD) and impulsive aggression in alcohol dependents. Alcohol dependents were investigated because these personality disorders and impulsive behavior are very frequent in alcohol dependence anf of clinical relevance. METHODS: One hundred and thirty-five patients of German descent meeting DSM-IV criteria of alcohol dependence were recruited. Blood samples were taken from alcohol dependents to determine 5-HT2A promoter polymorphisms using PCR (polymerase chain reaction) of lymphocyte DNA. Impulsive aggression was assessed using a German version of the Barratt Impulsiveness Scale which was translated and backtranslated. Alcohol dependents were subdivided into low- or high-impulsivity groups using a median split of the Barratt score. APD and borderline personality disorder (BPD) were assessed using the SCID-II interview. RESULTS: The low-impulsivity group was slightly older and showed a later age at alcoholism onset than the highly impulsive group. Alcohol dependents with high impulsive traits showed a significant association with 5-HT2A 1438 A alleles. After excluding alcohol dependents with APD or BPD from the analysis, this association remained significant. Furthermore, no association between APD, BPD and 5-HT2A alleles was noted. CONCLUSIONS: Inpatient alcohol dependents showed a significant association between 5-HT2A A alleles and impulsive traits, independent of the presence of APD or BPD. No association was noted between personality disorders and the polymorphism. This is the first report about an association of 5-HT2A promoter polymorphism and impulsive behavior in alcohol dependents. This finding may refer only to impulsive traits and may be independent of personality disorders in this sample. These results have to be confirmed in larger samples and in healthy control subjects to determine whether this association is of general validity.

Adult↗

PubMed2007

CSF testosterone: relationship to aggression, impulsivity, and venturesomeness in adult males with personality disorder.

OBJECTIVE: Studies of various species suggest that testosterone, assayed in various compartments, is correlated with aggression and possibly related behaviors. The objective of this study was to assess the relationship between cerebrospinal fluid testosterone (CSF TEST) and measures of aggression, impulsivity, and venturesomeness in male personality disordered subjects and test the hypothesis that CSF TEST would correlate directly with each measure in this group. METHODS: Lumbar CSF for morning basal levels of testosterone were obtained from 31 male subjects with personality disorder. Aggression was assessed dimensionally through the use of the life history of aggression (LHA) assessment, and categorically by the research diagnosis of intermittent explosive disorder. Impulsiveness and venturesomeness were assessed using the Eysenck personality questionnaire - II (EPQ-II). RESULTS: CSF TEST did not correlate with measures of aggression or impulsivity but did correlate directly with venturesomeness (r = .42, p = .021). Adjusting for age and height modestly reduced the magnitude and statistical significance of this correlation. CONCLUSIONS: In contrast to some published studies, CSF TEST was not found to have a significant relationship with aggression. The presence of a modest correlation between CSF TEST and venturesomeness, but not impulsivity, in male personality-disordered subjects suggests a possible relationship between CSF TEST and a type of sensation-seeking that involves consideration of the consequences of action taken.

Adult↗

PubMed1999

[Age-related factors of psychopathology of impulse control disorders].

15 children and adolescents with impulse control disorders (mean age 12.9 years) were examined. These disorders were presented as dromomania, kleptomania, aggressive-sadistic actions, tricholillomania, pyromania; a combination of different types was observed in some cases. Schizophrenia was diagnosed in 7 cases, affective disorders--in 8 patients. Independently of the nosologic unity of the disease, development of the impulse control disorders took place in affective disorders which manifested either by monopolar course (depression) (11 cases), or by bypolar attacks with unclear outlines of the phases (4 patients). Psychopathology of impulse control disorders in children and juveniles was analogous to that of the adults, however, their structure wasn't so complex and development of the phases wasn't so clear.

Adolescent↗

PubMed2005

Health and psychosocial correlates of disordered gambling in older adults.

OBJECTIVE: A number of regional prevalence studies suggest that disordered gambling is a clinically significant problem among older adults. However, little research has evaluated whether older adults with a gambling disorder experience increased health, psychiatric, substance use, and social problems as compared with older adults without a gambling disorder. METHODS: A group of 48 older-adult disordered gamblers and 48 older adult non/infrequent gamblers, matched by age, sex, race, and recruitment site, completed the Addiction Severity Index (ASI), Brief Symptom Inventory (BSI), and Short Form-36 Health Survey (SF-36). Multivariate general-linear models evaluated between-group differences on these indices. RESULTS: Compared with non/infrequent gamblers, disordered gamblers reported increased severity of medical, family/social, psychiatric, and alcohol problems on the ASI. They also scored higher on depression, anxiety, paranoid ideation, and psychoticism subscales of the BSI, and lower on vitality, physical functioning, role-physical, general health, and social functioning subscales of the SF-36. CONCLUSIONS: These results suggest that older adults with a gambling disorder experience increased severity of health and psychosocial problems, compared with older adult non/infrequent gamblers matched by age, sex, race, and recruitment site.

Aged↗

PubMed2003

Disordered gambling in adolescents : epidemiology, diagnosis, and treatment.

Rapid expansion of legalized gambling has been associated with increased rates of gambling disorders among adults and adolescents worldwide. Epidemiologic studies suggest that, in North America, up to 6% of adults and 20% of adolescents have a gambling problem. Despite increasing prevalence rates of gambling disorders, little research is available on how to treat such disorders in adolescents. Much of what is known about how to treat adolescent problem and pathological gambling comes from research on psychosocial and psychopharmacologic treatments for adult pathological gambling. Risk factors for adolescent gambling disorders include male gender, alcohol and drug use, deviant peers, family history of gambling, and impulsive behavior. While several risk factors characterize disordered gambling among adolescents, the extent to which these characteristics are related remains to be determined. In terms of screening for adolescent problem and pathological gambling, several instruments designed to reflect the Diagnostic and Statistical Manual of Mental Disorders diagnostic criteria for pathological gambling are available. Psychosocial approaches used to treat adult pathological gambling include Gamblers Anonymous, cognitive-behavioral therapy (CBT), and motivational enhancement therapy (MET). Among adolescents, CBT as well as an eclectic therapy have been helpful in reducing problematic gambling behavior. In terms of pharmacotherapy, three classes of psychotropic drugs have been used to treat adult pathological gambling - serotonin reuptake inhibitors, opioid antagonists, and mood stabilizers. While some of these pharmacotherapies have been efficacious in treating adult pathological gambling, additional double-blind, placebo-controlled studies are needed to determine the long-term effectiveness of these treatments. No known study has evaluated the use of psychopharmacologic agents in treating adolescent pathological gambling. Possible reasons for the lack of research on treatment for adolescent gambling disorders include lack of motivation to pursue treatment, feelings of self-control, and negative perception of therapy. Referrals from parents, teachers, and peers of adolescents, as well as community outreach programs, may be useful in successfully deriving a treatment population. Clinicians are advised to be sensitive to behavioral risk factors and to screen for disordered gambling in high risk adolescents. A combination of CBT and MET, as well as medication for any comorbid psychiatric condition, is recommended.

Adolescent↗

PubMed1998

Personality, smoking and suicide: a prospective study.

From a random sample of Swiss army conscripts, 28 cases of suicide, 36 deaths due to accident and 2754 controls were analyzed for social and psychological features, in particular for personality factors at age 19 years; further information was collected during a follow-up study to age 36 years. Among the subjects who committed suicide low school achievement, smoking, and psychiatric disorders were overrepresented. In both groups of deaths aggressiveness (excitability, reactive aggression, spontaneous aggression) and depression scores were higher than among controls. The findings are compatible with those of other studies and biological theories about the role of impulsiveness in suicide.

Adult↗

PubMed2004

Pathological gambling in two patients on dopamine replacement therapy for Parkinson's disease.

We describe two cases where increases in dopaminergic therapy were initiated by the patients due to perceived deterioration in symptoms of idiopathic Parkinson's disease. Shortly afterwards, both cases also met clinical criteria for pathological gambling. To date, only 29 cases of pathological gambling in patients with Parkinson's disease have been reported. This "pathological gambling disorder" is an addiction-like behavior triggered by excessive dopaminergic drugs and does not respond to standard therapy for pathological gambling. It only responds to an adjustment of Parkinson's disease therapy.

Antiparkinson Agents↗

PubMedDate not supplied

Safety of high-dose naltrexone treatment: hepatic transaminase profiles among outpatients.

OBJECTIVES: This study was carried out to test the hypothesis that the hepatic safety profile of prolonged high-dose oral naltrexone (150 mg/d) is acceptable if over-the-counter analgesic use is restricted. METHODS: Data from 41 consecutive outpatients with impulse-control disorder receiving naltrexone therapy were analyzed. RESULTS: The mean treatment duration was 328 days and the mean naltrexone dose was 142 mg/d. Pretherapy/posttherapy mean aspartate transaminase and alanine transaminase levels in the naltrexone-alone group were 21.79/22.54 and 21.74/21.49 U, respectively (all within reference range). CONCLUSIONS: Although limited in scope, these findings support the hypothesis that long-term use of high-dose oral naltrexone is safe in otherwise healthy patients with impulse-control disorders who restrict their intake of acetaminophen, aspirin, or nonaspirin nonsteroidal anti-inflammatory drugs (NSAID). However, confirming studies are needed.

Adolescent↗

PubMed1995

Body dysmorphic disorder, pathological gambling, and sexual compulsions.

This article focuses on body dysmorphic disorder (BDD), pathological gambling, and sexual compulsions within the realm of obsessive-compulsive spectrum disorders. These three disorders affect sizable numbers of the population, have an early age at onset and chronic courses, and seem to have a preferential response to serotonin reuptake inhibitors (SRIs). They also have a high comorbidity with obsessive-compulsive disorder, depression, and other impulse control disorders. BDD patients lie more toward the compulsive/risk-aversive end of the dimensional model of obsessive-compulsive spectrum disorder and often have poor insight. Pathological gambling patients lie more toward the impulsivity/novelty-seeking end of the OCD spectrum and often have features of inattention. Sexual obsessions and/or compulsions encompass a heterogeneous group of disorders, as exhibited by differential response to SRIs within this group. These three disorders fall within a new and evolving field that requires further investigation and reconceptualization. This concept may have far-reaching consequences and yield more significant treatment outcomes.

Adolescent↗

PubMedDate not supplied

Cluster analysis of obsessive-compulsive spectrum disorders in patients with obsessive-compulsive disorder: clinical and genetic correlates.

BACKGROUND: Comorbidity of certain obsessive-compulsive spectrum disorders (OCSDs; such as Tourette's disorder) in obsessive-compulsive disorder (OCD) may serve to define important OCD subtypes characterized by differing phenomenology and neurobiological mechanisms. Comorbidity of the putative OCSDs in OCD has, however, not often been systematically investigated. METHODS: The Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition , Axis I Disorders-Patient Version as well as a Structured Clinical Interview for Putative OCSDs (SCID-OCSD) were administered to 210 adult patients with OCD (N = 210, 102 men and 108 women; mean age, 35.7 +/- 13.3). A subset of Caucasian subjects (with OCD, n = 171; control subjects, n = 168), including subjects from the genetically homogeneous Afrikaner population (with OCD, n = 77; control subjects, n = 144), was genotyped for polymorphisms in genes involved in monoamine function. Because the items of the SCID-OCSD are binary (present/absent), a cluster analysis (Ward's method) using the items of SCID-OCSD was conducted. The association of identified clusters with demographic variables (age, gender), clinical variables (age of onset, obsessive-compulsive symptom severity and dimensions, level of insight, temperament/character, treatment response), and monoaminergic genotypes was examined. RESULTS: Cluster analysis of the OCSDs in our sample of patients with OCD identified 3 separate clusters at a 1.1 linkage distance level. The 3 clusters were named as follows: (1) "reward deficiency" (including trichotillomania, Tourette's disorder, pathological gambling, and hypersexual disorder), (2) "impulsivity" (including compulsive shopping, kleptomania, eating disorders, self-injury, and intermittent explosive disorder), and (3) "somatic" (including body dysmorphic disorder and hypochondriasis). Several significant associations were found between cluster scores and other variables; for example, cluster I scores were associated with earlier age of onset of OCD and the presence of tics, cluster II scores were associated with female gender and childhood emotional abuse, and cluster III scores were associated with less insight and with somatic obsessions and compulsions. However, none of these clusters were associated with any particular genetic variant. CONCLUSION: Analysis of comorbid OCSDs in OCD suggested that these lie on a number of different dimensions. These dimensions are partially consistent with previous theoretical approaches taken toward classifying OCD spectrum disorders. The lack of genetic validation of these clusters in the present study may indicate the involvement of other, as yet untested, genes. Further genetic and cluster analyses of comorbid OCSDs in OCD may ultimately contribute to a better delineation of OCD endophenotypes.

Adolescent↗

PubMed2005

Pilot treatment program for shoplifting in eating disorders.

OBJECTIVE: There are no established treatment programs for shoplifting in eating disorder patients. Our objective was to observe the effect of an established behavioural treatment program in a series of eating disorder patients. METHODS: Patients with eating disorders who shoplift voluntarily took part in an 8-week behavioral treatment program at the Elizabeth Fry Society of Greater Vancouver, British Columbia. They completed assessments at the first session, last session, and at 1 and 6 months post intervention. RESULTS: Six patients enrolled in the study and three patients completed the treatment program. Only one patient reported a decrease in shoplifting frequency. All subjects reported an increase in self-esteem and ability to control shoplifting impulses. DISCUSSION: Our findings suggest that behavioral therapy may be effective in treating shoplifting in eating disorders, but that longer sessions and follow-up may be necessary to show benefit. A randomized control trial with longer-term follow-up is needed to determine whether there is a benefit.

Adult↗

PubMed2002

Gambling behavior in adolescent substance abuse.

This study assessed the prevalence and correlates of gambling behavior (GB) in adolescent substance abusers (N = 97) consecutively admitted to an outpatient treatment program. Thirty-four percent of the cohort had never gambled; 57% were classified as social/nonpathological gamblers; 8% were labeled as in transition gamblers; and only 1% met criteria for pathological gambling. A significant finding was that males are more likely to gamble and to have a higher severity score than do females. A younger age of GB onset is seen for girls than boys and is correlated with a history of suicide attempts, diagnosis of depression, number of symptoms of oppositional behavior, cluster B personality disorders, and a higher need for psychiatric treatment. None of the gambling youths was ever referred for GB counseling. Increased awareness for and additional studies of adolescent gambling are required.

Adolescent↗

PubMed1993

Expectations disease: a model for understanding stress, control and dependent behaviour.

Most issues of emotional health seen in primary care do not fit standard psychiatric labelling. An integrative model is described for understanding the relationships between stress, control and dependent behaviours with clinical utility for primary care. In this model, expectations disease occurs when expectations consistently disable rather than enable. This clinical diagnosis is characterized by five disorders of control which contribute to recurring episodes of loss of control. Disorders of control include, 1) unmet or excessive need for control, 2) impaired recognition of controllability, 3) misattribution of control, 4) control dissimulation and 5) fear of loss of control. Definitions and behavioural consequences for each control disorder are described. Loss of control is defined as a cascade of behaviours invoked to avoid or diminish chaotic or dissonant thinking through actions one would not deliberately choose (or not choose to the same degree) while feeling in control. Examples of loss of control include substance abuse, anger (rage or violence), binge behaviours (eating, shopping, gambling, sex, overwork), depression, panic and somatization. Loss of control paradoxically results in a transient sense of relief or shift of focus from the problem stimulus, but inevitably creates further problems over time. Expectations disease is determined not by the presence or absence of control disorders, but by the degree to which these problems exist--their chronicity, intensity and rigidity. For some, this disorder may be acute or intermittent, for others chronic; for some, a nuisance, for other, disabling. Short-term intervention for patients who present with clear distress, but unclear diagnosis is discussed. Advantages and disadvantages of the model are detailed.

Behavior↗

PubMed1996

Compulsive buying: a review.

Compulsive buying has a long history. Described nearly a century ago by Kraepelin, and later by Bleuler, the disorder has been of interest to psychoanalysts and to the popular media. Recent interest has been rekindled by consumer behavior research that shows it to be widespread and psychiatric research that shows it to have the earmarks of a psychiatric disorder. The author reviews the history, definition, epidemiology, family history, etiology, clinical symptoms, and treatments of compulsive buying. Preliminary data from an open-label study in which subjects received fluvoxamine are also presented.

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↗