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PubMed2003

Reliability, validity, and classification accuracy of a measure of DSM-IV diagnostic criteria for pathological gambling.

OBJECTIVE: The purpose of this study was to measure the reliability, validity, and classification accuracy of the DSM-IV diagnostic criteria for pathological gambling. METHOD: Participants in this study were drawn from two sources: 803 men and women from the general adult population of Minnesota and 259 men and women who were admitted to a gambling treatment program. A 19-item measure of the DSM-IV diagnostic criteria for pathological gambling was administered, along with other validity measures. RESULTS: The DSM-IV diagnostic criteria were found to be reliable and valid. With a standard cutoff score of 5, DSM-IV criteria yielded satisfactory classification accuracy results; however, a cutoff score of 4 made modest improvements in classification accuracy and, most important, reduced the rate of false negatives. CONCLUSIONS: The DSM-IV diagnostic criteria for pathological gambling, when operationalized into questions, demonstrated satisfactory reliability, validity, and classification accuracy, and a cutoff score of 4 improved diagnostic precision.

Adolescent↗
PubMed2004

Borderline personality disorder criteria associated with prospectively observed suicidal behavior.

OBJECTIVE: The authors prospectively examined associations between each DSM-IV borderline personality disorder criterion and suicidal behaviors. METHOD: Borderline personality disorder diagnosis and criteria, major depressive disorder, substance use disorders, and history of childhood sexual abuse were assessed with semistructured interviews. Participants (N=621) were followed for 2 years with repeated structured evaluations that included assessments of suicidality. RESULTS: With the self-injury criterion excluded, the borderline personality disorder criteria of affective instability, identity disturbance, and impulsivity significantly predicted suicidal behaviors. Only affective instability and childhood sexual abuse were significantly associated with suicide attempts (i.e., behavior with some intent to die). CONCLUSIONS: Affective instability is the borderline personality disorder criterion (excluding self-injury) most strongly associated with suicidal behaviors. Since major depressive disorder did not significantly predict suicidal behaviors, the reactivity associated with affective instability (more so than negative mood states) appears to be a critical element in predicting suicidal behaviors.

Adolescent↗
PubMed2005

Increased impulsivity associated with severity of suicide attempt history in patients with bipolar disorder.

BACKGROUND: Impulsivity is a prominent and measurable characteristic of bipolar disorder that can contribute to risk for suicidal behavior. The purpose of this study was to investigate the relationship between impulsivity and severity of past suicidal behavior, a potential predictor of eventual suicide, in patients with bipolar disorder. METHOD: In bipolar disorder subjects with either a definite history of attempted suicide or no such history, impulsivity was assessed with both a questionnaire (Barratt Impulsiveness Scale) and behavioral laboratory performance measures (immediate memory/delayed memory tasks). Diagnosis was determined with the Structured Clinical Interview for DSM-IV. Interviews of patients and review of records were used to determine the number of past suicide attempts and the medical severity of the most severe attempt. RESULTS: Subjects with a history of suicide attempts had more impulsive errors on the immediate memory task and had shorter response latencies, especially for impulsive responses. Impulsivity was highest in subjects with the most medically severe suicide attempts. Effects were not accounted for by presence of depression or mania at the time of testing. Barratt Impulsiveness Scale scores were numerically, but not significantly, higher in subjects with suicide attempts. A history of alcohol abuse was associated with greater probability of a suicide attempt. Multivariate analysis showed that ethanol abuse history and clinical state at the time of testing did not have a significant effect after impulsivity was taken into account. DISCUSSION: These results suggest that a history of severe suicidal behavior in patients with bipolar disorder is associated with impulsivity, manifested as a tendency toward rapid, unplanned responses.

Adult↗
PubMed2006

Natural recovery and treatment-seeking in pathological gambling: results of two U.S. national surveys.

OBJECTIVE: Pathological gambling is described in DSM-IV as a chronic and persisting disorder, but recent community-based longitudinal studies that have highlighted the transitory nature of gambling-related problems have called into question whether this is an accurate characterization. This emerging evidence of high rates of recovery coupled with low rates of treatment-seeking for pathological gambling suggests that natural recovery might be common. The purpose of the present study was to document the rates of recovery, treatment-seeking, and natural recovery among individuals with DSM-IV pathological gambling disorder in two large and representative U.S. national surveys. METHOD: Prevalences of recovery, treatment-seeking, and natural recovery were estimated among individuals from the Gambling Impact and Behavior Study (N=2,417) and the National Epidemiologic Survey on Alcohol and Related Conditions (N=43,093) who reported a lifetime history of DSM-IV pathological gambling disorder (N=21 and N=185, respectively). RESULTS: Among individuals with a lifetime history of DSM-IV pathological gambling, 36%-39% did not experience any gambling-related problems in the past year, even though only 7%-12% had ever sought either formal treatment or attended meetings of Gamblers Anonymous. About one-third of the individuals with pathological gambling disorder in these two nationally representative U.S. samples were characterized by natural recovery. CONCLUSIONS: Pathological gambling may not always follow a chronic and persisting course. A substantial portion of individuals with a history of pathological gambling eventually recover, most without formal treatment. The results of large epidemiological surveys of pathological gambling may eventually overturn the established wisdom about pathological gambling disorder.

Adult↗
PubMed2002

An analysis of cue reactivity among persons with and without schizophrenia who are addicted to cocaine.

OBJECTIVE: Persons with schizophrenia who are addicted to cocaine experience more psychiatric and substance abuse relapses and worse long-term outcomes than persons with only one of these conditions. This study examined whether individuals with cocaine dependence and schizophrenia experience more cue-elicited craving than those without schizophrenia. METHODS: Ninety-one cocaine-dependent participants who had been abstinent from cocaine for at least 72 hours were recruited from substance abuse treatment programs in the Veterans Affairs New Jersey Health Care System. The study used a cue-exposure paradigm to stimulate cocaine craving. A self-report instrument was used to measure changes from baseline in four areas: craving intensity, happy or depressed mood, increased or decreased energy, and physical health or sickness. RESULTS: The participants with schizophrenia (N=35) reported significantly more cocaine craving than those without schizophrenia (N=56). When data for participants who were cue reactive were analyzed without regard to diagnosis, 97 percent of the cocaine-dependent participants with schizophrenia were cue reactive, compared with 43 percent of those without schizophrenia. CONCLUSIONS: Future research on cocaine dependence should focus on craving, particularly among patients with coexisting psychiatric disorders.

Adult↗
PubMed1987

Kleptomania as risk-taking behavior in response to depression.

The psychodynamic etiology of kleptomania has historically been linked to "ungratified sexual instinct." This paper is the first report of kleptomanic behavior associated with masturbation during the shoplifting or at the time of discovery by authorities. However, in this case kleptomania was in fact risk-taking behavior in response to depression. Psychodynamically, risk-taking behavior may be important in kleptomania.

Arousal↗
PubMed1988

Clinical perspectives on elderly first-offender shoplifters.

For more than a decade shoplifting first offenses by people over the age of 60 have been increasing. Because elderly shoplifters are usually not motivated to steal by economic hardship, their shoplifting may be symptomatic of a psychiatric disorder. The diagnostic criteria for kleptomania are summarized, and four cases of elderly patients whose shoplifting was a factor in their psychiatric diagnoses are presented. Multidimensional psychiatric evaluation of elderly first offenders is recommended and should take into account psychodynamic and neurobehavioral factors, as well as the psychiatric sequelae of the trauma of arrest and criminal processing.

Aged↗
PubMed2004

Comparisons between the South Oaks Gambling Screen and a DSM-IV-based interview in a community survey of problem gambling.

OBJECTIVE: To directly compare 2 forms of assessment for determining gambling problems in a community survey, and to examine the characteristics of respondents who endorsed DSM-IV symptoms but who scored below the formal DSM-IV diagnostic cut-off for pathological gambling. METHOD: We interviewed 1489 Winnipeg adults by phone (response rate 70.5%) using th South Oaks Gambling Screen (SOGS), a DSM-IV-based instrument, and several gambling-related variables. RESULTS: The lifetime prevalence of "probable pathological gambling" (according to the SOGS, having a score of > or = 5) was 2.6%. The SOGS items and DSM-IV symptoms were highly correlated (r = 0.80), but a score of 5 or more symptoms for a DSM-IV diagnosis produced lower prevalence figures. Comparisons between recreational gamblers (those with no DSM-IV symptoms), subthreshold pathological gamblers (those with 1 to 4 DSM-IV symptoms), and pathological gamblers (those with > or = 5 DSM-IV symptoms) on series of gambling-related variables (for example, high use of video lottery terminals) revealed that subthreshold individuals significantly differed from recreational gamblers and more closely approximated the characteristics displayed by pathological gamblers. CONCLUSIONS: SOGS items show a high degree of association with the DSM-IV clinical symptoms of pathological gambling, but the DSM-IV cut-off of 5 symptoms is more conservative in defining gambling problems. Results support a continuum view of gambling problems in the community. DSM-IV scores of 3 or 4 represent the higher end of the group officially considered diagnostically "subthreshold" and may be important from both a clinical and public health perspective.

Adult↗
PubMed2004

The road less travelled: moving from distribution to determinants in the study of gambling epidemiology.

This article reviews the current status of gambling epidemiology studies and suggests that it is time to move from general population-prevalence research toward the investigation of risk and protective factors that influence the onset of gambling disorders. The study of incidence among vulnerable and resilient populations is a road yet to be taken. In this review, we briefly introduce the history of the field and thoroughly review the epidemiologic research on disordered gambling before providing a critical assessment of the current diagnostic tools. Overall, the extant research shows that disordered gambling is a relatively stable phenomenon throughout the world. Given that certain segments of the population (for example, adolescents and substance users) have elevated prevalence rates, we suggest focusing future prevalence studies on groups with apparently increased vulnerability. Moreover, we suggest that, for the field of gambling studies to progress, researchers need to take the road less travelled and examine more carefully the onset and determinants of disordered gambling. That said, given the problems with the current diagnostic screens, investigators need to refine their theoretical concepts and the epidemiologic tools used to examine them before the field can travel down this new road.

Adolescent↗
PubMed2006

Inattention, hyperactivity, and impulsivity in teenagers with intellectual disabilities, with and without autism.

OBJECTIVE: To explore inattentive, hyperactive, and impulsive behaviours in teenagers with intellectual disabilities (ID), with and without autism. METHOD: We identified teenagers with ID, with and without autism, in a single geographic area. Those with autism were matched for age, sex, and nonverbal IQ to those with ID only. We compared inattentive, hyperactive, and impulsive (IHI) behaviours in the 2 groups, along with adaptive functioning and medical circumstances. We further subdivided the autism group into those with IHI behaviours (autism IHI) and those without (autism non-IHI) and explored similarities and differences between autism subgroups. RESULTS: As a group, those with autism and ID had more IHI behaviours than those with ID alone. More in the autism group met criteria for attention-deficit hyperactivity disorder and hyperkinetic syndrome. Lifetime exposure to psychotropic medication was greater in the autism group, with stimulant and antipsychotic medications predominating. However, just under one-half of those in the autism group showed no IHI behaviours. Comparison of autism IHI and autism non-IHI groups showed that those with IHI behaviours were significantly more likely to have past (but not current) exposure to stimulant medication. CONCLUSIONS: One in 2 teenagers with ID and coexisting autism displayed clinically significant inattentive, hyperactive, and (or) impulsive behaviours, compared with 1 in 7 of those with ID alone. Most of the remaining teenagers with autism displayed no IHI behaviours. Our results support the need for further investigation into the prevalence and etiology of these IHI behaviours in individuals with autism.

Adolescent↗
PubMed1983

Shoplifting: is there a specific psychiatric syndrome?

The psychiatric, psychosocial and medicolegal variables of 50 shoplifters and two comparison groups are described. The shoplifters were found to be an almost identical population when compared to general, (non-forensic) psychiatric outpatients, and differed significantly from a comparison group of general forensic patients excluding shoplifters. A high level of psychosocial stress antedating the shoplifting behaviour was a significant finding. A profile of a typical shoplifter referred for psychiatric examination is a 37 year old married female person, employed at the professional end of the occupational spectrum, who is suffering from a depressive neurosis and who steals an item of insignificant value or use to herself. The psychiatric diagnostic profile supports the lenient legal disposition by the courts.

Adult↗
PubMed2004

Pathological gambling among elderly veterans.

The purpose of the present study was to examine elderly patients, aged 60 and older, admitted to a residential gambling treatment program and to compare them to a younger cohort on a variety of mental health factors and measures. A retrospective chart review was performed for 37 elderly gamblers consecutively admitted to the Gambling Treatment Program of a VA center between December 1999 and December 2002. These elderly subjects were compared with a younger cohort of 98 gamblers. On intake, the gamblers completed the Addiction Severity Index (ASI) and a variety of mental health questionnaires. Compared to the younger cohort, elderly gamblers were more likely to be retired but demonstrated similar impairment on the ASI composite employment severity score. Elderly gamblers were just as likely as the younger gamblers to have a lifetime history of serious suicidal ideation. They were equally likely as the younger cohort to carry a psychiatric diagnosis, and depression was the most common diagnosis.

Adult↗
PubMed2004

Pharmacotherapy outcome in older pathological gamblers: a preliminary investigation.

Although pharmacotherapy is often effective for pathological gambling, little is known about how it affects older populations. The present study examines the response to pharmacotherapy in a series of pathological gamblers age 60 years and older. Fourteen older patients who fulfilled DSM-IV criteria for pathological gambling were treated in an outpatient clinic. Subjects were assessed retrospectively with the Clinical Global Impressions scale (both severity and improvement measures) using information collected on gambling symptoms during clinic visits. Eight (57.1%) older patients achieved sustained response to pharmacotherapy. The present findings indicate that many older pathological gamblers respond to "off-label" use of pharmacotherapy. The present findings are preliminary. Further studies with larger samples are needed to confirm these findings.

Aged↗
PubMed2003

Callous-unemotional traits, impulsivity, and emotional processing in adolescents with antisocial behavior problems.

Examined the emotional reactivity of adolescents with antisocial behavior problems using a lexical decision paradigm. Evidence from adult forensic samples indicates that psychopathic traits are associated with abnormalities in the processing of emotional stimuli. In an attempt to extend these findings earlier in development, this association was tested in a sample of adolescents (mean age = 16.01; SD = 1.32) referred to a diversion program for delinquent behavior. Emotional processing was assessed by comparing recognition time for emotional words, both positive and negative, to recognition time for nonemotional words. Consistent with adult findings, the callous-unemotional (CU) dimension of psychopathy was associated with slower reaction times to negative words. In contrast, problems of impulse control were associated with faster recognition times for negative emotional words. These findings suggest that different patterns of emotional reactivity may characterize distinct subgroups of youth with antisocial behavior problems.

Adolescent↗