Pathological gambling and obsessive-compulsive disorder: towards a spectrum of disorders of volition Jogo patológico e transtorno obsessivo-compulsivo: rumo a um espectro de transtornos da volição

OBJECTIVE: Pathological gambling is proposed as a participant of an impulsive-compulsive spectrum related to obsessive-compulsive disorder. This study aims to contrast pathological gambling and obsessive-compulsive disorder regarding course, comorbidity, and personality, hence testing the validity of the impulsive-compulsive spectrum. METHOD: 40 pathological gambling and 40 obsessive-compulsive disorder subjects matched to 40 healthy volunteers according to gender, age, and education were assessed with the Temperament Personality Questionnaire and the Barratt Impulsiveness Scale. Psychiatric patients were also assessed for course and comorbidity data. RESULTS: Obsessive-compulsive disorder presented an earlier onset, but the full syndrome took longer to evolve. Pathological gambling had higher comorbidity with substance-related disorders, and obsessive-compulsive disorder higher comorbidity with somatoform disorders. Gamblers scored higher than controls on the sub-factors Impulsiveness, Extravagance, Disorderliness, and Fear of Uncertainty. Obsessive-compulsive patients scored higher than controls on Fear of Uncertai-nty. Impulsiveness, Extravagance, and Disorderliness significantly correlated with the Barratt Impulsiveness Scale total score, Fear of Uncertainty did not. DISCUSSION: The course and comorbidity profiles of pathological gambling resemble an addiction and differ from obsessive-compulsive disorder. Pathological gambling combines impulsive and compulsive traits. Impulsivity and compulsivity should be regarded as orthogonal constructs, and as drives implicated in volition aspects of behavioral syndromes.<br>OBJETIVO: Propõe-se que o jogo patológico faça parte de um espectro impulsivo-compulsivo relacionado ao transtorno obsessivo-compulsivo. O presente estudo propõe-se a comparar o jogo patológico e o transtorno obsessivo-compulsivo em relação a curso, comorbidade e personalidade, a fim de testar a validade do espectro impulsivo-compulsivo. MÉTODO: Quarenta jogadores e 40 portadores de transtorno obsessivo-compulsivo pareados a 40 voluntários normais de acordo com gênero, idade e nível educacional foram avaliados através do Questionário de Temperamento e Caráter e da Escala de Impulsividade de Barratt. Para os pacientes, dados sobre curso da doença e comorbidade psiquiátrica também foram avaliados. RESULTADOS: O transtorno obsessivo-compulsivo apresentou início mais precoce, mas o desenvolvimento da síndrome completa foi mais longo. O jogo patológico teve comorbidade mais elevada com transtornos pelo uso de substâncias, e o transtorno obsessivo-compulsivo teve maior comorbidade com transtornos somatoformes. Os jogadores tiveram escores mais elevados do que os controles nos subfatores Impulsividade, Extravagância e Desorganização, e Medo da Incerteza. Os pacientes obsessivo-compulsivos tiveram escores mais elevados do que os controles em Medo da Incerteza. Impulsividade, Extravagância e Desorganização se correlacionaram significativamente com o escore total na Escala de Impulsividade de Barratt, enquanto Medo da Incerteza não. DISCUSSÃO: O perfil de curso e comorbidade do jogo patológico se parece com o de uma dependência, diferindo do transtorno obsessivo-compulsivo. O jogo patológico combina traços impulsivos e compulsivos. Impulsividade e compulsividade são construtos ortogonais e implicados nos aspectos volitivos das síndromes comportamentais

Gambling: An Addictive Behavior with Health and Primary Care Implications

Over the past several decades, and particularly during the last 10 to 15 years, there has been a rapid increase in the accessibility of legalized gambling in the United States and other parts of the world. Few studies have systematically explored the relationships between patterns of gambling and health status. Existing data support the notion that some gambling behaviors, particularly problem and pathological gambling, are associated with nongambling health problems. The purpose of this article is to provide a perspective on the relationship between gambling behaviors and substance use disorders, review the data regarding health associations and screening and treatment options for problem and pathological gambling, and suggest a role for generalist physicians in assessing problem and pathological gambling. A rationale for conceptualization of pathological gambling as an addictive disorder and a model proposing stress as a possible mediating factor in the relationship between gambling and health status are presented. More research is needed to investigate directly the biological and health correlates associated with specific types of gambling behaviors and to define the role for generalist physicians in the prevention and treatment of problem and pathological gambling

Treatment consideration and manifest complexity in comorbid neuropsychiatric disorders

Psychiatric disorders may co-occur in the same individual. These include, for example, substance abuse or obsessive-compulsive disorder with schizophrenia, and movement disorders or epilepsy with affective dysfunctional states. Medications may produce iatrogenic effects, for example cognitive impairments that co-occur with the residual symptoms of the primary disorder being treated. The observation of comorbid disorders in some cases may reflect diagnostic overlap. Impulsivity, impulsiveness or impulsive behaviour is implicated in a range of diagnostic conditions including substance abuse, affective disorder and obsessive-compulsive disorder. These observations suggest a need to re-evaluate established diagnostic criteria and disorder definitions, focusing instead on symptoms and symptom-profiles