頭部外傷の治療(交通事故による脳障害,第48回千葉医学会学術大会,第17回千葉県医師会学術大会,第10回日医医学講座,連合大会)

BACKGROUND:The negative consequences of energy dense foods are well known, yet people increasingly make unhealthy food choices leading to obesity (i.e., risky decisions). The aims of this study were: [1] to compare performance in decision-making tasks under risk and under ambiguity between individuals with obesity, overweight and normal weight; [2] to examine the associations between body mass index (BMI) and decision-making, and the degree to which these associations are modulated by reward sensitivity. METHODS:Seventy-nine adults were recruited and classified in three groups according to their BMI: obesity, overweight and normal-weight. Groups were similar in terms of age, education and socio-economic status, and were screened for comorbid medical and mental health conditions. Decision-making under risk was measured via the Wheel of Fortune Task (WoFT) and decision-making under ambiguity via the Iowa Gambling Task (IGT). Reward sensitivity was indicated by the Sensitivity to Punishment and Sensitivity to Reward Questionnaire (SPSRQ). RESULTS:Individuals with obesity made riskier choices in the WoFT, specifically in choices with an expected value close to zero and in the propensity to risk index. No differences were found in IGT performance or SPSRQ scores. BMI was associated with risk-taking (WoFT performance), independently of reward sensitivity. CONCLUSIONS:Obesity is linked to a propensity to make risky decisions in experimental conditions analogous to everyday food choices

Altered decision-making under risk in obesity

Background: The negative consequences of energy dense foods are well known, yet people increasingly make unhealthy food choices leading to obesity (i.e., risky decisions). The aims of this study were: [1] to compare performance in decision-making tasks under risk and under ambiguity between individuals with obesity, overweight and normal weight; [2] to examine the associations between body mass index (BMI) and decision-making, and the degree to which these associations are modulated by reward sensitivity. Methods: Seventy-nine adults were recruited and classified in three groups according to their BMI: obesity, overweight and normal-weight. Groups were similar in terms of age, education and socio-economic status, and were screened for comorbid medical and mental health conditions. Decision-making under risk was measured via the Wheel of Fortune Task (WoFT) and decision-making under ambiguity via the Iowa Gambling Task (IGT). Reward sensitivity was indicated by the Sensitivity to Punishment and Sensitivity to Reward Questionnaire (SPSRQ). Results: Individuals with obesity made riskier choices in the WoFT, specifically in choices with an expected value close to zero and in the propensity to risk index. No differences were found in IGT performance or SPSRQ scores. BMI was associated with risk-taking (WoFT performance), independently of reward sensitivity. Conclusions: Obesity is linked to a propensity to make risky decisions in experimental conditions analogous to everyday food choices

The role of affect-driven impulsivity in gambling cognitions: A convenience-sample study with a Spanish version of the Gambling-Related Cognitions Scale

Abnormal cognitions are among the most salient domain-specific features of gambling disorder. The aims of this study were: (a) to examine and validate a Spanish version of the Gambling-Related Cognitions Scale (GRCS; Raylu & Oei, 2004) and (b) to examine associations between cognitive distortion levels, impulsivity, and gambling behavior. Methods This study first recruited a convenience sample of 500 adults who had gambled during the previous year. Participants were assessed using the Spanish version of GRCS (GRCS-S) questionnaire, the UPPS-P impulsivity questionnaire, measures of gambling behavior, and potentially relevant confounders. Robust confirmatory factor analysis methods on half the sample were used to select the best models from a hypothesis-driven set. The best solutions were validated on the other half, and the resulting factors were later correlated with impulsivity dimensions (in the whole n = 500 factor analysis sample) and clinically relevant gambling indices (in a separate convenience sample of 137 disordered and non-disordered gamblers; validity sample). Results This study supports the original five-factor model, suggests an alternative four-factor solution, and confirms the psychometric soundness of the GRCS-S. Importantly, cognitive distortions consistently correlated with affect- or motivation-driven aspects of impulsivity (urgency and sensation seeking), but not with cognitive impulsivity (lack of premeditation and lack of perseverance). Discussion and conclusions Our findings suggest that the GRCS-S is a valid and reliable instrument to identify gambling cognitions in Spanish samples. Our results expand upon previous research signaling specific associations between gambling-related distortions and affect-driven impulsivity in line with models of motivated reasoning

The role of affect-driven impulsivity in gambling cognitions: a convenience-sample study with a Spanish version of the Gambling-Related Cognitions Scale

Background and aims: abnormal cognitions are among the most salient domain-specific features of gambling disorder. The aims of this study were: (a) to examine and validate a Spanish version of the Gambling-Related Cognitions Scale (GRCS; Raylu & Oei, 2004) and (b) to examine associations between cognitive distortion levels, impulsivity, and gambling behavior. Methods: this study first recruited a convenience sample of 500 adults who had gambled during the previous year. Participants were assessed using the Spanish version of GRCS (GRCS-S) questionnaire, the UPPS-P impulsivity questionnaire, measures of gambling behavior, and potentially relevant confounders. Robust confirmatory factor analysis methods on half the sample were used to select the best models from a hypothesis-driven set. The best solutions were validated on the other half, and the resulting factors were later correlated with impulsivity dimensions (in the whole n = 500 factor analysis sample) and clinically relevant gambling indices (in a separate convenience sample of 137 disordered and non-disordered gamblers; validity sample). Results: this study supports the original five-factor model, suggests an alternative four-factor solution, and confirms the psychometric soundness of the GRCS-S. Importantly, cognitive distortions consistently correlated with affect-or motivation-driven aspects of impulsivity (urgency and sensation seeking), but not with cognitive impulsivity (lack of premeditation and lack of perseverance). Discussion and conclusions: our findings suggest that the GRCS-S is a valid and reliable instrument to identify gambling cognitions in Spanish samples. Our results expand upon previous research signaling specific associations between gambling-related distortions and affect-driven impulsivity in line with models of motivated reasoning

"Food Addiction" in Patients with Eating Disorders is Associated with Negative Urgency and Difficulties to Focus on Long-Term Goals

Objectives: The present study aimed to investigate if eating disorder patients differ in specific personality traits depending on a positive screening of food addiction (FA) and to find a model to predict FA in eating disorder patients using measures of personality and impulsivity. Methods : Two hundred seventy eight patients, having an eating disorder, self-reported on FA, impulsivity, personality, eating and general psychopathology. Patients were then split into two groups, depending on a positive or negative result on the FA screening. Analysis of variance was used to compare means between the two groups. Stepwise binary logistic regression was used to obtain a predictive model for the presence of FA. Results: Patients with FA had lower self-directedness, and more negative urgency and lack of perseverance than patients not reporting addictive eating. The probability of FA can be predicted by high negative urgency, high reward dependence, and low lack of premeditation. Conclusion: Eating disorder patients who have more problems to pursue tasks to the end and to focus on long-term goals seem to be more likely to develop addictive eating patterns

'Food Addiction' in Patients with Eating Disorders is Associated with Negative Urgency and Difficulties to Focus on Long-Term Goals

Objectives: The present study aimed to investigate if eating disorder patients differ in specific personality traits depending on a positive screening of food addiction (FA) and to find a model to predict FA in eating disorder patients using measures of personality and impulsivity. Methods: Two hundred seventy eight patients, having an eating disorder, self-reported on FA, impulsivity, personality, eating and general psychopathology. Patients were then split into two groups, depending on a positive or negative result on the FA screening. Analysis of variance was used to compare means between the two groups. Stepwise binary logistic regression was used to obtain a predictive model for the presence of FA. Results: Patients with FA had lower self-directedness, and more negative urgency and lack of perseverance than patients not reporting addictive eating. The probability of FA can be predicted by high negative urgency, high reward dependence, and low lack of premeditation. Conclusion: Eating disorder patients who have more problems to pursue tasks to the end and to focus on long-term goals seem to be more likely to develop addictive eating patterns

Effect of A Very Low-Calorie Ketogenic Diet on Food and Alcohol Cravings, Physical and Sexual Activity, Sleep Disturbances, and Quality of Life in Obese Patients

Psychological well-being and hunger and food control are two relevant factors involved in the success of weight-loss therapy in treating obesity. Thus, this study aims to evaluate food and alcohol cravings, physical and sexual activity, sleep, and life quality (QoL) in obese patients following a very low-calorie ketogenic (VLCK) diet, as well as the role of weight lost and ketosis on these parameters. A battery of psychological test was performed in twenty obese patients (12 females, 47.2 +/- 10.2 year and BMI of 35.5 +/- 4.4) through the course of a 4-month VLCK diet on four subsequent visits: baseline, maximum ketosis, reduced ketosis, and endpoint. Each subject acted as their own control. Relevantly, the dietary-induced changes in body composition (7.7 units of BMI lost, 18 kg of fat mass (1.2 kg of visceral fat mass)) were associated with a statistically significant improvement in food craving scores, physical activity, sleepiness, and female sexual function. Overall, these results also translated in a notable enhancement in QoL of the treated obese patients. Therefore, the rapid and sustained weight and fat mass (FM) loss induced by the VLCK diet is associated with good food control and improvements in the psychological well-being parameters in obese subjects, which could contribute to the long-term success of this therapy

Impulsividad y conciencia del problema predicen la adherencia terapéutica y el abandono del tratamiento en el trastorno por juego de azar

Este estudio investiga el valor predictivo de la impulsividad como rasgo (evaluada con la escala de conducta impulsiva UPPS-P) y de covariados relevantes (variables sociodemográficas, severidad del juego de azar, estado de ánimo disfórico, otras conductas adictivas e inteligencia no verbal), con respecto al abandono del tratamiento y los niveles de cumplimiento de las prescripciones terapéuticas en pacientes con trastorno por juego de azar. Sesenta y seis pacientes con este trastorno, participantes del proyecto G-Brain, fueron evaluados inicialmente en impulsividad rasgo y en los covariados mencionados. Dicha evaluación se realizó durante los seis primeros meses desde el inicio de su tratamiento. En el seguimiento realizado a los 6 meses, 24 pacientes habían abandonado (grupo ABD) y 42 continuaban el tratamiento (grupo NABD). Los análisis multivariados con las subescalas de impulsividad mostraron diferencias prospectivas entre ambos grupos. Aparentemente, estas diferencias son atribuibles a las dimensiones afectivas de impulsividad (urgencias positiva y negativa). Entre ambas dimensiones, solo la urgencia positiva fue un predictor independiente de un ligero incremento en la probabilidad de abandono. Dentro del grupo NABD, un mayor grado de adherencia terapéutica vino predicho, de manera independiente, tanto por una baja búsqueda de sensaciones como por una mayor conciencia de los problemas vinculados al juego. Estos resultados sugieren que los rasgos de impulsividad de origen afectivo son predictores de abandono del tratamiento en pacientes con trastorno por juego. La conciencia de problemas asociados al juego de azar y una baja búsqueda de sensaciones predisponen a una mayor adherencia a las prescripciones terapéuticas

Olfaction in eating disorders and abnormal eating behavior: a systematic review

The study provides a systematic review that explores the current literature on olfactory capacity in abnormal eating behavior. The objective is to present a basis for discussion on whether research in olfaction in eating disorders may offer additional insight with regard to the complex etiopathology of eating disorders (ED) and abnormal eating behaviors. Electronic databases (Medline, PsycINFO, PubMed, Science Direct, and Web of Science) were searched using the components in relation to olfaction and combining them with the components related to abnormal eating behavior. Out of 1352 articles, titles were first excluded by title (n = 64) and then by abstract and fulltext resulting in a final selection of 14 articles (820 patients and 385 control participants) for this review. The highest number of existing literature on olfaction in ED were carried out with AN patients (78.6%) followed by BN patients (35.7%) and obese individuals (14.3%). Most studies were only conducted on females. The general findings support that olfaction is altered in AN and in obesity and indicates toward there being little to no difference in olfactory capacity between BN patients and the general population. Due to the limited number of studies and heterogeneity this review stresses on the importance of more research on olfaction and abnormal eating behavior

Impulsivity and problem awareness predict therapy compliance and dropout from treatment for gambling disorder

Este estudio investiga el valor predictivo de la impulsividad como rasgo (evaluada con la escala de conducta impulsiva UPPS-P) y de covariados relevantes (variables sociodemográficas, severidad del juego de azar, estado de ánimo disfórico, otras conductas adictivas e inteligencia no verbal), con respecto al abandono del tratamiento y los niveles de cumplimiento de las prescripciones terapéuticas en pacientes con trastorno por juego de azar. Sesenta y seis pacientes con este trastorno, participantes del proyecto G-Brain, fueron evaluados inicialmente en impulsividad rasgo y en los covariados mencionados. Dicha evaluación se realizó durante los seis primeros meses desde el inicio de su tratamiento. En el seguimiento realizado a los 6 meses, 24 pacientes habían abandonado (grupo ABD) y 42 continuaban el tratamiento (grupo NABD). Los análisis multivariados con las subescalas de impulsividad mostraron diferencias prospectivas entre ambos grupos. Aparentemente, estas diferencias son atribuibles a las dimensiones afectivas de impulsividad (urgencias positiva y negativa). Entre ambas dimensiones, solo la urgencia positiva fue un predictor independiente de un ligero incremento en la probabilidad de abandono. Dentro del grupo NABD, un mayor grado de adherencia terapéutica vino predicho, de manera independiente, tanto por una baja búsqueda de sensaciones como por una mayor conciencia de los problemas vinculados al juego. Estos resultados sugieren que los rasgos de impulsividad de origen afectivo son predictores de abandono del tratamiento en pacientes con trastorno por juego. La conciencia de problemas asociados al juego de azar y una baja búsqueda de sensaciones predisponen a una mayor adherencia a las prescripciones terapéuticas.This study investigates the predictive value of impulsivity traits (as measured by the UPPS-P impulsive behaviour scale) and relevant covariates (sociodemographics, gambling severity, dysphoric mood, other potentially addictive behaviours, and non-verbal intelligence) with regard to treatment dropout and level of adherence to therapy guidelines and instructions in patients with gambling disorder. Sixtysix patients seeking treatment for gambling disorder, and recruited to participate in a larger protocol (G-Brain), were initially assessed in impulsivity traits and relevant covariates in the first six months after admission. 24 patients dropped out (DO) and 42 patients remained in therapy (NDO) during the subsequent 6-month follow-up period. A multivariate analysis of impulsivity subscales suggested prospective differences between DO and NDO, with affect-driven dimensions (positive and negative urgency) seemingly driving these differences. Among these, only positive urgency independently predicted a slight increase in the drop-out probability. In the NDO group, a higher degree of adherence to therapy was independently predicted by lower sensation-seeking scores and stronger awareness of gambling-related problems. Results suggest the presence of affect-driven impulsivity traits as dropout predictors in patients with gambling disorder. Awareness of gambling-related problems and lower sensation-seeking enhanced compliance with therapeutic guidelines and instructions