How to measure monetary losses in gambling disorder? An evidence-based refinement.

Diverse monetary measures have been utilized across different studies in gambling disorder (GD). However, there are limited evidence-based proposals regarding the best way to assess financial losses. We investigated how different variables of monetary losses correlate with validated assessments of gambling severity and overall functioning in a large sample of subjects with GD (n = 436). We found that relative monetary variables (i.e. when financial losses were evaluated in relation to personal income) showed the most robust correlations with gambling severity and overall psychosocial functioning. Percentage of monthly income lost from gambling was the variable with the best performance. Keywords:Open Access funded by Wellcome Trus

Impact of obsessive-compulsive personality disorder (OCPD) symptoms in Internet users

Background: Internet use is pervasive in many cultures. Little is known about the impact of Obsessive-Compulsive Personality Disorder (OCPD) symptoms on impulsive and compulsive psychopathologies in people who use the Internet. Method: 1323 adult Internet users completed an online questionnaire quantifying OCPD symptoms, likely occurrence of select mental disorders (OCD, ADHD, problematic Internet use, anxiety), and personality questionnaires of impulsivity (Barratt) and compulsivity (Padua). Predictors of presence of OCPD symptoms (endorsement of at least 4 of 8 DSM criteria) were identified using binary logistic regression. Results: In regression (p<0.001, AUC 0.77), OCPD symptoms were significantly associated with (in order of decreasing effect size): lower non-planning impulsivity, higher ADHD symptoms, problematic Internet use, avoidant personality disorder, female gender, generalized anxiety disorder, and some types of compulsions (checking, dressing/washing). Conclusions: These data suggest that OCPD symptoms, defined in terms of at least 4 of 8 DSM tick-list criteria being met, are common in Internet users. OCPD symptoms were associated with considerably higher levels of psychopathology relating to both impulsive (ADHD) and compulsive (OC-related and problematic Internet use) disorders. These data merit replication and extension using gold-standard in-person clinical assessments, as the current study relied on self-report over the Internet.This research was supported by a Grant from the Academy of Medical Sciences (UK) and by a Wellcome Trust Clinical Fellowship (110049/Z/15/Z)

Palliative care making a difference in rural Uganda, Kenya and Malawi: three rapid evaluation field studies

<p>Abstract</p> <p>Background</p> <p>Many people live and die in pain in Africa. We set out to describe patient, family and local community perspectives on the impact of three community based palliative care interventions in sub-Saharan Africa.</p> <p>Methods</p> <p>Three palliative care programmes in Uganda, Kenya and Malawi were studied using rapid evaluation field techniques in each country, triangulating data from three sources: <b><it>interviews </it></b>with key informants, <b><it>observations </it></b>of clinical encounters and the local health and social care context, and routine data from local <b><it>reports and statistics</it></b>.</p> <p>Results</p> <p>We interviewed 33 patients with advanced illness, 27 family carers, 36 staff, 25 volunteers, and 29 community leaders and observed clinical care of 12 patients. In each site, oral morphine was being used effectively. Patients valued being treated with dignity and respect. Being supported at home reduced physical, emotional and financial burden of travel to, and care at health facilities. Practical support and instruction in feeding and bathing patients facilitated good deaths at home.</p> <p>In each country mobile phones enabled rapid access to clinical and social support networks. Staff and volunteers generally reported that caring for the dying in the face of poverty was stressful, but also rewarding, with resilience fostered by having effective analgesia, and community support networks.</p> <p>Conclusions</p> <p>Programmes were reported to be successful because they integrated symptom control with practical and emotional care, education, and spiritual care. Holistic palliative care can be delivered effectively in the face of poverty, but a public health approach is needed to ensure equitable provision.</p

Cold pressor pain in skin picking disorder.

Excoriation (skin-picking) disorder (SPD) is a disabling, under-recognized condition in which individuals repeatedly pick at their skin, leading to noticeable tissue damage. There has been no examination as to whether individuals with SPD have different pain thresholds or pain tolerances compared to healthy counterparts. Adults with SPD were examined on a variety of clinical measures including symptom severity and functioning. All participants underwent the cold pressor test. Heart rate, blood pressure, and self-reported pain were compared between SPD participants (n=14) and healthy controls (n=14). Adults with SPD demonstrated significantly dampened autonomic response to cold pressor pain as exhibited by reduced heart rate compared to controls (group x time interaction using repeated ANOVA F=3.258, p<0.001). There were no significant differences between the groups in terms of overall pain tolerance (measured in seconds), recovery time, or blood pressure. SPD symptom severity was not significantly associated with autonomic response in the patients. In this study, adults with SPD exhibited a dampened autonomic response to pain while reporting pain intensity similar to that reported by the controls. The lack of an autonomic response may explain why the SPD participants continue a behavior that they cognitively find painful and may offer options for future interventions.Dr. Grant has received research grants from NIMH, National Center for Responsible Gaming, the American Foundation for Suicide Prevention, the TLC Foundation for Body Focused Repetitive Behaviors, Brainsway, Forest, Takeda, and Psyadon Pharmaceuticals. He receives yearly compensation from Springer Publishing for acting as Editor-in-Chief of the Journal of Gambling Studies and has received royalties from Oxford University Press, American Psychiatric Publishing, Inc., Norton Press, and McGraw Hill. Dr. Chamberlain's involvement in this research was funded by a grant from the Academy of Medical Sciences, and by a Wellcome Trust Intermediate Clinical Fellowship (110049/Z/15/Z)

Orientation dependence of ground motion and structural response of reinforced concrete space frames

Horizontal seismic demand is represented in seismic design codes by a single elastic response spectrum. Using a single spectrum conceals the difference between ground motions that are highly polarised and those for which the demand does not depend significantly on the orientation. In this study, two suites of ground motion were developed using the program RspMatchBi, with each suite characterised by different orientation dependence and seismic demand. Reinforced concrete space frames with various arrangements in plan were modelled in OpenSees. Non-linear time history analysis was carried out with the suites of records applied to the models at 9 degree increments, through 360 degrees of non-redundant orientations. An iteration process was implemented to determine the scaling factor for each ground motion at which storey drift exceeded a design level of 2.5% in 50% of applied orientations. Various performance criteria were also taken into account to investigate the changes in orientation dependence of seismic structural response. Results suggest that azimuthdependent structures are more vulnerable to orientation-dependent seismic demand, and that the investigation of directionality for seismic design needs further consideration in terms of performance criteria and structural periods at each principle axis

Associations between self-harm and distinct types of impulsivity

$\textbf{OBJECTIVE}$: There is an ongoing debate regarding how self-harm should be classified. The aim of this study was to characterize associations between self-harm and impulsivity. $\textbf{METHOD}$: Total 333 adults (mean [SD] age 22.6 (3.6) years, 61% male) were recruited from the general community. History of self-harm was quantified using the Self-Harm Inventory (SHI), which asks about 22 self-harm behaviors. Principal components analysis was used to identify latent dimensions of self-harming behaviors. Relationships between self-harm dimensions and other measures were characterized using ordinary least squares regression. $\textbf{RESULTS}$: Principal Components Analysis yielded a three factor solution, corresponding to self-injurious self-harm (e.g. cutting, overdoses, burning), interpersonal related self-harm (e.g. engaging in emotionally or sexually abusive relationships), and reckless self-harm (e.g. losing one's job deliberately, driving recklessly, abusing alcohol). Regression modelling showed that all three dimensions of self-harm were associated with lower quality of life. $\textbf{CONCLUSIONS}$: This study suggests the existence of three distinct subtypes or 'latent factors' of self-harm: all three appear clinically important in that they are linked with worse quality of life. Clinicians should screen for impulse control disorders in people with self-harm, especially when it is self-injurious or involves interpersonal harm.This research was supported by a grant from the National Center for Responsible Gaming to Dr. Grant, by a grant from the Academy of Medical Sciences to Dr. Chamberlain, and by a Welcome Trust Intermediate Clinical Fellowship to Dr. Chamberlain (Reference 110049/Z/15/Z)

Trichotillomania and co-occurring anxiety

$\textit{Background:}$ Trichotillomania appears to be a fairly common disorder, with high rates of co-occurring anxiety disorders. Many individuals with trichotillomania also report that pulling worsens during periods of increased anxiety. Even with these clinical links to anxiety, little research has explored whether trichotillomania with co-occurring anxiety is a meaningful subtype. $\textit{Methods:}$ One hundred sixty-five adults with trichotillomania were examined on a variety of clinical measures including symptom severity, functioning, and comorbidity. Participants also underwent cognitive testing assessing motor inhibition and cognitive flexibility. Clinical features and cognitive functioning were compared between those with current co-occurring anxiety disorders (i.e. social anxiety, generalized anxiety disorder, panic disorder, and anxiety disorder NOS) (n = 38) and those with no anxiety disorder (n = 127). $\textit{Results:}$ Participants with trichotillomania and co-occurring anxiety reported significantly worse hair pulling symptoms, were more likely to have co-occurring depression, and were more likely to have a first-degree relative with obsessive compulsive disorder. Those with anxiety disorders also exhibited significantly worse motor inhibitory performance on a task of motor inhibition (stop-signal task). $\textit{Conclusions:}$ This study suggests that anxiety disorders affect the clinical presentation of hair pulling behavior. Further research is needed to validate our findings and to consider whether treatments should be specially tailored differently for adults with trichotillomania who have co-occurring anxiety disorders, or more pronounced cognitive impairment

Latent traits of impulsivity and compulsivity: towards dimensional psychiatry

Background: The concepts of impulsivity and compulsivity are commonly used in psychiatry. Little is known about whether different manifest measures of impulsivity and compulsivity (behavior, personality, and cognition) map onto underlying latent traits; and if so, their inter-relationship. Methods: 576 adults were recruited using media advertisements. Psychopathological, personality, and cognitive measures of impulsivity and compulsivity were completed. Confirmatory Factor Analysis was used to identify the optimal model. Results: The data were best explained by a two factor model, corresponding to latent traits of impulsivity and compulsivity respectively, which were positively correlated with each other. This model was statistically superior to the alternative models of their being one underlying factor (“disinhibition”) or two anti-correlated factors. Higher scores on the impulsive and compulsive latent factors were each significantly associated with worse quality of life (both p<0.0001). Conclusions: This study supports the existence of latent functionally impairing dimensional forms of impulsivity and compulsivity, which are positively correlated. Future work should examine the neurobiological and neurochemical underpinnings of these latent traits; and explore whether they can be used as candidate treatment targets. The findings have implications for diagnostic classification systems, suggesting that combining categorical and dimensional approaches may be valuable and clinically relevant

Gambling disorder: Association between duration of illness, clinical, and neurocognitive variables

BACKGROUND & AIMS: Gambling disorder (GD) may have its onset in a wide range of ages, from adolescents to old adults. In addition, individuals with GD tend to seek treatment at different moments in their lives. As a result of these characteristics (variable age at onset and variable age at treatment seeking), we find subjects with diverse duration of illness (DOI) in clinical practice. DOI is an important but relatively understudied factor in GD. Our objective was to investigate clinical and neurocognitive characteristics associated with different DOI. METHODS: This study evaluated 448 adults diagnosed with GD. All assessments were completed prior to treatments being commenced. RESULTS: Our main results were: (a) there is a negative correlation between DOI and lag between first gambling and onset of GD; (b) lifetime history of alcohol use disorder (AUD) is associated with a longer duration of GD; (c) the presence of a first-degree relative with history of AUD is associated with a more extended course of GD; and (d) there is a negative correlation between DOI and quality of life. DISCUSSION: This study suggests that some important variables are associated with different DOI. Increasing treatment-seeking behavior, providing customized psychological interventions, and effectively managing AUD may decrease the high levels of chronicity in GD. Furthermore, research on GD such as phenomenological studies and clinical trials may consider the duration of GD in their methodology. DOI might be an important variable when analyzing treatment outcome and avoiding confounders.The clinical trials gathered in this study were funded by different grants received by Dr. JEG. The research grants were provided by the National Institute of Mental Health (NIMH), the National Institute on Drug Abuse (NIDA) (grant number: RC1-DA028279-01), the National Center for Responsible Gaming, Forest, Transcept, Roche, and Psyadon Pharmaceuticals

Resource use data by patient report or hospital records: Do they agree?

Background: Economic evaluations alongside clinical trials are becoming increasingly common. Cost data are often collected through the use of postal questionnaires; however, the accuracy of this method is uncertain. We compared postal questionnaires with hospital records for collecting data on physiotherapy service use. Methods: As part of a randomised trial of orthopaedic medicine compared with orthopaedic surgery we collected physiotherapy use data on a group of patients from retrospective postal questionnaires and from hospital records. Results: 315 patients were referred for physiotherapy. Hospital data on attendances was available for 30% (n = 96), compared with 48% (n = 150) of patients completing questionnaire data (95% Cl for difference = 10% to 24%); 19% (n = 59) had data available from both sources. The two methods produced an intraclass correlation coefficient of 0.54 (95% Cl 0.31 to 0.70). However, the two methods produced significantly different estimates of resource use with patient self report recalling a mean of 1.3 extra visits (95% Cl 0.4 to 2.2) compared with hospital records. Conclusions: Using questionnaires in this study produced data on a greater number of patients compared with examination of hospital records. However, the two data sources did differ in the quantity of physiotherapy used and this should be taken into account in any analysi