The Placebo Effect and Its Clinical Associations in Gambling Disorder

Background: Gambling disorder is prevalent and functionally impairing, yet no FDA approved medications exist for its treatment. The ability of clinical trials to discriminate active treatment benefits has been hindered by the unusually high placebo response. Virtually nothing is known about baseline clinical characteristics that might be predictive of placebo response in gamblers. Methods: 152 participants assigned to placebo were pooled from multiple double-blind trials in gambling disorder. Participants were classified as placebo responders or non-responders based on a cut-off of 35% reduction in symptom severity on the Gambling Severity Scale (GSAS). Baseline group differences were characterized using t-tests and equivalent non-parametric tests as appropriate. Results: Fifty-one percent of individuals assigned to placebo treatment showed a significant clinical response to placebo. Placebo responders stayed in treatment for significantly longer, were more likely to endorse ‘enjoyment’ as a trigger for gambling, and were less likely to endorse ‘boredom’ or ‘loneliness’ as triggers for gambling. Placebo responders and non-responders did not differ significantly on age, gender, age at symptom onset, baseline symptom severity, comorbidities, or likelihood of having received a previous treatment. Conclusions: Predictors of placebo response for gambling disorder appear markedly different from those reported for other mental health disorders.Wellcome Trust Clinical Fellowship (110049/Z/15/Z

How Similar Are the Disorders Included Under the Umbrella of Obsessive-Compulsive Disorder and Related Disorders?-Reply

Wellcome Trus

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

Aerosols from biomass burning over the tropical South Atlantic region: Distributions and impacts

The NASA Global Tropospheric Experiment (GTE) Transport and Atmospheric Chemistry Near the Equator-Atlantic (TRACE A) expedition was conducted September 21 through October 26, 1992, to investigate factors responsible for creating the seasonal South Atlantic tropospheric ozone maximum. During these flights, fine aerosol (0.1-3.0 μm) number densities were observed to be enhanced roughly tenfold over remote regions of the tropical South Atlantic and greater over adjacent continental areas, relative to northern hemisphere observations and to measurements recorded in the same area during Ac wet season. Chemical and meteorological analyses as well as visual observations indicate that the primary source of these enhancements was biomass burning occurring within grassland regions of north central Brazil and southeastern Africa. These fires exhibited fine aerosol (N) emission ratios relative to CO (dN/dCO) of 22.5 ± 9.7 and 23.6 ± 15.1 cm-3 parts per billion by volume (ppbv)-1 over Brazil and Africa, respectively. Convection coupled with counterclockwise flow around the South Atlantic subtropical anticyclone subsequently distributed these aerosols throughout the remote South Atlantic troposphere. We calculate that dilute smoke from biomass burning produced an average tenfold enhancement in optical depth over the continental regions as well as a 50% increase in this parameter over the middle South Atlantic Ocean; these changes correspond to an estimated net cooling of up to 25 W m-2 and 2.4 W m-2 during clear-sky conditions over savannas and ocean respectively. Over the ocean our analyses suggest that modification of CCN concentrations within the persistent eastern Atlantic marine stratocumulus clouds by entrainment of subsiding haze layers could significantly increase cloud albedo resulting in an additional surface radiative cooling potentially greater in magnitude than that caused by direct extinction of solar radiation by the aerosol particles themselves

Light attenuation characteristics of glacially-fed lakes

Transparency is a fundamental characteristic of aquatic ecosystems and is highly responsive to changes in climate and land use. The transparency of glacially-fed lakes may be a particularly sensitive sentinel characteristic of these changes. However, little is known about the relative contributions of glacial flour versus other factors affecting light attenuation in these lakes. We sampled 18 glacially-fed lakes in Chile, New Zealand, and the U.S. and Canadian Rocky Mountains to characterize how dissolved absorption, algal biomass (approximated by chlorophyll a), water, and glacial flour contributed to attenuation of ultraviolet radiation (UVR) and photosynthetically active radiation (PAR, 400–700 nm). Variation in attenuation across lakes was related to turbidity, which we used as a proxy for the concentration of glacial flour. Turbidity-specific diffuse attenuation coefficients increased with decreasing wavelength and distance from glaciers. Regional differences in turbidity-specific diffuse attenuation coefficients were observed in short UVR wavelengths (305 and 320 nm) but not at longer UVR wavelengths (380 nm) or PAR. Dissolved absorption coefficients, which are closely correlated with diffuse attenuation coefficients in most non-glacially-fed lakes, represented only about one quarter of diffuse attenuation coefficients in study lakes here, whereas glacial flour contributed about two thirds across UVR and PAR. Understanding the optical characteristics of substances that regulate light attenuation in glacially-fed lakes will help elucidate the signals that these systems provide of broader environmental changes and forecast the effects of climate change on these aquatic ecosystems

Clinical correlates of symptom severity in skin picking disorder

BACKGROUND: Skin picking disorder (SPD) remains poorly understood with limited data regarding its underlying pathophysiology and appropriate treatment choices. One approach to refining our treatment of SPD might be to better understand the range of illness severity and the clinical associations with severity. METHODS: 125 adults aged 18 to 65 with a primary, current DSM-5 diagnosis of SPD were assessed for the severity of their picking, using the Skin Picking Symptom Assessment Scale, and related mental health symptoms. To identify clinical and demographic measures associated with variation in disease severity, we utilized the statistical technique of partial least squares (PLS). RESULTS: Greater SPD symptom severity was associated with higher Barratt attentional impulsiveness and motor impulsivity, higher Eysenck impulsivity, higher state anxiety/depression, having a current anxiety disorder, and having a lifetime substance use disorder. CONCLUSIONS: The present analysis is, to our knowledge, the most complete assessment of clinical variables and their relationship to illness severity in a sample of adults with SPD. Aspects of impulsivity and anxiety are both strongly associated with worse illness severity, and functional disability, in SPD. Treatment approaches should incorporate these as possible treatment targets when developing new treatment approaches to this disorder.Open Access funded by Wellcome Trus

Growth, Body Composition, and Lung Function in Prepubertal Children with Cystic Fibrosis Diagnosed by Newborn Screening

Background: Children with cystic fibrosis (CF) are at risk of altered body composition (BC). Newborn screening (NBS) may lead to improved BC outcomes. We investigated BC and its relationship with lung function in prepubertal children diagnosed with CF by NBS. Secondary aims explored predictors of fat‐free mass (FFM) and lung function. / Methods: Thirty‐seven screened (non‐meconium ileus) children with CF (20 boys) born 2007–2012 had a dual‐energy x‐ray absorptiometry scan at 5–8 years to determine whole‐body (WB) and appendicular BC. Anthropometry was performed and routine spirometry recorded. Results were converted to z‐scores, height‐adjusted (fat mass index [FMI] and FFM index [FFMI]) and compared with population mean values. Predictors of forced expiratory volume in 1 second (FEV1) were assessed using linear regression. / Results: Height, body mass index (BMI), and FEV1 were within normal limits, however, weight and BC were significantly low compared with reference data (weight, P = .03; WB FMI, P = .001; WB FFMI, P = .009). Gender differences were detected, with lower appendicular BC in boys and lower weight, BMI, and BC in girls. The association between FEV1 and WB FFMI (r = 0.38; P = .02) was stronger than with BMI (r = 0.29; P = .08). WB FFMI was the only significant predictor of FEV1 in a multivariable model (95% CI, 0.11–0.99; P = .016). / Conclusion: In this NBS CF population, gender differences in growth and BC were apparent despite preserved lung function. These results support BC assessment in prepubertal children, particularly girls, with an opportunity to direct interventions to optimize FFM

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)

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)

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)