Commentary on: Are we overpathologizing everyday life? A tenable blueprint for behavioral addiction research : Can the emerging domain of behavioral addictions bring a new reflection for the field of addictions, by stressing the issue of the context of addiction development?

Background This paper is a commentary to the article entitled: “Are we overpathologizing everyday life? A tenable blueprint for behavioral addiction research”, by Billieux, Schimmenti, Khazaal, Maurage and Heeren (2015). Methods and Aims In this manuscript, we commented on two aspects developed by the authors. Billieux et al. (2015) propose that the recent development of propositions of behavioral addiction is driven by an unwise application of an addiction model to excessive behaviors and rests on a confirmatory research strategy that does not question the psychological processes underlying the development of the conduct. They also show that applying a process driven strategy leads to a more appropriate description of the reality of the behavior and conduct, in particular by describing a variety of motivations for the excessive behavior, which is central to understanding the nature of the conduct. We believe that this new approach, which is fruitful to the emerging domain of behavioral addictions, could also apply to the domain of addictions in general. The latter is characterized by the application of a generic biological model, largely influenced by animal models, focusing on neurophysiological determinants of addiction. This approach may have decreased the attention paid to dimensions of addictions that are more specifically human. We will firstly briefly argue on the limitation of this neurophysiological addiction model for the field of excessive behavioral conducts. Secondly, we will argue for an approach centered on the differentiation of motivations and on the adaptive dimension of the behavior when it first developed and on the evocation of a transition where the conduct became independent of its original function. Conclusions The emerging domain of behavioral addictions, where no animal model has been developed so far, may bring a new reflection that may apply to the domain of addictions in general, with a specific attention to human questions

Oxytocin makes us trusting but not gullible

Originally known for its role in childbirth and lactation, oxytocin (OT) has recently proved to play a key role in social behavior. Deprived of OT, humans are unable to recognize and to bond to their peers. Inversely, once boosted with OT, people become more caring, trusting and generous. Effect-sizes on trust and generosity were sufficiently large that OT started to be perceived as a natural drug that would make people credulous. But could OT really impede judgment and lead individuals to trust untrustworthy peers? Here we show that oxytocin makes people trusting, but not gullible. Namely, OT did not have a trust-enhancing effect on people who interacted with seemingly unreliable peers. These results emphasize that the effect of OT is much more context-dependent than previously thought. This finding therefore invalidates some of the potential commercial or military applications of oxytocin

Relationship between transcranial magnetic stimulation markers of motor control and clinical recovery in obsessive compulsive disorder/Gilles de la Tourette syndrome: a proof of concept case study

BackgroundObsessive compulsive disorder (OCD) and Gilles de la Tourette syndrome (GTS) are neurodevelopmental disorders characterized by difficulties in controlling intrusive thoughts (obsessions) and undesired actions (tics), respectively. Both conditions have been associated with abnormal inhibition but a tangible deficit of inhibitory control abilities is controversial in GTS.MethodsHere, we examined a 25 years-old male patient with severe OCD symptoms and a mild form of GTS, where impairments in motor control were central. Transcranial magnetic stimulation (TMS) was applied over the primary motor cortex (M1) to elicit motor-evoked potentials (MEPs) during four experimental sessions, allowing us to assess the excitability of motor intracortical circuitry at rest as well as the degree of MEP suppression during action preparation, a phenomenon thought to regulate movement initiation.ResultsWhen tested for the first time, the patient presented a decent level of MEP suppression during action preparation, but he exhibited a lack of intracortical inhibition at rest, as evidenced by reduced short-interval intracortical inhibition (SICI) and long-interval intracortical inhibition (LICI). Interestingly, the patient’s symptomatology drastically improved over the course of the sessions (reduced obsessions and tics), coinciding with feedback given on his good motor control abilities. These changes were reflected in the TMS measurements, with a significant strengthening of intracortical inhibition (SICI and LICI more pronounced than previously) and a more selective tuning of MEPs during action preparation; MEPs became even more suppressed, or selectively facilitated depending on the behavioral condition in which they we probed.ConclusionThis study highlights the importance of better understanding motor inhibitory mechanisms in neurodevelopmental disorders and suggests a biofeedback approach as a potential novel treatment

Interference-based methods to mitigate gambling craving: a proof-of-principle pilot study

Craving is central in the prognosis of gambling disorder. The elaborated intrusion theory (EIT) provides a sound framework to account for craving in addictive disorders, and interference methods inspired from the EIT have substantiated their effectiveness in mitigating substance and food-related cravings. The principle of these methods is to recruit the cognitive resources underlying craving (e.g., visuospatial skills, mental imagery) for another competitive and cognitively demanding task, thus reducing the vividness and overwhelming nature of craving. Here we conducted two experiments employing a between-subjects design to test the efficacy of interference methods for reducing laboratory-induced craving. In these experiments, gamblers (n = 38 for both experiments) first followed a craving induction procedure. They then performed either a visuospatial interference task (making a mental and vivid image of a bunch of keys [experiment 1] or playing the video game Tetris [experiment 2]; experimental conditions) or another task supposed not to recruit visuospatial skills and mental imagery (exploding bubble pack [experiment 1] or counting backwards [experiment 2]; control conditions). Results show that all methods successively mitigated induced craving. Although previous research evidenced the superiority of visuospatial tasks to reduce substance-related craving, our findings question their superiority in the context of gambling craving

Individual Differences in Impulsivity Predict Anticipatory Eye Movements

Impulsivity is the tendency to act without forethought. It is a personality trait commonly used in the diagnosis of many psychiatric diseases. In clinical practice, impulsivity is estimated using written questionnaires. However, answers to questions might be subject to personal biases and misinterpretations. In order to alleviate this problem, eye movements could be used to study differences in decision processes related to impulsivity. Therefore, we investigated correlations between impulsivity scores obtained with a questionnaire in healthy subjects and characteristics of their anticipatory eye movements in a simple smooth pursuit task. Healthy subjects were asked to answer the UPPS questionnaire (Urgency Premeditation Perseverance and Sensation seeking Impulsive Behavior scale), which distinguishes four independent dimensions of impulsivity: Urgency, lack of Premeditation, lack of Perseverance, and Sensation seeking. The same subjects took part in an oculomotor task that consisted of pursuing a target that moved in a predictable direction. This task reliably evoked anticipatory saccades and smooth eye movements. We found that eye movement characteristics such as latency and velocity were significantly correlated with UPPS scores. The specific correlations between distinct UPPS factors and oculomotor anticipation parameters support the validity of the UPPS construct and corroborate neurobiological explanations for impulsivity. We suggest that the oculomotor approach of impulsivity put forth in the present study could help bridge the gap between psychiatry and physiology

PROPOSING CONCURRENT ALCOHOL AND TOBACCO WITHDRAWAL. Analysis of the perceptions of Belgian nurses in the alcoholism unit

Introduction: Dual tobacco-alcohol addiction is common, but the literature often considers only the issue of withdrawal from one substance at a time and emphasises that the assessment of tobacco use seems to be neglected in psychiatry. Subject and methods: In this study, we analysed the perceptions of nurses working in alcoholism units before and after motivational interviewing trainingon proposing concurrent alcohol-tobacco withdrawal to patients. Results: Nurses, unlike psychiatry postgraduates, were able to achieve acomprehensive and systematic history of substance abuse, but bothtended not to recommend concurrent tobacco-alcohol withdrawal. Training in motivational interviewing was inclined to reverse this tendency. Discussion: Reducing feelings of helplessness that carers experience when patientsrelapse is one of the factors to change. Conclusion: Recommendations for the development of concurrent alcohol tobacco withdrawal programmes

Non-epileptic seizures: delayed diagnosis in patients presenting with electroencephalographic (EEG) or clinical signs of epileptic seizures

AbstractThe clinical differentiation between epileptic seizures (ES) and non-epileptic seizures (NES) is often difficult and mostly based on the presence or absence of widely recognized features of ES such as tongue biting, falling, incontinence or concomitant epileptic abnormalities in the electroencephalogram (EEG). We retrospectively analysed the records of all patients referred to our Epilepsy Centre for refractory epilepsy and finally diagnosed with NES between 1980 and 1999 ( n= 103), half of them also exhibiting ES. The mean time-lapse between first attack and NES diagnosis was 8.7 ± 1.3 years and 16.5 ± 1.4 years for the NES and NES + ES groups respectively. At least one of the usual signs associated with generalized tonic–clonic seizures (tongue biting, falling or incontinence) was reported by 66% and 60% of patients with NES or NES + ES respectively. Interictal EEG abnormalities were recorded in 16% of NES patients vs. 80% of NES + ES patients. In the NES group, delay before establishing the correct diagnosis was significantly longer when the patients exhibited ≥1 symptom(s) of generalized seizures, or when patients exhibited interictal EEG abnormalities. Upon admission, 72% of NES patients and all NES + ES patients were being treated with antiepileptic drugs (AEDs).We conclude that EEG or clinical abnormalities suggestive of epileptic seizures are common in undiagnosed NES patients. Such diagnostic pitfalls, besides considerably delaying NES diagnosis, also considerably delay appropriate treatment implementation

The Associations between Self-Consciousness, Depressive State and Craving to Drink among Alcohol Dependent Patients Undergoing Protracted Withdrawal

Context In order to understand how certain personality traits influence the relation between depression symptoms and craving for alcohol, trait self-consciousness (trait SC) was examined during a withdrawal and detoxification program. Methods: Craving (Obsessive and Compulsive Drinking Scale), depressive state (Beck Depression Inventory) and trait SC (Revised Self-Consciousness Scale) were assessed in alcohol-dependent inpatients (DSM-IV, N = 30) both at the beginning (T1: day 1 or 2) and at the end (T2: day 14 to18) of protracted withdrawal during rehabilitation. Results: A significant decrease in craving and depressive symptoms was observed from T1 to T2, while SC scores remained stable. At both times, strong positive correlations were observed between craving and depression. Moreover, regression analyses indicated that trait SC significantly moderated the impact of depression on cravings for alcohol. Limitations This study was performed on a relatively small sample size. Administration of medications during detoxification treatment can also be a confounding factor. Finally, craving could have been evaluated through other types of measurements. Conclusions: During protracted withdrawal, alcohol craving decreased with the same magnitude as depressive mood. Depressive symptoms were related to alcohol craving but only among patients with high trait SC scores. Our results suggest that metacognitive approaches targeting SC could decrease craving and, in turn, prevent future relapses

A POSSIBLE ROLE OF GUT MICROBIOTA IN THE BEHAVORIAL CONTROL OF ALCOHOL-DEPENDENT SUBJECTS

These observations suggest that alterations at the level of the gut microbiota influence the gut permeability and activate specific inflammation pathways that are related to psychological symptoms of alcoholdependence. Altogether these observations are consistent with a role of inflammation as one mediator of a gut-brain communication in AD patients