Family History of Substance Use Disorders: Significance for Mental Health in Young Adults who Gamble?

Background: Although family history of psychiatric disorders has often been considered potentially useful in understanding clinical presentations in patients, it is less clear what a positive family history means for people who gamble in the general community. We sought to understand the clinical and cognitive impact of having a first-degree relative with a substance use disorder (SUD) in a sample of non-treatment seeking young adults. Methods: 576 participants (aged 18-29 years) who gambled at least 5 times in the preceding year undertook clinical and neurocognitive evaluations. Those with a first-degree relative with a SUD were compared to those without on a number of demographic, clinical and cognitive measures. We used Partial Least Squares regression (PLS) to identify which variables (if any) were significantly associated with family history of SUDs, controlling for the influence of other variables on each other. Results: 180 (31.3%) participants had a first-degree family member with a SUD. In terms of clinical variables, family history of SUD was significantly associated with higher rates of substance use (alcohol, nicotine), higher rates of problem gambling, and higher occurrence of mental health disorders. Family history of SUD was also associated with more set-shifting problems (plus higher rates of obsessive-compulsive tendencies), lower quality of decision-making, and more spatial working memory errors. Conclusions: These results indicate that gamblers with a first-degree family member with a SUD may have a unique clinical and cognition presentation. Understanding these differences may be relevant to developing more individualized treatment approaches for disordered gambling. Compulsivity may be important as a proxy of vulnerability towards addiction

Firearm ownership among young adults: associations with impulsivity and impulse control disorders

Background: Firearm ownership is extremely common in parts of the USA. Yet little research has examined whether it is associated with impulsive symptoms and traits. Methods: Adults aged 18-29 years who gamble at least occasionally were recruited in two US cities using media advertisements for an exploratory study examining general mental health, impulse control disorders, impulsive personality, and aspects of cognition (decision-making, response inhibition, and flexible responding). The participants were grouped as firearm owners and non-firearm owners; these two groups were compared on the above measures. Results: 149 young adults took part, of whom 33 (22.1%) endorsed owning one or more firearms. Firearm ownership was significantly associated with male gender and elevated risk of gambling disorder, but not with other measures of impulsivity. Discussion: The link between firearm ownership and disordered gambling merits further research and may have policy implications, such as in terms of screening for guns in gambling arenas including casinos. Further research is needed to explore potential associations between gun ownership and impulsivity in cohorts with other demographic characteristics, including longitudinally.This study was funded by internal funds. Dr. Grant has received research grants from Promentis and Otsuka Pharmaceuticals and 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 consults for Cambridge Cognition, Shire, Promentis, and Ieso Digital Health. Dr. Chamberlain’s involvement in this study was supported by a Wellcome Trust Clinical Fellowship (110049/Z/15/Z)

Trichotillomania and Skin-Picking Disorder: Different Kinds of OCD

This is the author accepted manuscript. The final version is available from the American Psychiatric Association via http://dx.doi.org/10.1176/appi.focus.130212Trichotillomania (hair-pulling disorder) and skin-picking disorder are common neuropsychiatric disorders but are underrecognized by professionals. Affected individuals repeatedly pull out their own hair or pick at their skin, and these symptoms not only have a negative impact on the individual because of the time they occupy but also can lead to considerable physical disfigurement, with concomitant loss of self-esteem and avoidance of social activities and intimate relationships. The behaviors may also have potentially serious physical consequences. Trichotillomania and skin picking frequently co-occur, and both disorders commonly present with co-occurring depression or anxiety. Currently, behavioral therapy appears to be the most effective treatment of both disorders. Pharmacotherapy in the form of N-acetylcysteine or olanzapine may play a role in treatment as well.This research was supported by a grant from the National Center for Responsible Gaming to Dr. Grant. Dr. Chamberlain’s involvement in this work was funded by a grant from the Academy of Medical Sciences, UK

Expanding the definition of addiction: DSM-5 vs. ICD-11.

While considerable efforts have been made to understand the neurobiological basis of substance addiction, the potentially "addictive" qualities of repetitive behaviors, and whether such behaviors constitute "behavioral addictions," is relatively neglected. It has been suggested that some conditions, such as gambling disorder, compulsive stealing, compulsive buying, compulsive sexual behavior, and problem Internet use, have phenomenological and neurobiological parallels with substance use disorders. This review considers how the issue of "behavioral addictions" has been handled by latest revisions of the Diagnostic and Statistical Manual of Mental Disorders (DSM) and the International Classification of Diseases (ICD), leading to somewhat divergent approaches. We also consider key areas for future research in order to address optimal diagnostic classification and treatments for such repetitive, debilitating behaviors.Wellcome-trust and Academy of Medical Sciences

Gambling disorder and its relationship with substance use disorders: Implications for nosological revisions and treatment.

BACKGROUND: Gambling disorder, recognized by the DSM-5 as a behavioral addiction, affects .4-1.6% of adults worldwide, and is highly comorbid with other mental health disorders, particularly substance use disorders (SUDs). OBJECTIVES: To provide a concise primer on the relationship between gambling disorder and SUDs, focusing on phenomenology/clinical presentation, co-morbidity, familiality, cognition, neuroanatomy/neurochemistry, and treatment. METHODS: Selective review of the literature. RESULTS: Scientific evidence shows that gambling and SUDs have consistently high rates of comorbidity, similar clinical presentations, and some genetic and physiological overlap. Several treatment approaches show promise for gambling disorder, some of which have previously been effective for SUDs. SCIENTIFIC SIGNIFICANCE: It is hoped that recognition of overlap between gambling disorder and SUDs in terms of phenomenology and neurobiology will signal novel treatment approaches and raise the profile of this neglected condition. (Am J Addict 2013;XX:1-6).This research was supported by a Center for Excellence in Gambling Research grant by the National Center for Responsible GamingThis is the author accepted manuscript. The final version is available from Wiley via https://doi.org/10.1111/j.1521-0391.2013.12112.

The impact of comorbid impulsive/compulsive disorders on problematic internet use

Background and Aims: Problematic Internet Use (PIU) is commonplace but is not yet recognized as a formal mental disorder. Excessive Internet use could result from other conditions such as gambling disorder. The aim of the study was to assess the impact of impulsive-compulsive comorbidities on the presentation of PIU, defined using Young’s Diagnostic Questionnaire. Methods: 123 adults aged 18-29 years were recruited using media advertisements, and attended the research center for a detailed psychiatric assessment, including interviews, completion of questionnaires and neuropsychological testing. Participants were classified into three groups: PIU with no comorbid impulsive/compulsive disorders (n=18), PIU with one or more comorbid impulsive/compulsive disorders (n=37), and healthy controls (n=67). Differences between the three groups were characterized in terms of demographic, clinical, and cognitive variables. Effect sizes for overall effects of group were also reported. Results: The three groups did not differ significantly on age, gender, levels of education, nicotine consumption, or alcohol use (small effect sizes). Quality of life was significantly impaired in PIU irrespective of whether or not individuals had comorbid impulsive/compulsive disorders (large effect size). However, impaired response inhibition and decision-making were only identified in PIU with impulsive/compulsive comorbidities (medium effect sizes)

Motivations for Participation in Socially Networked Collective Intelligence Systems

One of the most significant challenges facing systems of collective intelligence is how to encourage participation on the scale required to produce high quality data. This paper details ongoing work with Phrase Detectives, an online game-with-a-purpose deployed on Facebook, and investigates user motivations for participation in social network gaming where the wisdom of crowds produces useful data.Comment: Presented at Collective Intelligence conference, 2012 (arXiv:1204.2991

Salivary Inflammatory Markers in Trichotillomania: A Pilot Study.

BACKGROUND: Immune dysregulation has been hypothesized to be important in the development and pathophysiology of compulsive disorders such as obsessive compulsive disorder (OCD), which has a high comorbid overlap with trichotillomania (both are OC-related disorders). The role of inflammation in the pathophysiology of trichotillomania has garnered little research to date. METHODS: Individuals with trichotillomania provided saliva sample for analysis of inflammatory cytokines. Additionally, these participants were examined on a variety of demographic variables (including body mass index [BMI], previously found to relate to inflammation) along with clinical measures (symptom severity, functioning, and comorbidity). RESULTS: Thirty-one participants, mean age of 24.7 (±10.2) years, 27 (87.1%) females were -included. The mean score on the Massachusetts General Hospital Hair Pulling Scale was 15.7 (±4.2), reflective of moderate symptom severity. Compared to normative data, the mean inflammatory marker levels in the trichotillomania sample had the following Z scores: interleukin-1β (IL-1β) Z = -0.26, IL-6 Z = -0.39, IL-8 Z = -0.32, and tumor necrosis factor-α Z = -0.83. Levels of inflammatory markers did not correlate significantly with BMI, depressive mood, symptom severity, or disability. CONCLUSIONS: The relatively low level of inflammatory saliva cytokines observed in the current study (negative z scores versus normative data with medium effect sizes) indicates that evaluation of blood inflammatory levels in trichotillomania versus matched controls would be valuable in future work. If a hypoinflammatory state is confirmed -using blood samples, this would differentiate trichotillomania from other mental disorders (such as OCD, schizophrenia, and depression), which have typically been linked with high inflammatory measures in the literature, at least in some cases

Symptom severity and its clinical correlates in kleptomania

BACKGROUND: Kleptomania (compulsive stealing) remains poorly understood, with limited data regarding its underlying pathophysiology and appropriate treatment choices. METHODS: Participants (N = 112) age 18 to 65 with a primary, current diagnosis of kleptomania were assessed for the severity of their stealing behavior and urges to steal, as well as 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. RESULTS: Greater kleptomania symptom severity was associated with having more frequent urges to steal, feeling excited by stealing, having a current eating disorder, and having a current diagnosis of obsessive-compulsive disorder (OCD). Worse symptom severity was associated with a shorter transition time (between first stealing and diagnosis of kleptomania), as well as with a higher chance of stealing from relatives and seeking treatment at some point. CONCLUSIONS: Feeling a sense of reward from stealing and co-occurrence of certain disorders associated with compulsivity (eg, OCD, anorexia nervosa) were strongly associated with worse illness severity in kleptomania. Treatment approaches should incorporate these disorders as possible treatment targets. These data also may support conceptualizing kleptomania as an obsessive-compulsive–related disorder rather than being allied to substance use or impulsive disorders

Problematic smart phone use is associated with greater alcohol consumption, mental health issues, poorer academic performance, and impulsivity

Background: This study sought to examine the occurrence of the problematic use of smartphones in a university sample and associated physical and mental health correlates, including potential relationships with risky sexual practices. Methods: A 156-item anonymous online survey was distributed via email to a sample of 9,449 university students. In addition to problematic smartphone usage, current use of alcohol and drugs, psychological and physical status, and academic performance were assessed. Results: A total of 3,425 participants were included in the analysis, of whom 20.1% reported problematic smartphone use. Problematic use of smartphones was associated with lower grade point averages and with alcohol use disorder symptoms. Problematic use of smartphones was also significantly associated with impulsivity (Barratt scale, ADHD), and elevated occurrence of PTSD, anxiety and depression. Finally, those with current problems with smartphone use were significantly more sexually active. Conclusion: Problematic use of smartphones is common, and has public health importance due to these demonstrable associations with alcohol use, certain mental health diagnoses (especially ADHD, anxiety, depression, and PTSD), and worse scholastic performance. Clinicians should enquire about excessive smartphone use as it may be associated with a range of mental health issues. Research is needed to address longitudinal associations