The classification of substance and behavioural addictions: A preliminary investigation

The term addiction has been used to refer to impaired control over substance use for several centuries however recently there has been a shift toward using this term in the context of non-substance use disorders, such as pathological gambling. A preliminary investigation was conducted in an attempt to clarify the most appropriate classification of 'behavioural addictions'. Participants with alcohol dependence (AD, n = 24), pathological gambling (PG, n = 20) and compulsive buying disorder (CBD, n = 14) completed an Addictive Disorder Questionnaire (ADQ); the Symptom Checklist 90 Revised (SCL-90R); Barratt Impulsivity Scale II; and substance specific adaptations of the Yale-Brown Obsessive Compulsive Scale (Y-BOCS). Although the AD group reported more severe addiction symptoms and had higher levels of depression and anxiety, there were broad similarities across the three disorders in relation to cravings, dyscontrol, impulsivity and obsessions. Despite the small sample size and the different recruitment strategies used across the groups, the findings from this preliminary study provide support for broadening addiction diagnostic definitions to include non-substance related disorders which in turn may contribute to the development of more efficacious treatments

A Bayesian reanalysis of the Standard versus Accelerated Initiation of Renal-Replacement Therapy in Acute Kidney Injury (STARRT-AKI) trial

Background Timing of initiation of kidney-replacement therapy (KRT) in critically ill patients remains controversial. The Standard versus Accelerated Initiation of Renal-Replacement Therapy in Acute Kidney Injury (STARRT-AKI) trial compared two strategies of KRT initiation (accelerated versus standard) in critically ill patients with acute kidney injury and found neutral results for 90-day all-cause mortality. Probabilistic exploration of the trial endpoints may enable greater understanding of the trial findings. We aimed to perform a reanalysis using a Bayesian framework. Methods We performed a secondary analysis of all 2927 patients randomized in multi-national STARRT-AKI trial, performed at 168 centers in 15 countries. The primary endpoint, 90-day all-cause mortality, was evaluated using hierarchical Bayesian logistic regression. A spectrum of priors includes optimistic, neutral, and pessimistic priors, along with priors informed from earlier clinical trials. Secondary endpoints (KRT-free days and hospital-free days) were assessed using zero–one inflated beta regression. Results The posterior probability of benefit comparing an accelerated versus a standard KRT initiation strategy for the primary endpoint suggested no important difference, regardless of the prior used (absolute difference of 0.13% [95% credible interval [CrI] − 3.30%; 3.40%], − 0.39% [95% CrI − 3.46%; 3.00%], and 0.64% [95% CrI − 2.53%; 3.88%] for neutral, optimistic, and pessimistic priors, respectively). There was a very low probability that the effect size was equal or larger than a consensus-defined minimal clinically important difference. Patients allocated to the accelerated strategy had a lower number of KRT-free days (median absolute difference of − 3.55 days [95% CrI − 6.38; − 0.48]), with a probability that the accelerated strategy was associated with more KRT-free days of 0.008. Hospital-free days were similar between strategies, with the accelerated strategy having a median absolute difference of 0.48 more hospital-free days (95% CrI − 1.87; 2.72) compared with the standard strategy and the probability that the accelerated strategy had more hospital-free days was 0.66. Conclusions In a Bayesian reanalysis of the STARRT-AKI trial, we found very low probability that an accelerated strategy has clinically important benefits compared with the standard strategy. Patients receiving the accelerated strategy probably have fewer days alive and KRT-free. These findings do not support the adoption of an accelerated strategy of KRT initiation