頭部外傷の治療(交通事故による脳障害,第48回千葉医学会学術大会,第17回千葉県医師会学術大会,第10回日医医学講座,連合大会)

BACKGROUND:The negative consequences of energy dense foods are well known, yet people increasingly make unhealthy food choices leading to obesity (i.e., risky decisions). The aims of this study were: [1] to compare performance in decision-making tasks under risk and under ambiguity between individuals with obesity, overweight and normal weight; [2] to examine the associations between body mass index (BMI) and decision-making, and the degree to which these associations are modulated by reward sensitivity. METHODS:Seventy-nine adults were recruited and classified in three groups according to their BMI: obesity, overweight and normal-weight. Groups were similar in terms of age, education and socio-economic status, and were screened for comorbid medical and mental health conditions. Decision-making under risk was measured via the Wheel of Fortune Task (WoFT) and decision-making under ambiguity via the Iowa Gambling Task (IGT). Reward sensitivity was indicated by the Sensitivity to Punishment and Sensitivity to Reward Questionnaire (SPSRQ). RESULTS:Individuals with obesity made riskier choices in the WoFT, specifically in choices with an expected value close to zero and in the propensity to risk index. No differences were found in IGT performance or SPSRQ scores. BMI was associated with risk-taking (WoFT performance), independently of reward sensitivity. CONCLUSIONS:Obesity is linked to a propensity to make risky decisions in experimental conditions analogous to everyday food choices

Altered decision-making under risk in obesity

Background: The negative consequences of energy dense foods are well known, yet people increasingly make unhealthy food choices leading to obesity (i.e., risky decisions). The aims of this study were: [1] to compare performance in decision-making tasks under risk and under ambiguity between individuals with obesity, overweight and normal weight; [2] to examine the associations between body mass index (BMI) and decision-making, and the degree to which these associations are modulated by reward sensitivity. Methods: Seventy-nine adults were recruited and classified in three groups according to their BMI: obesity, overweight and normal-weight. Groups were similar in terms of age, education and socio-economic status, and were screened for comorbid medical and mental health conditions. Decision-making under risk was measured via the Wheel of Fortune Task (WoFT) and decision-making under ambiguity via the Iowa Gambling Task (IGT). Reward sensitivity was indicated by the Sensitivity to Punishment and Sensitivity to Reward Questionnaire (SPSRQ). Results: Individuals with obesity made riskier choices in the WoFT, specifically in choices with an expected value close to zero and in the propensity to risk index. No differences were found in IGT performance or SPSRQ scores. BMI was associated with risk-taking (WoFT performance), independently of reward sensitivity. Conclusions: Obesity is linked to a propensity to make risky decisions in experimental conditions analogous to everyday food choices

The role of affect-driven impulsivity in gambling cognitions: A convenience-sample study with a Spanish version of the Gambling-Related Cognitions Scale

Abnormal cognitions are among the most salient domain-specific features of gambling disorder. The aims of this study were: (a) to examine and validate a Spanish version of the Gambling-Related Cognitions Scale (GRCS; Raylu & Oei, 2004) and (b) to examine associations between cognitive distortion levels, impulsivity, and gambling behavior. Methods This study first recruited a convenience sample of 500 adults who had gambled during the previous year. Participants were assessed using the Spanish version of GRCS (GRCS-S) questionnaire, the UPPS-P impulsivity questionnaire, measures of gambling behavior, and potentially relevant confounders. Robust confirmatory factor analysis methods on half the sample were used to select the best models from a hypothesis-driven set. The best solutions were validated on the other half, and the resulting factors were later correlated with impulsivity dimensions (in the whole n = 500 factor analysis sample) and clinically relevant gambling indices (in a separate convenience sample of 137 disordered and non-disordered gamblers; validity sample). Results This study supports the original five-factor model, suggests an alternative four-factor solution, and confirms the psychometric soundness of the GRCS-S. Importantly, cognitive distortions consistently correlated with affect- or motivation-driven aspects of impulsivity (urgency and sensation seeking), but not with cognitive impulsivity (lack of premeditation and lack of perseverance). Discussion and conclusions Our findings suggest that the GRCS-S is a valid and reliable instrument to identify gambling cognitions in Spanish samples. Our results expand upon previous research signaling specific associations between gambling-related distortions and affect-driven impulsivity in line with models of motivated reasoning

The role of affect-driven impulsivity in gambling cognitions: a convenience-sample study with a Spanish version of the Gambling-Related Cognitions Scale

Background and aims: abnormal cognitions are among the most salient domain-specific features of gambling disorder. The aims of this study were: (a) to examine and validate a Spanish version of the Gambling-Related Cognitions Scale (GRCS; Raylu & Oei, 2004) and (b) to examine associations between cognitive distortion levels, impulsivity, and gambling behavior. Methods: this study first recruited a convenience sample of 500 adults who had gambled during the previous year. Participants were assessed using the Spanish version of GRCS (GRCS-S) questionnaire, the UPPS-P impulsivity questionnaire, measures of gambling behavior, and potentially relevant confounders. Robust confirmatory factor analysis methods on half the sample were used to select the best models from a hypothesis-driven set. The best solutions were validated on the other half, and the resulting factors were later correlated with impulsivity dimensions (in the whole n = 500 factor analysis sample) and clinically relevant gambling indices (in a separate convenience sample of 137 disordered and non-disordered gamblers; validity sample). Results: this study supports the original five-factor model, suggests an alternative four-factor solution, and confirms the psychometric soundness of the GRCS-S. Importantly, cognitive distortions consistently correlated with affect-or motivation-driven aspects of impulsivity (urgency and sensation seeking), but not with cognitive impulsivity (lack of premeditation and lack of perseverance). Discussion and conclusions: our findings suggest that the GRCS-S is a valid and reliable instrument to identify gambling cognitions in Spanish samples. Our results expand upon previous research signaling specific associations between gambling-related distortions and affect-driven impulsivity in line with models of motivated reasoning

MAL regulates clathrin-mediated endocytosis at the apical surface of Madin–Darby canine kidney cells

MAL is an integral protein component of the machinery for apical transport in epithelial Madin–Darby canine kidney (MDCK) cells. To maintain its distribution, MAL cycles continuously between the plasma membrane and the Golgi complex. The clathrin-mediated route for apical internalization is known to differ from that at the basolateral surface. Herein, we report that MAL depends on the clathrin pathway for apical internalization. Apically internalized polymeric Ig receptor (pIgR), which uses clathrin for endocytosis, colocalized with internalized MAL in the same apical vesicles. Time-lapse confocal microscopic analysis revealed cotransport of pIgR and MAL in the same endocytic structures. Immunoelectron microscopic analysis evidenced colabeling of MAL with apically labeled pIgR in pits and clathrin-coated vesicles. Apical internalization of pIgR was abrogated in cells with reduced levels of MAL, whereas this did not occur either with its basolateral entry or the apical internalization of glycosylphosphatidylinositol-anchored proteins, which does not involve clathrin. Therefore, MAL is critical for efficient clathrin-mediated endocytosis at the apical surface in MDCK cells

"Food Addiction" in Patients with Eating Disorders is Associated with Negative Urgency and Difficulties to Focus on Long-Term Goals

Objectives: The present study aimed to investigate if eating disorder patients differ in specific personality traits depending on a positive screening of food addiction (FA) and to find a model to predict FA in eating disorder patients using measures of personality and impulsivity. Methods : Two hundred seventy eight patients, having an eating disorder, self-reported on FA, impulsivity, personality, eating and general psychopathology. Patients were then split into two groups, depending on a positive or negative result on the FA screening. Analysis of variance was used to compare means between the two groups. Stepwise binary logistic regression was used to obtain a predictive model for the presence of FA. Results: Patients with FA had lower self-directedness, and more negative urgency and lack of perseverance than patients not reporting addictive eating. The probability of FA can be predicted by high negative urgency, high reward dependence, and low lack of premeditation. Conclusion: Eating disorder patients who have more problems to pursue tasks to the end and to focus on long-term goals seem to be more likely to develop addictive eating patterns

'Food Addiction' in Patients with Eating Disorders is Associated with Negative Urgency and Difficulties to Focus on Long-Term Goals

Objectives: The present study aimed to investigate if eating disorder patients differ in specific personality traits depending on a positive screening of food addiction (FA) and to find a model to predict FA in eating disorder patients using measures of personality and impulsivity. Methods: Two hundred seventy eight patients, having an eating disorder, self-reported on FA, impulsivity, personality, eating and general psychopathology. Patients were then split into two groups, depending on a positive or negative result on the FA screening. Analysis of variance was used to compare means between the two groups. Stepwise binary logistic regression was used to obtain a predictive model for the presence of FA. Results: Patients with FA had lower self-directedness, and more negative urgency and lack of perseverance than patients not reporting addictive eating. The probability of FA can be predicted by high negative urgency, high reward dependence, and low lack of premeditation. Conclusion: Eating disorder patients who have more problems to pursue tasks to the end and to focus on long-term goals seem to be more likely to develop addictive eating patterns

Effect of A Very Low-Calorie Ketogenic Diet on Food and Alcohol Cravings, Physical and Sexual Activity, Sleep Disturbances, and Quality of Life in Obese Patients

Psychological well-being and hunger and food control are two relevant factors involved in the success of weight-loss therapy in treating obesity. Thus, this study aims to evaluate food and alcohol cravings, physical and sexual activity, sleep, and life quality (QoL) in obese patients following a very low-calorie ketogenic (VLCK) diet, as well as the role of weight lost and ketosis on these parameters. A battery of psychological test was performed in twenty obese patients (12 females, 47.2 +/- 10.2 year and BMI of 35.5 +/- 4.4) through the course of a 4-month VLCK diet on four subsequent visits: baseline, maximum ketosis, reduced ketosis, and endpoint. Each subject acted as their own control. Relevantly, the dietary-induced changes in body composition (7.7 units of BMI lost, 18 kg of fat mass (1.2 kg of visceral fat mass)) were associated with a statistically significant improvement in food craving scores, physical activity, sleepiness, and female sexual function. Overall, these results also translated in a notable enhancement in QoL of the treated obese patients. Therefore, the rapid and sustained weight and fat mass (FM) loss induced by the VLCK diet is associated with good food control and improvements in the psychological well-being parameters in obese subjects, which could contribute to the long-term success of this therapy

Impulsividad y conciencia del problema predicen la adherencia terapéutica y el abandono del tratamiento en el trastorno por juego de azar

Este estudio investiga el valor predictivo de la impulsividad como rasgo (evaluada con la escala de conducta impulsiva UPPS-P) y de covariados relevantes (variables sociodemográficas, severidad del juego de azar, estado de ánimo disfórico, otras conductas adictivas e inteligencia no verbal), con respecto al abandono del tratamiento y los niveles de cumplimiento de las prescripciones terapéuticas en pacientes con trastorno por juego de azar. Sesenta y seis pacientes con este trastorno, participantes del proyecto G-Brain, fueron evaluados inicialmente en impulsividad rasgo y en los covariados mencionados. Dicha evaluación se realizó durante los seis primeros meses desde el inicio de su tratamiento. En el seguimiento realizado a los 6 meses, 24 pacientes habían abandonado (grupo ABD) y 42 continuaban el tratamiento (grupo NABD). Los análisis multivariados con las subescalas de impulsividad mostraron diferencias prospectivas entre ambos grupos. Aparentemente, estas diferencias son atribuibles a las dimensiones afectivas de impulsividad (urgencias positiva y negativa). Entre ambas dimensiones, solo la urgencia positiva fue un predictor independiente de un ligero incremento en la probabilidad de abandono. Dentro del grupo NABD, un mayor grado de adherencia terapéutica vino predicho, de manera independiente, tanto por una baja búsqueda de sensaciones como por una mayor conciencia de los problemas vinculados al juego. Estos resultados sugieren que los rasgos de impulsividad de origen afectivo son predictores de abandono del tratamiento en pacientes con trastorno por juego. La conciencia de problemas asociados al juego de azar y una baja búsqueda de sensaciones predisponen a una mayor adherencia a las prescripciones terapéuticas