Transtorno de Jogo: contribuição da abordagem psicodinâmica no tratamento / Gambling Disorder: contributions of the psychodynamic approach to treatment / Jeu Pathologique: contributions de l'approche psychodynamique au traitement / Trastorno de Juego: contribución del enfoque psicodinámico al tratamiento

Resumo Jogos de azar podem ser uma atividade de lazer, mas sua prática em excesso pode levar a consequências adversas, como o Transtorno de Jogo. Apesar dos sérios prejuízos provocados por esse quadro, tanto o Transtorno de Jogo em si quanto estratégias de tratamento são pouco conhecidos no Brasil. Este trabalho aborda o Transtorno de Jogo e seu tratamento, tendo como objetivo explicitar a contribuição da abordagem psicodinâmica. São apresentadas as principais hipóteses psicodinâmicas existentes na literatura e tecidas considerações sobre a psicoterapia psicodinâmica realizada em um serviço que atende jogadores em São Paulo, o Programa Ambulatorial do Jogo Patológico (PRO-AMJO) do Instituto de Psiquiatria do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (IPq HC-FMUSP). Por fim, alguns exemplos de perfis de jogadores patológicos são apresentados.

Abstract Gambling may be a leisure activity, but overdoing it can lead to adverse consequences such as Gambling Disorder. Despite the serious damage caused by the disorder, both Gambling Disorder and its treatment strategies are little known in Brazil. This study investigates Gambling Disorder and its treatment, emphasizing the contributions of the psychodynamic approach. The paper presents the main psychodynamic hypotheses in the literature and comments on the psychodynamic psychotherapy carried out in facilities treating pathological gamblers in São Paulo, such as the Pathological Gambling Outpatient Program (PRO-AMJO) of the Psychiatric Institute of Hospital das Clínicas (IPq HC-FMUSP). Finally, some examples of pathological gambler profiles are discussed.

Résumé Le jeu de hasard peut être un loisir, mais l'excès peut avoir des conséquences néfastes, comme le Jeu Pathologique. Malgré les graves consequences causés par ce trouble, le Jeu Pathologique et ses stratégies de traitement sont peu connus au Brésil. Cettte étude porte sur la Dépendence au jeu et son traitement, en mettant l'accent sur les contributions de l'approche psychodynamique. L'article présente les principales hypothèses psychodynamiques dans la littérature et reflète sur la psychothérapie psychodynamique réalisée dans les services qui s'occupent de joueurs à São Paulo, telles que le Programma ambulatoire sur la dépendance au jeu (PRO-AMJO) del'Institut de psychiatrie de l'Hospital das clínicas (IPq HC-FMUSP). Enfin, quelques exemples de profils de joueurs pathologiques sont discutés.

Resumen Los juegos de azar pueden ser una actividad de diversión, pero su práctica excesiva puede traer consecuencias adversas como el Trastorno de Juego. A pesar de los graves daños causados por este comportamiento, tanto el Trastorno de Juego en sí como las estrategias de tratamiento son poco conocidos en Brasil. Este trabajo aborda el Trastorno de Juego y su tratamiento, con el objetivo de hacer explícito la contribución del enfoque psicodinámico. Se presentan las principales hipótesis psicodinámicas en la literatura y se hacen consideraciones sobre la psicoterapia psicodinámica realizada en un servicio que atiende a jugadores en São Paulo, como el Programa del Hospital das Clínicas de la Facultad de Medicina de la Universidad de São Paulo (IPq HC-FMUSP). Finalmente, se presentan algunos ejemplos de perfiles de jugadores patológicos.

Pathological Gambling Due to Aripiprazole: Two Cases

ABSTRACT Aripiprazole is an atypical antipsychotic agent which has a partial agonistic effect on dopamine D2 and D3 receptors. It is effective in the treatment of schizophrenia and bipolar disorder. Owing to its partial agonistic effect, hyperactivity of dopamine may occur in the mesolimbic pathway. In the literature, there are few case reports about pathological gambling due to aripiprazole. In this article, there are two case reports of patients who showed pathological gambling behaviour and alcohol abuse and who were under treatment with aripiprazole. The patient had a history of gambling in the past. With the use of aripiprazole, pathological gambling behaviour occurred quickly and with discontinuation of aripiprazole it ended completely. Aripiprazole causes pathological gambling by forming a hyperdopaminergic condition in the mesolimbic dopaminergic pathway. Aripiprazole should be recommended cautiously and carefully to patients who are impulsive and have a history of alcohol/substance abuse.

Juegos de apuestas en estudiantes universitarios: diferencias en impulsividad rasgo, distorsiones cognitivas y severidad en función del tipo de apuestas / Gambling behavior in college students: differences in trait-like impulsivity, cognitive distortions and severity as a function of gambling preference

Resumen El juego patológico se caracteriza por un patrón persistente y excesivo de juego, con interferencias en la vida personal, social, familiar y laboral. Objetivo: Examinar en estudiantes universitarios diferencias en impulsividad rasgo, distorsiones cognitivas y severidad en el involucramiento con los juegos de apuestas en función de los juegos de apuestas de preferencia (estratégicos y no estratégicos); y variaciones en impulsividad en función de los diferentes niveles de severidad en el involucramiento con los juegos de apuestas (sin riesgo, bajo riesgo, alto riesgo). Método: Participaron 295 estudiantes que completaron instrumentos para medir: 1-ocurrencia y preferencia de juegos de apuestas (cuestionario ad-hoc), 2-severidad en el involucramiento con los juegos de apuestas (versión en español del South Oaks Gambling Screen, 3-impulsividad rasgo (versión en español de UPPS-P Impulsive Behavior Scale), 4-distorsiones cognitivas (versión en español del Gamblers' Beliefs Questionnaire). Resultados: Se encontraron diferencias estadísticamente significativas en impulsividad, distorsiones cognitivas y severidad en el involucramiento con los juegos de apuestas en función de la preferencia por determinados tipos de apuestas, y en impulsividad en función del nivel de severidad en el involucramiento con los juegos de apuestas. Conclusión: Los hallazgos describen características psicológicas asociadas a una mayor vulnerabilidad a exhibir modalidades problemáticas de involucramiento con los juegos de apuestas; y sugieren que quienes exhiben preferencias por juegos de apuestas categorizados como estratégicos, o por apuestas estratégicas y no estratégicas combinadas, son quienes parecen estar en mayor riesgo de presentar problemas con el juego de apuestas.

Abstract Pathological gambling is characterized by a persistent and excessive pattern of gambling, with interference in personal, social, family and work life. Objective: To examine, in college students, differences in impulsivity trait, cognitive distortions and severity in gambling involvement as a function gambling preference (strategic and non-strategic); and variations in impulsivity as a function of levels of severity in gambling involvement (no risk, low risk, risk). Method: 295 students completed a survey to measure: 1-occurrence and preference of gambling (ad-hoc questionnaire), 2-severity of gambling involvement (Spanish version of the South Oaks Gambling Screen), 3- impulsivity trait (Spanish version of the UPPS-P Impulsivity Behavior Scale), 4-cognitive distortions (Spanish version of the Gamblers' Beliefs Questionnaire). Results: Analysis of Variance revealed significant differences in impulsivity, cognitive distortions and gambling severity as a function of gambling preference; and significant differences in trait-like impulsivity as a function of gambling severity. Conclusion: These findings describe psychological characteristics associated with increased vulnerability to exhibit gambling problems. The findings also suggest that individuals with a preference for strategic gambling or strategic and no strategic gambling, seem to be at heightened risk for problematic gambling.

Validez de contenido del cuestionario de juego patológico SOGS en el ámbito forense colombiano / The Validity of the SOGS Pathological Gambling Survey's Content in the Colombian Forensic Field / Validade de conteúdo do questionário de jogo patológico SOGS no campo forense colombiano

Resumen Tradicionalmente se ha distinguido el juego como pasatiempo (play) del juego con apuestas (gambling). El juego con apuestas ha facilitado la aparición de conductas problemáticas como el juego patológico, conocido como ludopatía. En Colombia la Ley 1554 de 2012 en el artículo 7° parágrafo I, menciona la importancia de definir guías y protocolos de atención y evaluación de la ludopatía. No obstante, en el contexto colombiano son escasos los estudios que evalúen y atiendan esta problemática. El presente estudio, tuvo como objetivo establecer la validez de contenido del instrumento South Oaks Gambling Screen (SOGS) ampliamente utilizado en el ámbito de la psicología forense. La metodología consistió, en primer lugar, en una etapa de adaptación y ajustes al instrumento, y posteriormente, una etapa de juicio de expertos mediante el método Delphi. Entre los principales resultados del estudio se encuentran: la adaptación de los criterios diagnósticos del cuestionario del DSM-III-R al DSM-5, la adaptación al lenguaje colombiano que permite establecer una mayor comprensión del cuestionario y la incorporación de aspectos relacionados con el juego y las apuestas en línea. El producto de este estudio constituye un instrumento viable para su utilización en el ámbito jurídico y forense, mediante el criterio probatorio del artículo 226 del Código General del Proceso.

Abstract Traditionally, "play" has been distinguished as a hobby within "gambling". Gambling has facilitated the appearance of problematic conducts, such as pathological gambling, also known as compulsive gambling. In Colombia, Law 1554/2020, in article 7, paragraph 1, mentions the importance of defining attention and assessment guides and protocols for compulsive gambling. However, there are few studies in the Colombian context that assess and attend to this issue. This study's objective was to establish the validity of the South Oaks Gambling Screen (SOGS) instrument's content, which is widely used in the field of forensic psychology. The methodology first consisted of a stage adapting to and adjusting the instruments and then a stage of expert judgment through the Delphi method. The study's main results includes: adapting the survey's diagnostic criteria from DSM-III-R to DSM-5, adapting it to Colombian Spanish, which ensures better understanding of the survey and incorporating aspects related to online gambling and betting. This study's product comprises an instrument that may be used in legal and forensic fields through the standard of proof in article 226 of the General Procedural Code.

Resumo Tradicionalmente, tem sido distinguido o jogo como um passatempo (play) do jogo com apostas (gambling). O jogo com apostas facilitou o aparecimento de comportamentos problemáticos, como o jogo patológico, conhecido como jogo compulsivo. Na Colômbia, a Lei 1554 de 2012 em seu artigo 7, parágrafo I, menciona a importância de definir diretrizes e protocolos para o atendimento e avaliação do jogo patológico. Porém, no contexto colombiano, existem poucos estudos que avaliem e abordem esse problema. O presente estudo teve como objetivo estabelecer a validade de conteúdo do instrumento South Oaks Gambling Screen (SOGS) amplamente utilizado na área da psicologia forense. A metodologia consistiu, em primeiro lugar, em uma etapa de adaptação e ajustes do instrumento e, posteriormente, em uma etapa de julgamento de especialistas através método Delphi. Entre os principais resultados do estudo estão: a adaptação dos critérios de diagnóstico do questionário DSM-III-R ao DSM-5, a adaptação à língua colombiana que permite uma maior compreensão do questionário e a incorporação de aspectos relacionados com o jogo e as apostas online. O produto deste estudo constitui um instrumento viável para sua utilização no campo jurídico e forense, através do critério probatório do artigo 226 do Código Geral do Processo.

Testing a Model to Predict Problem Gambling in Speculative Game Users

PURPOSE: The purpose of the study was to develop and test a model for predicting problem gambling in speculative game users based on Blaszczynski and Nower's pathways model of problem and pathological gambling. METHODS: The participants were 262 speculative game users recruited from seven speculative gambling places located in Seoul, Gangwon, and Gyeonggi, Korea. They completed a structured self-report questionnaire comprising measures of problem gambling, negative emotions, attentional impulsivity, motor impulsivity, non-planning impulsivity, gambler's fallacy, and gambling self-efficacy. Structural Equation Modeling was used to test the hypothesized model and to examine the direct and indirect effects on problem gambling in speculative game users using SPSS 22.0 and AMOS 20.0 programs. RESULTS: The hypothetical research model provided a reasonable fit to the data. Negative emotions, motor impulsivity, gambler's fallacy, and gambling self-efficacy had direct effects on problem gambling in speculative game users, while indirect effects were reported for negative emotions, motor impulsivity, and gambler's fallacy. These predictors explained 75.2% problem gambling in speculative game users. CONCLUSION: The findings suggest that developing intervention programs to reduce negative emotions, motor impulsivity, and gambler's fallacy, and to increase gambling self-efficacy in speculative game users are needed to prevent their problem gambling.

Relationship between Horse Racing Addiction and Health Status Indicators

BACKGROUND: The purpose of this study is to investigate relationship between the horse racing addiction and the health status indicators. METHODS: Surveys were conducted with visitors of the Korea Racing Association in Gyeonggi-do, from September 1 to September 24, 2017. We used the questionnaire, which contains questions to assess the horse racing addiction, mood depression, health-related quality of life, smoking amount, alcohol dependency, etc. Survey data were analyzed through t-test, chi-square test, logistic regression analysis, and multiple regression analysis by SPSS program (IBM Corp., Chicago, IL, USA). RESULTS: The pathological gambling group was 47.5% (n=38) of the visitors, and they showed a different racecourse use behavior compared to the normal group. In addition, we found that the pathological gambling group had a significantly different health-related quality of life score and a depression score from the normal group, and that the addiction score and the depression score had a linear correlation. CONCLUSIONS: Among the racecourse visitors, the ratio of the pathological gambler was considerably high, and the pathological gambling group showed different health-related quality of life score and a depression score compared to the normal group; especially, the depression score has a significant correlation with horse racing addiction. Therefore, the horse racing association and the health authorities should recognize the seriousness of the horse racing addiction, make an effort to select high risk users, and prepare a program to prevent pathological gambling.

Testing an Explanatory Model for Preventing College Students' Problem Gambling

PURPOSE: A mediated model of Korean college students' problem gambling based on Blaszczynski and Nower's pathway model is developed and tested to explore mediating roles of self-control and irrational gambling beliefs in the association between emotionally vulnerable variables and problem gambling. METHODS: 273 student participants recruited from 4 universities in Seoul and Gyeonggi, Korea responded. Data were collected with a structured self-report questionnaire comprising measures of problem gambling, depression, anxiety, coping styles, irrational gambling belief, and self-control. RESULTS: The modified research model provides a reasonable fit to the data. Depression, anxiety, reflective coping, irrational beliefs, and self-control turned out to have direct effects on problem gambling, while indirect effects were reported in some suppressive and reactive styles. These predictors account for 38% of the college students' problem gambling. CONCLUSION: The findings suggest that developing intervention programs for reducing depression, anxiety, irrational gambling beliefs, and increasing reflective coping and self-control are needed to prevent Korean college students' problem gambling.

Cuestionario breve de juego patológico en estudiantes colombianos: propiedades psicométricas / Pathological Gambling Short Questionnaire in Colombian Students: Psychometrics Properties

Resumen Son escasos los estudios sobre instrumentos de evaluación de la ludopatía en población colombiana, así como sobre su prevalencia. El objetivo de este trabajo fue obtener las propiedades psicométricas del Cuestionario Breve de Juego Patológico (CBJP), así como determinar la prevalencia de probable juego patológico en una muestra no aleatoria (n= 5858) de estudiantes de formación superior de todas las ciudades capitales de Colombia. El CBJP mostró una fiabilidad interna (0.74) aceptable y validez convergente con una medida de distorsiones cognitivas sobre los juegos de azar -r(5618)= 0.462, p < 0.001-. La prevalencia de posibles problemas de adicción al juego fue similar a la encontrada con instrumentos más amplios en población análoga (19.2 %), y dicha prevalencia fue más alta en hombres, en personas más jóvenes y de nivel socioeconómico más bajo. De acuerdo con estos resultados, es necesario confirmar con otros instrumentos la prevalencia del juego patológico, impulsar medidas legales y sociosanitarias de prevención para los grupos en riesgo alto, y conocer la utilidad del CBJP en muestras clínicas colombianas.

Abstract There are few studies on pathological gambling (PG) tests and prevalence for Colombian population. The aim of this paper was to obtain both psychometric properties of the Pathological Gambling Short Questionnaire (PGSQ), as well as to calculate the prevalence of pathological gambling (PG) for a non-randomized sample of university and technical courses from all Colombian capital cities. Results showed a PGSQ good internal reliability (0.74) and convergent validity with a cognitive distortions indicator -r(5618)= 0.462, p < 0.001-. The prevalence of possible pathological gamblers was similar to other studies which have used broader measures of pathological gambling (19.2 %). Men, youngest people and members of low social class had higher scores in PG. According to these results, it should be confirmed PG prevalence with other measures, in order to boost legal and socio-health actions for prevention of PG in high risk groups and to know utility of PGSQ for Colombian clinical samples.

Características sociodemográficas y comorbilidad de sujetos con juego patológico e intento de suicidio en España / Sociodemographic Traits and Comorbidities in Pathological Gamblers With a Suicide Attempt in Spain

Objetivo: El suicidio se sitúa en España como la primera causa de muerte no natural, y el juego patológico es uno de sus principales factores de riesgo de los trastornos adictivos. El estudio realizado tiene como objetivo describir y comparar las características sociodemográficas, la comorbilidad y las características del intento en pacientes con intentos de suicidio que cumplen criterios de juego patológico frente a pacientes con intento de suicidio sin criterios de juego patológico. Métodos: Para los distintos análisis se empleó una muestra de 345 pacientes con intento de suicidio recogida a partir de las admisiones en el servicio de Urgencias de un Hospital Universitario de la Comunidad Autónoma de Madrid durante el periodo comprendido entre 1999 y 2004. Para describir y comparar las características sociodemográficas, de comorbilidad y las relacionadas con el intento de suicidio, se utilizaron modelos de regresión logística ajustados por sexo y edad. Resultados: Los resultados muestran que los pacientes con intento de suicidio que cumplen criterios de juego patológico son predominantemente varones, con bajo nivel de estudios y con mayor tendencia a tener descendencia. Además presentan mayor prevalencia en determinadas comorbilidades: dependencia global de sustancias, dependencia de nicotina, dependencia de cocaína y dependencia de opiáceos. Conclusiones: En este estudio se muestra cierta evidencia sobre la existencia de un subtipo de suicida (jugador patológico suicida) con ciertas características propias, similares a las encontradas en muestras de jugadores patológicos.

Objective: Suicide is the first cause of non-natural death in Spain. Among addictive disorders, pathological gambling is one the most significant independent risk factors for suicidal behavior. The objective of this study is to describe and compare the sociodemographic traits, comorbidity and attempt characteristics, between suicide attempters who fulfill diagnostic criteria for pathological gambling and those who do not. Methods: A total of 345 patients admitted to the emergency department of a University Hospital in Madrid between 1999 and 2004 were interviewed for this study. To describe and compare the demographic characteristics, comorbidity and those related to attempted suicide, using logistic regression models adjusted for sex and age were used. Results: Suicide attempters who fulfilled diagnostic criteria for pathological gambling were predominantly male, with a low education level, and had more offspring. Furthermore, these patients had more comorbidities, such as: global substance dependence, nicotine, cocaine and opioid dependence. Conclusions: The present study suggests that pathological gamblers represent a distinct subgroup among suicide attempters, with particular characteristics, similar to those found in pathological gamblers in the general population.

Piribedil and Pathological Gambling in six Parkinsonian patients / Piribedil e Jogo Patológico em seis pacientes parkinsonianos

Impulse control disorders (ICD) in Parkinson's disease (PD) have attracted increasing interest. They are characterized by the inability to control the impulse to perform an act that can be detrimental to them or to others. Although dopamine agonists (DA), as a group, have been associated with impulse control disorders (ICD), piribedil has rarely been reported to cause them. Method Case reports of six parkinsonian patients on piribedil presenting pathological gambling (PG). Results All of the patients presented ICD associated with piribedil use. Two of them received this medication as first treatment and four of them who had developed ICDs secondary to other DA that reappeared with piribedil. Conclusion Despite piribedil is commercially available in only a few countries, it should be considered in the differential diagnosis of PG in patients with PD. .

Os distúrbios do controle do impulso (DCI) na doença de Parkinson (DP) têm atraído crescente interesse. Eles são caracterizados pela incapacidade da pessoa em controlar o impulso para realizar um ato que pode ser prejudicial a ela própria ou aos outros. Embora os agonistas dopaminérgicos (AD), como um grupo, têm sido associados com distúrbios do controle do impulso, o piribedil tem sido relatado raramente como causa dos mesmos. Método Relatos de seis casos de pacientes parkinsonianos em uso de piribedil apresentando jogo patológico (JP). Resultados Todos os pacientes apresentaram DCI com o uso do piribedil. Dois deles receberam piribedil como primeiro tratamento e quatro deles que haviam desenvolvido DCI devido a outro AD, reapresentaram o quadro com piribedil. Conclusão Apesar de o piribedil estar disponível comercialmente apenas em alguns países, deveria ser considerado no diagnóstico diferencial de JP em pacientes com DP. .

Prevalencia estimada de juego patológico en estudiantes de la Universidad Austral de Chile, Valdivia, año 2013 / Estimated prevalence of pathological gambling among college students of the Universidad Austral de Chile, Valdivia, 2013

INTRODUCCIÓN: Las adicciones conductuales se caracterizan por una pérdida del control del sujeto sobre una determinada conducta, siendo el juego patológico (JP) la más estudiada de ellas. El JP se asocia con graves problemas académicos, alcoholismo, depresión y suicidio por lo que es fundamental saber su prevalencia en la población universitaria. El objetivo de este estudio fue determinar la prevalencia de potenciales ludópatas entre estudiantes regulares de pregrado de la Universidad Austral de Chile durante el año 2013. MATERIAL Y MÉTODO: Estudio descriptivo de corte transversal. A fines de 2013 se invitó a participar de una encuesta de auto aplicación on-line a los estudiantes de la Universidad Austral de Chile. Esta incluyó el cuestionario sobre JP basado en los criterios DSM-IV-TR y DSM V. El punto de corte para determinar potencial adicción fue de 5/10 criterios. Se utilizó Microsoft Excel para análisis. RESULTADOS: Se recopilaron 1.613 encuestas, siendo 1.254 válidas. La muestra se conformó por hombres: 53,9% y mujeres: 46,09%, la edad media correspondió a 21,62 años. El 6,38% (n=80) puede ser catalogado como potenciales jugadores patológicos. De ellos, el 77,5% (n=62) fueron hombres y 22,5% (n=18) mujeres. Si se compara la prevalencia obtenida con DSM-IV-TR y DSM V esta aumenta en un 60% con DSM V respecto al anterior. DISCUSIÓN: La prevalencia estimada de JP en este estudio es similar a la de otros países. Hay marcado predominio de hombres. Se aprecia importante diferencia en la prevalencia dependiendo de qué criterio diagnóstico se use

INTRODUCTION: Behavioral addictions are characterized by a loss of control of the subject over a certain behavior, being pathological gambling (JP) the most studied of them. JP is associated with serious academic problems, alcoholism, depression and suicide, so it is essential to know its prevalence in the university population. The objective of this study was to determine the prevalence of potential gamblers among regular undergraduate students of the Austral University of Chile during 2013. MATERIAL AND METHODS: Descriptive study of transverse cut. At the end of 2013, the students of the Austral University of Chile were invited to participate in an online self-application survey. This included the JP questionnaire based on the DSM-IV-TR and DSM V criteria. The cut-off point for determining potential addiction was 5/10 criteria. Microsoft Excel was used for analysis. RESULTS: 1,613 surveys were collected, 1,254 of which were valid. The sample was made up of 53.9% men and 46.09% women, the mean age was 21.62 years. 6.38% (n = 80) can be classified as potential pathological players. Of these, 77.5% (n = 62) were men and 22.5% (n = 18) were women. If the prevalence obtained with DSM-IV-TR and DSM V is compared, it increases by 60% with DSM V compared to the previous one. DISCUSSION: The estimated prevalence of JP in this study is similar to that of other countries. There is a marked predominance of men. There is a significant difference in prevalence depending on which diagnostic criterion is used.

Juego patológico y dependencia del alcohol en una muestra de trabajadores y estudiantes universitarios: prevalencias, interrelaciones y diferencias de género / Pathological gambling and alcohol dependence in a sample of workers and university students: prevalences, relationships and gender differences

El objetivo de este trabajo fue conocer la prevalencia de la adicción al juego en una muestra no probabilística de estudiantes universitarios y trabajadores adultos, y explorar las relaciones entre niveles de adicción al juego y problemas con el alcohol y analizar las posibles diferencias entre hombres y mujeres. En este marco, se aplicó un instrumento a una muestra de algo más de 150 sujetos, que respondieron el South Oaks Gambling Screen (sogs) y el Cuestionario Breve de Dependencia del Alcohol, junto con preguntas de hábitos de juego y de datos sociodemográficos. Entre los resultados se encontró que un 13,4% de los hombres y un 1,3% de las mujeres podrían ser jugadores patológicos, y que las mujeres presentaban menor frecuencia de participación en juegos de azar. Además, se halló una correlación directa entre síntomas de juego patológico y de dependencia de alcohol, pero la relación fue más fuerte en los hombres. También, las deudas por juegos de azar se relacionaron directamente con los puntajes en el sogs en los hombres, y en las mujeres con la frecuencia de juego.

The aim of this research was to know pathological gambling prevalence in a Colombian people, relationships between pathological gambling and alcohol drinking problems, and to explore differences between men and women. A university students and adult workers non-randomized sample (n=150) answered the South Oaks Gambling Screen -sogs- and the Brief Questionnaire on Alcohol Dependence, several questions on gaming patterns and social and demographic background. Results showed that, according to sogs scores, 13.4% of men and a 1.3% of women were classified as pathological gamblers, and women reported a lower gambling frequencies than a direct correlation was founded between both drinking and pathological symptomatology, but men showed a stronger relationship between this indicators. Also, gambling debts were correlated with SOGS scores for men, and with gambling frequency for women.

Effects of a Family Education Program for Families of Pathological Gamblers

PURPOSE: This study was done to examine the intervention effects on the family of a family education program for pathological gamblers based on Community Reinforcement and Family Training (CRAFT). METHODS: A quasi-experimental, nonequivalent control group pretest-posttest design was used. The participants were 44 families of pathological gamblers from G center in Gyung-gi Province and 5 Gam-Anon groups in Seoul City and Gyung-gi Province. The experimental group (n=22) attended the 6 weekly 2 hour-long CRAFT family education program. The control group (n=22) attended the 12-step program of Gam-Anon. Data were collected from November, 2011 to May, 2012. RESULTS: Compared with the control group, the experimental group showed significant decrease in depression (p=.001) and state anger (p=.039). There were no significant differences between groups in the level of interpersonal communication, trait anger, the mode of anger expression and self-esteem. CONCLUSION: Findings from this study suggest that the CRAFT family education program is effective in decreasing depression and state anger in families of pathological gamblers.

A Case of Frontotemporal Dementia with Amyotrophic Lateral Sclerosis Presenting with Pathological Gambling

BACKGROUND: Pathological gambling (PG), which is characterized by consistent, repetitive gambling and unsuccessful quitting attempts, is classified as an impulse control disorder. PG has also been reported in patients with Parkinson's disease, frontotemporal dementia, and amyotrophic lateral sclerosis. CASE REPORT: A 53-year-old male visited the outpatient clinic due to excessive gambling and personality changes. Based on electrophysiological findings and neuropsychiatric assessment, he was diagnosed as frontotemporal dementia-amyotrophic lateral sclerosis. CONCLUSIONS: This case report underlines that PG can also be seen in patients with neurological disorders involving the orbitofrontal cortex.

The Clinical Characteristics of Pathological Gamblers Who Completed about 10 Weeks' Admission Treatment Programs : The Change of Depression and Anxiety after Treatment / 신경정신의학

OBJECTIVES: The purpose of this study is investigate the clinical characteristics and the change of depression and anxiety in pathological gamblers who completed 10-week admission treatment programs. METHODS: To investigate the clinical characteristics, we included 40 pathological gamblers who completed admission treatment programs from Jan 2006 to Jun 2010. To measure the change through treatment, we included 16 patients who completed pre-treatment and post-treatment assessment scales, including the Korean-National Opinion Research Center DSM-IV Screen for Gambling Problems (K-NODS), Beck's Depression Inventory (BDI), and the State-trait Anxiety Inventory (STAI), from May 2008 to Aug 2008. RESULTS: Mean age of the patients was 42.9+/-9.0 years and mean intelligent quotient was 109.7+/-10.4. Thirty (75%) patients showed comorbid disorders, including depression (14 patients, 35%), anxiety disorder (five patients, 12.5%), alcohol use disorder (five patients, 12.5%), and personality disorder (four patients, 10%). After treatment, K-NODS, BDI, STAI-I, and STAI-II scores showed improvement, from 9.1+/-1.5 to 7.6+/-2.7, from 23.5+/-5.8 to 11.1+/-3.2, from 52.6+/-10.3 to 41.9+/-7.1, and from 53.7+/-10.6 to 46.0+/-4.4, respectively. CONCLUSION: In treatment of pathological gambling, comorbid psychiatric risk factors, such as depression and anxiety should be considered.

Motivação para mudança de comportamento em amostra de jogadores patológicos / Motivation for behavior change in a sample of pathological gamblers

OBJETIVO: O objetivo deste trabalho foi conhecer o perfil e avaliar as características de jogadores patológicos que frequentavam clínicas e grupos especializados no tratamento desse problema, quanto à motivação para mudança de comportamento. MÉTODO: Foram avaliados 69 sujeitos com diagnóstico de jogo patológico, segundo critérios diagnósticos do DSM-IV-TR. A amostra foi subdividida em dois grupos, conforme o tipo de tratamento: grupo em tratamento ambulatorial (TA) e grupo de jogadores anônimos (JA). Os instrumentos utilizados foram a University of Rhode Island Change Assessment (URICA), a Régua de Prontidão e a South Oaks Gambling Screen (SOGS). RESULTADOS: A análise dos resultados evidenciou que o grupo TA apresentou escore médio maior do que o do grupo JA tanto no estágio de pré-contemplação quanto no estágio de ação. Comparando os grupos TA e JA com relação ao tempo de abstinência, observou-se que o grupo de JA está associado a um tempo maior de abstinência do que o grupo de ambulatório. CONCLUSÃO: A importância de pesquisar estratégias que favoreçam a compreensão e a adesão aos tratamentos para jogadores patológicos é fundamental. A avaliação da motivação e dos estágios para mudança permite uma direção para o tratamento, auxiliando na elaboração de estratégias terapêuticas.

OBJECTIVE: The goal of this study was to evaluate the profile and the characteristics of pathological gamblers who attended clinics and groups specialized in the treatment of this problem, focusing on patients' motivation to change this behavior. METHOD: 69 subjects with a diagnosis of pathological gambling, according to diagnostic criteria of DSM-IV-TR were evaluated. The sample was divided in two groups according to treatment regimen: ambulatory care group and gamblers anonymous group (GA). The instruments used were the University of Rhode Island Change Assessment (URICA), the Ruler of Readiness and SOGS (South Oaks Gambling Screen). RESULTS: The results showed that the ambulatory group had a higher mean score than the GA group, both in the precontemplation stage and in the action stage. Comparing the group of ambulatory care and GA with regard to length of abstinence, it was observed that the group of GA is associated with a longer period of abstinence than the ambulatory group. CONCLUSION: The importance of searching strategies that enhance the understanding and treatment adherence for pathological gamblers is crucial. The evaluation of the motivation to change and the stages of change allow professionals to find a better direction for treatment, assisting in the development of therapeutic strategies.

An Association Study of the Dopamine D2 Receptor Taq1A Polymorphism and Temperament in Korean Pathological Gamblers

OBJECTIVE: It has been suggested that the dopamine D2 receptor gene (DRD2) is associated with pathological gambling (PG). We investigated the association of the DRD2 Taq1A polymorphism and the temperament in PG using Cloninger's temperament and characteristic inventory (TCI). METHODS: 104 PG patients and 114 control subjects were recruited. Tests for DRD2 Taq1A polymorphism were conducted in both PG patients and controls. PG patients were requested to complete the TCI. RESULTS: There were no significant differences in frequencies of the genotype (chi2 = 0.77, p = 0.681), allele (chi2 = 0.52, p = 0.469), and allele (A1) carrier (chi2 = 0.15, p = 0.695) between the PG patients and the control group. When we compared the TCI profile in the PG patients according to genotypes, there were significant differences in harm-avoidance (HA, p = 0.033), and self-directedness (SD, p = 0.012) among genotypes. These difference were more evident between A1 allele carriers and non-carriers (HA, p = 0.009 and SD, p = 0.004). CONCLUSION: Present results suggest Taq1A polymorphism may not play an important role in the susceptibility to pathological gambling in our population. However, Taq1A polymorphism might be associated with some temperament in Korean PG patients.

Pathological Gambling: obsessive-compulsive disorder or behavioral addiction? / Juego patológico: ¿trastorno obsesivo-compulsivo o conducta adictiva?

Introducción: Existe un debate considerable acerca de la conceptualización de la ludopatía o juego patológico (JP) y su lugar en la nosología psiquiátrica. Se ha formulado la hipótesis de representarlo tanto como un trastorno del espectro obsesivo-compulsivo como una conducta adictiva, que es una adicción sin drogas. La conceptualización del juego patológico es fundamental para guiar las estrategias de investigación y desarrollo de tratamientos eficaces. En este artículo se revisará la investigación ya existente que apoya el modelo de adicción no farmacológica y la que apoya la conceptualización del espectro del trastorno obsesivo-compulsivo (TOC). Objetivo: Revisar la conceptualización del JP y los aspectos asociados con el TOC o una adicción de comportamiento. Resultados y conclusiones: Aunque al parecer el JP tiene rasgos del TOC en algunos dominios, la mayoría de los datos existentes sugieren diferencias sustanciales entre ellos. Los hallazgos de la fenomenología, la epidemiología, la respuesta al tratamiento y estudio por imágenes parecen apoyar que el JP se parece más a una adicción. Sin embargo, a pesar de los progresos en la última década en la comprensión de las adicciones, el JP y el TOC, los datos existentes son a menudo limitados e incluyen deficiencias metodológicas que complican la interpretación y las comparaciones entre grupos de sujetos...

Introduction: There has considerable debate about the appropriate conceptualization of pathological gambling (PG) and its place in psychiatric nosology. PG has been hypothesized to represent both an Obsessive-Compulsive spectrum disorder (OCD) and a behavioral addiction, that is an addiction without a drug. Conceptualization of pathological gambling is vital to guide research strategies and the development and testing of effective treatments we will review the existing research supporting the non-pharmacologic addiction model and that supporting the obsessive-compulsive spectrum conceptualization. Objetive: To review the conceptualization of PG and the aspects associated with the OCD or a behavioral addiction. Results and Conclusions: Although PG resembles OCD in some domains, the majority of the existing data suggests substantial differences between them. Findings from phenomenology, epidemiology, treatment response, and imaging study appear to support that PG resembles more closely an addiction. Nevertheless, despite the progress over the last decade in understanding addictions, PG, and OCD, existing data are often limited and include methodological concerns that complicate interpretation and comparisons across subject groups...

Juego patológico en usuarios de casinos en Bogotá: prevalencia y relaciones con consumo de alcohol, búsqueda de sensaciones y patrones de juego / Pathological gambling in casino users in Bogotá: Prevalence and relation with alcohol consumption, search for sensations and gambling patterns

En Colombia son muy pocos los trabajos que abordan la adicción al juego en algún grupo poblacional. En este trabajo se estudió la prevalencia de juego patológico y la validez concurrente del South Oaks Gambling Score (SOGS) en una muestra no aleatoria de usuarios de juegos de azar, localizados, en su mayoría, en casinos. Como resultados se destaca: (a) un 49.1% de sujetos con probable juego patológico; (b) mayor variedad en juegos, mayor consumo de alcohol en fines de semanay más demanda de dinero, para jugar o para consumir alcohol en los sujetos con problemas de adicción al juego, y (c) algunos ítems de la Escala de Búsqueda de Sensaciones pueden formar un indicador específicamente asociado con el juego patológico.

In Colombia, very few researches approach gambling addiction in any population group. This research focused on the prevalence of pathological gambling, and concurrent validity of South Oaks Gambling Score (SOGS) in a non-randomized sample of casino users. The most remarkable results showed that (a) 49.1% of the interviewees were likely to have pathological gambling, (b) subjects with probable pathological gambling showed a higher game variety and alcohol consumption on weekends, and higher expenses for gambling and drinking, and (c) some Search for Sensations Scale items could serve to build a specific indicator for gambling addiction.

Wives of pathological gamblers: personality traits, depressive symptoms and social adjustment / Esposas de jogadores patológicos: traços de personalidade, sintomas depressivos e ajustamento social

Objective: Wives of pathological gamblers tend to endure long marriages despite financial and emotional burden. Difficulties in social adjustment, personality psychopathology, and comorbidity with psychiatric disorders are pointed as reasons for remaining on such overwhelming relationships. The goal was to examine the social adjustment, personality and negative emotionality of wives of pathological gamblers. Method: The sample consisted of 25 wives of pathological gamblers, mean age 40.6, SD = 9.1 from a Gambling Outpatient Unit and at GAM-ANON, and 25 wives of non-gamblers, mean age 40.8, SD = 9.1, who answered advertisements placed at the Universidade de São Paulo hospital and medical school complex. They were selected in order to approximately match demographic characteristics of the wives of pathological gamblers. Subjects were assessed by the Social Adjustment Scale, Temperament and Character Inventory, Beck Depression Inventory and State-Trait Anxiety Inventory. Results: Three variables remained in the final Multiple Logistic Regression model, wives of pathological gamblers presented greater dissatisfaction with their marital bond, and higher scores on Reward Dependence and Persistence temperament factors. Both, Wives of pathological gamblers and wives of non-gamblers presented well-structured character factors excluding personality disorders. Conclusion: This personality profile may explain wives of pathological gamblers emotional resilience and their marriage longevity. Co-dependence and other labels previously used to describe them may work as a double edged sword, legitimating wives of pathological gamblers problems, while stigmatizing them as inapt and needy.

Objetivo: Esposas de jogadores patológicos tendem a permanecer casadas por muitos anos, apesar das dificuldades financeiras e emocionais. Dificuldades de ajustamento social, transtornos de personalidade, e comorbidades com transtornos psiquiátricos são apontados como razões para permanecerem nesses relacionamentos tão opressivos. O objetivo foi examinar o ajustamento social, a personalidade e as emoções negativas das esposas de jogadores patológicos. Método: A amostra foi constituída por 25 esposas de jogadores patológicos, média de idade 40,6 anos (DP = 9,1), do Ambulatório de Jogadores Patológicos e do Jog-Anon, e 25 esposas de não jogadores, média de idade 40,8 anos (DP = 9,1), que responderam a anúncios colocados no complexo do hospital da faculdade de medicina da Universidade de São Paulo. Foram selecionadas aquelas que apresentavam características demográficas próximas às das esposas de jogadores patológicos. Os sujeitos foram avaliados por meio da Escala de Ajustamento Social, do Inventário de Temperamento e Caráter, do Inventário de Depressão de Beck, e do Inventário de Ansiedade Traço-Estado. Resultados: Três variáveis permaneceram no modelo final da Análise de Regressão Logística Múltipla. Esposas de jogadores patológicos apresentaram maior insatisfação no relacionamento marital e escores mais altos nos fatores de temperamento Dependência de Gratificação e Persistência. Ambas, as esposas de jogadores patológicos e de não jogadores apresentaram fatores de caráter bem estruturados, excluindo transtornos de personalidade. Conclusão: Este perfil de personalidade pode explicar a resiliência emocional das esposas de jogadores patológicos e a longa duração de seus casamentos. Codependência e outros rótulos utilizados anteriormente para descrevê-las podem, de um lado, legitimar seus problemas e, de outro, estigmatizá-las como inaptas e carentes.