Decision-making deficits in pathological gambling: the role of executive functions, explicit knowledge and impulsivity in relation to decisions made under ambiguity and risk.

BACKGROUND: A variety of cognitive and emotional processes influence the decision-making deficits observed in pathological gambling (PG). This study investigated the role of immediate/delayed sensitivity to reward and punishment, executive functions, impulsivity and explicit knowledge in relation to decision-making performance on the original Iowa Gambling Task (IGT-ABCD) and a variant (IGT-EFGH). METHODS: We assessed 131 consecutive patients with a diagnosis of PG by using executive functioning and decision-making tasks, self-report measures of impulsivity and explicit knowledge. RESULTS: The majority of pathological gamblers (PGs) showed deficits in decision-making, characterized mainly by myopia for the future. Decisions made under risk showed different predictors. Performance on the IGT-ABCD for decisions made under risk was predicted by medium and high levels of explicit knowledge of the task, as well as by scores on the Disorderliness subscale and the degree of Stroop interference. By contrast, IGT-EFGH results were only associated with self-report impulsivity measures. CONCLUSIONS: Decision making in PG involves distinct patterns of deficits, and the predictors differ depending on the reinforcement schedule. Decisions made under risk on the IGT-ABCD are associated with explicit knowledge, executive functions and impulsivity traits related to conscious awareness and control processes. On the IGT-EFGH, however, only impulsivity traits predict decision making.

Effect of executive functioning, decision-making and self-reported impulsivity on the treatment outcome of pathologic gambling.

BACKGROUND: Impairments in self-regulatory behaviour reflect a deficit in executive functioning and decision-making, as well as higher levels of self-reported impulsivity, and may be involved in the development and maintenance of addictive disorders. We sought to explore the association between self-reported impulsivity and neurocognitive measures, and their association with treatment outcome in pathologic gambling. METHODS: We assessed patients with pathologic gambling using executive functioning and decision-making tests and self-report measures of impulsivity. Patients underwent cognitive-behavioural therapy (CBT) for pathologic gambling. RESULTS: We included 88 patients (8% women) in our study. High self-reported extravagance was associated with poor performance in the Iowa Gambling Task (IGT)-ABCD version. High impulsiveness, low disorderliness, high exploratory excitability (trend), poor backward block span and poor IGT-EFGH scores (trend) predicted dropout. We observed no self-reported or neurocognitive predictors of relapse or number of treatment sessions attended. LIMITATIONS: Most participants were slot-machine gamblers seeking treatment. No follow-up data and no control group were included in the study. The missing sample (i.e., individuals who were recruited and assessed in the pretreatment stage but who chose not to begin treatment) had higher extravagance scores than the final sample. CONCLUSION: Neurocognitive reward sensitivity was related to self-reported overspending behaviour. Self-regulatory impairments (especially rash impulsiveness and punishment sensitivity) and executive dysfunction predicted only dropout of CBT in participants with pathologic gambling. Different neurocognitive processes and personality traits might mediate treatment response to psychological therapy of pathologic gambling according to the specific target variable assessed.

Age of onset in pathological gambling: clinical, therapeutic and personality correlates.

We aimed to explore the association between age of onset of gambling problems and current psychopathological and clinical status, personality profile and therapeutic outcome in a sample of pathological gamblers. A total of 904 consecutive pathological gambling patients were administered several instruments about gambling behavior, psychopathology and personality. They received a 4-month cognitive-behavioral group treatment. Information of dropouts and relapses during treatment was registered. Older age of onset of gambling problems was associated with higher general psychopathology (SCL-90-R Paranoid Ideation, Psychoticism, Depression; P < 0.015). Younger age of onset was related to greater severity of pathological gambling (P < 0.015), higher novelty seeking, and lower self-directedness (P < 0.015). No statistically significant association was found between age of onset and relapse and dropouts during treatment. Age of onset of gambling problems seems to influence the clinical presentation of pathological gambling but not treatment outcome.

Predictors of early change in bulimia nervosa after a brief psychoeducational therapy.

We aimed to examine baseline predictors of treatment response in bulimic patients. 241 seeking-treatment females with bulimia nervosa completed an exhaustive assessment and were referred to a six-session psychoeducational group. Regression analyses of treatment response were performed. Childhood obesity, lower frequency of eating symptomatology, lower body mass index, older age, and lower family's and patient's concern about the disorder were predictors of poor abstinence. Suicidal ideation, alcohol abuse, higher maximum BMI, higher novelty seeking and lower baseline purging frequency predicted dropouts. Predictors of early symptom changes and dropouts were similar to those identified in longer CBT interventions.

Individual versus group cognitive-behavioral treatment for obsessive-compulsive disorder: a controlled pilot study.

This study sought to examine the effectiveness of group and individual cognitive-behavioral treatment (CBT) and to compare the results with those of a wait-list control group among a sample of patients with obsessive-compulsive disorder (OCD). Fifty-seven individuals diagnosed with OCD were evaluated pre- and posttreatment with the Yale-Brown Obsessive Compulsive Scale and the Hamilton Rating Scales for Anxiety and Depression. Both group and individual CBT obtained statistically significant reductions in anxiety and depressive symptoms. Patients in individual treatment achieved a statistically significant reduction in OCD symptoms compared with those in group treatment, but their dropout rate was twice as high. Patients with symmetry and order rituals presented less improvement in anxiety symptoms than those with other rituals. Associated general symptoms were lower in patients receiving either mode of CBT compared with wait-list participants. The authors found that individual treatment is more effective in reducing obsessive-compulsive symptoms than group treatment.

Comparison of personality risk factors in bulimia nervosa and pathological gambling.

OBJECTIVE: The objective of the study was to assess the predictive value of personality profiles to classify individuals with bulimia nervosa (BN), pathological gambling (PG), and a nonpsychiatric comparison group while controlling for sex. METHODS: The sample comprised 270 BN (241 women, 29 men), 429 PG (42 women, 387 men), and 96 comparison (nonpsychiatric) subjects (35 women, 61 men). All patients were consecutively admitted to our Psychiatry Department and were diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision criteria. We administered the Temperament and Character Inventory-Revised as well as other clinical indices. Multinomial and binary logistic regression models adjusted for age and stratified by sex were used to assess the predictive value of personality in relation to group status. RESULTS: In comparison to controls, high Novelty Seeking (P < .001) was specifically associated with a diagnosis of PG. Independently of sex, low Self-Directedness was associated with both BN (P < .001) and PG (P < .001). Some sex-specific differences were also observed; namely, women with BN and PG displayed higher Harm Avoidance and Cooperativeness than control women, whereas men with PG reported higher Reward Dependence and Persistence than control men. CONCLUSIONS: Our results suggested that, whereas there are some shared personality traits between BN and PG when compared with healthy controls, there are also some sex- and diagnostic-specific personality traits that weigh against the consideration of BN as an impulse control disorder.

Exophenotypical profile of adolescents with sustained attention deficit: A 10-year follow-up study.

UNLABELLED: We aimed to explore prospectively the relationship between the presence of sustained attention deficit (SAD) in early adolescence and exophenotypical measures of vulnerability to schizophrenia spectrum disorders (personality and psychosocial measures) in early adulthood. Two cohorts of community adolescents were selected in 1993 according to the presence or absence of a CPT-linked SAD. In 2003, both cohorts (Index: n=42, and CONTROL: n=38) were administered the O-LIFE, the SCID-II, the DOI battery and the COPE scale, among other tests. T-tests were used to compare both cohorts. Index subjects showed a higher level of negative schizotypy, avoidant, depressive and narcissistic personality traits, as well as more asocial behavior and poorer use of coping resources than CONTROL subjects did. A SAD in early adolescence may be associated with coping and social deficits, negative schizotypy, and personality traits indicative of emotional disturbance in adulthood. Our results suggest that SAD in early adolescence might be an indicator of psychopathology in adulthood and give support to dimensional models of psychopathology.

Impulse control disorders in eating disorders: clinical and therapeutic implications.

OBJECTIVE: Few studies have explored impulse control disorders (ICDs) in women with bulimia nervosa (BN). We explored the prevalence of lifetime ICDs in women with BN, compared the severity of eating disorder symptoms in women with BN with and without ICD, and compared their personality profiles to females with one form of ICD, namely, pathologic gambling. METHOD: A total sample of 269 female patients consecutively admitted to our unit participated in the current study (173 BN without comorbid ICD [BN - ICD]; 54 BN with comorbid ICD [BN + ICD]; and 42 pathologic gamblers [PG]). All participants were diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria. EVALUATION: Assessment measures included the Symptom Checklist-90 revised and the Temperament and Character Inventory-revised, as well as a number of other clinical and psychopathologic indices. RESULTS: In BN, the observed lifetime prevalence of ICD was 23.8%. Lifetime compulsive buying (17.6%) and intermittent explosive disorder (13.2%) were the most frequently reported ICD. Bulimia nervosa subtype was not significantly associated with lifetime ICD (P = .051) or with ICD subtype (P = .253). After using multinomial regression models, we observed that BN + ICD and PG showed the highest scores on novelty seeking (P < .0001). But BN + ICD women had the lowest scores on self-directedness (P < .03) and higher scores on general psychopathology (P < .01) and drug abuse (P < .01). CONCLUSIONS: Individuals with BN + lifetime ICD presented more extreme personality profiles, especially on novelty seeking and impulsivity, and general psychopathology than individuals with BN without ICD. On some personality traits, those BN + ICD more closely resembled individuals with PG than those with BN without ICD.