A Latent Class Analysis of DSM-III-R Pathological Gambling Criteria in Middle-Aged Men: Association with Psychiatric Disorders.

PURPOSE: : This study was designed to empirically derive latent classes based on PG criteria and to assess the association between nongambling psychiatric disorders and specific classes. METHODS: : A total of 8138 community-based middle-aged men were surveyed, and 2720 were assessed for Diagnostic Interview Schedule, Version 3, Revised (DIS-III-R) pathologic gambling (PG). Latent class analysis (LCA) was applied to Diagnostic and Statistical Manual Version 3, Revised (DSM-III-R) criteria to identify gambling classes. χ and logistic regression models evaluated the association between gambling classes and lifetime psychiatric disorders. RESULTS: : The final model included 4 classes: class 0 (ie, 5418 individuals who never gambled 25 or more times per year) and classes 1-3 (identified by the LCA and comprising 2720 respondents assessed for PG). For the 9 individual criteria of PG, endorsement percentages ranged from 2%-6%, 4%-58%, and 53%-100% for classes 1-3, respectively. Nongambling psychiatric disorders were differentially associated with the 4 gambling classes, and psychopathology was more common in groups more frequently acknowledging PG criteria. CONCLUSIONS: : Empirical support is provided for distinct classes of gambling behaviors demonstrating differential associations with individual PG criteria and nongambling psychiatric disorders. The data-driven categorization of gambling behaviors provides direction for research on defining, preventing, and treating syndromal and subsyndromal PG.

Lifetime and 12-month prevalence of psychiatric disorders in 8,169 male Vietnam War era veterans.

OBJECTIVE: This study reports the prevalence of psychiatric disorders among a nationally distributed sample of Vietnam Era veterans assessed using standardized psychiatric interviewing methods. METHODS: In 1992, the National Institute of Mental Health Diagnostic Interview Schedule was administered by telephone to 8,169 middle-aged males who served in the military during the Vietnam era (1965-1975). RESULTS: Approximately 72% of respondents reported a lifetime history and 36% reported a 12-month history of at least one psychiatric disorder. The most prevalent psychiatric disorders included alcohol abuse and/or dependence (54% lifetime, 17% 12 month), nicotine dependence (48% lifetime, 22% 12 month), and posttraumatic stress disorder (10% lifetime, 4.5% 12 month). CONCLUSIONS: Because of possible participation bias, these results likely represent conservative estimates of psychiatric disorder prevalences among the more than eight million Vietnam Era veterans and reinforces the major public health challenge of preventing, identifying, and treating psychiatric illness in American veterans.

A twin study of the neuropsychological consequences of stimulant abuse.

BACKGROUND: Previous studies document neuropsychological deficits associated with stimulant abuse, but findings are inconsistent. METHODS: We identified 50 twin pairs in which only 1 member had heavy stimulant abuse (cocaine and/or amphetamines) ending at least 1 year before the evaluation. The co-twin control research design controls for familial vulnerability and makes it easier to identify neuropsychological deficits that are consequences of stimulant abuse. Subjects were administered an extensive neuropsychological test battery organized into the following 5 functions: attention, executive functioning, motor skills, intelligence, and memory. RESULTS: Multivariate tests showed that abusers performed significantly worse than nonabusers on functions of attention and motor skills. Within each of these functions, univariate tests showed that abusers performed significantly worse on certain tests of motor skills and attention. In contrast, abusers performed significantly better on one test of attention measuring visual vigilance. Within the abuser group, higher levels of stimulant use were largely uncorrelated with neuropsychological test scores, although a few significant correlations indicated better functioning with more stimulant use. CONCLUSIONS: With ideal controls, this study demonstrates that deficits in attention and motor skills persist after 1 year of abstinence from stimulant use and raises hypotheses regarding relative strengths on a vigilance task among abusers.

Does marijuana use have residual adverse effects on self-reported health measures, socio-demographics and quality of life? A monozygotic co-twin control study in men.

AIMS: To assess the effects of former heavy marijuana use on selected aspects of health. DESIGN: A monozygotic co-twin control design was used to compare the health of former heavy marijuana using male monozygotic twins to that of their co-twins who never used marijuana significantly. SETTING: In-person survey and questionnaires. PARTICIPANTS: Fifty-six marijuana use discordant monozygotic twin pair members of the Vietnam Era Twin (VET) Registry. MEASUREMENTS: Current socio-demographic characteristics; current nicotine and alcohol use; life-time nicotine and alcohol abuse/dependence; past 5-year physical and mental health services utilization; and health-related quality of life. FINDINGS: The mean number of days on which the marijuana user twin used marijuana in his life-time was 1085, while the non-marijuana user used marijuana a maximum of 5 days. Marijuana was last used a mean of 20 years previously. No significant differences were found between the former marijuana user twins and their siblings for current socio-demographic characteristics; current nicotine or alcohol use; life-time nicotine or alcohol abuse/dependence; past 5-year out-patient or emergency room visits, hospitalizations or medication use for medical problems; past 5-year mental health out-patient use or hospitalizations; or health-related quality of life. CONCLUSIONS: Previous heavy marijuana use a mean of 20 years earlier by a group of men who reported no other significant illicit drug use does not appear to be associated with adverse socio-demographic, physical or mental health adverse effects. The conclusions of the study are limited by possible participation and recall biases, relatively small sample size and the absence of a physical health examination.

The usefulness of subtraction ictal SPECT coregistered to MRI in single- and dual-headed SPECT cameras in partial epilepsy.

PURPOSE: To prove the clinical usefulness of SISCOM and compare SISCOM images derived from single- and dual-headed single-photon computed tomography (SPECT) cameras for localization of partial epileptic seizures. METHODS: We retrospectively studied 38 partial epilepsy patients, using subtraction SPECT coregistered to magnetic resonance imaging (MRI; SISCOM). SPECT imaging of the first 15 patients was performed by single-headed camera, and the next 23 patients by dual-headed camera. Side-by-side ictal-interictal SPECT evaluation and SISCOM images were blindly reviewed and classified as either localizing to one of 16 sites or nonlocalizing. A third reviewer evaluated cases of disagreement between primary reviewers. Results were compared with seizure localization by any of the following three traditional techniques: surgical outcome, invasive, and noninvasive video-EEG monitoring. The results from the single- and dual-headed SPECT cameras were compared. RESULTS: Reviewers localized areas of hyperperfusion with SISCOM images more often than with side-by-side SPECT evaluation (71.0 vs. 47.4%; p = 0.01). When we compared results of SPECT evaluation with traditional techniques, SISCOM showed greater concordance than side-by-side SPECT evaluation (60.53 vs. 36.84%; p = 0.006). There were no differences in localization between images derived from single- and dual-headed cameras. Concordance of seizure localization, compared with traditional techniques, also was not different between these groups [kappa = 0.38, 95% confidence interval (CI), 0.18-0.58] vs. kappa = 0.63, 95% CI (0.45-0.81)]. CONCLUSIONS: SISCOM is a worthwhile technique for preoperative evaluation in partial epilepsy patients and improves the sensitivity and specificity of seizure localization of SPECT images derived from both single- and dual-headed SPECT cameras.