Discounting delayed monetary rewards and decision making in behavioral addictions - A comparison between patients with gambling disorder and internet gaming disorder.

Behavior addictions, such as Gambling Disorder and Internet Gaming Disorder, have been demonstrated to have severe negative impact. Heightened impulsivity, deficits in decision making, and cognitive biases in the preference of immediate rewards have been shown to be crucial aspects in addictive disorders. While for Gambling Disorder (GD), dysfunctional decision making has been documented before, data for Internet Gaming Disorder (IGD) are still underrepresented. In order to allow for a direct comparison of both disorders, we assessed different measures of impulsivity (trait, impulsive choice, and decision making) in a clinical sample. N = 31 patients meeting criteria for GD and n = 30 patients with IGD were recruited from an outpatient clinic and compared regarding their performance in a Delay Discounting Task (DDT), the Iowa Gambling Task (IGT), and self-report data on impulsivity (Barratt Impulsiveness Scale). Healthy controls (n = 27) were included as a reference group. In the DDT, the area under the curve was associated with the severity of GD only. No correlations were found for the impulsivity subscales and the area under the curve which, however, was similar between the two patient groups in contrast to controls. The GD-group performed poorer then the other groups in the IGT while IGD-patients performed poorer only at the beginning of the experiment. Although only few significant differences occurred, similarities between GD and IGD regarding the DDT point towards a tendency on discounting rewards faster. Likewise, both patient groups were performing worse in the IGT than healthy controls which indicates deficiencies in decision making. Interestingly, the IGD-group was able to shift towards more advantageous decision making, which might have important implications for therapeutic interventions.

Recovery, relapse, or else? Treatment outcomes in gambling disorder from a multicenter follow-up study.

PURPOSE: Gambling disorder is associated with various adverse effects. While data on the immediate effectiveness of treatment programs are available, follow-up studies examining long-term effects are scarce and factors contributing to a stable therapy outcome versus relapse are under-researched. MATERIALS AND METHODS: Patients (n=270) finishing inpatient treatment for gambling disorder regularly participated in a prospective multicenter follow-up study (pre-treatment, post-treatment, 12-month follow-up). Criteria for gambling disorder, psychopathology, functional impairment were defined as endpoints. Changes in personality were defined as an additional parameter. RESULTS: At follow-up, three groups were identified: subjects maintaining full abstinence (41.6%), patients still meeting criteria for gambling disorder (29.2%), and subjects still participating in gambling without meeting the diagnostic criteria for gambling disorder (29.2%). Every group had improvements in functional impairment, abstinent subjects showed the lowest psychopathology. Significant decreases in neuroticism and increases in both extraversion and conscientiousness were found among abstinent subjects but not in patients still meeting criteria for gambling disorder. DISCUSSION: One year after treatment, a considerable percentage of patients kept on gambling but not all of them were classified with gambling disorder leading to the question if abstinence is a necessary goal for every patient. CONCLUSIONS: The changes of personality in abstinent patients indicate that after surmounting gambling disorder a subsequent maturing of personality might be a protective factor against relapse.

The microstructure and micromechanics of the tendon-bone insertion.

The exceptional mechanical properties of the load-bearing connection of tendon to bone rely on an intricate interplay of its biomolecular composition, microstructure and micromechanics. Here we identify that the Achilles tendon-bone insertion is characterized by an interface region of ∼500 µm with a distinct fibre organization and biomolecular composition. Within this region, we identify a heterogeneous mechanical response by micromechanical testing coupled with multiscale confocal microscopy. This leads to localized strains that can be larger than the remotely applied strain. The subset of fibres that sustain the majority of loading in the interface area changes with the angle of force application. Proteomic analysis detects enrichment of 22 proteins in the interfacial region that are predominantly involved in cartilage and skeletal development as well as proteoglycan metabolism. The presented mechanisms mark a guideline for further biomimetic strategies to rationally design hard-soft interfaces.

Free-to-play: About addicted Whales, at risk Dolphins and healthy Minnows. Monetarization design and Internet Gaming Disorder.

INTRODUCTION: Video games are not only changing due to technical innovation, but also because of new game design and monetization approaches. Moreover, elite gamer groups with financial in-game-investments co-finance all users of free-to-play-games. Besides questions on youth protection, the growing popularity of free-to-play games has fostered discussions on supposed associations to Internet Gaming Disorder (IGD). METHOD: Children and adolescents using free-to-play browser games were examined in a German school-based representative study (N=3967; age range 12 to 18). Based on a clinical self-report AICA-S (Wölfling et al., 2011), students were categorized into non-problematic, risky, and addicted users. Psycho-social problems (SDQ; Goodman, 1997), perceived stress (PSS; Cohen, Kamarck & Mermelstein, 1983), coping strategies (BriefCOPE; Carver, 1997), and Average Revenue per (Paying) User (ARPU) were investigated as dependent variables. Furthermore, an industry classification (Freeloaders, Minnows, Dolphins, and Whales) for free-to-play gamers was used for additional relations regarding IGD, SDQ, PSS, BriefCOPE, and ARPU. RESULTS: Among free-to-play gamers the prevalence of IGD amounted to 5.2%. Subjects classified with IGD displayed higher psycho-social symptoms than non-problematic users, reported higher degrees of perceived stress, and applied dysfunctional coping strategies more frequently. Additionally, we found a higher ARPU among subjects with IGD. CONCLUSION: ARPU is significantly associated with IGD. Whales share significant characteristics with addicted video gamers; Dolphins might be classified as risky consumers; Minnows and Freeloaders are rather non-pathological gamers. Vulnerability for stress, dysfunctional coping, and free-to-play gaming represent an unhealthy combination.

Is Sensation Seeking a correlate of excessive behaviors and behavioral addictions? A detailed examination of patients with Gambling Disorder and Internet Addiction.

Sensation Seeking has repeatedly been related to substance use. Also, its role as a correlate of Gambling Disorder has been discussed although research has led to heterogeneous results. Likewise, first studies on Internet Addiction have indicated increased Sensation Seeking, to some extent contradicting clinical impression of patients suffering from internet addiction. We assessed Sensation Seeking in a clinical sample of n=251 patients with Gambling Disorder, n=243 patients with internet addiction, n=103 clients with excessive but not addictive internet use, and n=142 healthy controls. The clinical groups were further sub-divided according to the preferred type of addictive behavior (slot-machine gambling vs. high arousal gambling activities and internet gaming disorder vs. other internet-related addictive behaviors). Decreased scores in some subscales of Sensation Seeking were found among male patients compared to healthy controls with no differences between patients with Gambling Disorder and Internet Addiction. The type of preferred gambling or online activity was not related to differences in Sensation Seeking. Previous findings indicating only small associations between Sensation Seeking and Gambling Disorder were confirmed. Regarding Internet Addiction our results contradict findings from non-clinical samples. Sensation Seeking might be relevant in initiating contact to the health care system.

A single charge in the actin binding domain of fascin can independently tune the linear and non-linear response of an actin bundle network.

Actin binding proteins (ABPs) not only set the structure of actin filament assemblies but also mediate the frequency-dependent viscoelastic moduli of cross-linked and bundled actin networks. Point mutations in the actin binding domain of those ABPs can tune the association and dissociation dynamics of the actin/ABP bond and thus modulate the network mechanics both in the linear and non-linear response regime. We here demonstrate how the exchange of a single charged amino acid in the actin binding domain of the ABP fascin triggers such a modulation of the network rheology. Whereas the overall structure of the bundle networks is conserved, the transition point from strain-hardening to strain-weakening sensitively depends on the cross-linker off-rate and the applied shear rate. Our experimental results are consistent both with numerical simulations of a cross-linked bundle network and a theoretical description of the bundle network mechanics which is based on non-affine bending deformations and force-dependent cross-link dynamics.

Regular gaming behavior and internet gaming disorder in European adolescents: results from a cross-national representative survey of prevalence, predictors, and psychopathological correlates.

Excessive use of online computer games which leads to functional impairment and distress has recently been included as Internet Gaming Disorder (IGD) in Section III of the DSM-5. Although nosological classification of this phenomenon is still a matter of debate, it is argued that IGD might be described best as a non-substance-related addiction. Epidemiological surveys reveal that it affects up to 3% of adolescents and seems to be related to heightened psychosocial symptoms. However, there has been no study of prevalence of IGD on a multi-national level relying on a representative sample including standardized psychometric measures. The research project EU NET ADB was conducted to assess prevalence and psychopathological correlates of IGD in seven European countries based on a representative sample of 12,938 adolescents between 14 and 17 years. 1.6% of the adolescents meet full criteria for IGD, with further 5.1% being at risk for IGD by fulfilling up to four criteria. The prevalence rates are slightly varying across the participating countries. IGD is closely associated with psychopathological symptoms, especially concerning aggressive and rule-breaking behavior and social problems. This survey demonstrated that IGD is a frequently occurring phenomenon among European adolescents and is related to psychosocial problems. The need for youth-specific prevention and treatment programs becomes evident.

Treatment outcomes in patients with internet addiction: a clinical pilot study on the effects of a cognitive-behavioral therapy program.

Internet addiction is regarded as a growing health concern in many parts of the world with prevalence rates of 1-2% in Europe and up to 7% in some Asian countries. Clinical research has demonstrated that Internet addiction is accompanied with loss of interests, decreased psychosocial functioning, social retreat, and heightened psychosocial distress. Specialized treatment programs are needed to face this problem that has recently been added to the appendix of the DSM-5. While there are numerous studies assessing clinical characteristics of patients with Internet addiction, the knowledge about the effectiveness of treatment programs is limited. Although a recent meta-analysis indicates that those programs show effects, more clinical studies are needed here. To add knowledge, we conducted a pilot study on the effects of a standardized cognitive-behavioral therapy program for IA. 42 male adults meeting criteria for Internet addiction were enrolled. Their IA-status, psychopathological symptoms, and perceived self-efficacy expectancy were assessed before and after the treatment. The results show that 70.3% of the patients finished the therapy regularly. After treatment symptoms of IA had decreased significantly. Psychopathological symptoms were reduced as well as associated psychosocial problems. The results of this pilot study emphasize findings from the only meta-analysis conducted so far.

A contribution to the clinical characterization of Internet addiction in a sample of treatment seekers: validity of assessment, severity of psychopathology and type of co-morbidity.

OBJECTIVE: Internet addiction becomes a growing health problem worldwide with prevalence rates up to 3%. Still, uncertainties exist regarding its diagnostics and clinical characterization. Especially the lacking clinical evidence regarding self-report measures assessing Internet addiction has been criticized. METHODS: This study aimed to characterize 290 German treatment seekers and to determine the diagnostic accuracy of a self-report scale for Internet addiction. Patients filled in self-report measures (SCL-90R, PHQ, AICA-S - Scale for the Assessment of Internet and Computer game Addiction) and underwent diagnostic interviews to assess symptoms of Internet addiction and level of functioning. RESULTS: Of the predominantly male treatment seekers 71% met the clinical diagnosis of Internet addiction. These displayed higher levels of psychopathology, especially depressive and dissociative symptoms. Half of the patients met criteria for one further psychiatric disorder according to clinical interviews, especially depressive disorders. Their level of functioning was decreased in all domains. AICA-S showed good psychometric properties and satisfying diagnostic accuracy (sensitivity: 80.5%; specificity: 82.4%). DISCUSSION: In this sample, Internet addiction was associated with high levels of psychosocial distress that is mainly related to depressive symptoms. Co-morbid disorders were common among those patients. First analyses on diagnostic accuracy of AICA-S (using the therapist's rating on Internet addiction as an independent external criterion) showed promising results.

Investigating risk factors for Internet gaming disorder: a comparison of patients with addictive gaming, pathological gamblers and healthy controls regarding the big five personality traits.

Engaging in online games has become increasingly important as a part of leisure activity in adolescents and adults. While the majority of people use these games in a healthy way, epidemiological studies show that some develop excessive use and symptoms that are related to those of substance-related addictions. Despite increasing research concerning the epidemiology of internet gaming disorder (IGD), predisposing factors have been examined to a lesser extent. Knowing about specific risk factors would help clarify the nosological features of IGD and enhance prevention and intervention. This study aimed to evaluate the relationships between personality traits and IGD. A total of 115 patients meeting the criteria for IGD were compared to 167 control subjects displaying either regular or intense use of online games. Additionally, 115 patients meeting diagnostic criteria for pathological gambling were included. IGD was associated with higher neuroticism, decreased conscientiousness and low extraversion. The comparisons to pathological gamblers indicate that low conscientiousness and low extraversion in particular are characteristic of IGD. An integration of personality variables into an etiopathological model describing presumable mechanisms fostering and maintaining addictive online gaming is proposed. This model could be helpful for the theoretical understanding of addictive gaming, public health campaigns and psychoeducation within therapeutic settings.

Addressing the question of disorder-specific risk factors of internet addiction: a comparison of personality traits in patients with addictive behaviors and comorbid internet addiction.

Uncontrolled use of the internet has been reported to affect the lives of some users in a negative way. According to epidemiological studies, about 1% of the general population is showing signs of internet addiction. Since internet addiction is becoming a growing health concern, research on potential risk factors is becoming more important in order to develop strategies for prevention and to adopt therapeutic treatment. Although there are some studies investigating personality traits in internet addiction, most of these studies are based on samples of healthy subjects. In this research project, we compared personality profiles of a sample of patients in different rehabilitation centers. 70 patients with an addiction disorder that additionally met the criteria for internet addiction were compared to 48 patients suffering from alcohol dependence. Besides Big Five personality traits, we also assessed depressive symptoms. It was shown that patients with comorbid internet addiction can be discriminated from other patients by higher neuroticism and lower extraversion as well as lower conscientiousness. After controlling for depressive symptoms, lower conscientiousness especially turned out to be a disorder-specific risk factor. As internet addiction is related to unique patterns of personality traits and can be discriminated from alcohol dependence, treatment approaches are needed that meet the specific requirements of patients with internet addiction.

[Pathological gambling and computergame-addiction. Current state of research regarding two subtypes of behavioural addiction]. / Pathologisches Glücksspiel und Computerspielabhängigkeit. Wissenschaftlicher Kenntnisstand zu zwei Varianten substanzungebundener Abhängigkeitserkrankungen.

Behavioral addictions, like pathological gambling and computer game addiction (or internet addiction), have become a growing concern in research and public interest. Currently similarities between behavioral addictions and substance dependency are controversially discussed in the scientific community. Unfortunately a mismatch exists between the large number of people seeking treatment and the small number of scientific studies on pathological gambling and computer game addiction. Prevalence of pathological gambling among the German population is estimated to be 0.2-0.5%. These estimations are comparable to prevalence rates reported for drug dependency. Latest research states that about 3% of German adolescents and young adults are believed to suffer from computer game addiction. Therefore, it is important to enhance investigations regarding the clinical and neuroscientific basis of computer game addiction. This review offers a summary of current results of research regarding pathological gambling and internet addiction. The phenomenological description of these two disorders is meant to allow a deeper understanding of behavioral addictions.

[Application of the Isler and Ganz classification of pelvic ring fractures in clinical practice]. / Anwendbarkeit der Klassifikation der Beckenringfrakturen nach Isler und Ganz im klinischen Alltag.

The classification of pelvic fractures proposed by Isler and Ganz was applied to 152 patients. On the basis of this experience, the following conclusion were drawn. 1. It is possible to classify all pelvic ring injuries by dividing them in lesions of the anterior and of the posterior ring segment. 2. The classification requires a thorough examination; often a CT scan is needed. The original classification of 9 out of 18 patients based on X-ray morphology had to be revised after CT examination. 3. Once the pelvic injury is definitely classified the mode of therapy is determined as well.

Local muscular strain dependent on the direction of horizontal arm movements.

Manual material handling still plays an important role in assembly work as well as in the service industry. By means of an ergonomic layout of working places, the effects of disadvantageous working conditions, especially static load resulting from unfavourable postures of the body as well as unnecessary physiological cost arising from body movements may be avoided. In this context knowledge about the optimum directions of horizontal arm movements is fundamental. Therefore by means of advanced methods of multi-channel electromyography (EMG) and applying computer assisted evaluation methods, physiological responses to one-handed horizontal material handling in a sitting position were recorded. In order to obtain myoelectric signals from the most important task-relevant muscles out of more than 40 muscle groups of the hand-arm-shoulder-system, preceding research was done also aiming at standardized lead positions for surface EMG. Groups of five young females each participated in a series of successive experiments, in which the direction of movements of the left arm was varied. The subjects worked without and with an external load imposed by weights of 0, 1, 2 and 4 kg. The movements between 20 degrees and 230 degrees--measured from the frontal plane of the subjects--included working from ahead and from behind. The lifting distance was 38 cm starting from different outward points within the reach to a fixed point near the body. Also in one test series the handling frequency was varied between 12, 24 and 48 lifts per minute. Assessment of the physiological cost by electromyographic activities (EA), especially the determination of the most stressful and least expensive directions of repetitive horizontal movements, was more effective when differentiating static and dynamic portions of muscular strain than common means of EA.

A concept for detecting unexpected changes in the environment early.

A project was established under the auspices of the German Federal Ministry of Research and Technology with the task of developing a concept for the early recognition of signals for unexpected deleterious changes in the environment. Predictive assessments of products (e.g., chemicals) and technologies as regards their potential environmental impacts contain numerous sources of error and uncertainties. Therefore, appropriate observation systems are needed in order to detect unexpected developments in the environment and in human health. Long-term storage of samples (environmental specimen banking) is the third basic activity that must be undertaken within an early warning system. When monitoring the environment for unwanted changes, it is not sufficient to trace some individual agents, preselected for their well-known capacity to inflict harm. The following avenues of identifying symptoms of change in the environment were identified: development and deployment of "key indicators"; acquisition and correlative treatment of conventional monitoring data from different sources; and execution of concise studies in environmental problem areas. Key indicators are defined as scientific measurement and observation methods which respond to early stages of anthropogenically induced environmental changes and are capable of responding to a multitude of simultaneously present agents. A series of examples is discussed. Approaches concerning how the statistical evaluation of available sets of environment-related data could reveal unexpected developments are presented.

[Alterations of sleep stage pattern in human beings and hang-over effects under the influence of estazolam/2nd Comm.: Studies on the hang-over effect in psycho-physiological performance (author's transl)]. / Veränderungen der Schlafstadienmuster des Menschen und Hang-over-Effekte unter Estazolam. 2. Mitteilung: Untersuchungen zur Hang-over-Wirkung im psycho-physiologischen Leistungsbereich).

10 healthy male and female subjects spent 7 nights both with a quiet surrounding and defined noise of subsonic jet fly-overs in a sleep laboratory. During the last 4 nights they were medicated in a double-blind cross-over test design with the benzodiazepine 8-chloro-6-phenyl-4H-s-triazolo (4,3-a)-(1,4)benzodiazepine (estazolam, BAY k 4200) at a dosage of 2 mg and placebo. On each following morning they passed a tracking test and an apparative mental arithmetic calculation test in order to evaluate a potential hangover. Simultaneously heart rate was registered continuously. The results were as follows: About 10 h after medication significant hang-over effects of estazolam in psycho-physiological performance could still be seen. Statistically significant differences between the conditions with estazolam and placebo in the range of 5 to 15% were found. Hang-over is not restricted to tracking and mental performance but can also be seen in slightly lowered heart rate.

[Experimental study on the tracking behaviour with a view to differentiating the effects of an antidepressant in various doses compared to placebo (author's transl)]. / Experimentelle Untersuchungen des Regelleistungsverhaltens zur Wirkungsdifferenzierung eines Antidepressivums in verschiedener Dosierung im Vergleich zu Plazebo

In a double-blind cross-over study 15 highly motivated, healthy male subjects (Ss), aged from 23 to 29 years, were given 200 mg and 400 mg p-methoxy-phenoxyaceticacid-diethylaminoethylamide-hydrochloride (mefexamide) and a placebo. On each of the three days the Ss were tested in different tracking devices and the integrated absolute error was measured in the tests of a duration of three hours each. Influences of practice, leading to unwanted and disturbing effects were excluded by a preceding period of four training sessions on different days. The main result of the investigation was that performance in tracking was ambivalent. The single dosage (200 mg mefexamide) caused small improvements in tracking in the range of about 5%. These differences from placebo partly could be determined to be significant at the level of 5% compared to placebo. The double dosage (400 mg mefexamide) deteriorated tracking performance significantly (5%-and partly 1%-level, two-tailed test) in the range of about 10% on the average. Differences in performance between the two dosages were correspondingly larger and could be determined at a higher level of significance, too.