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Nancy M Petry - One of the best experts on this subject based on the ideXlab platform.
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towards a comprehensive developmental model of Pathological Gambling
2015Co-Authors: Carlos Blanco, Nancy M Petry, Joan W Hanania, Melanie M Wall, Shuai Wang, Chelsea J Jin, Kenneth S KendlerAbstract:Aims To develop a comprehensive etiological model of Pathological Gambling (PG) for men and women based on Kendler's development model for major depression, which groups 22 risk factors into five developmental tiers (childhood, early adolescence, late adolescence, adulthood, last year). We hypothesized that: (1) all risk factors would be associated significantly with PG; (2) the effect of risk factors in earlier developmental tiers would be accounted for by later tiers; and (3) there would be few gender differences. Design Separate models were built for life-time Gambling and for 12-month PG among those with life-time Gambling. Setting Data drawn from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) in the United States. Participants Respondents to NESARC wave 1 (n = 43 093). Measurements Odds ratios (OR) and adjusted OR (AOR) were used to determine the risk factors in multiple models. Findings After mutually adjusting for other risk factors, family history of substance use disorders (SUD) or depression, impulsivity, childhood-onset anxiety, number of Axis I and II disorders, history of SUD, nicotine dependence, social deviance in adulthood, and past-year history of SUD, nicotine dependence and independent stressful life events predicted life-time Gambling. Past history of PG, number of personality disorders and past year nicotine dependence were associated significantly with 12-month PG (all P < 0.05). There were no significant gender interactions for 12-month PG. Conclusions A modification of Kendler's model for major depression provides a foundation for the development of a comprehensive developmental model of Pathological Gambling. Life-time history of Gambling and 12-month Pathological Gambling appear to be determined by risk factors in several developmental levels, with the effect of earlier development tiers accounted for by later ones.
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An Overview of and Rationale for Changes Proposed for Pathological Gambling in DSM-5
2014Co-Authors: Nancy M Petry, Carlos Blanco, Deborah S Hasin, Bridget F Grant, Marc Auriacombe, Guilherme Borges, Kathleen Bucholz, Thomas J. Crowley, Charles O’brienAbstract:The fifth revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) is scheduled for publication in 2013. It will include several changes to the diagnosis of Pathological Gambling: the name of the disorder will be altered, the threshold for diagnosis will decrease, and one criterion will be removed. This paper reviews the rationale for these changes and addresses how they may impact diagnosis and treatment of the disorder, as well as potential for future research in the field.
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should the scope of addictive behaviors be broadened to include Pathological Gambling
2006Co-Authors: Nancy M PetryAbstract:Aims Pathological Gambling is currently considered an impulse control disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM). This paper considers the prospect of reclassifying and broadening the substance use disorders to include non-pharmacological addictions such as Pathological Gambling. Methods Literature reviews were conducted on areas relevant to Pathological Gambling and its classification and similarities to substance use disorders. Results The diagnostic criteria for Pathological Gambling are outlined across the three versions of the DSM since its initial introduction. The paper also describes instruments that have been used to assess the disorder, basic epidemiology and some biological and genetic data, especially in terms of potential overlap with substance use disorders. Similarities and differences with respect to treatments are reviewed as well. Conclusions Both advantages and disadvantages should be considered with respect to expanding the classification system to include Pathological Gambling within the context of addictive disorders.
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sex differences in subclinical and dsm iv Pathological Gambling results from the national epidemiologic survey on alcohol and related conditions
2006Co-Authors: Carlos Blanco, Nancy M Petry, Deborah S Hasin, Frederick S Stinson, Bridget F GrantAbstract:Background. To examine sex differences in DSM-IV subclinical and Pathological Gambling in nationally representative data of the US population. Method. Data come from a large (n=43 093) representative sample of the adult US population. Results. The lifetime prevalence rate of DSM-IV Pathological Gambling was 0·64% (95% CI 0·50-0·78) for men and 0·23 % (95% CI 0·17-0·29) for women, whereas the lifetime prevalence of subclinical Pathological Gambling was 6·79% (95% CI 6·32-7·26) for men and 3·26% (95% CI 2·93-3·59) for women. For subclinical Pathological Gambling, men were significantly (p<0·01) more likely than women to have smoked more than two packs of cigarettes a day, to be classified as heavy drinkers and to have lifetime diagnoses of alcohol and drug use disorders. Women with subclinical and Pathological Gambling were significantly more likely than men to have lifetime mood and anxiety disorders. With respect to Pathological Gambling, women had later ages of onset of the disorder, and were significantly more likely than men to report Gambling to relieve depressed mood and to prefer casino Gambling. Rates of treatment-seeking for DSM-IV Pathological Gambling were low for both men and women. Conclusions. There are important sex differences in the prevalence, symptom pattern, sociodemographic and clinical correlates and course of DSM-IV subclinical and Pathological Gambling. Results underscore the need to investigate sex differences in the social determinants, neurobiology and treatment response of DSM-IV subclinical and Pathological Gambling.
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comorbidity of dsm iv Pathological Gambling and other psychiatric disorders results from the national epidemiologic survey on alcohol and related conditions
2005Co-Authors: Nancy M Petry, Frederick S Stinson, Bridget F GrantAbstract:OBJECTIVE: To present nationally representative data on lifetime prevalence and comorbidity of Pathological Gambling with other psychiatric disorders and to evaluate sex differences in the strength of the comorbid associations. METHOD: Data were derived from a large national sample of the United States. Some 43,093 household and group quarters residents age 18 years and older participated in the 2001-2002 survey. Prevalence and associations of lifetime Pathological Gambling and other lifetime psychiatric disorders are presented. The diagnostic interview was the National Institute on Alcohol Abuse and Alcoholism Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-IV Version. Fifteen symptom items operationalized the 10 Pathological Gambling criteria. RESULTS: The lifetime prevalence rate of Pathological Gambling was 0.42%. Almost three quarters (73.2%) of Pathological gamblers had an alcohol use disorder, 38.1% had a drug use disorder, 60.4% had nicotine dependence, 49.6% had a mood disorder, 41.3% had an anxiety disorder, and 60.8% had a personality disorder. A large majority of the associations between Pathological Gambling and substance use, mood, anxiety, and personality disorders were overwhelmingly positive and significant (p .05). CONCLUSION: Pathological Gambling is highly comorbid with substance use, mood, anxiety, and personality disorders, suggesting that treatment for one condition should involve assessment and possible concomitant treatment for comorbid conditions.
Jon E Grant - One of the best experts on this subject based on the ideXlab platform.
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pharmacological treatments in Pathological Gambling
2014Co-Authors: Jon E Grant, Brian L Odlaug, Liana R N SchreiberAbstract:Pathological Gambling (PG) is a relatively common and often disabling psychiatric condition characterized by intrusive urges to engage in deleterious Gambling behaviour. Although common and financially devastating to individuals and families, there currently exist no formally approved pharmacotherapeutic interventions for this disorder. This review seeks to examine the history of medication treatments for PG. A systematic review of the 18 double-blind, placebo-controlled pharmacotherapy studies conducted for the treatment of Pathological Gambling was conducted. Study outcome and the mean dose of medication administered was documented in an effort to determine a preferred medication choice in this population. A variety of medication classes have been examined in the treatment of PG with varying results. Antidepressants, atypical antipsychotics and mood stabilizers have demonstrated mixed results in controlled clinical trials. Although limited information is available, opioid antagonists and glutamatergic agents have demonstrated efficacious outcomes, especially for individuals with PG suffering from intense urges to engage in the behaviour. Given that several studies have demonstrated their efficacy in treating the symptoms associated with PG, opioid antagonists should be considered the first line treatment for PG at this time. Most published studies, however, have employed relatively small sample sizes, are of limited duration and involve possibly non-representative clinical groups (e.g. those without co-occurring psychiatric disorders). Response measures have varied across studies. Heterogeneity of PG treatment samples may also complicate identification of effective treatments. Identification of factors related to treatment response will help inform future studies and advance treatment strategies for PG.
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nalmefene in the treatment of Pathological Gambling multicentre double blind placebo controlled study
2010Co-Authors: Jon E Grant, Marc N Potenza, Eric Hollander, Brian L Odlaug, Suck Won KimAbstract:Pathological Gambling is a disabling disorder experienced by about 1% of adults. We randomised 233 participants (41.6% women) 1:1:1 to nalmefene (20 or 40 mg) or placebo. In analyses performed using an intention-to-treat (ITT) population, nalmefene failed to show statistically significant differences from placebo on primary and secondary outcomes. Post hoc analyses of only participants who received a full titration of the medication for at least 1 week demonstrated that nalmefene 40 mg/day resulted in significantly greater reductions on the primary outcome measure. These findings suggest that medication dosing may be an important consideration in achieving symptom control.
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a pilot study of impulsivity and compulsivity in Pathological Gambling
2009Co-Authors: Carlos Blanco, Marc N Potenza, Ángela Ibáñez, Suck Won Kim, Jeronimo Saizruiz, Rocco Zaninelli, Jon E GrantAbstract:We examined the relationship between Gambling severity, impulsivity and obsessionality/compulsivity in 38 Pathological gamblers, representing the complete Minnesota sample of a randomized, placebo-controlled clinical trial of paroxetine for the treatment of Pathological Gambling (PG), using Pearson correlations and linear regression models at baseline and treatment endpoint. At baseline, Pathological Gambling Modification of the Yale-Brown Obsessive-Compulsive Scale (PG-YBOCS) scores correlated significantly with those of the Eysenck Impulsiveness Questionnaire (EIQ) Impulsiveness subscale and Padua Inventory (PI) factors I and IV (corresponding to impaired control over mental and motor activities, respectively). None of the associations between PI factors and the PG-YBOCS were significant after adjusting for Impulsiveness scores. There were no differences in changes in the PG-YBOCS between the paroxetine and placebo group. Changes in PG-YBOCS scores after treatment correlated with changes in Impulsiveness scores. These changes appeared independent of paroxetine treatment. The results suggest that, although PG exhibits features of both obsessionality/compulsivity and impulsivity and elements of both decrease with treatment, impulsivity predominates and changes in Gambling severity are most associated with changes in impulsivity.
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n acetyl cysteine a glutamate modulating agent in the treatment of Pathological Gambling a pilot study
2007Co-Authors: Jon E Grant, Suck Won Kim, Brian L OdlaugAbstract:Background Although Pathological Gambling (PG) is relatively common, pharmacotherapy research for PG is limited. N-acetyl cysteine (NAC), an amino acid, seems to restore extracellular glutamate concentration in the nucleus accumbens and therefore offers promise in reducing addictive behavior. Methods Twenty-seven subjects (12 women) with DSM-IV PG were treated in an 8-week open-label trial of NAC with responders (defined as a ≥ 30% reduction in Yale Brown Obsessive Compulsive Scale Modified for Pathological Gambling [PG-YBOCS] total score at end point) randomized to 6 weeks of double-blind NAC or placebo. Results The PG-YBOCS scores decreased from a mean of 20.3 ± 4.1 at baseline to 11.8 ± 9.8 at the end of the open-label phase ( p Conclusions The efficacy of NAC lends support to the hypothesis that pharmacological manipulation of the glutamate system might target core symptoms of reward-seeking addictive behaviors such as Gambling. Larger, longer, placebo-controlled double-blind studies are warranted.
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Pathological Gambling and mood disorders clinical associations and treatment implications
2006Co-Authors: Suck Won Kim, Jon E Grant, Elke D Eckert, Patricia L Faris, Boyd K HartmanAbstract:Abstract Background The rapidly expanding Gambling business has resulted in an increasing number of gamblers, and the problem is likely to get worse in the future. Traditionally, mood and Gambling symptoms have been known to overlap. In the present review we attempt to examine the diagnostic associations and implications for treatment. Method Selected published papers on the frequencies of mood disorders among patients who have Gambling disorder or Gambling disorder among patients who have mood disorder have been reviewed. Recently emerging new treatment methods for Gambling disorder have been reviewed and a brief summary has been added. Results SCID based study results show a close link between Gambling and mood disorders. The prevalence of manic disorder reaches to approximately one fourth of the Pathological Gambling disorder population. The prevalence of depression is much higher, reaching to over half of the population in some studies. Limitations The studies included in the present paper involve inpatients, outpatients, subjects recruited through advertisements and prison populations. Thus the data need to be interpreted as such. Standardized assessment instruments are not used in all studies. Methodological issues such as primary or secondary nature of depression have not been addressed adequately in these studies. The findings, however, offer new insights for the assessment and treatment of complicated Gambling disorder cases. Conclusions A high prevalence rate of manic and depressive disorders has been recorded among Pathological Gambling disorder patients. A rational treatment approach to each defined subset of complicated Gambling disorder is discussed.
Henry R Lesieur - One of the best experts on this subject based on the ideXlab platform.
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costs and treatment of Pathological Gambling
1998Co-Authors: Henry R LesieurAbstract:The nature and social costs of Pathological Gambling are reviewed. Costs of Gambling in terms of indebtedness for the gambler, costs for family members, costs for the workplace, illegal activities, and physical and psychological costs are examined. The interaction of Pathological Gambling with other disorders, including substance abuse, anxiety, and depression, are noted. Methods of screening Pathological gamblers are summarized. Different treatment approaches and their effectiveness are reviewed, including Gamblers Anonymous and Gam-Anon, psychodynamic treatment, behavioral and cognitive approaches, and treatment based on an addiction model. Treatment for spouses is discussed. Gambling expenditure data are then examined to determine what portion of total expenditures is accounted for by problem gamblers.
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a study of the dopamine d2 receptor gene in Pathological Gambling
1996Co-Authors: David E Comings, Henry R Lesieur, D Muhleman, George Dietz, Richard J Rosenthal, Loreen J Rugle, Connie Chiu, R GadeAbstract:Pathological Gambling has been termed both the 'pure' and the 'hidden' addiction. 'Pure' because it is not associated with the intake of any addicting substance, and 'hidden' because it is an extension of a common, socially accepted behaviour. The Taq A1 variant of the human DRD2 gene has been associated with drug addiction, some forms of severe alcoholism, and other impulsive, addictive behaviours. We have sought to determine if there is a similar association with Pathological Gambling. A total of 222 non-Hispanic Caucasian Pathological gamblers from multiple sites across the US participated in the study. Of these 171 donated a sample of blood, 127 filled out several questionnaires, and 102 did both. Of the 171 Pathological gamblers 50.9% carried the D2A1 allele versus 25.9% of the 714 known non-Hispanic Caucasian controls screened to exclude drug and alcohol abuse, p < 0.00000001, odds ratio (OR) = 2.96. For the 102 gamblers who filled out the questionnaires, 63.8% of those in the upper half of the Pathological Gambling Score (more severe) carried the D2A1 allele (OR versus controls = 5.03), compared to 40.9% in the lower half (less severe). Of those who had no comorbid substance abuse, 44.1% carried the D2A1 allele, compared to 60.5% of those who had comorbid substance abuse. Forty-eight controls and 102 gamblers completed a shorter version of the Pathological Gambling Score. Of the 45 controls with a score of zero, 17.8% carried the D2A1 allele. Of the 99 gamblers with a score of 5 or more, 52.5% carried the D2A1 allele (chi 2 = 15.36, p = 0.00009). These results suggest that genetic variants at the DRD2 gene play a role in Pathological Gambling, and support the concept that variants of this gene are a risk factor for impulsive and addictive behaviours.
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Pathological Gambling eating disorders and the psychoactive substance use disorders
1993Co-Authors: Henry R Lesieur, Sheila B BlumeAbstract:Both Pathological Gambling disease and eating disorders have been conceptualized as addictive diseases, comparable to alcoholism and other drug dependencies. This paper briefly reviews both Pathological Gambling and the eating disorders, stressing their epidemiology and their overlap with psychoactive substance use and other psychiatric disorders. Common factors in the natural history and treatment of these disorders are also discussed.
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Pathological Gambling eating disorders and the psychoactive substance use disorders
1993Co-Authors: Henry R Lesieur, Sheila B BlumeAbstract:Both Pathological Gambling and the eating disorders have been conceptualized as addictive diseases, comparable to alcoholism and other drug dependencies. This paper briefly reviews both Pathological Gambling and the eating disorders, stressing their epidemiology and their overlap with psychoactive substance use and other psychiatric disorders. Common factors in the natural history and treatment of these disorders are also discussed.
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Pathological Gambling: A review of the literature (prepared for the American Psychiatric Association task force on DSM-IV committee on disorders of impulse control not elsewhere classified)
1991Co-Authors: Henry R Lesieur, Richard J RosenthalAbstract:This is a review of the literature on Pathological Gambling prepared for the work group on disorders of impulse control, not elsewhere classified of the American Psychiatric Association. It introduces the new DSM-IV criteria as well as outlines the phases of the career of the Pathological gambler. Research discussed includes that on Pathological Gambling and psychiatric disorders, substance abuse, family issues, children, finances, and crime. Psychoanalytic, personality, behavioral, sociological, psychologically based addiction theories, and physiological research are also summarized. Finally, treatment outcome studies are outlined.
Randy D Stinchfield - One of the best experts on this subject based on the ideXlab platform.
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age of onset in Pathological Gambling clinical therapeutic and personality correlates
2010Co-Authors: Susana Jimenezmurcia, Eva Alvarezmoya, Randy D Stinchfield, Fernando Fernandezaranda, Roser Granero, Neus Aymami, Monica Gomezpena, Nuria JaurrietaAbstract: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.
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DSM-IV diagnostic criteria for Pathological Gambling: reliability, validity, and classification accuracy.
2005Co-Authors: Randy D Stinchfield, Richard Govoni, G. Ron FrischAbstract:The purpose of this study was to examine the reliability, validity, and classification accuracy of the DSM-IV diagnostic criteria for Pathological Gambling. Given the lack of a laboratory test to diagnose Pathological Gambling, two groups were recruited in order to test DSM-IV diagnostic classification accuracy, one which likely had the disorder and the other which likely did not have the disorder (121 men and women clients at a Gambling treatment facility) (138 men and women selected at random from the Windsor, Ontario, community who had gambled in the past twelve months). The Gambling Behavior Interview was administered to both groups. The Gambling Behavior Interview was administered to both groups. The Gambling Behavior Interview includes items that measure the ten DSM-IV diagnostic criteria for Pathological Gambling as well as other Gambling problem severity measures and scales that served as tests of convergent validity. The ten DSM-IV diagnostic criteria were found to exhibit satisfactory reliability, validity, and classification accuracy; however, lowering the cut score to four and using item weights yielded improved classification accuracy over the standard cut score of five. Some diagnostic criteria were found to have greater discriminatory power than other criteria. The results of this study suggest that the classification accuracy of DSM-IV diagnostic criteria can be improved upon with a lower cut score or using weighted criteria.
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reliability validity and classification accuracy of a measure of dsm iv diagnostic criteria for Pathological Gambling
2003Co-Authors: Randy D StinchfieldAbstract:OBJECTIVE: The purpose of this study was to measure the reliability, validity, and classification accuracy of the DSM-IV diagnostic criteria for Pathological Gambling. METHOD: Participants in this study were drawn from two sources: 803 men and women from the general adult population of Minnesota and 259 men and women who were admitted to a Gambling treatment program. A 19-item measure of the DSM-IV diagnostic criteria for Pathological Gambling was administered, along with other validity measures. RESULTS: The DSM-IV diagnostic criteria were found to be reliable and valid. With a standard cutoff score of 5, DSM-IV criteria yielded satisfactory classification accuracy results; however, a cutoff score of 4 made modest improvements in classification accuracy and, most important, reduced the rate of false negatives. CONCLUSIONS: The DSM-IV diagnostic criteria for Pathological Gambling, when operationalized into questions, demonstrated satisfactory reliability, validity, and classification accuracy, and a cutof...
Carlos Blanco - One of the best experts on this subject based on the ideXlab platform.
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towards a comprehensive developmental model of Pathological Gambling
2015Co-Authors: Carlos Blanco, Nancy M Petry, Joan W Hanania, Melanie M Wall, Shuai Wang, Chelsea J Jin, Kenneth S KendlerAbstract:Aims To develop a comprehensive etiological model of Pathological Gambling (PG) for men and women based on Kendler's development model for major depression, which groups 22 risk factors into five developmental tiers (childhood, early adolescence, late adolescence, adulthood, last year). We hypothesized that: (1) all risk factors would be associated significantly with PG; (2) the effect of risk factors in earlier developmental tiers would be accounted for by later tiers; and (3) there would be few gender differences. Design Separate models were built for life-time Gambling and for 12-month PG among those with life-time Gambling. Setting Data drawn from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) in the United States. Participants Respondents to NESARC wave 1 (n = 43 093). Measurements Odds ratios (OR) and adjusted OR (AOR) were used to determine the risk factors in multiple models. Findings After mutually adjusting for other risk factors, family history of substance use disorders (SUD) or depression, impulsivity, childhood-onset anxiety, number of Axis I and II disorders, history of SUD, nicotine dependence, social deviance in adulthood, and past-year history of SUD, nicotine dependence and independent stressful life events predicted life-time Gambling. Past history of PG, number of personality disorders and past year nicotine dependence were associated significantly with 12-month PG (all P < 0.05). There were no significant gender interactions for 12-month PG. Conclusions A modification of Kendler's model for major depression provides a foundation for the development of a comprehensive developmental model of Pathological Gambling. Life-time history of Gambling and 12-month Pathological Gambling appear to be determined by risk factors in several developmental levels, with the effect of earlier development tiers accounted for by later ones.
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An Overview of and Rationale for Changes Proposed for Pathological Gambling in DSM-5
2014Co-Authors: Nancy M Petry, Carlos Blanco, Deborah S Hasin, Bridget F Grant, Marc Auriacombe, Guilherme Borges, Kathleen Bucholz, Thomas J. Crowley, Charles O’brienAbstract:The fifth revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) is scheduled for publication in 2013. It will include several changes to the diagnosis of Pathological Gambling: the name of the disorder will be altered, the threshold for diagnosis will decrease, and one criterion will be removed. This paper reviews the rationale for these changes and addresses how they may impact diagnosis and treatment of the disorder, as well as potential for future research in the field.
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a pilot study of impulsivity and compulsivity in Pathological Gambling
2009Co-Authors: Carlos Blanco, Marc N Potenza, Ángela Ibáñez, Suck Won Kim, Jeronimo Saizruiz, Rocco Zaninelli, Jon E GrantAbstract:We examined the relationship between Gambling severity, impulsivity and obsessionality/compulsivity in 38 Pathological gamblers, representing the complete Minnesota sample of a randomized, placebo-controlled clinical trial of paroxetine for the treatment of Pathological Gambling (PG), using Pearson correlations and linear regression models at baseline and treatment endpoint. At baseline, Pathological Gambling Modification of the Yale-Brown Obsessive-Compulsive Scale (PG-YBOCS) scores correlated significantly with those of the Eysenck Impulsiveness Questionnaire (EIQ) Impulsiveness subscale and Padua Inventory (PI) factors I and IV (corresponding to impaired control over mental and motor activities, respectively). None of the associations between PI factors and the PG-YBOCS were significant after adjusting for Impulsiveness scores. There were no differences in changes in the PG-YBOCS between the paroxetine and placebo group. Changes in PG-YBOCS scores after treatment correlated with changes in Impulsiveness scores. These changes appeared independent of paroxetine treatment. The results suggest that, although PG exhibits features of both obsessionality/compulsivity and impulsivity and elements of both decrease with treatment, impulsivity predominates and changes in Gambling severity are most associated with changes in impulsivity.
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sex differences in subclinical and dsm iv Pathological Gambling results from the national epidemiologic survey on alcohol and related conditions
2006Co-Authors: Carlos Blanco, Nancy M Petry, Deborah S Hasin, Frederick S Stinson, Bridget F GrantAbstract:Background. To examine sex differences in DSM-IV subclinical and Pathological Gambling in nationally representative data of the US population. Method. Data come from a large (n=43 093) representative sample of the adult US population. Results. The lifetime prevalence rate of DSM-IV Pathological Gambling was 0·64% (95% CI 0·50-0·78) for men and 0·23 % (95% CI 0·17-0·29) for women, whereas the lifetime prevalence of subclinical Pathological Gambling was 6·79% (95% CI 6·32-7·26) for men and 3·26% (95% CI 2·93-3·59) for women. For subclinical Pathological Gambling, men were significantly (p<0·01) more likely than women to have smoked more than two packs of cigarettes a day, to be classified as heavy drinkers and to have lifetime diagnoses of alcohol and drug use disorders. Women with subclinical and Pathological Gambling were significantly more likely than men to have lifetime mood and anxiety disorders. With respect to Pathological Gambling, women had later ages of onset of the disorder, and were significantly more likely than men to report Gambling to relieve depressed mood and to prefer casino Gambling. Rates of treatment-seeking for DSM-IV Pathological Gambling were low for both men and women. Conclusions. There are important sex differences in the prevalence, symptom pattern, sociodemographic and clinical correlates and course of DSM-IV subclinical and Pathological Gambling. Results underscore the need to investigate sex differences in the social determinants, neurobiology and treatment response of DSM-IV subclinical and Pathological Gambling.
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sertraline treatment of Pathological Gambling a pilot study
2005Co-Authors: Jeronimo Saizruiz, Carlos Blanco, Ángela Ibáñez, Xavier Masramon, Margarita M Gomez, Maria Madrigal, T DiezAbstract:Objective: Several open-label and double-blind studies have suggested that selective serotonin reuptake inhibitors may be useful in the treatment of Pathological Gambling. The purpose of this study was to evaluate the efficacy of sertraline in the treatment of Pathological Gambling. Method: Sixty patients meeting the DSM-IV criteria for Pathological Gambling were treated for 6 months in a double-blind, flexible-dose, placebo-controlled study of sertraline 50 to 150 mg/day. Data were collected from November 1998 to January 2001. The primary outcome measure assessing change in clinical status was the responder rate with respect to the Criteria for Control of Pathological Gambling Questionnaire (CCPGQ). Secondary measures included the Clinical Global Impressions scale (CGI) (Severity of Illness and Improvement subscales), and Visual Analogue Scales assessing Gambling frequency, severity, amount, and improvement. Concomitant medication and psychotherapy were not allowed during the study. Results: At the end of the study, 23 sertraline-treated subjects (74%) and 21 placebo-treated subjects (72%) were considered as responders on the CCPGQ (p = .9). Similar results were obtained when the CGI-Improvement scale limited to symptoms of Pathological Gambling was used as an outcome measure. Sertraline was well tolerated throughout the study. Conclusion: Sertraline was not statistically significantly superior to placebo in the overall sample. The power of the study was limited by the high placebo-response rate and the small sample size.
