Gambling Disorder and Increased Psychiatric Comorbidity: A Finnish Register-Based Study.

Non-substance addictive behaviors in the context of DSM-5

BackgroundComorbidity has been the focus of a substantial body of research and it is acknowledged that different mental disorders tend to co-occur more frequently than expected. Many studies of mental disorder comorbidity have been published in recent decades, but these studies tend to be restricted to subsets of disorders, and are difficult to combine based on different methodologies. There is a need to examine comorbidity within mental disorders in a manner that covers a comprehensive range of mental disorders. The aim of this study was to use high-quality registers to (a) provide bidirectional pairwise estimates between the major groups of mental disorders, (b) investigate if associations changed depending on time since first diagnosis, (c) explore sex-specific patterns of comorbidity, and (d) estimate absolute risks rather than only incidence rate ratios of developing certain disorders after being diagnosed with one specific disorder. This abstract focus on results based on schizophrenia.MethodsWe designed a population-based cohort study including all Danish residents between 2000 and 2016 (N = 5,940,778). Information on incident cases of mental diseases was obtained from the Danish Psychiatric Research Register, and we classified different disorders into 10 main groups: organic mental disorders (ICD10 F00-F09), substance abuse disorders (F10-F19), schizophrenia spectrum disorders (F20-F29), mood disorders (F30-F39), neurotic disorders (F40-F48), eating disorders (F50), personality disorders (F60), mental retardation (F70-F79), pervasive developmental disorders (F84) and behavioural and emotional disorders (F90-F98). We examined associations between all pairs of mental disorders. Hazard ratios (HR) were estimated using Cox Proportional Hazards models with age as time scale, and adjusting for sex, calendar time and other psychiatric comorbidity. Finally, we estimated the absolute risk of being diagnosed with other mental disorders after being diagnosed with a specific disorder.ResultsAll mental disorders were associated between them, with HR ranging from 1.1 to 19.5. There were 21,909 men and 20,106 women who were diagnosed with schizophrenia spectrum disorder (SSD) for the first time between 2000 and 2016. After onset of SSD, the rate of being diagnosed with substance abuse disorders was more than 4 times higher, compared to those without SSD (HR=4.4 [95%CI: 4.3–4.5]); the difference was larger within the first 6 months after being diagnosed with SSD (HR=31.8 [95%CI: 30.5–33.1]), although the rates remained higher even 15 years after the diagnosis (HR=3.2 [95%CI: 3.0–3.4]). Within the first 10 years after diagnosis of SSD, 23.8% [95%CI: 23.1–24.5] of men and 10.6% [95%CI: 10.2–11.1] of women were diagnosed for the first time with substance abuse disorders. Regarding mood disorders, the incidence rate was almost 3 times higher on individuals previously diagnosed with SSD than undiagnosed (HR=2.7 [95%CI: 2.6–2.7]). Analogous time-trends were observed, with larger differences within the first 6 months after diagnosis (HR=18.8 [95%CI: 18.1–19.6]), which diminished but remained higher 15 years later (HR=2.3 [95%CI: 2.2–2.4]). A total of 15.1% [95%CI: 14.5–15.6] of men and 20.8% [95%CI: 20.2–21.5] of women with a diagnosis of SSD were diagnosed with mood disorders within 10 years.DiscussionIn this population-based comprehensive study, we observed that comorbidity is pervasive and usually bidirectional. We observed that after being diagnosed with a specific disorder, the risk of being diagnosed with an additional disorder is particularly higher in the first 6 months, but even after 15 years the risk is higher compared to undiagnosed individuals.

This is the first nation-wide register study based on a total population sample measuring the gender-specific incidences of chronic diseases and conditions among adults diagnosed with gambling disorder (GD). The study used aggregated data for 2011-22 retrieved from the Register of Primary Health Care visits, Care Register for Health Care and Care Register for Social Welfare, including specialized outpatient and inpatient health care, inpatient social care and institutional care and housing services with 24-hour or part-time assistance, set in mainland Finland. Participants comprised people aged 18-90+ years with GD diagnosis [corresponding to pathological gambling, International Classification of Diseases 10th revision (ICD-10) code F63.0, n = 3605; men n = 2574, women n = 1031]and the general population (n = 4 374 192). Incidences of somatic diseases and psychiatric disorders were calculated for the people with diagnosed GD and for the general population, separately for women and men. After standardizing for age, the incidence of each diagnostic group was systematically higher for people with GD compared with the general population, except for cancer. The highest standardized incidence ratio (SIR) values were for psychiatric disorders [SIR = 234.2; 95% confidence interval (CI) = 226.1-242.4], memory disorders (SIR = 172.1; 95% CI = 119.1-234.8), nervous system diseases (SIR = 162.8; 95% CI = 152.8-173.1), chronic respiratory diseases (SIR = 150.6; 95% CI = 137.6-164.2), diabetes (SIR = 141.4; 95% CI = 127.9-155.5) and digestive diseases (SIR = 134.5; 95% CI = 127.1-142.2). In Finland, the incidence of chronic diseases and conditions among people with gambling disorder is higher compared with the general population, apart from cancer.

Relatively little is known about the temporal relation between at-risk gambling or problem gambling (PG) and mental and substance use disorders (SUDs) in young adulthood. Our study aimed to examine whether past-year, at-risk, or PG is associated with incident mental disorders and SUDs (that is, depression, generalized anxiety disorder, obsessive-compulsive disorder [OCD], or alcohol dependence) and illegal drug use, and whether past-year mental disorders and SUDs and illegal drug use is associated with incident at-risk or PG. Data for this longitudinal study were drawn from the Manitoba Longitudinal Study of Young Adults (MLSYA). Respondents aged 18 to 20 years in 2007 were followed prospectively for 5 years. In cross-sectional analyses, at-risk or PG was associated with increased odds of depression, OCD, alcohol dependence, and illegal drug use. In longitudinal analysis at-risk or PG at cycle 1 was associated with incident major depressive disorder, alcohol dependence, and illegal drug use in the follow-up period. Only illegal drug use at cycle 1 was associated with incident at-risk or PG during follow-up. At-risk or PG was associated with more new onset mental disorders and SUDs (depression, alcohol dependence, and illegal drug use), compared with the reverse (illegal drug use was the only association with new onset at-risk or PG). Preventing at-risk or PG from developing early in adulthood may correspond with decreases in new onset mental disorders and SUDs later in adulthood.

Pathological Gambling: A Clinical Guide to Treatment

Online gambling and suicide: Gambling with lives

Poster Abstracts from the AAAP 20th Annual Meeting and Symposium

Background. The extent to which excessive engagement in non-substance-related behaviors may constitute addictions has been debated. The recent classification of gambling disorder together with substance-use disorders in DSM-5 was based on similarities between the disorders and lends additional credence to the concept of non-substance or behavioral addictions. Methods. Data will be presented from studies into the biological underpinnings of substance-use and non-substance-use disorders involving excessive patterns of gambling, eating, Internet use, sex and other behaviors. Data from randomized clinical trials will be presented. Results. Gambling disorder is arguably the best studied of the behavioral addictions to date. Data indicate multiple similarities, as well as differences, between gambling disorder and substance-use disorders. Considerable debate exists as to whether obesity of other eating-related disorders might be best considered within an addiction framework, with data suggesting particular similarities between gambling, substance-use and binge-eating disorders. Although less data exist for excessive engagement in other behaviors (Internet use, sex), emerging data suggest similarities with substance-use disorders. Given biological similarities, a question arises as to whether behavioral and pharmacological treatments efficacious in the treatment of substance addictions might prove helpful in the treatment of behavioral addictions, with data providing support for cognitive-behavioral therapies and opioidergic and glutamatergic agents. Conclusions. An improved understanding of the biological factors underlying behavioral addictions is developing, and this understanding should lead to the greater availability of validated therapies.

In the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), gambling disorder was recategorized from the “Impulse Control Disorder” section to the newly expanded “Substance-related and Addictive Disorders” section. With this move, gambling disorder has become the first recognized nonsubstance behavioral addiction, implying many shared features between gambling disorder and substance use disorders. This review examines these similarities, as well as differences, between gambling and substance-related disorders. Diagnostic criteria, comorbidity, genetic and physiological underpinnings, and treatment approaches are discussed.

It might be hard to imagine that a leisure activity could turn to suffering and mental disorder in need of treatment. Nevertheless, emergent behavioral addictions (BAs) such as gambling disorder (GD) and Internet use disorders (e.g., Internet gaming disorder [IGD) have become common treatment-seeking motives in dedicated facilities and a flourishing field for research. These recent entities and their similarities to substance use disorders (SUDs) have raised debate in the scientific community and among clinicians. A major resulting revolution is that the addictive spectrum has recently been enlarged to include addictions that do not require the intake of a psychoactive substance. This inclusion has sparked debate on addiction determinism and whether neurobiological processes could be involved in repetitive exposure to a substance, as well as in cognitions and behaviors. A core clinical addiction syndrome can be extracted by comparing recent diagnostic criteria for SUDs in the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5; American Psychiatric Association [APA], 2013) with those for the two considered BAs: GD and IGD. Clinical, psychological, and neurobiological differences and similarities between BAs and SUDs are reviewed and discussed in the present work. Critical links are made between these scientific findings and recent DSM-5 criteria. A full picture of the magnitude of BAs remains imprecise because of several methodological limitations, a lack of standardized screening tools being the major obstacle. We present a recent study (Appendix 4) that we conducted to test the factorial structure of the most commonly used screening tool in which we made some psychometric enhancement proposals. We also presented the relevance of this screening tool for online GD and IGD. The research complexity (financial, ethical, and technical, as well as access to targeted samples) of this field is illustrated by the paper on IGD (Appendix 1). Our results nevertheless contribute to a better understanding of this disorder. High prevalence rates of IGD were found among gamers, and the impact of IGD on social functioning, health, and emotional states was self-reported in a representative adult gamer population. Withdrawal and tolerance symptoms in gaming activity were also self-reported, lending an additional link to SUDs. Neuro-functional and cognitive processes involved in GD have been reviewed (Appendix 2) to offer a better understanding of the development and evolution of GD from a neural, environmental, behavioral, and psychological perspective. Such a perspective will have therapeutic applications in the treatment of patients with these disorders, in consideration of the interconnection between biology, psyche, and behavior. The interactive relationship between clinical practice and research is vital to bring light to the phenomenological understanding of mental disorders. This is also the case for GD and IGD, with a need for a multivariate outlook that leads to a rich, multidimensional, comprehensive definition. To improve the early detection of and intervention in BAs and to reduce the impact of treatment delay on patients and their environment, preclinical efforts are a promising field of action in which to invest. A willingness and readiness of primary care to be part of this effort for GD is discussed in the present work (Appendix 3), with some interesting perspectives such as tailored information and training. The treatment strategy most commonly used in BAs is psychotherapy. Nevertheless, pharmacological approaches should be explored to alleviate suffering in patients who have BA or related disorders. We hereby present an overview of effective and promising drugs tested in clinical trials (Appendix 5) in order to help clinicians choose therapeutic options and to help researchers explore promising avenues of investigation. The field of BAs offers numerous and promising perspectives in development and research. We present some of our blueprints on the conceptualization and recognition of BAs (i.e., GD and IGD), vulnerability factor identification, detection and diagnosis, and care response. The application of a public health framework to BAs is a challenging step in order to fill the gap between individual support and a national and global strategy of harm reduction and care management. It needs to integrate many more parameters than those of a health system, as it must deal with contextual factors (e.g., law, economics, and culture)

Comorbidity of Pathological Gambling: clinical variables, personality and response to treatment

Among people with diabetes, co-occurring mental health (MH) or substance use (SU) disorders increase the risk of medical complications. Identifying how to effectively promote long-term medical benefits for at-risk populations, such as people with MH or SU disorders, is essential. Knowing more about how health care accessed before the onset of diabetes is associated with health benefits after the onset of diabetes could inform treatment planning and population health management. To analyze how preexisting MH or SU disorders and primary care utilization before a new diabetes diagnosis are associated with the long-term severity of diabetes complications. This cohort study analyzed medical record data from US Department of Veterans Affairs health care systems nationwide and used mixed-effects regressions to test associations between prediabetes patient or health care factors and longitudinal progression of diabetes complication severity from 2006 to 2015. Participants included patients who received a new diabetes diagnosis in 2008 and who were aged 18 to 85 years at the time of their diagnosis. Data analysis was conducted from March to August 2017. Patients were assigned to groups on the basis of a 2-year look-back period for MH or SU disorders status (MH disorder only, SU disorder only, MH and SU disorder, or no MH or SU disorder diagnoses) and on the basis of the amount of primary care utilization before diabetes was diagnosed. Nine-year trajectories of Diabetes Complication Severity Index (DCSI) scores. Among 122 992 patients with newly diagnosed diabetes, the mean (SD) age was 62.3 (11.1) years, 118 810 (96.6%) were male, and 28 633 (23.3%) had preexisting MH or SU disorders diagnoses. From the onset of diabetes to 7 years later, patients' mean estimated DCSI scores increased from 0.84 (95% CI, 0.82-0.87) to 1.42 (95% CI, 1.36-1.47). Controlling for sociodemographic characteristics and medical comorbidities, SU disorders only (decrease in DCSI score, -0.09; 95% CI, -0.13 to -0.04; P < .001) or both MH and SU disorders (decrease in DCSI score, -0.13; 95% CI, -0.16 to -0.09; P < .001), but not MH disorders only, were associated with lower DCSI scores at the time of the onset of diabetes compared with no MH or SU disorders. More than 90% of patients with MH or SU disorders had primary care visits before diabetes was newly diagnosed, compared with approximately 58% of patients without MH or SU disorders. Patients who had primary care visits before the onset of diabetes had lower baseline DCSI scores, compared with patients who did not have primary care visits (decrease in DCSI score, -0.41 [95% CI, -0.43 to -0.39] for 1-2 visits, -0.50 [95% CI, -0.52 to -0.48] for 3-4 visits, -0.39 [95% CI, -0.41 to -0.37] for 5-8 visits, and -0.15 [95% CI, -0.17 to -0.12] for ≥9 visits; P < .001 for all). Patients with MH or SU disorders had lower overall, but more rapidly progressing, mean DCSI scores through year 7 after the onset of diabetes (MH disorder only, 0.006 [95% CI, 0.005-0.008], P < .001; SU disorder only, 0.005 [95% CI, 0.001-0.008], P = .004; or both MH and SU disorders, 0.008 [95% CI, 0.006-0.011], P < .001), compared with patients without MH or SU disorders. Access to and engagement in integrated health care may be associated with modest, albeit impermanent, long-term health benefits for patients with MH and/or SU disorders with newly diagnosed diabetes.

Psychopathologie des joueurs pathologiques en ligne : une étude préliminaire

Still Not on the Radar: Adolescent Risk and Gambling, Revisited

The neural bases of cognitive processes in gambling disorder