Onset Of Gambling Research Articles

Concomitant development of hypersexuality and delusional jealousy in patients with Parkinson's disease: a case series.

Both impulse-control disorders and delusional jealousy (DJ) may be considered non-motor side-effects of dopamine agonist therapy in Parkinson's disease (PD). We aimed to investigate the possible concomitant development of these features in PD and their clinical correlates. We performed a cross-sectional investigation in 1063 consecutive PD patients with the Questionnaire for Impulsive Compulsive Disorders in Parkinson's disease and the Parkinson's Psychosis Questionnaire. 81 patients presented ICDs (prevalence 7.61%) and 23 patients presented DJ (17 males, 6 females; prevalence 2.16%). 9 male PD patients presented both DJ and ICDs (39.13% of patients with DJ, 11.11% of patients with ICDs; prevalence of 0.84% in the whole PD sample), with a concomitant onset of delusional jealousy and hypersexuality in 8 cases and a concomitant onset of delusional jealousy and pathological gambling in 2 cases. Hypersexuality and delusional jealousy may occur independently in PD patients "on" dopamine agonist therapy, but may develop together probably reflecting a common alteration of sexuality (sexual arousal and jealousy) The presence of both of these clinical features and sexuality more in general should be investigated when features of either one of them appear. Further confirmation is needed in larger samples of patients.

An 8-week stress management program in pathological gamblers: A pilot randomized controlled trial

Stress plays a major role at the onset and relapse of pathological gambling (PG), but at the same time it can also be the aftermath of gambling behavior, thus revealing a reciprocal relationship. Although the role of stress has been well-documented, there is a paucity of studies investigating the effect of an adjunctive stress management program on PG. In this 8-week parallel randomized waitlist controlled trial pathological gamblers, already in the gamblers anonymous (GA) group, were assigned randomly in two groups, with the intervention group (n = 22) receiving an additional stress management program (consisting of education on diet and exercise, stress coping methods, relaxation breathing –RB- and progressive muscle relaxation -PMR). Self-reported measures were used in order to evaluate stress, depression, anxiety, sleep quality/disturbances, life-satisfaction and daily routine. The statistical analyses for the between group differences concerning the main psychosocial study outcomes revealed a statistically significant amelioration of stress, depression, anxiety symptoms and an increase of life-satisfaction and a better daily routine in participants of the intervention group. We hope that these will encourage researchers and clinicians to adopt stress management in their future work.

Age of Pathological Gambling Onset

This study examined differences in the clinical and treatment-related features of pathological gambling (PG) on the basis of the age of PG onset among pathological gamblers who sought treatment. A total of 702 male outpatients with a primary diagnosis of PG and who were treated in a clinical practice were assessed by retrospective chart review. We selected the age of 25 years and younger as the threshold for "group 1." We then stratified the participants into 4 groups on the basis of the age of PG onset in 10-year intervals. Analysis of covariance with a covariant of age and the Pearson χ test were used for analyses. We found that the earlier-onset gamblers were less likely to be escape type (P < 0.05), used significantly more Internet-based gambling (P < 0.001), and were less likely to engage in nonstrategic gambling (P < 0.05) than the later-onset gamblers. In addition, the earlier-onset gamblers took anticraving medication, such as naltrexone, significantly more often (P < 0.05), and sought treatment significantly more slowly after the onset of PG than the later-onset group (P < 0.01). Regarding adherence to treatment, however, there was no significant difference among the 4 groups on the basis of the age of PG onset. The age of PG onset is associated with several important clinical and treatment features. More studies are needed to advance prevention and treatment strategies for each age group.

Factors Associated with Suicide and Bankruptcy in Japanese Pathological Gamblers

Pathological gambling can lead to a number of deleterious consequences, including bankruptcy and suicide. The present study examined the correlation between clinical characteristics of pathological gamblers and history of bankruptcy and suicide attempts. Subjects (141; 124 male) were outpatients at a psychiatric hospital from 2007 to 2010. Demographic and medical variables including age, gender, age of gambling onset, psychiatric complications, suicide attempts, and bankruptcy were assessed. Positive correlations were observed between suicide attempt and female gender, family history of addiction, and unemployment (p < 0.05). Similar variables correlated with bankruptcy (p < 0.05). Multivariate analysis revealed that a family history of addiction was the strongest independent predictor of suicide and bankruptcy. Results suggest that treatment for pathological gambling should address the patient’s past experience with addict family members, especially if the patient reports a history of bankruptcy or suicidal ideation.

Gambling Among Indigenous Men and Problem Gambling Risk Factors: An Australian Study

This paper aims to analyse the gambling activities and problem gambling risk factors for Indigenous Australian men, a topic which has previously drawn very little research attention. Using quantitative methods, we obtained a convenience sample of 1,259 women and men at Indigenous festivals, online and in several communities. This paper reports only on the responses of all 489 men in this sample. Risk factors significantly associated with problem gambling were being separated, divorced or widowed, working part-time, early gambling onset, using alcohol and/or drugs while gambling and spending high amounts of money on a favourite gambling form. Motivations significantly associated with risks of problem gambling were gambling to relax, because most family members and friends also gamble and self-reported addiction to gambling. However men who gamble to socialise with family and friends were significantly less likely to be problem gamblers. Risk factor identification may facilitate the development of effective preventative measures and risk management plans for Indigenous men.

Problem Gambling and Homelessness: Results from an Epidemiologic Study

The purpose of this study was to investigate the prevalence of gambling disorder and comorbid psychiatric disorders in a homeless population and identify features related to potential subtypes. At baseline, participants were administered a structured interview including socio-demographic sections of the National Comorbidity Study (NCS) interview; seven diagnostic sections of the Diagnostic Interview Schedule (DIS); the alcohol and drug abuse sections of the Composite International Diagnostic Interview-Substance Abuse Module (CIDI-SAM); and the Homeless Supplement to the DIS. At nine months post-baseline assessment, participants were administered additional NCS family history questions and the South Oaks Gambling Screen (SOGS). Participants were an epidemiologic sample of 275 predominately African-American homeless individuals, grouped as lifetime non-gamblers (n = 60), recreational gamblers (n = 152), and problem gamblers (n = 63), recruited on the street and through homeless shelters. Results indicate that lifetime rates of sub-clinical problem (46.2%) and disordered (12.0%) gambling were significantly higher than in the general population. Problem gamblers were more likely than non-problem gamblers to meet diagnostic criteria for antisocial personality disorder, post-traumatic stress disorder, bipolar disorder, and any psychiatric disorder, and more likely than non-gamblers to use illicit drugs or meet criteria for abuse/dependence for nicotine, alcohol, or any substance. This study provides evidence that problem gambling is a significant public health issue among the African-American homeless population. Homeless services should include assessment for problem gambling along with psychiatric disorders and referrals to resources and treatment programs. Future studies should explore the relationship of the onset and course of problem gambling and other psychiatric disorders with homelessness as well as racial differences in gambling patterns and problem severity over time.

A Direct, Controlled, Blind Family Study ofDSM-IVPathological Gambling

Pathological gambling is a major public health problem. We sought to examine the familiality of pathological gambling and determine patterns of familial aggregation of disorders. We assessed probands with DSM-IV pathological gambling, controls, and their first-degree relatives. Detailed family history information was collected on relatives who were deceased or unavailable. Ninety-five pathological gambling probands, 91 controls, and their 1,075 first-degree relatives over age 18 (537 relatives of pathological gambling probands, 538 relatives of controls) were evaluated between February 2005 and June 2010. Relatives were assessed blind to proband status. Best estimate diagnoses were assigned. Rates of lifetime pathological gambling (definite/probable) was significantly greater among the first-degree relatives of probands with pathological gambling than among comparison relatives (11% vs 1%, OR = 8.19, P < .001). The prevalence of pathological gambling and subclinical pathological gambling combined was 16% and 3% in case and control relatives, respectively (OR = 6.57, P < .001). Pathological gambling relatives had higher rates of major depression (OR = 1.49, P < .05), bipolar disorder (OR = 3.82, P < .05), any mood disorder (OR = 1.59, P < .05), social anxiety disorder (OR = 4.76, P < .01), any substance use disorder (OR = 1.47, P < .05), posttraumatic stress disorder (OR = 2.59, P < .05), and antisocial personality disorder (OR = 3.72, P < .001). Antisocial personality disorder (OR = 3.12, P < .01), social anxiety disorder (OR = 4.15, P < .01), and posttraumatic stress disorder (OR = 2.85, P < .05) were more frequent in case relatives independent of the presence of pathological gambling. Age at onset of pathological gambling in case probands (< 40 years/≥ 40 years) was not related to familiality in their first-degree relatives (OR = 1.03, P = .927). Pathological gambling is familial. Mood and substance use disorders may emerge as a consequence of the pathological gambling or as a more complex syndrome. In contrast, antisocial personality disorder, social anxiety disorder, and posttraumatic stress disorder may share a common familial etiology with pathological gambling. The phenotype may extend beyond pathological gambling to include subclinical forms of the disorder.

Gambling Behaviour and Gambling Risk Factors for Indigenous Australian Women

Minimal detailed research has been conducted into gambling by Indigenous women, despite indications from previous studies that they tend to be highly involved gamblers and a high risk group for gambling problems. This quantitative analysis investigates key aspects of gambling by Indigenous Australian women and determines risk factors underpinning problem gambling. Study participants were 687 Indigenous women recruited from Indigenous sports and cultural festivals. The survey instrument focused on socio-demographic characteristics, age of first gamble, gambling motivations, gambling behaviour, substance use while gambling, problem gambling severity, harms arising from gambling and help-seeking efforts. The findings reveal elevated rates of gambling participation, especially on poker machines, and a high prevalence of gambling problems when compared to the general population. Indigenous women who are motivated to gamble to socialise with friends and family are significantly less likely to be problem gamblers. However, risk factors for problem gambling include gambling on a greater number of gambling forms, high gambling expenditure, early onset of gambling, escape-based gambling motivations, self-reported addiction to gambling, and using alcohol and drugs while gambling. Findings point to an urgent need for culturally appropriate treatment for Indigenous Australian women with gambling problems. Culturally appropriate community education and harm minimisation measures should also be available for Indigenous women who gamble given the seemingly high proportion likely to experience at least some harm from gambling. The cost of such approaches would be returned in the enhanced health and wellbeing of Indigenous Australian women, their families and communities.

Birth cohort and sex differences in the age of gambling initiation in the United States: evidence from the National Comorbidity Survey Replication

Youth gambling has become a significant public health concern, and it appears that individuals are gambling at younger ages than they did in earlier generations. We tested this question by examining birth cohort differences in the age of onset of gambling in a national epidemiologic survey. Data were drawn from the United States National Comorbidity Survey Replication, a nationally representative general population survey of adults born 1904–84. Individuals were divided into four birth cohorts. The cohorts were compared on their lifetime gambling involvement and age of onset of gambling. Significant birth cohort and sex differences were found in the age of gambling initiation, with more recently born cohorts starting to gamble at progressively earlier ages, and men starting to gamble at younger ages than women. The mean age of onset of gambling for individuals born before 1942 was 32.9 years, and for those born between 1973 and 1984 it was 16.9 years. The overall mean ages of onset of gambling were 20.8 for men and 26.4 for women, but more recently born women appear to be ‘catching up’ with their male counterparts. This decreasing age of gambling initiation may help explain the increasing prevalence of disordered gambling in the United States.

Citalopram-Associated Gambling: A Case Report

Pathological gambling behaviour is a side effect of dopaminergic drugs used in Parkinson's disease, but has seldom been reported with selective serotonin reuptake inhibitors. A 58-years-old woman with somatisation disorder since the age of 20 and recent-onset major depression (at 54 years) received 40 mg/day intravenous citalopram, thereafter switching to the same dose of oral citalopram to treat her comorbid psychiatric disorders after showing poor response to paroxetine for one year. Her anxious and depressive symptoms were moderately reduced after 7 months of oral citalopram, but simultaneously, the patient admitted gambling. We gradually discontinued citalopram and introduced pregabalin and alprazolam; this was followed by a reduction of gambling compulsions, but the somatisation and depressive symptoms did not further improve. Pathological gambling may be mediated by an interplay of 5-HT1A serotonergic and D2 dopaminergic mechanisms. Citalopram affects both these mechanisms in areas that were shown to be involved in gambling behaviour, but while dopaminergic effects of citalopram appear to be consistent with the induction of gambling, its serotonergic mechanisms are rather inconsistent. In our patient, mood destabilisation induced by citalopram may have contributed to the first onset of pathological gambling.

Predictors of the Low Level Gambling Behavior in University Students

Purpose: The purpose of the study was to investigate the personal, familial, and environmental variables that affect low level gambling behavior in university students. Methods: The participants were 389 students in 4 universities. Data were obtained from these participants through self-report questionnaires, administered between August 19 and September 13, 2013 and data were analyzed using the SPSS/WIN 19.0 programs. Results: The significant predictors of low level gambling behavior in university students were self-control, family strengths, social motives, amusement motives, number of gambling peers, onset of gambling, irrational gambling beliefs, gambling experience of father, mother and peers, and risk taking. These personal, familial and environmental variables explained 65.5% of the variance in low level gambling behavior. Conclusion: The outcomes of this study indicate that, for university students to decrease gambling behavior, intervention programs that manage gambling experience of family and peers should be developed with an emphasis on decreasing irrational gambling beliefs, social motives, amusement motives, and risk taking behavior and increasing self-control and family strengths.

Predictors of Pathological Gambling Severity Taking Gender Differences into Account

Background: The current study aims to identify predictors of pathological gambling (PG) severity, taking gender differences into account, in an outpatient sample of pathological gamblers seeking treatment. Methods: The sample for this study consisted of 103 subjects (51 women and 52 men) meeting current DSM-IV-TR criteria for PG. Linear and logistic regression analyses were used to examine different risk factors (gender, age, impulsivity, sensation seeking, self-esteem) and risk markers (depression, anxiety, gambling-related thoughts, substance abuse) as predictors of PG severity. Results: Impulsivity, maladjustment in everyday life and age at gambling onset were the best predictors in the overall sample. When gender differences were taken into account, duration of gambling disorder in women and depression and impulsivity in men predicted PG severity. In turn, a high degree of severity in the South Oaks Gambling Screen score was related to older age and more familiy support in women and to low self-esteem and alcohol abuse in men. Female gamblers were older than male gamblers and started gambling later in life, but became dependent on gambling more quickly than men. Conclusions: Further research should examine these data to tailor treatment to specific patients’ needs according to sex and individual characteristics.

Arousal and Gambling Mode Preference: A Review of the Literature

The purpose of this paper is to review the literature examining subjective and physiological arousal associated with an individual's preferred modes of gambling. Arousal is hypothesised to play a central role in the onset and maintenance of problem gambling. Most studies have failed to differentiate relevant patterns of arousal elicited by stimuli associated with preferred versus non-preferred modes of gambling on the assumption that similar processes motivate all gamblers. At the conceptual level, sub-typing theories of problem gambling propose differences in the motivation to gamble, and the associated role arousal plays in maintaining behaviours. A review of the existing literature reveals preliminary findings that indicate that gamblers respond differentially to preferred compared to non-preferred gambling stimuli, and that gamblers may display greater reactivity in arousal to gambling cues compared to non-gamblers. Understanding differences in such patterns of arousal can be used to inform clinical interventions by effectively targeting the nature and role of arousal associated with preferred modes of gambling, and determining the extent to which non-preferred modes act as secondary reinforces triggering by gambling urges.

The relationship between age of gambling onset and adolescent problematic gambling severity

The aim of this study was to characterize the association between problem gambling severity and multiple health, functioning and gambling variables in adolescents aged 13–18 stratified by age of gambling onset. Survey data in 1624 Connecticut high school students stratified by age of gambling onset (≤11 years vs. ≥ 12 years) were analyzed in descriptive analyses and in logistic regression models. Earlier age of onset was associated with problem gambling severity as indexed by a higher frequency of at-risk/problem gambling (ARPG). Most health, functioning and gambling measures were similarly associated with problem gambling severity in the earlier- and later-age-of-gambling-onset groups with the exception of participation in non-strategic forms of gambling, which was more strongly associated with ARPG in the earlier-onset (OR = 1.74, 95%CI = [1.26, 2.39]) as compared to later-onset (OR = 0.94, 95%CI = [0.60, 1.48]) group (Interaction OR = 1.91, 95%CI = [1.18, 3.26]). Post-hoc analysis revealed that earlier-onset ARPG was more strongly associated with multiple forms of non-strategic gambling including lottery (instant, traditional) and slot-machine gambling. The finding that problem gambling severity is more closely associated with multiple non-strategic forms of gambling amongst youth with earlier-onset gambling highlights the relevance of these types of youth gambling. The extent to which non-strategic forms of gambling may serve as a gateway to other forms of gambling or risk behaviors warrants additional study, and efforts targeting youth gambling should consider how best to address non-strategic gambling through education, prevention, treatment and policy efforts.

Risk of Gambling Onset in Youth Who are Younger than Same-Grade Peers

To assess whether a child's age relative to the median age of classmates in the same grade is associated with the onset of gambling. Grade 7 students (n = 647) from 10 Montreal secondary schools were followed for 8 years. Relative age was expressed as years above or below the school-specific grade 7 median age. Hazard ratios and 95% confidence intervals (CI) were estimated for the association between relative age and age of gambling onset, with adjustment for sex, ethnicity, parent education, and impulsivity. A greater proportion of students in the youngest quartile gambled compared with the oldest (85.8% vs 74.7%). Hazards of gambling onset for students younger than the median age were elevated after age 10.5 years, but hazards were protective beforehand. At age 17 years, for example, the hazard for gambling onset was 61% greater (95% CI 1.4-1.9) for youth who were 1 year younger, but at age 8 years the hazard was 23% lower (95% CI 0.7-0.9). Younger relative age may be a risk factor for gambling onset in older youth.

Selective IGT decision-making impairment in a patient with juvenile Parkinson's disease and pathological gambling: A role for dopaminergic therapy?

The orbitofrontal cortex and the dopaminergic system are structures involved in managing impulsivity and sensibility to reinforcements, and both are typically impaired in Parkinson's disease (PD). Also, l-DOPA treatment can contribute to the development of the ‘Dopamine Dysregulation Syndrome’, a syndrome that can influence the patients' personality and lead to risk-taking behaviors. In this study, we describe the case of a 42-year-old woman (LT) affected by juvenile PD, treated with both l-DOPA and dopamine agonists, who showed a sudden onset of pathological gambling (PG), as the only neuropsychiatric symptom. We assessed LT with a full neuropsychological battery and the Iowa Gambling Task (IGT), in order to describe her specific failure in decision making. LT's performance on the IGT is compared with that of 15 non-demented PD patients under therapy with dopamine agonists and no behavioral dysregulations and with that of 16 age- and education-matched healthy subjects. Results showed fully preserved memory, executive functions, and reasoning abilities for LT, but a remarkable and stable impairment in the IGT. Performance of LT on the IGT is significantly lower than that of both control groups. This case shows, for the first time, that high cognitive functioning and preserved executive functions are no guarantee for advantageous decision making, and that the onset of PG is consistent with selective orbitofrontal disruption and side-effects of dopamine agonist therapy. It is also showed that the IGT is a useful neuropsychological device to detect specific risk-taking behaviors, which compromise functioning in real life.

The Profiles of Gamblers Seeking Counseling Services Evidence from Chinese Gamblers in Hong Kong

This study maps the demographic profiles of 4,480 clients of ten problem gambling services in Hong Kong. It attempts to identify help-seekers' characteristics associated with gender, adolescent onset of gambling, and suicidal thoughts/attempts. This aggregation of data to form a gambler service user profile among Hong Kong Chinese is the first of its kind. Service and research implications are discussed.

Past-year recreational gambling in a nationally representative sample: Correlates of casino, non-casino, and both casino/non-casino gambling

Data from the Gambling Impact and Behavior Study (GIBS), a national survey of 2417 U.S. adults, were examined by multivariate analysis to investigate characteristics of past-year recreational gamblers who participated in casino-only, non-casino-only, and both casino and non-casino gambling. Compared to non-casino-only gamblers, individuals who gambled in both locations had higher rates of alcohol use and abuse/dependence, lower rates of drug use, more frequent gambling, and larger wins and losses. Compared to casino-only gamblers, individuals who gambled in both locations reported less drug use, poorer subjective health, earlier age of gambling onset, greater frequency of gambling, and larger wins and losses. Compared to casino-only or non-casino-only gambling, gambling in both locations was associated with more frequent and heavier gambling. Findings suggest aspects of recreational gambling, such as gambling venue, may have important public health implications and should be considered in guidelines for responsible gambling.

Shared genetic contributions to anxiety disorders and pathological gambling in a male population

Pathological gambling (PG) frequently co-occurs with anxiety disorders. However, the extent to which the co-occurrence is related to genetic or environmental factors across PG and anxiety disorders is not known. Data from the Vietnam Era Twin Registry (n=7869, male twins) were examined in bivariate models to estimate genetic and shared and unique environmental contributions to PG and generalized anxiety disorder (GAD) and PG and panic disorder (PD). While both genetic and unique environmental factors contributed individually to PG, GAD, and PD, the best fitting model indicated that the relationship between PG and GAD was attributable predominantly to shared genetic contributions (r(A)=0.53). In contrast, substantial correlations were observed between both the genetic (r(A)=0.34) and unique environmental (r(E)=0.31) contributions to PG and PD. Results may be limited to middle aged males. The existence of shared genetic contributions between PG and both GAD and PD suggests that specific genes, perhaps those involved in affect regulation or stress responsiveness, contribute to PG and anxiety disorders. Overlapping environmental contributions to the co-occurrence of PG and PD suggest that common life experiences (e.g., early life trauma) contribute to both PG and PD. Conversely, the data suggest that distinct environmental factors contribute to PG and GAD (e.g., early onset of gambling in PG). Future studies should examine the relationship between PG and anxiety disorders amongst other populations (women and adolescents) to identify specific genetic and environmental influences that account for the manifestation of these disorders and their co-occurrences.

P01-16 - Effects of personality traits and psychiatric comorbidity on pathological gamblers’symptomatology

AimsTo evaluate, in a sample of pathological gamblers, the effects of personality traits and psychiatric comorbidity on the severity of this condition.Methods40 patients were evaluated with the following instruments: EuropASI, modified for pathological gambling; MINI; TCI, and BIS-11. Univariate linear regression analyses were conducted to evaluate the relationships between different scales.ResultsAge of onset was influenced by Novelty Seeking and NS-1 subscale, with higher scores related to earlier onset, Harm Avoidance 2 subscale, with higher scores related to a later onset; the presence of a lifetime panic disorder was related with a later onset; A positive correlation was found between age of onset of pathological gambling and both cigarette and cannabis smoking. Higher NS1 scores were related to a higher amount of money spent during the last month, while higher scores on the HA2 and Cooperativeness 5 subscales were related to a lesser number of days in which the patient had gambled during the last month. Moreover, higher scores in Gambling severity scores are related with the presence of a comorbid alcohol or substance abuse or dependence, dysthymia, post traumatic stress disorder, bipolar II mood disorder, and with higher BIS-11 Motor Impulsiveness, Non-planned Impulsiveness and total scores.ConclusionsPersonality traits and psychiatric comorbidity influence the age of onset of gambling, the severity of gambling and the functional and economic impact of the disease on the patient’s life. An evaluation of these aspects is needed to determine treatment options with a greater understanding of the phenomenon.