Gambling Symptom Assessment Scale Research Articles

Assessing the Relationship between Disordered Gamblers with Psychosis and Increased Gambling Severity: The Mediating Role of Impulsivity.

Recent research suggests that disordered gambling and psychosis co-occur at higher rates than expected in the general population. Gamblers with psychosis also report greater psychological distress and increased gambling severity. However, the mechanism by which psychosis leads to greater gambling symptomology remains unknown. The objective of the present research was to test whether impulsivity mediated the relationship between comorbid psychosis and gambling severity. The sample consisted of 394 disordered gamblers voluntarily seeking treatment at a large university hospital in São Paulo, Brazil. A semistructured clinical interview (Mini-International Neuropsychiatric Interview) was used to diagnosis the presence of psychosis by registered psychiatrists. Severity of gambling symptoms was assessed using the Gambling Symptom Assessment Scale, and the Barratt Impulsiveness Scale-11 provided a measure of impulsivity. Of the sample, 7.2% met diagnostic criteria for psychosis. Individuals with a dual diagnosis of psychosis did not report greater gambling severity. Conversely, dual diagnoses of psychosis were associated with greater levels of impulsivity. Higher levels of impulsivity were also associated with greater gambling severity. Importantly, support for our hypothesised mediation model was found such that impulsivity mediated the association between disordered gambling and psychosis and gambling severity. Impulsivity appears to be a transdiagnostic process that may be targeted in treatment among disordered gamblers with a dual diagnosis of psychosis to reduce problematic gambling behaviours.

The placebo effect and its clinical associations in gambling disorder.

Although gambling disorder is prevalent and functionally impairing, no FDA-approved medications exist for its treatment. The ability of clinical trials to detect the benefits of active treatment has been hindered by an unusually high placebo response. Virtually nothing is known about baseline clinical characteristics that might predict placebo response in those with gambling disorder. Participants (N = 152) assigned to placebo were pooled from multiple double-blind trials of gambling disorder. Participants were classified as placebo responders or non-responders based on a cut-off of 35% reduction in symptom severity on the Gambling Symptom Assessment Scale. Baseline group differences were characterized using t tests and equivalent non-parametric tests as appropriate. Fifty-one percent of individuals assigned to placebo showed a significant clinical response. Compared with non-responders, placebo responders remained in treatment for significantly longer, were more likely to report "enjoyment" as a trigger for gambling, and were less likely to state that "boredom" or "loneliness" triggered their gambling. Placebo responders and non-responders did not differ significantly in age, sex, age at symptom onset, baseline symptom severity, comorbidities, or likelihood of having received a previous treatment. Predictors of placebo response for gambling disorder appear markedly different from those reported for other mental illnesses.

GAMBLINGLESS: FOR LIFE study protocol: a pragmatic randomised trial of an online cognitive–behavioural programme for disordered gambling

IntroductionThe prevalence of disordered gambling worldwide has been estimated at 2.3%. Only a small minority of disordered gamblers seek specialist face-to-face treatment, and so a need for alternative treatment delivery...

Factor structure of the Gambling Symptom Assessment Scale among treatment-seeking adults in Singapore

The revised 12-item Gambling Symptom Assessment Scale (G-SAS) is a measure designed to assess gambling symptom severity. However, its factor structure has not been examined. The present study investigates the factor structure of the G-SAS based on a treatment-seeking population in Singapore. Participants were 521 patients presenting with problem gambling at a tertiary psychiatric hospital. Patients completed the G-SAS, gambling-related measures and the Personal Wellbeing Index (PWI), and were assessed by a psychiatrist for pathological gambling (PG) based on DSM-IV-TR criteria. Exploratory factor analysis resulted in a two-factor solution, with factors indicating (1) gambling impulse and (2) adverse consequences. Together, both factors explained for 77.10% of variance in G-SAS scores. The two-factor model was subsequently confirmed based on confirmatory factor analysis. Additionally, G-SAS scores were associated with multiple gambling-related indicators and discriminated between patients with and without a diagnosis of PG. Findings from the study suggest that the G-SAS consists of two factors, and is a reliable and valid tool for the assessment of gambling symptom severity in clinical settings.

The PROblem Gambling RESearch Study (PROGRESS) research protocol: a pragmatic randomised controlled trial of psychological interventions for problem gambling

IntroductionInternational prevalence rates for problem gambling are estimated at 2.3%. Problem gambling is a serious global public health concern due to adverse personal and social consequences. Previous research evaluating the...

Study on gambling impulse in patients with Parkinson's disease

The occurrence and risk factors for the urge to gamble in Parkinson's disease (PD) patients were investigated. This study enrolled 167 patients with PD. Gambling Symptom Assessment Scale (G-SAS) was used to estimate the gambling symptom of PD patients. The factors which might affect gambling symptom in patients, such as age, gender, education level, disease duration, history of smoking, drugs were also investigated. The results showed that the gambling impulse occurrence of Chinese PD patients was 2.39%. No related factors were found in this study.

2876 – Glutamatergic strategies in the treatment of pathological gambling: a pilot study

Aims There is substantial evidence indicating that pharmacological treatments targeting glutamatergic transmission are of potential utility in the treatment of drug addiction. The aim of this study was to evaluate the long-term outcome of glutamatergic treatments in patients with pathological gambling. Methods Fifteen patients fulfilling criteria for pathological gambling and receiving drugs with effects on glutamatergic transmission (amantadine, N-acetylcysteine, gabapentin, pregabalin and topiramate) were enrolled. Gambling craving (Gambling Symptom Assessment Scale, G-SAS, and visual analogue scale, VAS) and relapse (Gambling Timeline Follow Back, G-TLFB) rating scales were administered before and after treatment (1, 3, 6 months follow-up). Results Gambling craving and behavior were significantly reduced (p Discussion Our results are discussed in the context of the glutamatergic hypothesis of addiction. Our data seem to confirm the utility of targeting the glutamatergic system for the treatment of PG, in particular by acting on craving and increasing treatment retention. In particular, glutamatergic medications may offer some advantages in preventing relapse.

Predictors of Treatment Outcome Among Asian Pathological Gamblers (PGs): Clinical, Behavioural, Demographic, and Treatment Process Factors

Research on predictors of treatment outcome among pathological gamblers (PGs) is inconclusive and dominated by studies from Western countries. Using a prospective longitudinal design, the current study examined demographic, clinical, behavioural and treatment programme predictors of gambling frequency at 3, 6 and 12-months, among PGs treated at an addiction clinic in Singapore. Measures included the Hospital anxiety and depression scale, gambling symptom assessment scale (GSAS), personal well-being index (PWI), treatment perception questionnaire and gambling readiness to change scale. Treatment response in relation to changes in symptom severity, personal wellbeing and abstinence were also assessed. Abstinence rates were 38.6, 46.0 and 44.4% at 3, 6 and 12-months respectively. Significant reductions in gambling frequency, GSAS, and improvement in PWI were reported between baseline and subsequent outcome assessments, with the greatest change occurring in the initial three months. No demographic, clinical, behavioural or treatment programme variable consistently predicted outcome at all three assessments, though treatment satisfaction was the most frequent significant predictor. However, being unemployed, having larger than average debts, poor treatment satisfaction and attending fewer sessions at the later stages of treatment were associated with significantly poorer outcomes, up to 1-year after initiating treatment. These findings show promise for the effectiveness of a CBT-based treatment approach for the treatment of predominantly Chinese PGs. Clinical implications and suggestions for future research are discussed. Taken together, the findings suggest early treatment satisfaction is paramount in improving short-term outcomes, with baseline gambling behaviour and treatment intensity playing a more significant role in the longer term.

Pathological gambling in Parkinson disease is reduced by amantadine

To investigate the possible efficacy of amantadine in the control of pathological gambling (PG) associated with Parkinson disease (PD), 17 PD patients with PG were randomly selected for a double-blind crossover study with amantadine 200mg/day versus placebo and an open follow-up. Assessments included PG-specific scales (Yale-Brown Obsessive-Compulsive Scale for PG, Gambling-Symptom Assessment Scale, South Oaks Gambling Screen) and assessment of expenditures and time spent gambling. Amantadine abolished or reduced PG in all treated patients, as confirmed by scale score and daily expenditure reduction. Amantadine might be useful to treat PG. The effect of amantadine, acting as an antiglutamatergic agent, also opens new insights into the pathogenesis of PG.

Pathologic gambling and bankruptcy

Background Although prior studies have examined rates of bankruptcy in pathologic gambling (PG), there are only limited data regarding the clinical correlates of those with PG who declare bankruptcy because of gambling. Method Five hundred seventeen consecutive subjects with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, PG (54.7% females; mean age 47.6 years) were grouped into 2 categories: those who had (n = 93; 18.0%) and had not (n = 424; 82.0%) declared bankruptcy secondary to gambling. Groups were compared on clinical characteristics, gambling severity (using the Yale-Brown Obsessive-Compulsive Scale Modified for Pathological Gambling, Gambling Symptom Assessment Scale; Clinical Global Impression—severity scale, and time and money spent gambling), and psychiatric comorbidity. Results Gamblers who had declared bankruptcy were more likely to be single ( P = .004); have an earlier age of problem gambling onset ( P = .032); and have more financial ( P < .001), work-related ( P = .006), marital ( P < .001), and legal ( P < .001) problems secondary to their gambling. They also reported higher rates of depressive disorders ( P < .001), substance use disorders ( P = .005) and were more likely to be daily users of nicotine ( P = .022). Money spent gambling did not differ significantly between groups. Conclusion These preliminary results suggest that bankruptcy in PG may be associated with specific clinical differences. Treatment strategies may want to assess bankruptcy status to develop more effective treatments that take account of these clinical differences.

The Gambling Symptom Assessment Scale (G-SAS): A reliability and validity study

Two hundred seven patients with DSM-IV Pathological Gambling Disorder completed both the Gambling Symptom Assessment Scale (G-SAS) and the Yale–Brown Obsessive–Compulsive Scale — modified for Pathological Gambling (PG-YBOCS) at baseline visit and weekly or biweekly thereafter during the 12-week study period. The week 1 to week 2 visit data were used to assess test–retest reliability. Weekly or biweekly data were used for the G-SAS validity. The PG-YBOCS reliability and validity data have been published previously. We used the PG-YBOCS as the established scale and compared the G-SAS performance with the PG-YBOCS. Test–retest reliability was statistically significant. The correlations between the G-SAS and the PG-YBOCS and Clinical Global Impression rating were excellent. Findings suggest that the G-SAS is reliable and valid in assessing changes in symptoms during a drug treatment study.

Clinical correlates of pathological gambling symptoms in patients with epilepsy

Pathological gambling symptoms (PGS), that is, the subjective urge to gamble and the actual gambling behaviors, are currently acknowledged as relatively common symptoms among Western countries, with an estimated point prevalence of 0.6-1.1% in the general population. Converging evidence suggests that PGS are overrepresented in patients with neurological conditions affecting dopaminergic reward pathways, and can be expressed in both impulse control disorders and obsessive-compulsive spectrum disorders. This study explored the clinical correlates of PGS in patients with epilepsy. Eighty-eight consecutive adult outpatients recruited at three epilepsy clinics in northern Italy were assessed using the Gambling-Symptom Assessment Scale (G-SAS), along with a battery of psychometric instruments to index depression (Beck Depression Inventory [BDI]), anxiety (Spielberger State-Trait Anxiety Inventory [STAI]), and obsessionality (Yale-Brown Obsessive Compulsive Scale [YBOCS]) symptoms. On the G-SAS, patients with a diagnosis of temporal lobe epilepsy (TLE) reported a mean [sd] G-SAS score of 2.0 [5.7], significantly higher than patients with frontal lobe epilepsy (FLE) (0.6 [1.7]) and idiopathic generalized epilepsy (IGE) (0.4 [1.4]). Moreover, multiple regression analysis showed that G-SAS scores were selectively predicted by YBOCS scores, thus suggesting an association between the expression of obsessional spectrum symptoms and PGS in patients with TLE. Alterations in the mesolimbic reward system could represent the putative neuropathological substrate for this multifaceted clinical picture.

A Double-Blind, Placebo-Controlled Study of the Opiate Antagonist Naltrexone in the Treatment of Pathological Gambling Urges

Pathological gambling (PG) is a disabling disorder experienced by approximately 1% of adults and for which few empirically validated treatments exist. This study examined the efficacy and tolerability of the opioid antagonist naltrexone in adults with PG who have urges to gamble. An 18-week, double-blind, placebo-controlled trial was conducted to evaluate the safety and efficacy of 3 doses of oral naltrexone for PG. Seventy-seven individuals with DSM-IV-TR PG were randomly assigned to naltrexone (50 mg/day, 100 mg/day, or 150 mg/day) or placebo. Subjects were assessed with the Pathological Gambling Adaptation of the Yale-Brown Obsessive Compulsive Scale (PG-YBOCS), the urge and behavior subscales of the PG-YBOCS, the Gambling Symptom Assessment Scale (G-SAS), the Clinical Global Impressions-Severity of Illness scale (CGI-S), and measures of depression, anxiety, and psychosocial functioning. Data were collected from September 2002 to June 2005. Outcomes did not significantly differ between the various doses of naltrexone. Subjects assigned to naltrexone had significantly greater reductions in PG-YBOCS total scores (p = .0094), gambling urges (p = .0053), and gambling behavior (p = .0134) compared to subjects assigned to placebo. Subjects assigned to naltrexone also had greater improvement in overall gambling severity (reflected in the CGI-S scores) (p = .0080) and in psychosocial functioning (p = .0177) than subjects assigned to placebo. A complete analysis (N = 49) demonstrated significantly greater improvement on all variables for subjects assigned to naltrexone. A sex analysis demonstrated that men and women did not differ significantly in their response to naltrexone. Subjects assigned to naltrexone demonstrated statistically significant reductions in gambling urges and behavior in PG. Low-dose naltrexone (50 mg/day) appeared as efficacious as higher doses (100 mg/day and 150 mg/day), and all doses were well tolerated.

Treatment Success For Gamblers More Than Just Roll of the Dice

Back to table of contents Previous article Next article Clinical & Research NewsFull AccessTreatment Success For Gamblers More Than Just Roll of the DiceJoan Arehart-TreichelJoan Arehart-TreichelSearch for more papers by this authorPublished Online:7 May 2004https://doi.org/10.1176/pn.39.9.0057Although research on pathological gambling is increasing, little is known about what it takes to keep pathological gamblers in treatment.Jon Grant, M.D., J.D., an assistant professor of psychiatry at Brown University, and coworkers conducted a study of pathological gamblers to try to identify such factors.Fifty adult outpatients with a primary DSM-IV diagnosis of pathological gambling were enrolled in the study. All had sought help for their disorder, all were receiving medication, and some were getting psychotherapy as well. The subjects had been in treatment for a year on average, although some had been in treatment for as short as 20 days or as long as four years.The researchers then used the Clinical Global Impressions Scale for Pathological Gambling and the Gambling Symptom Assessment Scale to evaluate the clinical status of the subjects at the start of the study and then again every two months for a year.Subjects who dropped out of treatment during the study period were contacted by telephone to determine why they had discontinued treatment.Almost half of the subjects—48 percent—stopped treatment during the one-year study period, Grant and his colleagues reported in the March-April Comprehensive Psychiatry. Those who discontinued treatment gave two primary reasons—they missed the thrill of gambling or felt certain that they could win and reduce their gambling-related financial debts.On a more positive note, however, 52 percent of the subjects did stay in treatment during the study period, and two of the predictors of staying in treatment, Grant and his team found, were feeling at least minimally improved within 60 days of starting treatment and having someone in their lives whom they considered supportive of their receiving treatment and of their attempt to stop gambling.An abstract of the study, “Retrospective Review of Treatment Retention in Pathological Gambling,” is posted online at www.sciencedirect.com. Click “Browse A-Z of journals,” “C,” “Comprehensive Psychiatry,” and then the March-April 2004 issue. ▪ ISSUES NewArchived

A Double-Blind Placebo-Controlled Study of the Efficacy and Safety of Paroxetine in the Treatment of Pathological Gambling

This randomized, double-blind, placebo-controlled study investigated the efficacy and tolerability of paroxetine in the treatment of pathological gambling. Patients fulfilling DSM-IV criteria for pathological gambling and scoring > or = 5 on the South Oaks Gambling Screen were enrolled if no other Axis I disorder was present. A 1-week placebo run-in phase was followed by 8 weeks' treatment with paroxetine or placebo. The initial paroxetine dose of 20 mg/day could be increased after week 2 by 10 mg/week to a maximum of 60 mg/day. Changes in clinical status were assessed using the Gambling Symptom Assessment Scale (G-SAS) and the Clinical Global Impressions scale (CGI). Treatment-emergent symptoms were assessed weekly. Forty-five patients were included in an intent-to-treat analysis (N = 23 paroxetine, N = 22 placebo). Statistically significantly greater reductions in the total score of the G-SAS were observed in the paroxetine group compared with the placebo group at weeks 6 through 8 (p = .003, .003, and .042, respectively). Improvement on the CGI was also significantly greater in the paroxetine than in the placebo group at the same timepoints (p = .033, .014, and .025, respectively). A significantly greater proportion of patients in the paroxetine group were responders at weeks 7 and 8 (p = .011 and .010, respectively). The results of this trial indicate that paroxetine may be effective in the treatment of pathological gambling. There were no unexpected side effects from this treatment. However, additional studies with larger patient samples and a longer treatment phase are required to establish conclusively the efficacy and safety of paroxetine for this indication.

An open naltrexone treatment study in pathological gambling disorder.

The present study was designed to test the short-term efficacy and safety of naltrexone in the treatment of pathological gambling disorder. Seventeen subjects (seven men, 10 women) who fulfilled DSM-IV criteria for pathological gambling disorder, and were free from other Axis I diagnoses by Structured Clinical Interview for DSM-III-R screening, participated in a 6-week open naltrexone flexible dose trial. Gambling symptom change was assessed with the patient-rated Clinical Global Impression (CGI) Scale, the clinician-rated CGI and the Gambling Symptom Assessment Scale. Side-effects were monitored weekly and liver function tests biweekly. Naltrexone reduced urges to gamble and gambling behaviour. The mean change in gambling frequency per week was 1.40 +/- 0.28 episodes per week; the mean change in dollars lost per week was $66.95 +/- 13.77; and the mean change in clinician-rated CGI Improvement was 0.40 +/- 0.04. Of those who responded to the medication, the majority had done so by the end of the fourth week. Men responded to naltrexone as well as women. The average naltrexone dose required for effective symptom control was 157 mg/day. Nausea was common during the first week (47%). The present findings provide evidence that naltrexone may be effective in the treatment of pathological gambling disorder. The present report is preliminary and controlled trials are needed to confirm these findings.