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ABSTRACT: OBJECTIVE: Impulsivity is one of the most commonly reported behavioral characteristics of patients with schizophrenia. Although there is accumulating evidence regarding behavioral problems in individuals at ultra-high risk (UHR) for psychosis, as yet, no study has reported on impulsivity in this population. The aim of the present study was to assess impulsivity in UHR subjects and to investigate the associated grey matter correlates. METHOD: This study included 32 UHR subjects and 32 age- and gender-matched healthy controls (HC). The Barratt Impulsiveness Scale Version-11 (BIS-11) was employed to assess impulsivity. Differences between the groups in grey matter volume in the anterior cingulate cortex (ACC), dorsolateral prefrontal cortex (DLPFC), and orbitofrontal cortex (OFC) were assessed. Then, a correlational analysis between the BIS-11 scores and significant clusters of grey matter volume was conducted in UHR subjects. RESULTS: UHR subjects were more impulsive than HC subjects in terms of attention (t = 3.5187, p < 0.01), motor (t = 3.1751, p < 0.01), and non-planning (t = 4.4154, p < 0.01) scores. The grey matter volume of the ACC was negatively correlated with the motor (r = -0.472, p < 0.01) and non-planning (r = -0.354, p = 0.04) scores of the BIS-11 in UHR subjects. CONCLUSION: These results suggest that impulsivity in UHR subjects may reflect altered integrated conflict processing, which likely stems from abnormalities in the ACC, rather than altered reward/punishment processing or executive control.
Progress in Neuro-Psychopharmacology and Biological Psychiatry 04/2013; · 3.25 Impact Factor
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ABSTRACT: BACKGROUND: Abnormal synchronization of brain oscillations is found to be associated with various core symptoms of schizophrenia. However, the underlying mechanism of this association remains yet to be elucidated. RESULTS: In this study, we found that coupled local and global feedback (CLGF) circuits in the cortical functional network are related to the abnormal synchronization and also correlated to the negative symptom of schizophrenia. Analysis of the magnetoencephalography data obtained from patients with chronic schizophrenia during rest revealed an increase in beta band synchronization and a reduction in gamma band power compared to healthy controls. Using a feedback identification method based on non-causal impulse responses, we constructed functional feedback networks and found that CLGF circuits were significantly reduced in schizophrenia. From computational analysis on the basis of the Wilson-Cowan model, we unraveled that the CLGF circuits are critically involved in the abnormal synchronization and the dynamical switching between beta and gamma bands power in schizophrenia. Moreover, we found that the abundance of CLGF circuits was negatively correlated with the development of negative symptoms of schizophrenia, suggesting that the negative symptom is closely related to the impairment of this circuit. CONCLUSIONS: Our study implicates that patients with schizophrenia might have the impaired coupling of inter- and intra-regional functional feedbacks and that the CLGF circuit might serve as a critical bridge between abnormal synchronization and the negative symptoms of schizophrenia.
BMC Systems Biology 04/2013; 7(1):30. · 3.15 Impact Factor
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ABSTRACT: Background. Empirical evidence involving the processing of social information by patients with obsessive-compulsive disorder (OCD) has been relatively scarce. Our study investigated the perceptual abilities of patients with OCD to recognize human faces and bodies. Method. Fifty-four drug-free or drug-naïve patients with OCD and 42 healthy controls performed discrimination tasks consisting of four types of stimuli: two sets of faces that were manipulated with regard to configuration and features, human bodies, and chairs. The stimuli were presented in upright and upside-down orientations. Results. Patients with OCD were significantly less accurate in discriminating pairs of bodily postures implying actions. However, we found no significant differences between patient and control groups in the ability to recognize faces and chairs. The inversion effects for bodies and faces were also comparable between the two groups. Conclusions. The current findings suggest that patients with OCD experience difficulty in perceiving static forms of bodily postures, but are able to adequately recognize human faces. Our data indicate a selective deficit in the perception of bodily postures in those with OCD and suggest that this deficit is probably not related to the abnormal configurational processing of social objects.
Journal of Neuropsychology 03/2013; 7(1):58-71. · 1.74 Impact Factor
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Seunghyong Ryu,
Hee Jung Nam,
Sohee Oh,
Taesung Park,
Meerae Lim,
Ji Sun Choi,
Ji Hyun Baek, Joon Hwan Jang,
Hye Yoon Park,
Sung Nyun Kim,
Yeon Ho Joo,
Jun Soo Kwon,
Kyung Sue Hong
Journal of clinical psychopharmacology 12/2012; · 5.09 Impact Factor
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ABSTRACT: The anterior limb of the internal capsule (ALIC), which interconnects with the frontal cortex and thalamus, is volumetrically altered in schizophrenia patients. However, it is unclear whether an abnormal ALIC volume is apparent prior to the onset of schizophrenia and whether this aberrant ALIC volume is related to the frontal gray matter in individuals at ultra-high risk (UHR) for psychosis. We used magnetic resonance imaging of 43 UHR subjects, 36 schizophrenia patients, and 42 healthy controls to investigate manually traced ALIC volumes. Additionally, we evaluated the correlation between the ALIC volume and the frontal gray matter. Significantly reduced ALIC volumes were observed in the UHR and schizophrenia groups compared to the healthy controls. However, the volume of the frontal gray matter was decreased only in the schizophrenia group. A positive correlation between the volumes in the ALIC and frontal gray matter found in healthy controls was maintained only in UHR subjects. In addition, a negative correlation between the total scores on the Positive and Negative Syndrome Scale and the ALIC volumes was observed only in schizophrenia patients. An aberrant ALIC volume but its maintained correlation with the interconnecting frontal lobe was present prior to the onset of full psychosis, indicating the prodromal phase of psychosis.
Psychiatry research. 11/2012; 204(2-3):82-90.
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ABSTRACT: OBJECTIVE: Functional imaging studies of obsessive-compulsive disorder (OCD) have reported altered fronto-striatal activity during executive tasks. Additionally, altered connectivity of these regions during resting state was found. However, the relationship between brain activity during tasks and resting state remains poorly understood. The present study investigated neural correlates associated with abnormal response inhibition in OCD and to examine how resting state functional connectivity relates to task-related activity. METHOD: Eighteen unmedicated adult OCD patients and 18 age- and sex-matched control subjects underwent functional magnetic resonance imaging scans during both resting state and a response inhibition task. Brain activation during response inhibition was compared between groups. Fronto-striatal regions showing altered task-related activity were used as seeds for connectivity analyses during resting state. RESULTS: During the response inhibition task, OCD patients had lower activation in areas including the cingulate cortex and basal ganglia regions. Compared with control subjects, patients with OCD showed increased functional connectivity of the caudate nucleus with the middle cingulate cortex and precentral gyrus during rest, suggesting hyperactive striatal-cortical connections. CONCLUSION: This study found altered function in fronto-striatal regions during response inhibition and its relation to resting state functional connectivity in OCD. Our results suggest that dysfunctional striatal-cortical connections even during rest may result in the failure of response inhibition and error monitoring observed in OCD patients.
Progress in Neuro-Psychopharmacology and Biological Psychiatry 11/2012; · 3.25 Impact Factor
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ABSTRACT: The functional strategic mechanisms in the brain during performing visuospatial working memory tasks, especially tasks with heavy load, are controversial. We conducted the functional magnetic resonance imaging (fMRI) while sixteen subjects were performing face- and location-matching n-back tasks to examine causal relations within the frontoparietal networks.
We applied a sophisticated method, the structural equation modeling (SEM), to the fMRI data. The imaging data were analyzed by extracting the task-related eigenseries using the principal component analysis (PCA) and then by applying a form of data-driven model called the automated search method.
The SEM analyses revealed a functional shift of network connectivity from the right to the left hemisphere with increasing load in the face-matching n-back tasks while the location-matching tasks required bilateral activation. In the locating matching n-back tasks, a pattern of parallel processing was observed in the left phonological loop and the right inferior parietal regions. Furthermore, object working memory-related activities in the left hemisphere reliably contributed to performance of both the face- and location-matching 2-back tasks.
Our results are consistent with previous reports in terms of demonstrating parallel and distributed information processing during performing working memory tasks with heavy loads. Our results additionally suggest a dynamic shift between the fast imagery circuit (right hemisphere) and the stable verbal circuit (left hemisphere), depending on task load.
Psychiatry investigation 09/2012; 9(3):283-92. · 0.99 Impact Factor
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ABSTRACT: We investigated the relationships between sleep disturbances and psychotic-like experiences (PLEs) among adolescents.
A total of 8530 students (grades 7-11) were recruited in the Republic of Korea, and 7172 students who completed all of the relevant questionnaires participated in the current study. The survey included the Eppendorf Schizophrenia Inventory (ESI), the Youth Psychosis At Risk Questionnaire (Y-PARQ), the Beck Depression Inventory (BDI), the Epworth Sleepiness Scale and questionnaires about sleep disturbances (insomnia, cataplexy and snoring).
Subjects with insomnia, excessive daytime somnolence (EDS), or probable cataplexy had higher ESI and Y-PARQ scores after controlling for age, sex and BDI scores (all p<0.001). Insomnia (OR=4.40), EDS (OR=3.84) and probable cataplexy (OR=2.97) predicted clinical high risk of psychosis. Insomnia, EDS and probable cataplexy remained as significant predictors of clinical high risk for psychosis, even after controlling for depressive symptoms or when analyses were confined to non-depressive adolescents.
Insomnia and EDS were found to predict PLEs in adolescents, independent of depression. Our findings suggest that adolescents complaining of insomnia or sleepiness may require further assessment regarding potential risk of psychosis.
Sleep Medicine 07/2012; 13(8):1021-7. · 3.40 Impact Factor
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ABSTRACT: The present study focused on the relationship between psychotic-like experiences (PLEs) and attention deficits in adolescents.
A total of 2325 students, ages 14-19 years, across eight high schools in the Republic of Korea were recruited. Students performed the computerized Comprehensive Attention Test (CAT), which measures sustained and divided attention, and completed the Eppendorf Schizophrenia Inventory (ESI) and Beck Depression Inventory (BDI). One hundred sixty-six participants were excluded from the present study due to incomplete answers on the ESI; thus, data from 2159 students were included in the final analysis.
Higher ESI scores predicted more omission and commission errors in divided-attention tasks after controlling for age, sex, and depressed mood (p = 0.024; p = 0.001, respectively). Attention and speech impairments on the ESI were the most frequent predictors of an increased number of errors in the attention tasks. All four ESI domains predicted the number of commission errors in divided-attention tasks (p < 0.001, p = 0.040, p = 0.046, and p = 0.013, respectively). In the high-risk group for psychosis (ESI ≥ 29), higher scores on the ideas of reference subscale were significantly associated with a higher number of both omission and commission errors in divided-attention tasks (p = 0.006, p = 0.017, respectively).
PLEs during adolescents were associated with impaired attention on the divided-attention task, which demands increased attentional effort. Attention deficits in adolescents prone to psychosis may be related to thought-content disturbances rather than to cognitive and perceptual symptoms.
Journal of psychiatric research 07/2012; 46(10):1354-8. · 3.72 Impact Factor
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ABSTRACT: Higher cognitive dysfunction, lower perceptual disturbance and its relation to the structures that implicate such processes have been considered as key features in patients with schizophrenia. However, little is known about the relationship between perceptual processing and structural deficits in ultra-high-risk for psychosis.
We investigated the dipole moment of M100 auditory evoked response using a magnetoencephalography in 18 patients with schizophrenia, 16 ultra-high-risk for psychosis and 16 healthy controls, and their relation to cortical thinning on Heschl's gyrus and planum temporale.
The auditory evoked M100 dipole moment was decreased in the ultra-high-risk subjects and in the patients with schizophrenia. Ultra-high-risk subjects showed impaired right M100 dipole magnitude, similar to patients with schizophrenia. Robust correlations between the cortical thickness of left Heschl's gyrus and the left M100 dipole moment were found in patients with schizophrenia. Moreover, correlations were also evident between right Heschl's gyrus and right M100 in subjects at ultra-high-risk for psychosis.
The primary feature of auditory perception in ultra-high-risk subjects and schizophrenia patients is an encoding deficit that manifests as a reduced M100 dipole moment. The relationship between abnormal M100, thinning of cortical generators and their symptomatology were shown to exist prior to the onset of overt psychosis and progressively worsen over time. Therefore, they may be a potential indicator of the development of schizophrenia.
Biological Psychiatry 07/2012; 140(1-3):93-8. · 8.28 Impact Factor
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ABSTRACT: OBJECTIVE: Pathological gambling (PG) is a severe and persistent pattern of problem gambling that has been aligned with obsessive-compulsive disorder (OCD). However, no study has compared the neurocognitive profiles of individuals with PG and OCD. METHODS: We compared neurocognitive functioning, including executive function, verbal learning and memory, and visual-spatial organization and memory among 16 pathological gamblers, 31 drug-naïve OCD subjects, and 52 healthy controls. RESULTS: The only neurocognitive marker common to both groups was increased fragmentation errors on the Rey-Osterrieth Complex Figure Test (ROCF). The PG subjects showed increased nonperseverative error on the Wisconsin Card Sorting Test and organization difficulties in the ROCF, whereas the OCD subjects revealed longer response times on the Stroop test and retention difficulties on the immediate recall scale of the ROCF. CONCLUSIONS: A more careful approach is required in considering whether PG is a part of the OCD spectrum, as little evidence of neurocognitive overlap between PG and OCD has been reported.
CNS spectrums 07/2012; · 2.20 Impact Factor
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ABSTRACT: A convergent line of neuroscientific evidence suggests that meditation alters the functional and structural plasticity of distributed neural processes underlying attention and emotion. The purpose of this study was to examine the brain structural differences between a well-matched sample of long-term meditators and controls. We employed whole-brain cortical thickness analysis based on magnetic resonance imaging, and diffusion tensor imaging to quantify white matter integrity in the brains of 46 experienced meditators compared with 46 matched meditation-naïve volunteers. Meditators, compared with controls, showed significantly greater cortical thickness in the anterior regions of the brain, located in frontal and temporal areas, including the medial prefrontal cortex, superior frontal cortex, temporal pole and the middle and interior temporal cortices. Significantly thinner cortical thickness was found in the posterior regions of the brain, located in the parietal and occipital areas, including the postcentral cortex, inferior parietal cortex, middle occipital cortex and posterior cingulate cortex. Moreover, in the region adjacent to the medial prefrontal cortex, both higher fractional anisotropy values and greater cortical thickness were observed. Our findings suggest that long-term meditators have structural differences in both gray and white matter.
Social Cognitive and Affective Neuroscience 05/2012; · 6.13 Impact Factor
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ABSTRACT: To explore the differences in pharmacotherapy and clinical characteristics of individuals at ultra-high-risk (UHR) for psychosis according to the conversion status, we analyzed the data for UHR patients seen at the Seoul Youth Clinic.
This was a naturalistic observational study. We obtained clinical data, including demographic data, presenting complaint, duration of psychiatric symptoms, diagnosis and scores on clinical rating scales from individual records in the Seoul Youth Clinic. Prescription data were obtained from electronic medical records.
As of April 1, 2010, a total of 78 people were registered as being UHR for psychosis in the Seoul Youth Clinic. Patients commonly presented with paranoid ideas and anxiety. On entry to the Seoul Youth Clinic, 81% of the UHR group were diagnosed as having psychiatric disorders according to DSM-IV criteria. Of the 67 individuals who did not drop out of the Seoul Youth Clinic, 14 converted to psychosis. The mean time to conversion was 412 days post baseline examination. The mean duration of psychiatric symptoms before clinic presentation was shorter in the converter group than in the non-converter group. There were no differences in baseline scores on clinical rating scales between the two groups. Antipsychotics were commonly prescribed for UHR patients in the Seoul Youth Clinic, with the converter group exposed to antipsychotics for a longer period and at higher doses than the non-converter group.
In a naturalistic setting, the different pattern of exposure to antipsychotics between the converter and non-converter groups calls attention to the effects of antipsychotics on conversion to psychosis.
Early Intervention in Psychiatry 02/2012; 6(1):30-7. · 0.92 Impact Factor
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ABSTRACT: Obsessive-compulsive symptoms (OCS), which are common in psychotic-spectrum illnesses, are of clinical interest because of their association with poor prognosis or cognitive dysfunction. However, few studies on the clinical and neurocognitive implications of OCS in individuals at ultra-high risk for psychosis (UHR) have been conducted.
Sixty-five UHR subjects [24 with OCS (UHR+OCS), 41 without OCS (UHR-OCS)], and 40 healthy controls were assessed using clinical scales and neurocognitive tests.
Those with UHR+OCS showed more severe clinical symptoms and poorer global functioning as compared to both healthy controls and the UHR-OCS group, according to the results of the Global Assessment of Functioning, the Comprehensive Assessment of At-Risk Mental States, and the Positive and Negative Syndrome Scale (total, negative, and general scores). In the neurocognitive domain, those in the UHR-OCS group showed notably greater latency in the Stroop task and more confabulation errors in immediate recall in the Rey-Osterrieth Complex Figure Test compared with those in UHR+OCS group, whose performance levels were similar to those of the healthy control group.
The OCS manifested in UHR individuals was associated with a more severe clinical symptomatic presentation, including lower global functioning and more psychotic symptoms. On the other hand, those with UHR-OCS performed more poorly on some cognitive tests. The features that distinguish the groups can be used for developing prognoses and intervention strategies for the heterogeneous UHR group.
Australian and New Zealand Journal of Psychiatry 02/2012; 46(2):161-9. · 2.93 Impact Factor
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ABSTRACT: Abnormalities in cognitive abilities such as verbal fluency and in cognitive-related brain regions, particularly Broca's area, have been reported in patients with schizophrenia. Additionally, previous studies have demonstrated that structural and functional abnormalities in Broca's area were associated with clinical symptoms and cognitive deficits in patients with schizophrenia, suggesting that deficits in this area may reflect the core pathology of schizophrenia. Thus, it is important to understand how the structural volume and functional connectivity in this area changes at rest according to the course of the illness.
We used magnetic resonance imaging (MRI) to measure the structural volume of Broca's area as a region of interest in 16 schizophrenia, 16 ultra-high risk (UHR), and 23 healthy matched controls. We also assessed verbal fluency and analyzed differences across groups in the functional connectivity patterns using resting-state functional MRI. The UHR group showed significantly reduced structural volume in Broca's area and significantly reduced functional connectivity between Broca's area and the lateral and medial frontal cortex as well as decreased cognitive performance. Altered functional connectivity in patients was correlated with their positive symptoms.
Our results suggest the existence of functional disconnections in Broca's area, even during resting-states, among those with schizophrenia as well as those at UHR for this disorder. These alterations may contribute to their clinical symptoms, suggesting that this is one of the key regions involved in the pathophysiology of schizophrenia.
PLoS ONE 01/2012; 7(12):e51975. · 4.09 Impact Factor
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ABSTRACT: Pathological gambling (PG) and obsessive-compulsive disorder (OCD) are conceptualized as a behavioral addiction, with a dependency on repetitive gambling behavior and rewarding effects following compulsive behavior, respectively. However, no neuroimaging studies to date have examined reward circuitry during the anticipation phase of reward in PG compared with in OCD while considering repetitive gambling and compulsion as addictive behaviors.
To elucidate the neural activities specific to the anticipation phase of reward, we performed event-related functional magnetic resonance imaging (fMRI) in young adults with PG and compared them with those in patients with OCD and healthy controls. Fifteen male patients with PG, 13 patients with OCD, and 15 healthy controls, group-matched for age, gender, and IQ, participated in a monetary incentive delay task during fMRI scanning. Neural activation in the ventromedial caudate nucleus during anticipation of both gain and loss decreased in patients with PG compared with that in patients with OCD and healthy controls. Additionally, reduced activation in the anterior insula during anticipation of loss was observed in patients with PG compared with that in patients with OCD which was intermediate between that in OCD and healthy controls (healthy controls < PG < OCD), and a significant positive correlation between activity in the anterior insula and South Oaks Gambling Screen score was found in patients with PG.
Decreased neural activity in the ventromedial caudate nucleus during anticipation may be a specific neurobiological feature for the pathophysiology of PG, distinguishing it from OCD and healthy controls. Correlation of anterior insular activity during loss anticipation with PG symptoms suggests that patients with PG fit the features of OCD associated with harm avoidance as PG symptoms deteriorate. Our findings have identified functional disparities and similarities between patients with PG and OCD related to the neural responses associated with reward anticipation.
PLoS ONE 01/2012; 7(9):e45938. · 4.09 Impact Factor
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ABSTRACT: The N1 and the mismatch negativity (MMN) responses observed in electroencephalographic and magnetoencephalographic (MEG) recordings reflect sensory processing, sensory memory, and adaptation and are usually abnormal in patients with schizophrenia. However, their differential sensitivity to ultra-high-risk (UHR) status is controversial. The current study evaluated the sensitivity of MEG N1m, N1m adaptation, and magnetic counterpart of MMN (MMNm) in 16 UHR subjects, 15 schizophrenia patients, and 18 healthy controls (HCs) during a passive auditory oddball task. N1m adaptation was assessed using the difference in N1m dipole moment between the first and last standard tones in a standard stimulus sequence. N1m adaptation occurred in HCs, whereas neither the UHR nor the schizophrenia groups showed adaptation to the standard tone on repeated presentations. The UHR group had values between those for HCs and schizophrenia patients. Additionally, MMNm dipole moment was reduced in both the UHR and patient groups compared with HCs, whereas the UHR and schizophrenia groups did not differ from each other. These findings indicated that both N1m adaptation and MMNm were altered in UHR subjects and in schizophrenia patients, despite unaffected N1m dipole moment to the first standard tones. Moreover, both UHR and schizophrenia groups failed to show adaptation of the N1m to repeated standard tones. This failure in adaptation was more severe in patients than UHR subjects, suggesting that auditory adaptation may be sensitive to the progression of the illness and be an early biomarker of UHR for psychosis. Deficits in auditory sensory memory, on the other hand, may be similarly impaired in both groups.
Schizophrenia Bulletin 12/2011; · 8.80 Impact Factor
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Sung Nyun Kim,
Jun Sung Park, Joon Hwan Jang,
Wi Hoon Jung,
Geumsook Shim,
Hye Yoon Park,
Jae Yeon Hwang,
Chi-Hoon Choi,
Do-Hyung Kang,
Jong-Min Lee,
Jun Soo Kwon
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ABSTRACT: White matter abnormalities in the corpus callosum (CC) of schizophrenia have been reported to predate the illness onset. This study aimed to investigate the effect of genetic predisposition on the white matter integrity of the CC, in subjects at genetically high risk for schizophrenia (GHR) and schizophrenia patients.
Fractional anisotropy (FA) of the mid-sagittal CC in 22 young GHR, 15 schizophrenia, and 26 control subjects were examined. GHR subjects were defined as non-prodromal individuals who had more than two relatives with schizophrenia within third-degree relatives, one of whom must be a first-degree relative.
ANCOVA with age and gender as covariates revealed overall difference of FA in the genu and splenium among the three groups. Post-hoc analysis found significantly increased FA in the genu of GHR subjects compared to controls (corrected p<0.01), whereas schizophrenia patients showed significantly decreased FA in the splenium.
The white matter change of the CC in young GHR subjects was the opposite of that in schizophrenia. To consider previous reports on FA decrease in the CC in schizophrenia and the impaired frontal functioning in GHR group, the increased FA may be an indicator of compensatory alteration in white matter integrity in young GHR people.
Progress in Neuro-Psychopharmacology and Biological Psychiatry 12/2011; 37(1):50-5. · 3.25 Impact Factor
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09/2011; , ISBN: 978-953-307-738-3
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ABSTRACT: The phenomenological resemblance between pathological gambling (PG) and obsessive-compulsive disorder (OCD) has led to suggestions that PG be categorized as an obsessive-compulsive-spectrum disorder (OCSD). This study aimed to explore whether PG resembles OCD in terms of personality and temperament. Fifteen patients with PG, 18 patients with OCD, and 33 healthy control subjects were included in the study. The study subjects were all male and drug naïve. We analyzed data obtained from three self-report questionnaires assessing personality, impulsiveness, and affect: the short version of the NEO Personality Inventory-Revised (NEO-PI-R), the Barratt Impulsiveness Scale-11 (BIS-11), and the Positive Affect and Negative Affect Schedule (PANAS). Participants with PG and OCD demonstrated less conscientiousness (F = 7.089, P = .002) and less openness to experience (F = 6.268, P = .003) and less positive affect (F = 15.816, P < .001) than did healthy controls. The two diagnostic groups did not differ from each other with respect total BIS-11 scores, but those with OCD showed more neuroticism than did those with PG and healthy controls ( F = 9.556, P < .001), and those with PG obtained higher scores on the non-planning impulsiveness factor of BIS-11 than did those with OCD or healthy controls ( F = 9,835, P < .001). PG and OCD share similar profiles in terms of personality and temperament. This study provides phenomenological evidence supporting the conceptualization of PG as an OCSD.
Journal of Gambling Behavior 09/2011; 28(3):351-62. · 1.28 Impact Factor
