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Executive functioning among female pathological gambling and bulimia nervosa patients: Preliminary findings
Abstract
Shared vulnerabilities have been described across disorders of impulse control, including pathological gambling (PG) and bulimia nervosa (BN). Our aim was to compare the executive functioning of PG and BN females in order to confirm their similarity at a neurocognitive level. A total of 15 BN females, 15 PG females, and 15 healthy control (HC) females were administered the Wisconsin Card Sorting Test (WCST) and the Stroop Color and Word Test. Analysis of covariance adjusted for age and education was conducted to compare groups. PG showed the greatest impairment, that is, the highest percentage of WCST perseverative errors (p = .023), the lowest percentage of conceptual-level responses (p = .034), and the highest number of total trials administered (p = .021), while BN showed the highest percentage of WCST nonperseverative errors (p = .003). Both BN and PG females demonstrated executive dysfunction relative to HCs but different specific correlates (i.e., greater vulnerability to distraction in BN, but more cognitive inflexibility in PG).
... The mean BMI of AN, BN and BED participants was 15.7, 22.0 and 34.9 kg/m 2 respectively. Thirteen articles reported no co-morbid Axis I diagnosis in their patient groups (Fassino et al. 2002;Cavedini et al. 2004Cavedini et al. , 2006Fowler et al. 2006;Brand et al. 2007;Alvarez-Moya et al. 2009;Kim et al. 2010;Andrés-Perpiña et al. 2011;Lounes et al. 2011;McAnarney et al. 2011;Galimberti et al. 2012Galimberti et al. , 2013Shott et al. 2012). ...
... Murphy et al. 2002;Tchanturia et al. 2004a;Holliday et al. 2005;Fowler et al. 2006;Alvarez-Moya et al. 2009;Kim et al. 2010;Tenconi et al. 2010;Abbate-Daga et al. 2011;Giel et al. 2011;Konstantakopoulos et al. 2011;Nikendei et al. 2011;Darcy et al. 2012;Galimberti et al. 2012;Shott et al. 2012;Wittorf et al. 2012;Bischoff-Grethe et al. 2013;Sato et al. 2013), other antidepressant medication(Murphy et al. 2002), low-dose antipsychotic medication(Bischoff-Grethe et al. 2013) or benzodiazepine treatment(Alvarez-Moya et al. 2009). ...
... Murphy et al. 2002;Tchanturia et al. 2004a;Holliday et al. 2005;Fowler et al. 2006;Alvarez-Moya et al. 2009;Kim et al. 2010;Tenconi et al. 2010;Abbate-Daga et al. 2011;Giel et al. 2011;Konstantakopoulos et al. 2011;Nikendei et al. 2011;Darcy et al. 2012;Galimberti et al. 2012;Shott et al. 2012;Wittorf et al. 2012;Bischoff-Grethe et al. 2013;Sato et al. 2013), other antidepressant medication(Murphy et al. 2002), low-dose antipsychotic medication(Bischoff-Grethe et al. 2013) or benzodiazepine treatment(Alvarez-Moya et al. 2009). ...
Background:
In this meta-analysis we review the findings from neuropsychological studies on set-shifting in people with eating disorders (EDs) or overweight/obesity.
Method:
Four databases (PubMed, PsycINFO, PSYNDEX and Web of Science) were searched for eligible studies. Effect sizes (ESs) were pooled using random-effects models. Moderator analyses were conducted for ED and overweight/obese subgroups, adult/adolescent samples and measures of set-shifting.
Results:
Sixty-four studies with a total of 1825 ED patients [1394 anorexia nervosa (AN), 376 bulimia nervosa (BN) and 55 binge eating disorder (BED)] and 10 studies with a total of 449 overweight/obese individuals were included. The meta-analysis revealed a small to medium ES for inefficient set-shifting across all three ED diagnoses (Hedges' g = -0.45). Subgroup analyses yielded small to medium ESs for each ED subtype (g = -0.44 for AN, -0.53 for BED, -0.50 for BN), which did not differ significantly. There was a medium ES for restricting type AN (ANR; g = -0.51) but no significant ES for binge/purge type AN (AN/BP; g = -0.18). A medium ES was found across obesity studies (g = -0.61). The ES across overweight studies was not significant (g = -0.07). Adult samples did not differ from adolescent samples in either ED or overweight/obesity studies. The different set-shifting measures were associated with largely varying ESs.
Conclusions:
The meta-analysis provides strong support that inefficient set-shifting is a salient neuropsychological phenomenon across ED subtypes and obesity, but is less prominent in AN/BP and overweight. Compulsivity seems to be a common underlying factor supporting a dimensional and transdiagnostic conceptualization of EDs and obesity.
... The Serious Games (SGs) are games that are meant not only to entertain but also to educate since they are designed to help individuals to achieve specific objectives [7][8][9]. In the last years, SGs have been commercialized to improve psycho-education or specific behavioural changes in patients suffering from a variety of medical illnesses, such as asthma [10], cancer [11], obesity [12], diabetes [13], stroke [14], pain [15], as well as impulse-related disorders, dysfunctional emotional regulatory processes and disinhibited personality traits [16][17][18][19] that, even with well-established evidence-based psychological therapies, are the most difficult core symptoms to address [16,[19][20][21]. Virtual reality (VR) and SGs have been used since the last years as a good complementary tools to classical or computerized neuropsychological assessment due to increased ecological validity. ...
... The Serious Games (SGs) are games that are meant not only to entertain but also to educate since they are designed to help individuals to achieve specific objectives [7][8][9]. In the last years, SGs have been commercialized to improve psycho-education or specific behavioural changes in patients suffering from a variety of medical illnesses, such as asthma [10], cancer [11], obesity [12], diabetes [13], stroke [14], pain [15], as well as impulse-related disorders, dysfunctional emotional regulatory processes and disinhibited personality traits [16][17][18][19] that, even with well-established evidence-based psychological therapies, are the most difficult core symptoms to address [16,[19][20][21]. Virtual reality (VR) and SGs have been used since the last years as a good complementary tools to classical or computerized neuropsychological assessment due to increased ecological validity. ...
The Attention Deficit–Hyperactivity Disorder (ADHD) is a behavior-related disorder, already present in children in pre-scholar and scholar age, that mainly includes hyperactivity, lacks in attention skills, impulsivity (delay aversion). While several approaches have been studied and developed for modelling and facing the various aspects of ADHD, the Dual Pathway Model (DPM), by Sonuga-Barke, is an evidence-based model that synthetizes in the cognitive and motivational paths the key dysfunctions, the inhibitory and delay aversion ones. In this paper is presented the development of a prototype of a computer serious game, called Antonyms, based on the DPM model, that is aimed at promoting learning and autonomous management of impulsive behaviors and at inhibiting irrelevant thoughts in children with ADHD. The game is structured as a set of tasks, contextualized in a story, impelling the player to react in an inadequate and immediate way while the player, to win, has to enhance his/her own skills of self-regulation, waiting, reflecting upon a situation, finding a not-intuitive solution. Preliminary tests on a control group show that impulsivity and inattention are really addressed during gameplay.
... Compulsivity has been implicated in multiple mental disorders including obsessivecompulsive disorder (37), trichotillomania (38), and anorexia nervosa (39). In GD, compulsive features have been linked to genetic factors (40), and compulsivity-related impairments in cognitive flexibility may involve difficulty in learning from mistakes and implementing alternative problem-solving methods (41)(42)(43)(44). During performance of attentional set-shifting tasks like the Wisconsin card sorting test (WCST) (45), worse performance (less flexibility or more compulsivity) has been observed in individuals with GD vs. those without, as reflected in more perseverative errors (46). ...
Background and Objective: Complex associations between gambling disorder (GD) and impulsivity have been identified. However, little is known regarding how compulsivity associates with different impulsivity domains in GD. In this study, we examined associations between self-reported and behavioral measures of impulsivity–assessed through the Barratt Impulsiveness Scale (BIS-11) and the Experiential Discounting Task (EDT), respectively- and compulsivity-measured using the Padua Inventory and the Wisconsin Card Sorting Test (WCST), respectively-, in an adult sample with GD (N = 132, 94 men and 38 women, ages ranging from 18 to 69 years). GD severity was assessed using the South Oaks Gambling Screen.
Methods: Structural Equation Modeling was used to examine relationships between impulsivity and compulsivity measures, age, and GD severity.
Results: BIS-11 non-planning and BIS-11 total scores positively correlated with GD severity. The standardized coefficients for the SEM showed direct positive contributions of BIS-11 non-planning, Padua and EDT scores to GD severity. Only participants' ages directly contributed to WCST perseverative errors, and no direct or indirect effects were found with respect to GD severity.
Conclusion: The findings suggest that specific aspects of impulsivity and compulsivity contribute to GD severity. Interventions specifically targeting domains that are most relevant to GD severity may improve treatment outcomes.
... Nevertheless, there is some evidence that following therapy, inhibitory control may appear more similar to normative samples, suggesting this process as a malleable treatment target [13]. Similar to motor responses, there is substantial evidence for impaired cognitive control through increased errors or altered interference scores relative to healthy control comparison groups [14][15][16][17][18]. A recent meta-analysis confirms attentional impulsivity in GD populations across 15 Stroop studies with no significant moderating effect of gender or of other comorbid conditions [2 ]. ...
Understanding the neuropsychological features in GD has implications for highlighting addictive mechanisms in the absence of potentially neurotoxic effects of drugs. Several recent meta-analyses both within GD groups as well as across addictive disorders are clarifying broad and unique characteristics through more careful control of demographic and comorbid features. Several neuropsychological studies are also beginning to highlight aspects of self-awareness in GD, including metacognition and interoceptive processes and how they may relate to cognitive distortions and decision-making. Neuropsychological features of gambling products, including ‘near-misses’ and ‘losses disguised as wins’, tap into contextual effects and conditioned win responses and serve as a type of nudging behaviour. More broadly, investigating the neuropsychology of GD and gambling features can help us understand how reward, risk and uncertainty affect the decision-making process.
... It should be noted that poor cognitive flexibility (set-shifting) is robustly associated with high compulsivity and with disordered compulsive behaviours (Potenza, 2007). In GD, poor cognitive flexibility seems to be partially explained by a greater difficulty in learning from mistakes and finding alternative methods of problem-solving (Marazziti et al., 2008) when assessed with the Wisconsin Card Sorting Task (WCST: Alvarez-Moya et al., 2009;Forbush et al., 2008). ...
Background and aims:
Gambling disorder (GD) is a highly heterogeneous condition with high rates of chronicity, relapses and treatment dropout. The aim of this study was to longitudinally explore the associations between trait impulsivity, impulsivity-compulsivity related cognitive domains, and treatment outcome in an outpatient sample of adult patients with GD.
Methods:
144 adult male participants diagnosed with GD undergoing cognitive-behavioural treatment (CBT) at a specialized outpatient service completed a series of neuropsychological tests to assess executive functioning (including cognitive flexibility, inhibition control and decision making) and psychometric questionnaires.
Results:
Trait impulsivity predicted low compliance [UPPS-P negative urgency (B = 0.113; p = 0.019)] and relapse [UPPS-P negative urgency (B = 0.140; p = 0.015)] at 5 weeks of treatment and dropout at the end of treatment [(UPPS-P sensation seeking B = 0.056; p = 0.045)]. Cognitive flexibility performance predicted: dropout rates at the end of treatment [WCST perseverative errors (B = 0.043; p = 0.042)]; dropout [WCST categories completed (B = -1.827; p = 0.020)] and low compliance or relapses at follow-up [WCST perseverative errors (B = 0.128; p = 0.020)]; and time to first relapse [WCST failure to maintain set (B = -0.374; p = 0.048)] and time to dropout [WCST perseverative errors (B = 0.0198; p = 0.019)].
Conclusions:
Our findings indicate impulsivity-compulsivity levels may influence response to GD treatment (i.e.: low compliance and dropout or relapse rates) thus representing a potential target for improving treatment outcomes.
... Numerous similarities between ED and GD have been shown in terms of personality traits and neuropsychological factors (39,79,80). Moreover, both disorders have been associated with the presence of food addiction. ...
Aims: Due to the increasing evidence of shared vulnerabilities between addictive behaviors and excessive food intake, the concept of food addiction in specific clinical populations has become a topic of scientific interest. The aim of this study was to validate the Yale Food Addiction Scale (YFAS) 2.0 in a Spanish sample. We also sought to explore food addiction and its clinical correlates in eating disorder (ED) and gambling disorder (GD) patients.
Methods: The sample included 301 clinical cases (135 ED and 166 GD), diagnosed according to DSM-5 criteria, and 152 healthy controls (HC) recruited from the general population.
Results: Food addiction was more prevalent in patients with ED, than in patients with GD and HC (77.8, 7.8, and 3.3%, respectively). Food addiction severity was associated with higher BMI, psychopathology and specific personality traits, such as higher harm avoidance, and lower self-directedness. The psychometrical properties of the Spanish version of the YFAS 2.0 were excellent with good convergent validity. Moreover, it obtained good accuracy in discriminating between diagnostic subtypes.
Conclusions: Our results provide empirical support for the use of the Spanish YFAS 2.0 as a reliable and valid tool to assess food addiction among several clinical populations (namely ED and GD). The prevalence of food addiction is heterogeneous between disorders. Common risk factors such as high levels of psychopathology and low self-directedness appear to be present in individuals with food addiction.
... This proposition is based on clinical and neurological similarities between these two psychiatric disorders (Frascella et al., 2010). For example, bulimia nervosa and gambling disorders are characterized by behavioural disinhibition (Dawe & Loxton, 2004;Petry, 2001), executive functioning deficits (Alvarez-Moya et al., 2009), and dysregulation of the reward system (Fineberg et al., 2010;Probst & van Eimeren, 2013). In addition, pharmacological treatments that target the serotonin system have demonstrated efficacy in the treatment of bulimia nervosa (Kaye, Gendall, & Strober, 1998) and have shown some efficacy in the treatment of gambling disorder (Hodgins, Stea, & Grant, 2011). ...
Preliminary evidence suggests that binge/purge type eating disorders and gambling disorder may commonly co‐occur. However, this dual‐diagnosis population remains understudied. The present research examined the prevalence rates and correlates of binge/purge type eating disorders (i.e., bulimia nervosa, binge‐eating disorder, and anorexia nervosa binge/purge type) among adults seeking treatment for their gambling (N = 349). In total, 11.5% of the sample (n = 40) met criteria for a binge/purge type eating disorder, most commonly bulimia nervosa (n = 33). There was a higher preponderance of binge/purge type eating disorders in women. People with a comorbid binge/purge type eating disorder reported more days gambling, gambling‐related cognitive distortions, impulsivity, suicidality, and other current psychiatric comorbidities including addictive behaviours. These findings suggest that binge/purge type eating disorders in people seeking treatment for gambling may be more common than previously believed. Furthermore, the increased psychopathology among people with binge/purge type eating disorder and gambling disorder identify vulnerabilities of this dual‐diagnosed population that may require clinical attention.
... This proposition is based on clinical and neurological similarities between these two psychiatric disorders (Frascella et al., 2010). For example, bulimia nervosa and gambling disorders are characterized by behavioural disinhibition (Dawe & Loxton, 2004;Petry, 2001), executive functioning deficits (Alvarez-Moya et al., 2009), and dysregulation of the reward system (Fineberg et al., 2010;Probst & van Eimeren, 2013). In addition, pharmacological treatments that target the serotonin system have demonstrated efficacy in the treatment of bulimia nervosa (Kaye, Gendall, & Strober, 1998) and have shown some efficacy in the treatment of gambling disorder (Hodgins, Stea, & Grant, 2011). ...
Preliminary evidence suggests that binge/purge type eating disorders and gambling disorder may commonly co-occur. However, this dual diagnosis population remains understudied. The present research examined the prevalence rates and correlates of binge/purge type eating disorders (i.e., bulimia nervosa; binge-eating disorder; anorexia nervosa binge/purge type) among adults seeking treatment for their gambling (N=349). In total, 11.5% of the sample (n=40) met criteria for a binge/purge type eating disorder, most commonly bulimia nervosa (n=33). There was a higher preponderance of binge/purge type eating disorders in women. People with a comorbid binge/purge type eating disorder reported more days gambling, gambling-related cognitive distortions, impulsivity, suicidality, and other current psychiatric comorbidities including addictive behaviors. These findings suggest binge/purge type eating disorders in people seeking treatment for gambling may be more common than previously believed. Furthermore, the increased psychopathology among people with binge/purge type eating disorder and gambling disorder identify vulnerabilities of this dual-diagnosed population that may require clinical attention.
... Results were divergent. Of the 12 studies identified, only seven identified alterations in cognitive inhibition based on the Stroop task, but three of the five studies that did not pick up any difference involved very small sample sizes, or aimed to compare GD to other pathologies [one study was of a comparison with bulimia nervosa and included 15 PG (only females) ( Alvarez-Moya et al., 2009); one study was of a comparison with obsessive compulsive disorder and included 16 PG ( Hur et al., 2012); one study included 13 PG (only males) ( Potenza et al., 2003)]. More specifically and unexpectedly, the only study that used an addiction version of the Stroop test (Lorains et al., 2014b) did not find any differences between inhibition performance in PrG and controls. ...
Various therapeutic approaches are available for the treatment of gambling disorder (GD), especially cognitive behavioral therapy (CBT; the most widely used treatment). However, CBT has high dropout and relapse rates as well as non-compliance issues, which may be partly due to resistance to changing core characteristics, such as executive functioning, attention, and emotional regulation abnormalities. Finding new therapeutic approaches to treat GD is thus a key challenge. Cognitive remediation (CR) interventions represent a promising approach to GD management, which has recently been demonstrated to have efficacy for treating other addictive disorders. The objective of this review is to describe the possible benefits of CR interventions for GD management. Two systematic searches in MEDLINE and ScienceDirect databases were conducted up until January 2017. Potential neurocognitive targets of CR interventions for GD were reviewed, as is the use and efficacy of such interventions for GD. While there is evidence of several neurocognitive deficits in individuals with GD in terms of impulsive, reflective, and interoceptive processes, the literature on CR interventions is virtually absent. No clinical studies were found in the literature, apart from a trial of a very specific program using Playmancer, a serious videogame, which was tested in cases of bulimia nervosa and GD. However, neurocognitive impairments in individuals with addictive disorders are highly significant, not only affecting quality of life, but also making abstinence and recovery more difficult. Given that CR interventions represent a relatively novel therapeutic approach to addiction and that there is currently a scarcity of studies on clinical populations suffering from GD, further research is needed to examine the potential targets of such interventions and the effectiveness of different training approaches. So far, no consensus has been reached on the optimal parameters of CR interventions (duration, intensity, frequency, group vs. individual, pencil-and-paper vs. computerized delivery, etc.). Although no firm conclusions can be drawn, CR interventions represent a promising adjunct treatment for GD. Such a novel therapy could be associated with common interventions, such as CBT and educational and motivational interventions, in order to make therapies more effective and longer-lasting and to decrease the risk of relapse.
... A recent review by Morris and Voon (122) argued that the links between cognitive flexibility assessed using the WCST and addiction are inconsistent. Indeed, some studies reported impaired cognitive flexibility in substance-addicted (123) and non-substance-addicted (gambling, bulimia) individuals (124). However, others found no significant association between performance on the WCST and addiction (125)(126)(127). ...
Impulsivity refers to a tendency to act rapidly without full consideration of consequences. The trait is thought to result from the interaction between high arousal responses to potential rewards and poor self-control. Studies have suggested that impulsivity confers vulnerability to both addiction and obesity. However, results in this area are unclear, perhaps due to the high phenotypic complexity of addictions and obesity. Focusing on impulsivity, the aim of this review is to tackle the putative overlaps between addiction and obesity in four domains: (1) personality research, (2) neurocognitive tasks, (3) brain imaging, and (4) clinical evidence. We suggest that three impulsivity-related domains are particularly relevant for our understanding of similarities between addiction and obesity: lower self-control (high Disinhibition/low Conscientiousness), reward sensitivity (high Extraversion/Positive Emotionality), and negative affect (high Neuroticism/Negative Emotionality). Neurocognitive studies have shown that obesity and addiction are both associated with increased impulsive decision-making and attention bias in response to drug or food cues, respectively. Mirroring this, obesity and different forms of addiction seem to exhibit similar alterations in functional MRI brain activity in response to reward processing and during self-control tasks. Overall, our review provides an integrative approach to understand those facets of obesity that present similarities to addictive behaviors. In addition, we suggest that therapeutic interventions targeting inhibitory control may represent a promising approach for the prevention and/or treatment of obesity.
... Second, the rules of ingestion during SB aim at training patients to keep focused on a goal that is unrelated to binge food restriction. Specifically, patients would have to make their food rules more flexible, reorient planning abilities and ignore task irrelevant information [10,[13][14][15]. Pauses aim at training patients on command to inhibit the dominant compulsive ingestion of binge foods [10,16]. ...
Background and Objectives
A sizeable proportion of patients experiencing binge eating do not respond to cognitive behavioral therapy (CBT). We present the sequential binge (SB), a new behavioral intervention that complements CBT, and preliminary results of its effects. SB breaks up the binge into repeated identical sequences of eating separated by incremental pauses. This pattern of ingestion aims at facilitating boredom toward the ingested foods and at turning cognitive control away from binge food restriction. SB is hypothesized to reduce food intake during the binge and the number of daily binges.
Methods
Prospective pilot study. Fifteen binging patients with previous unsuccessful intensive CBT were given SB as an adjunct to their treatment and were followed up for 16 weeks from admission. All patients were reassessed 47 weeks on average after discharge.
Results
SB was associated with a 44% relative reduction in the planned food intake (p<0.001), a longer consecutive binge refractory period compared to regular binges (median: 48 hours versus 4 hours, p = 0.002) and an average relative reduction by 26% of binge number the day after each SB (p = 0.004). 47% of patients reached binge abstinence for four consecutive weeks 16 weeks after the first SB.
Conclusion
This case series shows promising evidence for the use of SB in patients with refractory binge eating. Further evaluation in a prospective randomized controlled trial would be justified.
... Cognitive 'rigidity' has been observed in studies that used the Wisconsin card-sorting test (e.g. Marazziti et al. 2008;Alvarez-Moya et al. 2009) and Set-shifting tasks (e.g. Choi et al. 2014). ...
In light of the upcoming eleventh edition of the International Classification of Diseases (ICD-11), the question arises as to the most appropriate classification of 'Pathological Gambling' ('PG'). Some academic opinion favors leaving PG in the 'Impulse Control Disorder' ('ICD') category, as in ICD-10, whereas others argue that new data especially from the neurobiological area favor allocating it to the category of 'Substance-related and Addictive Disorders' ('SADs'), following the decision in the fifth revision of the Diagnostic and Statistical Manual of Mental Disorders. The current review examines important findings in relation to PG, with the aim of enabling a well-informed decision to be made with respect to the classification of PG as a SAD or ICD in ICD-11. Particular attention is given to cognitive deficits and underlying neurobiological mechanisms that play a role in SADs and ICDs. These processes are impulsivity, compulsivity, reward/punishment processing and decision-making. In summary, the strongest arguments for subsuming PG under a larger SAD category relate to the existence of similar diagnostic characteristics; the high co-morbidity rates between the disorders; their common core features including reward-related aspects (positive reinforcement: behaviors are pleasurable at the beginning which is not the case for ICDs); the findings that the same brain structures are involved in PG and SADs, including the ventral striatum. Research on compulsivity suggests a relationship with PG and SAD, particularly in later stages of the disorders. Although research is limited for ICDs, current data do not support continuing to classify PG as an ICD.
... However, the WCST has yielded inconsistent results amongst individuals with PG. Both enhanced errors of perseveration in PG females [100] and lack of a difference from healthy controls [101,102] have been demonstrated. Increases in non-perseverative errors have been reported in PG during the WCST, suggesting that the observed impairments may not be specific to set-shifting but more of a broader cognitive dysfunction. ...
Cognitive constructs provide conceptual frame- works for transpathological characterization and improved phenotyping of apparently disparate psychiatric groups. This dimensional approach can be applied to the examination of individuals with behavioral addictions, for example, towards gambling, video-games, the internet, food, and sex, allowing operationalization of core deficits. We use this approach to review constructs such as impulsivity, compulsivity, and at- tention regulation, which may be most relevant, applicable, and successful for the understanding and subsequent treatment of the addictions.
... Perseveration tends to increase as demands on working memory increase, which may explain why this effect is only seen in Delay Blocks 40 and 60 (Stedron, Sahni, & Munakata, 2005). Compulsive behaviors (including perseveration) and impulsive behaviors are observed in a number of psychiatric conditions, including substance misuse and gambling disorders (Álvarez-Moya et al., 2009;Andersen & Teicher, 2009;de Ruiter et al., 2009;Lovallo, 2013). Whether compulsive and impulsive behaviors are a cause or a consequence of these disorders is a matter of some debate. ...
Adverse experiences during childhood are associated with the development of psychiatric disorders later in life. In particular, childhood abuse and neglect are risk factors for addictive disorders, such as substance misuse and pathological gambling. Impulsivity and compulsivity are key features of these disorders. Therefore, we investigated whether childhood adversity might increase vulnerability for addictive disorders through promotion of compulsive and impulsive behaviors. Rats were exposed to a brief, variable childhood or prepubertal stress protocol (Postnatal Days 25-27), and their behavior in a delay discounting task was compared with that of control animals in adulthood. Prepubertal stress produced compulsive-type behavior in females. Specifically, stressed females displayed inappropriate responses during a choice phase of the task, perseverating with nosepoke responding instead of choosing between 2 levers. Stressed females also showed learning impairments during task training. However, prepubertal stress was not associated with the development of impulsive behavior, as rates of delay discounting were not affected in either sex. Childhood adversity may contribute to the establishment and maintenance of addictive disorders by increasing perseveration in females. Perseverative behavior may therefore provide a viable therapeutic target for preventing the development of addictive disorders in individuals exposed to childhood adversity. These effects were not seen in males, highlighting sex differences in response to early life stress. (PsycINFO Database Record
(c) 2015 APA, all rights reserved).
... There is greater convergence of findings regarding the self-assessment of impulsivity in GD, with gamblers presenting higher scores than control individuals in all dimensions of the most-used self-report scales, such as the Barratt Impulsiveness Scale version 11 (BIS-11) and the urgency, premeditation, perseverance, sensation-seeking scale (UPPS), except for the sensation-seeking subdomain (Michalczuk et al., 2011). Conversely, some studies have failed to find differences in inhibitory control between GD individuals and matched controls (Lorains et al., 2014), but other features related to impulsivity, such as cognitive inflexibility and vulnerability to distraction, were found in GD patients (Álvarez-Moya et al., 2009). Even in the studies in which differences were found on both domains, self-assessment measures and neuropsychological testing remained utterly segregated in different dimensions (Kräplin et al., 2014). ...
... There is greater convergence of findings regarding the self-assessment of impulsivity in GD, with gamblers presenting higher scores than control individuals in all dimensions of the most-used self-report scales, such as the Barratt Impulsiveness Scale version 11 (BIS-11) and the urgency, premeditation, perseverance, sensation-seeking scale (UPPS), except for the sensation-seeking subdomain (Michalczuk et al., 2011). Conversely, some studies have failed to find differences in inhibitory control between GD individuals and matched controls (Lorains et al., 2014), but other features related to impulsivity, such as cognitive inflexibility and vulnerability to distraction, were found in GD patients (Álvarez-Moya et al., 2009). Even in the studies in which differences were found on both domains, self-assessment measures and neuropsychological testing remained utterly segregated in different dimensions (Kräplin et al., 2014). ...
... Evidences of a relation between decision-making failures and clinical characteristics were supported by means of a correspondence between performance on the IGT and obsessive-compulsive traits in BN, but not in AN (Liao et al., 2009). Nevertheless, since both AN and BN clinical groups did not perform within the negative range on the IGT (as is for instance the case with Ventromedial Prefrontal Cortex damaged patients), this can indicate that they were somewhat sensitive to punishment; therefore, their performance deficit may lie in faulty reward processing or in vulnerability to distraction (Alvarez-Moya et al., 2009). A recent study (Guillaume et al., 2010 ) found normal decisionmaking abilities from IGT in euthymic and non-medicated patients with ED, and researchers hypothesize that a cognitive bias on executive function may be related to depression and to its treatment with drugs, which can affect serotonine circuits. ...
... When asked to complete tasks requiring impulse inhibition, participants with BN performed worse than both control groups and those with AN (Jones, Duncan, Brouwers, & Mirsky, 1991;Kaye, Bastiani, & Moss, 1995;Lauer, Gorzewski, Gerlinghoff, Backmund, & Zihl, 1999). Another study found that performance on the WCST (Heaton et al., 1993) was significantly poorer among 15 women with BN compared to 15 healthy controls (Alvarez-Moya et al., 2009). Moreover, high levels of cognitive impulsivity are also implicated in the onset and maintenance of binge eating episodes (Steiger, Lehoux, & Gauvin, 1999). ...
... However, only one of these studies found significant group differences between BN patients and controls [11], and another reported impairments in AN-b patients [29]. With respect to interference control, the Stroop task has been used most commonly, with inconsistent findings in bulimic-type EDs [28,[30][31][32]. Thus, despite the clinical features and evidence from self-report measures, the current findings from neurocognitive tasks are ambiguous and have not been able to clearly demonstrate impaired inhibitory control in bulimic-type EDs. ...
The aim of this meta-analysis was to summarise data from neuropsychological studies on inhibitory control to general and disease-salient (i.e., food/eating, body/shape) stimuli in bulimic-type eating disorders (EDs). A systematic literature search was conducted to identify eligible experimental studies. The outcome measures studied included the performance on established inhibitory control tasks in bulimic-type EDs. Effect sizes (Hedges' g) were pooled using random-effects models. For inhibitory control to general stimuli, 24 studies were included with a total of 563 bulimic-type ED patients: 439 had bulimia nervosa (BN), 42 had anorexia nervosa of the binge/purge subtype (AN-b), and 82 had binge eating disorder (BED). With respect to inhibitory control to disease-salient stimuli, 12 studies were included, representing a total of 218 BN patients. A meta-analysis of these studies showed decreased inhibitory control to general stimuli in bulimic-type EDs (g = -0.32). Subgroup analysis revealed impairments with a large effect in the AN-b group (g = -0.91), impairments with a small effect in the BN group (g = -0.26), and a non-significant effect in the BED group (g = -0.16). Greater impairments in inhibitory control were observed in BN patients when confronted with disease-salient stimuli (food/eating: g = -0.67; body/shape: g = -0.61). In conclusion, bulimic-type EDs showed impairments in inhibitory control to general stimuli with a small effect size. There was a significantly larger impairment in inhibitory control to disease salient stimuli observed in BN patients, constituting a medium effect size.
... López et al [37] evaluaron 42 pacientes con BN y 42 controles sanos, encontrando alterada la coherencia central, y una asociación positiva con niveles de ansiedad en BN. Álvarez et al [38] también encontraron una alteración de la flexibilidad cognitiva al aplicar el WCST y el test de Stroop a 15 pacientes con BN, 15 con ludopatía y 15 controles sanos, pero compartida en los grupos con BN y ludopatía. Las pacientes con BN presentaban más errores no perseverativos en el WCST. ...
INTRODUCTION. Recent studies have shown that alterations to the executive cognitive functions may be endophenotypes of eating disorders. AIM. To perform a critical review of the literature on neuropsychological alterations in patients with eating disorders and their first-degree relatives. DEVELOPMENT. We review the papers written in English and in Spanish indexed in Medline and PsycINFO over the last 10 years. We included abstracts of papers that have still not been published and search terms were crossed. Excluding some isolated clinical cases, we obtained 41 studies on patients with anorexia nervosa (n = 17), bulimia nervosa (n = 5), both (n = 13) or a non-specific eating disorder (n = 6). CONCLUSIONS. The studies reviewed display important limitations due to their heterogeneous methodology and small samples, which give rise to contradictory results. Most of them were conducted on anorexia nervosa. Cognitive rigidity seems to be more frequent in patients with anorexia and their relatives, and alterations in decision-making or central coherence is more often found in bulimia nervosa. There is evidence suggesting that the neuropsychological alterations found in eating disorders are endophenotypes of the disease.
... The Stroop color-word test is a useful tool for assessing inhibitory control, one aspect of cognitive-control which is recruited to respond to attentional or response interference (Carter and van Veen, 2007;Kerns et al., 2004;MacDonald et al., 2000;MacLeod and MacDonald, 2000). The Stroop task has been widely used in behavioral and neuroimaging studies of psychiatric populations, including substance use disorders and proposed behavioral addictions such as pathological gambling (Keilp et al., 2005;Wright et al., 2003;Alvarez-Moya et al., 2009;Bolla et al., 2004;Brewer et al., 2008;MacLeod, 1991;McCusker and Gettings, 1997;Potenza et al., 2003). The incongruent stimuli in the Stroop paradigm require response inhibition to overcome increased cognitive interference, and IAD is thought to involve impaired inhibitory control. ...
'Internet addiction disorder' (IAD) is rapidly becoming a prevalent mental health concern in many countries around the world. The neurobiological underpinnings of internet addiction should be studied to unravel the potential heterogeneity in the disorder. The present study examines the neural correlates of response inhibition in males with and without IAD using an event-related functional magnetic resonance imaging (fMRI) Stroop task. The IAD group demonstrated significantly greater 'Stroop effect'-related activity in the anterior and posterior cingulate cortices compared with their healthy peers. These results may suggest diminished efficiency of response-inhibition processes in the IAD group relative to healthy controls.
... Rationale. Within severe impulse-related disorders, shared dysfunctional emotional regulatory processes and disinhibited personality traits (Alvarez-Moya et al., 2009; FernandezAranda et al., 2006; Harrison et al., 2010; Joos et al., 2011; Krug et al., 2008) are among the most difficult core symptoms to address, even with well-established evidence-based psychological therapies (Fernandez-Aranda et al., 2009a; Jimenez-Murcia et al., 2007; Klump et al., 2004). Due to the lack of effective strategies and adequate psychotherapy tools to remediate these cognitive and emotional processes, we have decided to consider approaches based on serious games. ...
Previous review studies have suggested that computer games can serve as an alternative or additional form of treatment in several areas (schizophrenia, asthma or motor rehabilitation). Although several naturalistic studies have been conducted showing the usefulness of serious video games in the treatment of some abnormal behaviours, there is a lack of serious games specially designed for treating mental disorders.
The purpose of our project was to develop and evaluate a serious video game designed to remediate attitudinal, behavioural and emotional processes of patients with impulse-related disorders.
The video game was created and developed within the European research project PlayMancer. It aims to prove potential capacity to change underlying attitudinal, behavioural and emotional processes of patients with impulse-related disorders. New interaction modes were provided by newly developed components, such as emotion recognition from speech, face and physiological reactions, while specific impulsive reactions were elicited. The video game uses biofeedback for helping patients to learn relaxation skills, acquire better self-control strategies and develop new emotional regulation strategies. In this article, we present a description of the video game used, rationale, user requirements, usability and preliminary data, in several mental disorders.
... Specifically, studies report deficits in cognitive inhibition, complex executive functions and attention. [9][10][11] This population also shows impairments in decision-making. [12][13][14] Decision-making impairments are observed in impulsive individuals in general. ...
Impairments in self-regulatory behaviour reflect a deficit in executive functioning and decision-making, as well as higher levels of self-reported impulsivity, and may be involved in the development and maintenance of addictive disorders. We sought to explore the association between self-reported impulsivity and neurocognitive measures, and their association with treatment outcome in pathologic gambling.
We assessed patients with pathologic gambling using executive functioning and decision-making tests and self-report measures of impulsivity. Patients underwent cognitive-behavioural therapy (CBT) for pathologic gambling.
We included 88 patients (8% women) in our study. High self-reported extravagance was associated with poor performance in the Iowa Gambling Task (IGT)-ABCD version. High impulsiveness, low disorderliness, high exploratory excitability (trend), poor backward block span and poor IGT-EFGH scores (trend) predicted dropout. We observed no self-reported or neurocognitive predictors of relapse or number of treatment sessions attended.
Most participants were slot-machine gamblers seeking treatment. No follow-up data and no control group were included in the study. The missing sample (i.e., individuals who were recruited and assessed in the pretreatment stage but who chose not to begin treatment) had higher extravagance scores than the final sample.
Neurocognitive reward sensitivity was related to self-reported overspending behaviour. Self-regulatory impairments (especially rash impulsiveness and punishment sensitivity) and executive dysfunction predicted only dropout of CBT in participants with pathologic gambling. Different neurocognitive processes and personality traits might mediate treatment response to psychological therapy of pathologic gambling according to the specific target variable assessed.
Objective:
Cognitive rigidity, or difficulty adapting to changing demands, is commonly observed in anorexia nervosa. Less is known, however, about cognitive flexibility (CF) in bulimia nervosa (BN) and, particularly, adolescence. Clarifying this relation and best assessment practices may guide informed clinical decision-making. The current study compared how two measures of CF (i.e., Wisconsin Card Sort Task [WCST] and Trail Making Task [TMT]) relate to BN symptoms among adolescents.
Methods:
Data from a subsample (n = 78) of adolescents with BN were analyzed. Linear and hurdle regressions were used to compare the effects of WCST perseverative errors and TMT performance on Eating Disorder Examination Global Scores, objective binge episodes, and self-induced vomiting episodes (SVEs) at baseline and end-of-treatment (EOT).
Results:
Neither CF measure associated with baseline BN symptoms. TMT performance positively associated with the likelihood of engaging in SVEs at EOT (𝛽 = 0.47, p = 0.01, 95% confidence interval [CI] = [0.11-0.84]) and, among adolescents who endorsed ≥1 SVE at EOT, WCST perseverative errors (𝛽 = 0.05, p = 0.005, 95% CI = [0.01-0.08]) positively associated with SVE frequency at EOT.
Discussion:
The overall lack of associations between CF and outcomes suggests that cognitive rigidity may not be as relevant to the clinical profile of adolescent BN as for anorexia nervosa. In the few significant associations that emerged, the WCST and TMT uniquely predicted the severity of vomiting at EOT in this sample. Given the lack of CF deficits, future work should aim to test the role of other executive functions (e.g., impulsivity), in addition to CF, to determine which deficits are present in adolescent BN and may predict outcomes.
Public significance:
Patients with eating disorders often have difficulties thinking flexibly, which may interfere with their recovery. We tested two ways of measuring flexible thinking in adolescents with BN. Overall, flexible thinking was not associated with symptom-level outcomes. However, less flexible thinking at the start of treatment predicted self-induced vomiting at EOT. If findings are replicable, then assessing and addressing flexible thinking could improve outcomes for adolescents with BN.
Background
Gambling disorder (GD) and bulimic spectrum eating disorders (BSDs) not only share numerous psychopathological, neurobiological, and comorbidity features but also are distinguished by the presence of inappropriate behaviours related to impulsivity and compulsivity. This study aimed to emphasise the differences and similarities in the main impulsivity and compulsivity features between GD and BSD patients, and to analyse the potential influence of sex in these domains.
Methods
Using self-reported and neurocognitive measures, we assessed different impulsive–compulsive components in a sample of 218 female and male patients (59 with BSD and 159 with GD) and 150 healthy controls.
Results
We observed that GD and BSDs exhibited elevated levels of impulsivity and compulsivity in all the dimensions compared to healthy controls. Moreover, these disorders showed differences in several personality traits, such as high novelty seeking in GD, and low persistence and high harm avoidance in BSDs. In addition, patients with BSDs also displayed a trend towards greater impulsive choice than GD patients. Regarding sex effects, GD women presented higher overall impulsivity and compulsivity than GD men. Nevertheless, no sex differences were found in BSDs.
Conclusions
Clinical interventions should consider these deficits to enhance their effectiveness, including adjunctive treatment to target these difficulties. Our findings also provide support to the relevance of sex in GD, which should also be considered in clinical interventions.
Objective
Prior work evaluating cognitive flexibility (i.e., the ability to alter behavior in response to environmental changes) in bulimia-spectrum eating disorders (BN-ED) has produced mixed findings, perhaps due to reliance on set-shifting paradigms that do not effectively isolate cognitive flexibility. Task-switching paradigms are more precise, but no study has examined task-switching in BN-ED. Further, no study has examined whether cognitive flexibility deficits in BN-ED are disorder-specific (e.g., confined to food-related responses). Thus, the present study re-evaluated cognitive flexibility in BN-ED using general and food-specific task-switching paradigms.
Method
Individuals with BN-ED (n = 28) and healthy controls (HC; n = 39) completed a cued color-shape switching task (CCSST) and a novel food-specific variation (FCCSST). We compared BN-ED and HC on switch costs (reflective of transient task-switching) and mix costs (reflective of maintenance of switching behavior).
Results
Switch and mix costs were not significantly different between BN-ED and HC in terms of either accuracy or reaction time on the CCSST or FCCSST.
Conclusions
Findings suggest neither general nor food-specific cognitive flexibility is impaired in BN-ED. Rigidity in BN-ED (e.g., continued engagement in compensatory behaviors despite psychoeducation that these behaviors are ineffective for weight loss) may be a result of other neurocognitive impairments rather than cognitive flexibility deficits.
Objective
This systematic review and meta‐analysis compared previously documented inefficiencies in central coherence and set‐shifting between people with nonunderweight eating disorders (bulimia nervosa and binge‐eating disorder) and people with anorexia nervosa.
Method
We performed random‐effects meta‐analyses on 16 studies (1,112 participants) for central coherence and 38 studies (3,505 participants) for set‐shifting. Random effects meta‐regressions were used to test whether the effect sizes for people with nonunderweight eating disorders were significantly different from the effect sizes for people with anorexia nervosa.
Results
People with anorexia nervosa (Hedge's g = −0.53, 95% CIs: −0.80, −0.27, p < .001) and bulimia nervosa (Hedge's g = −0.70, 95% CIs: −1.14, −0.25, p = .002), but not binge‐eating disorder, had significantly poorer central coherence than healthy controls. Similarly, people with anorexia nervosa (Hedge's g = −0.38, 95% CIs: −0.50, −0.26, p < .001) and bulimia nervosa (Hedge's g = −0.55, 95% CIs: −0.81, −0.29, p < .001), but not binge‐eating disorder, had significantly poorer set‐shifting than healthy controls. The effect sizes for people with nonunderweight eating disorders did not significantly differ from those for people with anorexia nervosa.
Discussion
Our meta‐analysis was underpowered to make definitive judgments about people with binge‐eating disorder. However, we found that people with bulimia nervosa clearly have central coherence and set‐shifting inefficiencies which do not significantly differ from those observed in people with anorexia nervosa. Clinically, this suggests that people with bulimia nervosa might benefit from adjunctive approaches to address these inefficiencies, such as cognitive remediation therapy.
Background and aims:
It has been suggested that compulsivity has an essential role in gambling disorder (GD), yet there is a lack of literature exploring the link between GD, compulsivity and gender. Our main aim was to explore gender differences between two of the neurocognitive domains of compulsivity (attentional set-shifting and attentional bias and disengagement) in patients with GD and compare them with healthy controls (HCs).
Methods:
The sample included 57 treatment-seeking adults with GD and 60 HCs recruited from the general population.
Results:
The pairwise comparisons showed a worse attentional set-shifting performance in women with GD than in men (total trials (p = 0.042, |d| = 0.56), perseverative responses (p = 0.001, |d| = 0.89), trails to complete the first category (p = 0.001, |d| = 0.78) and categories completed (p = 0.001, |d| = 0.98. Also, men with GD presented higher difficulties than HC men in the two assessed compulsivity domains (attentional bias and disengagement and attentional set-shifting; Stroop interference (p = 0.015, |d| = 0.11), TMT-B (p = 0.041, |d| = 1.96) and lower scores for the WCST perseverative responses (p = 0.007, |d| = 0.78), whereas the differences observed in women with GD and HCs were most significantly in attentional set-shifting.
Conclusions:
This study provides the first evidence of gender compulsivity differences in GD. The results are relevant for improving current treatments by targeting specific compulsivity domains that can lead to more successful treatment options.
The efficacy of cognitive-behavioral therapy (CBT) for pediatric obsessive-compulsive disorder (OCD) has been the subject of much study over the past fifteen years. Building on a foundation of case studies and open clinical trials, the literature now contains many methodologically sound studies that have compared full CBT protocols to waitlist controls, pill placebo, psychosocial comparison conditions, active medication, combined treatments, and brief CBT. This review is part of a series commissioned by The Canadian Institute for Obsessive Compulsive Disorders (CIOCD) in an effort to publish in one place what is known about the efficacy of treatments for OCD. A total of fourteen studies were identified; collectively their findings support the efficacy of CBT for youth with OCD. CBT protocols that emphasized either strictly behavioral or cognitive conceptualizations have each been found efficacious relative to waitlist controls. Efforts to enhance CBT׳s efficacy and reach have been undertaken. These trials provide guidance regarding next steps to be taken to maximize efficacy and treatment availability. Findings from studies in community clinics suggest that significant treatment benefits can be realized and are not reported only from within academic contexts. These findings bode well for broader dissemination efforts. Recommendations for future research directions are provided.
Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
Introduction:
Executive dysfunction can refer to both neurocognitive deficits and behavioral symptoms that include impaired judgment, slow decision making, disorganization, impulsiveness, and risk-taking behaviors. Executive dysfunction is relatively common in the post-stroke population but is often undetected. The impact of executive dysfunction on post-stroke driving is unclear but it may pose a risk to affected drivers and other road users.
Aim:
The aim of this study was to investigate the relationship between executive functioning following stroke and driving performance.
Methodology:
A case-control study design was used. Purposive sampling was used to recruit stroke participants (n=19) and healthy controls (n=22). Participants were screened using a battery of psychometric assessments including the Montreal Cognitive Assessment and the Benton Judgment of Line Orientation. Driving performance was assessed using the STISIM driving simulator. Executive function was assessed using the Behavioural Assessment of the Dysexecutive Syndrome (BADS) and the Trail Making Test Part B.
Results:
The control participants performed better than the stroke participants on the driving assessment and psychometric assessments. There was an association between the scores of the Trail Making Test Part B (Rho=0.34, p=0.034) and the Key Search Test of the BADS (Rho=-0.61, p=0.005), and the driving assessment scores. However, there was no association between the overall BADS scores and the driving assessment scores of the stroke participants.
Conclusions:
The stroke participants underperformed in the driving assessment and the psychometric assessments that detected neurocognitive deficits, which included executive function. The Trail Making Test Part B and Key Search Test of the BADS were related to identify participants' deterioration in driving performance. Practical Applications: In clinical practice, the latter could be used as an indication of a post-stroke driver's performance.
Impulsivity is considered a personality trait affecting behavior in many life domains, from recreational activities to important decision making. When extreme, it is associated with mental health problems, such as substance use disorders, as well as with interpersonal and social difficulties, including juvenile delinquency and criminality. Yet, trait impulsivity may not be a unitary construct. We review commonly used self-report measures of personality trait impulsivity and related constructs (e.g., sensation seeking), plus the opposite pole, control or constraint. A meta-analytic principal-components factor analysis demonstrated that these scales comprise 3 distinct factors, each of which aligns with a broad, higher order personality factor-Neuroticism/Negative Emotionality, Disinhibition versus Constraint/Conscientiousness, and Extraversion/Positive Emotionality/Sensation Seeking. Moreover, Disinhibition versus Constraint/Conscientiousness comprise 2 correlated but distinct subfactors: Disinhibition versus Constraint and Conscientiousness/Will versus Resourcelessness. We also review laboratory tasks that purport to measure a construct similar to trait impulsivity. A meta-analytic principal-components factor analysis demonstrated that these tasks constitute 4 factors (Inattention, Inhibition, Impulsive Decision-Making, and Shifting). Although relations between these 2 measurement models are consistently low to very low, relations between both trait scales and laboratory behavioral tasks and daily-life impulsive behaviors are moderate. That is, both independently predict problematic daily-life impulsive behaviors, such as substance use, gambling, and delinquency; their joint use has incremental predictive power over the use of either type of measure alone and furthers our understanding of these important, problematic behaviors. Future use of confirmatory methods should help to ascertain with greater precision the number of and relations between impulsivity-related components. (PsycINFO Database Record (c) 2013 APA, all rights reserved).
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The aim of this study was to examine morphometric features of the cerebral surface in adolescent and adult female subjects with bulimia nervosa (BN).
Anatomical magnetic resonance images were acquired from 34 adolescent and adult female subjects with BN and 34 healthy age-matched control subjects. We compared the groups in the morphological characteristics of their cerebral surfaces while controlling for age and illness duration.
Significant reductions of local volumes on the brain surface were detected in frontal and temporoparietal areas in the BN compared with control participants. Reductions in inferior frontal regions correlated inversely with symptom severity, age, and Stroop interference scores in the BN group.
These findings suggest that local volumes of inferior frontal regions are smaller in individuals with BN compared with healthy individuals. These reductions along the cerebral surface might contribute to functional deficits in self-regulation and to the persistence of these deficits over development in BN.
Obesity is a major problem of modern societies that sometimes, but not necessarily, is associated with binge-eating disorder (BED), a relatively new disorder characterized by binge eating without purging. The purpose of this article is to review the rationale for the potential use of pharmacological treatments in BED, and the potential use of the recently proposed compounds. Therefore, a careful medline of published articles from 1980 to December 2010 was carried out using the following keywords: BED and treatment, topiramate, zonisamide, sibutramine, venlafaxine, duloxetine, ghrelin, opiate blockers. Single case reports, observational studies, opinion articles, and studies concerning adults with syndromes resulting in BED (i.e., night eating syndrome) were also reviewed. All examined papers would indicate that the pharmacological treatment of BED is still heterogenous and poorly established, mainly for the lack of controlled studies in large samples of patients. In any case, the data on serotonin and norepinephrine reuptake inhibitors and on novel anticonvulsants seem quite promising in terms of efficacy and tolerability. In addition, the preliminary findings on the possibility of modulating appetite through the interference with the ghrelin system suggest new and intriguing ways of intervention in BED.
The aim of the study was to provide further and up to date information on the evaluation of the management of Anorexia and Bulimia nervosa at the Eating Disorders Unit (EDU) of the Ljubljana Psychiatric Clinic, based upon detailed assessment of the eating disorders specific and non specific symptoms of impulsive behaviors, highly correlated with these entities. 34 female patients with anorexia (restrictive or purgative type) and 38 female patients with Bulimia nervosa (purgative or non-purgative type) undergoing hospital treatment at the EDU were evaluated upon admission, as well as upon discharge and three and six months after discharge, using the Eating Disorder Questionnaire. Upon discharge a marked decrease in the overall symptoms was noted. The differences in symptoms incidences between the two groups were significantly specific for the individual form of eating disorder, especially upon admission, and were more pronounced in anorexia group. In later measurements, performed during the period of three and six months after discharge, a mild trend of increase in the disorder specific symptoms was detected in both groups, but was not statistically significant. In addition to binging on food, striking, quarreling and spending sprees are characteristics of patients with eating disorders, which in particular apply to the Bulimia nervosa group. Apart from the disorder specific symptoms, impulsive behavior was also reduced during study period, while the difference in its occurrence between the two groups gradually became non-significant. The management of patients with eating disorders at the EDU was successful in both groups, confirmed by an intense reduction of the disorder specific symptoms, impulsive behavior and increased stability recorded three and six months after discharge. The study strongly suggests that the effect of treatment regime for eating disorders can be predicted by careful assessment of the relevant symptoms and impulsive behavioral patterns.
Van den Eynde F, Guillaume S, Broadbent H, Stahl D, Campbell IC, Schmidt U, Tchanturia K. Neurocognition in bulimic eating disorders: a systematic review.
Objective: The aim of this study was to review the literature on neurocognition comparing people with a bulimic eating disorder in the acute phase of the illness with healthy controls (HC).
Method: The review follows the PRISMA (preferred reporting items for systematic reviews and meta-analysis) statement guidelines. Three databases (Medline, Web of Science, and Scopus) were searched combining the search terms ‘bulimic disorder’, ‘bulimia nervosa (BN)’, ‘binge-eating disorder (BED)’ with terms referring to cognitive domains (e.g. ‘executive functions’).
Results: Thirty-seven studies on people with BN and four on people with BED were selected for review. Overall, sample sizes were relatively small [bulimic disorders: median and range 22 (12–83); HC: 27 (13–172)]. The diversity in methodology precluded a meta-analytical approach. People with a bulimic disorder did not present with a clear neurocognitive profile. Inclusion of salient, disorder-related stimuli (e.g. body weight/shape words) in the neurocognitive paradigms tended to generate differences between people with a bulimic disorder and HC.
Conclusion: Neurocognition in bulimic eating disorders is under researched, and the available evidence is inconclusive. This review outlines strategies for further research in this area.
To explore the psychometric properties of the Cross-Cultural Questionnaire (CCQ), a new self-report tool for assessing factors of risk and maintenance for eating disorders (ED).
Data was collected during a multi-centre case-control study. The sample included 854 ED patients and 784 healthy participants from the UK, Spain, Austria, Slovenia and Italy. Exploratory factor analyses examined the factor structure of each section of the CCQ, and Cronbach's alpha coefficients valued the internal consistency of each derived scale score. Logistic regression and receiver operating characteristic (ROC) curve procedure assessed the screening accuracy and predictive validity of the empirical factors.
Based on a total of 127 items, nine dimensions emerged, with satisfactory internal consistency and high congruence between countries. CCQ scores demonstrated satisfactory accuracy for discriminating between ED cases and controls (area under the ROC curve = 0.88). Most of the items achieved discriminative accuracy.
This study offers preliminary evidence that the CCQ, available in five languages, is a useful and valid tool to assess factors of risk and maintenance for EDs.
The EDI-3 consists of 91 items organized onto 12 primary scales, consisting of 3 eating-disorder-specific scales and 9 general psychological scales that are highly relevant to, but not specific to,
eating disorders. It also yields six composites: one that is eating-disorder specific (i.e., Eating Disorder Risk) and five that are general integrative psychological constructs (i.e., Ineffectiveness,
Interpersonal Problems, Affective Problems, Overcontrol, General Psychological Maladjustment).
Psychological Assessment Resources (PAR) owns the copyright for the EDI (EDI, EDI-2, EDI-3, EDI-RF) and the manuals, tests and scoring
sheets can be ordered from PAR at www.parinc.com. The EDI is strictly protected under copyright laws.
Permissions Requests:
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BACKGROUND: The pathophysiology of eating disorders is still unknown, with many factors possibly involved. The existence of a central nervous system (CNS) dysfunction is being investigated with particular interest. One of the most employed strategies to reach this goal is the evaluation of cognitive functioning of patients with eating disorders with neuropsychological tests. OBJECTIVE: To evaluate the current knowledge about the neuropsychology of ED. METHODS: We performed a review of several data bases (including MedLINE, PsychoINFO, LILACS and Cochrane Data Bank), using terms related to main theme of interest. The review comprised articles published up to January, 2004. RESULTS: Anorexia Nervosa (AN) was t he most studied ED from the neuropsychological point-of-view, with studies tending to elicit attentive, visuo-spatial, and visuo-constructive deficits among such patients. On the other side, patients with Bulimia Nervosa (BN) exhibited déficits in the selective aspects of attention and in executive functions. As yet, there is no study covering the neuropsychological aspects of binge-eating disorder. After successful treatment, individuals show improvement of some cognitive deficits, while other seem to persist. CONCLUSIONS: The ED are possibly associated with a certain degree of neuropsychological dysfunction, even though there is no consesus with regard to which function is particularly impaired. The fact that some cognitive dysfunction tend to disappear after treatment argues in favor of the hypothesis that these are functional deficits. Other deficits, however, tend to persist, suggesting that they may precede the development of eating disorders or even contribute to their development or to a worse prognosis. The study of the neuropsychological aspects of ED may help tailoring more selective therapeutic approaches to patients suffering from these disorders.
Objective: The prevalence of eating disorders (EDs) in a representative scholastic sample was evaluated, and the demo-graphic factors associated with ED were assessed. Method: The study used a two-stage epidemiological design. The study population was a randomly selected sample of 1545 students (12-to 21-year-old males and females) in the region of Madrid (Spain). Results: ED prevalence was 3.43%. Prevalence estima-tions were as follows: 5.34% for females: 2.72% for eating disorders not otherwise specified (EDNOS), 2.29% for bulimia nervosa (BN), and 0.33% for anorexia nervosa (AN); and 0.64% for males: 0.48% for EDNOS, 0.16% for BN, and 0.00% for AN. Some demographic factors that were shown to be associated with ED included the following: sex, age, single child, single-parent families, and father or mother's death. Discussion: Despite the methodological improvements over previous epidemiological studies developed in Spain, there were no significant differences in the prevalence estimations.
The present project utilized the Five Factor Model of personality (FFM; McCrae & Costa, 1990) to clarify the multi-faceted nature of impulsivity. The NEO-PI-R and a number of commonly used impulsivity measures were administered to over 400 young adults. Exploratory factor analyses identified four distinct personality facets associated with impulsive-like behavior which were labeled urgency, (lack of) premeditation, (lack of) perseverance, and sensation seeking. Each of these traits was marked by a different facet of the FFM. Following the initial factor identification, scales to measure each of the personality facets were created and combined to form the UPPS Impulsive Behavior scale. Implications for the understanding of impulsive behavior and the FFM are discussed, as are future applications of the UPPS impulsive behavior scale.
Alcohol 'cognitions' were explored using an implicit methodology [Stacy, Leigh and Weingardt, 1994]. In Study 1, an Associations Questionnaire was developed with young adult undergraduates (median=20 years) comprising culturally available (i.e., high-frequency occurrence) and idiosyncratic (i.e., low-frequency occurrence) positive and negative alcohol consumption outcomes and positive and negative outcomes of behaviors-other-than-alcohol consumption. In Study 2, the relationship was explored between the alcohol consumption of young adult undergraduates (median AGE=19 years) and implicit alcohol-related associations made through the Associations Questionnaire. A significant positive relationship was found between consumption and positive and negative culturally available (experimental) outcomes but not for the other two types of (control) outcome. In Study 3, the relationship between alcohol consumption and alcohol-related associations was explored in mature adults (median=45 years) with many more years' drinking experience. The results of Study 1 were replicated except that a significant positive relationship between consumption and some control outcomes was now found—e.g., negative outcomes of what where hitherto behaviors-other-than-alcohol consumption. In Study 4, however, using the same techniques that were used to develop the Associations Questionnaire in Study 1, an extended set of negative alcohol consumption outcomes was found in mature adults (median=44 years) that included a proportion of the negative outcomes of behaviors-other-than-alcohol consumption that had served as controls in Studies 2 and 3. A reanalysis of the data from Study 3, with such items removed from the controls and designated 'new' negative alcohol consumption outcomes, showed a positive relationship between consumption and implicit alcohol-related associations made through these 'new' items of the Associations Questionnaire. The changing profile of associations with negative outcomes of consumption is discussed and related to negative expectancy research and drinking restraint. Yes Yes
The South Oaks Gambling Screen is a 20-item questionnaire based on DSM-III criteria for pathological gambling. It may be self-administered or administered by nonprofessional or professional interviewers. A total of 1,616 subjects were involved in its development: 867 patients with diagnoses of substance abuse and pathological gambling, 213 members of Gamblers Anonymous, 384 university students, and 152 hospital employees. Independent validation by family members and counselors was obtained for the calibration sample, and internal consistency and test-retest reliability were established. The instrument correlates well with the criteria of the revised version of DSM-III (DSM-III-R). It offers a convenient means to screen clinical populations of alcoholics and drug abusers, as well as general populations, for pathological gambling.
The pathophysiology of eating disorders is still unknown, with many factors possibly involved. The existence of a central nervous system (CNS) dysfunction is being investigated with particular interest. One of the most employed strategies to reach this goal is the evaluation of cognitive functioning of patients with eating disorders with neuropsychological tests.
To evaluate the current knowledge about the neuropsychology of ED.
We performed a review of several data bases (including MedLINE, PsychoINFO, LILACS and Cochrane Data Bank), using terms related to main theme of interest. The review comprised articles published up to January, 2004.
Anorexia Nervosa (AN) was the most studied ED from the neuropsychological point-of-view, with studies tending to elicit attentive, visuo-spatial, and visuo-constructive deficits among such patients. On the other side, patients with Bulimia Nervosa (BN) exhibited deficits in the selective aspects of attention and in executive functions. As yet, there is no study covering the neuropsychological aspects of binge-eating disorder. After successful treatment, individuals show improvement of some cognitive deficits, while other seem to persist.
The ED are possibly associated with a certain degree of neuropsychological dysfunction, even though there is no consensus with regard to which function is particularly impaired. The fact that some cognitive dysfunction tend to disappear after treatment argues in favor of the hypothesis that these are functional deficits. Other deficits, however, tend to persist, suggesting that they may precede the development of eating disorders or even contribute to their development or to a worse prognosis. The study of the neuropsychological aspects of ED may help tailoring more selective therapeutic approaches to patients suffering from these disorders.
Little population-based data exist on the prevalence or correlates of eating disorders.
Prevalence and correlates of eating disorders from the National Comorbidity Replication, a nationally representative face-to-face household survey (n = 9282), conducted in 2001-2003, were assessed using the WHO Composite International Diagnostic Interview.
Lifetime prevalence estimates of DSM-IV anorexia nervosa, bulimia nervosa, and binge eating disorder are .9%, 1.5%, and 3.5% among women, and .3% .5%, and 2.0% among men. Survival analysis based on retrospective age-of-onset reports suggests that risk of bulimia nervosa and binge eating disorder increased with successive birth cohorts. All 3 disorders are significantly comorbid with many other DSM-IV disorders. Lifetime anorexia nervosa is significantly associated with low current weight (body-mass index <18.5), whereas lifetime binge eating disorder is associated with current severe obesity (body-mass index > or =40). Although most respondents with 12-month bulimia nervosa and binge eating disorder report some role impairment (data unavailable for anorexia nervosa since no respondents met criteria for 12-month prevalence), only a minority of cases ever sought treatment.
Eating disorders, although relatively uncommon, represent a public health concern because they are frequently associated with other psychopathology and role impairment, and are frequently under-treated.
The aim was to critically appraise and synthesize the literature relating to set-shifting ability in eating disorders. PsycINFO, Medline, and Web of Science databases were searched to December 2005. Hand searching of eating-disorder journals and relevant reference sections was also undertaken.
The 15 selected studies contained both eating disorder and healthy control groups, and employed at least one of the following six neuropsychological measures of set-shifting ability; Trail Making Test (TMT), Wisconsin Card Sort Test (WCST), Brixton task, Haptic Illusion, CatBat task, or the set-shifting subset of the Cambridge Neuropsychological Test Automated Battery (CANTAB). The outcome variable was performance on the set-shifting aspect of the task. Pooled standardized mean differences (effect sizes) were calculated.
TMT, WCST, CatBat and Haptic tasks had sufficient sample sizes for meta-analysis. These four tasks yielded acceptable pooled standardized effect sizes (0.36; TMT -1.05; Haptic) with moderate variation within studies (as measured by confidence intervals). The Brixton task showed a small pooled mean difference, and displayed more variation between sample results. The effect size for CANTAB set shifting was 0.17.
Problems in set shifting as measured by a variety of neuropsychological tasks are present in people with eating disorders.
Anorexia nervosa (AN) is a severe mental illness. Drug treatments are not effective and there is no established first choice psychological treatment for adults with AN. Neuropsychological studies have shown that patients with AN have difficulties in cognitive flexibility: these laboratory based findings have been used to develop a clinical intervention based on Cognitive Remediation Therapy (CRT) which aims to use cognitive exercises to strengthen thinking skills.
1) To conduct a preliminary investigation of CRT in patients with AN 2) to explore whether cognitive training improves performance in set shifting tasks 3) to explore whether CRT exercises are appropriate and acceptable to AN patients 4) to use the data to improve a CRT module for AN patients.
Intervention was comprised of ten 45 minute sessions of CRT. Four patients with AN were assessed before and after the ten sessions using five set shifting tests and clinical assessments. At the end, each patient wrote a letter providing feedback on the intervention.
Post intervention, three of the five set shifting assessments showed a moderate to large effect size in performance and two showed a large effect size in performance, both indicative of improved flexibility. Patients were aware of an improvement in their cognitive flexibility qualitative feedback was generally positive towards CRT.
This preliminary study suggests that CRT changed performance on flexibility tasks and may be beneficial for acute, treatment resistant patients with AN. Feedback gathered from this small case series has enabled modification of the intervention for a future larger study, for example, by linking exercises with real life behavioural tasks and including exercises that encourage global thinking.
This exploratory study has produced encouraging data supporting the use of CRT in patients with AN: it has also provided insight into how the module should be tailored to maximise its effectiveness for people with acute AN.
The objective of the study was to assess the predictive value of personality profiles to classify individuals with bulimia nervosa (BN), pathological gambling (PG), and a nonpsychiatric comparison group while controlling for sex.
The sample comprised 270 BN (241 women, 29 men), 429 PG (42 women, 387 men), and 96 comparison (nonpsychiatric) subjects (35 women, 61 men). All patients were consecutively admitted to our Psychiatry Department and were diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision criteria. We administered the Temperament and Character Inventory-Revised as well as other clinical indices. Multinomial and binary logistic regression models adjusted for age and stratified by sex were used to assess the predictive value of personality in relation to group status.
In comparison to controls, high Novelty Seeking (P < .001) was specifically associated with a diagnosis of PG. Independently of sex, low Self-Directedness was associated with both BN (P < .001) and PG (P < .001). Some sex-specific differences were also observed; namely, women with BN and PG displayed higher Harm Avoidance and Cooperativeness than control women, whereas men with PG reported higher Reward Dependence and Persistence than control men.
Our results suggested that, whereas there are some shared personality traits between BN and PG when compared with healthy controls, there are also some sex- and diagnostic-specific personality traits that weigh against the consideration of BN as an impulse control disorder.
Pathological gambling (PG) is an impulse control disorder characterized by persistent and maladaptive gambling behaviors with disruptive consequences for familial, occupational and social functions. The pathophysiology of PG is still unclear, but it is hypothesized that it might include environmental factors coupled with a genetic vulnerability and dysfunctions of different neurotransmitters and selected brain areas. Our study aimed to evaluate a group of patients suffering from PG by means of some neuropsychological tests in order to explore the brain areas related to the disorder.
Twenty outpatients (15 men, 5 women), with a diagnosis of PG according to DSM-IV criteria, were included in the study and evaluated with a battery of neuropsychological tests: the Wisconsin Card Sorting Test (WCST), the Wechsler Memory Scale revised (WMS-R) and the Verbal Associative Fluency Test (FAS). The results obtained in the patients were compared with normative values of matched healthy control subjects.
The PG patients showed alterations at the WCST only, in particular they had a great difficulty in finding alternative methods of problem-solving and showed a decrease, rather than an increase, in efficiency, as they progressed through the consecutive phases of the test. The mean scores of the other tests were within the normal range.
Our findings showed that patients affected by PG, in spite of normal intellectual, linguistic and visual-spatial abilities, had abnormalities emerging from the WCST, in particular they could not learn from their mistakes and look for alternative solutions. Our results would seem to confirm an altered functioning of the prefrontal areas which might provoke a sort of cognitive "rigidity" that might predispose to the development of impulsive and/or compulsive behaviors, such as those typical of PG.
Bulimic (n = 23) and control subjects (n = 28) were compared on four neuropsychological tests and several clinical variables. Between‐group differences were observed on neuropsychological measures that reflected marked impulsivity and problem‐solving deficits in the bulimics. Additional between‐group comparisons, based on the variability of performance on the neuropsychological tests, revealed that bulimics were more variable than controls on approximately 50% of the tests given. Performance variability on the remaining two tests was equal across the bulimic and control groups. This represents the first known application of this performance variability analysis in subjects with bulimia nervosa. It is proposed that there may be considerable variability in performance among bulimics and that by examining performance from this “sub‐group” perspective may lead to a more analytic understanding of this eating disorder. © 1997 John Wiley & Sons, Inc.
Objectives
The aim of this study was to determine whether or not there are gender differences in personality, clinical features and associated traits in people with an eating disorder (ED)Method
The participants consisted of 40 ED patients (20 males and 20 females) consecutively admitted to our hospital. The two groups were matched in terms of age, diagnosis and duration of illness. All patients fulfilled DSM-IV-R criteria for those pathologies.AssessmentAssessment measures included the Eating Disorders Inventory-2 (EDI-2), the Symptom Check List (SCL-90-R) and the Temperament and Character Inventory-R (TCI-R), as well as a number of other clinical and psychopathological indices.ResultsIn terms of personality traits, the males demonstrated less harm avoidance (p < 0.025) compared to females. Males showed significantly lower scores on drive for thinness (p < 0.007), impulse regulation (p < 0.043) and body dissatisfaction (p < 0.01). There were no gender differences on other symptomatological and psychopathological measures. The male group gave a history of premorbid overweight or obesity more frequently (45% vs 15%, p < 0.038)Conclusions
The results of this study indicate that there were few gender differences in personality and psychological traits. However, higher premorbid obesity and overweight are more common antecedent factors in males. Copyright © 2004 John Wiley & Sons, Ltd and Eating Disorders Association.
The purpose of this study is to explore the effect of sex as a moderator variable for gambling and clinical profiles in a large sample of Spanish treatment-seeking patients for pathologic gambling (PG).
Clinical and personality profiles were compared between 143 male and 143 female pathologic gamblers who sought consultation at a specialized hospital unit. Multiple regressions explored the incremental predictive accuracy of sex on PG severity in consideration of sociodemographic and psychologic characteristics.
Men gambled most frequently using slot machines and lotteries, spent more money, and had most arguments with family and friends. Although the age of onset of PG was 7.1 years higher for females, the severity was equal for both sexes. Women evidenced more general psychopathology, with higher mean scores in all the Symptom ChekList-90 items scales (except for hostility and psychoticism), and had significantly higher scores for harm avoidance and lower scores for self-directedness than the male group. However, sex alone did not obtain a significant incremental validity for PG severity.
These results may provide guidance for obtaining accurate diagnostic information about PG, properly identifying patients with specific needs and planning sex-specific targets.
Compared the factor structure of the Sensation-Seeking Scale (SSS) in English and American samples, and constructed a new form of the SSS, applicable to both groups. The English Ss consisted of 254 males and 639 females from the Maudsley Twin Register, ages 15–70 yrs. The American sample included 97 male and female undergraduates. Three of the 4 factors showed good cross-national and cross-sex reliability (i.e., significant and reasonably high resemblance between the 4 national and sex symbols). English and American males did not differ on the total SSS score, but American females scored higher than English females. Males in both countries scored higher than females on the total SSS score and on the Thrill and Adventure-Seeking and Disinhibition subscales. Significant age declines occurred for both sexes, particularly on Thrill and Adventure Seeking and Disinhibition. (24 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Bulimic (n = 23) and control subjects (n = 28) were compared on four neuropsychological tests and several clinical variables. Between-group differences were observed on neuropsychological measures that reflected marked impulsivity and problem-solving deficits in the bulimics. Additional between-group comparisons, based on the variability of performance on the neuropsychological tests, revealed that bulimics were more variable than controls on approximately 50% of the tests given Performance variability on the remaining two tests was equal across the bulimic and control groups. This represents the first known application of this performance variability analysis in subjects with bulimia nervosa. It is proposed that there may be considerable variability in performance among bulimics and that by examining performance from this "sub-group" perspective may lead to a more analytic understanding of this eating disorder.
The study of smoker's personality has a long and controversial history. Smokers tend to be more extroverted, tense, and anxious and have more antisocial characteristics than nonsmokers. However, some of the data is contradictory, and the strength of the relationship between personality and smoking is weak, probably because smokers are not a homogeneous group. To test this possibility, we used cluster analysis to identify types of smokers in a general population sample. Using Ward's heirarchical clustering algorithm, two clusters were identified from the scores on 10 personality measures in 346 smokers. The smaller cluster (28.8% of the smokers) was higher on neuroticism-related characteristics. The clusters were not different on extroversion-related measures, but people in the smaller cluster were more likely to have symptoms of alcoholism and to have more drinking-related problems (although they didn't actually drink more). They were also younger, had lower income, and were antisocial. The pattern of results suggests that there is a subpopulation of smokers who are more anxious than other smokers and who have strong antisocial tendencies.
The specificity of the Wisconsin Card Sorting Test (WCST) as a marker of frontal lobe pathology remains controversial. One problem is the lack of a well established correspondence between WCST errors and specific cognitive or neural processes. The conventional scoring of non-perseverative WCST errors does not discriminate between errors related to the efficient test of hypotheses during set shifting ('efficient errors'), and random failures to maintain set ('random errors'). This inherent confusion in the non-perseverative error score probably minimizes the relative importance of random errors in frontal lobe pathology. In this study, we used a WCST version sensitive to differences between 'efficient' and random errors to examine set shifting deficits in patients with focal lesions to their lateral prefrontal cortex. As expected, patients showed abnormally high rates of perseverative errors. Interestingly, patients also showed enhanced rates of random errors suggesting constant shifts or fluctuations in their choice of sorting principle. These results suggest that more sensitive tests are needed to elucidate the association between a specific type of set shifting error and a particular type of frontal lobe pathology.
Endophenotypes, measurable components unseen by the unaided eye along the pathway between disease and distal genotype, have emerged as an important concept in the study of complex neuropsychiatric diseases. An endophenotype may be neurophysiological, biochemical, endocrinological, neuroanatomical, cognitive, or neuropsychological (including configured self-report data) in nature. Endophenotypes represent simpler clues to genetic underpinnings than the disease syndrome itself, promoting the view that psychiatric diagnoses can be decomposed or deconstructed, which can result in more straightforward-and successful-genetic analysis. However, to be most useful, endophenotypes for psychiatric disorders must meet certain criteria, including association with a candidate gene or gene region, heritability that is inferred from relative risk for the disorder in relatives, and disease association parameters. In addition to furthering genetic analysis, endophenotypes can clarify classification and diagnosis and foster the development of animal models. The authors discuss the etymology and strategy behind the use of endophenotypes in neuropsychiatric research and, more generally, in research on other diseases with complex genetics.
One of the primary personality dimensions or traits that has consistently been linked to substance abuse is impulsivity. However, impulsivity is not a homogenous construct and although many of the measures of impulsivity are correlated, the most recent review of published factor analytic studies has proposed two independent dimensions of impulsivity: reward sensitivity, reflecting one of the primary dimension of J. A. Gray's personality theory, and rash impulsiveness. These two facets of impulsivity derived from the field of personality research parallel recent developments in the neurosciences where changes in the incentive value of rewarding substances has been linked to alterations in neural substrates involved in reward seeking and with a diminished capacity to inhibit behavior due to chronic drug exposure. In this paper, we propose a model that integrates the findings from research into individual differences with recent models of neural substrates implicated in the development of substance misuse.
To explore the neural substrates corresponding to the perseverative errors in the Wisconsin Card Sorting Test (WCST).
The study examined the correlations between the WCST performances and the SPECT measurements of regional cerebral blood flow (rCBF) in subjects with neurodegenerative dementia. Negative non-linear correlations between the rCBF and the two different types of the perseverative errors ("stuck-in-set" and "recurrent" perseverative errors) were calculated on a voxel basis and volume-of-interest basis in the mixed groups of 72 elderly and dementia patients.
The stuck-in-set perseverative error was associated with the reduced rCBF in the rostrodorsal prefrontal cortex, whereas the recurrent perseverative error was related to the left parietal activity but not to the prefrontal activity.
These findings augment evidence that the rostrodorsal prefrontal cortex crucially mediates attentional set shifting, and suggest that the stuck-in-set perseverative errors would be a true pathognomonic sign of frontal dysfunction. Moreover, this study shows that the recurrent perseverative errors may not be associated closely with the prefrontal function, suggesting that this error and the stuck-in-set error should be differentially estimated in the WCST.
Pathological gambling (PG) is most likely associated with functional brain changes as well as neuropsychological and personality alterations. Recent research with the Iowa Gambling Task suggests decision-making impairments in PG. These deficits are usually attributed to disturbances in feedback processing and associated functional alterations of the orbitofrontal cortex. However, previous studies with other clinical populations found relations between executive (dorsolateral prefrontal) functions and decision-making using a task with explicit rules for gains and losses, the Game of Dice Task. In the present study, we assessed 25 male PG patients and 25 male healthy controls with the Game of Dice Task. PG patients showed pronounced deficits in the Game of Dice Task, and the frequency of risky decisions was correlated with executive functions and feedback processing. Therefore, risky decisions of PG patients might be influenced by both dorsolateral prefrontal and orbitofrontal cortex dysfunctions.
To present nationally representative data on lifetime prevalence and comorbidity of pathological gambling with other psychiatric disorders and to evaluate sex differences in the strength of the comorbid associations.
Data were derived from a large national sample of the United States. Some 43,093 household and group quarters residents age 18 years and older participated in the 2001-2002 survey. Prevalence and associations of lifetime pathological gambling and other lifetime psychiatric disorders are presented. The diagnostic interview was the National Institute on Alcohol Abuse and Alcoholism Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-IV Version. Fifteen symptom items operationalized the 10 pathological gambling criteria.
The lifetime prevalence rate of pathological gambling was 0.42%. Almost three quarters (73.2%) of pathological gamblers had an alcohol use disorder, 38.1% had a drug use disorder, 60.4% had nicotine dependence, 49.6% had a mood disorder, 41.3% had an anxiety disorder, and 60.8% had a personality disorder. A large majority of the associations between pathological gambling and substance use, mood, anxiety, and personality disorders were overwhelmingly positive and significant (p < .05), even after controlling for sociodemographic and socioeconomic characteristics. Male sex, black race, divorced/separated/widowed marital status, middle age, and living in the West and Midwest were associated with increased risk for pathological gambling. Further, associations between alcohol dependence, any drug use disorder, drug abuse, nicotine dependence, major depressive episode, and generalized anxiety disorder and pathological gambling were stronger among women than men (p > .05).
Pathological gambling is highly comorbid with substance use, mood, anxiety, and personality disorders, suggesting that treatment for one condition should involve assessment and possible concomitant treatment for comorbid conditions.
The specific role of particular cerebral regions with regard to executive functions remains elusive. We conducted a functional magnetic resonance imaging (fMRI) study to segregate different network components underlying the Wisconsin Card Sorting Test (WCST), a test widely applied clinically to assess executive abilities. Three different test variants of the WCST, differing in task complexity (A > B > C), were contrasted with a high-level baseline condition (HLB). Cognitive subcomponents were extracted in a serial subtraction approach (A-C, A-B, B-C). Imaging data were further subjected to a correlational analysis with individual behavioral parameters. Contrasting A with the HLB revealed the entire neural network underlying WCST performance, including frontoparietal regions and the striatum. Further analysis showed that, within this network, right ventrolateral prefrontal cortex related to simple working memory operations, while right dorsolateral prefrontal cortex related to more complex/manipulative working memory operations. The rostral anterior cingulate cortex (ACC) and the temporoparietal junction bilaterally represented an attentional network for error detection. In contrast, activation of the caudal ACC and the right dorsolateral prefrontal cortex was associated with increased attentional control in the context of increasing demands of working memory and cognitive control. Non-frontal activations were found to be related to (uninstructed relative to instructed) set-shifting (cerebellum) and working memory representations (superior parietal cortex, retrosplenium). The data provide neural correlates for the different cognitive components involved in the WCST. They support a central role of the right dorsolateral prefrontal cortex in executive working memory operations and cognitive control functions but also suggest a functional dissociation of the rostral and caudal ACC in the implementation of attentional control.
Pathological gambling is a relatively prevalent psychiatric disorder that typically leads to severe family, social, legal, and occupational problems and is associated with a high rate of suicide attempts. Understanding the neurobiological basis of pathological gambling is a current focus of research, and emerging data have demonstrated that pathological gamblers may have impaired decision-making because of an inability to inhibit irrelevant information. In this study, we examined pathological gamblers by using the Stroop Color-Word Test, a neurocognitive task used to assess interference control. The "reverse" variant of the Stroop Color-Word Test was administered to a cohort of medication-free pathological gamblers (n=62) and a cohort of age-matched controls (n=83). In the reverse variant of the Stroop task, subjects are asked to read the meaning of the word rather than name the ink color. The reverse Stroop task was chosen because it highly discriminates ability to inhibit interference in a population of psychiatric patients. In our study, performance on the reverse Stroop task in the pathological gamblers was significantly slower and less accurate than in the healthy subjects. A new finding in our study was that for pathological gamblers, the average reaction time in the neutral condition (where the color names are displayed in black letters) was slower than the average reaction time in the incongruent condition (where the meaning of the color name and the color of the printed letters are different). This controlled study extends previous findings by showing that performance on the Stroop task is impaired in a sample of medication-free pathological gamblers.
Few studies have explored impulse control disorders (ICDs) in women with bulimia nervosa (BN). We explored the prevalence of lifetime ICDs in women with BN, compared the severity of eating disorder symptoms in women with BN with and without ICD, and compared their personality profiles to females with one form of ICD, namely, pathologic gambling.
A total sample of 269 female patients consecutively admitted to our unit participated in the current study (173 BN without comorbid ICD [BN - ICD]; 54 BN with comorbid ICD [BN + ICD]; and 42 pathologic gamblers [PG]). All participants were diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria.
Assessment measures included the Symptom Checklist-90 revised and the Temperament and Character Inventory-revised, as well as a number of other clinical and psychopathologic indices.
In BN, the observed lifetime prevalence of ICD was 23.8%. Lifetime compulsive buying (17.6%) and intermittent explosive disorder (13.2%) were the most frequently reported ICD. Bulimia nervosa subtype was not significantly associated with lifetime ICD (P = .051) or with ICD subtype (P = .253). After using multinomial regression models, we observed that BN + ICD and PG showed the highest scores on novelty seeking (P < .0001). But BN + ICD women had the lowest scores on self-directedness (P < .03) and higher scores on general psychopathology (P < .01) and drug abuse (P < .01).
Individuals with BN + lifetime ICD presented more extreme personality profiles, especially on novelty seeking and impulsivity, and general psychopathology than individuals with BN without ICD. On some personality traits, those BN + ICD more closely resembled individuals with PG than those with BN without ICD.
The prevalence of eating disorders (EDs) in a representative scholastic sample was evaluated, and the demographic factors associated with ED were assessed.
The study used a two-stage epidemiological design. The study population was a randomly selected sample of 1545 students (12- to 21-year-old males and females) in the region of Madrid (Spain).
ED prevalence was 3.43%. Prevalence estimations were as follows: 5.34% for females: 2.72% for eating disorders not otherwise specified (EDNOS), 2.29% for bulimia nervosa (BN), and 0.33% for anorexia nervosa (AN); and 0.64% for males: 0.48% for EDNOS, 0.16% for BN, and 0.00% for AN. Some demographic factors that were shown to be associated with ED included the following: sex, age, single child, single-parent families, and father or mother's death.
Despite the methodological improvements over previous epidemiological studies developed in Spain, there were no significant differences in the prevalence estimations.
Impulse control disorders (ICDs), including pathological gambling, trichotillomania, kleptomania and others, have been conceptualized to lie along an impulsive-compulsive spectrum. Recent data have suggested that these disorders may be considered addictions. Here, we review the genetic and neuropathological bases of the impulse control disorders and consider the disorders within these non-mutually exclusive frameworks.
Evidence that psychoactive substance use disorders, bulimia nervosa, pathological gambling, and sexual addiction share an underlying biopsychological process is summarized. Definitions are offered for addiction and addictive process, the latter being the proposed designation for the underlying biopsychological process that addictive disorders are hypothesized to share. The addictive process is introduced as an interaction of impairments in three functional systems: motivation-reward, affect regulation, and behavioral inhibition. An integrative review of the literature that addresses the neurobiology of addiction is then presented, organized according to the three functional systems that constitute the addictive process. The review is directed toward identifying candidate neurochemical substrates for the impairments in motivation-reward, affect regulation, and behavioral inhibition that could contribute to an addictive process.
A neurobiological model of the brain emotional systems has been proposed to explain the persistent changes in motivation that are associated with vulnerability to relapse in addiction, and this model may generalize to other psychopathology associated with dysregulated motivational systems. In this framework, addiction is conceptualized as a cycle of decreased function of brain reward systems and recruitment of antireward systems that progressively worsen, resulting in the compulsive use of drugs. Counteradaptive processes, such as opponent process, that are part of the normal homeostatic limitation of reward function fail to return within the normal homeostatic range and are hypothesized to repeatedly drive the allostatic state. Excessive drug taking thus results in not only the short-term amelioration of the reward deficit but also suppression of the antireward system. However, in the long term, there is worsening of the underlying neurochemical dysregulations that ultimately form an allostatic state (decreased dopamine and opioid peptide function, increased corticotropin-releasing factor activity). This allostatic state is hypothesized to be reflected in a chronic deviation of reward set point that is fueled not only by dysregulation of reward circuits per se but also by recruitment of brain and hormonal stress responses. Vulnerability to addiction may involve genetic comorbidity and developmental factors at the molecular, cellular, or neurocircuitry levels that sensitize the brain antireward systems.
Please note that the year "1995" in the reference citation
- Patton
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Executive function abnormalities in pathological gamblers. Clinical Practice and Epidemiology in Mental Health
- D Marazziti
- Catena Dell 'osso
- M Conversano
- C Consoli
- G Vivarelli
- L Mungai
- Di Nasso
- E Golia
Marazziti, D., Catena Dell'osso, M., Conversano, C., Consoli, G.,
Vivarelli, L., Mungai, F., Di Nasso, E., & Golia, F. ( 2008 ). Executive function abnormalities in pathological gamblers. Clinical Practice and Epidemiology in Mental Health, 4, 7.
Please check if the "11.2" can be changed to " SD = 11.2" in the sentence "Mean age of onset was
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has been changed to "Álvarez-Moya" as per the reference list
- Alvarez-Moya
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(2007)" has been changed to "Álvarez-Moya" as per the reference list. Please check.
Stroop Color and Word Test: Manual for Clinical and Experimental Uses
- C J Golden
Golden, C.J. ( 1978 ). Stroop Color and Word Test: Manual for
Clinical and Experimental Uses. Chicago, IL : Stoeling.
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- Derogatis
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- Kertzman
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- Roberts
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