我国部分精神科医生对赌博成瘾认知程度的调查

目的:为了调查我国精神科医生对赌博成瘾的认识、经验和态度,以便做好今后的教育或培训工作,为促进我国精神科医生对于赌博成瘾的认知而提出更多建设性的建议。方法:采用自行设计的问卷来调查我国部分地区精神科医生对赌博成瘾的认识、诊断和治疗经验、接受培训的经历及有关态度。结果:共收回有效问卷110份,其中45%的精神科医生在临床实践中没有见过赌博成瘾病人,见过者中有67%的人见过病人不超过5个。所有110名被调查者中只有1人接受过赌博成瘾治疗的教育/培训,尽管有83%的人愿意接受该障碍识别与治疗方面的培训。90%以上的被调查者能认识到赌博成瘾的不良后果,80%者同意该障碍是一个公共卫生问题并且为一种成瘾障碍,70%者同意该障碍易共患其他重要的精神障碍,但仅有41%者知道精神病人赌博问题发生率比一般人群高。36%者表示能够评估并诊断赌博障碍,同时,23%者表示能够治疗该障碍。缺少知识、培训、资源及政府的支持是妨碍精神科医生参与治疗该障碍的主要因素,这些因素也是导致赌博成瘾在精神卫生场所未被识别的主要原因。结论:大多数精神科医生对赌博成瘾仅有很少的认识,几乎没有人接受过这方面的教育/培训。我国大多数精神科医生不仅对赌博成瘾的临床经验很少,也没有能力诊治该障碍。     

自评Young氏网络成瘾诊断问卷中文版信效度的初步研究

目的:评价目前国内通用的自评Young氏网络成瘾诊断问卷(IAD-DQ)中文版的信效度。方法:以医院为基础招募因网络使用相关问题而就诊的青少年患者和普通躯体疾病青少年为研究对象,由精神科副主任医师以IAD-DQ中文版的8项诊断标准为访谈提纲,通过访谈家长和青少年(金标准)确诊125例网络成瘾青少年和200例非网瘾青少年;访谈之前,由所有研究对象独立自评完成IAD-DQ。结果:自评IAD-DQ中文版的Cronbachα系数为0.817;诊断灵敏度(95%CI)为0.248(0.181,0.306),特异度(95%CI)为0.940(0.898,0.965)和Kappa(95%CI)为0.214(0.122,0.306)。结论:通行版本的自评IAD-DQ中文版的信度满意,但以5分为界值诊断效度偏低,未来的网络成瘾研究应谨慎使用该量表。     

初中生网络使用不当与父母养育方式关系初探

目的:探讨初中生网络使用不当与父母养育方式之间的关系,为解决网络使用不当问题提供理论依据。方法:使用父母养育方式评价量表对48名符合Young网络成瘾诊断标准的初中生网络使用不当者和50名健康初中生对照进行测试。结果:1.父母养育方式评价量表中,初中生网络使用不当组父亲因子Ⅰ(情感温暖理解因子)低于对照,而父亲因子Ⅱ(惩罚严厉)、因子Ⅵ(过度保护)两因子得分均高于对照;母亲因子Ⅰ(情感温暖理解因子)同样低于对照,而母亲因子Ⅱ(过干涉过保护)、因子Ⅲ(拒绝否认)以及因子Ⅴ(偏爱被试)各因子得分高于对照。2.父母亲养育方式中母亲的过干涉过保护因子对网络使用不当倾向的预测力居首位(β=0.360),其次是父母亲的情感温暖理解因子和拒绝否认因子(β=-0.308、-0.289,0.267)。结论:初中生网络使用不当者存在不良的家庭教养方式,不利于其人格发展。     

网络成瘾青少年的自卑与其社会支持﹑心理健康的关系

目的:探讨网络成瘾青少年的自卑与其社会支持﹑心理健康的关系。方法:82例符合网络成瘾诊断标准的住院青少年参与了自卑感量表﹑社会支持评定量表﹑症状自评量表测试。结果:(1)自卑与社会支持呈显著性负相关(r=0.233-0.445,P<0.05);(2)自卑与心理健康呈显著性正相关(r=0.226-0.411,P<0.05);(3)人际关系因子﹑支持利用度、客观支持﹑抑郁因子分别对自卑各因子具有重要预测作用(R2=0.127-0.314);(4)体能自卑、整体自卑、自尊自卑分别对强迫性因子﹑抑郁因子﹑焦虑因子﹑精神病性因子及包含饮食睡眠等的其他因子具有正向预测作用(R2=0.094-0.169)。结论:网络成瘾青少年的社会支持情况﹑心理健康状况与其自卑相互影响显著。     

北京部分高校大学生网络成瘾现状及其与人际关系的相关关系研究

目的:了解大学生网络成瘾现状及其与人际关系的相关关系.方法:本研究采用《中文网络成瘾量表》和《人际关系综合诊断量表》对北京三所大学的学生进行问卷调查,共有176份有效问卷.结果:大学生人际交往特点与网络成瘾存在显著相关.结论:人际交往有问题的大学生更容易网络成瘾.     

青少年网络成瘾与父母教养方式及应对方式的相关研究

目的探讨青少年网络成瘾与父母教养方式及应对方式之间的关系。方法将120例网络成瘾的青少年分为独生子女组和非独生子女组,均行网络成瘾诊断量表(YDQ)、父母教养方式评价量表、应对方式量表测评。结果两组在父情感温暖、父惩罚严厉、父过分干涉、母过度干涉保护、逃避、幻想的得分均存在统计学意义。结论过度干涉或保护、拒绝与否认的父母教养方式和消极的应对方式与独生子女青少年网络成瘾有关。     

网络成瘾患者的心身症状、人格特征及父母养育方式(英文)

目的:比较网络成瘾(IAD)青少年与正常对照组的心身症状、人格特征及父母养育方式。方法:在2007年5月至2007年12月间,采用症状自评量表(SCL-90)、艾森克人格问卷(EPQ)及父母养育方式量表(EMBU),对204例诊断为IAD的青少年进行评定。同时应用上述3种测量工具对100例正常青少年进行评定。结果:IAD青少年SCL-90的躯体化(P=0.006)、抑郁(P<0.0001)、敌对(P=0.001)和偏执因子(P=0.000)均高于正常对照,总症状指数也比正常对照高出近10%(P=0.001)。IAD青少年EPQ的内外向因子分低于正常对照(P<0.0001),精神质因子分高于正常对照(P=0.000)。EMBU测查表明,总体来说IAD青少年较正常对照的父母养育方式缺少情感温暖与理解、过分干涉、拒绝与否认(仅为母亲)(P<0.001)。结论:网络成瘾青少年常常出现各种精神症状,表现出内向和精神质的人格特征。父母对他们的养育方式常常表现为过分干涉、惩罚、缺少情感温暖。     

垂体后叶素联合酚妥拉明治疗肺结核咯血的疗效及安全性的系统评价

目的: 系统评价垂体后叶素联合酚妥拉明治疗肺结核咯血的疗效和安全性。方法: 计算机检索PubMed、EMbase、The Cochrane Library、CNKI、WanFang Data、CBM和VIP, 检索时限截至2015年6月, 纳入垂体后叶素联合酚妥拉明治疗肺结核咯血的相关随机对照试验(RCT)。由2位研究人员根据纳入与排除标准独立进行文献筛选、数据提取、质量评价并交叉核对结果。然后采用RevMan 5.2.3软件进行Meta分析。结果: 共纳入15个RCT。Meta分析结果显示:(1)垂体后叶素联合酚妥拉明组对比垂体后叶素组能提高显效率[RR=1.59, 95%CI(1.36, 1.86), P<0.000 01]和有效率[RR=1.31, 95%CI(1.21, 1.42), P<0.000 01], 缩短其咯血停止或缓解的时间[MD=-1.89, 95%CI(-3.03, -0.74), P=0.001]。(2)垂体后叶素联合酚妥拉明组对比垂体后叶素组能降低其腹痛[OR=0.08, 95%CI(0.01, 0.62), P=0.01]和血压升高[OR=0.06, 95%CI(0.01, 0.71), P=0.03]的发生率, 头晕[OR=0.07, 95%CI(0.00, 1.21), P=0.07] 发生率无统计学意义。(3)垂体后叶素联合酚妥拉明组对比酚妥拉明组能提高显效率[RR=1.50, 95%CI(1.12, 2.01), P=0.006]和有效率[RR=1.33, 95%CI(1.15, 1.54), P=0.000 2], 缩短其咯血停止或缓解的时间[MD=-1.35, 95%CI(-1.90, -0.80), P<0.000 01]。(4)垂体后叶素联合酚妥拉明组对比酚妥拉明组能降低其头晕[OR=0.07, 95%CI(0.02, 0.25), P<0.000 1]的发生率, 腹痛[OR=0.21, 95%CI(0.04, 1.04), P=0.06]和血压升高[OR=1.22, 95%CI(0.07, 21.18), P=0.89]发生率无统计学意义。结论: 垂体后叶素联合酚妥拉明组能提高垂体后叶素组的显效率和有效率、缩短咯血停止或缓解的时间, 并减少腹痛、血压升高的发生率, 其2组头晕发生率无统计学意义;垂体后叶素联合酚妥拉明组能提高酚妥拉明组的显效率和有效率、缩短咯血停止或缓解的时间, 并减少头晕发生率, 其2组腹痛和血压升高发生率无统计学意义。     

家庭环境、一般自我效能感与青少年网络成瘾的关系

目的:探讨家庭环境、一般自我效能感与青少年网络成瘾的关系,为防治网络成瘾提供依据。方法:采用分层抽样法、网络成瘾量表、家庭环境量表和一般自我效能感量表对陕西省1167名青少年进行问卷调查。结果:网络成瘾与网络使用正常青少年的家庭环境和一般自我效能感差异有统计学意义。结论:家庭环境和一般自我效能对青少年网络成瘾有一定的预测力,建立良好的家庭环境系统,提高青少年的一般自我效能感,可以防治青少年网络成瘾。     

网瘾患者的自尊与其家庭因素的关系研究

目的：探讨网瘾患者的自尊与其父母教养方式和家庭环境的关系,为网瘾的治疗工作提供参考。方法：108例符合网络成瘾临床诊断标准的住院男性网络成瘾患者参与了缺陷感量表、父母养育方式评定量表、家庭环境量表中文版测试。结果：（1）父母教养方式中父母情感温暖、理解,父母拒绝、否认,父惩罚严厉,家庭环境因素中的亲密度、情感表达、独立性、成功性、知识文化性、娱乐性、道德宗教观、组织性、控制性与自卑呈负相关（｜r｜=0.193-0.518）;父过分干涉、母干涉保护、矛盾性与自卑呈正相关（r=0.210-0.341）。（2）多元逐步回归分析发现,教养方式中母干涉保护及家庭环境中组织性、娱乐性、独立性、亲密度、情感表达、道德宗教观、控制性进入回归方程,其联合解释总变异量为（R2=0.100-0.541）;（3）反向回归分析显示自卑学习、自卑社交、自卑体能对父母教养方式也具有一定的预测作用（R2=0.037-0.117）。结论：父母不恰当的教养方式（如过度干涉）和不良的家庭环境可能是滋生网瘾患者自卑心理的一个重要因素,而网瘾患者的自卑对其父母教养方式也可能具有一定的影响。     

Sociodemographic and Substance Use Correlates of Gambling Behavior in the Canadian General Population

ABSTRACT

This study describes sociodemographic and substance use correlates of gambling behaviors, measured among 9,481 past-year gamblers from the Canadian general population. Compared to non-problem gamblers in this study (N = 8,035), the 98 problem gamblers who scored 8 or more points on the Canadian Problem Gambling Research Index were more likely to report being “drunk or high” while gambling (adjusted odds ratio [AOR]: 8.92; 95% confidence interval [CI]: 5.46,14.55; p < .001), to admit to having an alcohol or drug problem (AOR: 3.80; 95% CI:2.21,6.52; p < .001), and to use electronic gambling devices (AOR: 4.85; 95% CI: 3.08-7.66; p< .001).     

Identifying behavioral markers of disordered Internet sports gambling

Objective: To identify patterns of sports gambling that discriminate sports bettors with self-reported gambling-related problems from sports bettors without such difficulties.

Methods: Secondary data analysis of the actual betting behavior observed during the first 2 years of a longitudinal study of 47,134 subscribers to an Internet sports gambling site. This sample included the gambling behavior of 679 bettors who self-reported the reason for closing their accounts during that period. We contrasted the behavior of those who closed their accounts because of gambling-related problems (n = 215, 32%) to the behavior of other account closers (ACs) who were either not satisfied with the service (n = 113, 17%) or no longer interested in betting (n = 351, 52%).

Results: Exploratory multivariate discriminant function analyses identified a sub-group of approximately half the ACs with gambling-related problems who exhibited a homogeneous and distinct pattern of sports-betting behavior. Compared to other ACs, this sub-group made more and larger bets, bet more frequently, and were more likely to exhibit intense betting soon after enrollment. The group estimation formula derived from this prototype applied to an independent sample of ACs confirmed the prevalence of this distinct gambling pattern.

Conclusion: Because Internet gambling provides a unique opportunity to study actual gambling behavior, it is possible to identify betting patterns that can lead to the development of gambling-related problems. This pattern recognition can inform the development of interventions to help disordered gamblers recognize their risky behavior and avoid further problems.     

Volatile substance misuse among youth in Israel: results of a national school survey

Volatile substance misuse (VSM) among Israeli youth has been identified as widespread and growing. Using data from the 2009 National School Survey of 12-18 year olds (N = 7,166), this study describes VSM prevalence among Jews and Arabs, examining relationships between past-month VSM and sociodemographic, behavioral, psychological, and interpersonal characteristics. Past-month VSM, reported by 7.5% of respondents, was significantly associated with other risky behaviors including past-month illicit drug use (Adjusted odds ratios (AOR) = 5.41, 95% CI: 3.5-8.1), Internet gambling (AOR = 2.12, 95% CI: 1.5-3.1), smoking, binge drinking, and truancy. National drug policy must address VSM and develop strategies to reduce demand and supply. Potential study limitations are noted.     

Lay and scientific conceptualizations of impaired control at electronic gambling machines

How do experts in the field of gambling and lay people represent the notion of impaired control (IC) on electronic gambling machines? This study included 37 international experts on gambling, 34 non-pathological gamblers and 32 pathological gamblers. Participation took place in the form of focus groups for gamblers and on the Internet for experts. The mixed methodology of concept mapping was used for comparing the representation of IC by the different groups. It relied on multidimensional scaling and cluster analysis. Qualitative and quantitative analysis revealed an important similarity between experts’ and gamblers’ representation of IC. When respondents were asked about IC, they referred essentially to excessive gambling, irrational cognitions surrounding gambling and negative consequences following excessive gambling. Although considered as central in the conceptualization of problem gambling and often relied upon in clinical practice, IC is not a straightforward and unidimensional concept. Therefore, it needs to be explicitly operationalized and clearly articulated when used in research.     

Cigarette smoking status in pathological gamblers: association with impulsivity and cognitive flexibility

Background

While the majority of pathological gamblers are current cigarette smokers (CS), some have quit smoking (former smokers, FS) while others never smoked (never smokers, NS). The reasons for elevated smoking rates in pathological gambling are not known, but gamblers may use nicotine as a putative cognitive enhancer. This study evaluated impulsivity and cognitive flexibility in a sample of pathological gamblers with differing smoking status.

Methods

Fifty-five subjects with pathological gambling (CS, n = 34; FS, n = 10; NS, n = 11) underwent cognitive assessments using the Stop-Signal (SST) and Intradimensional/Extra-dimensional (ID/ED) set-shift tasks.

Results

CS reported less severe gambling problems than either FS or NS on the Yale Brown Obsessive Compulsive Scale modified for Pathological Gambling, and CS was associated with significantly fewer directional errors on the SST task, compared to NS. In addition, in CS, higher daily cigarette consumption was associated with fewer total errors on the ID/ED task.

Conclusions

The potential role of nicotine as a cognitive enhancer was supported by objective tests of impulsivity and cognitive flexibility. Human laboratory studies using nicotine challenges in pathological gambling will shed further light on this relationship.     

Adolescent Alcohol-Drinking Frequency and Problem-Gambling Severity: Adolescent Perceptions Regarding Problem-Gambling Prevention and Parental/Adult Behaviors and Attitudes

ABSTRACT. Background: The study examined in adolescents how alcohol-drinking frequency relates to gambling-related attitudes and behaviors and perceptions of both problem-gambling prevention strategies and adult (including parental) behaviors/attitudes. Methods: A survey assessing alcohol, gambling, and health and functioning measures in 1609 high school students. Students were stratified into low-frequency/nondrinking and high-frequency-drinking groups, and into low-risk and at-risk/problematic gambling groups. Results: High-frequency drinking was associated with at-risk/problematic gambling (χ²(1,N = 1842) = 49.22, P < .0001). High-frequency-drinking versus low-frequency/nondrinking adolescents exhibited more permissive attitudes towards gambling (e.g., less likely to report multiple problem-gambling prevention efforts to be important). At-risk problematic gamblers exhibited more severe drinking patterns and greater likelihood of acknowledging parental approval of drinking (χ²(1, N = 1842) = 31.58, P < .0001). Problem-gambling severity was more strongly related to gambling with adults among high-frequency-drinking adolescents (odds ratio [OR] = 3.17, 95% confidence interval [95% CI] = [1.97, 5.09]) versus low-frequency/nondrinking (OR = 1.86, 95% CI = [0.61, 2.68]) adolescents (interaction OR = 1.78, 95% CI = [1.05, 3.02]). Conclusions: Interrelationships between problematic drinking and gambling in youth may relate to more permissive attitudes across these domains. Stronger links between at-risk/problem gambling and gambling with adults in the high-frequency-drinking group raises the possibility that interventions targeting adults may help mitigate youth gambling and drinking.     

PATHOLOGICAL GAMBLING AND SUBSTANCE MISUSE

This paper first discusses the ways in which pathological gambling (a disorder of impulse control) and substance misuse are similar. It then examines research focusing on substance misuse among pathological gambles, and research on pathological gambling among substance misusers, focusing on a study examining gambling among 462 methadone patients from New York City. That study found that 21% of the sample were probable pathological gamblers, while an additional 9% were problem gamblers, i.e., they had some problem related to their gambling. The treatment implications of these findings and future research directions are also discussed.     

Drinking and gambling: a comparison with implications for theories of addiction

There is current concern about the level of excessive gambling in a number of countries, but problem gambling still occupies an uncertain place in the addictions field. The present paper presents results from a pilot study comparing 16 problem gamblers and 16 problem drinkers. Results from a new Attachment Questionnaire suggested that gamblers were just as strongly attached to gambling as drinkers to drinking, although they were significantly less likely to experience withdrawal symptoms. Interviews with the problem gamblers suggested that excessive attachment to gambling was maintained by cyclical processes involving strong, negative feelings associated with gambling losses, shortage of money and the need to keep the extent of gambling secret. It is proposed that these 'secondary' processes, along with primary incentive motivation and the tertiary effects of losses associated with excessive behaviour, are sufficient to explain addiction. It is further suggested that neuroadaptation, tolerance and withdrawal, often thought to be central to the process of addiction, may in fact be of comparatively little importance.     

Alexithymia and Pathological Gambling

ABSTRACT

The purpose of this study was to study the relationship between alexithymia and gambling in a community sample of pathological gamblers. Pathological, problem and non-problem gamblers were recruited from the community via advertisements and completed an assessment of their gambling behavior and the Toronto Alexithymia Scale. Alexithymia was higher among male pathological gamblers who identified slot machines, cards, and lotteries as their primary gambling problem. High alexithymics scored higher on Diagnostic and Statistical Manual symptoms related to poor self-regulation, communication, and problem-solving skills. Although a correlational study, the evidence suggests that further investigation of the clinical significance of alexithymia in individuals with severe gambling pathology is indicated.     

Psychological Correlates of Comorbid Gambling in Psychiatric Outpatients: A Pilot Study

This study compared psychiatric outpatients with and without lifetime gambling problems on clinical disorder and personality disorder scales, and the relationship of these scales with involvement in gambling. One hundred and sixty-two adults (females = 112) in an urban, outpatient psychiatric setting completed the South Oaks Gambling Screen (SOGS; Lesieur, H. R., Blume, S. B. (). The south oaks gambling screen (SOGS): a new instrument for the identification of pathological gamblers. Am. J. Psychiatry 144(9):1184–1188) and the Millon Clinical Multiaxial Inventory-II (MCMI-II; Millon, T. (). Manual for the MCMI-II: 2nd Edition. Minneapolis, MN: National Computer Systems, Inc.) after their initial psychiatric evaluation in . Avoidant and compulsive personality features were significantly related to gambling problem status. The Self-Defeating and Dysthymic Disorder scales were positively associated with gambling involvement. The Alcohol Dependence scale was predictive of gambling involvement for males only. Findings are somewhat consistent with the literature examining comorbidity in pathological gamblers seeking treatment, although no association was found with antisocial personality disorder.