The near-miss effect in slot-machine gambling: modulation of feedback-related negativity by subjective value

Near-miss plays an important role in the development of gambling addictions. In this study, we measured the neural correlates of the process by which near-miss outcomes are evaluated in simplified, static, slot-machine gambling using event-related potentials. Analysis of event-related potentials revealed that the size of FRN (feedback-related negativity) for a near miss is between the full miss and the win. These results suggest that participants distinguish among near misses, full misses, and wins during the early evaluation phase. The subjective value and objective value of outcome were assessed separately to discuss FRN on outcome evaluation. It is suggested that FRN is mediated not only by the objective value of outcomes but also by the subjective value of feedback.     

Addiction: a disease of volition caused by a cognitive impairment.

The common etiology of substance and behavioural addictions is one that suggests faulty volition caused by a cognitive impairment. A cognitive impairment that minimizes the recall of the negative effects of the addictive behaviour is viewed as necessary and causal to all addictions. The proposed definition for addiction clarifies the confusion associated with addictive disorders, explains the many variable presentations, and provides an explanation of comorbidity and treatment outcomes. In addition, this paper suggests why this process has not been previously identified.     

The effect of rugby match outcome on spectator aggression and intention to drink alcohol

Background Alcohol, aggression and assault injury are strongly associated with popular sporting events, but mediating factors are not clear. Aims To explore aggression, happiness and plans to consume alcohol among spectators before and spectators after sports matches. Methods Cross‐sectional surveys of male rugby football fans at an international stadium generated four groups: a pre‐match group of 111 men, and three post‐match groups of supporters, 17 whose team had won, 23 whose team had lost and 46 whose team had drawn. Consenting participants were assessed using the assault sub‐scale of the Buss‐Durkee Hostility Inventory, on a self‐rating of happiness (Likert scale), for planned alcohol consumption and demographic variables. Pre‐ and post‐match group mean responses were compared. Results Analyses were performed on 197 male spectators (mean age 42 years). Spectators in ‘win’ (z = 2.63, p < 0.01) and ‘draw’ (z = 2.76, p < 0.01) groups rated themselves as more aggressive than those in the pre‐game group, but those in the losing group did not (z = ?0.03, p > 0.05). No differences, however, were observed between pre‐match, ‘win’, ‘draw’ or ‘lose’ groups on the decision to drink after the match. Winning did not increase happiness (t = 0.25, p > 0.05), but losing (t = 2.09, p < 0.05) or drawing (t = 7.64, p < 0.001) decreased it. Conclusions This study suggests that team success but not failure may increase aggression among supporters, and that aggression, not celebration, drives post‐match alcohol consumption. Losing and drawing decreased happiness but winning did not increase it. Better understanding of pathways to violence in these circumstances will pave the way for more effective prevention and management strategies. Copyright © 2007 John Wiley & Sons, Ltd.     

Dopamine release in ventral striatum of pathological gamblers losing money

Linnet J, Peterson E, Doudet DJ, Gjedde A, Møller A. Dopamine release in ventral striatum of pathological gamblers losing money. Objective: To investigate dopaminergic neurotransmission in relation to monetary reward and punishment in pathological gambling. Pathological gamblers (PG) often continue gambling despite losses, known as ‘chasing one’s losses’. We therefore hypothesized that losing money would be associated with increased dopamine release in the ventral striatum of PG compared with healthy controls (HC). Method: We used Positron Emission Tomography (PET) with [¹¹C]raclopride to measure dopamine release in the ventral striatum of 16 PG and 15 HC playing the Iowa Gambling Task (IGT). Results: PG who lost money had significantly increased dopamine release in the left ventral striatum compared with HC. PG and HC who won money did not differ in dopamine release. Conclusion: Our findings suggest a dopaminergic basis of monetary losses in pathological gambling, which might explain loss‐chasing behavior. The findings may have implications for the understanding of dopamine dysfunctions and impaired decision‐making in pathological gambling and substance‐related addictions.     

Moral cognitive correlates of empathy in juvenile delinquents

Introduction Numerous theories of anti‐social behaviour have featured lack of empathy as an essential characteristic of the anti‐social personality. Aim To investigate the relationships between empathy and three theoretically related moral cognitive constructs: moral judgement maturity, moral identity and self‐serving cognitive distortion. Methods Seventy‐eight adjudicated juvenile delinquents aged 13 to 21 years who had been directed by the court to attend a 10‐week empathy training programme completed self‐report measures as part of routine evaluation. Their anonymised scores were retrieved from programme records. Results Applying zero‐order correlation, followed by regression analysis, we established that moral judgement maturity was associated with greater empathy, whereas extensive endorsement of self‐serving cognitive distortions was associated with lower empathy. An observed association between moral identity and empathy was mediated or ‘neutralised’ by self‐serving cognitive distortion. Conclusions and implications for practice Our results suggest that interventions designed to promote empathy and curtail anti‐social behaviour should embrace strategies that facilitate moral judgement maturity and correct or counteract self‐serving cognitive distortions. Copyright © 2009 John Wiley & Sons, Ltd.     

The rates of co-occurring behavioural addictions in treatment-seeking individuals with obsessive-compulsive disorder: a preliminary report

Abstract

Objectives: To assess the rates of co-occurring putative ‘behavioural addictions’ in patients with obsessive-compulsive disorder (OCD).

Methods: Twenty-three international centres specialising in the treatment of OCD were invited to participate in a survey of the rates of behavioural addictions and other relevant comorbidity within their samples.

Results: Sixteen of 23 (69.6%) invited centres from 13 countries had sufficient data to participate in the survey. The use of validated diagnostic tools was discrepant, with most centres relying on a ‘clinical diagnosis’ to diagnose behavioural addictions. The final sample comprised of 6916 patients with a primary diagnosis of OCD. The reported rates of behavioural addictions were as follows: 8.7% for problematic internet use, 6.8% for compulsive sexual behaviour disorder, 6.4% for compulsive buying, 4.1% for gambling disorder and 3.4% for internet gaming disorder.

Conclusions: Behavioural addictions should be better assessed for patients with OCD. The absence of diagnostic scales developed specifically for behavioural addictions and overlapping obsessive-compulsive phenomena such as compulsive checking of information on the internet may explain the relatively high rate of problematic internet use in this sample. The study encourages better efforts to assess and to conceptualise the relatedness of behavioural addictions to obsessive-compulsive ‘spectrum’ disorders.     

Psychopharmaceutical Enhancers: Enhancing Identity?

The use of psychopharmaceuticals to enhance human mental functioning such as cognition and mood has raised a debate on questions regarding identity and authenticity. While some hold that psychopharmaceutical substances can help users to ‘become who they really are’ and thus strengthen their identity and authenticity, others believe that the substances will lead to inauthenticity, normalization, and socially-enforced adaptation of behaviour and personality. In light of this debate, we studied how persons who actually have experience with the use of psychopharmaceutical medication would view their ‘self’ or their authentic personal identity in relation to the use of medication. We have interviewed a number of adults diagnosed with ADHD and discussed their experiences with medication use in relation to their conceptions of self and identity. In the first part of this paper we illustrate that the concepts of identity and authenticity play an important and sometimes problematic role in experiences of ADHD adults. This shows that the question about identity and psychopharmacology is not merely an ‘academic’ issue, but one that influences everyday lives of real people. In order to answer the question whether psychopharmaceuticals threaten personal identity and authenticity, more than empirical research is needed. We also need to analyse the concepts of personal identity, authenticity and self: what do we mean when we are using statements as ‘a way of living that is uniquely our own’, ‘our true self’, or ‘who we really are’? In the second part of this paper we discuss two important philosophical views on personal identity, authenticity and self: the self-control view as elaborated by Frankfurt, and the self-expression view as proposed by Schechtman. We compare these with the experiences of our respondents to see which view can help us to understand the diverse and often conflicting experiences that people have with medication for ADHD. This will contribute to a better understanding of whether and in which cases personal identity and authenticity are threatened by psychopharmacology.     

Learning disability,neurology, and long-term outcome: Some implications for the individual and for society

Abstract

This paper presents an examination of the relationship between neurological impairment and learning disabilities (LD). After a brief review of the history of this relationship, alternative explanation will be explored. The main part of the discussion will be devoted to a review of the ‘neurological connection’, including a detailed analysis of neurological data on LD children in a follow-up study into adulthood. Finally, first results of an attempt to relate specific neurological findings in LD children to adult outcome will be presented.     

Quality of life of adults with intellectual disabilities who live with families in Taiwan

Background Little research has been conducted about the quality of life (QOL) of people with intellectual disabilities (ID) in Taiwan, particularly their subjective QOL. This study examined the personal perceptions of these individuals as measured on internationally recognized core QOL domains and indicators. Methods A census interview survey was conducted in Hsin‐Chu City in Taiwan; 233 adults aged over 16 years with mild ID and living with their families participated in the study. Data were collected using the Cross‐Cultural QOL Indicators (CCQOLI) together with socio‐demographic data that included ‘activities of daily living’ and ‘instrumental activities of daily living’ (IADL). The CCQOLI were based on the three most commonly reported indicators of each of the eight QOL domains: emotional well‐being, interpersonal relations, material well‐being, personal development, physical well‐being, self‐determination, social inclusion and rights. Each indicator has two sets of questions related to the indicator's ‘importance’ and ‘use’. These are answered by the respondent using a 4‐point Likert scale. Results The importance and use of the QOL indicators were evaluated positively by the respondents. The adults' individual characteristics, namely IADL and educational level, were significant predictors for the ‘importance’ while the adults' perceptions of ‘use’ for overall QOL were significantly affected by his/her socio‐economic data, that is, residence location and father's educational level. Conclusions The present study addressed the issue of self‐reported QOL in people with ID in Taiwanese society, becoming a possible benchmark for similar measurements carried out by disability movements there. These results contribute to current advocacy efforts towards creating a supportive environment for people with ID.     

Exploring Individual Differences in Online Addictions: the Role of Identity and Attachment

Research examining the development of online addictions has grown greatly over the last decade with many studies suggesting both risk factors and protective factors. In an attempt to integrate the theories of attachment and identity formation, the present study investigated the extent to which identity styles and attachment orientations account for three types of online addiction (i.e., internet addiction, online gaming addiction, and social media addiction). The sample comprised 712 Italian students (381 males and 331 females) recruited from schools and universities who completed an offline self-report questionnaire. The findings showed that addictions to the internet, online gaming, and social media were interrelated and were predicted by common underlying risk and protective factors. Among identity styles, ‘informational’ and ‘diffuse-avoidant’ styles were risk factors, whereas ‘normative’ style was a protective factor. Among attachment dimensions, the ‘secure’ attachment orientation negatively predicted the three online addictions, and a different pattern of causal relationships were observed between the styles underlying ‘anxious’ and ‘avoidant’ attachment orientations. Hierarchical multiple regressions demonstrated that identity styles explained between 21.2 and 30% of the variance in online addictions, whereas attachment styles incrementally explained between 9.2 and 14% of the variance in the scores on the three addiction scales. These findings highlight the important role played by identity formation in the development of online addictions.     

An adapted Severity of Dependence Scale is valid for the detection of medication overuse: the Akershus study of chronic headache

Background and Objective: Medication overuse headache is a common subtype of chronic headache involving the overuse of simple analgesics, opioids, ergotamine or triptans or combinations of these medications. Medication overuse may worsen the headache and has been described to have many characteristics similar to addiction. The purpose of this study was to validate and optimize the Severity of Dependence Scale (SDS) for use amongst people with chronic headache. Design/setting: In a cross‐sectional epidemiological survey, an age‐ and gender‐stratified sample of 30 000 30‐ to 44 ‐year‐old people were recruited via a posted questionnaire. Those with self‐reported chronic headache were interviewed by neurological residents at Akershus University Hospital, Oslo. Headache was classified according to the International Classification of Headache Disorders. Split file methodology was employed for data analysis. Main outcome measure: Severity of Dependence Scale score in those with and without medication overuse. Results: Severity of Dependence Scale score was a significant predictor of medication overuse amongst chronic headache patients. Medication overuse could be predicted with sensitivity, specificity, positive and negative predictive values of 0.79, 0.84, 0.84 and 0.79, respectively, in men and 0.76, 0.77, 0.73 and 0.79 in women. Linear regression and factor analysis suggested a redundancy for the SDS question ‘Do you think your use of your headache medication was out of control?’ Removal of this question improved Chronbach’s alpha = 0.76. Conclusion: The SDS is valid for detecting medication overuse and dependency like behaviour amongst people with chronic headache. The adapted version may be used to identify chronic headache patients who may benefit from detoxification.     

The orbitofrontal cortex regulates outcome‐based decision‐making via the lateral striatum

The orbitofrontal cortex (oPFC) sends substantial projections to the ventrolateral striatum and aspects of the nucleus accumbens that are, functionally, poorly understood. This is despite probable cortico‐striatal involvement in multiple diseases such as addiction and obsessive‐compulsive disorder. Here we surgically disconnected the oPFC from the ventrolateral striatum using unilateral asymmetric lesions in mice and classified instrumental decision‐making strategies. Mice with symmetric lesions that spared one oPFC–striatal network served as controls. As a complementary approach, we selectively knocked down Brain‐derived neurotrophic factor (Bdnf) bilaterally in the oPFC and ascertained behavioral and neurobiological consequences within the downstream striatum. oPFC–striatal disconnection and oPFC Bdnf knockdown blocked sensitivity to outcome‐predictive relationships in both food‐reinforced and cocaine‐associated settings. Bdnf knockdown simultaneously regulated striatal BDNF expression, and striatal c‐Fos predicted sensitivity to action–outcome associative contingencies. Previous evidence strongly implicates the dorsolateral striatum in stimulus–response habit formation. Our findings thus provide novel evidence for functional compartmentalisation within the lateral striatum, with the dorsal compartment subserving classical stimulus–response habit systems and a ventral compartment coordinating outcome‐based decision‐making via oPFC interactions. This compartmentalisation may apply to both ‘natural’, as in the case of food‐reinforced behavior, and ‘pathological’, as in the case of cocaine‐seeking, contexts.     

A systematic review of correlates of physical activity in patients with schizophrenia

Vancampfort D, Knapen J, Probst M, Scheewe T, Remans S, De Hert M. A systematic review of correlates of physical activity (PA) in patients with schizophrenia. Objective: The present review evaluates systematically the published quantitative studies of correlates of PA in patients with schizophrenia. Method: EMBASE, PsycINFO, PubMed, ISI Web of Science, CINAHL and PEDro were searched from their inception to 1 July 2011 combining the medical subject heading ‘schizophrenia’ with ‘physical activity’ or ‘physical inactivity’ or ‘exercise’ or ‘health education’ or ‘health behaviour’ or ‘health promotion’. Results: Out of 68 potentially eligible studies, 25 papers (n = 25 013) evaluating 36 correlates were included. Correlates consistently associated with lower PA participation are the presence of negative symptoms and cardio‐metabolic comorbidity. Also, side‐effects of antipsychotic medication, lack of knowledge on cardiovascular disease risk factors, no belief in the health benefits, a lower self‐efficacy, other unhealthy lifestyle habits and social isolation correlated with lower PA participation. The quality of the PA measurement was not related to the proportion of significant associations (χ² = 3.8, P = 0.07). Current gaps in literature that need to be examined more in detail are the role of environmental and policy‐level factors on PA participation in patients with schizophrenia. Conclusion: All correlates should be confirmed in prospective studies, and interventions to improve the modifiable variables should be developed and evaluated.     

The relationship between levels of mood, interest and pleasure and 'challenging behaviour' in adults with severe and profound intellectual disability

Background Research on affective disorders in adults with intellectual disability (ID) suggests that depression may not present a ‘classic picture’ in individuals with severe and profound ID, but may include challenging behaviours, which are referred to as ‘atypical symptoms’, such as self‐injury, aggression and irritability. The aim of the present study was to explore whether there is an association between constructs relating closely to the core symptoms of depression and challenging behaviours in adults with severe and profound ID. Method Mood and levels of interest and pleasure were measured in 53 adults with severe or pro‐found ID using the Mood, Interest and Pleasure Questionnaire (MIPQ). Results Two groups of adults were identified based on MIPQ scores: (1) a ‘low mood’ group (lowest score = 12); and (2) a comparison group (highest scoring = 12). The groups were clearly differentiated on the MIPQ (P < 0.0001), but were comparable on age, gender and medication use. The Challenging Behaviour Interview showed no difference between the two groups in self‐injury, aggression or disrupting the environment. A secondary analysis revealed that participants who showed challenging behaviour scored significantly lower on the MIPQ than those who did not show challenging behaviour. Conclusions Possible reasons for these results and considerations for future studies are discussed.     

Mothers with substance addictions show reduced reward responses when viewing their own infant's face

Maternal addiction constitutes a major public health problem affecting children, with high rates of abuse, neglect, and foster care placement. However, little is known about the ways in which substance addiction alters brain function related to maternal behavior. Prior studies have shown that infant face cues activate similar dopamine‐associated brain reward regions to substances of abuse. Here, we report on a functional MRI study documenting that mothers with addictions demonstrate reduced activation of reward regions when shown reward‐related cues of their own infants. Thirty‐six mothers receiving inpatient treatment for substance addiction were scanned at 6 months postpartum, while viewing happy and sad face images of their own infant compared to those of a matched unknown infant. When viewing happy face images of their own infant, mothers with addictions showed a striking pattern of decreased activation in dopamine‐ and oxytocin‐innervated brain regions, including the hypothalamus, ventral striatum, and ventromedial prefrontal cortex—regions in which increased activation has previously been observed in mothers without addictions. Our results are the first to demonstrate that mothers with addictions show reduced activation in key reward regions of the brain in response to their own infant's face cues. Hum Brain Mapp 38:5421–5439, 2017. © 2017 Wiley Periodicals, Inc.     

Does engagement with an intensive outreach service predict better treatment outcomes in ‘high‐risk’ youth?

Aim: Engagement is critical in ensuring that the most ‘at risk’ clients receive care from psychiatric services, but the relationship between engagement and treatment outcomes remains unclear. This study investigated possible improvements in client engagement and the relationship between engagement and treatment outcomes in a group of difficult‐to‐engage, ‘high‐risk’ young people seen by the Intensive Mobile Youth Outreach Service (IMYOS) in Western Metropolitan Melbourne, Australia. Methods: Data from standardized outcome measures on client engagement, suicidality, hostility, well‐being and functioning obtained at referral, after initial assessment and at discharge, were analysed retrospectively. Results: Improved engagement was achieved after initial assessment and remained steady at discharge. All outcome measures showed significant improvement at discharge. Higher overall engagement following assessment was associated with decreased hostility risk and greater well‐being and functioning at discharge. The engagement dimensions ‘collaboration’, ‘perceived usefulness’ and ‘client‐therapist interaction’ were most consistently associated with better treatment outcomes. Conclusion: Engagement at an early stage of treatment can be a useful predictor for later hostility risk, well‐being and functioning. To promote better outcomes for difficult‐to‐engage youth, service delivery needs to focus on collaborative client involvement, the development of a ‘strong’ therapeutic alliance and individualization of treatment in regard to client needs.     

Concepts of job satisfaction in people with intellectual disability

Background

There is a growing body of research on job satisfaction in people with intellectual disability (ID). However, little is known about the subjective concepts of job satisfaction in this population. Knowledge on the conceptualisation of job satisfaction in people with ID and whether currently used concepts are meaningful for this population are crucial prerequisites to purposeful research for this group.

Method

Qualitative interviews on subjective concepts of job satisfaction were conducted with 129 employees of sheltered workshops. Relevant concepts and associated aspects were extracted using content analysis.

Results

Concepts can be grouped into holistic concepts, facet‐related concepts and self‐actualising concepts of job satisfaction in people with ID. Twenty‐five percent of the sample did not have any concept of job satisfaction.

Conclusions

The concepts of job satisfaction in people with ID are closely related to those concepts as reported in organisational psychology. However, sufficient comprehension of the term has to be ensured prior to conducting research on job satisfaction in people with ID.     

Off-hours admission for acute stroke is not associated with worse outcome--a nationwide Israeli stroke project

Background and purpose: Several studies reported worse outcome for stroke patients arriving on weekends. We compared working hours to off‐work hours throughout the week as there is lack of experienced staff and special services during off‐hours. Methods: A nationwide stroke survey project on acute stroke was carried out in all acute care hospitals in Israel during 2004, 2007 and 2010 (2‐month each). ‘On‐hours’ were defined as regular Israel working hours and the rest, including holidays, were defined as ‘off‐hours’. The modified Rankin scale (mRS) at discharge was used for the main analysis on outcome. Results: A total of 4827 acute strokes patients were analyzed (2139 arrived on‐hours and 2688 during off‐hours). ‘Off‐hours’ patients were 1 year younger (mean 70 vs. 71 years in ‘on‐hours’) had lower rates of prior cardiac interventions, but had higher admission blood pressure levels and had more intracerebral hemorrhages (ICH) (11% vs. 8% in ‘on‐hours’ patients, P < 0.001). Death during hospitalization was recorded in 9% of ‘off‐hours’ vs. 6% of ‘on‐hours’ patient (P = 0.004). Controlling for age, blood pressure, stroke type, pre‐stroke mRS, admission NIHSS, and thrombolysis, the relative odds of poor outcome (i.e. mRS ≥ 2) amongst ‘off‐hours’ admissions compared to on‐hours was 1.09 (95% CI: 0.92–1.30). Odds ratio amongst ischaemic stroke patients was 1.08 (95% CI: 0.88–1.33). Conclusions: Off‐hours stroke admissions were associated with higher short‐term mortality rate, probably due to a higher rate of ICH. After controlling for the latter and other potential confounders, ‘off‐hours’ admissions were not different from ‘on‐hours’ with respect to poor outcome.     

Functional consistency across two behavioural modalities: fire-setting and self-harm in female special hospital patients

Background Fire‐setting and self‐harm behaviours among women in high security special hospitals may be understood using Shye's Action System Theory (AST) in which four functional modes are recognized: ‘adaptive’, ‘expressive’, ‘integrative’, and ‘conservative’. Aims To test for relationships between different forms of fire‐setting and self‐harm behaviours and AST modes among women in special hospital, and for consistency within modes across the two behaviours. Method Clinical case files evidencing both fire‐setting and self‐harm behaviours (n = 50) were analysed for content, focusing on incident characteristics. A total of 29 fire‐setting and 22 self‐harm variables were analysed using Smallest Space Analysis (SSA). Chi‐square and Spearman's rho (ρ) analyses were used to determine functional consistency across behavioural modes. Results Most women showed one predominant AST mode in fire‐setting (n = 39) and self‐harm (n = 35). Significant positive correlations were found between integrative and adaptive modes of functioning. The lack of correlation between conservative and expressive modes reflects the differing behaviours used in each activity. Despite this, significant cross‐tabulations revealed that each woman had parallel fire‐setting and self‐harm styles. Discussion Findings suggest that, for some women, setting fires and self harm fulfil a similar underlying function. Support is given to AST as a way of furthering understanding of damaging behaviours, whether self‐ or other‐inflicted. Copyright © 2007 John Wiley & Sons, Ltd.     

A conceptual and quantitative analysis of 178 historical cases of dysmorphophobia

The construction of the clinical category dysmorphophobia (now known as body dysmorphic disorder) resulted from the historical convergence of a neologism (coined by Enrico Morselli), a family of clinical concepts (already available during the late 19th century), and a specifiable behaviour (an ‘attitude’ towards part of the self and/or the body). The stability of such convergence has so far depended upon the epistemological capacity of the concepts involved and the social duration of the said attitude. This paper analyses the historical framework within which such convergence took place, and traces the history of dysmorphophobia in qualitative and quantitative terms. With regard to the latter, it compares cases reported before (139 subjects) and after (39 subjects) the publication of the DSM III criteria map. Patients in the former group were found to constitute a more heterogeneous group, and in the latter to have a better outcome. In the pre-DSM III group, differences were also found between delusional and non-delusional patients. The implications of these differences are discussed.