Anat Aizer

Go–no-go performance in pathological gamblers

Previous neuropsychological studies demonstrated various deficits of impulse control in pathological gamblers (PGs). However, there are limited data available on response-inhibition impairment among PGs. The present study attempted to assess response inhibition in untreated PGs (N=83), in comparison with normal subjects (N=84). Go/no-go and target-detection conditions of a computerized task were used as a measure of response-inhibition ability. A repeated measures analysis of covariance (ANCOVA-RM) was used with response time, variability of response time, and number of false alarms and misses as dependent measures; group (PG and controls) as the between-subjects measure; condition (target detection or go/no-go) and time slice (first and second in each condition) as repeated measures within-subject factors; and educational level as a covariate. Our results showed that PGs were significantly more impaired in both target detection and go/no-go task performance than controls. The PGs had significantly more false alarms and misses than controls, and they were slower and less consistent in their responses.

Risk-taking decisions in pathological gamblers is not a result of their impaired inhibition ability

This work investigates whether inhibition impairments influence the decision making process in pathological gamblers (PGs). The PG (N=51) subjects performed the Iowa Gambling Task (IGT as the measure of the decision making process) and two tests of inhibition: the Stroop (interference inhibition), and the Go/NoGo (response inhibition), and were compared with demographically matched healthy subjects (N=57). Performance in the IGT block 1 and block 2 did not differ between the groups, but the differences between the PGs and healthy controls began to be significant in block 3, block 4 and block 5. PGs learned the IGT task more slowly than the healthy controls and had non-optimal outcomes (more disadvantageous choices). Impaired IGT performance in PGs was not related to an inhibition ability measured by the Stroop (interference response time) and the Go/NoGo (number of commission errors) parameters. Further controlled studies with neuroimaging techniques may help to clarify the particular brain mechanisms underlying the impaired decision making process in PGs.

Speed-Accuracy Tradeoff in Decision-Making Performance among Pathological Gamblers

Background: Pathological gambling is classified as an impulse control disorder in the DSM-IV-TR; however, few studies have investigated the relationship between gambling behavior and impulsive decision-making in time-non-limited situations. Methods: The subjects performed the Matching Familiar Figures Test (MFFT). The MFFT investigated the reflection-impulsivity dimension in pathological gamblers (n = 82) and demographically matched healthy subjects (n = 82).Results:Our study demonstrated that pathological gamblers had a significantly higher rate of errors than healthy controls (p = 0.01) but were not different in terms of response time (p = 0.49). We found a similar power of correlation between the number of errors and response time in both pathological gamblers and controls. We may conclude that impaired performance of our pathological gamblers as compared to controls in a situation without time limit pressure cannot be explained by a trade-off of greater speed at the cost of less accuracy. Conclusions: The results of our study showed that pathological gamblers tend to make more errors but do not exhibit quicker responses as compared to the control group. Diminished MFFT performance in pathological gamblers as compared to controls supports findings of previous studies which show that pathological gamblers have impaired decision-making. Further controlled studies with a larger sample size which examine MFFT performance in pathological gamblers are necessary to confirm our results.

Pharmacotherapy of pathological gambling: review of new treatment modalities

Pathological gambling is classified in the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition as an impulse-control disorder. In the International Classification of Diseases of the WHO, pathological gambling is coded under the heading of ‘Habit and Impulse Disorders’. Pathological gambling is a chronic, progressive disorder, which has a prevalence of 1–3.4% among western civilizations. The enormous personal and social consequences of this disorder include a high rate of suicide attempts, job loss, marital and family problems, legal problems, and criminal behavior. Recent studies have demonstrated that pathological gambling patients respond well to treatment with selective serotonin reuptake inhibitors, mood stabilizers and opioid antagonists. These findings support the idea that pathological gambling and other disorders of impulse control may be conceptualized as part of the obsessive–compulsive spectrum disorders or addictive disorders. This article will discuss possible treatment strategies according to different behavior patterns in pathological gambling and also remind the physicians who intend to treat this disorder of the possible diagnosis of pathological gambling.

Alternation learning in pathological gamblers: an fMRI Study

ObjectivesWe have previously reported that pathological gamblers have impaired performance on the Stroop color word naming task, go-no-go task and speed accuracy tradeoff performance, tasks used to assess executive function and interference control. The aim of the present neuroimaging study was to explore the relationship between frontal cortex function and gambling severity in pathological gamblers.Materials and methodsFunctional MRI (fMRI) was used to estimate brain activity of ten male medication-free pathological gamblers during performance of an alternation learning task. Performance of this task has been shown to depend on the function of regions in the frontal cortex.ResultsThe executive functions needed to perform the alternation learning task were expressed as brain activation in lateral and medial frontal as well as parietal and occipital regions. By correlating the level of local brain activation to task performance, parietal regions and lateral frontal and orbitofrontal regions were demonstrated. A higher score in SOGS was associated with intrusion on the task-specific activation in the left hemisphere, to some extant in parietal regions and even more pronouncedly in left frontal and orbitofrontal regions.ConclusionsOur preliminary data suggests that pathological gambling may be characterized by specific neuro-cognitive changes related to the frontal cortex.

Kleptomania: Differential Diagnosis and Treatment Modalities

Kleptomania is classified in the psychiatric nomenclature as an impulse control disorder. Patients with kleptomania, however, often suffer from repetitive intrusive thoughts about stealing, an inability to avoid the compulsion to steal as well as a relief of tension following the theft. These associated symptoms suggest that kleptomania may be a form of obsessive compulsive spectrum disorder. On the other hand, some authors describe kleptomania as a nonpharmacological addiction because of the inability to control maladaptive behavior. A broad range of pharmacotherapeutic agents has been found to be beneficial in the treatment of kleptomania including serotonin reuptake inhibitors (SSRIs), mood stabilizers, and opioid receptor antagonist medications. Adjuvant cognitive behavioral therapy (CBT) is recommended.