Isabelle Varescon

Depressive symptoms predict long-term mortality after liver transplantation☆☆☆

OBJECTIVE Depressive symptoms are common after liver transplantation (LT). We studied whether depressive symptoms affect long-term survival after LT. METHODS In a prospective cohort study, 134 liver transplant patients were assessed for depressive symptoms using the Beck Depression Inventory-short form (BDI), focusing on the 3 months post-LT score and on the score change from the waiting list period. They were followed up for long-term survival. The median duration of the follow-up period was 43 months post-LT. None of the 134 patients was lost to follow-up for survival. RESULTS A total of 33.6% of the LT patients had mild to moderate depressive symptoms 3 months post-LT. Eighteen (13.4%) patients died during the follow-up. Using Cox proportional hazards analysis, depressive symptoms were significantly associated with mortality (hazard ratio [HR] 1.22, 95% confidence interval (CI) 1.07-1.40, P<.003), one more point in the BDI score being associated with a 17% increase in mortality risk. Other predictive factors of mortality were older age and hepatitis C virus with recurrence 3 months post-LT. Similarly, an increase in depressive symptoms between the waiting list and 3 months post-LT periods predicted mortality (HR 1.18, 95% CI 1.01-1.38, P=.03), especially for patients without depressive symptoms on waiting list (HR 1.56, 95% CI 1.16-2.12, P=.004). CONCLUSION Depressive symptoms after LT and an increase in depressive symptoms between the waiting list and post-LT are associated with an increased risk of long-term mortality. Interventions that could reduce depressive symptoms could potentially decrease long-term mortality after LT.

Pathological gambling and sensation seeking–How do gamblers playing games of chance in cafés differ from those who bet on horses at the racetrack?

The purpose of this study was to study the sensation seeking personality trait in two groups of French pathological gamblers: one group who play games available in cafés (n = 57) and one group who bet on horses at the racetrack (n = 42). Sensation seeking was measured with the Zuckermans Sensation Seeking Scale; intensity of gambling behavior with the South Oaks Gambling Screen and the DSM-IV criteria of pathological gambling. Pathological gamblers who bet at the racetracks had significantly higher scores on Sensation Seeking than those who play games available in cafés. These findings are consistent with the idea of identifying clinically distinct subgroups of gamblers essential in the treatment pathological gambling. One subtype is made of those who play “active” games who gamble for the arousal produced by the game. The second subtype would be one made up of those who play “passive” games who gamble to avoid unpleasant emotional states.

Cognitive distortions, anxiety, and depression among regular and pathological gambling online poker players.

The aims were to assess cognitive distortions and psychological distress (anxiety and depression) among online poker players of different levels of gambling intensity (non-pathological gamblers [NPG], problem gamblers [PbG], and pathological gamblers [PG]), and to examine the relationship between these variables and gambling pathology. Overall, 245 regular online poker players recruited on an Internet forum completed online self-report scales assessing pathological gambling (South Oaks Gambling Screen [SOGS]), psychological distress (Hospital Anxiety and Depression Scale [HADS]) and cognitive distortions (Gambling-Related Cognition Scale). Based on their SOGS scores, poker players were ranked into three groups: NPG (n=146), PbG (n=55), and PG (n=44). All poker players appeared to be more anxious than depressive. PG exhibited higher levels of depression and anxiety than did PbG and NPG. Cognitive distortions also significantly discriminated PG from PbG and NPG. A regression model showed that the perceived inability to stop gambling, the illusion of control, depression (HADS D), and anxiety were good predictors for pathological gambling among poker players. Our results suggest that cognitive distortions play an important role in the development and maintenance of gambling pathology. This study also underlines the role of anxiety and depression in pathological gambling among poker players. It seems relevant to take these elements into account in the research, prevention, and treatment of pathological gambling poker players.

Report of depressive symptoms on waiting list and mortality after liver and kidney transplantation: a prospective cohort study

BackgroundLittle research has explored pre-transplantation psychological factors as predictors of outcome after liver or kidney transplantation. Our objective is to determine whether report of depressive symptoms on waiting list predicts outcome of liver and kidney transplantation.MethodsPatients on waiting list for liver or kidney transplantation were classified for report or non-report of depressive symptoms on waiting list. 339 were transplanted 6 months later on average, and followed prospectively. The main outcome measures were graft failure and mortality 18 months post-transplantation.ResultsAmong the 339 patients, 51.6% reported depressive symptoms on waiting list, 16.5% had a graft failure and 7.4% died post-transplantation.Report of depressive symptoms on waiting list predicted a 3 to 4-fold decreased risk of graft failure and mortality 18-months post-transplantation, independently from age, gender, current cigarette smoking, anxiety symptoms, main primary diagnosis, UNOS score, number of comorbid diagnoses and history of transplantation. Data were consistent for liver and kidney transplantations. Other baseline predictive factors were: for graft failure, the main primary diagnosis and a shorter length since this diagnosis, and for mortality, older age, male gender and the main primary diagnosis.ConclusionFurther studies are needed to understand the underlying mechanisms of the association between report of depressive symptoms on waiting list and decreased risk of graft failure and mortality after transplantation.

Special features of poker

Poker is now one of the most popular types of online gambling, mostly because of its particular structural characteristics. This study aims to investigate the representations of regular poker players of the games special features, along with their probable links with tilt (i.e. loss of control during the game) and problem gambling. Twenty-three regular poker players recruited online took part in a research interview. All interviews were recorded and fully transcribed. A quantitative lexical analysis was performed using the software Alceste®. Six classes were identified, encompassing 73% of the whole corpus. The main themes were chance vs. skill, sensations and emotions linked to poker, discovery of poker, tilt, differences between live and online gambling, and risks of excessive poker involvement. The experience of tilt appears to be an important feature of poker. Poker players also tended to report more emotional and social aspects of problem gambling than financial consequences. The results underline the structural specificities of poker through the players representations. The role of emotions and sensations in poker, as they are both sought by the players and involved in the loss of control, may have an influence on the development and maintenance of problem gambling.

Self-Esteem, Psychological Distress, and Coping Styles in Pregnant Smokers and Non-Smokers

The literature underscores that psychological factors could play an important role in smoking behavior, which is considered a coping mechanism. To study relations among measures of self-esteem, psychological distress, anxiety, depressive symptoms, and coping styles in pregnant smokers, a cross-sectional study was conducted. These factors were assessed in two groups of pregnant women (Smokers, n = 40; Non-smokers, n = 40) contacted at one University Hospital in Paris. All participants filled out the Fagerström Test for Nicotine Dependence, the Rosenberg Self-esteem Scale, the General Health Questionnaire, the Hospital Anxiety Depression Scale, and the Brief Cope Scale. Comparisons, correlations, and regression models were used to analyze the data. The results showed that the group of pregnant women who smoked had significantly lower mean self-esteem, elevated psychological distress and anxiety scores, and reported using more emotion-focused coping than the group of pregnant non-smokers. Self-esteem significantly predicted problem-focused coping. This study confirms the importance of assessing these psychological variables to offer women more specific support to quit smoking.

Online and live regular poker players: Do they differ in impulsive sensation seeking and gambling practice?

Background and aims Online gambling appears to have special features, such as anonymity, speed of play and permanent availability, which may contribute to the facilitation and increase in gambling practice, potentially leading to problem gambling. The aims of this study were to assess sociodemographic characteristics, gambling practice and impulsive sensation seeking among a population of regular poker players with different levels of gambling intensity and to compare online and live players. Methods 245 regular poker players (180 online players and 65 live players) completed online self-report scales assessing sociodemographic data, pathological gambling (SOGS), gambling practice (poker questionnaire) and impulsive sensation seeking (ImpSS). We used SOGS scores to rank players according to the intensity of their gambling practice (non-pathological gamblers, problem gamblers and pathological gamblers). Results All poker players displayed a particular sociodemographic profile: they were more likely to be young men, executives or students, mostly single and working full-time. Online players played significantly more often whereas live players reported significantly longer gambling sessions. Sensation seeking was high across all groups, whereas impulsivity significantly distinguished players according to the intensity of gambling. Discussion Our results show the specific profile of poker players. Both impulsivity and sensation seeking seem to be involved in pathological gambling, but playing different roles. Sensation seeking may determine interest in poker whereas impulsivity may be involved in pathological gambling development and maintenance. Conclusions This study opens up new research perspectives and insights into preventive and treatment actions for pathological poker players.

L’impulsivité dans le TDAH : prévalence des troubles du contrôle des impulsions et autres comorbidités, chez 81 adultes présentant un trouble déficit de l’attention/hyperactivité (TDA/H)

UNLABELLED Attention deficit hyperactivity disorder (ADH/D) is a neuropsychological developmental disorder characterized by pervasive and impairing symptoms of inattention, hyperactivity, and impulsivity. Whereas it is well known in children, there is still little information about ADH/D in adults, including prevalence. Indeed, there are actually no epidemiological studies in France, despite the considerable impact of this disorder in a patients professional and affective life. Moreover, ADH/D rarely stays isolated, and many comorbidities often complicate the diagnostic investigation. It is well known that the so-called ADH/D is composed of two main categories of symptoms (Attentional Disorder/Hyperactiviy Disorder), but Impulsiveness also remains a major symptom. OBJECTIVE The aim of this study was to evaluate not only the prevalence of Impulse Control Disorders (ICD) but also psychological and addictive comorbidities among adult patients with ADH/D. A total of 100 patients from specialized consultations of adult ADH/D were evaluated in this study, but only 81 were included after presenting all the clinical criteria of ADH/D. METHOD We used the DSM IV-T-R for ADH/D, the Minnesota Impulsive Disorders Interview a semi-structured clinical interview assessing impulse control disorders (ICD) (compulsive buying, trichotillomania, compulsive sexual behaviour, kleptomania, pyromania and intermittent explosive disorder), and the Mini International Neuropsychiatric Interview in order to evaluate psychiatric and addictive comorbidities. RESULTS More than 90 % of the patients met the early apparition criteria of ADH/D (before 7years). More than half of the patients presented a mixed type of ADH/D (both inattentive and hyperactive-impulsive forms): 55.6 % vs 44.4 % for the inattentive type. The vast majority of patients showed a complete form (with a total of 6 or more symptoms out of 9, of inattentive and/or impulsive-hyperactivity category): 93.8 % and only 6.2 % presented a sub-syndromic form of ADH/D (with 3 symptoms at least of one and/or the other category). Regarding the ICDs, we found a proportion of 66 % of patients manifesting at least one, the most frequent ICD being the Intermittent Explosive Disorder (IED): 29.6 %, followed by Compulsive Buying (CB): 23.4 %, Pathological Gambling (PG): 7.4 %, Kleptomania and Compulsive Sexual Behaviour: 2.4 %, and Trichotillomania: 1.2 %. Among the psychiatric comorbidities evaluated, generalized anxiety disorder: 61.7 %, followed by dysthymia: 44.4 %, major depressive episode: 28.3 %, Agoraphobia: 22.2 %, panic disorder: 17.2 %, hypomanic episode: 16 %, social phobia: 11.1 %, bulimia nervosa: 8.6 %, and antisocial personality disorder and obsessive-compulsive disorder: 3.7 %. Regarding the addictive comorbidities, we found a prevalence of 14.8 % of substance abuse (non-alcohol), followed by 7.4 % of alcohol abuse, 6.1 % of substance dependence (non-alcohol), and 3.7 % of alcohol dependence. CONCLUSION ADH/D in adults continues to be unrecognized in France. The aim of this study was to evaluate the prevalence of impulse control disorders, psychiatric and addictive comorbidities in adults with ADH/D. The results enable us to appreciate quantitative and qualitative data for 81 French adults with ADH/D. This disorder rarely remains isolated and is often associated with many others, especially anxiety and mood disorders. We also observed that impulsivity stays at the heart of the ADH/D, either through impulsive behaviours or addictive disorders. Considering the lack of studies with ADH/D adults, it is difficult to compare our data. The diagnosis of ADH/D is complex and stays controversial, moreover the strong prevalence of comorbidities points out the importance of differential diagnosis.

The impact of alexithymia on pathological gamblers' decision making: a preliminary study of gamblers recruited in "sportsbook" casinos.

Objective:We investigated whether alexithymia is at the root of the decision-making deficit classically reported in pathological gamblers. Background:Alexithymia has been shown to be a recurrent personality trait of pathological gamblers and to impair the decision-making abilities of nonpathological gamblers, but no previous studies have investigated whether alexithymia significantly affects pathological gamblers’ decision making. Although investigations of pathological gamblers typically have studied those seeking treatment, most pathological gamblers do not seek treatment. Thus, to study people representative of the general population of pathological gamblers, we conducted our study in “sportsbook” casinos with a small sample of gamblers who were not seeking treatment. Methods:We recruited gamblers in sportsbooks and classified them based on their scores on the South Oaks Gambling Screen and the Toronto Alexithymia Scale: 3 groups of pathological gamblers (6 alexithymic, 8 possibly alexithymic, and 6 nonalexithymic) and 8 healthy controls. All of the participants completed an adaptation of the Iowa Gambling Task. Results:The alexithymic group chose less advantageously on the task than the other groups. The severity of the deficit in decision-making abilities was related to the severity of alexithymia, even when we controlled for the effects of anxiety and depression. Conclusions:Our findings provide preliminary evidence that alexithymia might be a critical personality trait underlying pathological gamblers’ decision-making deficits.

Sensation seeking in a community sample of French gamblers: Comparison between strategic and non-strategic gamblers

The purpose of this research is to examine the relationship between sensation seeking and gambling disorder (GD) in a community sample of gamblers (when controlling for the effect of substance use, gender and age) and see whether sensation seeking scores depend on the gambling activity when comparing strategic and non-strategic gamblers. A total of 380 gamblers was recruited. First, pathological gamblers (PGs) (n =143) were compared to non-pathological gamblers (NPGs) (n =237). Second, strategic gamblers (n =93) were compared to non-strategic gamblers (n =110). Sociodemographic data, gambling behavior (SOGS, DSM-IV), tobacco and alcohol use (CAGE), and sensation seeking (SSS) were evaluated. PGs have higher boredom susceptibility scores than NPGs and this factor is associated with GD. Nevertheless, the relationship between sensation seeking and GD depends on the gambling activity. In fact, sensation seeking is associated with GD in strategic gamblers only. PGs playing strategic games display different profiles from non-strategic PGs. Thus, factors associated with GD differ when the gambling activity is taken into account. These findings are consistent with the idea of it being essential to identify clinically distinct subgroups of PGs in the treatment of GD.