Liana R. N. Schreiber

Neuropsychological deficits associated with cannabis use in young adults

BACKGROUND Cannabis is the most widely used illicit substance and has been associated with cognitive impairment. It is unclear whether such impairment can occur in the absence of potential confounding influences of co-morbid axis-I disorders and use of other illicit substances. METHOD Young adult volunteers (18-29 years) were recruited from the general community on the basis of having no axis-I disorders or history of illicit substance use other than cannabis use. Subjects were then grouped according to presence or absence of cannabis use (>1 time/week over past 12 months). Cognition was compared between groups using selected paradigms from the CANTAB. RESULTS Cannabis users (N=16) and controls (N=214) did not differ significantly on salient demographic characteristics. Compared to controls, cannabis users showed significant impairments on quality of decision-making (Cambridge Gamble task), and executive planning (One Touch Stockings of Cambridge task). Response inhibition, spatial working memory, and sustained attention were intact. CONCLUSIONS This study identified cognitive deficits in cannabis users even in the absence of axis-I disorders and a history of using other illicit drugs. Future work should use longitudinal designs to track whether these deficits predate cannabis use or are due to its consumption.

Impulse Control Disorders: Updated Review of Clinical Characteristics and Pharmacological Management

Impulse control disorders (ICDs) are characterized by urges and behaviors that are excessive and/or harmful to oneself or others and cause significant impairment in social and occupational functioning, as well as legal and financial difficulties. ICDs are relatively common psychiatric conditions, yet are poorly understood by the general public, clinicians, and individuals struggling with the disorder. Although ICD treatment research is limited, studies have shown ICDs may respond well to pharmacological treatment. This article presents a brief overview about the clinical characteristics of ICDs and pharmacological treatment options for individuals with ICDs.

Emotion regulation and impulsivity in young adults

Past research has linked both emotion regulation and impulsivity with the development and maintenance of addictions. However, no research has investigated the relationship between emotion regulation and impulsivity within young adults. In the present study, we analyzed 194 young adults (27.8% female; 21.3 ± 3.32 years old; 91.8% single; 85.1% Caucasian), grouping them as low, average, or high emotionally dysregulated, and compared self-reported impulsivity, impulsive behaviors (such as alcohol and substance use and gambling) and cognitive impulsivity. We hypothesized that those with high levels of emotion dysregulation would score higher on self-reported and cognitive impulsivity, and report more impulsive behaviors. Analysis indicated that compared to low, the high emotion dysregulation group scored significantly higher on two self-report measures of impulsivity, harm avoidance, and cognitive reasoning. No significant differences were found between groups in impulsive behaviors and cognitive impulsivity. Overall, this study highlights the relationship between emotion dysregulation and impulsivity, suggesting that emotion regulation may be an important factor to consider when assessing individuals at a higher risk for developing an addiction.

Pharmacological treatments in pathological gambling

Pathological gambling (PG) is a relatively common and often disabling psychiatric condition characterized by intrusive urges to engage in deleterious gambling behaviour. Although common and financially devastating to individuals and families, there currently exist no formally approved pharmacotherapeutic interventions for this disorder. This review seeks to examine the history of medication treatments for PG. A systematic review of the 18 double‐blind, placebo‐controlled pharmacotherapy studies conducted for the treatment of pathological gambling was conducted. Study outcome and the mean dose of medication administered was documented in an effort to determine a preferred medication choice in this population. A variety of medication classes have been examined in the treatment of PG with varying results. Antidepressants, atypical antipsychotics and mood stabilizers have demonstrated mixed results in controlled clinical trials. Although limited information is available, opioid antagonists and glutamatergic agents have demonstrated efficacious outcomes, especially for individuals with PG suffering from intense urges to engage in the behaviour. Given that several studies have demonstrated their efficacy in treating the symptoms associated with PG, opioid antagonists should be considered the first line treatment for PG at this time. Most published studies, however, have employed relatively small sample sizes, are of limited duration and involve possibly non‐representative clinical groups (e.g. those without co‐occurring psychiatric disorders). Response measures have varied across studies. Heterogeneity of PG treatment samples may also complicate identification of effective treatments. Identification of factors related to treatment response will help inform future studies and advance treatment strategies for PG.

Problematic Internet use and associated risks in a college sample.

OBJECTIVE The Internet is commonly used among young adults; however, Internet use may become a problematic behavior. Past research has examined Internet behavior in young adults and its relationship to other behaviors and health issues, yet further research is needed to gain a more comprehensive understanding of this relationship. METHOD A sample (n=2108) of college students (56.9% female) was examined using a self-report Internet survey concerning demographic characteristics, Internet use, health behaviors, psychosocial functioning, and psychiatric comorbidities. The IAT was used to determine levels of problematic Internet use (limited use (none or almost no use), mild use (typical user), moderate use (occasional problems) and severe use (frequent, serious problems)) and the MINI for testing for psychiatric problems. RESULTS We found that 237 students (12.9%) met criteria for limited Internet use, 1502 (81.8%) for mild Internet use and 98 (5.3%) for moderate to severe Internet use. Variables significantly associated with greater frequency of Internet use included lower Grade Point Average (p=.006), less frequent exercise (p=.018), higher PHQ-9 scores (p<.0001) (indicative of greater depression symptoms) and higher Perceived Stress Scores (p<.0001). CONCLUSIONS These data indicate that moderate to severe Internet use is associated with a range of psychosocial problems in young adults. More research is needed to better understand the relationship between Internet use and physical and mental health, as well as academic variables.

Phenomenology and treatment of behavioural addictions.

Behavioural addictions are characterized by an inability to resist an urge or drive resulting in actions that are harmful to oneself or others. Behavioural addictions share characteristics with substance and alcohol abuse, and in areas such as natural history, phenomenology, and adverse consequences. Behavioural addictions include pathological gambling, kleptomania, pyromania, compulsive buying, compulsive sexual behaviour, Internet addiction, and binge eating disorder. Few studies have examined the efficacy of pharmacological and psychological treatment for the various behavioural addictions, and therefore, currently, no treatment recommendations can be made.

The opiate antagonist, naltrexone, in the treatment of trichotillomania: Results of a double-blind, placebo-controlled study

Abstract Trichotillomania (TTM) is characterized by repetitive hair pulling resulting in hair loss. Data on the pharmacological treatment of TTM are limited. This study examined the opioid antagonist, naltrexone, in adults with TTM who had urges to pull their hair. Fifty-one individuals with TTM were randomized to naltrexone or placebo in an 8-week, double-blind trial. Subjects were assessed with measures of TTM severity and selected cognitive tasks. Naltrexone failed to demonstrate significantly greater reductions in hair pulling compared to placebo. Cognitive flexibility, however, significantly improved with naltrexone (P = 0.026). Subjects taking naltrexone with a family history of addiction showed a greater numerical reduction in the urges to pull, although it was not statistically significant. Future studies will have to examine whether pharmacological modulation of the opiate system may provide promise in controlling pulling behavior in a subgroup of individuals with TTM.

A randomized, placebo-controlled trial of N-acetylcysteine plus imaginal desensitization for nicotine-dependent pathological gamblers

OBJECTIVE Pathological gambling is associated with elevated proportions of nicotine dependence, and tobacco smoking in pathological gamblers has been associated with increased problem-gambling severity. This study examined the addition of N-acetylcysteine to imaginal desensitization in adults with co-occurring nicotine dependence and pathological gambling. METHOD Twenty-eight individuals with co-occurring DSM-IV nicotine dependence and pathological gambling who were receiving behavioral therapy were recruited from December 2009 to February 2012 and randomized to augmentation with N-acetylcysteine or placebo in an 12-week, double-blind trial. Subjects were assessed with measures of nicotine and gambling severity and followed for 3 months after treatment. The primary outcomes were the Fagerström Test for Nicotine Dependence and the pathological gambling adaptation of the Yale-Brown Obsessive-Compulsive Scale. RESULTS During the first 6 weeks, there was a significant benefit of N-acetylcysteine treatment versus placebo on Fagerström Test for Nicotine Dependence total scores (t = -2.224; P = .031). After the initial 6 weeks, all subjects significantly (P < .001) benefited from imaginal desensitization. During the 3-month follow-up, there was a significant additional benefit for N-acetylcysteine versus placebo on measures of problem-gambling severity (t = 2.069; P = .043). CONCLUSIONS N-acetylcysteine treatment during therapy facilitates long-term application of behavioral therapy techniques once patients are in the community after therapy has been completed. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT00967005.

Pathologic gambling and bankruptcy

BACKGROUND Although prior studies have examined rates of bankruptcy in pathologic gambling (PG), there are only limited data regarding the clinical correlates of those with PG who declare bankruptcy because of gambling. METHOD Five hundred seventeen consecutive subjects with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, PG (54.7% females; mean age 47.6 years) were grouped into 2 categories: those who had (n = 93; 18.0%) and had not (n = 424; 82.0%) declared bankruptcy secondary to gambling. Groups were compared on clinical characteristics, gambling severity (using the Yale-Brown Obsessive-Compulsive Scale Modified for Pathological Gambling, Gambling Symptom Assessment Scale; Clinical Global Impression-severity scale, and time and money spent gambling), and psychiatric comorbidity. RESULTS Gamblers who had declared bankruptcy were more likely to be single (P = .004); have an earlier age of problem gambling onset (P = .032); and have more financial (P < .001), work-related (P = .006), marital (P < .001), and legal (P < .001) problems secondary to their gambling. They also reported higher rates of depressive disorders (P < .001), substance use disorders (P = .005) and were more likely to be daily users of nicotine (P = .022). Money spent gambling did not differ significantly between groups. CONCLUSION These preliminary results suggest that bankruptcy in PG may be associated with specific clinical differences. Treatment strategies may want to assess bankruptcy status to develop more effective treatments that take account of these clinical differences.

Neurocognitive dysfunction in strategic and non-strategic gamblers.

OBJECTIVE It has been theorized that there may be subtypes of pathological gambling, particularly in relation to the main type of gambling activities undertaken. Whether or not putative pathological gambling subtypes differ in terms of their clinical and cognitive profiles has received little attention. METHOD Subjects meeting DSM-IV criteria for pathological gambling were grouped into two categories of preferred forms of gambling - strategic (e.g., cards, dice, sports betting, stock market) and non-strategic (e.g., slots, video poker, pull tabs). Groups were compared on clinical characteristics (gambling severity, and time and money spent gambling), psychiatric comorbidity, and neurocognitive tests assessing motor impulsivity and cognitive flexibility. RESULTS Seventy-seven subjects were included in this sample (45.5% females; mean age: 42.7±14.9) which consisted of the following groups: strategic (n=22; 28.6%) and non-strategic (n=55; 71.4%). Non-strategic gamblers were significantly more likely to be older, female, and divorced. Money spent gambling did not differ significantly between groups although one measure of gambling severity reflected more severe problems for strategic gamblers. Strategic and non-strategic gamblers did not differ in terms of cognitive function; both groups showed impairments in cognitive flexibility and inhibitory control relative to matched healthy volunteers. CONCLUSION These preliminary results suggest that preferred form of gambling may be associated with specific clinical characteristics but are not dissociable in terms of cognitive inflexibility and motor impulsivity.