Sarah Sauchelli

Comparative analysis of distinct phenotypes in gambling disorder based on gambling preferences

BackgroundStudies examining gambling preferences have identified the importance of the type of gambling practiced on distinct individual profiles. The objectives were to compare clinical, psychopathological and personality variables between two different groups of individuals with a gambling disorder (strategic and non-strategic gamblers) and to evaluate the statistical prediction capacity of these preferences with respect to the severity of the disorder.MethodA total sample of 2010 treatment-seeking patients with a gambling disorder participated in this stand-alone study. All were recruited from a single Pathological Gambling Unit in Spain (1709 strategic and 301 non-strategic gamblers). The design of the study was cross-sectional and data were collected at the start of treatment. Data was analysed using logistic regression for binary outcomes and analysis of variance (ANOVA) for quantitative responses.ResultsThere were significant differences in several socio-demographic and clinical variables, as well as in personality traits (novelty seeking and cooperativeness). Multiple regression analysis showed harm avoidance and self-directedness were the main predictors of gambling severity and psychopathology, while age at assessment and age of onset of gambling behaviour were predictive of gambling severity. Strategic gambling (as opposed to non-strategic) was significantly associated with clinical outcomes, but the effect size of the relationships was small.ConclusionsIt is possible to identify distinct phenotypes depending on the preference of gambling. While these phenotypes differ in relation to the severity of the gambling disorder, psychopathology and personality traits, they can be useful from a clinical and therapeutic perspective in enabling risk factors to be identified and prevention programs targeting specific individual profiles to be developed.

Moderate-Vigorous Physical Activity across Body Mass Index in Females: Moderating Effect of Endocannabinoids and Temperament

Background Endocannabinoids and temperament traits have been linked to both physical activity and body mass index (BMI) however no study has explored how these factors interact in females. The aims of this cross-sectional study were to 1) examine differences among distinct BMI groups on daytime physical activity and time spent in moderate-vigorous physical activity (MVPA), temperament traits and plasma endocannabinoid concentrations; and 2) explore the association and interaction between MVPA, temperament, endocannabinoids and BMI. Methods Physical activity was measured with the wrist-worn accelerometer Actiwatch AW7, in a sample of 189 female participants (43 morbid obese, 30 obese, and 116 healthy-weight controls). The Temperament and Character Inventory-Revised questionnaire was used to assess personality traits. BMI was calculated by bioelectrical impedance analysis via the TANITA digital scale. Blood analyses were conducted to measure levels of endocannabinoids and endocannabinoid-related compounds. Path-analysis was performed to examine the association between predictive variables and MVPA. Results Obese groups showed lower MVPA and dysfunctional temperament traits compared to healthy-weight controls. Plasma concentrations of 2-arachidonoylglyceryl (2-AG) were greater in obese groups. Path-analysis identified a direct effect between greater MVPA and low BMI (b = −0.13, p = .039) and high MVPA levels were associated with elevated anandamide (AEA) levels (b = 0.16, p = .049) and N-oleylethanolamide (OEA) levels (b = 0.22, p = .004), as well as high Novelty seeking (b = 0.18, p<.001) and low Harm avoidance (b = −0.16, p<.001). Conclusions Obese individuals showed a distinct temperament profile and circulating endocannabinoids compared to controls. Temperament and endocannabinoids may act as moderators of the low MVPA in obesity.

Predictors of Outcome among Pathological Gamblers Receiving Cognitive Behavioral Group Therapy

Aims: The aim of this study was to evaluate posttreatment changes of individuals with a diagnosis of gambling disorder (GD) treated with group cognitive behavioral therapy (CBT), to assess the potential moderator effect of sex on CBT outcome, and to explore the best predictors of posttreatment changes, relapse, and dropout rates. Methods: A cohort design was applied with a prospective follow-up. The sample comprised 440 patients and the CBT intervention consisted of 16 weekly outpatient group sessions and a 3-month follow-up period. Results: Patients showed significant improvements in both the level of psychopathology and the severity of the gambling behavior. High self-transcendence and the involvement of the spouse or partner in the therapy predicted a higher risk of relapse. Younger age and low education predicted a higher risk of dropout. Conclusion: Many patients with GD can be treated with strategies to improve self-control and emotional regulation, but other techniques should be incorporated to address the individual characteristics of each patient. This is particularly important in group therapy, in which the same treatment is applied to several patients simultaneously. The involvement of a family member needs to be carefully considered since it may have a negative effect on the response to treatment if not adequately managed.

Differences and similarities between bulimia nervosa, compulsive buying and gambling disorder.

AIM The objective of the study was to analyse shared commonalities and differences between bulimia nervosa (BN) and certain impulse-related disorders, namely compulsive buying (CB) and gambling disorder (GD), with respect to general psychopathology and personality traits. METHODS A total of 188 female patients [50 BN without comorbid CB (BN-CB), 49 BN with comorbid CB (BN+CB), 53 GD and 36 CB] and 50 comparison non-psychiatric women participated in the current study. All patients were diagnosed using the Diagnostic and Statistical Manual of Mental Disorders, Fourth revised edition, the Temperament and Character Inventory-Revised, and other clinical indices. RESULTS A positive-growing trend was observed in psychopathology and personality traits across the four clinical groups. Comorbid BN with CB was associated with highest eating psychopathology and social anxiety. On Novelty Seeking, the CB, GD and BN+CB were similar to each other, whereas BN-CB presented a distinct profile. Moreover, the BN+CB group displayed more dysfunctional personality traits and higher general psychopathology. The clinical groups demonstrated overall higher levels of psychopathology compared with the control group. CONCLUSIONS The results of this study demonstrate that disorders with impulsive traits (CB, GD, BN+CB and BN-CB) follow a linear trend in general psychopathology and specific personality traits, but differ along specific personality and psychopathological dimensions.

Contribution of illegal acts to pathological gambling diagnosis: DSM-5 implications.

The purposes of this study were to examine the specific contribution of illegal acts to the diagnostic criteria of pathological gambling, to assess the possibility of differential item functioning across patients’ sex and age, and to explore the existence of different clinical phenotypes based on the presence of illegal acts. The sample consisted of 2,155 patients seeking treatment for pathological gambling at the University Hospital of Bellvitge in Barcelona, Spain. The illegal acts item did not show different item functioning, and younger patients presented higher latent means than middle-aged and older patients, whereas no differences were found across sex. This item also showed the lowest discrimination coefficient; its exclusion would maintain satisfactory internal consistency for the remaining 9 symptoms and was poorly related to psychopathology and the severity of the gambling behavior. The relevance of the illegal acts as a diagnostic criterion appears to be limited, and its elimination from the Diagnostic and Statistical Manual for Mental Disorders, 5th edition, seems justified. However, illegal acts have implications for both the clinical and legal domains and contribute to increase the patients’ impairment.

Orexin and sleep quality in anorexia nervosa: Clinical relevance and influence on treatment outcome

BACKGROUND AND AIMS Orexins/hypocretins are orexigenic peptides implicated in the regulation of feeding behavior and the sleep/wake cycle. Little is known about the functioning of these peptides in anorexia nervosa (AN). The aims of the current study were to evaluate the extent to which orexin-A might be linked to sleep and treatment outcome in AN. METHOD Fasting plasma orexin-A concentrations were measured in 48 females with AN at the start of a day hospital treatment and in 98 normal-eater/healthy-weight controls. The Pittsburgh Sleep Quality Index was administered at the beginning of the treatment as a measure of sleep quality. Other psychopathological variables were evaluated with the Symptom Checklist-Revised (SCL90R) and the Eating Disorder Inventory-2 (EDI). Patients were assessed at the start and end of treatment by means of commonly used diagnostic criteria and clinical questionnaires. RESULTS The AN patients presented more sleep disturbances and poorer overall sleep quality than did the healthy controls (p=.026) but there were no global differences between groups in plasma orexin-A concentrations (p=.071). In the AN sample, orexin-A concentrations were associated with greater sleep disturbances (|r|=.30), sleep inefficiency (|r|=.22) and poorer overall sleep (|r|=.22). Structural Equation Modeling (SEM) showed that both elevated orexin-A concentrations and inadequate sleep predicted poorer treatment outcome. CONCLUSION Plasma orexin-A concentrations contribute to poor sleep quality in AN, and both of these variables are associated with therapy response.

Modulation of Irisin and Physical Activity on Executive Functions in Obesity and Morbid obesity

Whether the executive profile is different between obesity (OB) and morbid obesity (MO) remains unclear. Recent evidence suggests that physical activity (PA) can act as a cognitive enhancer. Irisin is a recently discovered hormone associated with some of the positive effects of PA. The objective of the study was to investigate the executive profile in OB and MO, and to explore the role of PA and irisin. 114 participants were included (21 OB, 44 MO and 49 healthy controls-HC) in the study and assessed with the Wisconsin Card Sorting Test, Stroop Color and Word Test, and Iowa Gambling Task. All participants were female, aged between 18 and 60 years. Results showed a similar dysfunctional profile on decision making in OB and MO compared with HC. Thus, no specific neuropsychological profiles between OB and MO can be clearly observed in our sample. However, a negative correlation was found between irisin and executive functioning. These results demonstrate a specific executive profile in OB and a relevant and negative modulation of irisin on executive functioning. Although irisin might be a promising target for the treatment of obesity, its effects on cognition might be considered when thinking about its therapeutic use.

Dimensions of Compulsive Exercise across Eating Disorder Diagnostic Subtypes and the Validation of the Spanish Version of the Compulsive Exercise Test

Objectives: Compulsive exercise in eating disorders has been traditionally considered as a behavior that serves the purpose of weight/shape control. More recently, it has been postulated that there may be other factors that drive the compulsive need to exercise. This has led to the development of the Compulsive Exercise Test (CET); a self-reported questionnaire that aims to explore the cognitive-behavioral underpinnings of compulsive exercise from a multi-faceted perspective. The objectives of this study were threefold: (1) to validate the Spanish version of the CET; (2) to compare eating disorder diagnostic subtypes and a healthy control group in terms of the factors that drive compulsive exercise as defined by the CET; (3) to explore how the dimensions evaluated in the CET are associated with eating disorder symptoms and general psychopathology. Methods: The CET was administered to a total of 157 patients with an eating disorder [40 anorexia nervosa, 56 bulimia nervosa (BN), and 61 eating disorder not-otherwise-specified (EDNOS)] and 128 healthy weight/eating controls. Patients were assessed via a semi-structured interview to reach a DSM-IV-TR diagnosis. Additionally, all participants completed the Symptom Checklist-90-Revised (SCL-90R) and the Eating Disorders Inventory-2 (EDI-2). Results: Confirmatory factor analysis demonstrated adequate goodness-of-fit to the original five-factor model of the CET. BN and EDNOS patients scored higher in the avoidance and rule-driven behavior, weight control, and total CET scales in comparison to the healthy controls, and higher across all scales apart from the exercise rigidity scale compared to the anorexia nervosa patients. Mean scores of the anorexia nervosa patients did not differ to those of the control participants, except for the mood improvement scale where the anorexia nervosa patients obtained a lower mean score. Mean scores between the BN and EDNOS patients were equivalent. The CET scales avoidance and rule-driven behavior, weight of control and total CET scores were positively correlated with the clinical assessment measures of the SCL-90R and EDI-2. Conclusion: Compulsive exercise is a multidimensional construct and the factors driving compulsive exercise differ according to the eating disorder diagnostic subtype. This should be taken into account when addressing compulsive exercise during the treatment of eating disorders.

Physical activity in anorexia nervosa: How relevant is it to therapy response?

OBJECTIVE Elevated physical activity has been observed in some patients with anorexia nervosa (AN) despite their emaciated condition. However, its effects on treatment outcome remain unclear. This study aimed to examine objectively measured physical activity in this clinical population and how it might be related to a partial hospitalization therapy response, after considering potential confounders. METHOD The sample comprised 88 AN patients consecutively enrolled in a day hospital treatment program, and 116 healthy-weight controls. All participants were female and a baseline assessment took place using an accelerometer (Actiwatch AW7) to measure physical activity, the Eating Disorders Inventory-2 and the Depression subscale of the Symptom Checklist-Revised. Outcome was evaluated upon the termination of the treatment program by expert clinicians. RESULTS Although AN patients and controls did not differ in the average time spent in moderate-to-vigorous physical activity (MVPA) (P=.21), nor daytime physical activity (P=.34), fewer AN patients presented a high physical activity profile compared to the controls (37% vs. 61%, respectively; P=.014). Both lower levels of MVPA and greater eating disorder severity had a direct effect on a poor treatment outcome. Depression symptoms in the patients were associated with lower MVPA, as well as with an older age, a shorter duration of the disorder and greater eating disorder psychopathology. CONCLUSIONS There is a notable variation in the physical activity profile of AN patients, characterized by either low or very high patterns. Physical activity is a highly relevant issue in AN that must be taken into account during the treatment process.