Cannabis and Depression.

There is a growing body of evidence pointing to the co-occurrence of cannabis use and depression. There is also some evidence that the use of cannabis may lead to the onset of depression; however, strong evidence points to the inverse association; i.e. that depression may lead to the onset or increase in cannabis use frequency. Observational and epidemiological studies have not indicated a positive long-term effect of cannabis use on the course and outcome of depression. The association between cannabis use and depression may be stronger among men during adolescence and emerging adulthood and stronger in women during midlife. There is an indication for potential genetic correlation contributing to the comorbidity of cannabis dependence and major depression, namely that serotonin (5-HT) may mediate such association and there is also evidence for specific risk alleles for cannabis addiction. There is preclinical evidence that alteration in the endocannabinoid system could potentially benefit patients suffering from depression. However, the issue of using cannabis as an anti-depressant is at an early stage of examination and there is little evidence to support it. Finally, there has been little support to the notion that selective serotonin reuptake inhibitors (SSRIs) may be effective in decreasing depressive symptoms or rates of substance use in adolescents treated for depression and a co-occurring substance use disorder. In conclusion, despite methodological limitations, research in the past decades has broadened our knowledge on the association between cannabis use and depression from epidemiological, neurological, genetic, and pharmacological perspectives.

Modulatory effects of cannabinoids on brain neurotransmission.

Recreational and chronic cannabis use has been associated with a range of acute and chronic effects including; anti-nociceptive actions, anxiety, depression, psychotic symptoms and neurocognitive impairments. The mechanisms underlying cannabinoid-based drugs effects are not fully known but given the neuro-modulatory functions of the endocannabinoid system, it seems likely that agonistic activity at the cannabinoid type-1 receptors (CB1 ) might modulate the functions of other neurotransmitter systems. The present review has summarized the currently available pre-clinical and clinical data on the interactions of CB1 and cannabinoid type-2 receptors (CB2 ) with the central neurotransmitters; dopamine, serotonin, noradrenaline, GABA, glutamate and opioids. Acute and chronic exposures to cannabinoids exert pharmacological alterations in the mammalian brain that have profound implications for our understanding of the neuropharmacology of cannabinoid-based drugs and their effects on mental health and the brain. A recent emergence uses of cannabis for medical purpose together with legalization and decriminalization of cannabis and increasing use of highly potent synthetic cannabinoids raise a growing concern over the effects of cannabinoids and their interaction with other neurotransmitters on physical and mental health.

Buying-shopping disorder-is there enough evidence to support its inclusion in ICD-11?

The phenomenon of buying-shopping disorder (BSD) was described over 100 years ago. Definitions of BSD refer to extreme preoccupation with shopping and buying, to impulses to purchase that are experienced as irresistible, and to recurrent maladaptive buying excesses that lead to distress and impairments. Efforts to stop BSD episodes are unsuccessful, despite the awareness of repeated break-downs in self-regulation, experiences of post-purchase guilt and regret, comorbid psychiatric disorders, reduced quality of life, familial discord, work impairment, financial problems, and other negative consequences. A recent meta-analysis indicated an estimated point prevalence of BSD of 5%. In this narrative review, the authors offer a perspective to consider BSD as a mental health condition and to classify this disorder as a behavioral addiction, based on both research data and on long-standing clinical experience.

The contribution of ADHD and attachment difficulties to online pornography use among students.

BACKGROUND: There is a high rate of ADHD among individuals with compulsive sexual behavior disorder (CSBD). There is also evidence for an association between compulsive sexual behavior disorder, sensation seeking and attachment difficulties. Problematic pornography use may be considered as a subtype of CSBD hence it merits investigation. The aim of the current study was to investigate the relationships between ADHD, attachment style, sensation seeking and problematic use of pornography online in the general population. METHODS: The sample was comprised of 85 participants [38 men (44.7%) and 47 women (55.3%)] with mean age 25. 66 (SD = 4.63) and 26.42 (SD = 6.94) years, respectively. There were 30 participants (35%) with ADHD and 55 participants (65%) without ADHD. They were recruited on-line via social network sites. They filled in a demographic questionnaire, Zukerman's Sensation Seeking Scale, Experience in Close Relationship (ECR) questionnaire that assessed anxious and avoidant attachment and the Cyber Pornography Use Inventory (CPUI). RESULTS: Individuals with self-reported ADHD had higher scores of avoidant attachment on the ECR and CPUI compared with individuals without ADHD. Multivariate linear regression analysis has indicated that male gender, ADHD and anxious attachment on the ECR contributed significantly to the variance of cyber pornography use, and explained 34% of the variance. CONCLUSIONS: The results indicate that males with ADHD and anxious attachment show an extensive use of pornography online. Males with ADHD who have difficulties in close relationship may use online pornography excessively that in turn may exacerbate their difficulty in forming secure attachment at adult life, a finding that has major clinical implications.

Negative association of pretreatment cigarette use with smoking-induced striatal dopamine release in smokers receiving bupropion treatment.

BACKGROUND AND OBJECTIVES: In an effort to help identify factors that maintain heavy smoking, this study tested the association of pretreatment cigarette use (cigarettes per day) with striatal dopamine release during smoking-cessation treatment. METHODS: Thirteen regular smokers (≥10 cigarettes per day) were evaluated on parameters of smoking behavior, and they entered a smoking cessation treatment protocol, including bupropion administration and individual counseling for 2 months. On week 7 of treatment, 10 of the participants underwent brain scans using [(11) C]raclopride with positron emission tomography to assess smoking-induced dopamine release in the caudate nucleus and putamen, inferred from changes in dopamine D2 -type receptor availability. RESULTS: Receptor availability, measured as binding potential referred to non-displaceable uptake (BPND ) in both striatal regions re-demonstrated a significant decrease after smoking a cigarette; and pre-treatment cigarette use significantly negatively correlated with smoking-induced dopamine release in the caudate. CONCLUSIONS AND SIGNIFICANCE: The negative association of cigarette use with dopamine release suggests tolerance or down-regulation of the dopamine system by chronic smoking, or a pre-existing condition that promotes more frequent smoking. This association should be regarded as preliminary evidence that warrants verification. (Am J Addict 2016;25:486-492).

Internet addiction is associated with social anxiety in young adults.

BACKGROUND: Problematic Internet use or excessive Internet use is characterized by excessive or poorly controlled preoccupations, urges, or behaviors regarding computer use, and Internet access that leads to impairment or distress. Cross-sectional studies on samples of patients reported high comorbidity of Internet addiction with psychiatric disorders, especially affective disorders (including depression), anxiety disorders (generalized anxiety disorder, social anxiety disorder), and attention-deficit/hyperactivity disorder. METHODS: We have investigated the association between Internet addiction and social anxiety in 2 samples of 120 university students (60 males and 60 females in each sample). RESULTS: We found a correlation between Internet addiction and social anxiety in the 2 samples (r=0.411, P<.001; r=0.342, P<.01) respectively. Secondly, we found no difference between males and females on the level of Internet addiction. Thirdly, we did not find a preference for social networks among participants with high levels of social anxiety. CONCLUSIONS: The results of the study support previous evidence for co-occurrence of Internet addiction and social anxiety, but further studies need to clarify this association.

New developments on the neurobiological and pharmaco-genetic mechanisms underlying internet and videogame addiction.

BACKGROUND: There is emerging evidence that the psychobiological mechanisms underlying behavioral addictions such as internet and videogame addiction resemble those of addiction for substances of abuse. OBJECTIVES: Review of brain imaging, treatment and genetic studies on videogame and internet addiction. METHODS: Literature search of published articles between 2009 and 2013 in Pubmed using "internet addiction" and "videogame addiction" as the search word. Twenty-nine studies have been selected and evaluated under the criteria of brain imaging, treatment, and genetics. RESULTS: Brain imaging studies of the resting state have shown that long-term internet game playing affected brain regions responsible for reward, impulse control and sensory-motor coordination. Brain activation studies have shown that videogame playing involved changes in reward and loss of control and that gaming pictures have activated regions similarly to those activated by cue-exposure to drugs. Structural studies have shown alterations in the volume of the ventral striatum possible as result of changes in reward. Furthermore, videogame playing was associated with dopamine release similar in magnitude to those of drugs of abuse and that there were faulty inhibitory control and reward mechanisms videogame addicted individuals. Finally, treatment studies using fMRI have shown reduction in craving for videogames and reduced associated brain activity. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE: Videogame playing may be supported by similar neural mechanisms underlying drug abuse. Similar to drug and alcohol abuse, internet addiction results in sub-sensitivity of dopamine reward mechanisms. Given the fact that this research is in its early stage it is premature to conclude that internet addiction is equivalent to substance addictions.

Internet Addiction and Attention Deficit Hyperactivity Disorder Among Schoolchildren.

BACKGROUND: Use of the internet and videogames by children and adolescents has risen dramatically over the last decade. Increasing evidence of internet and videogame addiction among children is causing concern due to its harmful physical, emotional and social consequences. There is also emerging evidence for an association between computer and videogame addiction and attention deficit/hyperactivity disorder (ADHD). OBJECTIVES: To investigate the relationship between ADHD and internet addiction. METHODS: We compared 50 male schoolchildren, mean age 13 years, diagnosed with ADHD to 50 male schoolchildren without ADHD on measures of internet addiction, internet use and sleep patterns. RESULTS: Children with ADHD had higher scores on the Internet Addiction Test (IAT), used the internet for longer hours, and went to sleep later than those without ADHD. CONCLUSIONS: These findings indicate an association of ADHD, sleep disorders and internet/videogame addiction.

Stroop task among patients with obsessive-compulsive disorder (OCD) and pathological gambling (PG) in methadone maintenance treatment (MMT).

OBJECTIVES: To evaluate the impaired attention selection (Stroop interference effect) and general performance [reaction times (RTs)] on the Stroop task among methadone maintenance treatment (MMT) patients with obsessive compulsive disorder (OCD), pathological gambling (PG), both PG/OCD or none, and the influence if having ADHD. METHODS: Eighty-six patients and 15 control subjects underwent the Stroop task, which measured RTs of condition-related words (color, obsessive compulsive disorder, pathological gambling, addiction) and neutral words. RESULTS: MMT patients had longer RTs on the Stroop task compared with controls. RTs were longer among patients with OCD and in those who abused drugs on the study day. The combined PG/OCD group had the longest RTs, but they were also characterized as abusing more drugs, being older, and having worse cognitive status. Stroop color interference differed only among MMT patients with ADHD, and it was higher among those with OCD than those without OCD. The modified condition-related Stroop did not show any interference effect of OCD, addiction, or gambling words. CONCLUSIONS: MMT patients had generally poorer performance, as indicated by longer RTs, that were related to clinical OCD, drug abuse, poor cognitive state, and older age. Patients with both clinical OCD and ADHD had a higher Stroop interference effect, which is a reflection of an attention deficit. In order to improve clinical approach and treatment of MMT patients, OCD and ADHD should be evaluated (and treated as needed).

Recent treatment and novel imaging studies evaluating treatment of internet gaming disorder: a narrative review.

Internet Gaming Disorder (IGD) is an emerging public health concern; effective treatments are still under development. This mini-review focuses on summarizing the main scientific evidence from psychological, pharmacological, brain imaging, and emerging treatment approaches for IGD. We searched PubMed and Scopus databases using keywords related to IGD and treatment. Cognitive behavioral therapy (CBT) is the most extensively researched psychological treatment for IGD, supported by several randomized controlled trials (RCTs). Other promising approaches include mindfulness, relapse prevention, abstinence protocols, and family therapy. Pharmacological treatments like bupropion and escitalopram have shown benefits, especially when IGD is comorbid with conditions like major depressive disorder. However, the quality of evidence is moderate for psychological interventions but low to moderate for pharmacological approaches. Emerging treatments such as transcranial direct current stimulation (tDCS), repetitive transcranial magnetic stimulation (rTMS), and electro-acupuncture have demonstrated efficacy in reducing IGD symptoms and modulating brain activity. Brain imaging techniques like functional magnetic resonance imaging (fMRI) have provided insights into the neural mechanisms underlying IGD and treatment effects, although these studies lack randomized controlled designs. While multimodal approaches show promise, larger, well-designed RCTs are needed to establish effective IGD treatments.

Digital Media and Developing Brains: Concerns and Opportunities.

Purpose of Review: The incorporation of digital technologies and their use in youth's everyday lives has been increasing rapidly over the past several decades with possible impacts on youth development and mental health. This narrative review aimed to consider how the use of digital technologies may be influencing brain development underlying adaptive and maladaptive screen-related behaviors. Recent Findings: To explore and provide direction for further scientific inquiry, an international group of experts considered what is known, important gaps in knowledge, and how a research agenda might be pursued regarding relationships between screen media activity and neurodevelopment from infancy through childhood and adolescence. While an understanding of brain-behavior relationships involving screen media activity has been emerging, significant gaps exist that have important implications for the health of developing youth. Summary: Specific considerations regarding brain-behavior relationships involving screen media activity exist for infancy, toddlerhood, and early childhood; middle childhood; and adolescence. Transdiagnostic frameworks may provide a foundation for guiding future research efforts. Translating knowledge gained into better interventions and policy to promote healthy development is important in a rapidly changing digital technology environment.

Reward, motivation and brain imaging in human healthy participants - A narrative review.

Over the past 20 years there has been an increasing number of brain imaging studies on the mechanisms underlying reward motivation in humans. This narrative review describes studies on the neural mechanisms associated with reward motivation and their relationships with cognitive function in healthy human participants. The brain's meso-limbic dopamine reward circuitry in humans is known to control reward-motivated behavior in humans. The medial and lateral Pre-Frontal Cortex (PFC) integrate motivation and cognitive control during decision-making and the dorsolateral PFC (dlPFC) integrates and transmits signals of reward to the mesolimbic and meso-cortical dopamine circuits and initiates motivated behavior. The thalamus and insula influence incentive processing in humans and the motor system plays a role in response to action control. There are reciprocal relationships between reward motivation, learning, memory, imagery, working memory, and attention. The most common method of assessing reward motivation is the monetary incentive delay task (DMRT) and there are several meta-analyses of this paradigm. Genetics modulates motivation reward, and dopamine provides the basis for the interaction between motivational and cognitive control. There is some evidence that male adolescents take more risky decisions than female adolescents and that the lateralization of reward-related DA release in the ventral striatum is confined to men. These studies have implications for our understanding of natural reward and psychiatric conditions like addiction, depression and ADHD. Furthermore, the association between reward and memory can help develop treatment techniques for drug addiction that interfere with consolidation of memory. Finally, there is a lack of research on reward motivation, genetics and sex differences and this can improve our understanding of the relationships between reward, motivation and the brain.

A brain imaging study of dopamine receptor D2 availability in cannabis dependent users after recovery from cannabis-induced psychosis.

There is increased risk of psychosis associated with cannabis use disorder and the interaction of THC with dopamine neurotransmission is complex. It is important to investigate the recovery from cannabis-induced psychosis and its effects on the brain's dopamine neurotransmission. This study was to evaluate dopamine receptor D2 availability in the striatum (caudate/putamen) in recently abstinent cannabis dependent users after recovery from psychosis in comparison with abstinent MDMA "ecstasy" abusers and healthy control participants. Participants were eight abstinent ex cannabis-dependent users who were treated for cannabis-induced psychosis with anti-psychotic medication and psychosocial support for 4 months in an inpatient treatment center for drug users. They were compared with nine abstinent ex MDMA "ecstasy" abusers who received medication and psycho-social treatment for 4 months at the same treatment facility and eight healthy control participants. All participants were scanned with bolus and constant infusion of [123I] Iodobenzamide (IBZM) in Single Photon Computed Tomography (SPECT). Cannabis abstinent users who were treated for cannabis-induced psychotic episodes showed no difference in dopamine D2 receptor availability in the caudate compared with abstinent MDMA "ecstasy" abusers and healthy control participants. This finding indicates minimal effects of cannabis-induced psychosis on dopamine reward mechanisms. There is evidence for reduced D2 receptor availability measures in the right putamen (uncorrected) which may indicate a residual effect of anti-psychotic medication.

Exercise addiction: A narrative overview of research issues.

This narrative overview summarises the work on exercise addiction (EA) over the past 12 years and exposes critical conceptual and methodological issues. More than 1000 articles exist on EA, conceptualised as uncontrolled training harming the individual. Still, EA has no clinical diagnosis criteria at this time. Research is increasing continuously, but it is stale in advancing knowledge. Scalar measurement and lack of differentiation between addictive and instrumental exercise could be reasons for insufficient progress. Exercise addiction fits in the framework of behavioural addictions, but excessive exercise patterns also co-occur with other morbidities, including eating or body-image disorders. In these cases, exercise is instrumental; it functions to achieve a non-exercise-related goal. Therefore, it is essential to separate primary from secondary EA. Based on the interactional model, significant stress and capacity-exceeding ambitions fuel primary EA, while chief motives behind secondary EA embed body image dissatisfaction and eating disorders. Few reports exist on EA's brain mechanisms, which could delay its classification as a distinct psychiatric dysfunction. Treatment of EA involves cognitive-behavioural approaches, but we know little about their effectiveness. Conceptually focussed psychophysiological research and in-depth interviews, complementing scalar data, could answer several open questions in this widely studied but relatively stagnant scholastic field.

Emerging association between addictive gaming and attention-deficit/hyperactivity disorder.

Children's and adolescent's use of computer games and videogames is becoming highly popular and has increased dramatically over the last decade. There is growing evidence of high prevalence of addiction to computer games and videogames among children, which is causing concern because of its harmful consequences. There is also emerging evidence of an association between computer game and videogame addiction and attention deficit/hyperactivity disorder (ADHD). This is indicated by the occurrence of gaming addiction as a co-morbid disorder of ADHD, common physiological and pharmacological mechanisms, and potential genetic association between the two disorders. A proper understanding of the psychological and neurotransmitter mechanisms underlying both disorders is important for appropriate diagnostic classification of both disorders. Furthermore, it is important for development of potential pharmacological treatment of both disorders. Relatively few studies have investigated the common mechanisms for both disorders. This paper reviews new findings, trends, and developments in the field. The paper is based on a literature search, in Medline and PUBMED, using the keywords addictive gaming and ADHD, of articles published between 2000 and 2012.

Problematic Social Networking Site use-effects on mental health and the brain.

The association between excessive use of Social Networking Sites (SNS) and mental health is raising serious concern among health and education professionals. Problematic SNS use has been associated with an increased rate of depression, anxiety, stress, obsessive-compulsive disorder (OCD), attention-deficit/hyperactivity disorder (ADHD), and propensity to excessive alcohol use. It may also lead to vulnerability to aggression, cyberbullying and fear of missing out (FOMO). There is little evidence for cognitive impairments, but there is some preliminary event-related potentials (ERPs) evidence for inefficiency in allocating and monitoring resources and inhibitory control. Problematic SNS has been associated with the personality traits of conscientiousness agreeableness and neuroticism, and with narcissism. There is evidence for reduced sleep quality and quantity, longer sleeping latency and more sleep disturbance. The few brain imaging studies show some similarity between problematic SNS use and other addictions related to inhibitory-control mechanism, reduced gray matter volumes in the nucleus accumbens, amygdala, and the insula, suggesting rewarding effects of SNS use on the brain. Finally, there is preliminary evidence that treatment with Cognitive Behavior Therapy (CBT) can assist in short-term abstinence intervention to treat problematic SNS use. We conclude that problematic SNS use may have deleterious effects on emotional and social relationships, and more research is required on its effects on cognitive and brain function.

Excessive Smartphone Use Is Associated With Health Problems in Adolescents and Young Adults.

Background and Aims: This present paper will review the existing evidence on the effects of excessive smartphone use on physical and mental health. Results: Comorbidity with depression, anxiety, OCD, ADHD and alcohol use disorder. Excessive smartphone use is associated with difficulties in cognitive-emotion regulation, impulsivity, impaired cognitive function, addiction to social networking, shyness and low self-esteem. Medical problems include sleep problems, reduced physical fitness, unhealthy eating habits, pain and migraines, reduced cognitive control and changes in the brain's gray matter volume. In Conclusion: Excessive smartphone use is associated with psychiatric, cognitive, emotional, medical and brain changes that should be considered by health and education professionals.

Expert appraisal of criteria for assessing gaming disorder: an international Delphi study.

BACKGROUND AND AIMS: Following the recognition of 'internet gaming disorder' (IGD) as a condition requiring further study by the DSM-5, 'gaming disorder' (GD) was officially included as a diagnostic entity by the World Health Organization (WHO) in the 11th revision of the International Classification of Diseases (ICD-11). However, the proposed diagnostic criteria for gaming disorder remain the subject of debate, and there has been no systematic attempt to integrate the views of different groups of experts. To achieve a more systematic agreement on this new disorder, this study employed the Delphi expert consensus method to obtain expert agreement on the diagnostic validity, clinical utility and prognostic value of the DSM-5 criteria and ICD-11 clinical guidelines for GD. METHODS: A total of 29 international experts with clinical and/or research experience in GD completed three iterative rounds of a Delphi survey. Experts rated proposed criteria in progressive rounds until a pre-determined level of agreement was achieved. RESULTS: For DSM-5 IGD criteria, there was an agreement both that a subset had high diagnostic validity, clinical utility and prognostic value and that some (e.g. tolerance, deception) had low diagnostic validity, clinical utility and prognostic value. Crucially, some DSM-5 criteria (e.g. escapism/mood regulation, tolerance) were regarded as incapable of distinguishing between problematic and non-problematic gaming. In contrast, ICD-11 diagnostic guidelines for GD (except for the criterion relating to diminished non-gaming interests) were judged as presenting high diagnostic validity, clinical utility and prognostic value. CONCLUSIONS: This Delphi survey provides a foundation for identifying the most diagnostically valid and clinically useful criteria for GD. There was expert agreement that some DSM-5 criteria were not clinically relevant and may pathologize non-problematic patterns of gaming, whereas ICD-11 diagnostic guidelines are likely to diagnose GD adequately and avoid pathologizing.

Pharmacological approaches to methamphetamine dependence: a focused review.

Methamphetamine dependence is a serious worldwide public health problem with major medical, psychiatric, socioeconomic and legal consequences. Various neuronal mechanisms implicated in methamphetamine dependence have suggested several pharmacological approaches. A literature search from a range of electronic databases (PubMed, EMBASE, PsycInfo, the NIDA research monograph index and the reference list of clinicaltrials.gov) was conducted for the period from January 1985 to October 2009. There were no restrictions on the identification or inclusion of studies in terms of publication status, language and design type. A variety of medications have failed to show efficacy in clinical trials, including a dopamine partial agonist (aripiprazole), GABAergic agents (gabapentin) and serotonergic agents (SSRI, ondansetron, mirtazapine). Three double-blind placebo-controlled trials using modafinil, bupropion and naltrexone have shown positive results in reducing amphetamine or methamphetamine use. Two studies employing agonist replacement medications, one with d-amphetamine and the other with methylphenidate, have also shown promise. Despite the lack of success in most studies to date, increasing efforts are being made to develop medications for the treatment of methamphetamine dependence and several promising agents are targets of further research.

Computer and video game addiction-a comparison between game users and non-game users.

BACKGROUND: Computer game addiction is excessive or compulsive use of computer and video games that may interfere with daily life. It is not clear whether video game playing meets diagnostic criteria for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). OBJECTIVES: First objective is to review the literature on computer and video game addiction over the topics of diagnosis, phenomenology, epidemiology, and treatment. Second objective is to describe a brain imaging study measuring dopamine release during computer game playing. METHODS: Article search of 15 published articles between 2000 and 2009 in Medline and PubMed on computer and video game addiction. Nine abstinent "ecstasy" users and 8 control subjects were scanned at baseline and after performing on a motorbike riding computer game while imaging dopamine release in vivo with [123I] IBZM and single photon emission computed tomography (SPECT). RESULTS: Psycho-physiological mechanisms underlying computer game addiction are mainly stress coping mechanisms, emotional reactions, sensitization, and reward. Computer game playing may lead to long-term changes in the reward circuitry that resemble the effects of substance dependence. The brain imaging study showed that healthy control subjects had reduced dopamine D2 receptor occupancy of 10.5% in the caudate after playing a motorbike riding computer game compared with baseline levels of binding consistent with increased release and binding to its receptors. Ex-chronic "ecstasy" users showed no change in levels of dopamine D2 receptor occupancy after playing this game. CONCLUSION: This evidence supports the notion that psycho-stimulant users have decreased sensitivity to natural reward. SIGNIFICANCE: Computer game addicts or gamblers may show reduced dopamine response to stimuli associated with their addiction presumably due to sensitization.