Individuals with problem gambling and obsessive-compulsive disorder learn through distinct reinforcement mechanisms.

Obsessive-compulsive disorder (OCD) and pathological gambling (PG) are accompanied by deficits in behavioural flexibility. In reinforcement learning, this inflexibility can reflect asymmetric learning from outcomes above and below expectations. In alternative frameworks, it reflects perseveration independent of learning. Here, we examine evidence for asymmetric reward-learning in OCD and PG by leveraging model-based functional magnetic resonance imaging (fMRI). Compared with healthy controls (HC), OCD patients exhibited a lower learning rate for worse-than-expected outcomes, which was associated with the attenuated encoding of negative reward prediction errors in the dorsomedial prefrontal cortex and the dorsal striatum. PG patients showed higher and lower learning rates for better- and worse-than-expected outcomes, respectively, accompanied by higher encoding of positive reward prediction errors in the anterior insula than HC. Perseveration did not differ considerably between the patient groups and HC. These findings elucidate the neural computations of reward-learning that are altered in OCD and PG, providing a potential account of behavioural inflexibility in those mental disorders.

Sex/Gender Differences in the Time-Course for the Development of Substance Use Disorder: A Focus on the Telescoping Effect.

Sex/gender effects have been demonstrated for multiple aspects of addiction, with one of the most commonly cited examples being the "telescoping effect" where women meet criteria and/or seek treatment of substance use disorder (SUD) after fewer years of drug use as compared with men. This phenomenon has been reported for multiple drug classes including opioids, psychostimulants, alcohol, and cannabis, as well as nonpharmacological addictions, such as gambling. However, there are some inconsistent reports that show either no difference between men and women or opposite effects and a faster course to addiction in men than women. Thus, the goals of this review are to evaluate evidence for and against the telescoping effect in women and to determine the conditions/populations for which the telescoping effect is most relevant. We also discuss evidence from preclinical studies, which strongly support the validity of the telescoping effect and show that female animals develop addiction-like features (e.g., compulsive drug use, an enhanced motivation for the drug, and enhanced drug-craving/vulnerability to relapse) more readily than male animals. We also discuss biologic factors that may contribute to the telescoping effect, such as ovarian hormones, and its neurobiological basis focusing on the mesolimbic dopamine reward pathway and the corticomesolimbic glutamatergic pathway considering the critical roles these pathways play in the rewarding/reinforcing effects of addictive drugs and SUD. We conclude with future research directions, including intervention strategies to prevent the development of SUD in women. SIGNIFICANCE STATEMENT: One of the most widely cited gender/sex differences in substance use disorder (SUD) is the "telescoping effect," which reflects an accelerated course in women versus men for the development and/or seeking treatment for SUD. This review evaluates evidence for and against a telescoping effect drawing upon data from both clinical and preclinical studies. We also discuss the contribution of biological factors and underlying neurobiological mechanisms and highlight potential targets to prevent the development of SUD in women.

Feedback-related brain activity in individual decision: evidence from a gambling EEG study.

In this study, based on scalp electroencephalogram (EEG), we conducted cortical source localization and functional network analyses to investigate the underlying mechanism explaining the decision processes when individuals anticipate maximizing gambling benefits, particularly in situations where the decision outcomes are inconsistent with the profit goals. The findings shed light on the feedback monitoring process, wherein incongruity between outcomes and gambling goals triggers a more pronounced medial frontal negativity and activates the frontal lobe. Moreover, long-range theta connectivity is implicated in processing surprise and uncertainty caused by inconsistent feedback conditions, while middle-range delta coupling reflects a more intricate evaluation of feedback outcomes, which subsequently modifies individual decision-making for optimizing future rewards. Collectively, these findings deepen our comprehension of decision-making under circumstances where the profit goals are compromised by decision outcomes and provide electrophysiological evidence supporting adaptive adjustments in individual decision strategies to achieve maximum benefit.

The role of loss aversion in social conformity: psychological and neural representations.

The impact of others' choices on decision-making is influenced by individual preferences. However, the specific roles of individual preferences in social decision-making remain unclear. In this study, we examine the contributions of risk and loss preferences as well as social influence in decision-making under uncertainty using a gambling task. Our findings indicate that while both individual preferences and social influence affect decision-making in social contexts, loss aversion plays a dominant role, especially in individuals with high loss aversion. This phenomenon is accompanied by increased functional connectivity between the anterior insular cortex and the temporoparietal junction. These results highlight the critical involvement of loss aversion and the anterior insular cortex-temporoparietal junction neural pathway in social decision-making under uncertainty. Our findings provide a computational account of how individual preferences and social information collectively shape our social decision-making behaviors.

Decision-making under conditions of explicit risk and uncertainty in autistic and typically developing adolescents and young adults.

Adolescence has been characterized as a period of risky and possibly suboptimal decision-making, yet the development of decision-making in autistic adolescents is not well understood. To investigate decision-making in autism, we evaluated performance on 2 computerized tasks capturing decision-making under explicit risk and uncertainty in autistic and non-autistic adolescents/young adults ages 12-22 years. Participants completed the Game of Dice Task (32 IQ-matched participant pairs) to assess decision-making under explicit risk and the modified Iowa Gambling Task (35 IQ-matched pairs) to assess decision-making under uncertainty. Autistic participants overall made riskier decisions than non-autistic participants on the Game of Dice Task, and the odds of making riskier decisions varied by age and IQ. In contrast, the autistic group showed comparable levels of learning over trial blocks to the non-autistic group on the modified Iowa Gambling Task. For both tasks, younger autistic participants performed poorer than their non-autistic counterparts, while group differences diminished in older ages. This age-related pattern suggests positive development during adolescence on risk assessment and decision-making in autism but also implies differential developmental trajectories between groups. These findings also suggest differential performance by the risk type, with additional complex influences of IQ and fluid cognition, which warrants further investigations.

Loss aversion, the endowment effect, and gain-loss framing shape preferences for noninstrumental information.

We often talk about interacting with information as we would with a physical good (e.g., "consuming content") and describe our attachment to personal beliefs in the same way as our attachment to personal belongings (e.g., "holding on to" or "letting go of" our beliefs). But do we in fact value information the way we do objects? The valuation of money and material goods has been extensively researched, but surprisingly few insights from this literature have been applied to the study of information valuation. This paper demonstrates that two fundamental features of how we value money and material goods embodied in Prospect Theory-loss aversion and different risk preferences for gains versus losses-also hold true for information, even when it has no material value. Study 1 establishes loss aversion for noninstrumental information by showing that people are less likely to choose a gamble when the same outcome is framed as a loss (rather than gain) of information. Study 2 shows that people exhibit the endowment effect for noninstrumental information, and so value information more, simply by virtue of "owning" it. Study 3 provides a conceptual replication of the classic "Asian Disease" gain-loss pattern of risk preferences, but with facts instead of human lives, thereby also documenting a gain-loss framing effect for noninstrumental information. These findings represent a critical step in building a theoretical analogy between information and objects, and provide a useful perspective on why we often resist changing (or losing) our beliefs.

Linking Impulsivity to Activity Levels in Pre-Supplementary Motor Area during Sequential Gambling.

Impulsivity refers to the tendency to act prematurely or without forethought, and excessive impulsivity is a key problem in many neuropsychiatric disorders. Since the pre-supplementary motor area (pre-SMA) has been implicated in inhibitory control, this region may also contribute to impulsivity. Here, we examined whether functional recruitment of pre-SMA may contribute to risky choice behavior (state impulsivity) during sequential gambling and its relation to self-reported trait impulsivity. To this end, we performed task-based functional MRI (fMRI) after low-frequency (1 Hz) repetitive transcranial magnetic stimulation (rTMS) of the pre-SMA. We expected low-frequency rTMS to modulate task-related engagement of the pre-SMA and, hereby, tune the tendency to make risky choices. Twenty-four healthy volunteers (12 females; age range, 19-52 years) received real or sham-rTMS on separate days in counterbalanced order. Thereafter, participants performed a sequential gambling task with concurrently increasing stakes and risk during whole-brain fMRI. In the sham-rTMS session, self-reported trait impulsivity scaled positively with state impulsivity (riskier choice behavior) during gambling. The higher the trait impulsivity, the lower was the task-related increase in pre-SMA activity with increasingly risky choices. Following real-rTMS, low-impulsivity participants increased their preference for risky choices, while the opposite was true for high-impulsivity participants, resulting in an overall decoupling of trait impulsivity and state impulsivity during gambling. This rTMS-induced behavioral shift was mirrored in the rTMS-induced change in pre-SMA activation. These results provide converging evidence for a causal link between the level of task-related pre-SMA activity and the propensity for impulsive risk-taking behavior in the context of sequential gambling.SIGNIFICANCE STATEMENT Impulsivity is a personal trait characterized by a tendency to act prematurely or without forethought, and excessive impulsivity is a key problem in many neuropsychiatric disorders. Here we provide evidence that the pre-supplementary motor area (pre-SMA) is causally involved in implementing general impulsive tendencies (trait impulsivity) into actual behavior (state impulsivity). Participants' self-reported impulsivity levels (trait impulsivity) were reflected in their choice behavior (state impulsivity) when involved in a sequential gambling task. This relationship was uncoupled after perturbing the pre-SMA with repetitive transcranial stimulation (rTMS). This effect was contingent on trait impulsivity and was echoed in rTMS-induced changes in pre-SMA activity. Pre-SMA is key in translating trait impulsivity into behavior, possibly by integrating prefrontal goals with corticostriatal motor control.

Sex modulated the relationship between trait approach motivation and decision-making.

It has been observed that one's Behavioral Approach System (BAS) can have an effect on decision-making under uncertainty, although the results have been mixed. To discern the underlying neural substrates, we hypothesize that sex may explain the conflicting results. To test this idea, a large sample of participants was studied using resting state fMRI, utilizing fractional Amplitude of Low Frequency Fluctuations (fALFF) and Resting-State Functional Connectivity (rsFC) techniques. The results of the Iowa Gambling Task (IGT) revealed an interaction between sex and BAS, particularly in the last 60 trials (decision-making under risk). Males with high BAS showed poorer performance than those with low BAS. fALFF analysis showed a significant interaction between BAS group and sex in the left superior occipital gyrus, as well as the functional connectivity between this region and the left ventrolateral prefrontal cortex. Additionally, this functional connectivity was further positively correlated with male performance in the IGT, particularly in the decision-making under risk stage. Furthermore, it was found that the functional connectivity between left ventrolateral prefrontal cortex and left superior occipital gyrus could mediate the relationship between BAS and decision-making in males, particularly in the decision-making under risk stage. These results suggest possible sex-based differences in decision-making, providing an explanation for the inconsistent results found in prior research. Since the research was carried out exclusively with Chinese university students, it is essential to conduct further studies to investigate whether the findings can be generalized.

Changes in decision-making function in patients with subacute mild traumatic brain injury.

Although awareness regarding patients with mild traumatic brain injury has increased, they have not received sufficient attention in clinics; hence, many patients still experience only partial recovery. Deficits in decision-making function are frequently experienced by these patients. Accurate identification of impairment in the early stages after brain injury is particularly crucial for timely intervention and the prevention of long-term cognitive consequences. Therefore, we investigated the changes in decision-making ability under tasks of ambiguity and risk in patients with mild traumatic brain injury with a rule-based neuropsychological paradigm. In this study, patients (n = 39) and matched healthy controls (n = 38) completed general neuropsychological background tests and decision-making tasks (Iowa Gambling Task and Game of Dice Task). We found that patients had extensive cognitive impairment in general attention, memory and information processing speed in the subacute phase, and confirmed that patients had different degrees of impairment in decision-making abilities under ambiguity and risk. Furthermore, the decline of memory and executive function may be related to decision-making dysfunction.

Dopamine activity in the nigrostriatal pathway alters cue-induced risky choice patterns in female rats.

Deficits in cost/benefit decision making is a critical risk factor for gambling disorder. Reward-paired cues may play an important role, as these stimuli can enhance risk preference in rats. Despite extensive research implicating the dorsal striatum in the compulsive aspects of addiction, the role of nigrostriatal dopaminergic activity in cue-induced risk preference remains unclear, particularly in females. Accordingly, we examined the effects of manipulating the dopaminergic nigrostriatal pathway on cue-induced risky choice in female rats. TH:Cre rats were trained on the cued version of the rat Gambling Task. This task was designed such that maximal reward is attained by avoiding the high-risk, high-reward options and instead favouring the options associated with lower per-trial gains, as they feature less frequent and shorter time-out penalties. Adding reward-paired audiovisual cues to the task leads to greater risky choice on average. To assess the role of the nigrostriatal pathway, a viral vector carrying either Cre-dependent inhibitory or excitatory DREADD was infused into the substantia nigra. Rats then received clozapine-N-oxide either during task acquisition or after a stable performance baseline was reached. Inhibition of this pathway accelerated the development of risk preference in early sessions and increased risky choice during performance, but long-term inhibition actually improved decision making. Activation of this pathway had minimal effects. These results provide evidence for the involvement of the dopaminergic nigrostriatal pathway in cue-induced risk preference in females, therefore shedding light on its role in cost/benefit decision-making deficits and expanding our knowledge of the female dopaminergic system.

Odds of gambling among adolescents: a secondary analysis of the cross-sectional European School Survey Project on Alcohol and Other Drugs.

BACKGROUND: Gambling among adolescents is associated with gambling disorder in adulthood. This study investigated factors associated with gambling and excessive gambling in adolescents. METHODS: This secondary analysis of the cross-sectional European School Survey Project on Alcohol and Other Drugs (ESPAD) used nationally representative data from the Irish cohort of the 2019 ESPAD wave. Data were collected between March and May 2019. We included 1949 students aged 15-16 years (946 [48·5%] male, 1003 [51·5%] female), with a response rate of 85%. We calculated past year gambling prevalence as the rate of those who had gambled for money on at least one of four games of chance (slot machines, cards or dice, the lottery, betting on sports or animals) in the past 12 months. An adapted version of the three-item Consumption Screen for Problem Gambling was used to identify excessive gambling (score ≥4). We carried out descriptive and logistic regression analyses using binary covariates with Stata v16.1. We included 19 variables in the multivariable analysis. Ethics approval was granted by Dublin Institute of Technology's Ethics Committee. Non-consent forms were issued to all parents to opt out. FINDINGS: Overall, 447 (23%) of 1949 students gambled in the past year, of whom 45 (10%) engaged in excessive gambling. Using a mutually adjusted multivariable logistic regression analysis, past year gambling was associated with alcohol use (adjusted odds ratio [aOR] 1·6, 95% CI 1·1-2·2), experiencing serious arguments (aOR 1·4, 1·1-1·9), and trouble with the police (aOR 1·9, 1·2-2·8). Female gender was a protective factor (aOR 0·6, 0·4-0·9). In the univariable analysis, excessive gambling was associated with gaming (OR 2·3, 1·0-5·1), tobacco use (2·1, 1·1-4·2), e-cigarette use (2·1, 1·1-4·1), heavy episodic drinking (2·7, 1·4-5·1), trouble with the police (2·8, 1·5-5·4, p<0·01), and deliberately hurting themselves (2·8, 1·4-5·6). Female gender (OR 0·3, 0·1-0·6) and social media use (0·4, 0·2-0·8) were protective factors. Excessive gambling was also associated with betting on sports and animals (OR 3·6, 1·6-8·4), slot machines (2·9, 1·5-5·8), card or dice (2·4, 1·2-4·6), and online gambling (4·2, 2·0-8·0). INTERPRETATION: A large proportion of 15-16 year olds in Ireland have gambled for money in the past year, with one in ten of those having engaged in excessive gambling. This number is likely to be underestimated due to recall and social desirability bias. Reducing the availability, access, and appeal of gambling products in Ireland should be addressed through ongoing gambling reform. FUNDING: Institute of Public Health.

Test-retest reliability of the play-or-pass version of the Iowa Gambling Task.

The Iowa Gambling Task (IGT) is used to assess decision-making in clinical populations. The original IGT does not disambiguate reward and punishment learning; however, an adaptation of the task, the "play-or-pass" IGT, was developed to better distinguish between reward and punishment learning. We evaluated the test-retest reliability of measures of reward and punishment learning from the play-or-pass IGT and examined associations with self-reported measures of reward/punishment sensitivity and internalizing symptoms. Participants completed the task across two sessions, and we calculated mean-level differences and rank-order stability of behavioral measures across the two sessions using traditional scoring, involving session-wide choice proportions, and computational modeling, involving estimates of different aspects of trial-level learning. Measures using both approaches were reliable; however, computational modeling provided more insights regarding between-session changes in performance, and how performance related to self-reported measures of reward/punishment sensitivity and internalizing symptoms. Our results show promise in using the play-or-pass IGT to assess decision-making; however, further work is still necessary to validate the play-or-pass IGT.

Enhancing cognitive control of our decisions: Making the most of humor during the IGT in females and males.

We studied the impact of humor on the Iowa Gambling Task (IGT) decision-making performance and the cognitive control exerted during this task, considering sex as a moderator, and examined whether cognitive control mediated the influence of humor on decision-making. Sixty participants (30 females) performed an extended version of the IGT (500 trials divided into 20 blocks). We randomly assigned them to either an experimental group (Humor Group; Hg; n = 30), where humorous videos were interspersed in the decision-making trials or a control group (Non-Humor Group; NHg; n = 30), where nonhumorous videos were interspersed in the decision-making trials. We recorded participant performance and feedback-related negativity (FRN) and P3b event-related potentials (ERP) during IGT feedback as task monitoring and attention allocation indicators, respectively. We expected that whereas humor would improve IGT decision-making under risk in females during the last blocks (17-20) as well as cognitive control (specifically attention allocation and task monitoring) across the entire IGT, it would impair them in males. Contrary to our expectations, humor improved IGT decision-making under risk for both sexes (specifically at blocks 19 and 20) and attention allocation for most IGT blocks (P3b amplitudes). However, humor impaired IGT decision-making under ambiguity in males during the block six and task monitoring (FRN amplitudes) for most IGT blocks. Attention allocation did not mediate the beneficial effect of humor on decision-making under risk in either sex. Task monitoring decrements fully mediated the humor's detrimental influence on men's decision-making under ambiguity during block six.

Dissociable Roles of the mPFC-to-VTA Pathway in the Control of Impulsive Action and Risk-Related Decision-Making in Roman High- and Low-Avoidance Rats.

BACKGROUND: Impulsive action and risk-related decision-making (RDM) are associated with various psychiatric disorders, including drug abuse. Both behavioral traits have also been linked to reduced frontocortical activity and alterations in dopamine function in the ventral tegmental area (VTA). However, despite direct projections from the medial prefrontal cortex (mPFC) to the VTA, the specific role of the mPFC-to-VTA pathway in controlling impulsive action and RDM remains unexplored. METHODS: We used positron emission tomography with [18F]-fluorodeoxyglucose to evaluate brain metabolic activity in Roman high- (RHA) and low-avoidance (RLA) rats, which exhibit innate differences in impulsive action and RDM. Notably, we used a viral-based double dissociation chemogenetic strategy to isolate, for the first time to our knowledge, the role of the mPFC-to-VTA pathway in controlling these behaviors. We selectively activated the mPFC-to-VTA pathway in RHA rats and inhibited it in RLA rats, assessing the effects on impulsive action and RDM in the rat gambling task. RESULTS: Our results showed that RHA rats displayed higher impulsive action, less optimal decision-making, and lower cortical activity than RLA rats at baseline. Chemogenetic activation of the mPFC-to-VTA pathway reduced impulsive action in RHA rats, whereas chemogenetic inhibition had the opposite effect in RLA rats. However, these manipulations did not affect RDM. Thus, by specifically targeting the mPFC-to-VTA pathway in a phenotype-dependent way, we reverted innate patterns of impulsive action but not RDM. CONCLUSION: Our findings suggest a dissociable role of the mPFC-to-VTA pathway in impulsive action and RDM, highlighting its potential as a target for investigating impulsivity-related disorders.

The risk and development of work disability among individuals with gambling disorder: a longitudinal case-cohort study in Sweden.

BACKGROUND: This longitudinal register study aimed to investigate the association between gambling disorder (GD) and work disability and to map work disability in subgroups of individuals with GD, three years before and three years after diagnosis. METHODS: We included individuals aged 19-62 with GD between 2005 and 2018 (n = 2830; 71.1% men, mean age: 35.1) and a matched comparison cohort (n = 28 300). Work disability was operationalized as the aggregated net days of sickness absence and disability pension. Generalized estimating equation models were used to calculate adjusted odds ratios (AORs) and 95% confidence intervals (CIs) for the risk of long-term work disability (>90 days of work disability/year). Secondly, we conducted Group-based Trajectory Models on days of work disability. RESULTS: Individuals with GD showed a four-year increased risk of long-term work disability compared to the matched cohort, peaking at the time of diagnosis (AOR = 1.89; CI 1.67-2.13). Four trajectory groups of work disability days were identified: constant low (60.3%, 5.6-11.2 days), low and increasing (11.4%, 11.8-152.5 days), medium-high and decreasing (11.1%, 65.1-110 days), and constant high (17.1%, 264-331 days). Individuals who were females, older, with prior psychiatric diagnosis, and had been dispensed a psychotropic medication, particularly antidepressants, were more likely to be assigned to groups other than the constant low. CONCLUSION: Individuals with GD have an increased risk of work disability which may add financial and social pressure and is an additional incentive for earlier detection and prevention of GD.

Exploring decision-making performance in young adults with mental health disorders: a comparative study using the Cambridge gambling task.

Decision-making deficits, assessed cognitively, are often associated with mental health symptoms, however, this relationship is not fully understood. This paper explores the relationship between mental health disorders and decision-making, using the Cambridge Gambling Task (CGT). Our study investigated how decision-making varied across 20 different mental health conditions compared to controls in a sample of 572 young adults from the Minneapolis and Chicago metropolitan areas, using a computerized laboratory-based task. Almost all mental health conditions were associated with at least mild (i.e. at least small effect size) impairment in all three studied parameters of the CGT (risk adjustment, quality of decision-making and overall proportion of bet). Notably, binge eating disorder had the largest cognitive impairment and gambling disorder had moderate impairment. Post-traumatic stress disorder (PTSD) was associated with impaired decision-making while obsessive-compulsive disorder (OCD) and depression showed moderate impairment. Additionally, half of the disorders assessed had moderate to large impairment in risk adjustment.These findings suggest that mental health conditions may have a more complex cognitive profile than previously thought, and a better understanding of these impairments may aid in risk assessment and targeted clinical interventions. This study underscores the need for further research to determine the causal pathways between mental health conditions and cognition, as well as to better understand the day-to-day impact of such deficits.

Losses disguised as wins evoke the reward positivity event-related potential in a simulated machine gambling task.

Electronic gambling machines include a suite of design characteristics that may contribute to gambling-related harms and require more careful attention of regulators and policymakers. One strategy that has contributed to these concerns is the presentation of "losses disguised as wins" (LDWs), a type of salient losing outcome in which a gambling payout is less than the amount wagered (i.e., a net loss), but is nonetheless accompanied by the celebratory audio-visual stimuli that typically accompany a genuine win. These events could thereby be mistaken for gains, or otherwise act as a reward signal, reinforcing persistent gambling, despite being a loss. This study aimed to determine whether LDWs evoke a reward positivity component in a task modeled on slot machine gambling. A prominent account of the reward positivity event-related potential suggests that it is evoked during the positive appraisal of task-related feedback, relative to neutral or negative events, or that it is evoked by neural systems that implement the computation of a positive reward prediction error. We recruited 32 individuals from university recruitment pools and asked them to engage in a simple gambling task designed to mimic key features of a slot machine design. The reward positivity was identified using temporospatial principal components analysis. Results indicated a more positive reward positivity following LDWs relative to clear losses, consistent with the theory that LDWs contribute to positive reinforcement of continued gambling, despite being net losses.

Willingness valued more than ability in partner choice: Insights into behavioral and ERP data.

In human cooperation, people prefer to choose partners with high willingness and ability-while both are valued by partners, individuals often prioritize willingness. Two event-related potential (ERP) experiments were conducted to discern the neural processes underpinning this preference. In the first experiment, participants made a choice between two potential partners and received feedback on the selected partner's willingness to cooperate. This was followed by feedback on the partner's task performance (ability) or a gambling outcome. In contrast, the second experiment first provided feedback on ability, then presented feedback on willingness or a gambling outcome. This study revealed that a potential partner's willingness trait significantly influences individuals' emotional evaluations and monetary allocations than the ability trait. Electrophysiological data indicated that low-willingness feedback elicited a diminished feedback-related negative (FRN) and an amplified P3 compared to high-willingness feedback. In contrast, no such difference was discernible between high- and low-ability feedback. Moreover, the P3 difference from high versus low willingness was considerably more pronounced than that from gambling outcomes, whereas the difference wave between high and low ability paralleled gambling outcomes. These findings bolster the novel finding that partner willingness may provide more substantial social rewards than ability. Furthermore, this study provides the first ERP evidence of willingness and ability trait perceptions in partner choice decisions.

Problem gambling in psychotic disorders: A systematic review and meta-analysis of prevalence.

INTRODUCTION: Problem gambling (PBG) is more common in people with mental health disorders, including substance use, bipolar, and personality disorders, than in the general population. Although individuals with psychotic disorders might be expected to be more vulnerable to PBG, fewer studies have focused on this comorbidity. The aim of this review was to estimate the prevalence of PBG in people with psychotic disorders. METHODS: Medline (Ovid), EMBASE, PsycINFO (Ovid), CINAHL, CENTRAL, Web of science, and ProQuest were searched on November 1, 2023, without language restrictions. Observational and experimental studies including individuals with psychotic disorders and reporting the prevalence of PBG were included. Risk of bias was assessed using the Joanna Briggs Institute critical appraisal for systematic reviews of prevalence data. The pooled prevalence of PBG was calculated using a fixed effects generalized linear mixed model and presented through forest plots. RESULTS: Of 1271 records screened, 12 studies (n = 3443) were included. The overall prevalence of PBG was 8.7% (95% CI = 7.8%-9.7%, I2 = 69%). A lower prevalence was found in studies with a low risk of bias (5.6%; 95% CI = 4.4%-7.0%) compared with studies with a moderate risk of bias (10.4%; 95% CI = 9.2%-11.7%). Different methods used to assess PBG also contributed to the heterogeneity found. CONCLUSION: This meta-analysis found substantial heterogeneity, partly due to the risk of bias of the included studies and a lack of uniformity in PBG assessment. Although more research is needed to identify those at increased risk for PBG, its relatively high prevalence warrants routine screening for gambling in clinical practice.

Current approaches to the identification and management of gambling disorder: a narrative review to inform clinical practice in Australia and New Zealand.

Gambling disorder is a recognised psychiatric disorder in the Diagnostic and statistical manual of mental disorders (DSM-5) and is classified as an addiction alongside alcohol and substance use disorders. The DSM-5 describes a past-year timeframe, episodic or persistent specifiers, early or sustained remission specifiers, and three gambling disorder severity specifiers (mild, moderate and severe). Although anyone can develop gambling disorder, there are known risk factors. In studies involving general adult populations, the likelihood of developing the disorder varies with the type of gambling, and is particularly high for internet gambling, casino table games and poker machines. Australia and New Zealand have shifted the focus of gambling disorder to the identification of gambling harm, in recognition that efforts targeting the prevention of harm may be more effective as they potentially influence a larger segment of the population. Temporal categories of gambling harm (crisis harms versus legacy harms) affect help-seeking and need for treatment. Crisis harms often motivate people to change their behaviour or seek help, whereas treatment addresses legacy harms, which emerge or continue to occur after gambling behaviour ceases. The evidence base and clinical guidelines recommend cognitive behavioural therapy and motivational interviewing but there are many gaps in our understanding of treatment for gambling disorder, including an absence of high quality evaluations that assess treatment effectiveness over the longer term, especially for treatment delivered in community settings. There is also an urgent need to understand how, why and for whom treatment works so that interventions can be optimised to individual needs, thereby facilitating client engagement. Because of limited access to health care and poor retention in treatment, in recent years there has been an increase in treatment choices in the form of internet therapies and smartphone applications.