Normatively irrelevant disgust interferes with decision under uncertainty: Insights from the Iowa gambling task.

This study investigates whether a not informative, irrelevant emotional reaction of disgust interferes with decision-making under uncertainty. We manipulate the Iowa Gambling Task (IGT) by associating a disgust-eliciting image with selections from Disadvantageous/Bad decks (Congruent condition) or Advantageous/Good decks (Incongruent condition). A Control condition without manipulations is also included. Results indicate an increased probability of selecting from a Good deck as the task unfolds in all conditions. However, this effect is modulated by the experimental manipulation. Specifically, we detect a detrimental effect (i.e., a significant decrease in the intercept) of the disgust-eliciting image in Incongruent condition (vs. Control), but this effect is limited to the early stages of the task (i.e., first twenty trials). No differences in performance trends are detected between Congruent and Control conditions. Anticipatory Skin Conductance Response, heart rate, and pupil dilation are also assessed as indexes of anticipatory autonomic activation following the Somatic Marker Hypothesis, but no effects are shown for the first two indexes in any of the conditions. Only a decreasing trend is detected for pupil dilation as the task unfolds in Control and Incongruent conditions. Results are discussed in line with the "risk as feelings" framework, the Somatic Marker Hypothesis, and IGT literature.

Mobile App Intervention to Reduce Substance Use, Gambling, and Digital Media Use in Vocational School Students: Exploratory Analysis of the Intervention Arm of a Randomized Controlled Trial.

BACKGROUND: During adolescence, substance use and digital media exposure usually peak and can become major health risks. Prevention activities are mainly implemented in the regular school setting, and youth outside this system are not reached. A mobile app ("Meine Zeit ohne") has been developed specifically for vocational students and encourages participants to voluntarily reduce or abstain from a self-chosen addictive behavior including the use of a substance, gambling, or a media-related habit such as gaming or social media use for 2 weeks. Results from a randomized study indicate a significant impact on health-promoting behavior change after using the app. This exploratory study focuses on the intervention arm of this study, focusing on acceptance and differential effectiveness. OBJECTIVE: The aims of this study were (1) to examine the characteristics of participants who used the app, (2) to explore the effectiveness of the mobile intervention depending on how the app was used and depending on participants' characteristics, and (3) to study how variations in app use were related to participants' baseline characteristics. METHODS: Log data from study participants in the intervention group were analyzed including the frequency of app use (in days), selection of a specific challenge, and personal relevance (ie, the user was above a predefined risk score for a certain addictive behavior) of challenge selection ("congruent use": eg, a smoker selected a challenge related to reducing or quitting smoking). Dichotomous outcomes (change vs no change) referred to past-month substance use, gambling, and media-related behaviors. The relationship between these variables was analyzed using binary, multilevel, mixed-effects logistic regression models. RESULTS: The intervention group consisted of 2367 vocational students, and 1458 (61.6%; mean age 19.0, SD 3.5 years; 830/1458, 56.9% male) of them provided full data. Of these 1458 students, 894 (61.3%) started a challenge and could be included in the analysis (mean 18.7, SD 3.5 years; 363/894, 40.6% female). Of these 894 students, 466 (52.1%) were considered frequent app users with more than 4 days of active use over the 2-week period. The challenge area most often chosen in the analyzed sample was related to social media use (332/894, 37.1%). A total of 407 (45.5%) of the 894 students selected a challenge in a behavioral domain of personal relevance. The effects of app use on outcomes were higher when the area of individual challenge choice was equal to the area of behavior change, challenge choice was related to a behavior of personal relevance, and the individual risk of engaging in different addictive behaviors was high. CONCLUSIONS: The domain-specific effectiveness of the program was confirmed with no spillover between behavioral domains. Effectiveness appeared to be dependent on app use and users' characteristics. TRIAL REGISTRATION: German Clinical Trials Register DRKS00023788; https://tinyurl.com/4pzpjkmj. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1186/s13063-022-06231-x.

Negative and positive mental health characteristics of affected family members: Findings from a cross-sectional Australian general population gambling study.

Despite the impact of problem gambling on affected family members (AFMs), there are limited large-scale population level studies identifying the negative mental health (NMH) and positive mental health (PMH) characteristics of AFMs. Furthermore, no study has explored whether PMH characteristics are protective in the relationships between AFM status and NMH characteristics. This study involved secondary data analysis from the Third Social and Economic Impact Study of Gambling in Tasmania. Using a subsample of 1,869 adults (48.30 % male; meanage = 48.48; 4.67 % AFMs), this study aimed to explore whether: (1) AFM status is associated with NMH (depression, anxiety, panic, post-traumatic stress disorder, social anxiety, binge drinking, tobacco use, and drug use symptoms) and PMH (quality of life [QOL], personal growth/autonomy, interpersonal/social skills, coping skills) characteristics after separately controlling for sociodemographic, problem gambling severity, and other NMH characteristics; (2) PMH characteristics moderate (buffer) the relationships between AFM status and NMH characteristics; and (3) gender influences these relationships. AFM status, defined as exposure to family member gambling problems, significantly positively predicted NMH characteristics (depression, anxiety, panic, PTSD, and tobacco use symptoms) and negatively predicted QOL (physical, social) and planning coping. The strength of these relationships generally attenuated after controlling for various covariates. Gender did not moderate these relationships. Religious coping exacerbated the relationship between AFM status and panic disorder symptoms. These findings can inform the development of intervention initiatives for family members exposed to gambling problems. Future population-representative research is required using a range of affected other types, longitudinal study designs, and more comprehensive measures.

Brand and addiction: A network analysis of scientific literature.

OBJECTIVE: The paper conducts a network analysis of the fragmented literature on brand and addiction. METHOD: A thematic map, thematic evolution, word cloud, co-citation analysis, and cooperation networks were utilized to identify brand addiction study trends and topics. RESULTS: The data show that marketing and psychiatry have interdisciplinary groupings and multidisciplinary publications. These groups reflect societal changes, particularly the shift from traditional to digital challenges. Fast food addiction is different from alcohol and cigarette addictions due to its ease and extensive marketing. The decline in internet and gambling addiction suggests a shift in priorities. CONCLUSIONS: This research helps researchers, policymakers, and practitioners in addiction prevention and intervention. The study also understands brand addiction and its effects on psychology, psychiatry, and management by providing insights into emerging topics, thematic maps and evolution of studies, collaboration opportunities, geographical distribution of studies, and more.

Exploring Socioeconomic, Demographic and Psychological Predictors of At-risk Gambling and Participation in Specific Gambling Activities: A Comparative Approach.

In this research, we aimed to provide a comparative examination of at-risk gambling and four types of gambling activities from the standpoint of socioeconomic, demographic and psychological factors. Using data collected from 7,385 adults aged 18-64 from Serbia, we investigated how specific variables contribute to the likelihood of participation in lottery playing, sports betting, casino games, and slot games across the three time frames (lifetime, last year, and last month), and at-risk gambling. Logistic regressions revealed that male sex, ages 18 to 34, drug use, harmful alcohol use, and elevated levels of distress were significant predictors of participation in any point of life in sports betting, casino games, and slot games, and at-risk gambling. Secondary education, residing in an urban area, and harmful alcohol use predicted - across three time frames - the engagement in lottery playing, sports betting, and slot games playing, respectively. Smoking, and specifically heavy smoking, was shown to be predictive of lifetime participation in all types of gambling, while having single marital status and being unemployed emerged as the factors increasing the odds for the last-month slot games playing. Notably, the 18 to 24 age cohort turned out to be the most vulnerable part of the population, as they displayed the largest odds for at-risk gambling, and both lifetime and last-year involvement in sports betting, casino games, and slot games playing. This highlights the necessity of targeted public health interventions for the young adult population and people who experiment or already experience problems related to substance use.

Transtorno de Jogo: contribuição da abordagem psicodinâmica no tratamento / Gambling Disorder: contributions of the psychodynamic approach to treatment / Jeu Pathologique: contributions de l'approche psychodynamique au traitement / Trastorno de Juego: contribución del enfoque psicodinámico al tratamiento

Resumo Jogos de azar podem ser uma atividade de lazer, mas sua prática em excesso pode levar a consequências adversas, como o Transtorno de Jogo. Apesar dos sérios prejuízos provocados por esse quadro, tanto o Transtorno de Jogo em si quanto estratégias de tratamento são pouco conhecidos no Brasil. Este trabalho aborda o Transtorno de Jogo e seu tratamento, tendo como objetivo explicitar a contribuição da abordagem psicodinâmica. São apresentadas as principais hipóteses psicodinâmicas existentes na literatura e tecidas considerações sobre a psicoterapia psicodinâmica realizada em um serviço que atende jogadores em São Paulo, o Programa Ambulatorial do Jogo Patológico (PRO-AMJO) do Instituto de Psiquiatria do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (IPq HC-FMUSP). Por fim, alguns exemplos de perfis de jogadores patológicos são apresentados.

Abstract Gambling may be a leisure activity, but overdoing it can lead to adverse consequences such as Gambling Disorder. Despite the serious damage caused by the disorder, both Gambling Disorder and its treatment strategies are little known in Brazil. This study investigates Gambling Disorder and its treatment, emphasizing the contributions of the psychodynamic approach. The paper presents the main psychodynamic hypotheses in the literature and comments on the psychodynamic psychotherapy carried out in facilities treating pathological gamblers in São Paulo, such as the Pathological Gambling Outpatient Program (PRO-AMJO) of the Psychiatric Institute of Hospital das Clínicas (IPq HC-FMUSP). Finally, some examples of pathological gambler profiles are discussed.

Résumé Le jeu de hasard peut être un loisir, mais l'excès peut avoir des conséquences néfastes, comme le Jeu Pathologique. Malgré les graves consequences causés par ce trouble, le Jeu Pathologique et ses stratégies de traitement sont peu connus au Brésil. Cettte étude porte sur la Dépendence au jeu et son traitement, en mettant l'accent sur les contributions de l'approche psychodynamique. L'article présente les principales hypothèses psychodynamiques dans la littérature et reflète sur la psychothérapie psychodynamique réalisée dans les services qui s'occupent de joueurs à São Paulo, telles que le Programma ambulatoire sur la dépendance au jeu (PRO-AMJO) del'Institut de psychiatrie de l'Hospital das clínicas (IPq HC-FMUSP). Enfin, quelques exemples de profils de joueurs pathologiques sont discutés.

Resumen Los juegos de azar pueden ser una actividad de diversión, pero su práctica excesiva puede traer consecuencias adversas como el Trastorno de Juego. A pesar de los graves daños causados por este comportamiento, tanto el Trastorno de Juego en sí como las estrategias de tratamiento son poco conocidos en Brasil. Este trabajo aborda el Trastorno de Juego y su tratamiento, con el objetivo de hacer explícito la contribución del enfoque psicodinámico. Se presentan las principales hipótesis psicodinámicas en la literatura y se hacen consideraciones sobre la psicoterapia psicodinámica realizada en un servicio que atiende a jugadores en São Paulo, como el Programa del Hospital das Clínicas de la Facultad de Medicina de la Universidad de São Paulo (IPq HC-FMUSP). Finalmente, se presentan algunos ejemplos de perfiles de jugadores patológicos.

Comorbid addictive behaviors in disordered gamblers with psychosis

Objective: While it has been shown that disordered gamblers with psychosis are at increased risk for comorbid psychopathology, it is unclear whether this dual-diagnosis population is also at greater risk of problematic engagement with comorbid addictive behaviors. Methods: We tested for association between disordered gambling with psychosis and comorbid addictive behaviors in a sample of 349 treatment-seeking disordered gamblers. Results: Twenty-five (7.2%) disordered gamblers met criteria for psychosis. Disordered gamblers with psychosis were no more likely to meet diagnostic criteria for current alcohol/substance use disorder than disordered gamblers without psychosis. However, this dual-disorder population reported greater misuse of shopping, food bingeing, caffeine, and prescription drugs. When controlling for multiple comparisons, binge eating was the only addictive behavior to remain significant. Conclusion: Given these findings, a comprehensive assessment of addictive behaviors - specifically food bingeing - in this population may be warranted.

Development and validation of the Gambling Follow-up Scale, Self-Report version: an outcome measure in the treatment of pathological gambling

Objective: To validate the Gambling Follow-up Scale, Self-Report version (GFS-SR), a 10-item scale designed to assess gambling frequency, time and money spent on gambling, gambling craving, debts, emotional distress, family relationships, autonomy, and frequency of and satisfaction with leisure activities in individuals diagnosed with gambling disorder according to the DSM-5 criteria. Methods: One hundred and twenty treatment-seeking gamblers were evaluated, 84 of whom proceeded to treatment. Fifty-two relatives provided collateral informant reports at baseline. Six months later, the 50 patients who completed the program were reassessed. Results: The GFS-SR showed good inter-rater agreement and internal consistency. Factor analysis presented a three-factor solution: gambling behavior (factor 1); social life (factor 2); and personal hardship (factor 3). There was a high degree of convergence between GFS-SR scores and those of reference scales. The GFS-SR scores showed excellent sensitivity to change (factor 1), predictive validity for treatment response (factor 2), and ability to distinguish recovered from unrecovered patients after treatment (factor 3). A cutoff score of 33 was found to have 87% sensitivity and 80% specificity for gambling recovery. Conclusion: The GFS-SR is well suited to providing reliable follow-up of gamblers under treatment and assessing the efficacy of their treatment.

Sobre o jogo do amor e do azar / Considerations on the game of love and chance

Este artigo discute o estatuto conferido ao acaso nos jogos de azar e do encontro amoroso faltoso, tendo como paradigma as descrições de Alexis, personagem principal e, em parte, autobiográfico de Dostoiévski em Um jogador (1866b). A atmosfera de apostas e riscos em todos os níveis da trama permite destacar os aspectos em que se entrecruzam o amor e o jogo como no ditado universal: sorte em um, azar no outro. A aposta na transformação (pelo jogo ou pelo amor) e a repetição são, então, discutidas pela via do desejo de reconhecimento e dos conceitos de narcisismo e ideal do eu. São igualmente exploradas as estratégias da posição masoquista da escravidão voluntária, que exibem o jogador como joguete, objeto ordinário. O texto é finalizado com algumas considerações sobre o autor russo e o texto que Freud (1928) a ele consagrou, Dostoiévski e o parricídio...

This article discusses the role conferred to chance in gambling and wrongful tryst, taking as a basis the descriptions of Alexis, the main character of Dostoyevsky’s partly autobiographical novel, The gambler (1866b). The atmosphere of bets and risks at all levels of the plot makes it possible to highlight aspects where love and gambling intertwine as the well-known saying goes: lucky at cards, unlucky in love. The bet on transformation (by gambling or by love) and the manifest repetition are then discussed via the desire for recognition and the concepts of narcissism and ego ideal. Furthermore, the discussion examines the strategies of the masochistic position of voluntary slavery that reveal the player as a plaything, an ordinary object. The article concludes with some considerations on the russian author and the text that Freud (1928) devoted to him, Dostoyevsky and parricide...

Este artículo discute el estatuto conferido al acaso en los juegos de azar y del encuentro amoroso faltoso, teniendo como paradigma las descripciones de Alexis, personaje principal y en parte autobiográfico de Dostoiévski en Un jugador (1866b). La atmósfera de apuestas y riesgos en todos los niveles de la trama permite destacar los aspectos en que se entrecruzan el amor y el juego como en el dictado universal: suerte en uno, azar en el otro. La apuesta en la transformación (por el juego o por el amor) y la repetición son así discutidas por la vía del deseo de reconocimiento y de los conceptos del narcisismo e ideal del Yo. Son igualmente exploradas las estrategias de la posición masoquista de la esclavitud voluntaria, que exhiben el jugador como juguete, objeto ordinario. El texto se concluye con algunas consideraciones sobre el autor ruso y el texto que Freud (1928) le consagró, Dostoiévski y el parricidio...

Prevalencia de adicción al juego y estrategias de afrontamiento de adolescentes escolarizados en el municipio de la Unión (Colombia) / Prevalence of addiction to gambling and coping strategies of adolescents enrolled in the town of Union (Colombia)

Objetivo Identificar la prevalencia de adicción al juego y las estrategias de afrontamiento empleadas por jóvenes escolarizados en un municipio de Colombia. MetodologíaEstudio descriptivo, transversal en una población de 294 estudiantes adolescentes escolarizados. Para la medición del riesgo de juego se usó el cuestionario de Fisher basado en los criterios del DSM IV- J y se aplicó la escala de estrategias de afrontamiento para adolescentes (ACS) diseñada por Frydenberg y Lewis. Resultados El 73,5% de los participantes afirmó que había jugado alguna vez en su vida en máquinas paga monedas y el 79,6% reportaron haber hecho uso de video y juegos en línea. Entre los varones, se clasificaron como probables jugadores sociales el 7,5% y como probables jugadores patológicos el 2,5% y entre las mujeres el 17,2% y el 11,2%, respectivamente. Las estrategias de afrontamiento más utilizadas por los jóvenes fueron: hacerse ilusiones, falta afrontamiento, reducción de la tensión, acción social, ignorar el problema, auto inculparse, reservarlo para sí y reducción de la tensión. Conclusiones Los resultados se convierten en un referente para la creación de programas de intervención en salud mental, orientados a generar estrategias de prevención que lleven a los jóvenes a dominar sus impulsos de jugar, a auto-regular el tiempo que pasan jugando y a tratar a quienes tengan dificultades para controlar sus impulsos de jugar, con el fin de que puedan rehabilitarse de manera oportuna.

ObjectiveTo identify the prevalence of gambling addiction and coping strategies used by youth enrolled in a municipality of Colombia. Methodology Descriptive cross-sectional study in a population of 294 school adolescent students. Questionnaire Fisher based on criteria of DSM IV - J was used for measuring the risk of game and applied the scale of coping strategies for adolescents (ACS) designed by Frydenberg and Lewis. Results73,5% of respondents stated that he had played once in his life in machines pay coins and 79,6% reported having made use of video and games online. Among men, it was classified as probable social players 7,5% and as probable pathological players 2,5%, and among women the 17,2% and 11,2%, respectively. Coping strategies used most by young people were: do illusions, lack coping, stress, social action, ignoring the problem, auto indict is, reserve it for themselves and stress reduction. ConclusionsThe results become a reference for the creation of intervention in mental health programs, oriented to generate prevention strategies that lead to young people to master their impulses of play, to auto-regulate the time spent playing and to treat those who have difficulties to control their impulses to play, so they can be rehabilitated in a timely manner.

Nuevos retos en el tratamiento del juego patológico / New challenges in the treatment of disordered gambling

En este artículo se señalan los avances y retos de futuro en el tratamiento del juego patológico. El objetivo terapéutico (abstinencia o juego moderado) es actualmente objeto de controversia. Los tratamientos para la ludopatía incluyen la terapia hospitalaria, los tratamientos cognitivo-conductuales individuales o grupales, Jugadores Anónimos y la farmacoterapia, así como la prevención de recaídas. La terapia cognitivo-conductual presenta unas tasas de éxito del 50 por ciento al 80 por ciento de los casos tratados en un seguimiento a largo plazo. La farmacoterapia es un complemento cuando los pacientes tienen un estado de ánimo deprimido o un elevado nivel de impulsividad. El juego controlado puede ser una alternativa terapéutica para los jugadores jóvenes o que no presentan aún una dependencia severa. Se requiere más información sobre el tratamiento del juego on-line y de poblaciones específicas (mujeres y jóvenes). Se comentan las implicaciones de esta revisión para la práctica clínica y para las investigaciones futuras.

This paper deals with the new developments in the treatment of disordered gambling, as well as with the challenges for further research. Abstinence versus moderated gambling is an issue that raises many concerns and that needs to be addressed. Current treatment for disordered gambling involves a number of different options, including inpatient treatments, individual and group cognitive-behavioral options, Gamblers Anonymous and pharmacotherapy, as well as an intervention in relapse prevention. Cognitive-behavioral therapy may have asuccess rate ranging from 50 percent to 80 percent of treated patients in a long-term follow-up. Psychopharmacological therapy may have incremental benefit when patients have comorbid depression or high impulsivity. Responsible gambling may be a therapeutic option for young gamblers or people without a severe dependence. Further information is required about treatment for online gambling addictions and for dealing with specific populations (women and young people). Unanswered questions for future research in this field are commented upon.

Ludopatía: accesibilidad de los adictos al juego y de sus familias a las instituciones del sistema de salud / Gambling: accessibility of Gamblers and their Families to Health Care Institutions

En la década de 1990 se amplió progresivamente la oferta de juegos de azar en Argentina, lo que trajo aparejada una problemática poco conocida: la ludopatía. OBJETIVO: Describir la accesibilidad de los jugadores compulsivos y sus familiares al sistema de salud, indagando sobre las experiencias obstaculizadoras y facilitadoras. MÉTODOS: Se realizó un abordaje cualitativo exploratorio en Avellaneda y Lanús (Provincia de Buenos Aires). Se seleccionaron los vínculos que establecen las personas jugadoras y sus familias con las instituciones del sistema de salud. La muestra se construyó con criterios basados en definiciones conceptuales. Se realizaron 26 entrevistas en profundidad a jugadores compulsivos, familiares, profesionales de la salud del sector público/privado y coordinadores de grupos de pares. RESULTADOS: Los modelos de atención abordados (profesional y grupo de pares) presentan atributos ideológicos y operativos diferenciados, aunque conviven y son utilizados articuladamente en las prácticas de los sujetos. En sus trayectorias se visualizó el sistema de salud “real”, así como las experiencias facilitadoras y obstaculizadoras del acceso. CONCLUSIONES: La problemática tiene hoy un reconocimiento mayor al de años anteriores. Sin embargo, los actores entrevistados no identificaron los espacios de tratamiento y las estrategias de salud plausibles. El abordaje desde el concepto de enfermedad no permite visualizar el padecimiento presente en toda la red vincular e impide alcanzar una respuesta asistencial integral

In the 90’s, the offer of gambling games gradually expanded in Argentina, leading to the appearance of a little-known problem: compulsive gambling. OBJECTIVE: To describe the accessibility of gamblers and their families to health care system, inquiring about the experiences of barriers and facilitators. METHODS:An exploratory qualitative approach was used for this study in Avellaneda and Lanús (Province of Buenos Aires),selecting the links established by gamblers and their families with health care institutions. The sample was based on conceptual definitions. The study performed 26 in-depth interviews to compulsive gamblers, family members, health professionals from public/private sector and peer group coordinators. RESULTS: Models of care, professional type and peer group coexist with distinct ideological and operational attributes, although they are used together in the practices of the subjects. Their paths reflected the “real” health care system, as well as facilitating opportunities and obstacles to the access. CONCLUSIONS: Comparing to previous years, compulsive gambling is now more recognized as a health problem. How ever, the surveyed actors did not identify the appropriate treatment paths and health strategies. Addressing this issue from the concept of disease does not allow to understand the suffering occurring throughout the close personal network and prevents from reaching a comprehensive care approach

Decision-making impairment in obsessive-compulsive disorder as measured by the Iowa Gambling Task / Prejuízo no processo de tomada de decisão mensurado pelo Iowa Gambling Task no transtorno obsessivo-compulsivo

OBJECTIVE: This study aims to evaluate the process of decision-making in patients with obsessive-compulsive disorder (OCD) using the Iowa Gambling Task (IGT). In addition, we intend to expand the understanding of clinical and demographic characteristics that influence decision-making. METHOD: Our sample consisted of 214 subjects (107 diagnosed with OCD and 107 healthy controls) who were evaluated on their clinical, demographic and neuropsychological features. Moreover, the Iowa Gambling Task (IGT), a task that detects and measures decision-making impairments, was used. RESULTS: We found that OCD patients performed significantly worse on the IGT. Furthermore, features such as symptoms of anxiety did not influence IGT performance. CONCLUSION: Impaired decision-making seems to be a key feature of OCD. Given that OCD is a complex heterogeneous disorder, homogeneous groups are necessary for an accurate characterization of our findings.

OBJETIVO: Avaliar o processo de tomada de decisão em pacientes com transtorno obsessivo-compulsivo (TOC) utilizando o Iowa Gambling Task. Pretende-se, também, avaliar características demográficas e clínicas que possam influenciar essa função executiva. MÉTODO: Nossa amostra é composta de 214 sujeitos (107 pacientes com diagnóstico de TOC e 107 controles) que foram avaliados do ponto de vista clínico, demográfico e neuropsicológico. O Iowa Gambling Task, um teste que avalia o processo de tomada de decisão, foi aplicado. RESULTADOS: Observamos um prejuízo no desempenho dos pacientes com TOC no IGT. Características como sintomas depressivos e ansiosos não foram responsáveis por esse prejuízo. CONCLUSÃO: O prejuízo no processo de tomada de decisão parece ser um componente importante na fisiopatologia do TOC. Como o TOC é um transtorno heterogêneo, grupos mais homogêneos são necessários para uma melhor caracterização e confirmação dos nossos achados.

Motivação para mudança de comportamento em amostra de jogadores patológicos / Motivation for behavior change in a sample of pathological gamblers

OBJETIVO: O objetivo deste trabalho foi conhecer o perfil e avaliar as características de jogadores patológicos que frequentavam clínicas e grupos especializados no tratamento desse problema, quanto à motivação para mudança de comportamento. MÉTODO: Foram avaliados 69 sujeitos com diagnóstico de jogo patológico, segundo critérios diagnósticos do DSM-IV-TR. A amostra foi subdividida em dois grupos, conforme o tipo de tratamento: grupo em tratamento ambulatorial (TA) e grupo de jogadores anônimos (JA). Os instrumentos utilizados foram a University of Rhode Island Change Assessment (URICA), a Régua de Prontidão e a South Oaks Gambling Screen (SOGS). RESULTADOS: A análise dos resultados evidenciou que o grupo TA apresentou escore médio maior do que o do grupo JA tanto no estágio de pré-contemplação quanto no estágio de ação. Comparando os grupos TA e JA com relação ao tempo de abstinência, observou-se que o grupo de JA está associado a um tempo maior de abstinência do que o grupo de ambulatório. CONCLUSÃO: A importância de pesquisar estratégias que favoreçam a compreensão e a adesão aos tratamentos para jogadores patológicos é fundamental. A avaliação da motivação e dos estágios para mudança permite uma direção para o tratamento, auxiliando na elaboração de estratégias terapêuticas.

OBJECTIVE: The goal of this study was to evaluate the profile and the characteristics of pathological gamblers who attended clinics and groups specialized in the treatment of this problem, focusing on patients' motivation to change this behavior. METHOD: 69 subjects with a diagnosis of pathological gambling, according to diagnostic criteria of DSM-IV-TR were evaluated. The sample was divided in two groups according to treatment regimen: ambulatory care group and gamblers anonymous group (GA). The instruments used were the University of Rhode Island Change Assessment (URICA), the Ruler of Readiness and SOGS (South Oaks Gambling Screen). RESULTS: The results showed that the ambulatory group had a higher mean score than the GA group, both in the precontemplation stage and in the action stage. Comparing the group of ambulatory care and GA with regard to length of abstinence, it was observed that the group of GA is associated with a longer period of abstinence than the ambulatory group. CONCLUSION: The importance of searching strategies that enhance the understanding and treatment adherence for pathological gamblers is crucial. The evaluation of the motivation to change and the stages of change allow professionals to find a better direction for treatment, assisting in the development of therapeutic strategies.

Juego patológico en usuarios de casinos en Bogotá: prevalencia y relaciones con consumo de alcohol, búsqueda de sensaciones y patrones de juego / Pathological gambling in casino users in Bogotá: Prevalence and relation with alcohol consumption, search for sensations and gambling patterns

En Colombia son muy pocos los trabajos que abordan la adicción al juego en algún grupo poblacional. En este trabajo se estudió la prevalencia de juego patológico y la validez concurrente del South Oaks Gambling Score (SOGS) en una muestra no aleatoria de usuarios de juegos de azar, localizados, en su mayoría, en casinos. Como resultados se destaca: (a) un 49.1% de sujetos con probable juego patológico; (b) mayor variedad en juegos, mayor consumo de alcohol en fines de semanay más demanda de dinero, para jugar o para consumir alcohol en los sujetos con problemas de adicción al juego, y (c) algunos ítems de la Escala de Búsqueda de Sensaciones pueden formar un indicador específicamente asociado con el juego patológico.

In Colombia, very few researches approach gambling addiction in any population group. This research focused on the prevalence of pathological gambling, and concurrent validity of South Oaks Gambling Score (SOGS) in a non-randomized sample of casino users. The most remarkable results showed that (a) 49.1% of the interviewees were likely to have pathological gambling, (b) subjects with probable pathological gambling showed a higher game variety and alcohol consumption on weekends, and higher expenses for gambling and drinking, and (c) some Search for Sensations Scale items could serve to build a specific indicator for gambling addiction.

Wives of pathological gamblers: personality traits, depressive symptoms and social adjustment / Esposas de jogadores patológicos: traços de personalidade, sintomas depressivos e ajustamento social

Objective: Wives of pathological gamblers tend to endure long marriages despite financial and emotional burden. Difficulties in social adjustment, personality psychopathology, and comorbidity with psychiatric disorders are pointed as reasons for remaining on such overwhelming relationships. The goal was to examine the social adjustment, personality and negative emotionality of wives of pathological gamblers. Method: The sample consisted of 25 wives of pathological gamblers, mean age 40.6, SD = 9.1 from a Gambling Outpatient Unit and at GAM-ANON, and 25 wives of non-gamblers, mean age 40.8, SD = 9.1, who answered advertisements placed at the Universidade de São Paulo hospital and medical school complex. They were selected in order to approximately match demographic characteristics of the wives of pathological gamblers. Subjects were assessed by the Social Adjustment Scale, Temperament and Character Inventory, Beck Depression Inventory and State-Trait Anxiety Inventory. Results: Three variables remained in the final Multiple Logistic Regression model, wives of pathological gamblers presented greater dissatisfaction with their marital bond, and higher scores on Reward Dependence and Persistence temperament factors. Both, Wives of pathological gamblers and wives of non-gamblers presented well-structured character factors excluding personality disorders. Conclusion: This personality profile may explain wives of pathological gamblers emotional resilience and their marriage longevity. Co-dependence and other labels previously used to describe them may work as a double edged sword, legitimating wives of pathological gamblers problems, while stigmatizing them as inapt and needy.

Objetivo: Esposas de jogadores patológicos tendem a permanecer casadas por muitos anos, apesar das dificuldades financeiras e emocionais. Dificuldades de ajustamento social, transtornos de personalidade, e comorbidades com transtornos psiquiátricos são apontados como razões para permanecerem nesses relacionamentos tão opressivos. O objetivo foi examinar o ajustamento social, a personalidade e as emoções negativas das esposas de jogadores patológicos. Método: A amostra foi constituída por 25 esposas de jogadores patológicos, média de idade 40,6 anos (DP = 9,1), do Ambulatório de Jogadores Patológicos e do Jog-Anon, e 25 esposas de não jogadores, média de idade 40,8 anos (DP = 9,1), que responderam a anúncios colocados no complexo do hospital da faculdade de medicina da Universidade de São Paulo. Foram selecionadas aquelas que apresentavam características demográficas próximas às das esposas de jogadores patológicos. Os sujeitos foram avaliados por meio da Escala de Ajustamento Social, do Inventário de Temperamento e Caráter, do Inventário de Depressão de Beck, e do Inventário de Ansiedade Traço-Estado. Resultados: Três variáveis permaneceram no modelo final da Análise de Regressão Logística Múltipla. Esposas de jogadores patológicos apresentaram maior insatisfação no relacionamento marital e escores mais altos nos fatores de temperamento Dependência de Gratificação e Persistência. Ambas, as esposas de jogadores patológicos e de não jogadores apresentaram fatores de caráter bem estruturados, excluindo transtornos de personalidade. Conclusão: Este perfil de personalidade pode explicar a resiliência emocional das esposas de jogadores patológicos e a longa duração de seus casamentos. Codependência e outros rótulos utilizados anteriormente para descrevê-las podem, de um lado, legitimar seus problemas e, de outro, estigmatizá-las como inaptas e carentes.

Jogo e trabalho: do homo ludens, de Johann Huizinga, ao ócio criativo, de Domenico De Masi / Play and work: from Homo ludens, by Johann Huizinga, to creative leisure, by Domenico De Masi

Este estudo propõe-se a discutir as relações entre jogo e trabalho, em uma perspectiva histórica, tendo como marco inicial a marcante obra erudita Homo ludens, de Johann Huizinga, e o livro mais recente e polêmico, Ócio criativo, de Domenico De Masi. A discussão apenas começa, no entanto, para compreensão das novas situações que se criam no atual momento da humanidade, parece-nos promessa de um caminho fértil esse em que se mostra o mundo do trabalho como afim e próximo ao do jogo, quando antes, ao contrário, essa aproximação fazia-se na direção inversa, como a do mundo do jogo que se abria para os nexos da profissionalização e da regra do trabalho.

This study aims to discuss the relationship between play and work, in an historical perspective, having as first reference the remarkable and erudite work of Johann Huizinga, Homo ludens, and the more recent and controversial Creative leisure, of Domenico De Masi. The discussion only begins, therefore, in order to understand the new situations that are created in the present moment of the humanity, it seems to be a promising way, that which shows the world of work as compatible and close to the play, when before, on the contrary, the association used to be made on the other direction, from the world of play opening to the logic of professional activity and the rule of work.

Neuropsychological assessment of impulsive behavior in abstinent alcohol-dependent subjects / Avaliação neuropsicológica do comportamento impulsivo de sujeitos dependentes de álcool em abstinência

OBJECTIVE: Poor impulse control is thought to be one of the characteristics of alcohol addiction. The capacity to remain abstinent may be linked to cognitive bias related to three dimensions of impulsivity: motor, non-planning, and attentional impulsivity. The aim of this study was to evaluate the neuropsychological profile related to these impulsivity dimensions in alcohol-dependent patients within 15 -120 days of abstinence. METHOD: We compared 31 alcohol-dependent patients to 30 matched healthy controls regarding their performances on the Continuous Performance Task, the Iowa Gambling Test, and the Wisconsin Card Sorting Test, each of which is thought to tax primarily one of the three dimensions of impulsivity just outlined. RESULTS: When compared to controls, alcohol-dependent patients presented more commission errors on the Continuous Performance Task; made more disadvantageous choices on the Iowa Gambling Test; and made more perseverative errors on the Wisconsin Card Sorting Test. There was no significant correlation between performance on these tests and the length of abstinence. CONCLUSIONS: These results suggest that deficits related to motor, non-planning and attentional components of impulsivity exist in alcohol-dependent patients, in the period immediately after acute alcohol withdrawal. These results may help guide interventions designed to prevent the risk of relapse in alcohol-abstinent patients.

OBJETIVO: O controle deficiente dos impulsos é considerado uma das características da dependência do álcool. A capacidade de permanecer abstinente pode estar ligada a viés cognitivo relacionado a três dimensões da impulsividade: motora, de atenção e por falta de planejamento. O presente estudo objetivou avaliar o perfil neuropsicológico relacionado a estas dimensões da impulsividade em pacientes dependentes de álcool em 15 a 120 dias de abstinência. MÉTODO: Nós comparamos o desempenho de 31 pacientes dependentes de álcool a 30 controles saudáveis na Continuous Performance Task, no Iowa Gambling Test e no Wisconsin Card Sorting Test, que são considerados testes capazes de avaliar primariamente as citadas dimensões de impulsividade. RESULTADOS: Em relação aos controles, o grupo pacientes dependentes de álcool cometeu mais erros de comissão na Continuous Performance Task; fez escolhas menos vantajosas no Iowa Gambling Test e mais erros perseverativos no Wisconsin Card Sorting Test. Não houve correlação significativa entre o desempenho nestes testes e o tempo de abstinência. CONCLUSÕES: Estes resultados sugerem que há déficits relacionados aos componentes da impulsividade (motores, atencionais e por não-planejamento) em pacientes dependentes de álcool, no período imediatamente após a fase aguda de retirada do álcool. Estes resultados podem ajudar a guiar intervenções para impedir o risco do recaída em pacientes em curto período de abstinência de álcool.