Silymarin (Milk Thistle) Treatment of Adults With Gambling Disorder: A Double-Blind, Placebo-Controlled Trial.

OBJECTIVE: Data on the pharmacological treatment of gambling disorder are limited. Silymarin (derived from milk thistle) has antioxidant properties. The goal of the current study was to determine the efficacy and tolerability of silymarin in adults with gambling disorder. METHODS: Forty-three individuals (18 [41.9%] women; mean age=49.61 [±13.1] years) with gambling disorder entered an 8-week, double-blind, placebo-controlled study. Dosing of silymarin ranged from 150 to 300 mg twice a day. The primary outcome measure was the Yale Brown Obsessive Compulsive Scale Modified for Pathological Gambling (PG-YBOCS). Secondary outcome measures comprised the Gambling Symptom Assessment Scale and measures of depression and anxiety. Outcomes were examined using mixed-effect models. RESULTS: Silymarin did not statistically differentiate from the placebo on any of the outcome measures of interest, in terms of treatment group×time interactions. There was a robust response in the placebo group (57% reduction on the PG-YBOCS), and on average there was a 56% reduction in YBOCS score for the milk thistle. CONCLUSIONS: The findings of this study do not support the use of silymarin/milk thistle in the treatment of gambling disorder but highlight the large placebo response seen in gambling disorder. Treatment interventions for gambling disorder need to better understand and address the placebo response. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT02337634.

Associations between dimensions of behaviour, personality traits, and mental-health during the COVID-19 pandemic in the United Kingdom.

The COVID-19 pandemic (including lockdown) is likely to have had profound but diverse implications for mental health and well-being, yet little is known about individual experiences of the pandemic (positive and negative) and how this relates to mental health and well-being, as well as other important contextual variables. Here, we analyse data sampled in a large-scale manner from 379,875 people in the United Kingdom (UK) during 2020 to identify population variables associated with mood and mental health during the COVID-19 pandemic, and to investigate self-perceived pandemic impact in relation to those variables. We report that while there are relatively small population-level differences in mood assessment scores pre- to peak-UK lockdown, the size of the differences is larger for people from specific groups, e.g. older adults and people with lower incomes. Multiple dimensions underlie peoples' perceptions, both positive and negative, of the pandemic's impact on daily life. These dimensions explain variance in mental health and can be statistically predicted from age, demographics, home and work circumstances, pre-existing conditions, maladaptive technology use and personality traits (e.g., compulsivity). We conclude that a holistic view, incorporating the broad range of relevant population factors, can better characterise people whose mental health is most at risk during the COVID-19 pandemic.

Personality traits and their clinical associations in trichotillomania and skin picking disorder.

BACKGROUND: Despite being discussed in the psychiatric literature for decades, very little is known about personality features associated with trichotillomania and skin picking disorder (known as body focused repetitive behavior disorders, BFRBs); and the contribution of personality traits to their clinical presentations. AIM: The present study assessed personality traits in a large and well-characterized sample of adults with either trichotillomania or skin picking disorder or both. METHODS: Adults (n = 98, aged 18-65 years), with trichotillomania (n = 37), skin picking disorder (n = 32), both trichotillomania and skin picking disorder (n = 10), and controls (n = 19) were enrolled. Participants completed self-report questionnaires to quantify personality (NEO Personality Inventory), as well as extent/severity of picking/pulling symptoms, mood and anxiety, impulsive and perfectionistic tendencies, and neurocognitive functioning. Group differences were characterized and correlations with other measures were examined. RESULTS: In comparison to controls, BFRBs had elevated neuroticism scores (p < 0.001), lower extraversion scores (p = 0.023), and lower conscientiousness scores (p = 0.007). Neuroticism was significantly related to both hair pulling (r = 0.24, p < 0.001) and skin picking severity (r = 0.48, p < 0.001), as well as elevated perceived stress, worse anxiety and depressive symptoms, and poorer quality of life. Introversion (i.e. lower extraversion) was significantly associated with worse picking severity, higher perceived stress, and higher depression. Lack of conscientiousness was significantly associated with more depression, impulsivity, and perceived stress. DISCUSSION: Personality traits of neuroticism, introversion, and lack of conscientiousness are heightened in individuals with BFRBs and show strong associations with a number of clinically relevant features of illness. The holistic understanding and treatment of these disorders is likely to require consideration of dimensional traits such as these.

Milk Thistle Treatment for Children and Adults with Trichotillomania: A Double-Blind, Placebo-Controlled, Crossover Negative Study.

BACKGROUND: Data on the pharmacological treatment of trichotillomania are limited. Milk thistle has antioxidant properties and showed promise in trichotillomania in a prior case report. The goal of the current study was to determine the efficacy and tolerability of silymarin in children and adults with trichotillomania. METHODS: Twenty individuals (19 [95.0%] women; 16 adults; mean age, 27.9 [11.5] years) with trichotillomania entered a 12-week, double-blind, placebo-controlled crossover study (6 weeks of milk thistle and 6 weeks of placebo with a 1-week wash-out in between). Dosing of milk thistle ranged from 150 mg twice a day to 300 mg twice a day. Subjects were assessed with the National Institute of Mental Health Trichotillomania Severity Scale (primary outcome), the Massachusetts General Hospital Hair Pulling Scale, Clinical Global Impression scale, and measures of depression, anxiety, and psychosocial functioning. Outcomes were examined using linear mixed models with a random intercept for subject and t tests. RESULTS: There were no statistically significant treatment type-by-time interactions for the main outcome measure, but significant effects were seen for secondary measures (eg, time spent pulling per day for the past week). From baseline to week 6, there was a significant decrease in Clinical Global Impression severity for the milk thistle group but not in the placebo group. CONCLUSIONS: This trial failed to show that milk thistle was more effective than placebo on the main outcome measure, but milk thistle did demonstrate significant improvements on select secondary outcome measures. These findings may shed light on important neurochemical targets worthy of future investigation.