Screening for Problematic Internet Use.

Problematic Internet use (PIU) by adolescents is of growing concern among both parents and pediatricians. Early controversies may have contributed to challenges in defining and measuring PIU. A variety of screening tools have evolved, aligned with different constructs of PIU, although a validated screening tool does exist. Current data and American Academy of Pediatrics policy reflect evidence-driven screening for PIU for all youth.

What drugs modify the risk of iatrogenic impulse-control disorders in Parkinson's disease? A preliminary pharmacoepidemiologic study.

INTRODUCTION: Parkinson's disease (PD) patients treated with pramipexole (PPX) and ropinirole (ROP) exhibit a higher risk of developing impulse control disorders (ICDs), including gambling disorder, compulsive shopping, and hypersexuality. The management of ICDs in PD is challenging, due to the limited availability of effective therapeutic alternatives or counteractive strategies. Here, we used a pharmacoepidemiological approach to verify whether the risk for PPX/ROP-associated ICDs in PD patients was reduced by drugs that have been posited to exert therapeutic effects on idiopathic ICDs-including atypical antipsychotics (AAs), selective serotonin reuptake inhibitors (SSRIs), and glutamatergic modulators (GMs). METHODS: To quantify the strength of the associations between PPX/ROP and other medications with respect to ICD risk, odds ratios (ORs) were calculated by multivariable logistic regression, adjusting for age, gender, marital status race, psychiatric comorbidities, and use of cabergoline and levodopa. RESULTS: A total of 935 patients were included in the analysis. Use of GMs, SSRIs, and AAs was not associated with a decreased ICD risk in PD patients treated with PPX/ROP; conversely, ICD risk was significantly increased in patients treated with either GMs (Adjusted Odds Ratio, ORa: 14.00 [3.58-54.44]) or SSRIs (ORa: 3.67 [1.07-12.59]). Results were inconclusive for AAs, as available data were insufficient to compute a reliable ORa. CONCLUSIONS: These results suggest that some of the key pharmacological strategies used to treat idiopathic ICD may not be effective for ICDs associated with PPX and ROP in PD patients. Future studies with larger cohorts are needed to confirm, validate, and extend these findings.

Developing Attributes and Attribute-Levels for a Discrete-Choice Experiment: An Example for Interventions of Impulsive Violent Offenders.

BACKGROUND: Discrete-Choice Experiments (DCEs) are used to assess the strength of preferences and value of interventions, but researchers using the method have been criticised for failing to either undertake or publish the rigorous research for selecting the necessary attributes and levels. The aim of this study was to elicit attributes to inform a DCE to assess societal and offenders' preferences for, and value of, treatment of impulsive-violent offenders. In doing so, this paper thoroughly describes the process and methods used in developing the DCE attributes and levels. METHODS: Four techniques were used to derive the final list of attributes and levels: (1) a narrative literature review to derive conceptual attributes; (2) seven focus group discussions (FGDs) comprising 25 participants including offenders and the general public and one in-depth interview with an offender's family member to generate contextual attributes; (3) priority-setting methods of voting and ranking to indicate participants' attributes of preference; (4) a Delphi method consensus exercise with 13 experts from the justice health space to generate the final list of attributes. RESULTS: Following the literature review and qualitative data collection, 23 attributes were refined to eight using the Delphi method. These were: treatment effectiveness, location and continuity of treatment, treatment type, treatment provider, voluntary participation, flexibility of appointments, treatment of co-morbidities and cost. CONCLUSION: Society and offenders identified similar characteristics of treatment programs as being important. The mixed methods approach described in this manuscript contributes to the existing limited methodological literature in DCE attribute development.

Evaluación del Abordaje Terapéutico en un Centro de Justicia Juvenil / Evaluation of the therapeutic approach in Juvenile Justice Center / Avaluació de l'abordatge terapéutic en un centre de justícia juvenil

El objeto del estudio es evaluar la intervención en un Centro de Justicia Juvenil mediante el contraste del estado clínico en 18 episodios de ingreso realizados por 16 adolescentes. La intervención se basa en la Psicoterapia de Vinculación Emocional Validante. Es un enfoque integrador de tiempo limitado centrado en generar conciencia de problema, adherencia al tratamiento, remisión de la sintomatología aguda y experiencias emocionales correctoras con el objetivo, en última instancia, de poder beneficiarse de un tratamiento en la comunidad. Los resultados muestran un perfil diferencial del grupo de menores infractores. Asimismo se constata un cambio estadísticamente significativo en este grupo tras la intervención. Finalmente, se discuten aspectos relevantes de la evaluación y medidas terapéuticas a aplicar en esta población

The aim of this study is to evaluate the effectiveness of the intervention in a Juvenile Justice Center contrasting the clinical status of 18 hospitalizations in 16 teenagers. The intervention is based on the Validative Emotional Bonding Psychotherapy. It is a limited time integrative-approach to make patients become aware of the problem, of the treatment adherence, of the remission of severe symptoms and the corrective emotional experiences in order to take advantage from the treatment in the community. The results show a differential profile of the group of juvenile offenders and a statistically significant change after the treatment. Finally, we discuss about the important aspects of the assessment and the therapeutic measures applied in this population

L'objecte de l'estudi és el d'avaluar la in-tervenció en un centre de justícia juvenil mitjançant el contrast de l'estat clínic en 18 episodis d'ingrés realitzats per 16 adolescents. La intervenció es basa en la Psicoterápia de Vinculació Emocional Validant. És un enfoc in-tegrador de temps limitat centrat en generar consciéncia del problema, adheréncia al tractament, remissió de la simptomatologia aguda I experiéncies emocionals correctores amb l'objectiu, en última instància, de poder beneficiar-se d'un tractament en la comunitat. Els resultats mostren un perfil diferencial del grup de menors infractors. Al mateix temps, es constata un canvi estadísticament significatiu en aquest grup després de la inter-venció. Finalment, es discuteixen aspectes rellevants en l'avaluació I mesures terapéutiques a aplicar en aquesta població

[Hypersexuality and other impulse control disorders in Parkinson's disease]. / Hyperseksualiteit en andere impulscontrolestoornissen bij de ziekte van Parkinson.

Impulse control disorders (ICD) in Parkinson's disease (PD) pose a therapeutic challenge. This article provides a description of the symptoms and management strategies of ICD in PD. We present two men aged 52 and 69 with ICD, especially hypersexuality, in response to dopaminergic medication. In the first case the symptoms of hypersexuality and gambling decreased after reducing the dose of the dopamine-agonist. In the second case the hypersexuality symptoms decreased after addition of naltrexon. It is important to recognize the symptoms of ICD in PD because of the large impact on social and relational functioning. It is of great importance to repeatedly ask the patient and their partner about these symptoms, since feelings of shame and guild hamper spontaneous report. The first step of treatment consists of reducing the dose of dopaminergic medication and/or to switch from dopamine-agonist to levodopa. Although the research on effective treatment options has been limited so far, treatment alternatives from the addiction field seem promising.

Regular el juego para prevenir la adicción: hoy más necesario que nunca / Regulating gambling to prevent addiction: more necessary now than ever

En mayo de 2013 apareció la quinta edición de la clasificación de los trastornos mentales (DSM-5) de la American Psychiatric Association (APA, 2013), en la cual se incluye el trastorno de juego dentro de la categoría de trastornos adictivos, que es algo que era demandado desde hace décadas desde los ámbitos clínicos, sociales y científicos. El juego de azar, que según la propia APA tiene la misma consideración que las drogas o el alcohol en cuanto a la activación de los circuitos cerebrales de recompensa y a las consecuencias clínicas del trastorno del juego, no tiene, sin embargo, esa consideración desde el principal ámbito desde donde se debe llevar a cabo la prevención de la adicción, que es en los poderes públicos. El trabajo que presentamos es una propuesta de regulación del juego para llevar a cabo desde la Administración mediante acciones de gobierno que competen a diferentes niveles de la misma (estatal, autonómico e incluso local), con el objetivo final de prevenir la adicción al juego. Dicha propuesta ha sido presentada tanto a la Dirección General de Ordenación del Juego como a la Cámara del Congreso de los Diputados, esta última en el marco de la Comisión Mixta Congreso-Senado para el Estudio del Problema de las Drogas. En este trabajo se defiende la propuesta de regulación desde la evidencia que proporcionan los estudios científicos en materia de prevención de las adicciones

The American Psychiatric Association published the 5th Edition of DSM in May 2013, in which the gambling disorder is included within the category of addictive disorders -a long-standing and recurrent demand from the clinical, social and scientific fields. Nevertheless, the harmful effects of gambling have not been considered by the Government, which is the main area of addiction prevention. The present article is a proposal for the regulation of gambling by the Government through the different levels of the State (national, regional and even local), which has the ultimate goal of preventing gambling addiction. This proposal has been presented to the Chamber of Deputies of the Congress, as part of the Congress-Senate Joint Committee for the Study of Drug Problems. The proposed regulation is based on the evidence provided by scientific studies on the prevention of addiction

Adicción a la cuasi-muerte / Addition to near-death

Este artículo describe un tipo muy maligno de autodestrucción observado en un grupo reducido de pacientes. Está presente en la manera en la que administran sus vidas y surge, peligrosamente, en la transferencia. Este tipo de autodestrucción, a mi juicio, radica en una disposición de índoles sadomasoquista particular que dichos pacientes son incapaces de resistir. Es como un impulso constante hacia la desesperación y la muerte que los fascina a la vez que, inconscientemente, disfrutan del proceso. Se dan ejemplos para demostrar cómo tales disposiciones dominan la forma en la que el paciente se comunica con su analista e, interiormente, consigo mismo, y la manera en la que esto afecta sus procesos mentales. Es, con seguridad, extremadamente difícil para estos pacientes acercarse a placeres más reales y más ligados a sus objetos, ya que ello significaría la renuncia a hábitos gratificadores que todo lo absorben (AU)

This paper describes a very malignant type of self-destructiveness seen in a small group of patients. It is active in the way that they run their lives and it emerges in a deadly way in the transference. This type of self-destructiveness is, I suggest, in the nature of an addiction of a particular sado-masochistic type, which these patients feel unable to resist. It seems to be like a constant pull towards despair and near-death, so that the patient is fascinated and unconsciously excited by the whole process. Examples are given to show how such addictions dominate the way in which the patient communicates with the analyst and internally, with himself, and thus how they affect his thinking processes. It is clearly extremely difficult for such patients to move towards more real and object-related enjoyments, which would mean giving up the all-consuming addictive gratifications (AU)

'Wanting' and 'liking' skin picking: A validation of the Skin Picking Reward Scale.

BACKGROUND AND AIMS: Excoriation (skin-picking) disorder (SPD) is often conceptualized as a behavioral addiction in which aberrant reward processing may play an important role. The current study sought to develop a self-report instrument--the Skin Picking Reward Scale (SPRS)--that measures how strongly skin picking is 'liked' (i.e., the degree of pleasurable feelings while receiving the reward) and 'wanted' (i.e., the degree of the motivation to seek the reward). METHODS: We administered the SPRS to individuals who endorsed excessive skin picking in online surveys and examined the scale's factor structure (Studies 1 and 2). We then asked individuals with documented pathological skin picking to complete the SPRS and other relevant questionnaires on two occasions one week apart (Study 3). RESULTS: Exploratory (Study 1; n = 330) and confirmatory (Study 2; n = 144) factor analyses consistently supported a two-factor structure reflecting the 'liking' and 'wanting' constructs. Results from Study 3 (N = 36) indicated that the Wanting and the Liking scales had adequate internal consistency and test-retest reliability. Additionally, consistent with predictions, the Wanting scale, but not the Liking scale, was associated with picking urges the following week, greater cue-reactivity, and more picking-related routines/habits. DISCUSSION: These initial findings suggest that SPRS is a psychometrically sound measure of 'wanting' and 'liking' in pathological skin picking. The SPRS may facilitate research on reward processing anomalies in SPD and serve as a useful clinical instrument (e.g., to identify those at risk for cue-induced relapse).

¿Confiamos demasiado en el valor de la cognición y de la educación en la prevención? / Do we place too much faith in the value of cognition and education in prevention?

Muchas estrategias de prevención todavía se basan predominantemente en conceptos cognitivos e informativos y se asume, implícitamente, que los seres humanos actúan de manera racional, ponderando riesgos contra placeres en situaciones relacionadas con el consumo. Los estudios sobre la efectividad de las intervenciones preventivas y los estudios etiológicos sin embargo destacan la importancia central del control de impulsos y de los procesos automáticos como determinantes de los comportamientos de riesgo, incluyendo el consumo problemático de drogas. Las intervenciones de prevención eficaces muchas veces incluyen elementos de presión normativa, supervisión de los hijos, incentivos y oportunidades, y otras componentes cuyo modus operandi no es necesariamente consciente. Estos principios preventivos son eficaces en varios ámbitos comportamentales: uso problemático de substancias, delincuencia y comportamientos violentos y antisociales. Sin embargo se utilizan poco en la práctica preventiva. La preponderancia de intervenciones basadas únicamente en procesos cognitivos y enfocados en el individuo conlleva también una serie de problemas éticos

Many prevention strategies are still predominantly based on cognitive and informational concepts, implicitly assuming that humans act rationally and weigh risks against pleasures in consumption-prone situations. Research on aetiology and on the effectiveness of prevention interventions nevertheless highlights the crucial roles of impulse-control and of automatic processes as determinants of risk behaviours, including problematic substance use. Effective preventive interventions often include elements of normative pressure, parental monitoring, incentives and opportunities, and other components whose modus operandi is not necessarily conscious. These preventive principles are effective in several behavioural domains such as problematic substance use, delinquency and violent antisocial behaviours. They are however seldom used in prevention practice. The preponderance of interventions that are solely based on cognitive processes and are focused on individuals also entails a number of ethical problems

Does response inhibition have pre- and postdiagnostic utility in Parkinson's disease?

Parkinson's disease (Pd) is the second most prevalent degenerative neurological condition worldwide. Improving and sustaining quality of life is an important goal for Parkinson's patients. Key areas of focus to achieve this goal include earlier diagnosis and individualized treatment. In this review the authors discuss impulse control in Pd and examine how measures of impulse control from a response inhibition task may provide clinically useful information (a) within an objective test battery to aid earlier diagnosis of Pd and (b) in postdiagnostic Pd, to better identify individuals at risk of developing impulse control disorders with dopaminergic medication.

Ethical Gambling: a commitment to preventing gambling addiction from the political and social standpoints

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"Juego Ético": un compromiso en la prevención de la adicción al juego desde el ámbito político y social / No disponible

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Lamotrigine use in patients with binge eating and purging, significant affect dysregulation, and poor impulse control.

OBJECTIVE: Some patients with symptoms of binge eating and purging are successfully treated with specific serotonin reuptake inhibitors (SSRIs), but others experience only partial or no benefit. Significant affect dysregulation and poor impulse control may be characteristics that limit responsiveness. METHOD: We report on the treatment of five patients with bulimia nervosa (BN), anorexia nervosa-binge/purge type (AN-B/P) or eating disorder not otherwise specified (EDNOS), using the anticonvulsant lamotrigine after inadequate response to SSRIs. RESULTS: Following addition of lamotrigine to an antidepressant in four cases, and switch from an antidepressant to lamotrigine in one case, patients experienced substantial improvement in mood reactivity and instability, impulsive drives and behaviors, and eating-disordered symptoms. DISCUSSION: These findings raise the possibility that lamotrigine, either as monotherapy or as an augmenting agent to antidepressants, may be useful in patients who binge eat and purge, and have significant affect dysregulation with poor impulse control.

Hábitos psicológicos asociados al apetito: un acercamiento preliminar a su comprensiónn / Psychological habits associated with appetite: a preliminary approach to their comprehension

Fundamento: El apetito y el déficit de control de impulsos en la población obesa es el resultado de la perspectiva multidisciplinar de la obesidad, completand o el modelo actual y proporcionando las bases científicas a un nuevo modelo explicativo más completo. Método: En este trabajo se presenta un estudio preliminar evaluando diez variables psicológicas a una muestra compuesta con población obesa y no obesa. Resultados: Los datos obtenidos describen un problema psicológico causante del exceso de peso denominado síndrome de edorexia y caracterizado por cuatro factores principales, la dimensión emocional, el déficit del bienestar psicológico, la dependencia a los alimentos y la evitación de la obesidad; incrementando la importancia de los aspectos psicológicos y el ambiente. Además, se plantea un modelo de interacción entre dichos factores y con el modelo integral comprensivo de la obesidad desde la perspectiva multidisciplinar.Conclusiones: En resumen, se describe brevemente la principal causa de las elevadas tasas de incidencia de obesidad, apoyándose en evidencias de diferentes disciplinas, aportando una visión multidisciplinar y desarrollando un marco teórico y empírico para una mejor compresión del comportamiento de la población obesa y también en la población con problemas en el control del apetito patológico (AU)

Background: Appetite and impulse control deficit in obese population are the outcomes of a multidisciplinary perspective on obesity, completing the actual model and supplying scientific basis for a new explicative one. Methods: This research displays a preliminary study which evaluates ten psychological variables in both obese and non-obese samples. Results: The resultant data describes a psychological problems as the cause of excess weight called edorexia syndrome, which is characterized by four main components: emotional dimension, psychological welfare deficit, food dependency and obesity avoidance; and aims to increase the relevance of psychological aspects and the environment. In addition, an interactive model between these factors is proposed together with a comprehensive integrated model for obesity from a multidisciplinary perspective. Conclusions: In summary, the main cause of the elevated incidence rates of obesity is addressed, based on evidences from different disciplines, contributing to a multidisciplinary vision and developing a theoretical and empirical framework towards a better understanding of obese individuals’ behavior, and also of the population with pathological problems regarding to appetite control (AU)

Biological contributions to addictions in adolescents and adults: prevention, treatment, and policy implications.

PURPOSE: Despite significant advances in our understanding of the biological bases of addictions, these disorders continue to represent a huge public health burden that is associated with substantial personal suffering. Efforts to target addictions require consideration of how the improved biological understanding of addictions may lead to improved prevention, treatment, and policy initiatives. METHOD: In this article, we provide a narrative review of current biological models for addictions with a goal of placing existing data and theories within a translational and developmental framework targeting the advancement of prevention, treatment, and policy strategies. RESULTS: Data regarding individual differences, intermediary phenotypes, and main and interactive influences of genetic and environmental contributions in the setting of developmental trajectories that may be influenced by addictive drugs or behavior indicate complex underpinnings of addictions. CONCLUSIONS: Consideration and further elucidation of the biological etiologies of addictions hold significant potential for making important gains and reducing the public health impact of addictions.

Attempted suicide under high dose dopaminergic therapy including apomorphine.

Impulse control disorder during continuous subcutaneous apomorphine treatment (CAI) was recently reported. We describe a 54-year-old patient with familial Parkinson's disease, who after initiation of CAI in addition to high dose levodopa and amantadine, developed impulse control disorder (major financial loss related to risky transactions and self-medication), psychosis and depression, which lead up to attempted suicide. To our knowledge, this is the first case of attempted suicide under apomorphine treatment.

Social media and suicide: a public health perspective.

There is increasing evidence that the Internet and social media can influence suicide-related behavior. Important questions are whether this influence poses a significant risk to the public and how public health approaches might be used to address the issue. To address these questions, we provide an overview of ways that social media can influence suicidal behavior, both negatively and positively, and we evaluate the evidence of the risk. We also discuss the legal complexities of this important topic and propose future directions for research and prevention programs based on a public health perspective.

Impulse control disorders in patients with Parkinson's disease.

In patients with Parkinson's disease with higher prevalence than in current population there appear pathological behaviours characterized by compulsion, repetitiveness and impulsivity, which are connected with material profit or pleasurable experience. They are, in particular, pathological gambling, hypersexuality, compulsive shopping and compulsive eating (in the literature they are collectively referred to as impulse control disorders). Pathological preoccupation with repeated mechanical activities (so-called punding) and excessive compulsive intake of dopaminergic medication (so-called dopamine dysregulation syndrome or also syndrome of hedonistic homeostatic dysregulation) are of similar nature. The paper treats briefly the risk factors and prevalence of these pathological behaviours. In current clinical practice, these psychiatric complications frequently escape doctors' attention, they are underdiagnosed. Although no generally valid recommendations for their therapy are currently available, they can be influenced medically. Of advantage can be modified dopaminergic medication (usually dose reduction ofdopaminergic agonists); multidisciplinary approach to the problem is appropriate. The pathological behaviours given above can frequently lead to considerable material losses and markedly aggravate patients' handicap in the social sphere; it can be expected that in the future they can become a problem also from the ethical and legal points of view.

A survey of pharmacy students' experiences with gambling.

OBJECTIVES: To assess gambling among pharmacy students using the South Oaks Gambling Screen (SOGS). METHODS: Six hundred fifty-eight pharmacy students enrolled at Creighton University were surveyed to determine the extent and characteristics of their gambling. RESULTS: Four hundred eighty-eight students (74.2%) participated (mean age was 26.6 years and 63.4% were female). Almost two-thirds (63.1%) gambled at least once during the past 12 months. Slightly more than 16% (80) of students were identified as "at-risk" (SOGS scores of 1 to 2). Another 5% (24) were likely to be problem gamblers (SOGS scores of 3 to 4), while 1% of students were identified as probable pathological gamblers (SOGS scores > or = 5). Students who gambled were significantly more likely than non-gamblers to be single males. Gamblers with a score > or = 1were significantly more likely to report gambling had affected their relationships with others, compared to casual gamblers. CONCLUSIONS: Gambling is a common activity among pharmacy students. While the incidence of problem gambling is relatively small, the percentage of our students who may be at-risk for gambling-related problems is noteworthy.