2nd International Conference on Behavioral Addictions
Abstracts of the 2nd International Conference on Behavioral Addictions. March 16–18, 2015; Budapest, Hungary
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Abstracts of the 2nd International Conference on Behavioral Addictions. March 16–18, 2015; Budapest, Hungary
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The initial treatment of obsessive–compulsive disorder (OCD) has generally been limited to serotonergic agents, cognitive-behavioral therapy (CBT), or a combination of the two. These findings were supported by the POTS study for OCD in children and adolescents. However, treatment with serotonergic agents or CBT can take several weeks before benefit is seen; severe cases of OCD may require more immediate treatment. Case report: The authors present a case of severe OCD in an adolescent that required immediate treatment due to her critical medical condition. The patient’s symptoms included not eating or taking medications or fluids by mouth due to fears of contamination. A medical hospitalization was previously required due to dehydration. As treatment with an SSRI would not have quick enough onset and the patient was initially resistant to participating in CBT, the patient was psychiatrically hospitalized and first started on liquid risperidone. After several doses of risperidone, the patient was able to participate in CBT and start sertraline. Discussion: The authors discuss the differential diagnosis of such a patient, including the continuum of OCD symptoms and psychotic symptoms. The authors discuss the different treatment options, including the utilization of inpatient psychiatric hospitalization. The authors discuss the potential risks and benefits of using atypical antipsychotics in lieu of benzodiazepines for the initial treatment of severe adolescent OCD. The authors also discuss other current treatment recommendations and rationale for the treatment that was pursued. Conclusions: This patient received benefit of her symptoms relatively quickly with psychiatric hospitalization and an atypical antipsychotic. The diagnosis of a psychotic disorder should be considered. These treatment options must be weighed against the risks of atypical antipsychotics, including extrapyramidal symptoms, weight gain, and metabolic syndrome; benzodiazepines also have their risks and benefits. Additionally, the cost of time and finances of inpatient hospitalization must be considered. More research is needed regarding the short- and long-term efficacy and safety of antipsychotics in the treatment of OCD in the child and adolescent population.
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Corticostriatal-limbic neurocircuitry, emotional and motivational processing, dopaminergic and noradrenergic systems and genetic factors have all been implicated in pathological gambling (PG). However, allelic variants of genes influencing dopaminergic and noradrenergic neurotransmitters have not been investigated with respect to the neural correlates of emotional and motivational states in PG. Dopamine beta-hydroxylase (DBH) converts dopamine to norepinephrine; the T allele of a functional single-nucleotide polymorphism rs1611115 (C-1021T) in the DBH gene is associated with less DBH activity and has been linked to emotional processes and addiction. Here, we investigate the influence of rs1611115 on the neural correlates of emotional and motivational processing in PG and healthy comparison (HC) participants. Methods: While undergoing functional magnetic resonance imaging, 18 PG and 25 HC participants, all European Americans, viewed gambling-, sad-, and cocaine-related videotapes. Analyses focused on brain activation differences related to DBH genotype (CC/T-carrier [i.e., CT and TT]) and condition (sad/gambling/cocaine). Results: CC participants demonstrated greater recruitment of corticostriatal-limbic regions, relative to T-carriers. DBH variants were also associated with altered corticostriatal-limbic activations across the different videotape conditions, and this association appeared to be driven by greater activation in CC participants relative to T-carriers during the sad condition. CC relative to T-carrier subjects also reported greater subjective sadness to the sad videotapes. Conclusions: Individual differences in genetic composition linked to aminergic function contribute significantly to emotional regulation across diagnostic groups and warrant further investigation in PG.
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In this paper we present an ERP study examining the underlying nature of semantic representation of animate and inanimate objects. Time-locking ERP signatures to the onset of auditory stimuli we found topological similarities in animate and inanimate object processing. Moreover, we found no difference between animates and inanimates in the N400 amplitude, when mapping more specific to more general representation (visual to auditory stimuli). These studies provide further evidence for the theory of unitary semantic organization, but no support for the feature-based prediction of segregated conceptual organization. Further comparisons of animate vs. inanimate matches and within– vs. between-category mismatches revealed following results: processing of animate matches elicited more positivity than processing of inanimates within the N400 time-window; also, inanimate mismatches elicited a stronger N400 than did animate mismatches. Based on these findings we argue that one of the possible explanations for finding different and sometimes contradictory results in the literature regarding processing and representations of animates and inanimates in the brain could lie in the variability of selected items within each of the categories, that is, homogeneity of the categories.
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We greatly appreciate the care and thought that is evident in the 10 commentaries that discuss our debate paper, the majority of which argued in favor of a formalized ICD-11 gaming disorder. We agree that there are some people whose play of video games is related to life problems. We believe that understanding this population and the nature and severity of the problems they experience should be a focus area for future research. However, moving from research construct to formal disorder requires a much stronger evidence base than we currently have. The burden of evidence and the clinical utility should be extremely high, because there is a genuine risk of abuse of diagnoses. We provide suggestions about the level of evidence that might be required: transparent and preregistered studies, a better demarcation of the subject area that includes a rationale for focusing on gaming particularly versus a more general behavioral addictions concept, the exploration of non-addiction approaches, and the unbiased exploration of clinical approaches that treat potentially underlying issues, such as depressive mood or social anxiety first. We acknowledge there could be benefits to formalizing gaming disorder, many of which were highlighted by colleagues in their commentaries, but we think they do not yet outweigh the wider societal and public health risks involved. Given the gravity of diagnostic classification and its wider societal impact, we urge our colleagues at the WHO to err on the side of caution for now and postpone the formalization.
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Abstracts of the 1st International Conference on Behavioral Addictions; March 11–12, 2013, Budapest, Hungary
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Given that unwanted thoughts are enhanced when suppressed, we tested among college freshmen who were about to take an academic exam if an acceptance strategy consisting of not suppressing intrusive thoughts will improve test performance. This strategy proved superior to students’ own default strategies as much as a modified, alternative strategy, avoiding the antecedents of intrusive thoughts. Moreover, the combination of the two strategies counteracted a stronger, negative effect of test anxiety on test performance as compared with each strategy used alone. The results suggest that not only intrusive thoughts per se but also the suppression of these thoughts can disrupt test performance, and hint that approaching such thoughts with acceptance may not interfere with simultaneously working toward avoiding the antecedents of these thoughts.
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From a developmental and clinical point of view attachment theory and mentalization are closely connected and have become increasingly important to understand the origins of psychopathological development. However, very little is known about how exactly different inner working models of attachment are related to diverse mentalizing abilities and this is particularly true for adult populations – healthy as well as clinical populations. In the present study we investigated this relation with a sample of inpatients diagnosed with depression and a sample of healthy individuals. In an experimental setting the attachment system was activated using the Adult Attachment Projective Picture System (AAP). Mentalization was assessed during activation and in comparison to a control condition using a modified version of the Reading the Mind in the Eyes Test (RMET). We expected that an activation of the attachment system i) diminishes the capacity to take another’s perspective in individuals with unresolved state of mind, ii) has no impact in individuals with secure attachment representation and iii) is dependent of clinical status in individuals with insecure (but organized) working models of attachment. Overall, these hypotheses were confirmed. However, the impact of clinical status on mentalization in insecure attachment has to be further explored. We summarize that attachment state of mind has a mediating influence on mentalization basically in such situations where the attachment system is activated.
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The number of refugees and asylum seekers in Serbia is significantly increasing. Many have experienced traumatic events and suffer from posttraumatic stress disorder and depression. In order to provide them with adequate assistance, caregivers need adjusted assessment tools. The main goal of this research was the adaptation of the Harvard Trauma Questionnaire for working with refugees and asylum seekers in Serbia. A total of 16 focus groups were interviewed in two phases in order to create an adequate list of traumatic events for this population. The adapted list was subsequently administered to 226 persons seeking asylum in Serbia, along with the remaining parts of HTQ, HSCL-25 and BDI-II. Results show that the adapted list of traumatic events, as well as a shorter version, has good validity and other metric properties. The adaptation of the first assessment tool for working with refugees and asylum seekers in Serbia has significant practical implications.
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Adolescent shoplifting occurs in an estimated 15% of the United States population. Although adolescent stealing is associated with significant psychosocial consequences there is limited research concerning efficacious treatments. Case study: A 17-year-old male with a history of compulsive stealing was treated using a six-session, individualized cognitive-behavioral therapy protocol which included motivational interviewing, psycho-education, behavioral modification, and an exposure script using imaginal desensitization. After the six-session therapy, the patient continued for eight further sessions of therapy to maintain treatment gains. His Yale–Brown Obsessive Compulsive Scale scores dropped from a 22 pre-treatment to a 3 at the end of the 14 sessions of therapy and he remained abstinent from stealing. Discussion: This case reports on the successful use of an individualized, cognitive behavioral therapy on an adolescent with compulsive shoplifting and other antisocial behaviors. This treatment provides a promising step towards the treatment of a relatively common adolescent behavior.
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Marijuana is the most largely used drug worldwide, its users counting more than 200 million people globally. Known since antiquity, cannabis has been used for its psychoactive effects, but also for its analgesic and antiemetic properties. Currently, in the USA it is legal to use it both medically and for recreational purposes, similar tendencies being observed in the European Union as well. The current wave of decriminalisation has the potential of increasing recreational use of cannabis, at least in the short and medium term, therefore both cardiologists and psychiatrists are encouraged to carefully look for adverse cardiovascular outcomes, due to their increasing frequency in the population. This study sought to target the cardiovascular effects of inhaled marijuana among human subjects, this being the main route of administration in the EU and the US. Temporal associations between marijuana use and the onset of important adverse effects have been found, including acute myocardial infarction, cardiomyopathy, strokes, transient ischemic attacks, cannabinoid arteritis, changes in blood pressure and heart rate. In conclusion, it is important to note that the current legalisation policy dynamics observed globally impose the need for increasing research efforts regarding safety of marijuana administration and particular attention over its potential side effects.
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To inform clinical treatment and preventative efforts, there is an important need to understand the pathways to late-life gambling disorder. Aims: This study assesses the association between age-related physical health, social networks, and problem gambling in adults aged over 65 years and assesses the mediating role of affective disorders in this association. Methods: The sample comprised 595 older adults (mean age: 74.4 years, range: 65–94 years; 77.1% female) who were interviewed using a structured questionnaire to assess physical frailty, geriatric pain, loneliness, geriatric depression, geriatric anxiety, and problem gambling. Results: Pathway analysis demonstrated associations between these variables and gambling problems, providing a good fit for the data, but that critically these relationships were mediated by both anxiety and depression symptoms. Conclusions: This study indicates that late-life problem gambling may develop as vulnerable individuals gamble to escape anxiety and depression consequent to deteriorating physical well-being and social support. When individuals develop late-life problem gambling, it is recommended that the treatment primarily focuses upon targeting and replacing avoidant coping approaches.
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Recent papers on the Capgras delusion have focused on the role played by subpersonal abductive inference in the formation and maintenance of the delusional belief. In these accounts, the delusional belief is posited as the first delusion-related event of which the patient is conscious. As a consequence, an explanatory role for anomalous patient experience is denied. The aim of this paper is to challenge this revisionist position and to integrate subpersonal inference within a model of the Capgras delusion which includes a role for experiential content. I argue that the following revisionist claims are problematic: (a) that a fully-formed belief enters consciousness, and (b) that this is the first conscious delusion-related event. Instead, it is my contention that a delusional thought (arrived at through subpersonal abductive inference) and an anomalous experience co-occur in consciousness prior to the formation of the delusional belief. The co-occurrence of thought and anomalous experience overcomes problems with the revisionist position resulting in an account of the Capgras delusion with greater explanatory efficacy.
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There are some uncertainties about the services that will be offered to patients with mental disorders in the community mental health centers opened in our country. One-fourth of the employees in these centers are nurses. This is an important figure that could affect the quality of the services offered. In order to improve the quality of the services offered, nurses need models that can be applied in the field. In this sense, “Recovery” model, is a model that is quite suitable for the community mental health services which centers the individual as a part of its basic philosophy. The aim of this study is to define the “Recovery” model and to discuss it as model for the treatment and maintenance of patients by nurses working in community mental health centers.
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The study deals with theoretical psychiatric proposals about relations between anxiety and depressive disorders. Three theoretical positions developed on the basis of numerous evidence on relationship of anxiety and depressive disorders: unitaristic (anxious and depressive disorders represent one disorder with different clinical pictures or phases of the disorder), pluralistic (there are two classes of disorders with clearly recognizable boundaries) and anxious-depressive position (mixed anxious-depressive disorder represents also a single disorder). Possible reasons for antagonisms, connections (i.e. lack of connections) to some proposals of psychologists are commented upon, as well as the significance of this problem for classification of mental disorders in general.
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Virtual reality is a relatively new exposure tool that uses three-dimensional computer-graphics-based technologies which allow the individual to feel as if they are physically inside the virtual environment by misleading their senses. As virtual reality studies have become popular in the field of clinical psychology in recent years, it has been observed that virtual-reality-based therapies have a wide range of application areas, especially on anxiety disorders. Studies indicate that virtual reality can be more realistic than mental imagery and can create a stronger feeling of “presence”; that it is a safer starting point compared to in vivo exposure; and that it can be applied in a more practical and controlled manner. The aim of this review is to investigate exposure studies based on virtual reality in anxiety disorders (specific phobias, panic disorder and agoraphobias, generalized anxiety disorder, social phobia), posttraumatic stress disorder and obsessive compulsive disorder.
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It is suggested to link Antoni Kępiński to the vicinity of the so-called Anthropological Psychiatry. This hypothesis is supported by his criticism of psychiatric objectivity, his personally committed style of psychotherapy and his assumption that mental sanity and illness is based on a constitutive value-based condition according to the model of information metabolism. This paper examines the most important criteria of his psychiatric work and research in contrast to Humanistic Psychology. The provisional conclusion that Kępiński and Anthropological Psychiatry are in accordance cannot be fully justified. However, with a broader concept of anthropological psychiatry it is possible to integrate Kępiński's views.
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Classificatory systems (DSM-IV, ICD-10) use different criteria for defining a rather common antisocial disorder, traditionally referred as psychopathy. Most empirical studies of this phenomenon use Cleckley’s operational definition that was applied and amended in Hare’s revised Psychopathy Checklist (PCL-R). In modern literature, the fact that there is less than a perfect correspondence between classificatory systems and Hare’s PCL-R is often cited as an indication that antisocial behavior is not confined to a distinct category of people but is rather a continuous personality dimension. In order to further elucidate the nosology of antisocial behaviors, a Psychopathy Assessment Questionnaire (PAQ) based on Cleckley – Hare’s criteria and consisting of 40 binary items was administered to 339 men (135 prisoners and 204 members of the general population). Four distinct clusters of respondents were identified by means of hierarchical cluster analysis: Psychopathic type (characterized by high positive scores on dimension of Unemotionality; Antisocial type (characterized by high positive scores on Social deviance dimension); Adapted type (characterized by negative scores on all dimensions); and Hyper-controlled type (characterized by extremely negative scores on dimension Social deviance accompanied with positive scores on Unemotionality dimension). Additional comparison with MMPI profiles which classified prison sample in two groups (“Psychopathic profiles” and “NonPsychopathic profiles”) shows that there is no expected compatibility between MMPI and PAQ. We conclude that Antisocial type can be treated as a distinct category, while Psychopathic type displays characteristics of dimensional distribution.
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Antoni Kępiński remains an often read and quoted author even 40 years after his premature death. Usually he is read in the context of his times and his connections with contemporary philosophy. This paper aims to show other aspects of his reflections on psychiatry. His views on the position of psychiatry within medicine, its methods, psychophysical problems, and other issues are compared with current knowledge and current thought paradigms. The goal is to show that while Kępiński was obviously functioning within a different scientific and philosophical paradigm many of his ideas and reflections can still be found within current debates. The important conclusion is to not hold on to the views that Kępiński held himself because he did not know as much as we do, but to see the importance of the debates that he foresaw even then and possibly learn something from his extensive clinical experience.
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Most individuals with hoarding disorder (HD) are prone to excessively acquiring new possessions. Understanding the factors that contribute to this collecting behavior will allow us to develop better treatment approaches for HD. The aim of this study was to test our assumption that an anxious attachment style is associated with a tendency to anthropomorphize comforting objects and an inability to tolerate distress, which in turn leads to excessive acquisition. Methods: A total of 361 participants with subclinical to clinical acquisition problems (77.8% female) completed a series of self-report measures. Results: As expected, greater anxious attachment was related to greater distress intolerance and stronger tendencies to anthropomorphize inanimate objects. In turn, greater distress intolerance and anthropomorphism were related to more excessive buying and greater acquisition of free items. Examination of the pathways and indirect effects showed support for double mediation rather than serial mediation, as distress intolerance did not predict anthropomorphism. Discussion and conclusion: These novel findings, if replicated, suggest that adding treatment modules that target improving distress tolerance and reducing anthropomorphism to standard treatment for HD may lead to further reductions in excessive acquiring.
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