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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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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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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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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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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Illness, emotions, art and therapy – is there a connection between them? Is there a significant bond betweennursing and art therapy and if there is one, how can we put it in practice?The belief that the mind plays an important role in physical illness goes back to the earliest days of medicine.New molecular and pharmacological tools have made it possible to identify the network that exists between theimmune system and the brain, and allows the two system to signal each other continuously and rapidly. Disruptionof this communication in any way exacerbates the diseases that the immune system guards against. Itis getting clear now for scientists how signals from the immune system can affect the brain and the emotionaland physical responses it controls: the molecular basis of feeling sick. In all this, the boundaries between mindand body are beginning to blur.The significance of these findings seems promising to extend the range of therapeutic treatments available forvarious disorders.Nursing, as identified with keeping care for the patients during the process of healing, is facing the challengeto create and maintain a relationship with the patients. And this unity between nurses and patients should bebuilt on the base of commitment, compassion, good will and empathy. The art of nursing is the heart of caring.It is obvious in recent years, that there are great benefits in asking patients to connect themselves in any kind ofart therapy. Artistic expression is an activity that involves the brain in ways that can be used to enhance therapeutictreatment and evaluation.This article is showing that there is a bond between illness and emotions, and that art therapeutic methods canbe used in nursing, in order to achieve better results in the process of healing.Using art therapeutic methods in nursing practice gives a way to improve the well-being of the patients, to createa relationship filled with empathy, courage and compassion.
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Attachment representations are related to maintaining biological homeostasis, including physiological stress and emotional regulation. Therefore, recent research has focused on attachment stress regulation and hypothalamus pituitary adrenal (HPA) axis reactivity. However, the attachment disorganization underlying emotion regulation associated with the HPA axis response has not yet been investigated. In our study, the attachment representation and the HPA-axis reactivity by cortisol level before and after the Trier Social Stress Test were assessed in a sample of 98 healthy non-clinical subjects. As expected, approximately 30% of this sample showed a disorganized attachment representation. The subjects’ unresolved attachment (breakdown of emotional regulation) showed a prolonged cortisol recovery. No differences were found between the attachment patterns in the increase and the delta of the cortisol response. However, the cortisol reactivity differed significantly for the occurrence of emotional regulation. The subjects with a high occurrence of attachment-related emotion regulation showed a higher cortisol response than the subjects with an unresolved attachment and the ones with a low occurrence of attachment-related emotion regulation. Regulating the negative emotions of stressful situations may require more attention as it might lead to an increased activation of the physiological system.
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Scientific Problem. The study of the phenomenon of resilience to trauma within the framework of positive psychology has been started relatively recently and has received quite controversial evaluations. Some scientists recognize the resilience to trauma as a feature, whilst the others – as a process or even as a result. All researchers agree that there are internal and external resilience factors which help in coping with trauma. Scientists distinguish different internal resilience factors. A more thorough analysis of the concept of the psychological trauma resilience and the empirical research could help to transform the theoretical knowledge into practical methods more effectively, such as creation of interventional and preventive programmes for psychological resilience to trauma. Research Subject. The research subject is the internal factors of resilience to trauma. Goals of the Research. Goals of the research include to carry out a critical review of the concept of the internal factors of resilience to psychological trauma, integrate the ideas arising from the empirical research results related to the internal factors of resilience. Research Method. The method of theoretical analysis, i.e. comparison and summarizing of scientific literature and interpretation of data, has been applied by the author. Results and Conclusions. The analysis of the empirical research based upon different theoretical paradigms and related to the internal psychological factors of resilience to trauma allowed distinguishing the following internal factors of resilience to trauma: hardiness, ego-resilience, self-esteem, self-image, control, hope, attachment. Also, it allowed determining that the factors distinguished may be of three different types: 1) factors that help to overcome the trauma; 2) factors protecting from the adverse effects of the trauma; 3) factors helping to accept a traumatic event as a challenge and an opportunity to grow.
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Background: The permissibility of euthanasia raises many moral dilemmas, dividing the general public on thismatter. Attitudes towards euthanasia depend on socio-cultural (age, beliefs) and individual factors (personalitytraits or working in medical professions).Aim of the study: The aim of the study was to establish attitudes towards euthanasia and the level of anxietybefore death among people in close contact with persons suffering from paresis. The hypotheses assumed thatcontact with disabled patients, who require constant care, and the type of such contact, modify the perceivedfear of death and attitudes towards euthanasia.Material and methods: Two clinical groups were involved in the study: physiotherapists dealing with strokerehabilitation, family caregivers permanently taking care of close relatives of cerebral stroke survivors. Theresults of the two groups were compared to those of the control group, who were individuals with no personalexperience in the care of patients with paresis. Attitudes towards euthanasia were measured in three dimensions:information support, liberal attitudes and conservative attitudes.Results: The results showed no intergroup differences in two dimensions: liberal attitude and the fear of death.Physiotherapists were the least conservative in their attitudes in comparison to other participants and theyappreciated the information support more than participants from the control group. Conclusions: The results indicated that everyday contact with the patients suffering from paresis can increase conservative attitudes toward euthanasia but only among caregivers
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Knowledge on autism has undergone a rapid development over the past few decades, as well as autism spectrum disorder (ASD) diagnosis rates increasing dramatically. These changes emphasize the need for increased services and wider specialised support for people with ASD and their families. Autism is not only a medical, psychological or special pedagogical topic it is also a social issue. There have been several sociological studies on the topic conducted abroad, however the Czech case is specific in several aspects due to the political-cultural context of the country. Apart from a few exceptions, the topic has not been reflected in Czech social science. The present paper will introduce five approaches to autism based on research which has been conducted abroad and will also discuss to which extent they are applicable in the Czech Republic. The ideas presented are a multidisciplinary combination of sociology of knowledge, historical sociology, sociology of health and illness, cultural anthropology and disability studies. The subtopics discussed include: the social construction of autism, the development of knowledge on autism, social movements related to autism, autism across cultures and lastly, causes of the increasing prevalence of autism.
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Over the last 20 years, behavioral addictions (e.g., addictions to gambling, playing video games, work, etc.) have become more accepted among both public and scientific communities. Addiction to sex is arguably a more controversial issue, but this does not take away from the fact that some individuals seek professional help for problematic excessive sex, irrespective of how the behavior is conceptualized. Empirical evidence suggests that among treatment seekers, men are more likely than women to seek help for sex addiction (SA). Methods: Using the behavioral addiction literature and the authors’ own expertise in researching female SA, this paper examines potential barriers to the treatment for female sex addicts. Results: Four main types of barriers for female sex addicts not seeking treatment were identified. These comprised (a) individual barriers, (b) social barriers, (c) research barriers, and (d) treatment barriers. Conclusions: Further research is needed to either confirm or disconfirm the identified barriers that female sex addicts face when seeking treatment, and if conformation is found, interested stakeholders should provide better awareness and/or see ways in which such barriers can be overcome to aid better uptake of SA services.
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This paper considers psychotic symptoms in terms of false inferences or beliefs. It is based on the notion that the brain is an organ of inference that actively constructs hypotheses to explain or predict its sensations. This perspective provides a normative (Bayes optimal) account of action and perception that emphasises probabilistic representations; in particular, the confidence or precision of beliefs about the world. We consider sensory attenuation deficits, catatonia and delusions as various expressions of the same core pathology: namely, an aberrant encoding of precision in a predictive coding hierarchy. In predictive coding, precision is thought to be encoded by the postsynaptic gain of neurons reporting prediction error. This suggests that both pervasive trait abnormalities and florid failures of inference in the psychotic state can be linked to factors controlling postsynaptic gain—such as NMDA receptor function and (dopaminergic) neuromodulation. We illustrate these points using a biologically plausible simulation of attribution of agency—showing how a reduction in the precision of prior beliefs, relative to sensory evidence, can lead to false inference.
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The aim of this study is to examine the psychological symptoms and Attachment-Based Mental Representations of university students who experienced the death of first and second-degree relatives or the break-up of their romantic relationships. The sample consisted of 122 female and 102 male students. The age of the participants ranged between 18 and 29 with a mean of 21.31 years (SD = 1.90). Demo- graphic Information Form, Brief Symptom Inventory and Attachment-Based Mental Representation Scale were used to collect data. One-way Analysis of Variance (ANOVA) results showed that there was no significant difference on Attachment-Based Mental Representations among the groups. There- fore, all groups are assumed to be homogeneous in terms of attachment-based mental representations. To compare psychological symptom levels of the groups, ANOVA was also conducted. The results indicated that there were significant differences between the groups who lost their second-degree relatives and who break-up their romantic relationship. However, there was no significant differences between the groups who lost their first-degree relatives and who break-up their romantic relationships. Regression analysis revealed that negative self-representation and negative father-representation significantly predicted psychological symptoms of the group who experienced the break-up. Consequently, break-up of the romantic relationship is quite important for emerging adulthood. In addition, current study revealed that negative self-representation and negative father-representation of adolescents who experienced the break-up led to the risk factors for psychological symptoms.
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