Kräplin Anja, Behrendt Silke, Scherbaum Stefan, Dshemuchadse Maja, Bühringer Gerhard, Goschke Thomas
a Department of Psychology , Technische Universitaet Dresden , Dresden , Germany.
J Clin Exp Neuropsychol. 2015;37(4):367-78. doi: 10.1080/13803395.2015.1018145. Epub 2015 Mar 30.
It has been highlighted that increased impulsivity is an important etiological factor in pathological gambling (PG). However, the role of the highly prevalent comorbid mental disorders in PG remains unclear. This is of special concern as the highest comorbidity was found between PG and nicotine dependence (ND), which, in turn, has also been associated with heightened impulsivity. This study aimed to find out whether increased impulsivity in PG is a specific characteristic related to comorbid mental disorders in general or especially to ND.
A cross-sectional study was designed that included a healthy control group and three disorder groups with comorbid PG excluding ND, comorbid PG including ND, and ND alone according to the Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition. Impulsivity was assessed according to the dimensions response and choice impulsivity applying behavioral and self-report measures.
We found (a) increased response impulsivity in the comorbid PG group when compared to the control group. Furthermore, increased choice impulsivity was found (b) in comorbid PG excluding ND and (c) in comorbid PG including ND when compared to ND alone. Other group differences did not reach significance.
Our findings highlight that comorbid PG shares deficits in inhibitory control with ND. In contrast, maladaptive choices are a specific disorder characteristic of comorbid PG when compared to ND. If replicated in further studies, intervention strategies strengthening cognitive control skills might be effective for comorbid PG as well as ND whereas strategies enhancing maladaptive valuation of rewards might be specifically effective in comorbid PG.
研究强调，冲动性增强是病理性赌博（PG）的一个重要病因。然而，PG中高度普遍的共病精神障碍的作用仍不明确。这一点尤为值得关注，因为PG与尼古丁依赖（ND）的共病率最高，而尼古丁依赖又与冲动性增强有关。本研究旨在探究PG中冲动性增强是与一般共病精神障碍相关的特定特征，还是尤其与尼古丁依赖相关的特定特征。
设计了一项横断面研究，根据《精神疾病诊断与统计手册》第四版，纳入一个健康对照组和三个疾病组，分别为不合并ND的PG共病组、合并ND的PG共病组以及单独的ND组。根据反应和选择冲动性维度，采用行为和自我报告测量方法评估冲动性。
我们发现，（a）与对照组相比，PG共病组的反应冲动性增强。此外，（b）与单独的ND组相比，不合并ND的PG共病组以及（c）合并ND的PG共病组的选择冲动性增强。其他组间差异未达到显著水平。
我们的研究结果表明，PG共病与ND在抑制控制方面存在缺陷。相比之下，与ND相比，适应不良的选择是PG共病的一种特定疾病特征。如果在进一步研究中得到验证，加强认知控制技能的干预策略可能对PG共病和ND都有效，而增强对奖励的适应不良评估的策略可能对PG共病特别有效。
