Chamberlain Samuel R, Stochl Jan, Redden Sarah A, Odlaug Brian L, Grant Jon E
Department of Psychiatry, University of Cambridge, UK; Cambridge and Peterborough NHS Foundation Trust, UK.
Department of Psychiatry & Behavioral Neuroscience, University of Chicago, United States.
Addict Behav. 2017 Sep;72:79-85. doi: 10.1016/j.addbeh.2017.03.020. Epub 2017 Mar 28.
Gambling disorder has been associated with cognitive dysfunction and impaired quality of life. The current definition of non-pathological, problem, and pathological types of gambling is based on total symptom scores, which may overlook nuanced underlying presentations of gambling symptoms. The aims of the current study were (i) to identify subtypes of gambling in young adults, using latent class analysis, based on individual responses from the Structured Clinical Interview for Gambling Disorder (SCI-GD); and (ii) to explore relationships between these gambling subtypes, and clinical/cognitive measures.
Total 582 non-treatment seeking young adults were recruited from two US cities, on the basis of gambling five or more times per year. Participants undertook clinical and neurocognitive assessment, including stop-signal, decision-making, and set-shifting tasks. Data from individual items of the Structured Clinical Interview for Gambling Disorder (SCI-GD) were entered into latent class analysis. Optimal number of classes representing gambling subtypes was identified using Bayesian Information Criterion and differences between them were explored using multivariate analysis of variance.
Three subtypes of gambling were identified, termed recreational gamblers (60.2% of the sample; reference group), problem gamblers (29.2%), and pathological gamblers (10.5%). Common quality of life impairment, elevated Barratt Impulsivity scores, occurrence of mainstream mental disorders, having a first degree relative with an addiction, and impaired decision-making were evident in both problem and pathological gambling groups. The diagnostic item 'chasing losses' most discriminated recreational from problem gamblers, while endorsement of 'social, financial, or occupational losses due to gambling' most discriminated pathological gambling from both other groups. Significantly higher rates of impulse control disorders occurred in the pathological group, versus the problem group, who in turn showed significantly higher rates than the reference group. The pathological group also had higher set-shifting errors and nicotine consumption.
Even problem gamblers who had a relatively low total SCI-PG scores (mean endorsement of two items) exhibited impaired quality of life, objective cognitive impairment on decision-making, and occurrence of other mental disorders that did not differ significantly from those seen in the pathological gamblers. Furthermore, problem/pathological gambling was associated with other impulse control disorders, but not increased alcohol use. Groups differed on quality of life when classified using the data-driven approach, but not when classified using DSM cut-offs. Thus, the current DSM-5 approach will fail to discriminate a significant fraction of patients with biologically plausible, functionally impairing illness, and may not be ideal in terms of diagnostic classification. Cognitive distortions related to 'chasing losses' represent a particularly important candidate treatment target for early intervention.
赌博障碍与认知功能障碍和生活质量受损有关。目前对非病理性、问题性和病理性赌博类型的定义基于总症状评分，这可能会忽略赌博症状细微的潜在表现。本研究的目的是：（i）基于赌博障碍结构化临床访谈（SCI-GD）的个体反应，使用潜在类别分析确定年轻成年人中的赌博亚型；（ii）探讨这些赌博亚型与临床/认知测量之间的关系。
从美国两个城市招募了总共582名未寻求治疗的年轻成年人，他们每年赌博五次或更多次。参与者进行了临床和神经认知评估，包括停止信号、决策和定势转换任务。将赌博障碍结构化临床访谈（SCI-GD）各个项目的数据输入潜在类别分析。使用贝叶斯信息准则确定代表赌博亚型的最佳类别数量，并使用多变量方差分析探讨它们之间的差异。
确定了三种赌博亚型，分别称为娱乐性赌徒（占样本的60.2%；参照组）、问题性赌徒（29.2%）和病理性赌徒（10.5%）。问题性和病理性赌博组均存在常见的生活质量受损、巴拉特冲动性评分升高、主流精神障碍的发生、有一级亲属成瘾以及决策受损的情况。诊断项目“追逐损失”最能区分娱乐性赌徒和问题性赌徒，而认可“因赌博导致社会、经济或职业损失”最能区分病理性赌博与其他两组。病理性组的冲动控制障碍发生率显著高于问题性组，而问题性组又显著高于参照组。病理性组的定势转换错误率和尼古丁消费量也更高。
即使是总SCI-PG评分相对较低（平均认可两项）的问题性赌徒，也表现出生活质量受损、决策方面的客观认知障碍以及其他精神障碍的发生，这些与病理性赌徒所见的情况没有显著差异。此外，问题性/病理性赌博与其他冲动控制障碍有关，但与酒精使用增加无关。使用数据驱动方法分类时，各组在生活质量方面存在差异，但使用DSM临界值分类时则不然。因此，当前的DSM-5方法将无法区分很大一部分具有生物学合理性、功能受损疾病的患者，在诊断分类方面可能并不理想。与“追逐损失”相关的认知扭曲是早期干预特别重要的候选治疗靶点。
