Impulse Control Disorders

Gambling is an important public health concern. To better understand gambling behavior, we conducted a classroom-based survey that assessed the role of the theory of planned behavior (TPB; i.e., intentions, subjective norms, perceived behavioral control, and attitudes) in past year gambling and gambling frequency among college students. Results from this research support the utility of the TPB to explain gambling behavior in this population. Specifically, in TPB models to predict gambling behavior, friend and family subjective norms and perceived behavioral control predicted past year gambling and friend and family subjective norms, attitudes and perceived behavioral control predicted gambling frequency. Intention to gamble mediated these relationships. These findings suggest that college responsible gambling efforts should consider targeting misperceptions of approval regarding gambling behavior (i.e., subjective norms), personal approval of gambling behavior (i.e., attitudes), and perceived behavioral control to better manage gambling behavior in various situations.

Nurses have been employed as behavioural psychotherapists for over 25 years. The first training in this field was established at The Maudsley Hospital ( Marks et al. 1977 ). Since then there have been a number of courses producing many specialist nurse behavioural psychotherapists (NBTs) ( Duggan et al. 1993 ). Nurse behavioural therapy is taken to mean nurses working as behavioural psychotherapists. This title does not mean they are practising a separate form of therapy from other professionals such as psychologists. In Australia there is no such training, with nurse behavioural psychotherapists working here having trained first in UK. Initially NBTs were trained to treat people with anxiety disorders. Over the past 25 years this emphasis has remained, but many NBTs have gone on to provide help to people with other problems. This paper will demonstrate the practical application of behavioural psychotherapy with problem gamblers, and how specialist trained nurses can provide such treatment. The paper will look briefly at nurse behavioural psychotherapy from its initial inception to its current status in Australia. The outcomes of the treatment programme carried out at Flinders Medical Centre for Problem Gamblers will be discussed with a view to nurses carrying out therapy. Finally, the future of nurse behavioural psychotherapy in Australia and how nurses can apply such skills across a wide range of problems, including gambling, will be reviewed.Aspects of this paper were first presented to the 7th NAGS conference, Adelaide 1996.

Goal This analysis was undertaken to assess the demographic and mental health characteristics of ''normal'' or non-problem gamblers versus non-gamblers in a representative community sample. Sample Study participants consisted of 557 North Central American Indian veterans. Data collection included a demographic and trauma questionnaire, a computer-based Diagnostic Interview Schedule for DSM-III-R, and a treatment history algorithm. Findings Univariate analyses revealed that gamblers had greater social competence (i.e., higher education, living with a spouse) and higher lifetime psychiatric morbidity. Binary regression analysis revealed that, compared to non-gamblers, J. Westermeyer Á P. Thuras Minneapolis VAMC, Minneapolis, MN, USA

An Insanity Defence precludes criminal liability, as the defendant was rendered incapable of understanding the consequences of the action. Due to the global relevance of the Indian Penal Code and the fact that "insanity is probably best suited for universal adoption since [it is] common to all human societies," this paper compares Singapore and India in how each state incorporates mental illness into its criminal law. While India and Singapore both adhere strictly to the common law M’Naghten Rules, Singaporean law through the concept of diminished responsibility has included provisions that nuance the role of mental illness in the commission of crimes. Although judges are not medical professionals, significant progress has been made in reliably diagnosing impulse control disorders, and making room for irresistible impulses in both criminal laws is thus long overdue.

Objectives. Regular access to a multi-sensory environment (MSE or Snoeqelen room) was compared with a non-complex sensory environment for individuals with learning disabilities. We also tested the prediction that those individuals whose challenging behaviour was maintained by sensory consequences would benefit most from exposure to the MSE.

OBJECTIVE Symptoms of borderline personality disorder (BPD) may reflect distinct breakdowns in the integration of posterior and frontal brain networks. We used a high temporal resolution measure (40-Hz gamma phase synchrony) of brain activity to examine the connectivity of brain function in BPD. METHODS Unmedicated patients with BPD (n = 15) and age-and sex-matched healthy control subjects (n = 15) undertook a task requiring discrimination of salient from background tones. In response to salient stimuli, the magnitude and latency of peak gamma phase synchrony for early (0-150 ms post stimulus) and late (250-500 ms post stimulus) phases were calculated for frontal and posterior regions and for left and right hemispheres. We recorded skin conductance responses (SCRs) and reaction time (RT) simultaneously to examine the contribution of arousal and performance. RESULTS Compared with controls, patients with BPD had a significant delay in early posterior gamma synchrony and a reduction in...

Objective: Impulsivity is associated with mood instability, behavioral problems, and action without planning in patients with bipolar disorder. Increased impulsivity levels are reported at all types of mood episodes. This association suggests a high comorbidity between impulse control disorders (ICDs) and bipolar disorder. The aim of this study is to compare the prevalence of ICDs and associated clinical and sociodemographic variables in euthymic bipolar I patients.

Sensory over-responsivity (SOR) towards tactile and auditory input can impact children’s participation in academic and social activities; however the prevalence of SOR behaviors and their relation to social-emotional problems and competence has not been rigorously studied. This study investigated SOR in a representative sample of elementary school-aged children (n=925, 50 % boys, ages 7–11 years) who were followed from infancy. Sixteen percent of parents reported that at least four tactile or auditory sensations bothered their children. Being bothered by certain sensations was common while others were relatively rare. Parents of children with versus without elevated SOR in school-age reported higher frequencies of early and co-occurring internalizing, externalizing, and dysregulation problems, and lower levels of concurrent adaptive social behaviors. Early identification of elevated SOR and assessment of concurrent social-emotional status are important to minimize their impact on so...

An implementation and one-year follow-up of the Gambling Decisions program attempted to answer several important questions. First, is controlled gambling a viable treatment option for some gamblers? Can earlier stage problem gamblers be separated for treatment from those with more severe problems? Finally, would problem gamblers utilize a community health agency for treatment of their excessive gambling? A pretest/posttest design was chosen where the efficacy of the program was assessed using repeated measures ANOVA analysis. Results showed that an average loss of $608 over a 4-week period was reduced to $113 immediately after the 6-week program and to a loss of $73 at 12 months. The average number of hours spent gambling per 4 weeks was significantly reduced from 23.5 at pretest to 6.5 at the 12 month posttest. Significant decreases were also observed in the number of days per week that clients gambled, and clients reported significant reductions in everyday life problems related t...

Objective: The search for empirically based treatments for pathological gambling is in its infancy, with relatively few clinical trials and an absence of naturalistic studies. Treatment retention of gamblers has been a problem; cognitive-behavioral treatment and pharmacotherapy studies report especially high dropout rates. Psychodynamic approaches, with their emphasis on the therapeutic relationship, and the meaning of the patient's self-destructive and seemingly irrational behaviors, and on obstacles to self-forgiveness, might improve outcome. Method: After a description of psychodynamic psychotherapy, the literature on both short-term and longer therapies is reviewed regarding their efficacy for a variety of disorders. With regard to pathological gambling, the author summarizes the early (1914-1970) psychoanalytic literature then reviews the more recent psychodynamic psychotherapy literature on pathological gambling. Results: A review of the recent psychodynamic psychotherapy literature on pathological gambling failed to disclose a single randomized controlled study of treatment efficacy or effectiveness. However, there are eight positive outcome studies described as multi-modal eclectic; half of those seem to utilize psychodynamic approaches. Two of the more successful programs are described. Conclusions: A review of the outcomes literature for psychodynamic psychotherapy demonstrates efficacy for a variety of disorders sufficient to justify a clinical trial for pathological gambling. Short-term psychodynamic psychotherapy, with its focus on core issues, may be particularly applicable to the pathological gambler's need to avoid or escape intolerable affects and problems. Longer therapies may be needed to modify an avoidant coping style and defenses.

A disorder of impulsive aggression has been in the Diagnostic and Statistical Manual for Mental Disorders (DSM) since the first edition. In DSM-III, this disorder was codified as Intermittent Explosive Disorder (IED) and was thought to be rare. However, DSM criteria for IED were poorly operationalized and empiric research in IED was limited until the past decade when research criteria were developed. Subsequently, renewed interest in disorders of impulsive aggression led to a recent series of community based studies that have now documented IED to be as common as many other psychiatric disorders. Recent research indicates that the core of IED (A criteria) can be captured with new criteria that identify high frequency/low intensity aggressive outbursts (A 1 ) and low frequency/hi intensity outbursts (A 2 ). This paper presents new data regarding the phenomenology, comorbidity/life course of IED as a function of A 1 and A 2 criteria. Together with reanalysis of previously published data regarding family history, biomarkers, and treatment response in individuals with recurrent, problematic, impulsive aggression, these data provide empirical support for both A 1 and A 2 criteria for DSM-5 IED.

Exposure to early trauma has frequently been linked to adult psychopathology, including personality disorders. This cross-sectional study explored the relationship between personality and retrospectively rated levels of early trauma in 242 soldiers. Multiple regression analyses showed a significant relationship between early trauma and adult personality as exposure to emotional trauma predicted levels of self-directedness and cooperativeness on the Temperament and Character Inventory (TCI; C. R. Cloninger, T. R. Przybeck, D. M.

Uncontrolled low frequency, high intensity aggressive behavior is often a barrier to community living for individuals with developmental disabilities. Aggressive behaviors are typically treated with psychotropic medication, behavioral interventions or their combination; but often the behaviors persist at a level that is problematic for the individual as well as care providers. We developed a mindfulness-based, self-control strategy for an adult with mental retardation and mental illness whose aggression had precluded successful community placement. He was taught a simple meditation technique that required him to shift his attention and awareness from the anger-producing situation to a neutral point on his body, the soles of his feet. After practice he applied this technique fairly consistently in situations that would normally have elicited an aggressive response from him. The data show that he increased self-control over his aggressive behaviors, met the community provider's requirement for 6 months of aggression-free behavior in the inpatient facility before being transitioned to the community, and then successfully lived in the community without readmission to a facility. No aggressive behavior was seen during the 1-year follow-up after his community placement. Mindfulness-based intervention may offer a viable alternative to traditional interventions currently being used to treat behavioral challenges in children and adults with mild mental retardation.

Pedophilia is characterized by sexual attraction to prepubescent children. Despite the extensive literature documenting the pervasive and pernicious effects of childhood sexual abuse, there is surprisingly little psychiatric literature on pedophilia and its etiology remains enigmatic. In recent years, the psychiatric literature on the phenomenology, neurobiology, and treatment of impulsive-aggressive disorders has grown significantly. As some investigators have conceptualized pedophilia as an impulsive-aggressive disorder, it is of interest whether recent advances in the study of impulsive-aggressive disorders might shed light on pathological mechanisms underlying pedophilia. In the following study, 20 male subjects with a DSM-IV diagnosis of pedophilia, heterosexual type were recruited from an outpatient facility for sexual offenders and compared to 24 demographically simi-lar control subjects. Groups were compared on three personality instruments-the Millon Clinical Multiaxial Inventory-II (MCMI-II), the Temperament and Character Inventory (TCI), and the Dimensional Assessment of Personality Impairment-Questionnaire (DAPI-Q)-to assess for select impairment in impulsive-aggressive personality traits. Pedophiles showed severe and pervasive personality impairment relative to controls. Although there was evidence of impulsivity, the findings do not suggest a predominance of impulsive-aggressive traits, and in fact provide evidence of inhibition, passive-aggression, and harm avoidance. The notion of "compulsive-aggression" in pedophilia is proposed.

The current study examined the characteristics of pathological skin picking (PSP) in a population-based sample. Participants were recruited through several online resources for PSP and related conditions to complete a web-based survey assessing the functional and topographical phenomenology, physical and psychosocial impact, treatment utilization, and associated psychopathology of PSP. A total of 1663 participants consented, of whom 760 were over 18 and met study criteria for PSP. Results showed considerable heterogeneity in picking methods, body sites, and function (e.g., regulation of emotional, sensory, and cognitive states). Participants generally reported moderate psychosocial and physical impact from picking and tended to perceive available treatment as poor in quality. Severity of associated symptoms of psychopathology (depression, anxiety, and stress) was comparable to severity levels found in previous samples of persons with trichotillomania and obsessive-compulsive disorder. Severity of PSP was a statistically significant predictor of overall impairment after controlling for depression and anxiety symptoms. Results suggest that PSP is a significant public health concern in need of further rigorous investigation.

An implementation and one-year follow-up of the Gambling Decisions program attempted to answer several important questions. First, is controlled gambling a viable treatment option for some gamblers? Can earlier stage problem gamblers be separated for treatment from those with more severe problems? Finally, would problem gamblers utilize a community health agency for treatment of their excessive gambling? A pretest/posttest design was chosen where the efficacy of the program was assessed using repeated measures ANOVA analysis. Results showed that an average loss of $608 over a 4-week period was reduced to $113 immediately after the 6-week program and to a loss of $73 at 12 months. The average number of hours spent gambling per 4 weeks was significantly reduced from 23.5 at pretest to 6.5 at the 12 month posttest. Significant decreases were also observed in the number of days per week that clients gambled, and clients reported significant reductions in everyday life problems related to gambling after completing the program.

Pedophilia is characterized by sexual attraction to prepubescent children. Despite the extensive literature documenting the pervasive and pernicious effects of childhood sexual abuse, there is surprisingly little psychiatric literature on pedophilia and its etiology remains enigmatic. In recent years, the psychiatric literature on the phenomenology, neurobiology, and treatment of impulsive-aggressive disorders has grown significantly. As some investigators have conceptualized pedophilia as an impulsive-aggressive disorder, it is of interest whether recent advances in the study of impulsive-aggressive disorders might shed light on pathological mechanisms underlying pedophilia. In the following study, 20 male subjects with a DSM-IV diagnosis of pedophilia, heterosexual type were recruited from an outpatient facility for sexual offenders and compared to 24 demographically simi-lar control subjects. Groups were compared on three personality instruments-the Millon Clinical Multiaxial Inventory-II (MCMI-II), the Temperament and Character Inventory (TCI), and the Dimensional Assessment of Personality Impairment-Questionnaire (DAPI-Q)-to assess for select impairment in impulsive-aggressive personality traits. Pedophiles showed severe and pervasive personality impairment relative to controls. Although there was evidence of impulsivity, the findings do not suggest a predominance of impulsive-aggressive traits, and in fact provide evidence of inhibition, passive-aggression, and harm avoidance. The notion of "compulsive-aggression" in pedophilia is proposed.

Gambling disorders, including pathological gambling and problem gambling, have received increased attention from clinicians and researchers over the past three decades since gambling opportunities have expanded around the world. This Seminar reviews prevalence, causes and associated features, screening and diagnosis, and treatment approaches. Gambling disorders aff ect 0·2-5·3% of adults worldwide, although measurement and prevalence varies according to the screening instruments and methods used, and availability and accessibility of gambling opportunities. Several distinct treatment approaches have been favourably evaluated, such as cognitive behavioural and brief treatment models and pharmacological interventions. Although promising, family therapy and support from Gamblers Anonymous are less well empirically supported. Gambling disorders are highly comorbid with other mental health and substance use disorders, and a further understanding is needed of both the causes and treatment implications of this disorder.

A subtype-specific impairment of cognitive functions in spinocerebellar ataxia (SCA) patients is still debated. Thirty-two SCA patients (SCA1, 6; SC2, 3; SCA3, 15; SCA6, 8) and 14 matched healthy controls underwent neuropsychological evaluation testing attention, executive functions, episodic and semantic memory, and motor coordination. Severity of ataxia was assessed with the Scale for the Assessment and Rating of Ataxia (SARA),

INTEREST IN THE CONSTRUCT of sexual addiction was activated around 1983 with the publication of Carries' book, now entitled Out of the Shadows: Understanding Sexual Addiction. This work spurred the publication of a plethora of books and articles about the phenomena associated with excessive sexual behavior. Current estimates of the prevalence of sexual addiction range from 3 to 6% of the U.S. population (Carnes, 1991). To date, most literature on this topic pertains to controversy regarding the nature of and appropriate designation for the syndrome. In contrast, empirical investigations of the validity of the construct, nature of the disorder, and the efficacy of alternate approaches to its treatment are minimally represented.

The Yale Brown Obsessive Compulsive Scale adapted for Pathological Gambling (PG-YBOCS) was developed to measure the severity and change in severity of pathological gambling symptoms. The PG-YBOCS is a 10-item clinician-administered questionnaire that measures the severity of PG over a recent time interval (usually within the past one/two week(s)). In order to assess and validate the scale, it was administered to 337 subjects: 188 pathological gamblers and 149 healthy controls.

Objective. e Previous studies regarding Internet addiction have investigated associated psychological variables such as shyness, loneliness, self-consciousness, anxiety, depression and interpersonal relations. Few studies about the relationship between Internet Addiction and impulsivity have been done. This study aimed to assess whether Internet addiction is related to impulsivity among Chinese adolescents.

Purpose: The present study examined delinquent behavior from adolescence into adulthood within the dual systems model of adolescent risk-taking, which identifies maturational patterns of socioemotional and cognitive control systems as predictors of risk-taking. The role of sleep was also investigated within the relationship. Methods: Hierarchical regression and path analysis examined delinquency at three waves (1996, 2001, and 2008) of the National Longitudinal Study of Adolescent Health. Results: Impulse control and sensation-seeking predicted concurrent delinquent behavior at all three waves, demonstrating the developmental shift as described within the dual systems model in which the relative contribution of sensation-seeking decreases from adolescence into adulthood, whereas the relative contribution of impulse control improves. Data also revealed that sleep duration and delayed bedtimes had both direct and indirect associations with delinquent behavior during adolescence; sleep duration did not directly predict such activity during later waves. Conclusion: The dual systems model of adolescent risk-taking appears to be predictive of delinquent behavior during adolescence and the transition into adulthood. Preliminary findings suggest the importance of considering both adolescent sleep and cognitive and socioemotional development during research and prevention efforts of delinquent behavior.

Background-Several behaviors, besides psychoactive substance ingestion, produce short-term reward that may engender persistent behavior despite knowledge of adverse consequences, i.e., diminished control over the behavior. These disorders have historically been conceptualized in several ways. One view posits these disorders as lying along an impulsive-compulsive spectrum, with some classified as impulse control disorders. An alternate, but not mutually exclusive, conceptualization considers the disorders as non-substance or "behavioral" addictions.

There are a number of important reasons to examine the comorbidity of eating disorders with bipolar disorder (BD). First, patients presenting with BD and an eating disorder require specific treatment considerations (1, 2). For example, pharmacologic or psychotherapeutic interventions that might parsimoniously address both syndromes would be important to consider. When such interventions are not available, treatment choices involve considerations of approaches that are therapeutic for each syndrome but that do not adversely impact the other. Second, if the prevalence of eating disorders is higher than expected in patients with BD, then eating disorders need to be carefully assessed for upon evaluation of patients with bipolar illness. Conversely, if BD is more common among patients with eating disorders than in the general population, symptoms of BD need to be evaluated in patients presenting with an eating disorder. Third, if these syndromes are indeed more frequently comorbid than anticipated by their independent occurrence rates, then an

An Insanity Defence precludes criminal liability, as the defendant was rendered incapable of understanding the consequences of the action. Due to the global relevance of the Indian Penal Code and the fact that "insanity is probably best suited for universal adoption since [it is] common to all human societies," this paper compares Singapore and India in how each state incorporates mental illness into its criminal law. While India and Singapore both adhere strictly to the common law M’Naghten Rules, Singaporean law through the concept of diminished responsibility has included provisions that nuance the role of mental illness in the commission of crimes. Although judges are not medical professionals, significant progress has been made in reliably diagnosing impulse control disorders, and making room for irresistible impulses in both criminal laws is thus long overdue.

Due to recent changes of gambling laws, accessibility to gambling has become more widespread and thus, there has also been an increase in the prevalence of pathological gambling (PG). The wide range of social, economic, and psychological problems associated with PG are well known. There is a need for better understanding of PG and this review attempts to do so. Literature searches using the Medline and PsycINFO databases were used. Critical examining of the literature showed that familial/genetic, sociological, and individual factors (e.g., an individual's personality, biochemistry, psychological states, and cognitions) are implicated in the development and maintenance of PG, yet at present, the evidences are not solid. Similarly, there have been a lot of theories for PG but again, none of them are solid enough to provide a clear understanding of PG. Recent psychological-based theories seem to provide some solid ground for further research. We highlight four areas for future consideration for research. (1) Most studies have generalized findings from one form of gambling to another. It is suggested that it is now not tenable to consider gambling as a single phenomenon that can explain all forms of gambling.

Uncontrolled low frequency, high intensity aggressive behavior is often a barrier to community living for individuals with developmental disabilities. Aggressive behaviors are typically treated with psychotropic medication, behavioral interventions or their combination; but often the behaviors persist at a level that is problematic for the individual as well as care providers. We developed a mindfulness-based, self-control strategy for an adult with mental retardation and mental illness whose aggression had precluded successful community placement. He was taught a simple meditation technique that required him to shift his attention and awareness from the anger-producing situation to a neutral point on his body, the soles of his feet. After practice he applied this technique fairly consistently in situations that would normally have elicited an aggressive response from him. The data show that he increased self-control over his aggressive behaviors, met the community Research in Developmental Disabilities 24 (2003) 158-169 provider's requirement for 6 months of aggression-free behavior in the inpatient facility before being transitioned to the community, and then successfully lived in the community without readmission to a facility. No aggressive behavior was seen during the 1-year follow-up after his community placement. Mindfulness-based intervention may offer a viable alternative to traditional interventions currently being used to treat behavioral challenges in children and adults with mild mental retardation. #

There is increasing recognition of the limitations of current approaches to psychiatric classification. Nowhere is this more apparent than in the eating disorders (EDs). Several alternative methods of classifying EDs have been proposed, which can be divided into two major groups: 1) those that have classified individuals on the basis of disordered eating symptoms; and, 2) those that have classified individuals on the basis of comorbid psychopathology and associated features. Several reviews have addressed symptom-based approaches to ED classification, but we are aware of no paper that has critically examined comorbidity-based systems. Thus, in this paper, we review models of classifying EDs that incorporate information about comorbid psychopathology and associated features. Early approaches are described first, followed by more recent scholarly contributions to comorbidity-based ED classification.

Background: This study reports short scales for measuring several dimensions of schizotypy in the normal population based on a large twin sample. Methods: The four short scales use items drawn from a longer instrument, the Oxford-Liverpool Inventory of Feelings and Experiences. Using concordance estimates from MZ and DZ pairs, the items were selected both to have a high heritability and to offer broad coverage of each trait domain. Results: Preliminary descriptive statistics are reported for the short scales and suggest adequate reliability. Conclusions: New scales offer a time efficient and reliable method of studying proneness to psychosis in large N designs. D

The construction and initial psychometric evaluation of an interview assessment of clinically significant impulsivity (Lifetime History of Impulsive Behaviors; LHIB) is presented. Personality-disordered and control subjects participated by completing self-report measures of depression, anxiety and social desirability, along with self-report and laboratory analogue measures of impulsivity, and finally the LHIB. The LHIB demonstrated good to excellent internal consistency and test-retest reliability. Supporting concurrent construct validity, scores on the LHIB correlated with other selfreport measures of impulsivity. Diagnostic group differences were obtained and the LHIB evidenced concurrent validity in its ability to classify subjects by scores. No relationship was obtained between the LHIB and laboratory analogue measures. While evidence of discriminant validity was mixed, these data suggest that the LHIB may be a useful instrument for the assessment of impulsive behavior. ᮊ

Current formal psychiatric approaches to nosology are plagued by an unwieldy degree of heterogeneity with insufficient appreciation of the commonalities of emotional, personality, behavioral, and addictive disorders. We address this challenge by building a spectrum model that integrates the advantages of Cloninger's and Akiskalian approaches to personality and temperament while avoiding some of their limitations. We specifically propose that "fear" and "anger" traits − used in a broader connotation than in the conventional literature − provide an optimum basis for understanding how the spectra of anxiety, depressive, bipolar, ADHD, alcohol, substance use and other impulse-control, as well as cluster B and C personality disorders arise and relate to one another. By erecting a bidimensional approach, we attempt to resolve the paradox that apparently polar conditions (e.g. depression and mania, compulsivity and impulsivity, internalizing and externalizing disorders) can coexist without canceling one another. The combination of excessive or deficient fear and anger traits produces 4 main quadrants corresponding to the main temperament types of hyperthymic, depressive, cyclothymic and labile individuals, which roughly correspond to bipolar I, unipolar depression, bipolar II and ADHD, respectively. Other affective temperaments resulting from excess or deficiency of only fear or anger include irritable, anxious, apathetic and hyperactive. Our model does not consider schizophrenia. We propose that "healthy" or euthymic individuals would have average or moderate fear and anger traits. We further propose that family history, course and comorbidity patterns can also be understood based on fear and anger traits. We finally discuss the implications of the new derived model for clinical diagnosis of the common psychiatric disorders, and for subtyping depression and anxiety as well as cognitive and behavioral styles. We submit this proposed schema represented herein as a heuristic attempt to build bridges between basic and clinical science.

Background and purpose: Pathological gambling (PG) in ParkinsonÕs disease (PD) is a frequent impulse control disorder associated mainly with dopamine replacement therapy. As impairments in decision-making were described independently in PG and PD, the objective of this study was to assess decision-making processes in PD patients with and without PG. Methods: Seven PD patients with PG and 13 age, sex, education and disease severity matched PD patients without gambling behavior were enrolled in the study. All patients were assessed with a comprehensive neuropsychiatric and cognitive evaluation, including tasks used to assess decision-making abilities under ambiguous or risky situations, like the Iowa Gambling Task (IGT), the Game of Dice Task and the Investment Task. Results: Compared to PD patients without gambling behavior, those with PG obtained poorer scores in the IGT and in a rating scale of social behavior, but not in other decision-making and cognitive tasks. Conclusions: Low performance in decision-making under ambiguity and abnormal social behavior distinguished PD patients with PG from those without this disorder. Dopamine replacement therapy may induce dysfunction of the ventromedial prefrontal cortex and amygdala-ventral striatum system, thus increasing the risk for developing PG.

This paper reports on the development and psychometric properties of a Gambling Refusal Self-Efficacy Questionnaire (GRSEQ). Two hundred and ninety-seven gamblers from both normal and clinical populations completed an initial set of 31-items of which 26 were selected for inclusion in the final version of the GRSEQ. A series of factor analyses showed four clear factors accounting for 84% of the variance. These factors can be summarised as situations and thoughts associated with gambling, the influence of drugs on gambling, positive emotions associated with gambling and negative emotions associated with gambling. The GRSEQ total score and factors scores showed high internal consistency (Cronbach’s alpha ranging from 0.92 to 0.98). Participants experiencing problems with gambling scored significantly lower on the GRSEQ, and discriminant analyses showed that the scale is able to correctly classify the non-problem (i.e., community and student samples) and problem gamblers (i.e., clinical sample). Furthermore, the GRSEQ showed significant negative relationships with other gambling-related variables (gambling urge and gambling-related cognitions) and negative mood states (depression, anxiety and stress) and was shown to be sensitive to change in treatment of pathological gambling. The results suggest that the GRSEQ is a useful measure of gambling refusal self-efficacy that is suitable for assessment of gamblers from both normal and clinical populations.