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Gambling disorder is common, affects 0.5–2% of the population, and is under-treated. Duration of untreated illness (DUI) has emerged as a clinically important concept in the context of other mental disorders, but DUI in gambling disorder, has received little research scrutiny.
Data were aggregated from previous clinical trials in gambling disorder with people who had never previously received any treatment. DUI was quantified, and clinical characteristics were compared as a function of DUI status.
A total of 298 individuals were included, and the mean DUI (standard deviation) was 8.9 (8.4) years, and the median DUI was 6 years. Longer DUI was significantly associated with male gender, older age, earlier age when the person first started to gamble, and family history of alcohol use disorder. Longer DUI was not significantly associated with racial-ethnic status, gambling symptom severity, current depressive or anxiety severity, comorbidities, or disability/functioning. The two groups did not differ in their propensity to drop out of the clinical trials, nor in overall symptom improvement associated with participation in those trials.
These data suggest that gambling disorder has a relatively long DUI and highlight the need to raise awareness and foster early intervention for affected and at-risk individuals. Because earlier age at first gambling in any form was strongly linked to longer DUI, this highlights the need for more rigorous legislation and education to reduce exposure of younger people to gambling.
Problems with cognitive flexibility have been associated with multiple psychiatric disorders, but there has been little understanding of how cognitive flexibility compares across these disorders. This study examined problems of cognitive flexibility in young adults across a range of psychiatric disorders using a validated computerized trans-diagnostic flexibility paradigm. We hypothesized that obsessive-compulsive spectrum disorders (eg, obsessive-compulsive disorder, trichotillomania, and skin-picking disorder) would be associated with pronounced flexibility problems as they are most often associated with irrational or purposeless repetitive behaviors.
A total of 576 nontreatment seeking participants (aged 18-29 years) were enrolled from general community settings, provided demographic information, and underwent structured clinical assessments. Each participant undertook the intra-extra-dimensional task, a validated computerized test measuring set-shifting ability. The specific measures of interest were total errors on the task and performance on the extra-dimensional (ED) shift, which reflects the ability to inhibit and shift attention away from one stimulus dimension to another.
Participants with depression and PTSD had elevated total errors on the task with moderate effect sizes; and those with the following had deficits of small effect size: generalized anxiety disorder (GAD), obsessive-compulsive disorder (OCD), antisocial personality disorder, and binge-eating disorder. For ED errors, participants with PTSD, GAD, and binge-eating disorder exhibited deficits with medium effect sizes; those with the following had small effect size deficits: depression, social anxiety disorder, OCD, substance dependence, antisocial personality disorder, and gambling disorder.
These data indicate cognitive flexibility deficits occur across a range of mental disorders. Future work should explore whether these deficits can be ameliorated with novel treatment interventions.
Borderline personality disorder (BPD) is a common and disabling mental health disorder and has detrimental effects on affected individuals across multiple domains. We aimed to investigate whether individuals with BPD differ from control subjects in terms of cognitive functions, and to see if there is a relationship between cognitive functions, impulsivity, and BPD symptom severity.
BPD individuals (n = 26; mean age = 26.7; 69.2% female) and controls (n = 58; mean age = 25.3; 51.7% female) were enrolled. Intra/Extra-Dimensional Set Shift (IED) and One Touch Stockings of Cambridge (OTS) tasks from the Cambridge Neuropsychological Test Automated Battery (CANTAB) were used to assess cognitive functions. Barratt Impulsivity Scale-version 11 (BIS−11) was administered to measure impulsivity and both the Zanarini Scale for Borderline Personality Disorder self-report and the clinician-administered versions were used to assess BPD symptom severity.
BPD group showed significantly impaired cognitive performance on the IED task versus controls, but there was not a significant difference in the OTS task. BPD symptom severity was positively correlated with trait (BIS-11) impulsivity and no correlation was found between BPD symptom severity and cognitive functions.
This study suggests people with BPD experience impaired cognitive flexibility and heightened impulsivity. Only impulsivity appeared to be directly related to symptom severity, perhaps indicating that cognitive inflexibility could be a vulnerability marker. Future research should focus on a longitudinal approach to extend clinical and theoretical knowledge in this area.
Complex relationships between drugs and sex including alcohol, cannabis, stimulants, ecstasy. The effects of drugs on different aspects of sex such as arousal, risky decision-making, orgasm, and social responding. Effects of stopping drug use on sex. How to treat sexual problems linked to substance use. Effects of smoking on sex, and effects of prescription medications. Natural supplements and the search for aphodisiacs. Special issues around intimacy, and body image.
Sex and minority groups such as LGBT, sexual desire and sexual identity as fluid or dimensional phenomena, differences (or lack of differences) in desire in minority groups, special issues in relationships for minority groups such as discrimination, and effects of ageing,
Situations when people experience a lack of sex or interest in sex and reasons for this, including contribution of relationship status, stress, differences in drive, and mental plus physical health conditions. Hypoactive sexual desire disorder (HSDD). Treatments for these conditions and sources of support.
Relationship problems relating to sex and desire, including mismatches in desire and how to successfully address these; mismatches in preferred sexual activities and how to address these; the value of couples counselling for all couples.
Sex is everywhere in modern society, yet it remains taboo. We all have questions about sex that are too uncomfortable to ask – how do we get reliable answers? In this go-to guide Drs Grant and Chamberlain use their clinical expertise to answer the questions you wish you could ask about sex. Questions like: Is my sex drive or sex behavior normal? Can someone have too much sex? Or too little? How has Internet dating and pornography changed sex? This go-to guide will help you understand common sexual issues, know when to worry (or not) about different sexual behaviors, and learn how our sex lives adapt to changing technology or in times of crisis. It also provides step-by-step advice for dealing with a range of sexual issues, and practical strategies for strengthening relationships.
Discussion of effects sex can have on different aspects of health including cardiovascular, pain perception, and brain health. Special issues between sex and situations such as pregnancy, diabetes, and heart disease. Tips for addressing worries about physical health and sex, including supporting one’s partner.
Introduction to desire and how it relates to sex, including similarities and differences against other desires. Biology of desire and reward pathways in the brain. Reward transmitters such as dopamine and chemical messengers such as oxytocin.
This chapter considers how the Internet (and technology more widely) affects sex, including online pornography use, internet sex addiction, and dating apps. Practical advice on safe use of the Internet for dating is given. Advice for parents on the importance of open two-way discussion with children about online risks is covered.
How the Covid-19 pandemic affected sex including in single people and couples; how the pandemic changed sexually transmitted infections; lessons from other pandemics in the past; and why there should be more discussion and consideration around sex during pandemic(s).
Situations when people experience excessive sex drive or thoughts, and reasons for this, including compulsive sexual behavior (CSB), impact of some medications, and health conditions. Support and treatment options for people with excessive sex drive including psychotherapy, counselling, and medications.
Norms in sexual development as people get older, age of puberty and first sexual experiences, and variation in these. The role of cultural norms and parenting in sexual development norms and also biological factors.