IntroductionPathological gambling (PG) is currently included among Addictive Disorders (DSM-5). However, its phenomenology resembles features of Obsessive Compulsive Disorder. Several models of addiction conceptualize a progression from impulsivity to compulsivity transitioning from initial positive reinforcement motivations to later negative reinforcement and less pleasurable and automaticity mechanisms.Clinical presentationA 34-year-old male, since diagnosed with PG in 2013 and prescribed a group rehabilitation therapy, presented in 2015 complaining of intrusive thoughts and depression symptoms. During the psychiatric examination emerged: low mental concentration; dysphoria; hyporexia; irritability; insomnia; persistent ideas and excessive preoccupations to be betrayed by his girlfriend; and behaviours of hyper control on her life. He has been evaluated using MMPI-2 (obsessivity Tscore 70, depression Tscore 67) and BIS-11 (high score of non-planning impulsiveness).TreatmentIt appeared there was a shift from ego-syntonic novelty driven/impulsive behaviours focused primarily on gambling to ego-dystonic habit driven/compulsive behaviours focused on her girlfriend. He started an individual psychodynamic psychotherapy centred on dysfunctional beliefs and behavioural strategies for treating the compulsive features. As thought content was the most relevant aspect, he was prescribed olanzapine, not a SSRI (normally indicated for OCD), up to 10 mg/die. After a month obsessions and compulsions reduced, and he seemed to reach a good level of personal functioning, despite a rigid anankastic personality trait.ConclusionsAs the management of compulsive behaviours is complex, physician should better assess and recognize psychological personality aspect, collecting patients’ complete history, also testing them psychometrically, and paying more attention to an eventual treatment (both psychological and pharmacological).Disclosure of interestThe authors have not supplied their declaration of competing interest.

Internet Gambling has become one of the most popular and lucrative internet business. The recent improvements in technology have changed betting habits with online poker, casinos, sport betting, bingo and lotteries. Liberalization of the Italian online gambling market gradually started in 2006, but only in 2010 foreign gambling operators have been able to launch online real money games. Our aim is to study the impulsivity and personality traits of an Italian sample of Pathological Gamblers (PG), showing the peculiarities of Online Gambling (OG). 69 patients affected by PG, who accessed to our clinical center, were asked to fill the following questionnaires: Temperament and Character Inventory-Revised (TCI-R) Europ-ASI (Addiction Severity Index) Barratt Impulsiveness Scale (BIS-11) we found significant statistical correlations between OG and: younger age (p<0,01), early onset of gambling (p=0,012), male gender (p=0,015), gambling exclusively with active games (p<0,001), gambling that involves different games (p=0,04) and PG familiarity (p=0,03). Considering gamblers'personality traits, OG significantly correlates with higher scores in TCI-R subscales NS1(exploratory excitability) and Persistence, while lower scores in HA2 (fear of uncertain) and ST3 (spiritual acceptance). There is no correlation between OG and impulsivity. internet gamblers' young age could explain the correlations between OG and higher scores in NS1, HA2 and ST3, and consequently risky behaviours and less spiritual believes/acceptance. Higher scores in Persistence indicate perseverance in spite of fatigue or frustration. Cloninger's research found that Persistence, like the other temperament traits, is highly heritable.

over the past few years Gambling has significantly increased in Italy, being considered as an acceptable form of entertainment and leisure activity. Our aim is to study personality traits and the psychiatric comorbidity of gamblers in relation to the different age and the onset of gambling. 71 patients affected by Pathological Gambling (PG), who accessed in our service (A. Gemelli Hospital, Rome- Italy), underwent the following assessment tests: -Addiction Severity Index (ASI); -Temperament and Character Inventory-Revised (TCI-R) to study personality traits; -MINI-International Neuropsychiatric Interview for psychiatric comorbidity. we found that younger gamblers have higher TCI-R scores in the subscales NS1 (exploratory excitability)(p<0,001) and NS3 (extravagance)(p=0,024) and lower scores in HA2 (fear of uncertainty) and ST3 (spiritual acceptance)(p=0,005). An earlier age of onset of PG correlates with higher scores in NS1 (p=0,003), NS3 (p=0,047), Novelty Seeking (p=0,016) and lower HA2 (p=0,034). Patients with gambling onset before age 20 have more probabilities of playing multiple kinds of games (p=0,004), while lower probabilities of playing passive games (p=0026); furthermore they exhibit antisocial personality disorder (p=0,033) and addiction familiarity (p=0,006). Late-onset gamblers (age > 45 years) prefer passive games (p=0,007) and usually don't play online games (p=0,02). gamblers are a heterogeneous population with regard to personality traits, psychiatric comorbidity, familiarity and type of games played. Paying attention to the gamblers' age and the age of onset of PG could be useful to a greater understanding of the individual differences of patients, and to a deeper knowledge of their disorder.

A growing importance has been placed on the recognition and supervision of non-motor features of Parkinson's disease (PD). Depression has been estimated to affect one in three individuals with PD and can lead to worse health outcomes and decreased quality of life. Anxiety, apathy and anhedonia further complicate PD outcomes. In this double-blind, placebo-controlled trial, participants (individuals with mild to moderate PD; n = 24) were randomly assigned to treatment (800 mg/d docosahexaenoic acid (DHA) and 290 mg/d eicosapentaenoic acid, a precursor to DHA) or placebo (an equicaloric amount of corn oil). Treatment duration was 6 months. Treatment had no statistically significant effect on rate of change on either Unified Parkinson's Disease Rating Scale or Hoehn-Yahr Scale score. However, 75% of DHA-treated patients, reduced Hamilton Rating Scale for Depression total score by at least 50%, compared with only 25% into the placebo group. At the end of the six-month study, DHA integration reduced the depressive symptoms.

Introduction:Different questionnaires were formulated in order to assess the severity of gambling. The most used questionnaire is the South Oaks Gambling Screen (SOGS), based on DSM-III criteria for gambling, even though it has poor specificity, because overestimates the prevalence of the disorder when used in general population.Objectives:Try to overcome SOGS limits using a questionnaire based on DSM-IV criteria for gambling.Aims:Validate the questionnaire based on DSM-IV criteria, using as gold standard the clinical interview developed through the SOGS.Methods:The sample used is formed by 71 subjects, 58 men (81.7%) and 13 women (18.3%), recruited from the Psychiatric Department of Gemelli General Hospital in Rome, who were asked to fill out both questionnaires.Results:The sensitivity of our questionnaire was 93% (compared to 100% in the SOGS); the specificity was 100% (97.1% in the SOGS). False negatives were 7%, while they were absent in the SOGS ; false positives were absent in the DSM-IV questionnaire, while they were 2.9% in the SOGS.We also determined the prevalence of each item of DSM-IV questionnaire in all gamblers identified (66 subjects): the most relevant item was “chasing one's losses”(item6), instead the least one was “committing illegal acts such as forgery, fraud, theft, or embezzlement to finance gambling”(item8).Conclusions:Our data confirm the greater specificity of the questionnaire of DSM-IV criteria for gambling compared to the SOGS. We suggest its use for the identification of gamblers in a sample formed by general population.

Introduction:Frequent and increasing relations among psychiatric and substance dependence disorders, have made, to date, more complex the treatment of this dependence, especially when the patient is facing the difficult task of maintaining abstinence, which requires a work of self-awareness, motivation to change and active modification of dysfunctional lifestyles.Objectives:Our study has the aim to detect patients’ changes in personality between the beginning of the rehabilitative therapy and its end, trying to get information on aspects of addiction on which the treatment affects the most.Methods:Our sample was formed by 153 patients, recruited at the Department of Psychiatry of Gemelli General Hospital, who were subjected to an integrated approach of treatment, both pharmacological and rehabilitative group-therapy, according to Minnesota rehabilitation model, that considers addiction as a bio-psycho-social problem.Patients, after a first psychiatric evaluation, were asked to fill out two psychometric tests, the SymptomCheckList-90 R and the Structural Clinical Interview for DSM-IV, in two times, at the first meeting and at the last one, after 20 meetings of group therapy.Results:At the end of the group therapy 39 patients dropped-out, 114 patients had a significant improvement in depressive symptoms (DEP item), greater responsibility perseverance and attention in their activities and habitual contexts (GSI, DIS, W/S items), as well as better management of compulsion and impulsivity (OC item) and a lower sense of inferiority, inadequacy and discomfort in interpersonal relationships (PAR, ANX, IS, SOC. A., PSY. A. items).

Aims:There is substantial evidence indicating that pharmacological treatments targeting glutamatergic transmission are of potential utility in the treatment of drug addiction. The aim of this study was to evaluate the long-term outcome of glutamatergic treatments in patients with pathological gambling.Methods:Fifteen patients fulfilling criteria for pathological gambling and receiving drugs with effects on glutamatergic transmission (amantadine, N-acetylcysteine, gabapentin, pregabalin and topiramate) were enrolled. Gambling craving (Gambling Symptom Assessment Scale, G-SAS, and visual analogue scale, VAS) and relapse (Gambling Timeline Follow Back, G-TLFB) rating scales were administered before and after treatment (1, 3, 6 months follow-up).Results:Gambling craving and behavior were significantly reduced (p < 0.001) during the study period. Glutamatergic medications also yielded an improvement in treatment retention.Discussion:Our results are discussed in the context of the glutamatergic hypothesis of addiction. Our data seem to confirm the utility of targeting the glutamatergic system for the treatment of PG, in particular by acting on craving and increasing treatment retention. in particular, glutamatergic medications may offer some advantages in preventing relapse.

Pathological gambling (PG) disorder occurs when a person gambles repetitively despite severe negative effects on important aspects of life. PG tends to be a heterogonous disorder in which patients differ with respect to type and intensity of gambling behavior, psychiatric comorbidity, family history, age at onset and gender. Gamblers may accordingly be classified into three subtypes: the “impulsive”, “obsessive-compulsive” and “addicted” subtypes. to characterize a sample of Italian PG pathological gamblers and assess the prevalence of the various gambling subtypes in this population. 52 outpatients (44 men, 9 women), diagnosed with PG according to DSM IV-TR and SOGS criteria, were administered the Dannon Ainhold Gambling Scale (DAGS), which assesses the presence of the disorder and is useful for patient subtyping. 37 gamblers enrolled in our study played one specific kind of game, while 15 played multiple games. 30 patients played slot machines, 18 sport betting, 11 casino and card games, 14 bingo and scratch cards. According to DAGS, 5 (9,6%) patients belonged to the “addicted” subtype, 4 (7,7%) to the “obsessive-compulsive” subtype and 9 (17,3%) to the “impulsive” subtype. 15 (28,8%) gamblers were classified as “addicted-impulsive” subtype, 10 (19,2%) as “addicted-obsessive-impulsive” subtype, while 9 (17,3%) did not belong to any specific subtype though they displayed a tendency for one of the subtypes. DAGS allows to identify three major subtypes of gamblers and also considers possible combinations between the different subtypes. An evaluation of these aspects could be useful in treatment options based on patient subtype.

Pathological gambling refers to the uncontrollable impulse to gamble, irrespective of the interference the behaviour has on the individual's life. It often results in disrupted relationships, financial problems, criminal behaviour and yet the individual is unable to refrain. Our aim is to evaluate the relationship among impulsivity traits, personality assessment and psychiatric comorbidity in a sample of pathological gamblers. 78 pathological gamblers were evaluated with the following instruments: MINI to evaluate psychiatric comorbidity; TCI to evaluate personality traits, and BIS-11 to evaluate impulsivity. Pathological gambling was assessed with DSM-IV-TR criteria. In our sample we found an average score of BIS-11 (66,9) slightly higher than the score of the general population (63,8). The scores of TCI, compared with the mean scores of the general population, differ significantly with regard to NS, RD, C, ST. As to MINI, it reveals a significant prevalence of Major Depressive Episode, Dysthymia, GAD, and risk of suicide. We identified two groups at high and low impulsivity and we conducted an analysis in relation to personality traits measured by TCI and incidence of psychiatric comorbidity measured by the MINI. The group with high impulsivity was associated with significantly higher scores of NS and HA, and lower RD and SD. Also in this group there was a higher incidence of Major Depressive Episode and GAD. The analysis allows to identify the impulsive trait as a discriminating factor of two different types of players in relation to personality characteristics and psychiatric comorbidity.

IntroductionOur study aims to assess the prevalence of behavioural addictions in an adolescent populations, evaluating the effects of gender and age, and to assess the correlations and associations between different behavioural addictions.MethodsA population of 2853 students (1142 F and 1711 M, mean age 16.7± 1.9) was assessed in order to evaluate the prevalence of behavioural dependences such as Pathological Gambling (PG), Compulsive Buying (CB), Exercise Addiction (EA), Internet Addiction (IA), and Work Addiction (WA). The South Oaks Gambling Screen-Revised Adolescent, the Compulsive Buying Scale, the Exercise Addiction Inventory, the Internet Addiction Test, and the Work Addiction Risk Test, were compiled anonymously by the students.ResultsOverall prevalence was 7.0% for PG, 11.3% for CB, 1.2% for IA, 7.6% for WA, 8.5% for EA. PG, and EA were more common among boys, while gender had no effect on the other conditions. CB was more common among younger (< 18 years old) students. Each of these conditions showed a strong association with others, and the scores of all of these scales were correlated.DiscussionIn line with previous studies our results indicate that behavioural addictions are quite common among adolescents. The strong association between behavioural addictions stresses the concept that treatment for one of these conditions should involve assessment and treatment for the others.

AimsTo evaluate, in a sample of pathological gamblers, the effects of personality traits and psychiatric comorbidity on the severity of this condition.Methods40 patients were evaluated with the following instruments: EuropASI, modified for pathological gambling; MINI; TCI, and BIS-11. Univariate linear regression analyses were conducted to evaluate the relationships between different scales.ResultsAge of onset was influenced by Novelty Seeking and NS-1 subscale, with higher scores related to earlier onset, Harm Avoidance 2 subscale, with higher scores related to a later onset; the presence of a lifetime panic disorder was related with a later onset; A positive correlation was found between age of onset of pathological gambling and both cigarette and cannabis smoking. Higher NS1 scores were related to a higher amount of money spent during the last month, while higher scores on the HA2 and Cooperativeness 5 subscales were related to a lesser number of days in which the patient had gambled during the last month. Moreover, higher scores in Gambling severity scores are related with the presence of a comorbid alcohol or substance abuse or dependence, dysthymia, post traumatic stress disorder, bipolar II mood disorder, and with higher BIS-11 Motor Impulsiveness, Non-planned Impulsiveness and total scores.ConclusionsPersonality traits and psychiatric comorbidity influence the age of onset of gambling, the severity of gambling and the functional and economic impact of the disease on the patient’s life. An evaluation of these aspects is needed to determine treatment options with a greater understanding of the phenomenon.

IntroductionPsychiatrists play an important role as members of the bariatric surgery team. A preoperative psychiatric evaluation is considered as part of a mandatory workup before approving surgery.AimsThis evaluation focuses on the identification of any pre-existing psychiatric disorders among candidates for TOGa[1], a new experimental technique of bariatric surgery, and their correlations with post surgical weight loss.Method45 obese patients underwent a psychiatric interview and several psycho diagnostic questionnaires (SCL-90; HAM-D; HAM-A; EDI; TAS).A follow-up was set each 3 months.ResultsWe found that 34.1% of surgery candidates had a current diagnosis of depression; the majority showed anxiety symptoms. We also documented dissatisfaction about body shape, desire of slimness, fear of maturity, perfectionism, bulimia and binge eating disorder. Other frequent psychiatric symptoms were somatization, sensitivity, obsession and compulsion. After 3 months from surgery we found that the best weight loss was associated to low score in HAM-A, high score in hanger-hostility item (SCL-90) and low score in sensitiveness item (SCL-90).ConclusionThe diagnosis of a psychiatric pathology during the pre-surgical evaluation can be considered a predictive negative factor for the outcome of the surgery. The predictive positive factors are firstly the nonexistence of psychiatric symptoms, secondly the high score in sensitiveness-insight item (SCL-90) and the high score in the ability to express feelings. [1] (TransOral Gastroplasty)

age are also examined. Patterns of infant sleep within these groups are also explored. Methods: In the study, pregnant women were screened for depressive symptoms using the Edinburgh Postnatal Depression Scale (EPDS), and their symptom severity was assessed longitudinally with the Beck Depression Inventory. Women were divided into 6 risk groups: low/stable, intermediate, and high/increasing depression based upon longitudinal symptom severity and medication use. The infant neuroendocrine system was examined using cord blood ACTH and cortisol. These infants were examined at 2 weeks of age using Neonatal Intensive Care Unit Neurobehavioral Scale (NNNS). Results: Infants born to women of the high/increasing depression group had significant elevations in cord blood ACTH at birth. On NNNS examination at two weeks, these infants were more hypotonic and less attentive. They habituated to stimuli more quickly and had fewer visual signs and higher skin reactivity. Infants born to women using antidepressants had further elevations in cord blood ACTH, and were found to be more tremulous and excitable during NNNS examination. Infants born to women with higher depression severity demonstrating aberrations in their early sleep patterns and sleep entrainment. Conclusions: Maternal depression risk and antidepressant use may construe a different developmental pathway for development of the infant neuroendocrine axis which may impact early neonatal neurologic development.

Since November 2005 our Institute has been developing a group therapy program for pathological gamblers, alternating a counselling/rehabilitation and a group psychotherapy session each week. For a better understanding of psychodynamic aspects of our patients we have started to assess them through Rorschach test according to Klopfer signing and with TAS-20 (Toronto Alexithymia Scale, Taylor et al., 1990). Preliminary results regarding ten patients have shown the following features: a discrepancy between high ambition and real intellectual skills; a psychic life condition dominated by immature resources and impulses; an inappropriate self-control which is performed through emotional distance and experiences of deep anguish. These features can be indicative of a difficulty in expression of emotions, according to alexithymia construct. Most of the patients were found to have significantly higher levels of alexithymia at Tas-20. This outcome is in accordance with previous works on the topic.Our preliminary observations suggest to focus group therapy not only on communication contents, but also on the communication style of the patient. These results also suggest that could be important to help patient to recognize and discriminate emotional conditions to prevent relapses due to out of control or repressed emotions.[1]. Parker J.D., Wood L.M., Bond B.J., Shaughnessy P. (2005) Alexithymia in young adulthood: a risk factor for pathological gambling. Psychother. Psychosom. 74(1): 51-5.

The utility of gambling model posits that consumption benefits lead rational agents to gamble when faced with negative expected financial returns. We analyze the determinants of bet volume and dollars bet on NCAA basketball games from three on-line sports books to test the predictions of this model. Betting action depends on television coverage, team quality, and the expected closeness of the contest. Our results support the notion that consumption benefits, not financial gain, motivate gambling. Preferences of bettors appear similar to those of sports fans, suggesting that models of gamblers as wealth-maximizing investors may not explain observed betting behavior.

Gender perspective in sociological analysis provides large doses of pragmatism in the work of social problems. From this premise, we have developed a piece of research based on the problem suggested by the organization "Proyecto Hombre Murcia, Solidaridad y Reinserción", the main objective of which was to analyze the existing differences in problems among men and women in treatment, and the implications these have on the success of the treatment. Thus, we have performed an analysis of social perceptions of addicts receiving treatment. The methodology used was qualitative, allowing for the participation of people undergoing treatment in the focus groups, together with interviews developed for this research. This has helped explain and understand why gender roles are affecting welfare policies and intervention programs.

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