Socio demographic profile and psychiatric co morbidity of subjects with pathological gambling
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Socio-demographic Profile and Psychiatric Co-morbidity of Subjects with Pathological Gambling Dr R. M. Winslow Head, CAMP Community Addictions Management Programme Institute of Mental Health Study Goal

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Socio demographic profile and psychiatric co morbidity of subjects with pathological gambling l.jpg
Socio-demographic Profile and Psychiatric Co-morbidity of Subjects with Pathological Gambling

Dr R. M. Winslow

Head, CAMP

Community Addictions Management Programme

Institute of Mental Health


Study goal l.jpg
Study Goal Subjects with Pathological Gambling

  • This is a case-controlled descriptive study of 40 subjects with PG on their socio-demographic profile, co-morbidity and personality profile


Method l.jpg
Method Subjects with Pathological Gambling

  • Matched Case-Control Design

  • Subjects were screened using the South Oaks Gambling Screen (SOGS)

    • Participants scored more than 5 on SOGS

    • Participants diagnosed to have PG using DSM-IV

  • Control Group

    • Matching criteria

      • Age (+/- 1 year)

      • Gender


Method4 l.jpg
Method Subjects with Pathological Gambling

  • Instruments

    • Structured Questionnaire on Sociodemographic Data

    • Composite International Diagnostic Interview (CIDI-Auto)

    • Personality Diagnostic Questionnaire (PDQ)

      • Axis II Diagnoses

    • Eysenck Personality Inventory

      • Impulsivity


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Results & Discussion Subjects with Pathological Gambling


Discussion l.jpg
Discussion Subjects with Pathological Gambling

  • Typical profile of our sample’s pathological gambler

    • 38 year old married man

    • Tertiary education & employed

    • Started gambling at age 20

    • Lottery (4D) as most preferred form of gambling


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Discussion Subjects with Pathological Gambling

  • High rates of comorbid substance use & mood disorders were confirmed in this sample

  • Controls

    • Only 22.5% were diagnosed with a DSM-IV criteria for a lifetime disorder


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Discussion Subjects with Pathological Gambling

  • Most common lifetime disorders

    • Mood disorders

    • Substance Use Disorders

    • Anxiety Disorders

  • Similar to Black & Moyer (1998) and Petry et al (2005)

    • Black and Moyer reported that 90% of their sample of pathological gamblers suffered from a lifetime disorder

    • Petry et al found 49.6% and 41.3% of pathological gamblers with mood and anxiety disorders respectively

  • However, our study found higher rates of anxiety disorders whereas the above 2 studies found higher rates of mood disorders


Discussion13 l.jpg
Discussion Subjects with Pathological Gambling

  • Rates of anxiety, depression & substance use were significantly higher in pathological gamblers compared to controls

  • Rate of substance abuse disorders is low in Singapore among pathological gamblers compared to the West


Discussion14 l.jpg
Discussion Subjects with Pathological Gambling

  • Onset of gambling predated onset of substance abuse in all cases

  • Onset of gambling preceded onset of depression in most cases

  • Implication

    • 2 types of gamblers

      • Gambling leading to depression

      • Gambling as a means of coping with depression


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Discussion Subjects with Pathological Gambling

  • Most common Personality Disorders in our study

    • Obsessive-compulsive

    • Avoidant

    • Paranoid


Discussion17 l.jpg
Discussion Subjects with Pathological Gambling

  • Impulsivity

    • Pathological gamblers scored significantly higher than the controls on the impulsivity questionnaire (16.8 ± 4.7 and 11.3 ± 4.2 respectively)

    • Range of Impulsivity – 0 to 31


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Limitations Subjects with Pathological Gambling

  • Self-selected group of participants

  • Cross-sectional Design

  • Aetiological implications are unclear


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Thank You Subjects with Pathological Gambling


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Introduction Subjects with Pathological Gambling

  • Definition of Gambling

    • A wager of any type of item or possession of value upon a game or event of uncertain outcome in which chance, of a variable degree, determines the outcome (Bolen & Boyd, 1968)


Pathological gambling l.jpg
Pathological Gambling Subjects with Pathological Gambling

  • Characterized by

    • Failure to resist impulse to gamble despite disruption to personal, family & vocational life

  • Associated with

    • Adverse consequences for the person & family & society at large


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Pathological Gambling Subjects with Pathological Gambling

  • Pathological Gambling as an addiction

    (Potenza, 2001)

  • Pathological Gambling as an obsessive-compulsive spectrum disorder

    (Blaszczynski, 1999)


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Prevalence of Pathological Gambling Subjects with Pathological Gambling

  • United States & Canada

    • 0.4% - 2.0%

      • (Welte et al, 2002; Cunningham-Williams & Cottler, 2001)

  • Asian Countries

    • 1.0% - 2.0%

      • (Lee et al, 1990; Wong & So, 2003)

  • Singapore (MCYS, 2005)

    • 58% of Singapore residents aged 18 & above have taken part in some form of gambling activity over a 1-year period

    • 2.1% reported symptoms that suggest probable pathological gambling

    • Comparable to results of similar studies in HKG & Macau


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Co-morbidity with Pathological Gambling Subjects with Pathological Gambling

  • Affective Disorders

    • 33.3% of pathological gamblers have an affective disorder compared to 14.2% in non-gamblers (Bland et al, 1993)

    • Major depression significantly more prevalent in problem gamblers (8.8%) than non-gamblers (5.2%)

    • Among patients who engage in gambling, secondary depressive symptoms are very common (Thorson et al, 1994; Becona et al, 1996)


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Co-morbidity with Pathological Gambling Subjects with Pathological Gambling

  • Anxiety Disorders

    • Pathological gamblers significantly more likely than non-gamblers to have any anxiety disorder and agoraphobia (Bland et al, 1993)

    • High rates of prevalence of anxiety disorders among respondents with pathological gambling (Petry et al, 2005)


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Co-morbidity with Pathological Gambling Subjects with Pathological Gambling

  • Impulse Control Disorders

    • 22.9% of study subjects (pathological gambling) displayed compulsive shopping or compulsive sexual activity

    • Patients also reported more severe gambling symptoms

      Grant & Kim, 2003


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Co-morbidity with Pathological Gambling Subjects with Pathological Gambling

  • Personality Disorders

    • Positive association between PG & ASPD (Slutske et al, 2001; Cunningham-Williams et al, 1998)

    • 87% of subjects with PG met criteria for at least one PD

      • Most frequent – obsessive-compulsive, avoidant, & schizoid PD

    • Number of PD positively related to the South Oaks Gambling Screen (SOGS) score (Blaszczynski & Steel, 1998)


Co morbidity with pathological gambling29 l.jpg
Co-morbidity with Pathological Gambling Subjects with Pathological Gambling

  • Substance Use Disorders

    • Toneatto et al (2002) in a study of gamblers

      • 55.4% using alcohol

      • 10.1% using drugs

    • Welte et al (2001)

      • Extremely strong relationship between current alcohol dependence & current PG (OR = 23.1)

      • Drinking increased with gambling severity

    • Petry et al (2005)

      • Alcohol dependence, drug use disorder & tobacco dependence are significantly related to PG


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