Socio-demographic Profile and Psychiatric Co-morbidity of Subjects with Pathological Gambling

1. 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

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

3. Method 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

4. Method Instruments Structured Questionnaire on Sociodemographic Data Composite International Diagnostic Interview (CIDI-Auto) Personality Diagnostic Questionnaire (PDQ) Axis II Diagnoses Eysenck Personality Inventory Impulsivity

5. Results & Discussion

9. Discussion 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

11. Discussion 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

12. Discussion 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

13. Discussion 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

14. Discussion 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

16. Discussion Most common Personality Disorders in our study Obsessive-compulsive Avoidant Paranoid

17. Discussion 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

19. Limitations Self-selected group of participants Cross-sectional Design Aetiological implications are unclear

20. Thank You

21. Introduction 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)

22. 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

23. Pathological Gambling Pathological Gambling as an addiction (Potenza, 2001) Pathological Gambling as an obsessive-compulsive spectrum disorder (Blaszczynski, 1999)

24. Prevalence of 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

25. Co-morbidity 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)

26. Co-morbidity 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)

27. Co-morbidity 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

28. Co-morbidity 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)

29. Co-morbidity 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