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
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
Study Goal
  • This is a case-controlled descriptive study of 40 subjects with PG on their socio-demographic profile, co-morbidity and personality profile
method
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
method4
Method
  • Instruments
    • Structured Questionnaire on Sociodemographic Data
    • Composite International Diagnostic Interview (CIDI-Auto)
    • Personality Diagnostic Questionnaire (PDQ)
      • Axis II Diagnoses
    • Eysenck Personality Inventory
      • Impulsivity
discussion
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
discussion11
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
discussion12
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
discussion13
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
discussion14
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
discussion16
Discussion
  • Most common Personality Disorders in our study
    • Obsessive-compulsive
    • Avoidant
    • Paranoid
discussion17
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
limitations
Limitations
  • Self-selected group of participants
  • Cross-sectional Design
  • Aetiological implications are unclear
introduction
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)
pathological gambling
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
pathological gambling23
Pathological Gambling
  • Pathological Gambling as an addiction

(Potenza, 2001)

  • Pathological Gambling as an obsessive-compulsive spectrum disorder

(Blaszczynski, 1999)

prevalence of pathological gambling
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
co morbidity with pathological gambling
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)
co morbidity with pathological gambling26
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)
co morbidity with pathological gambling27
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

co morbidity with pathological gambling28
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)
co morbidity with pathological gambling29
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
ad