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S.10.02 Genetics of pathological gambling and substance use disorders
S.10. Pathological gambling: a non-chemical addiction? the mood stabilizing properties of some of new antiepileptics, favorable effects have been described on impulsivity, aggressive behavior, anxiety, eating disorders, and addictions. For this reason their utility is greater in bipolar patients with comorbid conditions, rather than in pure manic-depressive patients. The psychiatric comorbid conditions in which the mentioned properties can be from special interest are personality disorders, anxiety disorders, addictions, that frequently are coexisting with mixed states, and also atypical forms of bipolar disorder. Future research will have to specify their role and clarify their optimal conditions of use, as well as the best associations to use in resistant patients. References [1] Perugi G, Toni C, Frare F, Ruffolo G, Moretti L, Torti C, Akiskal HS., 2002. Effectiveness of adjunctive gabapentin in resistant bipolar disorder: is it due to anxious-alcohol abuse comorbidity? J Clin Psychopharmacol 22(6):584−91. [2] Spina E, Perugi G., 2004. Antiepileptic drugs: indications other than epilepsy. Epileptic Disord 6(2):57−75.
S.10. Pathological gambling: a nonchemical addiction? S.10.01 Pathological gambling: an addiction phenotype? J. Ad`es ° . Hopital Louis Mourier, Department of Psychiatry, Colombes Cedex, France Pathological gambling is defined in the DSM-IV TR as a persistent and recurrente maladaptive gambling behavior that disrupts personal, family, or vocational pursuits. Its nosographic status is discussed between Impulsive-Control Disorders, ObsessiveCompulsive Disorders and Addictions. Many arguments lead to consider pathological gambling as a behavioural or non-chemical addiction. At a clinical point of view, first of all, pathological gambling shares the main clinical features of all addictions: loss of control, continuation of the behavior despite negative consequences (as financial problems, lost of significant relationship, job, or educational or career opportunity because of gambling), increasing of tolerance (necessity to gamble more and more to achieve the same effect) and even psychological and physical withdrawal symptoms (restless or irritable when attempting to cut down or stop gambling). At an epidemiological point of view, pathological gambling has an important comorbidity with drug addictions (alcohol, cocaine, nicotine principally), with other behavioral addictions (compulsive buying, sexual addictions) and with psychiatric disorders as depressive and bipolar disorders, anxiety disorders and antisocial personality. At a biological level, pathological gambling has common features with other addictive disorders: implication of serotoninergic, noradrenergic and dopaminergic systems. Psychobiological dimensions as high impulsivity, high sensation seeking scores, high novelty seeking scores and low harm-avoidance are shared between pathological gambling and other addictions. Finally, the management of pathological gambling implies specific therapeutic programs including motivational therapies, group therapies and behavioural and cognitive therapies in a way very similar to other addictions. For all this reasons, pathological gambling may be considered as a typical addiction phenotype. References [1] Ad`es J, Lejoyeux M. Jeu pathologique. Encycl Med Chir, Psychiatrie, 37–396-A-25, 1384, 2000, 14 p.
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[2] Dickerson MG. Gambling: a dependence without drug. Int Rev Psychiatry, 1989, 1: 152–172.
S.10.02 Genetics of pathological gambling and substance use disorders D. Comings ° . Carlsbad Science Foundation, Molecular Genetics, CA 91016, USA The prevalence of pathological gambling (PG) averages 1 to 2 percent of the population with higher rates in some select groups. With the widespread access to gambling in virtually every state in the USA and throughout the world on the internet, this rate is destined to increase. Imagine what the prevalence of crack or cocaine dependence would be if it were readily available to every home in the world that had a computer. Genetic factors for both susceptibility and resistance will be a major factor in determining the eventual prevalence of PG. Like all behavioral traits, pathological gambling and substance use disorders (SUD) are polygenically inherited and due the interaction of many different genes, each with a small effect, interacting with the environment. These disorders also have in common the fact that they are likely to be inter-related by belonging to a larger entity, Reward Deficiency Syndrome or RDS. RDS is characterized by the presence of genetic defects in the reward pathways. PG, SUD and RDS involve the interaction of variant genes for dopamine, norepinephrine, serotonin, GABA, glutamic acid, opioids and others. Numerous studies show the important role of several specific genes including the DRD2 gene. The examination of multiple genes, the use of multivariate regression analysis, the inclusion of epistatic factors, and the assessment of the power of all these factors using ROC plots provide a powerful approach to the study of the molecular genetics of polygenic disorders. S.10.03 Neuroimaging findings in pathological gambling C. B¨uchel ° . University Hospital Hamburg – Eppendorf, Department of Systems Neuroscience Neurolmage Nord, Hamburg, Germany Pathological gambling shares similarities with drug dependence including features of tolerance withdrawal and diminished control. In analogy to drug dependence it has been speculated that the underlying pathology includes a sensitivity reduction of the reward system to natural reinforcers. We tested this hypothesis by studying pathological gamblers and healthy controls during a simple gambling task and fMRI. We studied 12 male pathological gamblers and 13 healthy, matched controls using fMRI and a gambling task. In this task participants were shown the backside of two playing cards and a target color (red or black) in the middle. They were then asked to chose either the right or the left card with a button press. The selected card was turned over and depending on a match of colors the participant either won or lose one Euro. To rule out the possibility that more severe depression scores in gamblers as indicated by the Beck depression scale are responsible for group differences, these scores were included in the random effects model as group specific nuisance regressors. The simple main effect of winning versus losing showed highly significant activation in the ventral striatum for patients and controls. Based on these results we further investigated the differences
S.10. Pathological gambling: a nonchemical addiction? S.10.01 Pathological gambling: an addiction phenotype? J. Ad`es ° . Hopital Louis Mourier, Department of Psychiatry, Colombes Cedex, France Pathological gambling is defined in the DSM-IV TR as a persistent and recurrente maladaptive gambling behavior that disrupts personal, family, or vocational pursuits. Its nosographic status is discussed between Impulsive-Control Disorders, ObsessiveCompulsive Disorders and Addictions. Many arguments lead to consider pathological gambling as a behavioural or non-chemical addiction. At a clinical point of view, first of all, pathological gambling shares the main clinical features of all addictions: loss of control, continuation of the behavior despite negative consequences (as financial problems, lost of significant relationship, job, or educational or career opportunity because of gambling), increasing of tolerance (necessity to gamble more and more to achieve the same effect) and even psychological and physical withdrawal symptoms (restless or irritable when attempting to cut down or stop gambling). At an epidemiological point of view, pathological gambling has an important comorbidity with drug addictions (alcohol, cocaine, nicotine principally), with other behavioral addictions (compulsive buying, sexual addictions) and with psychiatric disorders as depressive and bipolar disorders, anxiety disorders and antisocial personality. At a biological level, pathological gambling has common features with other addictive disorders: implication of serotoninergic, noradrenergic and dopaminergic systems. Psychobiological dimensions as high impulsivity, high sensation seeking scores, high novelty seeking scores and low harm-avoidance are shared between pathological gambling and other addictions. Finally, the management of pathological gambling implies specific therapeutic programs including motivational therapies, group therapies and behavioural and cognitive therapies in a way very similar to other addictions. For all this reasons, pathological gambling may be considered as a typical addiction phenotype. References [1] Ad`es J, Lejoyeux M. Jeu pathologique. Encycl Med Chir, Psychiatrie, 37–396-A-25, 1384, 2000, 14 p.
S181
[2] Dickerson MG. Gambling: a dependence without drug. Int Rev Psychiatry, 1989, 1: 152–172.
S.10.02 Genetics of pathological gambling and substance use disorders D. Comings ° . Carlsbad Science Foundation, Molecular Genetics, CA 91016, USA The prevalence of pathological gambling (PG) averages 1 to 2 percent of the population with higher rates in some select groups. With the widespread access to gambling in virtually every state in the USA and throughout the world on the internet, this rate is destined to increase. Imagine what the prevalence of crack or cocaine dependence would be if it were readily available to every home in the world that had a computer. Genetic factors for both susceptibility and resistance will be a major factor in determining the eventual prevalence of PG. Like all behavioral traits, pathological gambling and substance use disorders (SUD) are polygenically inherited and due the interaction of many different genes, each with a small effect, interacting with the environment. These disorders also have in common the fact that they are likely to be inter-related by belonging to a larger entity, Reward Deficiency Syndrome or RDS. RDS is characterized by the presence of genetic defects in the reward pathways. PG, SUD and RDS involve the interaction of variant genes for dopamine, norepinephrine, serotonin, GABA, glutamic acid, opioids and others. Numerous studies show the important role of several specific genes including the DRD2 gene. The examination of multiple genes, the use of multivariate regression analysis, the inclusion of epistatic factors, and the assessment of the power of all these factors using ROC plots provide a powerful approach to the study of the molecular genetics of polygenic disorders. S.10.03 Neuroimaging findings in pathological gambling C. B¨uchel ° . University Hospital Hamburg – Eppendorf, Department of Systems Neuroscience Neurolmage Nord, Hamburg, Germany Pathological gambling shares similarities with drug dependence including features of tolerance withdrawal and diminished control. In analogy to drug dependence it has been speculated that the underlying pathology includes a sensitivity reduction of the reward system to natural reinforcers. We tested this hypothesis by studying pathological gamblers and healthy controls during a simple gambling task and fMRI. We studied 12 male pathological gamblers and 13 healthy, matched controls using fMRI and a gambling task. In this task participants were shown the backside of two playing cards and a target color (red or black) in the middle. They were then asked to chose either the right or the left card with a button press. The selected card was turned over and depending on a match of colors the participant either won or lose one Euro. To rule out the possibility that more severe depression scores in gamblers as indicated by the Beck depression scale are responsible for group differences, these scores were included in the random effects model as group specific nuisance regressors. The simple main effect of winning versus losing showed highly significant activation in the ventral striatum for patients and controls. Based on these results we further investigated the differences