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Although there has been significant research on the relationship between alcohol consumption and demographic and psychological influences, this does not consider the effect of social influence among older drinkers and if these effects differ between men and women. One aspect of social influence is social capital. The aim of this paper is to examine whether relational and cognitive social capital are associated with higher or lower risk of alcohol use among adults aged 50 years or older and to assess the extent to which this relationship differs between men and women. To investigate this, data were collected from a cross-sectional questionnaire survey of adults over the age of 50 in the United Kingdom who were recruited from general practitioners. The sample consisted of 9,984 individuals whose mean age was 63.87 years. From these data, we developed proxy measures of social capital and associate these with the respondent's level of alcohol consumption as measured on the Alcohol Use Disorders Identification Test (AUDIT-10) scale. In the sample, just over 20 per cent reported an increasing risk or dependency on alcohol. Using two expressions of social capital – relational (social relationships) and cognitive (knowledge acquisition and understanding) – we found that greater levels of both are associated with a reduced risk of higher drinking risk. Being female had no significant effect when combined with relational capital but did have a significant effect when combined with cognitive capital. It is argued that interventions to enhance social relations among older people and education to help understand alcohol risks would be helpful to protect older people from the damaging effects of excessive alcohol consumption. [ABSTRACT FROM AUTHOR]

The concept of food addiction is currently a highly debated subject within both the general public and the scientific communities. The term food addiction suggests that individuals may experience addictive-like responses to food, similar to those seen with classic substances of abuse. An increasing number of studies have established the prevalence and correlates of food addiction. Moreover, food addiction may be associated with obesity and disordered eating. Thus, intervening on food addiction may be helpful in the prevention and therapy of obesity and eating disorders. However, controversy exists about if this phenomenon is best defined through paradigms reflective of Diagnostic and Statistical Manual of Mental Disorders (DSM-5) substance-related disorders (e.g. food addiction) or non-substance-related disorders (e.g. eating addiction) criteria. This review paper will give a brief summarisation of the current state of research on food addiction, a more precise definition of its classification, its differentiation from eating addiction and an overview on potential overlaps with eating disorders. Based on this review, there is evidence that food addiction may represent a distinct phenomenon from established eating disorders such as bulimia nervosa or binge-eating disorder. Future studies are needed to further examine and establish orthogonal diagnostic criteria specific to food addiction. Such criteria must differentiate the patterns of eating and symptoms that may be similar to those of eating disorders to further characterise food addiction and develop therapy options. To date, it is too premature to draw conclusions about the clinical significance of the concept of food addiction. [ABSTRACT FROM AUTHOR]

In 2018, an international group under supervision of Prof. dr. Astrid Müller wrote a paper in which they stated that it is really time to recognize Compulsive Buying (CB) as a separate mental health condition (Müller et al., 2018, CNS Spectrums, 1-6). My talk will be inspired by this statement paper of which I was a co-author. CB is often defined by the excessive preoccupations with buying/shopping, that are experienced as irresistible, and recurrent maladaptive buying/shopping excesses that lead to marked distress and impairments. A meta-analysis indicated a prevalence rate of CB of 5%, which is increasing in developing societies. The majority of studies found that CB is higher among women, certainly in treatment-seeking samples. Comorbidity rates with CB are high, with mood disorders, hoarding disorder, eating disorders and gambling and substance use disorders as well as personality disorders. There are some commonalities between CB and obsessive-compulsive disorders, impulse control disorder, substance-use disorders and gambling disorder, the latter suggesting that CB might be considered as a behavioral addiction. Considering recent research findings, the prevalence of CB, the interference with daily functioning and the number of treatment seeking people, it is really time to recognize CB as a separate mental health condition. [ABSTRACT FROM AUTHOR]

This article historicizes a single stage in how the contemporary obsessive–compulsive disorder (OCD) category was built. Starting from the position that the two central components which make up OCD are 'obsessions' and 'compulsions', it illustrates how these concepts were taken apart by a small group of clinical psychologists working at the Institute of Psychiatry and the Maudsley psychiatric hospital in south London in the early 1970s, and why compulsions were investigated whilst obsessions were ignored. The decision to distinguish the previously undifferentiated symptoms is attributed to the commitment amongst psychologists at the Maudsley, most notably Stanley Rachman, to an empirical conception of science which emphasized observability. Two aspects of this are discussed. First, compulsions were deemed 'visible' through their correspondence with animal behaviour. Second, the symptom was seen as open to an experimental modification procedure which privileged visible outcomes. Ultimately, the article concludes that the historical division between 'obsessions' and 'compulsions', and the extensive investigation of the latter, has had substantial implications for the development of OCD as a category centred on visible behaviours and treated through behavioural means. [ABSTRACT FROM AUTHOR]

Behavioral addiction (BA) and substance use disorder (SUD) share similarities and differences in clinical symptoms, cognitive functions, and behavioral attributes. However, little is known about whether and how functional networks in the human brain manifest commonalities and differences between BA and SUD. Voxel-wise meta-analyses of resting-state functional connectivity (rs-FC) were conducted in BA and SUD separately, followed by quantitative conjunction analyses to identify the common and distinct alterations across both the BA and SUD groups. A total of 92 datasets with 2444 addicted patients and 2712 healthy controls (HCs) were eligible for the meta-analysis. Our findings demonstrated that BA and SUD exhibited common alterations in rs-FC between frontoparietal network (FPN) and other high-level neurocognitive networks (i.e. default mode network (DMN), affective network (AN), and salience network (SN)) as well as hyperconnectivity between SN seeds and the Rolandic operculum in SSN. In addition, compared with BA, SUD exhibited several distinct within- and between-network rs-FC alterations mainly involved in the DMN and FPN. Further, altered within- and between-network rs-FC showed significant association with clinical characteristics such as the severity of addiction in BA and duration of substance usage in SUD. The common rs-FC alterations in BA and SUD exhibited the relationship with consistent aberrant behaviors in both addiction groups, such as impaired inhibition control and salience attribution. By contrast, the distinct rs-FC alterations might suggest specific substance effects on the brain neural transmitter systems in SUD. [ABSTRACT FROM AUTHOR]

Background: Excessive use of the internet is increasingly recognised as a global public health concern. Individual studies have reported cognitive impairment in problematic internet use (PIU), but have suffered from various methodological limitations. Confirmation of cognitive deficits in PIU would support the neurobiological plausibility of this disorder.Aims: To conduct a rigorous meta-analysis of cognitive performance in PIU from case-control studies; and to assess the impact of study quality, the main type of online behaviour (for example gaming) and other parameters on the findings.Method: A systematic literature review was conducted of peer-reviewed case-controlled studies comparing cognition in people with PIU (broadly defined) with that of healthy controls. Findings were extracted and subjected to a meta-analysis where at least four publications existed for a given cognitive domain of interest.Results: The meta-analysis comprised 2922 participants across 40 studies. Compared with controls, PIU was associated with significant impairment in inhibitory control (Stroop task Hedge's g = 0.53 (s.e. = 0.19-0.87), stop-signal task g = 0.42 (s.e. = 0.17-0.66), go/no-go task g = 0.51 (s.e. = 0.26-0.75)), decision-making (g = 0.49 (s.e. = 0.28-0.70)) and working memory (g = 0.40 (s.e. = 0.20-0.82)). Whether or not gaming was the predominant type of online behaviour did not significantly moderate the observed cognitive effects; nor did age, gender, geographical area of reporting or the presence of comorbidities.Conclusions: PIU is associated with decrements across a range of neuropsychological domains, irrespective of geographical location, supporting its cross-cultural and biological validity. These findings also suggest a common neurobiological vulnerability across PIU behaviours, including gaming, rather than a dissimilar neurocognitive profile for internet gaming disorder.Declaration Of Interest: S.R.C. consults for Cambridge Cognition and Shire. K.I.'s research activities were supported by Health Education East of England Higher Training Special interest sessions. A.E.G.'s research has been funded by Innovational grant (VIDI-scheme) from ZonMW: (91713354). N.A.F. has received research support from Lundbeck, Glaxo-SmithKline, European College of Neuropsychopharmacology (ECNP), Servier, Cephalon, Astra Zeneca, Medical Research Council (UK), National Institute for Health Research, Wellcome Foundation, University of Hertfordshire, EU (FP7) and Shire. N.A.F. has received honoraria for lectures at scientific meetings from Abbott, Otsuka, Lundbeck, Servier, Astra Zeneca, Jazz pharmaceuticals, Bristol Myers Squibb, UK College of Mental Health Pharmacists and British Association for Psychopharmacology (BAP). N.A.F. has received financial support to attend scientific meetings from RANZCP, Shire, Janssen, Lundbeck, Servier, Novartis, Bristol Myers Squibb, Cephalon, International College of Obsessive-Compulsive Spectrum Disorders, International Society for Behavioral Addiction, CINP, IFMAD, ECNP, BAP, the World Health Organization and the Royal College of Psychiatrists. N.A.F. has received financial royalties for publications from Oxford University Press and payment for editorial duties from Taylor and Francis. J.E.G. reports grants from the National Center for Responsible Gaming, Forest Pharmaceuticals, Takeda, Brainsway, and Roche and others from Oxford Press, Norton, McGraw-Hill and American Psychiatric Publishing outside of the submitted work. [ABSTRACT FROM AUTHOR]

Background: Characteristic changes in the asymmetric nature of the human brain are associated with neurodevelopmental differences related to autism. In people with autism, these differences are thought to affect brain structure and function, although the structural and functional bases of these defects are yet to be fully characterized. Methods: We applied a comprehensive meta-analysis to resting-state functional and structural magnetic resonance imaging datasets from 370 people with autism and 498 non-autistic controls using seven datasets of the Autism Brain Imaging Data Exchange Project. We studied the meta-effect sizes based on standardized mean differences and standard deviations (s.d.) for lateralization of gray matter volume (GMV), fractional amplitude of low-frequency fluctuation (fALFF), and regional homogeneity (ReHo). We examined the functional correlates of atypical laterality through an indirect annotation approach followed by a direct correlation analysis with symptom scores. Results: In people with autism, 85, 51, and 51% of brain regions showed a significant diagnostic effect for lateralization in GMV, fALFF, and ReHo, respectively. Among these regions, 35.7% showed overlapping differences in lateralization in GMV, fALFF, and ReHo, particularly in regions with functional annotations for language, motor, and perceptual functions. These differences were associated with clinical measures of reciprocal social interaction, communication, and repetitive behaviors. A meta-analysis based on s.d. showed that people with autism had lower variability in structural lateralization but higher variability in functional lateralization. Conclusion: These findings highlight that atypical hemispheric lateralization is a consistent feature in autism across different sites and may be used as a neurobiological marker for autism. [ABSTRACT FROM AUTHOR]

Background: High levels of multidimensional perfectionism may be dysfunctional in their own right and can also impact on the maintenance and treatment of Axis I psychiatric disorders., Aims: This paper sought to describe the behavioural expressions and imagery associated with perfectionism in a non-clinical sample., Method: Participants (n = 59) completed a newly developed questionnaire to assess behavioural expressions of perfectionism, and an adapted interview to assess perfectionism-related intrusive mental images., Results: The study found that those high in perfectionism took longer to complete tasks, experienced more checking and safety behaviour whilst carrying out tasks, and had greater trouble actually completing tasks compared to those low in perfectionism. In addition, those with higher levels of perfectionism experienced intrusive mental imagery, which was more distressing, harder to dismiss, and had more impact on behaviour than those with lower levels of perfectionism., Conclusions: This research provides an initial exploration of the specific behaviours and intrusive mental imagery associated with perfectionism. The new behavioural measure of perfectionism could prove useful clinically in the assessment of change; however, these findings are preliminary and warrant replication in a clinical sample in order to examine their treatment implications.

Information about several papers discussed at a symposium in South Carolina on the controversies and conundrums in mental health and illness are presented. Topics include cases on criminal responsibility, refusal of medication to avoid execution, and treatment of mental illness by force. The symposium featured the papers from Joseph Bloom, Melissa McDonnell and Robert Phillips, and Howard Zonana.

Eighty-two obsessional neurotics were studied from a phenomenological point of view in order to delineate the various forms and contents of obsessions and compulsions. An attempt was made to ascertain the frequency with which the different forms and content occur and their effect on the final outcome of the disorder. Five types of obsessions were identified: doubts, obsessive thinking, fears, impulses, and images, in order of frequency of their occurrence. Compulsive acts could be classified in two types, depending on whether they yielded to or diverted the underlying obsession. One-fourth of the patients displayed no compulsions. The content of obsession could be classified in five broad categories as relating to: dirt and contamination, aggression, inanimate-impersonal themes, religion, and sexual matters, in order of the frequency of their occurrence. The paper, while offering an interpretation of these findings, emphasizes the part played by socio-cultural factors in the character of an obsession's thought content. The absence of compulsions was found to be associated with good prognosis. A downward gradient was noted in the final outcome of patients without compulsions, those with controlling compulsions alone, those with both varieties of compulsions, and those displaying yielding compulsions alone, in that order. Based on this observation the paper suggests a prognosis-related hierarchical continuum of the severity of obsessional disorder. [ABSTRACT FROM AUTHOR]

Background: Disorders involving compulsivity, fear, and anxiety are linked to beliefs that the world is less predictable. We lack a mechanistic explanation for how such beliefs arise. Here, we test a hypothesis that in people with compulsivity, fear, and anxiety, learning a probabilistic mapping between actions and environmental states is compromised. Methods: In Study 1 (n = 174), we designed a novel online task that isolated state transition learning from other facets of learning and planning. To determine whether this impairment is due to learning that is too fast or too slow, we estimated state transition learning rates by fitting computational models to two independent datasets, which tested learning in environments in which state transitions were either stable (Study 2: n = 1413) or changing (Study 3: n = 192). Results: Study 1 established that individuals with higher levels of compulsivity are more likely to demonstrate an impairment in state transition learning. Preliminary evidence here linked this impairment to a common factor comprising compulsivity and fear. Studies 2 and 3 showed that compulsivity is associated with learning that is too fast when it should be slow (i.e. when state transition are stable) and too slow when it should be fast (i.e. when state transitions change). Conclusions: Together, these findings indicate that compulsivity is associated with a dysregulation of state transition learning, wherein the rate of learning is not well adapted to the task environment. Thus, dysregulated state transition learning might provide a key target for therapeutic intervention in compulsivity. [ABSTRACT FROM AUTHOR]

Newly emerging links between sugar and addiction raise challenging issues for public health policy. What was once a naturally occurring food ingredient is now a highly concentrated food additive. If foods containing artificially high levels of sugar are capable of triggering addictive behaviors, how should policymakers respond? What regulatory steps would be suitable and practical? This paper explores the concept and definition of addiction and presents evidence of the addictive potential of sugar. It also explores the legal implications if sufficient evidence demonstrates that sugar is indeed addictive. [ABSTRACT FROM AUTHOR]

Despite a strong evidence base for cognitive behavioural therapy (CBT) for obsessive compulsive disorder (OCD), there is limited evidence regarding the effectiveness of group therapy compared to individual therapy. As services struggle to manage high demands, CBT for OCD is often offered in group format. This paper examines the current evidence base for group CBT for OCD considering both clinical outcomes and cost, and describes a group CBT intervention for people with OCD. A CBT group was set up, consistent with NICE guidelines, but slightly adapted from standard group protocols, in line with recommendations from experts in the field. It was evaluated as part of an audit of the service. Statistical analyses demonstrated significant improvements in both measures of depression and the impact of difficulties, and on specific measures of OCD, in clients who attended group CBT (n = 17). The analyses also demonstrated improved effectiveness of therapist hours for group therapy compared to individual therapy. It is concluded that group therapy for OCD should be considered as an alternative to individual therapy when there are significant demands on the service. Recommendations regarding specific adaptations to the standard group CBT format are made. [ABSTRACT FROM PUBLISHER]

An editorial is presented on witnessing an enthusiastic revival of research into the therapeutic potential of psychedelic drugs. Topics include high scientific standards requiring clinical research in other areas also be applied to the evaluation of psychedelic medicines; and effect of psilocybin and methylenedioxymethamphetamine on mental, behavioral, or developmental disorders.

Delay discounting paradigms have gained widespread popularity across clinical research. Given the prevalence in the field, researchers have set lofty expectations for the importance of delay discounting as a key transdiagnostic process and a 'core' process underlying specific domains of dysfunction (e.g. addiction). We believe delay discounting has been prematurely reified as, in and of itself, a core process underlying psychological dysfunction, despite significant concerns with the construct validity of discounting rates. Specifically, high delay discounting rates are only modestly related to measures of psychological dysfunction and therefore are not 'core' to these more complex behavioral problems. Furthermore, discounting rates do not appear to be specifically related to any disorder(s) or dimension(s) of psychopathology. This raises fundamental concerns about the utility of discounting, if the measure is only loosely associated with most forms of psychopathology. This stands in striking contrast to claims that discounting can serve as a 'marker' for specific disorders, despite never demonstrating adequate sensitivity or specificity for any disorder that we are aware of. Finally, empirical evidence does not support the generalizability of discounting rates to other decisions made either in the lab or in the real-world, and therefore discounting rates cannot and should not serve as a summary measure of an individual's decision-making patterns. We provide recommendations for improving future delay discounting research, but also strongly encourage researchers to consider whether the empirical evidence supports the field's hyper-focus on discounting. [ABSTRACT FROM AUTHOR]

Background: Studies of Internet gaming disorder (IGD) suggest an imbalanced relationship between cognitive control and reward processing in people with IGD. However, it remains unclear how these two systems interact with each other, and whether they could serve as neurobiological markers for IGD. Methods: Fifty IGD subjects and matched individuals with recreational game use (RGU) were selected and compared when they were performing a cue-craving task. Regions of interests [anterior cingulate cortex (ACC), lentiform nucleus] were selected based on the comparison between brain responses to gaming-related cues and neutral cues. Directional connectivities among these brain regions were determined using Bayesian estimation. We additionally examined the posterior cingulate cortex (PCC) in a separate analysis based on data implicating the PCC in craving in addiction. Results: During fixed-connectivity analyses, IGD subjects showed blunted ACC-to-lentiform and lentiform-to-ACC connectivity relative to RGU subjects, especially in the left hemisphere. When facing gaming cues, IGD subjects trended toward lower left-hemispheric modulatory effects in ACC-to-lentiform connectivity than RGU subjects. Self-reported cue-related craving prior to scanning correlated inversely with left-hemispheric modulatory effects in ACC-to-lentiform connectivity. Conclusions: The results suggesting that prefrontal-to-lentiform connectivity is impaired in IGD provides a possible neurobiological mechanism for difficulties in controlling gaming-cue-elicited cravings. Reduced connectivity ACC-lentiform connectivity may be a useful neurobiological marker for IGD. [ABSTRACT FROM AUTHOR]

Obsessional slowness is regarded as an uncommon but severely disabling variant of obsessive-compulsive disorder. This paper examines the psychopathology, classification, pathophysiology and treatment of obsessional slowness. It argues that primary obsessional slowness does not require classification as a separate syndrome because it can be found to be secondary to recognised phenomena of obsessive-compulsive disorder or anankastic personality disorder. The treatment described in the literature is not thought to be successful in the long term, and controlled trials are required to evaluate new strategies and antidepressant medication. [ABSTRACT FROM AUTHOR]

Background: Impulsivity and compulsivity are central to understanding a range of psychiatric disorders but also to understanding the spectrum of normative human behavior. It was recently shown that separable latent phenotypes of impulsivity and compulsivity could be fractionated. The possible genetic contributions to these latent phenotypes have yet to be elicited. The catechol-o-methyl transferase (COMT) Val158Met polymorphism (rs4680) regulates cortical dopamine degradation and is a key area of interest in this context. Methods: COMT Val158Met polymorphism status was obtained from a random subset (n = 258) of young adults from an established cohort, for whom latent phenotype scores were previously reported. Differences in latent phenotype scores were explored between COMT groups using analysis of variance (ANOVA) and post-hoc t tests. Results: The Val-Val subgroup exhibited significantly elevated compulsivity scores compared to both other groups. Impulsivity scores did not differ significantly as a function of COMT Val158Met polymorphism status. Conclusions: These results suggest that the COMT polymorphism, and by implication cortical dopamine degradation, influences the expression of a trans-diagnostic compulsivity phenotype, even accounting for possible confounding effects of impulsivity. [ABSTRACT FROM AUTHOR]

This issue contains two reviews, one on chronic fatigue syndrome and one on suicide and the menstrual cycle. Other sets of papers examine various aspects of suicide, addictive behaviours, and depression, and three individual papers examine a variety of topics. [ABSTRACT FROM AUTHOR]

Background: Previous literature has extensively investigated the brain activity during response inhibition in adults with addiction. Inconsistent results including both hyper- and hypo-activities in the fronto-parietal network (FPN) and the ventral attention network (VAN) have been found in adults with addictions, compared with healthy controls (HCs). Methods: Voxel-wise meta-analyses of abnormal task-evoked regional activity were conducted for adults with substance dependence (SD) and behavioral addiction during response inhibition tasks to solve previous inconsistencies. Twenty-three functional magnetic resonance imaging studies including 479 substance users, 38 individuals with behavioral addiction and 494 HCs were identified. Results: Compared with HCs, all addictions showed hypo-activities in regions within FPN (inferior frontal gyrus and supramarginal gyrus) and VAN (inferior frontal gyrus, middle temporal gyrus, temporal pole and insula), and hyper-activities in the cerebellum during response inhibition. SD subgroup showed almost the same activity patterns, with an additional hypoactivation of the precentral gyrus, compared with HCs. Stronger activation of the cerebellum was associated with longer addiction duration for adults with SD. We could not conduct meta-analytic investigations into the behavioral addiction subgroup due to the small number of datasets. Conclusion: This meta-analysis revealed altered activation of FPN, VAN and the cerebellum in adults with addiction during response inhibition tasks using non-addiction-related stimuli. Although FPN and VAN showed lower activity, the cerebellum exhibited stronger activity. These results may help to understand the neural pathology of response inhibition in addiction. [ABSTRACT FROM AUTHOR]

Introduction: The history of social networking sites (SNSs) dates back to 1997, when the first SNS SixDegrees emerged (Boyd D et al, 2008). In 2004, Facebookwas launched. In SNSs individuals connect with others who share similar interests. The perceived need to be online may result in compulsive use of SNSs, which in extreme cases may result in symptoms and consequences traditionally associated with substance-related addictions. Objectives: To present a non systematic review on the subject of social networking sites addiction; to draw attention to its clinical features and therapeutic approach. Methods: Brief review of the english literature published using the Pubmed® database. Key-words: "social media addiction"; "social networking sites and addiction"; "psychiatric symptoms o and social networking sites addiction". Articles were selected based on the content of the abstract and its relevance. Results: SNS use may lead to symptoms traditionally associated with substance-related addictions (Kuss D.J et al, 2011; Andreassen C.S, 2015). These symptoms are salience, mood modification, tolerance, withdrawal, relapse, and conflict with regards to behavioral addictions (Griffiths M. D et al, 2005). High engagement in social networking is partially due to the 'fear of missing out' (FOMO), a pervasive apprehension that others might be having rewarding experiences fromwhich one is absent" (Przybyloki A. K et al, 2013). Conclusions: When SNS use is discontinued, addicted individuals will experience negative psychological and sometimes physiological symptoms (withdrawal), often leading to a reinstatement of the problematic behavior (relapse). SNSs addiction is a genuine mental health problem that needs attention from professionals, affecting person's social-biological development (Barker Vet al, 2009). [ABSTRACT FROM AUTHOR]

The question as to whether people with an addiction have control (and to what extent) over their addiction, and voluntarily decide to use substances is an ongoing source of controversy in the context of research on addiction, health policy and clinical practice. We describe and discuss a set of five challenges for further research into voluntariness (definition[s], measurement and study tools, first person perspectives, contextual understandings, and connections to broader frameworks) based on our own research experiences and those of others. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article about the stigma against people who use drugs.

Background: Gambling disorder (GD), recognized in Diagnostic and Statistical Manual of Mental Disorders, Version 5 (DSM-5) as a behavioral addiction, is associated with a range of adverse outcomes. However, there has been little research on the genetic and environmental influences on the development of this disorder. This study reports results from the largest twin study of GD conducted to date. Methods: Replication and combined analyses were based on samples of 3292 (mean age 31.8, born 1972–79) and 4764 (mean age 37.7, born 1964–71) male, female, and unlike-sex twin pairs from the Australian Twin Registry. Univariate biometric twin models estimated the proportion of variation in the latent GD liability that could be attributed to genetic, shared environmental, and unique environmental factors, and whether these differed quantitatively or qualitatively for men and women. Results: In the replication study, when using a lower GD threshold, there was evidence for significant genetic (60%; 95% confidence interval (CI) 45–76%) and unique environmental (40%; 95% CI 24–56%), but not shared environmental contributions (0%; 95% CI 0–0%) to GD liability; this did not significantly differ from the original study. In the combined analysis, higher GD thresholds (such as one consistent with DSM-5 GD) and a multiple threshold definitions of GD yielded similar results. There was no evidence for quantitative or qualitative sex differences in the liability for GD. Conclusions: Twin studies of GD are few in number but they tell a remarkably similar story: substantial genetic and unique environmental influences, with no evidence for shared environmental contributions or sex differences in GD liability. [ABSTRACT FROM AUTHOR]

A reply from the authors of the article about the stigma against people who use drugs is presented.

This paper details three case reports that suggest that pathological gambling activity may have been adversely modified following treatment for psychosis with the antipsychotic aripiprazole. These reports are discussed in the context of previous observations of the potential impact of aripiprazole on impulse control and the implications such observations could have for clinical practice and future research. [ABSTRACT FROM AUTHOR]

Excessive internet use has been linked to psychopathology. Therefore, understanding the genetic and environmental risks underpinning internet use and their relation to psychopathology is important. This study aims to explore the genetic and environmental etiology of internet use measures and their associations with internalizing disorders and substance use disorders. The sample included 2,059 monozygotic (MZ) and dizygotic (DZ) young adult twins from the Brisbane Longitudinal Twin Study (BLTS). Younger participants reported more frequent internet use, while women were more likely to use the internet for interpersonal communication. Familial aggregation in ‘frequency of internet use’ was entirely explained by additive genetic factors accounting for 41% of the variance. Familial aggregation in ‘frequency of use after 11 pm’, ‘using the internet to contact peers’, and ‘using the internet primarily to access social networking sites’ was attributable to varying combinations of additive genetic and shared environmental factors. In terms of psychopathology, there were no significant associations between internet use measures and major depression (MD), but there were positive significant associations between ‘frequency of internet use’ and ‘frequency of use after 11 pm’ with social phobia (SP). ‘Using the internet to contact peers’ was positively associated with alcohol abuse, whereas ‘using the internet to contact peers’ and ‘using the internet primarily to access social networking sites’ were negatively associated with cannabis use disorders and nicotine symptoms. Individual differences in internet use can be attributable to varying degrees of genetic and environmental risks. Despite some significant associations of small effect, variation in internet use appears mostly unrelated to psychopathology. [ABSTRACT FROM PUBLISHER]

BackgroundLittle is known about the factors influencing the stability of obsessive–compulsive behaviour (OCB) from childhood to adolescence. The current study aimed to investigate: (1) the stability of paediatric OCB over a 12-year period; (2) the extent to which genetic and environmental factors influence stability; and (3) the extent to which these influences are stable or dynamic across development.MethodThe sample included 14 743 twins from a population-based study. Parental ratings of severity of OCB were collected at ages 4, 7, 9 and 16 years.ResultsOCB was found to be moderately stable over time. The genetic influence on OCB at each age was moderate, with significant effects also of non-shared environment. Genetic factors exerted a substantial influence on OCB persistence, explaining 59–80% of the stability over time. The results indicated genetic continuity, whereby genetic influences at each age continue to affect the expression of OCB at subsequent ages. However, we also found evidence for genetic attenuation in that genetic influences at one age decline in their influence over time, and genetic innovation whereby new genes ‘come on line’ at each age. Non-shared environment influenced stability of OCB to a lesser extent and effects were largely unique to each age and displayed negligible influences on OCB at later time points.ConclusionsOCB appears to be moderately stable across development, and stability is largely driven by genetic factors. However, the genetic effects are not entirely constant, but rather the genetic influence on OCB appears to be a developmentally dynamic process. [ABSTRACT FROM AUTHOR]

Background.In this meta-analysis we review the findings from neuropsychological studies on set-shifting in people with eating disorders (EDs) or overweight/obesity.Method.Four databases (PubMed, PsycINFO, PSYNDEX and Web of Science) were searched for eligible studies. Effect sizes (ESs) were pooled using random-effects models. Moderator analyses were conducted for ED and overweight/obese subgroups, adult/adolescent samples and measures of set-shifting.Results.Sixty-four studies with a total of 1825 ED patients [1394 anorexia nervosa (AN), 376 bulimia nervosa (BN) and 55 binge eating disorder (BED)] and 10 studies with a total of 449 overweight/obese individuals were included. The meta-analysis revealed a small to medium ES for inefficient set-shifting across all three ED diagnoses (Hedges’ g = –0.45). Subgroup analyses yielded small to medium ESs for each ED subtype (g = –0.44 for AN, –0.53 for BED, –0.50 for BN), which did not differ significantly. There was a medium ES for restricting type AN (ANR; g = –0.51) but no significant ES for binge/purge type AN (AN/BP; g = –0.18). A medium ES was found across obesity studies (g = –0.61). The ES across overweight studies was not significant (g = –0.07). Adult samples did not differ from adolescent samples in either ED or overweight/obesity studies. The different set-shifting measures were associated with largely varying ESs.Conclusions.The meta-analysis provides strong support that inefficient set-shifting is a salient neuropsychological phenomenon across ED subtypes and obesity, but is less prominent in AN/BP and overweight. Compulsivity seems to be a common underlying factor supporting a dimensional and transdiagnostic conceptualization of EDs and obesity. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to a paper by Chapman and Chapman-Santana in the February 1995 issue about the influence of Friedrich Wilhelm Nietzsche on Sigmund Freud's ideas.

Belief in free will has been a mainstay in philosophy throughout history, grounded in large part in our intuitive sense that we consciously control our actions and could have done otherwise. However, psychology and psychiatry have long sought to uncover mechanistic explanations for human behavior that challenge the notion of free will. In recent years, neuroscientific discoveries have produced a model of volitional behavior that is at odds with the notion of contra-causal free will and our sense of conscious agency. Volitional behavior instead appears to have antecedents in unconscious brain activity that is localizable to specific neuroanatomical structures. Updating notions of free will in favor of a continuous model of volitional self-control provides a useful paradigm to conceptualize and study some forms of psychopathology such as addiction and impulse control disorders. Similarly, thinking of specific symptoms of schizophrenia as disorders of agency may help to elucidate mechanisms of psychosis. Beyond clinical understanding and etiological research, a neuroscientific model of volitional behavior has the potential to modernize forensic notions of responsibility and criminal punishment in order to inform public policy. Ultimately, moving away from the language of free will towards the language of volitional control may result in an enhanced understanding of the very nature of ourselves. [ABSTRACT FROM AUTHOR]

Craving for chocolate is a common phenomenon, which may evolve to an addictive-like behaviour and contribute to obesity. Nepicastat is a selective dopamine β-hydroxylase (DBH) inhibitor that suppresses cocaine-primed reinstatement of cocaine seeking in rats. We verified whether nepicastat was able to modify the reinforcing and motivational properties of a chocolate solution and to prevent the reinstatement of chocolate seeking in rats. Nepicastat (25, 50 and 100 mg/kg, intraperitoneal) produced a dose-related inhibition of operant self-administration of the chocolate solution in rats under fixed-ratio 10 (FR10) and progressive-ratio schedules of reinforcement, measures of the reinforcing and motivational properties of the chocolate solution, respectively. The effect of nepicastat on the reinstatement of chocolate seeking was studied in rats in which lever-responding had been extinguished by removing the chocolate solution for approximately 8 d. Nepicastat dose-dependently suppressed the reinstatement of lever-responding triggered by a ‘priming’ of the chocolate solution together with cues previously associated with the availability of the reward. In a separate group of food-restricted rats trained to lever-respond for regular food pellets, nepicastat reduced FR10 lever-responding with the same potency as for the chocolate solution. Spontaneous locomotor activity was not modified by nepicastat doses that reduced self-administration of the chocolate solution and regular food pellets and suppressed the reinstatement of chocolate seeking. The results indicate that nepicastat reduces motivation to food consumption sustained by appetite or palatability. Moreover, the results suggest that DBH inhibitors may be a new class of pharmacological agents potentially useful in the prevention of relapse to food seeking in human dieters. [ABSTRACT FROM PUBLISHER]

Recent developments in the drug field have prompted claims that criminal justice has displaced health from its formerly dominant position and have also been used to support general claims about the criminalisation of social policy. This article critically assesses such claims and offers an alternative interpretation, arguing that British drug policy has been shaped and reshaped by the broader workings of the modern state. Early controls reflected the influence of medicine and public health over emerging forms of state interventionism, while subsequent arrangements were consistent with the penal-welfare tradition that dominated criminal justice for much of the last century. More recently, it is the transformation of this tradition that has played a key role in reshaping the drug field, producing evidence of both continuity and change. What others have attributed to ‘criminalisation’, therefore, is said to reflect broader changes in the nature of criminal justice itself. Whilst the transformation of penal-welfarism helps to explain the development of more punitive and coercive forms of drug control, this is only part of the story. As with criminal justice more generally, the limitations of the sovereign state have given rise to various adaptive strategies and it is here that considerable continuity can be seen, particularly in relation to the on-going importance of drug treatment and harm reduction. [ABSTRACT FROM PUBLISHER]

Background. Pathological gambling (PG) is an impulse control disorder characterized by excessive monetary risk seeking in the face of negative consequences. We used tools from the field of behavioral economics to refine our description of risk-taking behavior in pathological gamblers. This theoretical framework allowed us to confront two hypotheses: (1) pathological gamblers distort winning probabilities more than controls; and (2) pathological gamblers merely overweight the whole probability range. Method. Eighteen pathological gamblers and 20 matched healthy participants performed a decision-making task involving choices between safe amounts of money and risky gambles. The online adjustment of safe amounts, depending on participants' decisions, allowed us to compute 'certainty equivalents' reflecting the subjective probability weight associated with each gamble. The behavioral data were then fitted with a mathematical function known as the 'probability weighting function', allowing us to disentangle our two hypotheses. Results. The results favored the second hypothesis, suggesting that pathological gamblers' behavior reflects economic preferences globally shifted towards risk, rather than excessively distorted probability weighting. A mathematical parameter (elevation parameter) estimated by our fitting procedure was found to correlate with gambling severity among pathological gamblers, and with gambling affinity among controls. Conclusions. PG is associated with a specific pattern of economic preferences, characterized by a global (i.e. probability independent) shift towards risky options. The observed correlation with gambling severity suggests that the present' certainty equivalent' task may be relevant for clinical use. [ABSTRACT FROM AUTHOR]

The aim of this study was to estimate the rates of recovery, treatment-seeking, and natural recovery from pathological gambling (PG) in men and women in a community-based national survey, and to examine the role of gambling problem recognition in recovery from PG. Participants were 4,764 individuals from a community-based Australian national twin registry (104 with a lifetime history of PG) who were administered a structured psychiatric telephone interview. Women were more likely than men to recover from (56% versus 36%; odds ratio = 2.3) and to seek treatment for PG (32% versus 13%; odds ratio = 3.2). Most individuals who recovered from PG did so without treatment (82%), but this was higher among men than among women (92% versus 57%; odds ratio = 5.3). This is the first study to document sex differences in treatment-seeking and recovery from PG. These findings highlight the value in continuing to develop self-help and brief treatments for PG that will appeal to those who are unlikely to seek formal help. [ABSTRACT FROM AUTHOR]

Background. Impairments in executive cognitive control, including a reduced ability to inhibit prepotent responses, have been reported in autism spectrum disorders (ASD). These deficits may underlie patterns of repetitive behaviors associated with the disorder. Method. Eighteen individuals with ASD and 15 age- and IQ-matched healthy individuals performed an antisaccade task and a visually guided saccade control task, each with gap and overlap conditions. Measures of repetitive behaviors were obtained using the Autism Diagnostic Inventory - Revised (ADI-R) and examined in relation to neurocognitive task performance. Results. Individuals with an ASD showed increased rates of prosaccade errors (failures to inhibit prepotent responses) on the antisaccade task regardless of task condition (gap/overlap). Prosaccade error rates were associated with the level of higher-order (e.g. compulsions, preoccupations) but not sensorimotor repetitive behaviors in ASD. Conclusions. Neurocognitive disturbances in voluntary behavioral control suggest that alterations in frontostriatal systems contribute to higher-order repetitive behaviors in ASD. [ABSTRACT FROM AUTHOR]

According to the cognitive model, an inflated sense of responsibility is an important cognitive mediator both in the development and maintenance of obsessive-compulsive disorder (OCD). Empirical findings assign differential roles to responsibility in different kinds of obsessive-compulsive (OC) symptoms. However, findings that suggested a different function for responsibility revealed the need for an operational definition of responsibility and its multi-factorial structure. Few studies have examined the role of responsibility in OC symptoms in adolescents. The present study therefore aimed to explore responsibility concerns and to evaluate the relationship between responsibility dimensions and obsessive-compulsive symptom subgroups in two samples of adolescents and university students in a developing non-Western country. The findings suggested that the Responsibility Attitude Scale had a bifactorial structure, responsibility being based on self-dangerousness and prevention. Adolescents reported more responsibility in prevention and self-dangerousness than university students. The results appear to contribute to the symptom differentiation of OC behaviour by highlighting the importance of both dimensions of responsibility for checking symptoms, responsibility based on danger prevention for cleaning and, finally, responsibility based on self-dangerousness for obsessive thinking. Replication with clinical samples and different methodologies are encouraged. [ABSTRACT FROM PUBLISHER]

BackgroundDisinhibition and decision-making skills play an important role in theories on the cause and outcome of addictive behaviors such as substance use disorders and pathological gambling. In recent studies, both disinhibition and disadvantageous decision-making strategies, as measured by neurocognitive tests, have been found to influence the course of substance use disorders. Research on factors affecting relapse in pathological gambling is scarce.MethodThis study investigated the effect of both self-reported impulsivity and reward sensitivity, and neurocognitively assessed disinhibition and decision-making under conflicting contingencies, on relapse in a group of 46 pathological gamblers.ResultsLogistic regression analysis indicated that longer duration of the disorder and neurocognitive indicators of disinhibition (Stop Signal Reaction Time) and decision-making (Card Playing Task) were significant predictors of relapse (explaining 53% of the variance in relapse), whereas self-reported impulsivity and reward sensitivity did not significantly predict relapse. Overall classification accuracy was 76%, with a positive classification accuracy of 76% and a negative classification accuracy of 75%.ConclusionsDuration of the disorder and neurocognitive measures of disinhibition and decision-making are powerful predictors of relapse in pathological gambling. The results suggest that endophenotypical neurocognitive characteristics are more promising in the prediction of relapse in pathological gambling than phenotypical personality characteristics. Neurocognitive predictors may be useful to guide treatment planning of follow-up contacts and booster sessions. [ABSTRACT FROM AUTHOR]

Generally, the suppression of unwanted thoughts is found to be ineffective. Moreover, in the longer run, suppression attempts may backfire in that they produce a delayed increase in unwanted thoughts (i.e. a rebound effect). This ineffectiveness and paradox have been observed in various studies, and with various targets, such as neutral thoughts, obsessive intrusions, worries, addictive urges, and phobia-related cognitions. The present study sought to explore the effect of suppression of a different intrusion, namely a hallucination. Healthy undergraduates were exposed to a laboratory procedure that was to provoke hallucinations. Half of the participants were additionally given instructions to suppress the hallucinations. Results indicated that suppression was somewhat effective in the short run, but ineffective in the long run. However, no rebound effect was observed. [ABSTRACT FROM AUTHOR]

The newly proposed framework for non-addictive psychoactive substances postulated by Müller & Schumann (M&S) provides an interesting and plausible explanation for non-addictive drug use. However, with specific reference to the relevant behavioral addiction literature, this commentary argues that the model may unexpectedly hold utility not only for non-addictive use of drugs, but also for non-addictive use of other potentially addictive behaviors. [ABSTRACT FROM AUTHOR]

Redish et al. present a compelling, interdisciplinary, unified framework of addiction. The effort to integrate pathological gambling is especially important, but only the vulnerability of misclassifying situations is described in detail as being linked directly to this disorder. This commentary focuses on further developing the comprehensiveness of this framework for pathological gambling using over-fast discounting as an illustrative example. [ABSTRACT FROM AUTHOR]

The model proposed by Redish et a!. considers vulnerabilities within decision systems based on expectancy-value assumptions. Further understanding of processes leading to addiction can be gained by considering other inputs to decision-making, particularly affective associations with behaviors. This consideration suggests additional decision-making vulnerabilities that might explain addictive behaviors. [ABSTRACT FROM AUTHOR]

The framework for addiction offered by the target article can perhaps be simplified into fewer, more basic, vulnerabilities. "Impulsivity" covers a number of vulnerabilities, not just enhanced delay discounting. Real-world drug-use decisions involve both delay and probability discounting. The motivational salience of, and attentional bias for, drug cues may be related to a number of vulnerabilities. Interactions among vulnerabilities are of significance and complicate the application of this framework. [ABSTRACT FROM AUTHOR]

The unified framework for addiction (UFA) formulated by Redish et al. is a tour de force. It uniquely predicts that there should be multiple addiction syndromes and pathways — a diversity that would reflect the complexity of the mammalian brain decision system. Here I explore some of the evolutionary and developmental ramifications of UFA and derive several new avenues for research. [ABSTRACT FROM AUTHOR]

Instinct theory parsimoniously clarifies the relationships between emotions, such as fear and anxiety, and perceptions, thoughts, and actions. Its acceptance allows more elegant insights into riddles of obsessions and compulsions. Their relationship to anxiety and dysexecutive function needs to be explained, as does their characteristic egodystonia, while avoiding the pitfalls of cognitivist, empiricist, and teleological thinking. [ABSTRACT FROM AUTHOR]

The drug-reinforcement theory explains why humans get engaged in drug taking behavior. This theory posits that drugs of abuse serve as biological rewards by activating the reinforcement system. Although from a psychological and neurobiological perspective this theory is extremely helpful, it does not tell us about the drug-taking motives and motivation of an individual. The definition of drug instrumentalization goals will improve our understanding of individual drug-taking profiles. [ABSTRACT FROM AUTHOR]

Neuroscientists and psychologists have proposed a variety of well-supported theories to explain addiction. Many of these theories suggest that addiction results from a single process or dysfunction across all of its forms. The authors of the current review, in contrast, have used a well-defined theoretical account of decision-making to outline the variety of dysfunctions that could account for addictive behavior. [ABSTRACT FROM AUTHOR]

The model of addiction proposed by Redish et al. shows a lack of fit with recent data and models in psychological studies of addiction. In these dual process models, relatively automatic appetitive processes are distinguished from explicit goal-directed expectancies and motives, whereas these are all grouped together in the planning system in the Redish et al. model. Implications are discussed. [ABSTRACT FROM AUTHOR]