neural mechanisms of pathological gambling holst.pdf · 2018. 10. 22. · pathological gambling:...
TRANSCRIPT
Pathological gambling: DSM-VIa disorder of self-regulation
• persistent and recurrent maladaptive gambling behavior
preoccupation with gambling
gambling with increasing amounts to achieve desired excitement
unsuccessful efforts to control or stop gambling
restless or irritated when trying to stop
financial and social problems due to gambling
2006
2007
Gambling: a real addiction?
2006
Goudriaan, Oosterlaan, de Beurs, van den Brink (2006), Addiction.
Background
Pathological gambling: DSM-5a behavioral addiction
• DSM-5 to reclassify PG with ‘Addiction and Related Disorders’ based on similarities:
–Core symptoms
–Co-morbidities
–Shared heritability / genetics
–Functional imaging and neurocognitive profile
–Effective treatments (CBT, nalmefene)
Similar brain processes in gambling as in drug addiction?
Winning money
- Gambling as a model for the behavioral effects of addiction
Dopamine as pleasure/saliency neurotransmitter
Impaired Response Inhibition-Salience Attribution model
(Goldstein & Volkow, 2002, 2006)
Reward circuitNucleus AccVentrale Tegm.Striatum
Motivation:OFC, insula
Control:ACCDLPFC
Cue reactivity in problem gamblers
Control Problem
group Gamblers
Goudriaan, De Ruiter, Veltman, Oosterlaan, van den Brink, 2009, Addiction Biology
Cue reactivity in problem gamblers
OR
Error Monitoring: Stop Signal Task
De Ruiter, Oosterlaan, Veltman, van den Brink, Goudriaan, 2012, Drug Alc Dep
Error Monitoring: Stop Task
Controls Smokers Problem Gamblers
Activation in response to errors
De Ruiter, Oosterlaan, Veltman, van den Brink, Goudriaan, 2012, Drug Alc Dep
Perseveration, Reward, Punishment
Probabilistic Reversal Learning Task
Try to win as much as possible!400 trials
CR = Correct ResponseBL = Baseline TrialPENS = Probabilistic Error, No Shift PRE = Preceding Reversal ErrorFRE = Final Reversal Error
De Ruiter, Veltman, Oosterlaan, Goudriaan, Sjoerds, van den Brink, 2009Neuropsychopharmacology
Probabilistic Reversal Learning Task
0
5
10
15
20
25
Controls Smokers Gamblers
Gains in Euro's
*(p<0.05)
*(p<0.01)
De Ruiter, Veltman, Oosterlaan, Goudriaan, Sjoerds, van den Brink, 2009Neuropsychopharmacology
Probabilistic Reversal Learning Task
Controls Smokers Problem Gamblers
Brain activity after winning money
Reuter et al. (2005, Nat Neurosc):Controls Gamblers
o Near misses increase gambling propensity and are known to activate the ‘reward circuit’
Clark et al 2009 Neuron
Near-misses in Gambling
Reward processing in pathological gambling
WAIT
Van Holst, Veltman, van den Brink, Goudriaan, Biol Psychiatry, 2012
Summary: Impaired Response Inhibition-Salience Attribution model also in Gambling
(Goldstein & Volkow, 2002, 2006)
Motivation:OFC, insula
Reward circuitNucleus AccVentrale Tegm.Striatum
Control:ACCDLPFC
Conclusion
• Disordered gambling resembles drug addiction in diminished control and abnormal reward sensitivity
• Disordered gambling is different from drug addiction in the absence of toxicity and possibly cognitions concerning gambling
