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Abnormal 3018 > Gambling > Flashcards

Gambling Flashcards

1
Q

Why do people persist in gambling despite negative consequences?

A
  1. to recoup losses (chasing)
  2. emotional escape
  3. for emotional reasons (narcissism, ego)
  4. manage dysfunctional affective states (depression, anxiety)
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2
Q

When did gambling increase significantly?

A
  • resurgence of gambling legislation since 1950s
  • in USA (lotteries), Oz (Casinos in hotels and states 1973), Britain (Royal Commission into gambling 1978), Europe (1990s), Asia 2000s
  • 2000s: technological advances leading to Internet and mobile interactive forms
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3
Q

What is the prevalence of gambling in the general population?

A
  • 60-85% of general population
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4
Q

What are the rates of pathological gamblers vs. problem gamblers in the USA, Australia & Europe?

A
  • 0.4-1.1% pathological gamblers

- 1-2% problem gamblers

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5
Q

What is the prevalence of gambling in adolescence?

A
  • 3-14% (median 5%)
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6
Q

What is the prevalence of pathological gamblers among gaming venue patrons?

A
  • 15-25% pathological gamblers
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7
Q

What is gambling now classified under in the DSM -V compared to DSM-IV?

A

DSM - IV: was classified as an ‘impulse control disorder’ (alongside Kleptomania, Pyromania etc)
DSM- V : now classified under addictions and related disorders under NON SUBSTANCE RELATED ADDICTIONS
Criteria same from DSM-IV to DSM-V except cut out need for illegal activity (and only need 4/9 instead of 5/10)

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8
Q

What classifies a gambling disorder (criterion a)?

A

CRITERION A: Four or more of:

  • Preoccupation (PSYCHOLOGICAL DEPENDENCE)
  • increased amount gambled (TOLERANCE)
  • irritability/restlessness on cessation (WITHDRAWAL)
  • escape from stress (-VE RFT & MOTIVATION)
  • chasing losses (ERRONEOUS & DISTORTED COGNITIONS)
  • lying
  • repeating failure to cease (IMPAIRED CONTROL)
  • ILLEGAL ACTS NOT ESSENTIAL
  • risked significant r/s
  • BAILOUT
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9
Q

What percentage of pathological gamblers experienced a win prior to developing problems?

A
  • 2/3
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10
Q

What is a facilitative cognition?

A

e.g. “I can win the casino”, “this is easy”

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11
Q

What happens in the early winning phase?

A
  • facilitative cognitions
  • gambling becomes a stronger influence on mood than other activities
  • increased frequency and intensity
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12
Q

What happens in the losing phase?

A
  • heightened preoccupation with gambling
  • growing losses & attempts to recoup (‘chasing losses’)
  • increased stress, irritability, withdrawal
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13
Q

What happens in the desperation phase of gambling?

A
  • efforts to survive financially & psychologically become increasingly extreme (e.g. illegal activities, r/s manipulation)
  • 60% have committed an offence to finance gambling
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14
Q

What % of pathological gamblers have committed an offence to finance their gambling?

A
  • 60%
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15
Q

What is the age of onset in gambling?

A
  • mostly in adolescence & young adults
    (average 12-15 yrs)
  • females bimodal (youth and >45 yrs)
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16
Q

What is the average age of seeking treatment in gambling?

A
  • 35-39 years
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17
Q

Do males/females tend to have more gambling problems?

A
  • males: 2 to impulsivity, substance use, risk-taking behaviours
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18
Q

What is a huge comorbidity related to pathological gambling?

A

Their risk of

  • substance abuse times 5.5 increase (30-40% alcohol abuse/dependence)
  • mood disorders by 3.7 times (75% dep.)
  • anxiety 3.1 times (40% anxiety)
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19
Q

What is the cause-effect r/s of gambling of comorbidities?

A
  • pathological gambling often precedes comorbid conditions in 23% of cases.
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20
Q

What percentage of problem gamblers seek formal treatment?

A
  • <10%
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21
Q

What is the integrated bio psych-social model of gambling?

A
  • suggests that there are multiple interactive vulnerability factors including:
    NEUROBIOLOGICAL/GENETIC: (meso-limbic/orbito-frontal reward systems (shared with substance use)
    PERSONALITY TREATS
    COPING STRATEGIES
    PEER GROUP INTERACTIONS
    BELIEF SCHEMAS
    FAMILY HX (modeling, exposure/attitude, trauma/rejection
22
Q

what is the pathophysiology related to problem gambling in relation to serotonin

A
  • problem gamblers show reduced concentrations of serotonin- metabolite (5 hydroxyindoleacetic acid) in CSF
  • subjective ‘high’ can be produced through postsynaptic serotonin receptor stimulation with a mixed agonist
  • SSRIs show therapeutic effects
23
Q

What is the pathophysiology of problem gambling in relation to dopamine?

A
  • problem gamblers show reduced neurnal responses within dopaminergic midbrain while engaging in gambling behaviour
  • admin of amphetamines can prime congitons about gambling in PG.
  • DRD2 association
  • d2 receptor antagonist (haloperidol) can enhance rewarding properties of gambling behaviour
  • dopaminergic treatments are associated with pathological gambling in a minority of patients with Parkinson’s dx.
24
Q

What are the reinforcement schedules seen in PG? (OPERANT CONDITIONING)

A
  • INTERMITTENT (occasional) and VARIABLE (unpredictable)

HIGHLY RESISTANT TO EXTINCTION

25
Q

How does classical conditioning potentially lead to problem gambling?

A

NEUTRAL STIMULI e.g. sights, sounds, time of day, people) become associated with physiological arousal and subjective excitement
- subsequent exposure to such cues will elicit arousal/excitement and in turn anticipation of winning (experiences as gambling cravings)

26
Q

What is the illusion of control?

A
  • belief and over-magnification of one’s skills and ability to influence or predict the outcome of an event
27
Q

What is the Gambler’s fallacy?

A
  • a series of losses must be followed by a win, when in fact the chances are still 50/50 (e.g. with every toss of coin, probability of heads or tails is 50%)
28
Q

What is biased evaluation?

A
  • winnings attributed to one’s skills, losses attributed to external, unrelated factors
29
Q

How do neuro-cognitive and psychophysiological processes lead to problem gambling?

A

COGNTIVE SCHEMAS reinforce pre-existing beliefs,establish new cognitions (biased evaluation, cognitive regret, illusions of control), reward circuits
EXPOSURE TO GAMBLING CUES leads to
DECISION TO GAMBLE
- cost/benefit analysis
- impulsivitiy (neural substrates/personality)
- personality needs (ego, narcsissism)
- emotional escape

30
Q

What is the premise of the Pathways model of pathological gambling?

A 
- that pathological gamblers are not a homogenous population
THREE SUBTYPES:
- common phenomenology
- differ in aetiological factors
- differ in treatment requirements
31
Q

What is an illusory correlation?

A

-misinterpretation of two mutually independent events being correlated

32
Q

What does the Pathway 1 gambler look like?

A
  • symptoms are causal outcomes of gambling- related problems
    i. e. starts out participating from arousal/excitement, cognitive schemas –>leads to PG –> phenomenology: affective disturbance, criminality, substance abuse, impaired r.s
  • responds well to psycho- education, brief interventions & brief CBT
33
Q

What does a Pathway 2 gambler look like?

A
  • affective disturbances, poor coping skills & substance use contribute to gambling
  • used therefore as a means of dissociation & escape
34
Q

What does a pathway 3 look like?

A
  • deficits in reward pathways (dopaminergic) & impulsive

- psychopharmacology & intensive interventions

35
Q

What are some of the demographics of pathway 1?

A
  • motivation to generate excitement, winning
  • less dissociation and more absorption
  • briefer history of excessive gambling
  • childhood & family stability
  • absence of psychopathology
  • depression/ anxiety is secondary issue
  • substance abuse secondary (usually minimal)
36
Q

what are some factors leading to pathway 2 gamblers?

A
  • childhood disturbance
  • personality (seek sensation, escape, boredom proneness)
  • arousal levels (hyper-arousal/anxious; hypo-arousal/depressed)
  • poor coping/problem solving skills
  • as well as ecological factors (conditioning - arousal and cognitive schemas)
  • leads to PG for excitement/emotional escape
    often comorbid conditions (addictions & mental health)
37
Q

What are some factors leading to pathway 3 in PG?

A
  • biological correlates (biochemical- serotonergic, noradrenergic, dopaminergic)
  • neuropsychological (ADD, impulsivity)
  • differential reward/punishment system
  • leads to associated behaviours (criminality, substance abuse, impaired r/s_
  • conditions
  • vulnerability factors
38
Q

What distinguishes pathway 3 from the other pathways of PG?

A
  • early hx of family instability, abuse/neglect
  • high levels of impulsivity, anti-social behaviour( involves in activities with high degree of stimulation, poorer performance at school)
  • gambling pursued for its stimulation and capacity to generate excitement/arousal.
  • substance-abuse, drugs & alcohol & broad spectrum of criminal behaviours
39
Q

What are some of the earlier causative models of pathological gambling?

A 
- psychodynamic
these all share some commonalities of biology
- behavioural 
- cognitive- behavioural
- addictions
- biological
40
Q

What are the functions of the dopamine pathways?

A
  • reward
  • pleasure, euphoria
  • motor function
  • compulsion
  • perseveration
41
Q

What are the functions of the serotonin pathways?

A
  • mood, memory processing, sleep, cognition
42
Q

What does the bio-psycho-social model suggest about treatment?

A
  • different interventions for different areas e.g. schema therapy for disorted schema, psychpharmacology for neurophysiology etc
43
Q

What learning mechanisms occur at the same time?

A
  • operant conditioning

- classical conditioning

44
Q

What is cognitive regret?

A
  • having invested considerable time and money in a session, a sense of regret at missing out on the next, potentially winning, gamble
45
Q

What is selective recall?

A
  • selectively recalling wins and forgetting losses
46
Q

What are superstitious beliefs and luck charms?

A
  • use of “lucky” charms, objects, prayers, or rituals to “improve” the chances of winning
47
Q

What is luck as a personal quality?

A
  • believing one has a special “lucky” quality. May have cultural association with reference to ancestors looking after one’s wellbeing.
48
Q

What is gambling as a source of income?

A
  • the belief that one can win at gamblng- that is, that over the long term one can come out ahead.
49
Q

Which type of gamblers participate in low skill games?

A
  • hyper-aroused/anxious participants
50
Q

Which type of gamblers participate in high skill games?

A
  • hypo-aroused/depressed gamblers
51
Q

What is the motivation for pathway 2 gamblers?

A
  • gambling WITH money, not FOR MONEY: prolong sessions to allow continued emotional escape
  • however, when loses, triggers downward depressive cycles
52
Q

What suggests that pathway three gamblers may have some neurological component?

A
  • correlation with ADHD

- ?low levels of serotonin/dopamine/norepinephrine

Abnormal 3018 (9 decks)

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