Grant et al. (2008) Flashcards

1
Q

What do endorphins bind to?

What does this allow?

A

Endorphins bind to opioid receptors, inhibit GABA and allow dopamine to increase.

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2
Q

What do opioid antagonists do?

A

Block opioid receptors and reduce euphoria.

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3
Q

What does a lack of reinforcement (euphoria) lead to?

A

The extinction of compulsive behaviours.

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4
Q

Aim & hypothesis

A

To investigate opiate antagonists as a treatment for gambling disorder.

Opiate antagonists are more effective in reducing gambling disorder in people with a family history of alcoholism, strong urges and euphoric response to alcohol compared to people who do not fit into these categories.

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5
Q

Method

A

Experiment/randomised control trials, independent measures, double-blind.

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6
Q

Participants

A
  • 284 pathological gamblers.
  • Had all gambled in the past 2 weeks.
  • Outpatients from 15 psychiatric centres.
  • Equal no. of males/females
  • From the USA.
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7
Q

What conditions were ppts assigned to?

A

Low, moderate or high dose of nalmefene, naltrexone or placebo.

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8
Q

What technique was used to assign ppts to their condition?

A

Random allocation.

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9
Q

How many trials took place?

What style were they?

How long did they last?

A

2 double-blind placebo clinical trials which lasted either 16 or 18 weeks.

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10
Q

How did Grant measure the severity of ppts’ gambling?

A

Yale-Brown obsessive compulsive scale modified for pathological gambling (PG-YBOCS).

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11
Q

Yale-Brown Obsessive Compulsive Scale Modified for Pathological Gambling (PG-YBOCS)

A

A clinician-administered scale to assess gambling severity by assessing symptoms over the previous 7 days, in terms of both gambling urges/thoughts and gambling behaviour.

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12
Q

Apart from using the PG-YBOCS, how was data gained from ppts?

What was the data about?

A

Semi-structured interviews were used to gather family history, particularly relating to first-degree relatives with alcoholism.

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13
Q

When were the measures taken?

A

After the 16-18 week long trials.

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14
Q

What 3 factors were associated with positive treatment outcomes?

A
  • Family history of alcoholism
  • Stronger baseline urges
  • Aged (reduced placebo effect in older ppts)
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15
Q

What was a treatment response operationalised as?

A

At least a 35% reduction in PG-YBOCS total score, for at least 1 month following treatment.

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16
Q

Conclusions

A

Opiate antagonists have the greatest effect for gamblers who have a family history of alcoholism.

The stronger the urges, the higher the probability that these drugs will be effective.

Efficacy in younger gamblers may be due to placebo effects.

17
Q

Strengths

A
  • Double-blind = eliminated ppt/researcher bias and increased validity.
  • Quantitative data = objective measurement of symptoms through standardised Y-BOCS.
  • Informed consent = before the placebo trial, ppts were informed of the process.
  • Generalisable = ppts were diverse in age/ethnicity.
  • RWA = showed the effectiveness of opiate antagonists in treating gamblers, this can help impact treatment in the future.
18
Q

Criticisms

A

Unethical = ppts believed they might be receiving the real drug (deception), but did not get treatment which is a risk to their health.
Self-report = ppts may not have accurate knowledge regarding family history of alcoholism.
No follow-up = long-term efficacy is unknown, family history might predict short-term improvement only.