IMPULSE DISORDERS: GRANT ET AL. Flashcards
1
Q
Describe the context of the study
A
- Opiates are a class of drugs that are produced from opium.
- They act as painkillers by binding onto opioid receptors in the nervous system
- One of GABAs jobs is to regulate dopamine. When opioid receptors are activated, they inhibit the release of GABA and so dopamine activity increases.
- Opiate antaginists do the opposite and block the opioid receptors and so reduced dopamine releases. These drugs are therefore used to treat substance addiction.
2
Q
state the aim
A
To investigate factors that predict the effectiveness of opiate antagonists in the treatment of gambling disorder
3
Q
What were the 2 hypothesis predicted
A
- That opiate antagonists would be more effective for people with a family history of alcoholism, stronger urges to gamble compared with people with no history of alcoholism
- They believed those with lower gambling urges may experience a placebo effect- whereby they will respond positively to the drugs and there would be no difference in the level of improvement between the real drug and the placebo
4
Q
Describe the sample
A
- 284 in total
- ages 19-72
- All american
- Were all diagnosed using the DSM-IV and scored 5 or more on the SOGS
- 45% were female
- All had gambled in the past 2 weeks and gambled more than once a week.
- None had used to the trial drugs before
4
Q
Describe how they were split into the trial drugs groups
A
- 207 outpatients from 15 psychiatric centres who attended a 16-week trial of nalmefene
- 77 patients participated in an 18 week trial of naltrexone
5
Q
How much were the daily doses for each drug from low, medium to the higher doses
A
NALMEFENE: 25mg, 50mg, 100mg
NALTREXONE: 50mg, 100mg, 150mg
6
Q
Describe the methodology of the study
A
- This was a meta-analysis as they combined the results of 2 randomised control trials
- Both RCTs were double-blind placebo-controlled experiments with independent measures.
7
Q
Describe the qualitative data gathered
A
- diagnosing was done through a structured interview
- A semi-structured interview was used to collect information about family history of psychiatric diagnoses
8
Q
Describe the quantitative data
A
- The Yale Brown Obsessive compulsive scale was modified for pathological gambling
- A decrease of more than 35% was classified as a positive response to the drugs.
- Daily functioning, anxiety and depression were assessed using other questionnaires
9
Q
Give 3 results from the demographics
A
- 48% played non-strategic games i.e bingo
- 24% met the criteria for mood disorders
- Average age of onset was 29 years
10
Q
State 3 results from the drug trials
A
- Those with a family history of alcohol responded positively to the treatment
- Stronger baseline urges to gamble scores were associated with positive treatment response to the higher doses of both drugs
- Younger participants were more likely to respond positively to the placebo
11
Q
What did they conclude
A
- Family history of alcoholism and strong urges to gamble are associated with a positive response to opiate antagonists as a treatment for gambling disorder.
12
Q
state 3 strengths of the study
A
- The use of double-blind, placebo-controlled design increases validity. For instance, they used a researcher to administer the Y-BOCS who was unaware of the condition to which the participant had been allocated
- Sample was representative. Nalmefene participants were recruited from 15 treatment centres. The age range was wide and a range of people were from different ethnicities, marital status and employment status.
- Ethical guidelines were kept with the trials approved by the Institutional review bored of the University of Minnesota. All participants were carefully screened to ensure that no-one would be at additional risk of physical or psychological harm.
13
Q
State 2 weaknesses
A
- Family history was self-reported in semi-structured interviews. This reduces validity as the info is sensitive and they may not have accurate knowledge regarding all of their first degree relatives especially if some were adopted. They lacked secondary data such as medical records. Semi- structured interviews cannot be replicated.
- Grant did not conduct follow up assessment after the trials ended. Family history may therefore only have been predicitive of short term positive effects of opiate antagonists. Relapses could occur and is common in gambling disorders. If the person is also not motivated to take the medication each day they can relapse.
14
Q
Application to everyday life
A
- Therapists can ask simple questions relating to family history. This is a cheap and valuable way to gain information
- It can help inform the patient of the probability of a positive response to the medication.
15
Q
Idiographic v Nomothetic
A
- the aim was to draw conclusions about factors that predict the efficacy of opiate antagonists that can be applied universally to people with gambling disorder.
- Some data was quantitative and some statistical techniques could be used to determine which factors can predict treatment response.
- However taking an idiographic approach could help provide more detailed understanding
16
Q
Reductionism v Holism
A
- Because they focus on biological factors, they are considered reductionist.
- People can quickly relapse if they stop taking their medication.
- Although the behaviour may no longer feel rewarding, underpinning beliefs remain the same.
- This suggests that pairing opiate antagonists with psychological therapies that focus on stress management and coping skills can be a better treatment.
