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New Research Shows Connections Between Gambling Disorders and Schizophrenia

by: Christine Reilly | Sep 8, 2009

As the body of research on gambling disorders continues to grow, scientific evidence is beginning to show that some vulnerable and special needs populations appear to be at a higher risk for developing gambling disorders than the general population. The National Center for Responsible Gaming (NCRG) and the Institute for Research on Gambling Disorders have made research on these groups a priority, supporting investigations of gambling problems among young people, women, homeless individuals and African-American adolescents.

Psychiatric patients constitute another population that has been identified by several studies as more vulnerable to excessive gambling. Numerous studies have documented the high rate of co-occurring psychiatric and addictive disorders among individuals with gambling problems.1, 2 However, to date, there has been no systematic examination of gambling behaviors in individuals in outpatient treatment for psychotic disorders. 

A new study by Yale University researchers Rani Desai, PhD, MPH and Marc Potenza, MD, PhD has filled this gap.  The results of their study were recently published online in the Journal of Clinical Psychiatry, the third most cited psychiatric journal in the world,3 in the article “A Cross-Sectional Study of Problem and Pathological Gambling in Patients with Schizophrenia/Schizoaffective Disorder.”4 The study was funded by the NCRG.

The researchers interviewed a sample of 337 patients diagnosed with and in outpatient treatment for schizophrenia/schizoaffective disorder. Using the DSM-IV criteria for pathological gambling and structured psychiatric assessments, the researchers found that these patients may be at a particularly high risk for gambling disorders. While 46 percent of the participants were categorized as non-gamblers and 34.7 percent as recreational gamblers (i.e., those who gamble and are able to do so without adverse consequences), 19.3 percent were classified as either problem or pathological gamblers.4 Of the group with gambling problems, 9.8 percent met the threshold for pathological gambling, the most severe form of the disorder.4 Recent national studies have estimated the rate of pathological gambling among the general adult population at one percent and lower.5, 6

Desai and Potenza conjecture that several reasons might predispose this population to gambling problems. First, the cognitive disturbances associated with psychotic disorders may make it difficult for these patients to control their gambling or understand the risks of excessive gambling.  Second, both schizophrenia/schizoaffective disorder and pathological gambling show evidence of impaired impulse control.  The authors note that, “Clinically, this finding is important, because co-occurring addictions can complicate treatment of schizophrenia/schizoaffective disorder itself, and because even if patients are in recovery from one addictive behavior (eg, alcoholism), they may be vulnerable to substituting another (eg, problem gambling).”4

They also note that clinicians should be aware of the potential for excessive gambling in patients with schizophrenia/schizoaffective disorder and screen such patients for gambling problems, especially those who are either in recovery or actively abusing drugs or alcohol. 

Third, the study showed significantly higher scores for depression among the patients with gambling problems, which can increase vulnerability to excessive gambling. The authors also note that depressive symptoms can be a response to the typical consequences of pathological gambling, such as financial stress.

This study represents a great advance as one of the largest to directly examine gambling patterns in a sample of people with schizophrenia/schizoaffective disorder. It demonstrates the importance of screening patients with psychotic disorders for gambling problems. These findings also provide a roadmap for future research, suggesting that future investigations should identify the factors that place these patients at risk for developing a gambling disorder. Finding effective therapies for this population is another priority for future investigations because current clinical trials for treatment of gambling disorders typically exclude subjects with psychotic disorders.

References

1. Cunningham-Williams RM, Cottler LB, Compton WM, 3rd, Spitznagel EL. Taking chances: problem gamblers and mental health disorders—results from the St. Louis Epidemiologic Catchment Area Study. Am J Public Health. Jul 1998;88(7):1093-1096.

2.  Grant JE, Levine L, Kim D, Potenza MN. Impulse control disorders in adult psychiatric inpatients. Am J Psychiatry. Nov 2005;162(11):2184-2188.

3. ISI Web of Knowledge. Journal of Citation Reports: Thomas Reuters; 2008. Available at http://thomsonreuters.com/products_services/science/science_products/scholarly_research_analysis/research_evaluation/journal_citation_repo Accessed September 4, 2009.

4. Desai RA, Potenza MN. A cross-sectional study of problem and pathological gambling in patients with schizophrenia/schizoaffective disorder. J Clin Psychiatry. Jun 16 2009.

5. Petry NM, Stinson FS, Grant BF. Comorbidity of DSM-IV pathological gambling and other psychiatric disorders: results from the National Epidemiologic Survey on Alcohol and Related Conditions. J Clin Psychiatry. May 2005;66(5):564-574.

6. Kessler RC, Hwang I, LaBrie R, et al. DSM-IV pathological gambling in the National Comorbidity Survey Replication. Psychol Med. Sep 2008;38(9):1351-1360.

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