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      Impulsivity and response inhibition in alcohol dependence and problem gambling

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          Abstract

          Introduction

          Impulsivity is a central feature of drug addiction and may arise as a result of impaired inhibitory control. The extent to which inhibitory deficits arise as a consequence of drug exposure or relate to pre-existing addiction vulnerability is unknown.

          Materials and methods

          This study compared measures of impulsivity in outpatients with alcohol dependence ( n = 23) and problem gambling ( n = 21), a putative behavioural addiction where direct effects of drug exposure may be minimal. Healthy controls ( n = 27) were also tested, in a cross-sectional design. Subjects completed the stop-signal test as a neurocognitive probe of response inhibition, alongside self-report ratings of impulsivity, adult ADHD and OCD.

          Results

          On the stop-signal test, Go reaction time and stop-signal reaction time were significantly slower in the alcohol-dependent group, compared with healthy controls. Healthy controls slowed their responding after successful and failed stop trials. Slowing after failed stop trials was significantly attenuated in the alcohol-dependent subjects. Go reaction time and post-error slowing were correlated with chronicity and severity, respectively, in the alcohol-dependent subjects. Problem gamblers did not differ significantly from controls on the stop-signal test, despite trait elevations in impulsivity ratings.

          Conclusion

          Inhibitory control is impaired in alcohol dependence but occurs in the context of psychomotor slowing. In addition, alcohol-dependent individuals failed to show behavioral adjustment following failed stops. These deficits may represent direct effects of chronic alcohol administration on fronto-striatal circuitry.

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          Most cited references61

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          Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Results from the National Comorbidity Survey.

          This study presents estimates of lifetime and 12-month prevalence of 14 DSM-III-R psychiatric disorders from the National Comorbidity Survey, the first survey to administer a structured psychiatric interview to a national probability sample in the United States. The DSM-III-R psychiatric disorders among persons aged 15 to 54 years in the noninstitutionalized civilian population of the United States were assessed with data collected by lay interviewers using a revised version of the Composite International Diagnostic Interview. Nearly 50% of respondents reported at least one lifetime disorder, and close to 30% reported at least one 12-month disorder. The most common disorders were major depressive episode, alcohol dependence, social phobia, and simple phobia. More than half of all lifetime disorders occurred in the 14% of the population who had a history of three or more comorbid disorders. These highly comorbid people also included the vast majority of people with severe disorders. Less than 40% of those with a lifetime disorder had ever received professional treatment, and less than 20% of those with a recent disorder had been in treatment during the past 12 months. Consistent with previous risk factor research, it was found that women had elevated rates of affective disorders and anxiety disorders, that men had elevated rates of substance use disorders and antisocial personality disorder, and that most disorders declined with age and with higher socioeconomic status. The prevalence of psychiatric disorders is greater than previously thought to be the case. Furthermore, this morbidity is more highly concentrated than previously recognized in roughly one sixth of the population who have a history of three or more comorbid disorders. This suggests that the causes and consequences of high comorbidity should be the focus of research attention. The majority of people with psychiatric disorders fail to obtain professional treatment. Even among people with a lifetime history of three or more comorbid disorders, the proportion who ever obtain specialty sector mental health treatment is less than 50%. These results argue for the importance of more outreach and more research on barriers to professional help-seeking.
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            Anterior cingulate conflict monitoring and adjustments in control.

            Conflict monitoring by the anterior cingulate cortex (ACC) has been posited to signal a need for greater cognitive control, producing neural and behavioral adjustments. However, the very occurrence of behavioral adjustments after conflict has been questioned, along with suggestions that there is no direct evidence of ACC conflict-related activity predicting subsequent neural or behavioral adjustments in control. Using the Stroop color-naming task and controlling for repetition effects, we demonstrate that ACC conflict-related activity predicts both greater prefrontal cortex activity and adjustments in behavior, supporting a role of ACC conflict monitoring in the engagement of cognitive control.
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              The World Health Organization Adult ADHD Self-Report Scale (ASRS): a short screening scale for use in the general population.

              A self-report screening scale of adult attention-deficit/hyperactivity disorder (ADHD), the World Health Organization (WHO) Adult ADHD Self-Report Scale (ASRS) was developed in conjunction with revision of the WHO Composite International Diagnostic Interview (CIDI). The current report presents data on concordance of the ASRS and of a short-form ASRS screener with blind clinical diagnoses in a community sample. The ASRS includes 18 questions about frequency of recent DSM-IV Criterion A symptoms of adult ADHD. The ASRS screener consists of six out of these 18 questions that were selected based on stepwise logistic regression to optimize concordance with the clinical classification. ASRS responses were compared to blind clinical ratings of DSM-IV adult ADHD in a sample of 154 respondents who previously participated in the US National Comorbidity Survey Replication (NCS-R), oversampling those who reported childhood ADHD and adult persistence. Each ASRS symptom measure was significantly related to the comparable clinical symptom rating, but varied substantially in concordance (Cohen's kappa in the range 0.16-0.81). Optimal scoring to predict clinical syndrome classifications was to sum unweighted dichotomous responses across all 18 ASRS questions. However, because of the wide variation in symptom-level concordance, the unweighted six-question ASRS screener outperformed the unweighted 18-question ASRS in sensitivity (68.7% v. 56.3%), specificity (99.5% v. 98.3%), total classification accuracy (97.9% v. 96.2%), and kappa (0.76 v. 0.58). Clinical calibration in larger samples might show that a weighted version of the 18-question ASRS outperforms the six-question ASRS screener. Until that time, however, the unweighted screener should be preferred to the full ASRS, both in community surveys and in clinical outreach and case-finding initiatives.
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                Author and article information

                Contributors
                +44-01223-764415 , +44-01223-333564 , lc260@cam.ac.uk
                Journal
                Psychopharmacology (Berl)
                Psychopharmacology
                Springer-Verlag (Berlin/Heidelberg )
                0033-3158
                1432-2072
                3 September 2009
                November 2009
                : 207
                : 1
                : 163-172
                Affiliations
                [1 ]Behavioural and Clinical Neuroscience Institute (BCNI), University of Cambridge, Cambridge, CB2 3EB UK
                [2 ]Department of Experimental Psychology, University of Cambridge, Cambridge, CB2 3EB UK
                [3 ]Southend Community Drug and Alcohol Service, South Essex Partnership NHS Trust, Essex, SS1 2NY UK
                [4 ]Derwent Centre, North Essex Partnership Foundation Trust, Harlow, Essex, CM20 1QX UK
                [5 ]Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Cambridge, CB2 2QQ UK
                [6 ]Behavioural and Clinical Neuroscience Institute, Department of Experimental Psychology, University of Cambridge, Downing St., Cambridge, CB2 3EB UK
                Article
                1645
                10.1007/s00213-009-1645-x
                2764851
                19727677
                99b1de4a-68fb-43d7-90cf-bbeb498f0145
                © The Author(s) 2009
                History
                : 22 April 2009
                : 10 August 2009
                Categories
                Original Investigation
                Custom metadata
                © Springer-Verlag 2009

                Pharmacology & Pharmaceutical medicine
                compulsivity,alcoholism,executive function,pathological gambling,post-error adjustment

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