neural mechanisms of pathological gambling holst.pdf · 2018. 10. 22. · pathological gambling:...

Neural mechanisms of pathological gambling

Ruth J. van Holst, PhD

Post-doctoral researchermail@ruthvanholst.nlwww.ruthvanholst.nl

Pathological gambling: DSM-VIa disorder of self-regulation

• persistent and recurrent maladaptive gambling behavior

preoccupation with gambling

gambling with increasing amounts to achieve desired excitement

unsuccessful efforts to control or stop gambling

restless or irritated when trying to stop

financial and social problems due to gambling

2006

2007

Gambling: a real addiction?

2006

Goudriaan, Oosterlaan, de Beurs, van den Brink (2006), Addiction.

Background

Pathological gambling: DSM-5a behavioral addiction

• DSM-5 to reclassify PG with ‘Addiction and Related Disorders’ based on similarities:

–Core symptoms

–Co-morbidities

–Shared heritability / genetics

–Functional imaging and neurocognitive profile

–Effective treatments (CBT, nalmefene)

Similar brain processes in gambling as in drug addiction?

Winning money

- Gambling as a model for the behavioral effects of addiction

Dopamine as pleasure/saliency neurotransmitter

Impaired Response Inhibition-Salience Attribution model

(Goldstein & Volkow, 2002, 2006)

Reward circuitNucleus AccVentrale Tegm.Striatum

Motivation:OFC, insula

Control:ACCDLPFC

Cue reactivity in problem gamblers

Control Problem

group Gamblers

Goudriaan, De Ruiter, Veltman, Oosterlaan, van den Brink, 2009, Addiction Biology

Cue reactivity in problem gamblers

OR

Error Monitoring: Stop Signal Task

De Ruiter, Oosterlaan, Veltman, van den Brink, Goudriaan, 2012, Drug Alc Dep

Error Monitoring: Stop Task

Controls Smokers Problem Gamblers

Activation in response to errors

De Ruiter, Oosterlaan, Veltman, van den Brink, Goudriaan, 2012, Drug Alc Dep

Perseveration, Reward, Punishment

Probabilistic Reversal Learning Task

Try to win as much as possible!400 trials

CR = Correct ResponseBL = Baseline TrialPENS = Probabilistic Error, No Shift PRE = Preceding Reversal ErrorFRE = Final Reversal Error

De Ruiter, Veltman, Oosterlaan, Goudriaan, Sjoerds, van den Brink, 2009Neuropsychopharmacology

Probabilistic Reversal Learning Task

0

5

10

15

20

25

Controls Smokers Gamblers

Gains in Euro's

*(p<0.05)

*(p<0.01)

De Ruiter, Veltman, Oosterlaan, Goudriaan, Sjoerds, van den Brink, 2009Neuropsychopharmacology

Probabilistic Reversal Learning Task

Controls Smokers Problem Gamblers

Brain activity after winning money

Reuter et al. (2005, Nat Neurosc):Controls Gamblers

o Near misses increase gambling propensity and are known to activate the ‘reward circuit’

Clark et al 2009 Neuron

Near-misses in Gambling

Reward processing in pathological gambling

WAIT

Van Holst, Veltman, van den Brink, Goudriaan, Biol Psychiatry, 2012

Summary: Impaired Response Inhibition-Salience Attribution model also in Gambling

(Goldstein & Volkow, 2002, 2006)

Motivation:OFC, insula

Reward circuitNucleus AccVentrale Tegm.Striatum

Control:ACCDLPFC

Conclusion

• Disordered gambling resembles drug addiction in diminished control and abnormal reward sensitivity

• Disordered gambling is different from drug addiction in the absence of toxicity and possibly cognitions concerning gambling

Thank you for your attention

Email: mail@ruthvanholst.nl

Website: www.ruthvanholst.nl