A Follow-up Study of Addictions and Co-Occurring Disorders in Older Adults

描述（由申请人提供）：本申请的目的是对患有病理性赌博（PG）的老年人进行对照、盲态纵向随访（f/u）。这项研究将是这类研究中的第一项，并将确立标准。病态赌博是一个可怕的公共卫生问题，与其他成瘾，抑郁症，家庭暴力，破产和自杀有关。病理性赌博一直被研究者所忽视，而且研究得也很不足。这是特别具有破坏性的老年人谁形成一个脆弱的子集的人在PG的风险。该项目具有重要的临床意义，因为它将显着推进了解PG的过程和结果在老年人中，包括其与其他成瘾和共发生的精神障碍，治疗利用和反应，自杀行为，经济损害，以及风险和保护因素。社交网络，关系的损失，退休，决策，以及其他相关的问题，老年人将被视为潜在的修饰符PG风险。这项工作将通过对75名老年人的深入研究来完成（例如，两个对照组：75名年龄<40岁的终身PG患者和75名老年对照组（娱乐性赌博或根本不赌博）。PG受试者将符合DSM-IV标准，并且South Oaks赌博筛查（SOGS）评分e 5。他们将从1）正在进行的家庭研究或2）从社区招募。在重要特征上匹配的老年对照将具有SOGS评分d 2。他们将通过随机数字拨号招募到北方爱荷华州大学，以获得一个无偏倚的对照组。将亲自入组，并在48个月内每隔6个月通过电话再次对受试者进行访谈。SCID、SIDP-IV和其他经验证的量表将用于评估成瘾和共发精神障碍、赌博行为、功能状态、生活事件、个性、冲动性、赌博相关认知、自杀倾向、社会支持、经济损失和生活质量。将仔细监测诊断的可靠性;将对新的评分员进行全面培训。将在摄入时进行神经认知评估。纵向间隔随访评价（LIFE）将用于跟踪PG、其他成瘾和共发疾病、自杀倾向和功能状态的轨迹。研究者将尽一切合理努力与受试者保持联系，并记录失访原因。退出的PG人员将被替换。研究人员假设，与年轻赌徒相比，患有PG的老年人将有更高水平的赌博参与，更大比例的赌博时间，以及更少的禁欲期;他们的赌博强度/严重程度将因药物滥用和共同发生的疾病（例如，严重抑郁症），生活事件（例如，关系损失，退休），社会支持，接近赌场，和治疗;那些结果最差的人将有冲动的反社会行为，决策受损，几乎没有保护因素。这项工作将推动该领域的进展，导致更好地了解PG在老年人和年轻人控制的过程和轨迹，并将告知该领域关于其正确的分类和有效性的亚型方案。这项工作将有助于制定更好和更有针对性的治疗/预防战略。 公共卫生相关性：病理性赌博（PG）是一个重要和普遍的公共卫生问题，与其他成瘾，共同发生的精神健康障碍，家庭暴力，破产和自杀有关。这个项目将是第一个详细的和控制的纵向跟踪老年人与PG;这是很重要的，因为老年人是特别容易发展成问题的赌博行为，并体验其破坏性的后果。这项工作对于更好地了解1）老年人和其他人的PG过程和轨迹至关重要，2）其与其他成瘾和并发症的时间关系，3）促进其发展的风险因素和保护因素，以及4）其正确的分类和有效性亚型方案。这项工作最终将有助于制定更好和更有针对性的治疗/预防战略。

DESCRIPTION (provided by applicant): The goal of this application is to conduct a controlled, blind longitudinal follow-up (f/u) of older adults with pathological gambling (PG). This study will be the first of its type and set the standard. Pathological gambling is a formidable public health problem associated with other addictions, depression, domestic abuse, bankruptcy, and suicide. Pathological gambling has been ignored by researchers and is greatly understudied. It is particularly devastating to elders who form a vulnerable subset of persons at risk for PG. This project has important clinical implications because it will significantly advance understanding of PG course and outcome among the elderly, including its relationship with other addictions and co-occurring mental disorders, treatment utilization and response, suicidal behavior, economic harm, and both risk and protective factors. Social networking, relationship loss, retirement, decision-making, and other issues pertinent to elders will be examined as potential modifiers of PG risk. This work will be accomplished through an intensive study of 75 older adults (e.g., >60 years of age) with lifetime PG and two comparison groups: 75 persons <40 years of age with lifetime PG and 75 elder controls (who gamble recreationally or not at all). Subjects with PG will meet DSM-IV criteria and have a South Oaks Gambling Screen (SOGS) score e 5. They will be recruited from 1) an ongoing family study or 2) from the community. Elder controls matched on important characteristics will have a SOGS score d 2. They will be recruited via random-digit dialing through a subcontract to the University of Northern Iowa to obtain an unbiased comparison group. Intake will occur in person and subjects will be re-interviewed by phone at six-month intervals through 48 months. The SCID, SIDP-IV, and other validated scales will be used to assess addictions and co-occurring mental disorders, gambling behavior, functional status, life events, personality, impulsivity, gambling-related cognitions, suicidality, social support, economic loss, and quality of life. Diagnostic reliability will be carefully monitored; new raters will be fully trained. Neurocognitive assessments will be administered at intake. The Longitudinal Interval Follow-up Evaluation (LIFE) will be used to track the trajectories of PG, other addictions and co- occurring disorders, suicidality, and functional status. The investigators will make every reasonable effort to maintain contact with subjects and document reasons for loss to f/u. Persons with PG who drop out will be replaced. The investigators hypothesize that elders with PG will have a higher level of gambling participation, greater percentage of time spent gambling, and fewer periods of abstinence than younger gamblers; that their gambling intensity/severity will vary in response to substance misuse and co-occurring disorders (e.g., major depression), life events (e.g., relationship loss, retirement), social support, proximity to casinos, and treatment; that those with the poorest outcome will have impulsive antisocial behavior, impaired decision making, and few protective factors. This work will push the field forward by leading to a better understanding of the course and trajectory of PG in elders and younger controls, and will inform the field regarding its proper classification and validity of subtyping schemes. This work will contribute to better and more targeted treatment/preventive strategies. PUBLIC HEALTH RELEVANCE: Pathological gambling (PG) is a significant and prevalent public health problem associated with other addictions, co-occurring mental health disorders, domestic abuse, bankruptcy, and suicide. This project will be the first detailed and controlled longitudinal follow-up of elders with PG; it is important because elders are uniquely vulnerable to develop problematic gambling behavior and to experience its devastating consequences. This work is essential to gain a better understanding of 1) the course and trajectory of PG in older adults and others, 2) its temporal relationship to other addictions and co-occurring disorders, 3) risk factors contributing to and protective factors mitigating against its development, and 4) its proper classification and validity of subtyping schemes. This work will ultimately contribute to better and more targeted treatment/preventive strategies.