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

描述(由申请人提供)：本申请的目标是对患有病理性赌博(PG)的老年人进行受控、盲目纵向随访(F/U)。这项研究将是此类研究中的第一项，并将设定标准。病态赌博是一种可怕的公共卫生问题，与其他成瘾、抑郁、家庭暴力、破产和自杀有关。病理性赌博一直被研究人员忽视，而且研究严重不足。这对老年人尤其具有破坏性，他们是PG风险人群中的弱势群体。这个项目具有重要的临床意义，因为它将极大地促进对老年人PG过程和结果的理解，包括它与其他成瘾和共生精神障碍的关系、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、关系丧失、退休、决策和其他与老年人相关的问题将被视为PG风险的潜在修饰者。这项工作将通过对75名终生PG老年人(例如，60岁)和两个对照组的深入研究来完成：75名40岁终生PG老年人和75名老年人对照组(他们娱乐赌博或根本不赌博)。患有PG的受试者将符合DSM-IV标准，南橡树赌博筛选(SOGS)得分为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组的SOGS得分为d 2。他们将通过分包合同通过随机数字拨号招募到北爱荷华大学，以获得一个没有偏见的对照组。录取将亲自进行，受试者将每隔6个月至48个月通过电话重新面谈一次。SCID、SIDP-IV和其他有效量表将用于评估成瘾和共生精神障碍、赌博行为、功能状态、生活事件、个性、冲动、赌博相关认知、自杀、社会支持、经济损失和生活质量。将仔细监测诊断的可靠性；新的评分员将接受全面培训。将在进食时进行神经认知评估。纵向间隔随访评估(LIFE)将用于跟踪PG、其他成瘾和共生障碍、自杀和功能状态的轨迹。调查人员将尽一切合理努力与受试者保持联系，并向F/U记录丢失的原因。退学的PG患者将被取代。研究人员假设，与年轻赌徒相比，患有PG的老年人参与赌博的程度更高，赌博时间百分比更高，禁欲时间更少；他们的赌博强度/严重程度会因药物滥用和共生疾病(如严重抑郁症)、生活事件(如失恋、退休)、社会支持、邻近赌场和治疗而有所不同；结果最差的人将有冲动的反社会行为，决策能力受损，几乎没有保护因素。这项工作将通过更好地理解PG在老年人和年轻对照组中的过程和轨迹来推动该领域的发展，并将向该领域通报其正确的分类和亚型方案的有效性。这项工作将有助于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.