Problem Gambling in SCID

1
Problem Gambling in SCID SCAN

• Masood Zangeneh
• Editor-in-Chief, eCOMMUNITY International
  Journal of Mental Health Addiction
• Centre for addiction and Mental
  Health-Psychiatric Neurogenetics (clinical)
  Section
• Mona Nouroozifar
• Centre for addiction and Mental
  Health-Psychiatric Neurogenetics (clinical)
  Section
• Ramin Zand
• The International Institute of Health Studies

2

• Problem at hand
• Problem gambling as a psychiatric disorder
• History of ICD DSM
• Finding a common language
• Rational for expansion

3
Problem at hand

• Often missed by physicians and other health
  workers since no section to pick it up
• SCAN SCID- chapters for all but PG
• No diagnostic tool for PG only screen

4
Problem gambling as a psychiatric disorder

• Models
• an addictive disorder (Jacobs, 1986 Blume, 1987)
  
• an unresolved intrapsychic conflict (Bergler,
  1957 Rosenthal, 1992 Wildman, 1997)
• having its causation through a biological/psychoph
  ysiological dysregulation (Blaszczynski, Winter
  McConaghy, 1986 Carlton Goldstein, 1987
  Lesieur Rosenthal, 1991 Rugle, 1993 Comings,
  Rosenthal, Lesieur Rugle, 1996)
• a learned behaviour (McConaghy, Armstrong,
  Blaszczynski Allcock, 1983 Anderson Brown,
  1984)
• a result of distorted/irrational cognitions
  (Sharpe Tarrier, 1993 Ladouceur Walker,
  1996).
• Pathway model (Blaszczynski, 2000)
• Biopsychosocial approach (Griffiths, 2001)
• Psycho-structural Cybernetics (Zangeneh Heydon,
  2004)

5
DSM category

• Pathological gambling is characterized by an
  impulse or urge to gamble in a persistent and
  maladaptive manner disrupting vital relationship
  and activities of daily living. It was first
  officially recognized by DSM-III. The criteria
  emphasized consequences of gambling on legal,
  social, vocational and interpersonal issues. In
  DSM-III R the criteria were modified to reflect
  similarities between pathological gambling and
  psychoactive substance abuse and dependence.
  modified to reflect similarities between
  pathological gambling and psychoactive substance
  abuse and dependence. Included in DSM-III R
  criteria were items that emphasized physiological
  symptoms such as tolerance and withdrawal (Burt
  and Katzman, 2000). Nevertheless, a number of
  criticisms were leveled at DSM-III R criteria.
  Some appeared too vague, while others overlapped
  one another. A new set of criteria that combined
  elements of DSM-III and III R were incorporated
  into revised criteria published in DSM-IV.
  Importantly DSM-IV has reinstalled the essence of
  DSM-III description that detail the multilevel
  consequences of pathological gambling. ICD-10
  emphasizes the detrimental effects on social,
  occupational, material and family values and
  commitment.

6
ICD category

• Chapter V
• Mental and behavioural disorders (F00-F99)
• Disorders of adult personality and behaviour
  (F60-F69)
• F63 Habit and impulse disorders This category
  includes certain disorders of behaviour that are
  not classifiable under other categories. They are
  characterized by repeated acts that have no clear
  rational motivation, cannot be controlled, and
  generally harm the patient's own interests and
  those of other people. The patient reports that
  the behaviour is associated with impulses to
  action. The cause of these disorders is not
  understood and they are grouped together because
  of broad descriptive similarities, not because
  they are known to share any other important
  features.
• Excludes habitual excessive use of alcohol or
  psychoactive substances (F10-F19)impulse and
  habit disorders involving sexual behaviour (F65)
  
• F63.0 Pathological gambling The disorder consists
  of frequent, repeated episodes of gambling that
  dominate the patient's life to the detriment of
  social, occupational, material, and family values
  and commitments.
• Compulsive gambling
• Excludes excessive gambling by manic patients
  (F30)gambling and betting NOS (272.6) gambling
  in dissocial personality disorder (F60.2)

7
History of ICD

• François Bossier de Lacroix (1706-1777) first
  attempt to classify diseases systematically
• (Knibbs G.H. The International Classification of
  Disease and Causes of Death and its revision.
  Medical journal of Australia, 1929, 12-12.)
• At the beginning of the 19th century, the
  classification of disease in most general use was
  one by William Cullen (1710-1790), of Edinburgh,
  which was published in 1785 under the title
  Synopsis nosologiae methodicae.
• But why such nomenclature?
• The advantages of a uniform statistical
  nomenclature, however imperfect, are obvious. In
  many instances certain disease has been denoted
  by few terms, and each term has been applied to
  as many different diseases vague, inconvenient
  names have been employed, or complications have
  been registered instead of primary diseases.
• The International Statistical Institute (1891)
  prepared a classification of causes of death.
• The French Government therefore convoked in
  Paris, in August 1900, the first International
  Conference for the revision of the International
  List of Causes of Death.
• The Fifth International Conference for the
  Revision of the International List of Causes of
  Death (1938)
• Classification of diseases for morbidity
  statistics the Conference recognized the growing
  need for a corresponding list of diseases to meet
  the statistical requirements of widely differing
  organizations, such as health insurance
  organizations, hospitals, military medical
  services, health administrations, and similar
  bodies.

8

• In 1948, the First World Health Assembly endorsed
  the list and adopted World Health Organization
  Regulations No. 1. The International
  Classification was incorporated into the Manual
  of the International Statistical Classification
  of Diseases, Injuries, and Causes of Death
  (Manual of the international statistical
  classification of diseases, injuries, and causes
  of death. Sixth revision Geneva, World Health
  Organization, 1949). The Manual consisted of two
  volumes, Volume 2 being an alphabetical index of
  diagnostic terms coded to the appropriate
  categories.

9
History of DSM

• The Diagnostic and Statistical Manual of Mental
  Disorders, published by the American Psychiatric
  Association, is the handbook used most often in
  diagnosing mental disorders in the United States
  and other countries.
• The first edition (DSM-I) was published in 1952,
  and had about 60 different disorders
• DSM-II was published in 1968
• Both of these editions were strongly influenced
  by the psychodynamic approach. There was no sharp
  distinction between normal and abnormal, and all
  disorders were considered reactions to
  environmental events. Mental disorders existed on
  a continuum of behavior. This way, everyone is
  more or less abnormal. The people with more
  severe abnormalities have more severe
  difficulties with functioning
• The early editions of the DSM distinguished
  between a psychosis and a neurosis. A psychosis
  is a severe mental disorder characterized by a
  break with reality.
• In 1980, with DSM-III, the psychodynamic view was
  abandoned and the medical model became the
  primary approach, introducing a clear distinction
  between normal and abnormal. The DSM became
  "atheoretical", since it had no preferred
  etiology for mental disorders.
• In 1987 the DSM-III-R appeared as a revision of
  DSM-III.
• In 1994, it evolved into DSM-IV. This book is
  currently in its fourth edition
• The most recent version is the 'Text Revision' of
  the DSM-IV, also known as the DSM-IV-TR,
  published in 2000.

10
Finding a common language

• 1979, WHO USA (Alcohol, Drug Abuse Mental
  Health Admin,ADAMHA), joint project to foster a
  common language improve accuracy and
  reliability of diagnosis, develop a trancultural
  tool
• Schedule for Clinical Assessment in
  Neuropsychiatry (SCAN) among other tools such as
  CIDI
• Intention operationalize the process of
  assessing the presence/absence of explicit
  inclusion and exclusion criteria, to reduce the
  observer, information and criteria variance in
  the assessment of psychiatric disorders.
• Designed for scoring and diagnosis according to
  ICD DSM
• Designed for in various cultures and countries
  (feasibilty and reliability tested)
• Requires formal training
• Similarity to SCID
• SCID more North American, SCAN more International

11
Rational for expansion

• Prevalence and other statistics- a major disorder
• Formal categorization
• Acceptance by governments for treatment
• Formalization process in academia research
• Going beyond mere couple questions