Examination of Proposed DSM-5 Changes to Pathological Gambling in a Helpline Sample.
Examination of Proposed DSM-5 Changes to Pathological Gambling in a Helpline Sample.
J Clin Psychol. 2013 Jun 24;
Weinstock J, Rash C, Burton S, Moran S, Biller W, O’Neil K, Kruedelbach N
To examine the effect of proposed the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5) changes to pathological gambling relative to DSM-IV criteria in a large gambling helpline sample (N = 2,750). Changes in prevalence rates, the diagnostic utility of the illegal acts criterion, and severity of alternative diagnostic formulation thresholds were examined.Callers to the helpline completed a semistructured interview and DSM-IV criteria were assessed.Without lowering the diagnostic threshold, removal of the illegal acts criterion resulted in loss of diagnostic status in less than 2% of helpline callers. The DSM-IV prevalence rate in this sample was 81.2%, and DSM-5 formulations with lowered thresholds of 4, 3, and 2 symptoms increased prevalence rates by 9% to 17%. However, item-level symptom endorsement suggested that subclinical gamblers experience significant adverse consequences.Lowered thresholds may lead to earlier provision of treatment to gamblers and prevent escalation of the disorder, while being more consistent with diagnostic thresholds of other addiction disorders. HubMed – addiction
DSM-5: Call for Commentaries on Gender Dysphoria, Sexual Dysfunctions, and Paraphilic Disorders.
Arch Sex Behav. 2013 Jun 25;
Zucker KJ
Association of Intensive Morphine Treatment and Increased Stroke Incidence in Prostate Cancer Patients: A Population-based Nested Case-Control Study.
Jpn J Clin Oncol. 2013 Jun 23;
Lee CW, Muo CH, Liang JA, Sung FC, Kao CH
We address the potential problem of stroke induced by morphine exposure by comparing the incidence of stroke in cancer patients treated with and without morphine.We performed a population-based nested case-control retrospective analysis on the Longitudinal Health Insurance Database 2000 and Registry for Catastrophic Illness Patients of Taiwan. This study is based on a malignancy cohort of 31 611 patients without a history of stroke, and 1208 patients who subsequently developed stroke served as the stroke group. Four controls of matched age, sex, entry year and entry month for each case were selected from the malignancy cohort from the non-stroke group. We used logistic regression to estimate the odds ratios and 95% confidence intervals, and applied the multivariable model to control for age, sex, hypertension, diabetes, hyperlipidemia and cardiovascular disease.Cancer patients who received morphine had a 12% higher risk of developing stroke than non-morphine users. However, the difference was nonsignificant. A significant difference only appears in prostate cancer patients, where morphine users have a 3.02-fold (4.24- and 2.90-fold for hemorrhagic and ischemic strokes, respectively) higher risk of suffering from stroke. The risk increased significantly as the morphine dosage increased to ?170 mg/year of treatment.Intense morphine treatment may be associated with an increased stroke incidence in patients with malignancy, and the association is particularly significant for prostate cancer patients. HubMed – addiction
Systemic Therapy and Synergies by Combination.
Dig Dis. 2013; 31(1): 104-111
Wörns MA
After years of therapeutic nihilism due to the inefficacy of conventional cytotoxic chemotherapy, the multikinase inhibitor sorafenib was the first agent to demonstrate a significant improvement in the survival of patients with advanced hepatocellular carcinoma (HCC). However, survival benefits on sorafenib treatment remain modest in clinical practice and developing more effective systemic therapies is challenging. No other targeted agent or regimen has proven efficacy to improve survival in a phase III trial in the first- or second-line setting, and no standard treatment option currently exists outside of clinical trials for patients with acquired resistance or intolerance to sorafenib. In contrast to other malignancies, no oncogene addiction has been identified in hepatocarcinogenesis thus far, which may explain why currently tested agents do not achieve sustained partial or complete response in the majority of patients. Several agents with mainly antiangiogenic properties are currently in phase II and III development, including brivanib, ramucirumab, everolimus, tivantinib and resminostat. In addition, the role of molecularly targeted therapy (MTT) in earlier stages of the disease in combination with transcatheter arterial chemoembolization or in the adjuvant setting after potentially curative approaches is under investigation. The identification of the key driver mutations and the assessment of relevant targets for specific subpopulations of patients according to their biomarker-based profile will hopefully lead to a more personalized medicine. This article attempts to provide a concise overview on recent developments of MTT in the phase II-III setting in advanced HCC with an additional focus on synergistic combinations and combined treatment approaches. HubMed – addiction