The Reward Deficiency Syndrome: A Biogenetic Model for the Diagnosis and Treatment of Impulsive, Addictive and Compulsive Behaviors

Blum, Kenneth; Braverman, Eric R.; Holder, Jay M.; Lubar, Joel F.; Monastra, Vincent J.; Miller, David; Lubar, Judith O.; Chen, Thomas J H; Comings, David E.

doi:10.1080/02791072.2000.10736099

Cited by 790 publications

(633 citation statements)

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“…11 Several lines of evidence suggest that the patients with ADHD may present with behaviors consistent with the 'reward deficiency syndrome'. [12][13][14][15] In particular, the compromised regulation of impulses as well as the poor planning and organization described in patients with ADHD may lead to abnormal eating behaviors, such as bulimic behaviors, which, in turn, may be associated with obesity. 16,17 Therefore, bulimic behaviors may mediate, at least in part, the association between ADHD and obesity.…”

Section: Introductionmentioning

confidence: 99%

Association between symptoms of attention-deficit/hyperactivity disorder and bulimic behaviors in a clinical sample of severely obese adolescents

et al. 2006

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Objective: Preliminary evidence suggests a comorbidity between attention-deficit/hyperactivity disorder (ADHD) and obesity. This study was carried out to identify the clinical characteristics of obese adolescents with a higher probability of ADHD and advance the understanding of the potential factors underlying the comorbidity between obesity and ADHD. We evaluated the association between ADHD symptoms and bulimic behaviors, depressive and anxiety symptoms, degree of obesity, pubertal stage, age and gender in a clinical sample of obese adolescents. Design: Cross-sectional study. Subjects: Ninety-nine severely obese adolescents aged 12-17 years. Measurements: Subjects filled out the Bulimic Investigatory Test, Edinburgh, the Beck Depression Inventory and the State-Trait Anxiety Inventory for Children. Their parents completed the Conners Parent Rating Scale, which assesses ADHD symptoms. The degree of overweight was expressed as body mass index-z score. Puberty development was clinically assessed on the basis of Tanner stages. Results: Bulimic behaviors were significantly associated with ADHD symptoms after controlling for depressive and anxiety symptoms. The degree of overweight, pubertal stage, age and gender were not significantly associated with ADHD symptoms. Conclusion: Obese adolescents with bulimic behaviors may have a higher probability to present with ADHD symptoms independently from associated depressive or anxiety symptoms. The degree of overweight, pubertal stage, age and gender might not be useful for detecting obese adolescents with ADHD symptoms. Therefore, we suggest systematic screening for ADHD in obese adolescents with bulimic behaviors. Further studies are needed to understand which specific dimension of ADHD primarily accounts for the association with bulimic behaviors. Future research should also investigate the causal link between bulimic behaviors and ADHD and explore potential common neurobiological alterations. This may lead to a better understanding of the effectiveness of stimulants for the treatment of bulimic behaviors in obese subjects.

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Section: Introductionmentioning

confidence: 99%

Association between symptoms of attention-deficit/hyperactivity disorder and bulimic behaviors in a clinical sample of severely obese adolescents

et al. 2006

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“…A relação entre obesidade, comportamento alimentar compulsivo e abuso de substâncias remete ao modelo neurobiológico que tem sido designado como síndrome da deficiência de recompensa (reward deficiency syndrome). Tal como proposto por Blum et al, o modelo estabelece as bases fisiológicas na gênese de comportamentos impulsivos e de adicção, implicando alterações no polimorfismo gênico codificador de receptores D2 envolvidos na circuitaria de recompensa 83,84 . De fato, em estudo controlado, Davis et al verificaram associação entre a presença de variação alélica para o gene DRD2, envolvido na síndrome da deficiência de recompensa, e maior prevalência de obesidade, TCAP e maiores escores em escalas de sensibilidade à recompensa 85 .…”

Section: Seguimento Pós-operatóriounclassified

Aspectos do acompanhamento psiquiátrico de pacientes obesos sob tratamento bariátrico: revisão

Gordon

Kaio²,

Sallet³

2011

Rev. psiquiatr. clín.

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ResumoContexto: Nas últimas décadas, diversos estudos longitudinais têm demonstrado a eficácia da cirurgia bariátrica no controle de peso em longo prazo e na redução da mortalidade resultante de complicações clínicas associadas à obesidade. Contudo, os estudos também revelam aumento significativo da mortalidade devida a suicídio e comportamento impulsivo, por razões largamente desconhecidas, o que demonstra a escassez de informações relativas ao manejo clínico de pacientes bariátricos. O presente estudo tem como objetivo sintetizar o estado atual de conhecimentos referentes ao acompanhamento psiquiátrico de pacientes bariátricos. Método: Revisão seletiva da literatura envolvendo artigos indexados no Medline e PubMed até junho de 2010, utilizando-se os termos: "bariatric surgery", "psychiatry", "binge eating", "follow-up" e "outcome". Resultados: Há relativo consenso na literatura de que não haja contraindicação psiquiátrica absoluta para a cirurgia bariátrica, embora a avaliação pré-operatória seja de extrema importância para o diagnóstico e tratamento de eventuais transtornos psiquiátricos, objetivando assegurar aderência ao tratamento multidisciplinar, melhor qualidade de vida e, possivelmente, melhor prognóstico pós-cirúrgico. Entre os transtornos mais prevalentes nessa população, encontra-se o transtorno da compulsão alimentar periódica (TCAP), que está relacionado com menor perda ponderal e pior qualidade de vida, especialmente quando presente no pós-operatório. No acompanhamento pós-operatório, também se deve atentar para o surgimento de sintomas impulsivos, incluindo abuso de álcool e outras substâncias. Conclusão: Diversos estudos indicam elevada prevalência de transtornos mentais e alterações psicopatológicas na população de pacientes bariátricos. Embora a maioria dos pacientes apresente adequado controle ponderal e melhora na qualidade de vida em médio e longo prazo, alguns pacientes desenvolvem alterações relativas ao comportamento alimentar, abuso de álcool e outras substâncias e complicações associadas a comportamento impulsivo, o que remete a hipóteses etiológicas que vão desde modelos neuroquímicos até teorias psicossociais. Por todas essas razões, é de fundamental importância que os profissionais de saúde mental integrem as equipes que avaliam e acompanham os pacientes bariátricos. Gordon PC, et al. / Rev Psiq Clín. 2011;38(4):148-54Palavras-chave: Obesidade, cirurgia bariátrica, psiquiatria, transtorno da compulsão alimentar periódica. AbstractBackground: In recent decades, several longitudinal studies show the efficacy of bariatric surgery on long-term weight control and reductions in mortality due to clinical complications associated with obesity. However, studies also show significantly increased mortality due to suicide and impulsive behavior, for reasons largely unknown, which demonstrates the paucity of information concerning the clinical management of bariatric patients. This study aims to synthesize the current state of knowledge regarding the psychiatric care of bariatric patients. Meth...

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“…For example, problem gamblers may be hyposensitive to non-reward/punishment (e.g., Reuter et al, 2005) and thus, the repeated detrimental losses experienced are not perceived to be averse; they may be hypersensitive to reward (e.g., Hewig et al, 2010;Oberg et al, 2011) and pursue wins at the expense of high costs; or they may be hyposensitive to reward (e.g., Blum et al, 2000) and engage in thrill-seeking behaviour (such as trying to obtain large wins) in order to reach the same level of excitement associated with smaller wins in non-problem gamblers.…”

Section: Introductionmentioning

confidence: 99%

Can event-related potentials serve as neural markers for wins, losses, and near-wins in a gambling task? A principal components analysis

Lole

Gonsalvez

Barry

et al. 2013

International Journal of Psychophysiology

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Originally, the feedback related negativity (FRN) event-related potential (ERP) component was considered to be a robust neural correlate of non-reward/punishment processing, with greater negative deflections observed following unfavourable outcomes. More recently, it has been suggested that this component is better conceptualised as a positive deflection following rewarding outcomes. The current study sought to elucidate the nature of the FRN, as well as another component associated with incentive-value processing, the P3b, through application of a spatiotemporal principal components analysis (PCA). Seventeen healthy controls played a computer electronic gaming machine (EGM) task and received feedback on credits won or lost on each trial, and ERPs were recorded. The distribution of reward/non-reward outcomes closely matched that of a real EGM, with frequent losses, and infrequent wins and near-wins. The PCA revealed that feedback elicited both a frontally maximal negative deflection to losses, and a positive deflection to wins (which was also sensitive to reward magnitude), implying that the neural generator/s of the FRN are differentially activated following these outcomes. As expected, greater P3b amplitudes were found for wins compared to losses. Interestingly, near-wins elicited significantly smaller FRN amplitudes than losses (with no differences in P3b amplitude), and may contribute to the maintenance of gambling behaviours on EGMs. The results of the current study are integrated into a response profile of healthy controls to outcomes of varying incentive value. This may provide a foundation for the future examination of individuals who exhibit abnormalities in reward/ punishment processing, such as problem gamblers. The PCA revealed that feedback elicited both a frontally maximal negative deflection to losses, and a positive deflection to wins (which was also sensitive to reward magnitude), implying that the neural generator/s of the FRN are differentially activated following these outcomes. As expected, greater P3b amplitudes were found for wins compared to losses.Interestingly, near-wins elicited significantly smaller FRN amplitudes than losses (with no differences in P3b amplitude), and may contribute to the maintenance of gambling behaviours on EGMs. The results of the current study are integrated into a response profile of healthy controls to outcomes of varying incentive value. This may provide a foundation for the future examination of individuals who exhibit abnormalities in reward/punishment processing, such as problem gamblers.

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The Reward Deficiency Syndrome: A Biogenetic Model for the Diagnosis and Treatment of Impulsive, Addictive and Compulsive Behaviors

Cited by 790 publications

References 479 publications

Association between symptoms of attention-deficit/hyperactivity disorder and bulimic behaviors in a clinical sample of severely obese adolescents

Association between symptoms of attention-deficit/hyperactivity disorder and bulimic behaviors in a clinical sample of severely obese adolescents

Aspectos do acompanhamento psiquiátrico de pacientes obesos sob tratamento bariátrico: revisão

Can event-related potentials serve as neural markers for wins, losses, and near-wins in a gambling task? A principal components analysis

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