Addiction Disorders

disorders: this is the main bias of the study, which, consequently, hinders estimaion of whether different diagnostic groups could affect on neuropsychological tests.

Our data present some points of interest: PG patients evaluated through a set of neurological tests such as the WCST, the WMS-R, and the FAS demonstrated adequate and normal intellectual, linguistic, and visual spatial abilities. Only qualitative differences were detected by means of the WCST between PG and healthy control groups: deficits were identified at some item subgroups and not in the whole scale. PG thinking persevered, since PG patients carried on with problem-solving for a longer time than healthy control subjects. The card-choosing tests22 and the go/no-go task24

also revealed similar impairments that are typical

of prefrontal lobe damage. Patients with such lesions persist in giving incorrect responses, even though sometimes they find the right answer.31–36

Since decision-making ability decreases with age due to the possible abnormal functioning of the ventromedial prefrontal areas,37

this

Every minimal brain injury, such as in the prefrontal lobe, has been associated with attention deficits or impulsivity in executive functions;39

variable was taken into account when we enrolled the subjects. In addition, our results are in line with other studies demonstrating worse functioning in cognitive ‘risk-taking’ tasks in patients with lesions of prefrontal areas than in healthy controls or subjects without temporal lobe injuries.38

sometimes these deficits are so marked that patients decline

Our data confirmed the absence of alterations on the WMS-R and the FAS, as previously reported, but highlighted dysfunction on the WCST.42

to follow rules.40,41

The WCST is related to dysfunction of the dorsolateral portion of the prefrontal cortex and cortical regions connected to the prefrontal cortex (e.g. parietal cortex).43,44

Although it has been suggested

that a selective ventromedial prefrontal cortex abnormality was associated with PG,42

our findings propose a more widespread frontal

lobe dysfunction, which corresponds to the results of another study about the link between PG and alterations of both the dorsolateral prefrontal and orbitofrontal cortex.45

Nevertheless, it is not yet

established whether the frontal lobe dysfunctions revealed in PG should be attributed to the pathophysiological ‘core’ of PG or to symptom clusters, or to the comorbid psychopathology.

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34

9.

Francesca Golia, MD, is a post-doctoral studentin the Department of Psychiatry, Neurobiology, Pharmacology, and Biotechnology at the University of Pisa. Her research interests include social anxiety disorder, psychopathology in non-psychiatric settings (thyroid disease, chronic hepatitis C, fibromyalgia, and rheumatoid arthritis), psychiatric comorbidity, and quality of life. She also studies serotonin transporters and psychiatric disorders and pathological gambling. In 2002, she graduated summa cum laude in medicine and surgery from the University of Pisa. In 2006, she completed a post-graduate diploma in psychiatry (summa cum laude) and in 2007 began a doctorate at the University of Pisa. Dr Golia holds an unrestricted license to practice medicine and surgery.

Conclusions

Our data showed alterations in the executive functions and choice- making of PG patients (as revealed by the WCST alterations) that are probably the cause of rigid cognition due to prefrontal area abnormalities. However, these data need to be confirmed in PG patients without other comorbid psychiatric disorders or in a larger sample. ■

Donatella Marazziti, MD, is a Professor of Psychiatry and Director of the Laboratory of Psychopharmacology in the Department of Psychiatry, Neurobiology, Pharmacology, and Biotechnology at the University of Pisa. Her research interests include peripheral serotonergic and dopaminergic markers in healthy subjects and neuropsychiatric patients, correlations with personality traits, clinical status, and pharmacological response, in situ hybridization of different neuroreceptors in the human brain from healthy subjects

and psychiatric patients and in peripheral cells, second messengers coupled to serotonin transporter and serotonergic receptors, oxytocin levels in different conditions, and neurobiology of social bonding. Dr Marazziti graduated summa cum laude in medicine and surgery in 1981 and attended the Post-graduation Specialty School of Psychiatry and the Post-graduation Specialty School of Clinical Biochemistry.

Marina Carlini, MD, is a post-doctoral student in the Department of Psychiatry, Neurobiology, Pharmacology, and Biotechnology at the University of Pisa. Her research interests include studies on social anxiety disorder, psychopathology in non-psychiatric settings (thyroid disease, chronic hepatitis C, Parkinson’s disease, fibromyalgia, and rheumatoid arthritis), psychiatric comorbidity, and quality of life. She also studies serotonin transporters and psychiatric disorders and pathological gambling. In 2001, Dr Carlini graduated summa cum laude in medicine and surgery from the University of Pisa. In 2005, she completed a post-graduate diploma in psychiatry (summa cum laude) and in 2006 began an ongoing doctorate. In 2006, she completed a European certificate in anxiety and mood disorders and an international masters in affective neuroscience. She holds an Italian National Board of Medical Examiners unrestricted license to practice medicine and surgery.

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treatment, Rev Saude Publica, 2005;39:217–22.

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20. Goudriaan AE, Oosterlaan J, De Beurs E, et al., Neurocognitive functions in pathological gambling: a comparison with alcohol dependence, Tourette syndrome and normal controls, Addiction, 2006;101:534–47.

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