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Gambling addiction

Altered orbitofrontal sulcogyral patterns in gambling disorder: a multicenter study

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Gambling addiction orbit youtube

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Thank you for visiting nature. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser or turn off compatibility mode in Internet Explorer. In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript. Gambling disorder is a serious psychiatric condition characterized by decision-making and reward processing impairments that are associated with dysfunctional brain activity in the orbitofrontal cortex OFC.

However, it remains unclear whether OFC functional abnormalities in gambling disorder are accompanied by structural abnormalities. We addressed this question by examining the organization of sulci and gyri in the OFC. This organization is in place very early and stable across life, such that OFC sulcogyral patterns classified into Types I, II, and III can be regarded as potential pre-morbid markers of pathological conditions. We gathered structural brain data from nine existing studies, reaching a total of individuals with gambling disorder and healthy controls.

Our results, supported by both frequentist and Bayesian statistics, show that the distribution of OFC sulcogyral patterns is skewed in individuals with gambling disorder, with an increased prevalence of Type II pattern compared with healthy controls. Examination of gambling severity did not reveal any significant relationship between OFC sulcogyral patterns and disease severity. Altogether, our results provide evidence for a skewed distribution of OFC sulcogyral patterns in gambling disorder and suggest that pattern Type II might represent a pre-morbid structural brain marker of the disease.

It will be important to investigate more closely the functional implications of these structural abnormalities in future work. Gambling disorder, from here onwards referred to as pathological gambling Footnote 1 , is a behavioral addiction with severe consequences, including bankruptcy, relationship problems, and suicide 1. Consistent with the idea that psychiatric disorders have a biological basis in the brain 2 , functional neuroimaging studies have revealed a core network of dysfunctional brain regions in individuals suffering from pathological gambling 3.

Central to this network is the orbitofrontal cortex OFC , which displays abnormal activity across a number of cognitive tasks, including expected reward valuation 4 , 5 , monetary reward processing 6 , 7 , 8 , risky decision-making 9 , 10 , and conflict monitoring However, it remains unclear whether this alteration in OFC brain function reflects underlying structural abnormalities. There is a large body of research suggesting that individual variability in brain function is closely related to individual variability in brain structure Using magnetic resonance imaging, most studies have focused on gray matter volume and cortical thickness as meaningful sources of structural variability.

While a few studies have reported decreased OFC gray matter volume 13 , 14 , 15 and decreased cortical thickness 16 in pathological gamblers PGs compared with healthy controls HCs , other studies have failed to report significant group differences 17 , 18 , 19 , These inconsistencies might reflect the influence of factors such as age, comorbidities, and head motion acting as confounds on structural brain measures 21 , as well as the heterogeneity existing among gamblers, as suggested by a recent study that found decreased OFC gray matter volume specifically in gamblers showing low risk-taking As a matter of fact, structural abnormalities observed in PGs are less consistent and of more modest magnitude than those reported in substance addiction 19 , 20 , Moreover, it is unclear whether these structural abnormalities represent a pre-morbid marker or are a mere consequence of the disease, as observed in other disorders 24 , One way to address this question is to examine the sulcogyral organization of the OFC.

The organization of sulci and gyri in the brain is governed by cortical folding, which occurs in the perinatal period and leads to sulcogyral patterns that are stable across life 26 , As such, these patterns can be regarded as reliable structural traits that provide an opportunity to investigate possible pre-morbid markers of psychiatric disorders, independently of confounding factors such as illness duration or medication use In previous work, we have observed that sulcogyral pattern types constrain the location of reward-related value signals in the OFC In the field of psychiatry, the impact of OFC sulcogyral patterns has been studied extensively in the context of schizophrenia.

Nakamura et al. These findings have been replicated in further studies 32 , 33 , 34 , 35 , 36 , 37 and extended to individuals at high risk of developing schizophrenia 38 , 39 but see ref. Among patients with schizophrenia, Type III in particular has been associated with poorer cognitive functioning and intelligence quotient IQ , as well as more severe symptoms and impulsivity 31 , 37 , However, very little work has been done outside of schizophrenia.

While one study reported an increased prevalence of Type III in autism spectrum disorders 41 , another study showed that Type III was associated with greater lifetime cannabis consumption in cannabis users Examples of the four major sulcogyral patterns from four different participants.

Patterns were classified into four subtypes Types I—IV according to the continuity of the lateral and medial orbital sulci LOS and MOS, respectively in the rostrocaudal direction r rostral, c caudal. Sulcal continuities of the MOS and LOS were determined by evaluating several consecutive axial slices rather than just a single slice.

TOS transverse orbital sulcus. In this study, we aimed to examine the distribution of OFC sulcogyral patterns among PGs, as well as their relationship with gambling severity, under the premise that the well-described functional impairments reported in the OFC might reflect pre-morbid structural markers.

In order to maximize statistical power, we pooled together nine existing structural magnetic resonance imaging MRI datasets. Because we found it hazardous to make predictions based on the existing literature, we refrained from making specific hypotheses and consider this study to be exploratory. A total of PGs and HCs were included in the present study. These data were pooled from nine separate previous neuroimaging studies 8 , 15 , 18 , 43 , 44 , 45 , 46 , 47 , 48 Supplementary Table 1.

From this aggregated sample, 18 participants 10 PGs and 8 HCs were excluded because of head movement artifacts on anatomical T1 scans preventing us from reliably identifying OFC sulcogyral patterns, and 4 participants 2 PGs and 2 HCs were excluded because either demographic or diagnostic information was missing.

The two groups were matched on age, gender, and handedness within individual studies, which was verified at the whole-population level Table 1. All participants gave written informed consent to be part of the original studies, which were approved by the local ethics committees. None of the HCs had a known history of neurological disorder or current psychiatric Axis I disorder, except for one of them meeting past criteria for alcohol abuse.

T1-weighted structural MR images were independently acquired at each imaging site. Data acquisition details are summarized in Supplementary Table 1 based on the descriptions from the original studies. The procedures for classifying the OFC sulcogyral patterns in this study were based on one of our previous studies With regard to the orbitofrontal sulci in the human brain, four main sulci have been identified, namely, the olfactory, medial, lateral, and transverse orbital sulci.

On the basis of the continuity of the medial and lateral orbital sulci MOS and LOS, respectively , the original work by Chiavaras and Petrides 29 classified the morphology of the human orbitofrontal sulci into three main types in each hemisphere Type I, II, and III , while a fourth type Type IV was later identified in a number of studies 36 , 38 , 40 , 41 Fig.

The sulcus continuity was determined by evaluating several adjacent axial slices rather than focusing on one single slice. Two raters Y. All ambiguous classifications identified in the current sample i. These analyses were performed across the left and right hemispheres, as well as separately in each hemisphere.

In order to verify that the OFC sulcogyral pattern distribution in HCs was comparable to that reported in the reference study of Chiavaras and Petrides 29 , we also compared these distributions statistically using the same tests as above. Finally, we used a categorical regression analysis to examine whether sulcogyral pattern types were associated with clinical symptoms SOGS scores in PGs.

Following the approach used in previous studies 31 , 37 , 41 , we defined three categorical predictors corresponding to the three main sulcogyral patterns Types I, II, and III. For each predictor and each participant, we assigned a value of two if the sulcogyral pattern under consideration was present in either hemisphere i. We report the overall fit as well as the standardized coefficients for each predictor.

Table 2 and Fig. This indicates that any group difference in the present study is more likely to result from an unusual distribution in the gambling group rather than in the healthy group.

In addition, and in line with the results from Nakamura et al. We thus treated hemispheres as independent and pooled them together in some of the subsequent analyses. In order to quantify the evidence in favor of a group difference, we performed a Bayesian contingency table analysis based on a Poisson sampling model 52 , using the default uniform priors implemented in JASP.

Such a BF is traditionally interpreted as moderate evidence for the alternative hypothesis that there is indeed an association between the group and OFC sulcogyral pattern distribution.

Furthermore, In terms of relative risk, participants with a Type II pattern in both hemispheres had a 1. Similarly, participants with at least one hemisphere with a Type II pattern had a 1. This study is the first to investigate the distribution of OFC sulcogyral patterns in pathological gambling, and more broadly, in addiction.

Our results, supported by both frequentist and Bayesian statistics, show that the distribution of OFC sulcogyral patterns is skewed in PGs, with the Type II pattern showing a moderate increase in prevalence compared with HCs.

The presence of a Type II pattern was not associated with higher gambling severity. Altogether, these results suggest that Type II pattern might represent a pre-morbid structural brain marker of pathological gambling but without predictive value for symptom severity.

The finding of a skewed distribution of OFC sulcogyral patterns in pathological gambling is of potential clinical relevance, especially given the lack of reliable neuroanatomical markers for this pathology. It also strengthens the existing evidence supporting a central role for the OFC in pathological gambling 3. Given that sulcogyral patterns are in place very early during brain development and are stable across the lifespan 26 , 27 , our results also support the idea that pathological gambling has a partly neurodevelopmental origin.

This idea resonates with the results of previous studies on substance abuse, showing that pre-existing structural traits in the OFC have predictive value for later substance use in adolescents 53 , Similarly, Chye et al.

Together, these results support the hypothesis that neurodevelopmental structural traits in the OFC might predispose to addictive behaviors. From a mechanistic perspective, the key question is how individual differences in OFC sulcogyral patterns would influence the vulnerability to develop gambling addictive behaviors.

One idea is that this may be mediated through individual differences in OFC connectivity. Indeed, cortical folding patterns are constrained by white matter tracts, such as the uncinate fasciculus that connects the OFC to the anterior temporal lobe within the limbic system 56 , and are thus thought to reflect structural 57 , 58 as well as functional connectivity Thus the skewed distribution of OFC sulcogyral patterns in PGs may reflect altered connectivity patterns, which may in turn affect important cognitive functions of the OFC such as decision-making or behavioral inhibition.

Altered OFC sulcogyral patterns and associated changes in OFC connectivity might also be associated with certain personality traits known to predispose to addictive behaviors. In particular, Type II pattern has been associated with positive emotionality 31 and increased physical anhedonia 60 in healthy individuals.

Thus, it could be that the increased prevalence of OFC sulcogyral Type II pattern among PGs in the present study reflects the increased prevalence of positive emotionality and anhedonic traits among these two subpopulations. Interestingly, in healthy individuals, Type III pattern has also been associated with improved regulatory control 31 , a trait known to be protective against addictive behaviors. This would be consistent with a trend toward a lower prevalence of Type III pattern among gamblers compared with HCs in the present study although the differences did not reach significance.

Future studies should explicitly test these hypotheses. This study has various strengths. The sample size was larger than in any previous structural imaging study on pathological gambling and was larger than in most previous studies investigating OFC sulcogyral patterns in psychiatric disorders. The OFC sulcogyral pattern classification was performed independently by two raters for all participants, thus reducing the chances of misclassification.

We also used a combination of frequentist and Bayesian statistics and applied stringent Bonferroni correction for multiple comparisons where appropriate. This study also has some limitations. First, the interpretation of our structural brain results in terms of functional consequences is limited by the fact that we did not have functional assessments at hand, such as behavioral scores, questionnaires, or brain activity measures. In particular, we were not able to distinguish between different subtypes of gamblers, while these subtypes may be associated with different brain abnormalities as suggested above.

This is the main drawback of our strategy to increase statistical power by pooling together datasets from different studies, since the functional assessments did not overlap between these studies. Future work needs to elucidate the link between OFC sulcogyral patterns and their functional implications. This might explain why the group difference in OFC sulcogyral pattern type distribution did not reach significance when examined in each hemisphere separately, even though these distributions were qualitatively very similar to the one seen across both hemispheres combined.

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