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Gambling in the modern era is pervasive owing to the variety of gambling opportunities available, including those that use technology (eg, online applications on smartphones). Although many people gamble recreationally without undue negative effects, a sizeable subset of individuals develop disordered gambling, which is associated with marked functional impairment including other mental health problems, relationship problems, bankruptcy, suicidality, and criminality. The National UK Research Network for Behavioural Addictions (NUK-BA) was established to promote understanding of, research into, and treatments for behavioural addictions including gambling disorder, which is the only formally recognised behavioural addiction. In this Health Policy paper, we outline the status of research and treatment for disordered gambling in the UK (including funding issues) and key research that should be conducted to establish the magnitude of the problem, vulnerability and resilience factors, the underlying neurobiology, long-term consequences, and treatment opportunities. In particular, we emphasise the need to: (1) conduct independent longitudinal research into the prevalence of disordered gambling (including gambling disorder and at-risk gambling), and gambling harms, including in vulnerable and minoritised groups; (2) select and refine the most suitable pragmatic measurement tools; (3) identify predictors (eg, vulnerability and resilience markers) of disordered gambling in people who gamble recreationally, including in vulnerable and minoritised groups; (4) conduct randomised controlled trials on psychological interventions and pharmacotherapy for gambling disorder; (5) improve understanding of the neurobiological basis of gambling disorder, including impulsivity and compulsivity, genetics, and biomarkers; and (6) develop clinical guidelines based on the best contemporary research evidence to guide effective clinical interventions. We also highlight the need to consider what can be learnt from approaches towards mitigating gambling-related harm in other countries., Competing Interests: Declaration of interests HB is the director of the National Problem Gambling clinic and the national centre for gaming disorders. These clinics have received funding from NHS England, CNWL NHS Trust, and GambleAware. HB is the President of the Psychiatry Section at the Royal Society of Medicine and sits on several national and international Boards. HB has been on research teams funded by the Medical Research Council, the Wellcome Trust, and the Wolfson Family Trust. SRC's role in this paper was funded by a Clinical Fellowship from the Wellcome Trust (reference 110049/Z/15/Z & 110049/Z/15/A). SRC consults for Promentis on work unrelated to the content of this paper. SRC also receives stipends from Elsevier for editorial work at Comprehensive Psychiatry, and at Neuroscience & Biobehavioral Reviews. JEG has received research grants from Biohaven, Promentis, and Otsuka Pharmaceuticals. JEG receives yearly compensation from Springer Publishing for acting as Editor in Chief of the Journal of Gambling Studies and has received royalties from Oxford University Press, American Psychiatric Publishing, Norton Press, and McGraw Hill. SC declares honoraria and reimbursement for travel and accommodation expenses for lectures from the following non-profit associations: Association for Child and Adolescent Central Health, Canadian ADHD Alliance Resource, British Association of Pharmacology, and Healthcare Convention for educational activity on ADHD. OC has received royalties from Routledge, Springer, and Elsevier for editorial duties and advises the UK Parliament and the United Nations on addiction-related matters. OC held various research grants from the European Union, World Anti-Doping Agency, and University of Hertfordshire. SAT has received royalties from Elsevier and research grants from the National Health and Medical Research Council, Australian Research Council, and the Victorian and Australian Governments. SD has received funding from GambleAware and is the Director of the Gambling Research, Education and Treatment Network Wales, which is funded by the Welsh Government through Health and Care Research Wales. BJS consults for Cambridge Cognition, Greenfield Bioventures, and Cassava Sciences. BJS's research is funded by Eton College and the Wallitt Foundation, and is conducted within the National Institute for Health Research (NIHR) MedTech and in-vitro diagnostic Co-operative, and the NIHR Cambridge Biomedical Research Centre Mental Health Theme. In the past 3 years NAF has held research or networking grants from the European College of Neuropsychopharmacology (ECNP), UK NIHR, EU H2020 (COST), Medical Research Council, and University of Hertfordshire. In the past 3 years NAF has accepted travel and hospitality expenses from the British Association for Pharmacology, ECNP, Royal College of Psychiatrists, CINP, International Forum of Mood and Anxiety Disorders, World Psychiatric Association, Indian Association for Biological Psychiatry, and Sun. In the past 3 years NAF has received payment from Taylor and Francis and Elsevier for editorial duties and has accepted paid speaking engagements sponsored by Abbott and Sun. Previously, NAF has accepted paid speaking engagements in symposia supported by various pharmaceutical companies and has recruited patients for various pharmaceutical industry-sponsored studies in the field of obsessive compulsive disorder (OCD) treatment. NAF leads an NHS treatment service for OCD and holds Board membership for various registered charities linked to OCD. NAF gives expert advice on psychopharmacology to the UK Medicines and Healthcare products Regulatory Agency. NAD reports research funding from multiple sources, including government departments (through hypothecated taxes from gambling revenue), and is the recipient of a Deakin University Faculty of Health Mid-Career Fellowship. TWR consults for Cambridge Cognition, Takeda, Greenfield Bioventures, Cassava, Shionogi, Heptares, Arcadia. TWR reports grants from GlaxoSmithKline, Shionogi Royalties, and Cambridge Cognition; and Editorial Honoraria from Springer Nature and Elsevier. The rest of the authors declared no competing interests., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Impulsive and compulsive symptoms are common, tend to co-occur, and collectively account for a substantive global disease burden. Latent phenotyping offers a promising approach to elucidate common neural mechanisms conferring vulnerability to such symptoms in the general population. We utilised the Neuroscience in Psychiatry Network (NSPN), a cohort of young people (aged 18-29 years) in the United Kingdom, who provided questionnaire data and Magnetic Resonance Imaging scans. Partial Least Squares was used to identify brain regions in which intra-cortical myelination (measured using Magnetisation Transfer, MT) was significantly associated with a disinhibition phenotype, derived from bi-factor modelling of 33 impulsive and compulsive problem behaviours. The neuroimaging sample comprised 126 participants, mean 22.8 (2.7 SD) years old, being 61.1% female. Disinhibition scores were significantly and positively associated with higher MT in the bilateral frontal and parietal lobes. 1279 genes associated with disinhibition-related brain regions were identified, which were significantly enriched for functional biological interactions reflecting receptor signalling pathways. This study indicates common microstructural brain abnormalities contributing to a multitude of related, prevalent, problem behaviours characterised by disinhibition. Such a latent phenotyping approach provides insights into common neurobiological pathways, which may help to improve disease models and treatment approaches. Now that this latent phenotyping model has been validated in a general population sample, it can be extended into patient settings.

Aim: The mobility trajectories of hospitalized older people are heterogeneous, and there is a need to understand patient groups with similar trajectories. Our aims were to identify mobility trajectories of older patients admitted to geriatric wards in an English university hospital, and describe patient characteristics and outcomes associated with different mobility groups., Methods: A retrospective observational study of first admissions to geriatric wards for 3 months starting 1 May 2016 was carried out. Anonymized routinely collected clinical data was extracted from the electronic patient records: age, sex, Clinical Frailty Scale score, presence of delirium (yes/no), diagnosis of dementia (yes/no), Charlson Comorbidity Index, falls in the past year and the highest recorded Modified Early Warning Score in the Emergency Department. Physiotherapists routinely collected the Elderly Mobility Scale on admission and discharge; this information was entered in a K-means cluster analysis to identify mobility trajectory groups. We compared clinical characteristics and outcomes between these groups and used logistic regression models to determine independent predictors of group membership., Results: The overall functional trajectory was improvement, from a median Elderly Mobility Scale of 11 on admission to 14 on discharge. Cluster analysis identified five mobility trajectory groups: low-low (n = 117), intermediate-intermediate (n = 95), intermediate-high (n = 205), low-high (n = 89) and high-high (n = 209). Higher frailty and the presence of cognitive impairment were associated with the low-low and intermediate-intermediate group membership, and negatively associated with the high-high group membership., Conclusions: The majority of hospitalized patients experienced functional improvement. Frailty and cognitive impairment might be associated with poorer mobility trajectories and hence require early identification. Geriatr Gerontol Int 2019; 19: 305-310., (© 2019 Japan Geriatrics Society.)

What Is Known and Objective: Drugs with anticholinergic properties increase the risk of falls, delirium, chronic cognitive impairment, and mortality and counteract procholinergic medications used in the treatment of dementia. Medication review and optimisation to reduce anticholinergic burden in patients at risk is recommended by specialist bodies. Little is known how effective this review is in patients who present acutely and how often drugs with anticholinergic properties are used temporarily during an admission. The aim of the study was to describe the changes in the anticholinergic cognitive burden (ACB) in patients admitted to hospital with a diagnosis of delirium, chronic cognitive impairment or falls and to look at the temporary use of anticholinergic medications during hospital stay., Methods: This is a multi-centre observational study that was conducted in seven different hospitals in the UK, Finland, The Netherlands and Italy., Results and Discussion: 21.1% of patients had their ACB score reduced by a mean of 1.7%, 19.7% had their ACB increased by a mean of 1.6%, 22.8% of DAP naïve patients were discharged on anticholinergic medications. There was no change in the ACB scores in 59.2% of patients. 54.1% of patients on procholinergics were taking anticholinergics. Out of the 98 medications on the ACB scale, only 56 were seen. Medications with a low individual burden were accounting for 64.9% of the total burden. Anticholinergic drugs were used temporarily during the admission in 21.9% of all patients. A higher number of DAPs used temporarily during admission was associated with a higher risk of ACB score increase on discharge (OR = 1.82, 95% CI for OR: 1.36-2.45, P < .001)., What Is New and Conclusion: There was no reduction in anticholinergic cognitive burden during the acute admissions. This was the same for all diagnostic subgroups. The anticholinergic load was predominantly caused by medications with a low individual burden. More than 1 in 5 patients not taking anticholinergics on admission were discharged on them and similar numbers saw temporary use of these medications during their admission. More than half of patients on cholinesterase-inhibitors were taking anticholinergics at the same time on admission, potentially directly counteracting their effects., (© 2018 John Wiley & Sons Ltd.)

The factors determining hospital discharge outcomes in older people are complex. This retrospective study was carried out in an in-patient geriatric ward over a month in 2015 and aimed to explore if self-reported feeling of loneliness and clinical frailty contribute to longer hospital stays or higher rates of readmission to hospital after discharge in the older population. Twenty-two men and twenty-five women (mean age 85.1 years) were assessed. There was a significant multivariate association between both self-reported loneliness (p=0.021) and the Clinical Frailty Scale (p=0.010) with length of stay, after adjusting for age, dementia and living alone. In multivariate analysis, patients who lived alone were more likely to be readmitted to hospital within 30 days (p=0.036). Loneliness, living alone and clinical frailty were associated with adverse discharge outcomes. Lower thresholds for referral to voluntary organisations and for psychosocial interventions in patients who report loneliness or live alone may be beneficial.

This chapter considers the pragmatic integration of frailty in primary care. While some patients present to primary care practitioners with relatively well-defined problems that can be managed by a single intervention and/or organ-specific specialist referral, others present with nonacute, poorly defined problems that are complex and rooted in multiple factors. The latter are often in need of a comprehensive geriatric assessment (CGA). CGA can have important positive impacts on the health of older people, but it is labor-intensive and costly. Therefore, patients at higher risk of adverse outcomes should have higher priority to publicly funded CGA services. Frailty is an age-independent marker of risk that fits the biopsychosocial model of primary care, and its use (as opposed to age alone) may promote equity of access to CGA services. A number of frailty assessment tools have been recommended for use in primary care. Some randomized controlled trials have shown that frailty screening in primary care, with subsequent CGA and intervention, can prevent adverse outcomes. However, this result has not been obtained with every screening tool, and comparative trials are ongoing. Meanwhile, primary care commissioners in the UK are establishing new frailty care pathways and developing frailty registers in primary care., (2015 S. Karger AG, Basel.)