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A 62-year-old accountant is brought to the emergency department by police after he shoved a shop assistant who asked him to stop taking lollies from an open display. Over two years his wife has watched him make crude remarks to strangers, eat sweets by the bagful and sit unmoved while she wept about her mother's death; he gambles online most nights. His sleep and mood are unchanged, and she has never heard him talk to himself or voice odd beliefs. He is oriented and attentive and scores 28 out of 30 on the Mini-Mental State Examination. Which one of the following best accounts for his behaviour?
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