Internet Gaming Disorders and Early Onset Psychosis in Young People: A Case Study and Clinical Observations

Pixels and perception: Mapping the association between digital media and psychotic-like experiences in adolescents

INTRODUCTION

Psychotic-like experiences (PLEs) during adolescence can lead to psychotic disorders. Digital media usage has been suggested to link to PLEs, but research is limited on how different types of screen exposure may differentially relate to PLEs over time. This study aimed to examine longitudinal associations between screen usage patterns and PLEs in adolescents.

METHODS

Participants comprised 11,876 adolescents assessed annually from ages 9-12 years as part of the Adolescent Brain Cognitive Development study (ABCD). Screen usage (TV, video games, online video, social media, texting, video chat) and PLEs were assessed via self-report. Longitudinal network analysis models were estimated to examine connections between screen usage types and PLEs across three time points.

RESULTS

Two clusters were formed, including digital media for socializing (e.g., social media/texting/video chat) and digital media for entertainment (e.g., online video/video games/TV). Texting and online video(s) had the highest centrality at each time point, suggesting importance in the network. PLE symptoms of hallucinations and concentration difficulties exhibited higher centrality than other symptoms. Online video and TV were influential bridges between screen usage and PLEs. Network structure significantly differed between ages 9-10 and 10-12 years, but global strength was unchanged over time.

DISCUSSION

Results highlight the importance of understanding the associations between specific screen usage types and PLE symptoms. Texting and online video usage appear most influential in the development of adolescent PLEs over time. Findings can inform targeted interventions to promote healthy screen habits and reduce PLEs in at-risk youth.

Phubbing and its impact on the individual's psychological well-being

Increasingly, smartphones have become a part of people's everyday lives, and are now considered by many to be an indispensable social accessory. Since attachment to a smartphone could have negative psychological consequences, a burgeoning new area of research has emerged which examines the effects of smartphones on individuals' well-being. Hence, this study focuses on phubbing - one's engagement with the smartphone during a face-to-face conversation with another person or group of people - and its association with psychological well-being. For this investigation, a quantitative descriptive approach has been adopted involving a sample of 370 women and men from Spain between 25 and 60 years old. The survey was distributed during late 2019 and the first quarter of 2020. The Phubbing Behaviors Survey was conducted, comprising five dimensions (cultural, technological, social, communicational, and psychological), and a total of 33 items requiring responses on a 5-point Likert scale. This survey was used in conjunction with the General Health Questionnaire (GHQ-28), consisting of four categories (somatic symptoms, social dysfunction, anxiety and insomnia, and severe depression), and 7 items per category. The findings reveal a positive correlation between phubbing and severe depression and, young women under 25 years old show higher levels of somatic symptoms than men in the same age group. This study demonstrates the need to raise awareness via health education and to promote healthy use of the Internet to prevent psychological distress resulting from phubbing.

Digital Phenotypes for Early Detection of Internet Gaming Disorder in Adolescent Students: Explorative Data-Driven Study

BACKGROUND

Limited awareness, social stigma, and access to mental health professionals hinder early detection and intervention of internet gaming disorder (IGD), which has emerged as a significant concern among young individuals. Prevalence estimates vary between 0.7% and 15.6%, and its recognition in the International Classification of Diseases, 11th Revision and Diagnostic and Statistical Manual of Mental Disorders, 5th Edition underscores its impact on academic functioning, social isolation, and mental health challenges.

OBJECTIVE

This study aimed to uncover digital phenotypes for the early detection of IGD among adolescents in learning settings. By leveraging sensor data collected from student tablets, the overarching objective is to incorporate these digital indicators into daily school activities to establish these markers as a mental health screening tool, facilitating the early identification and intervention for IGD cases.

METHODS

A total of 168 voluntary participants were engaged, consisting of 85 students with IGD and 83 students without IGD. There were 53% (89/168) female and 47% (79/168) male individuals, all within the age range of 13-14 years. The individual students learned their Korean literature and mathematics lessons on their personal tablets, with sensor data being automatically collected. Multiple regression with bootstrapping and multivariate ANOVA were used, prioritizing interpretability over predictability, for cross-validation purposes.

RESULTS

A negative correlation between IGD Scale (IGDS) scores and learning outcomes emerged (r166=-0.15; P=.047), suggesting that higher IGDS scores were associated with lower learning outcomes. Multiple regression identified 5 key indicators linked to IGD, explaining 23% of the IGDS score variance: stroke acceleration (β=.33; P<.001), time interval between keys (β=-0.26; P=.01), word spacing (β=-0.25; P<.001), deletion (β=-0.24; P<.001), and horizontal length of strokes (β=-0.21; P=.02). Multivariate ANOVA cross-validated these findings, revealing significant differences in digital phenotypes between potential IGD and non-IGD groups. The average effect size, measured by Cohen d, across the indicators was 0.40, indicating a moderate effect. Notable distinctions included faster stroke acceleration (Cohen d=0.68; P=<.001), reduced word spacing (Cohen d=.57; P=<.001), decreased deletion behavior (Cohen d=0.33; P=.04), and longer horizontal strokes (Cohen d=0.34; P=.03) in students with potential IGD compared to their counterparts without IGD.

CONCLUSIONS

The aggregated findings show a negative correlation between IGD and learning performance, highlighting the effectiveness of digital markers in detecting IGD. This underscores the importance of digital phenotyping in advancing mental health care within educational settings. As schools adopt a 1-device-per-student framework, digital phenotyping emerges as a promising early detection method for IGD. This shift could transform clinical approaches from reactive to proactive measures.

The Lived Experiences of Individuals and Coping Strategies in the Context of Internet Gaming Disorder: A Qualitative Study Within Higher Education Setting in Uganda

Background

Internet Gaming Disorder (IGD), recognized as a mental disorder in both the Diagnostic and Statistical Manual (DSM-5) and International Classification of Diseases (ICD-11), poses significant threats to physical, social, and mental well-being. This study aims to delve into the experiences of individuals grappling with IGD.

Methods and Materials

The study employed an interpretive phenomenology, conducting interviews with 10 graduate students at Makerere University. Participants were purposefully sampled until data saturation was achieved during interviews, which took place between May and July 2023. An interview guide facilitated data collection (Supplementary File 1), and thematic analysis was manually applied for data interpretation, utilizing intuition and imaginative approaches.

Results

The findings revealed that the majority of participants started gaming during childhood, starting with offline games. Exposure to gadgets and games, idle time, and stress emerged as key triggers for IGD. Participants reported experiencing sleep deficits, deteriorating interpersonal relationships, declining job performance, unhealthy eating habits, academic challenges, and wastage of money and time. The study also identified strategies employed by participants to mitigate their gaming behaviors, such as refraining from purchasing data, seeking support from friends, and uninstalling the game app, although relapses were common.

Conclusion

The study highlights a global pattern of early initiation into gaming, emphasizing the need for early intervention and preventive measures. Factors such as easy accessibility and affordability of gaming platforms, idleness, and stress play significant roles in motivating internet gaming, contributing to a higher prevalence among the studied population. The research underscores the adverse effects of IGD on students, affecting academic performance, interpersonal relationships, and job performance. Notably, participants demonstrate agency in addressing IGD through practical coping strategies, including controlling data access, seeking social support, and uninstalling games. These coping mechanisms provide valuable insights into the complex nature of addressing IGD and form a basis for developing targeted interventions and support systems within the higher education setting in Uganda.

Effects of Game-Related Tasks for the Diagnosis and Classification of Gaming Disorder

Gaming disorder (GD) is an addictive behavior characterized by an insatiable need to play video games and shares similar symptoms with the failure of self-control due to a decline in cognitive function. Current GD diagnostic and screening tools rely on questionnaires and behavioral observations related to cognitive functions to assess an individual's capacity to maintain self-control in everyday life. However, current GD screening approaches rely on subjective symptoms, and a reliable diagnosis requires long-term clinical follow-up. Recent studies have measured biosignals along with cognitive functional tasks to provide objectivity to GD diagnosis and to acquire immediate results. However, people with GD are hypersensitive to game-related cues, so their responses may vary depending on the type of stimuli, and the difference in response to stimuli might manifest as a difference in the degree of change in the biosignal. Therefore, it is critical to choose the correct stimulus type when performing GD diagnostic tasks. In this study, we investigated the task dependence of cognitive decline in GD by comparing two cognitive functional tasks: a continuous performance task (CPT) and video game play. For this study, 69 young male adults were classified into either the gaming disorder group (GD, n = 39) or a healthy control group (HC, n = 30). CPT score, EEG signal (theta, alpha, and beta), and HRV-HF power were assessed. We observed differences in the left frontal region (LF) of the brain between the GD and HC groups during online video game play. The GD group also showed a significant difference in HF power of HRV between CPT and online video gaming. Furthermore, LF and HRV-HF significantly correlated with Young's Internet Addiction Test (Y-IAT) score, which is positively associated with impulsivity score. The amount of change in theta band activity in LF and HRV-HF-both biomarkers for changes in cognitive function-during online video game play suggests that people with GD express task-dependent cognitive decline compared with HC. Our results demonstrate the feasibility of quantifying individual self-regulation ability for gaming and underscore its importance for GD classification.