Estrogen, progesterone, cortisol, brain-derived neurotrophic factor, and vascular endothelial growth factor during the luteal phase of the menstrual cycle in women with premenstrual dysphoric disorder

The interplay between ovarian hormones, stress, and inflammatory markers in developing premenstrual dysphoric disorder (PMDD) remains inadequately understood. This study investigated the associations of dynamic changes in the levels of estrogen, progesterone, cortisol, brain-derived neurotrophic factor (BDNF), and vascular endothelial growth factor (VEGF) with PMDD during the luteal phase of the menstrual cycle. A total of 58 women with PMDD and 50 healthy women were recruited in this study. These women's estrogen, progesterone, cortisol, BDNF, and VEGF levels were evaluated during the preovulation (PO), mid-luteal (ML), and late-luteal (LL) phases. Furthermore, the severity of P MDD symptoms, depressive symptoms, perceived stress, inattention, craving for sweet foods, and fatigue was assessed. The findings revealed that women with PMDD with higher levels of progesterone during the ML or LL phase or a greater increase (ML-PO) or higher sum (ML + LL) of luteal progesterone level exhibited a greater increase in PMDD symptoms during the luteal phase than did the healthy controls. Furthermore, women with PMDD exhibited higher cortisol levels during the LL phase than did the controls. The BDNF level was negatively correlated with PMDD severity. Furthermore, BDNF and VEGF levels were negatively correlated with inattention and craving for sweet foods among women with PMDD. These results suggest an association between progesterone and the exacerbation of PMDD symptoms during the LL phase. Women with PMDD have relatively high cortisol levels during the LL phase. Future investigations with experimental designs or larger sample sizes are warranted to verify the roles of progesterone and cortisol in the development of PMDD.

Heterogeneity of gaming disorder: A clinically-based typology for developing personalized interventions

Background

The eleventh revision of the International Classification of Diseases (ICD-11) defines the three key diagnostic criteria for gaming disorder (GD). These are loss of control over gaming, gaming as a priority over daily activities, and impaired functioning due to gaming. While this definition has implications for the prevention and treatment of GD, there is significant heterogeneity in the symptoms and etiology of GD among individuals, which results in different treatment needs. Cognitive control, emotional regulation, and reward sensitivity are three critical dimensions in the etiology model for GD. Aspects such as gender, comorbidity, motivation for gaming, stage or severity of GD, and risk factors all contribute to the heterogeneity of etiology among individuals with the disorder.

Method

On the basis of clinical symptoms and comorbidity characteristics among approximately 400 patients with gaming disorder, the present paper proposes a clinical typology of patients with GD based on the authors' clinical experience in treating individuals with GD.

Results

The findings indicated three common types of patients with GD: (i) impulsive male patients with attention deficit hyperactivity disorder (ADHD), (ii) dysphoria patients with dysfunctional coping skills, and (iii) isolated patients with social anxiety. The paper also discusses the presentation and treatment priority for these patients.

Conclusion

Personalized treatments for patients with GD should be developed to fit their individual needs. Future studies should examine the heterogeneity of GD and confirm these types, as well as obtain evidence-based information that can help in the development of personalized treatment. Treatment resources should be developed, and professionals should be trained to provide integrated individualized treatment.

Circadian typologies and insomnia in individuals with internet gaming disorder comorbid with attention deficit/hyperactivity disorder

The alteration in circadian typology and insomnia were prevalent among both Individuals with IGD and those with attention deficit hyperactivity disorder (ADHD), the most comorbid psychiatric disorder of IGD. This study aimed to evaluate the relationships between circadian typologies, insomnia, and internet gaming disorder (IGD) and how ADHD affects this relationship. We recruited three groups of 69 young adults: an IGD group, a control group comprising age- and sex-matched nongamers, and a group of gamers without IGD through diagnostic interviews. The participants with IGD exhibited lower composite scale of morningness (CSM) scores and thus a higher eveningness preference In addition, the score of Pittsburgh insomnia rating scale-20-item version (PIRS_20) was significantly higher among those with IGD. The participants with IGD and ADHD exhibited lower CSM scores but higher PRIS_20 scores than the participants with IGD but without ADHD. The present findings indicate that participants with IGD exhibited a tendency of eveningness preference and experienced more severe insomnia. ADHD exacerbated the eveningness preference and insomnia of individuals with IGD. Close attention should be paid to sleep problems in individuals with IGD, particularly to those with ADHD.

Attention, response inhibition, impulsivity, and decision-making within luteal phase in women with premenstrual dysphoric disorder

Cognitive impairment is a key feature of depressive disorder. Various forms of cognitive function have yet to be investigated in women with premenstrual dysphoric disorder (PMDD) during early luteal (EL) and late luteal (LL) phases. Therefore, we evaluated response inhibition and attention in PMDD in these two phases. We also examined the associations between cognitive functions, impulsivity, decision-making style, and irritability. There is a total of 63 female participants with PMDD and 53 controls, as determined through psychiatric diagnostic interviewing and a weekly symptoms checklist. The participants completed a Go/No-go task, Dickman's impulsivity inventory, Preference for Intuition and Deliberation scale, and the Buss-Durkee Hostility Inventory: Chinese Version-Short Form at the EL and LL phases. The women with PMDD had poorer attention in the Go trials at the LL phase and poorer response inhibition in the No-go trials at the EL and LL phases. Repeated measures analysis of variance revealed an LL exacerbation of deficit in attention among PMDD group. In addition, impulsivity negatively correlated with response inhibition at the LL phase. Preference for deliberation correlated with attention at the LL phase. Women with PMDD experienced LL declined attention and impaired response inhibition across the luteal phase. Response inhibition is linked to impulsivity. The deficit in attention links preference for deliberation among women with PMDD. These results reveal the different courses in different domains of cognitive impairment in PMDD. Further studies are required to elucidate the mechanism underlying cognitive dysfunction in PMDD.

Functional impairment, insight, and comparison between criteria for gaming disorder in the International Classification of Diseases, 11 Edition and internet gaming disorder in Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition

AIM

This study evaluated the consistency between the International Classification of Diseases, 11th Edition (ICD-11) for gaming disorder (ICD-11-GD) and Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria for internet gaming disorder (DSM-5-IGD). Moreover, the functional impairment of participants and their insight of their GD were evaluated.

METHODS

We recruited 60 participants with GD, 45 participants who engaged in hazardous gaming (HG), and 120 controls based on a diagnostic interview. Their operationalization of functional impairment and stage of change were evaluated by interviews and questionnaires, including the Brief Gaming Negative Consequence Scale (BGNCS).

RESULTS

We observed satisfactory consistency (kappa value = 0.80) with a diagnostic accuracy of 91.5% between the ICD-11-GD and DSM-5-IGD criteria. Furthermore, 16 participants with IGD in DSM-5 were determined to have HG based on the ICD-11 criteria. Participants of GD group experienced impaired functioning in their health (96.7%), career (73.3%), social life (61.6%), academic performance (36.7%), and job performance (35%). Moreover, a proportion of them were in the pre-contemplation (25.0%), contemplation (61.7%), preparation (10%), and action stages (3.3%).

CONCLUSION

There is a good consistency between ICD-11-GD and DSM-5-IGD criteria. The ICD-11 criteria have a high threshold for diagnosing GD. HG criteria could compensate for this high threshold and identify individuals with a gaming-related functional impairment who require help. Most of the participants with GD were in the early stage of change. Interventions to promote their insight are essential. The BGNCS can be used to examine the negative consequences of gaming and aid mental health professionals in assessing functional impairment.

Screening, Brief Intervention, and Referral to Treatment Model Based on ICD-11 Criteria of Gaming Disorder and Hazardous Gaming During the COVID-19 Pandemic

Purpose of Review

This commentary aimed to propose the screening, brief intervention, and referral to treatment (SBIRT) model for gaming disorder (GD) and hazardous gaming (HG) on the basis of the International Classification of Disease, 11th version (ICD-11) classification.

Recent Findings

COVID-19 and its preventive measures increase the risk of GD and the treatment needs could exceed the capacities of mental health systems. Brief intervention could be provided for adolescents with HG after screening. Psychiatrists make diagnoses of GD or HG and then refer them to school counselors, specialized psychologists, or integrated teams based on the severity, comorbidity, and complication of GD.

Summary

The classification of GD and HG was suitable to develop a SBIRT model intervention. The SBIRT should work through the shortage of resources and provide a brief intervention guild to make it practical.

Early and Late Luteal Executive Function, Cognitive and Somatic Symptoms, and Emotional Regulation of Women with Premenstrual Dysphoric Disorder

Objective: Cognitive and somatic symptoms were vital factors in developing personalized treatment of depressive disorder. The study aimed to evaluate the following: (1) the cognitive and somatic symptoms of premenstrual dysphoric disorder (PMDD) in the early luteal (EL) and later luteal (LL) phase; and (2) their association with depression and functional impairment of PMDD. Methods: We prospectively evaluated executive function, emotion regulation, cognitive and somatic symptoms, and depression in the EL and LL phases in women with PMDD. Sixty-three women with PMDD and 53 healthy controls completed Simon’s task and questionnaire to assess emotion regulation, inattention, fatigue, insomnia, and depression. Results: Women with PMDD had a poor performance in Simon’s task during the LL phase. They were less likely to exercise cognitive reappraisal during EL and LL phases. Their cognitive reappraisal positively correlated with executive function and negatively associated with depression. In the LL phase, they also experience higher inattention, insomnia, and fatigue, which correlate with the depression and functional impairment of PMDD. Inattention is the most associated factor of PMDD and functional impairment in controlling depression. Conclusion: Executive function was impaired in women with PMDD during the LL phase. Its performance correlated positively with emotion regulation and negatively with depression. The association between inattention and PMDD functional impairment indicates that evaluation and intervention for cognitive impairment were essential in treating women with PMDD. Further studies were required to elucidate the possible etiology underlying these associations.

The withdrawal-related affective, gaming urge, and anhedonia symptoms of internet gaming disorder during abstinence

Aim

The study explores IGD withdrawal-related presentations, including autonomic reaction, affective symptoms, anhedonia, and gaming urge during abstinence from gaming. We prospectively evaluated these withdrawal-related symptoms (WRS) and gaming craving during abstinence from gaming.

Methods

We examined 69 individuals with IGD and 69 regular gamers and evaluated their WRS (using an exploratory questionnaire), affective and behavioral WRS (using the Questionnaire on Gaming Urge-Brief Version gaming disorder questionnaire), and heart rate. All the participants attempted to abstain from gaming before our assessment. Subsequently, some participants' WRS and gaming craving before they engaged in gaming were prospectively evaluated.

Results

In the IGD group, 85.5% experienced gaming WRS, including affective, anhedonia, and gaming urge symptoms. They could relieve these symptoms through gaming. The IGD group experienced more severe gaming WRS, gaming craving, and a higher heart rate than the regular gamer group. Gaming urge was most associated WRS of IGD. Participants with IGD experienced more severe gaming cravings when their gaming abstinence before the assessment was shorter. WRS attenuated at night and the following morning when they maintained their gaming abstinence after assessment.

Conclusion

Individuals with IGD experience withdrawal-related affective, anhedonia, and gaming urge symptoms and a higher heart rate during abstinence. The WRS attenuated in 1 day. Most participants agreed that these symptoms could be relieved through gaming. Further prospective evaluation by objective assessment in an adequate sample was required to understand gaming withdrawal symptoms comprehensively.

Association of Internet gaming disorder with catechol-O-methyltransferase: Role of impulsivity and fun-seeking

Dopamine functioning is an essential mechanism underlying addictive behaviors. This paper evaluates the association of Internet gaming disorder (IGD) with the catechol-O-methyltransferase (COMT) val158met polymorphism and examines the roles of impulsivity and reinforcement sensitivity in this association. Using diagnostic interviews, this study recruited 69 participants with IGD and 138 participants without. All participants underwent diagnostic interviews for IGD and an evaluation for the COMT val158met polymorphism, impulsivity, and reinforcement sensitivity. Among participants with the Val/Val genotype, the odds ratio (95% confidence interval) for IGD was 2.09 (1.15-3.80). The IGD-Val/Val genotype association was mediated by impulsivity and fun-seeking. The Val/Val genotype is indicative of low frontal functioning and is a predictive factor of IGD, with this effect being confounded by impulsivity and fun-seeking. Interventions targeting impulsivity and fun-seeking might attenuate the risk of IGD, particularly among individuals with the Val/Val genotype. Additional studies are necessary to elucidate the possible role of dopamine functioning.

The frustration intolerance of internet gaming disorder and its association with severity and depression

This study aimed to evaluate the belief of frustration intolerance of individuals with internet gaming disorder (IGD) and its association with depression among them. We recruited 69 participants with IGD and 138 controls (69 regular gamers and other non-gamers). IGD is diagnosed based on DSM-5 (DSM stands for diagnostic and statistical manual of mental disorders) criteria through psychiatric interviews. They had completed the questionnaire for the belief of frustration intolerance, depression, and severity of IGD. The participant with IGD had a higher score on the frustration discomfort scale and its subscales, discomfort intolerance, entitlement, emotional intolerance, and achievement. Further regression analysis demonstrated an independent association between entitlement and IGD in control of depression. The frustration intolerance is also associated with depression and the severity of IGD among the IGD group. The discomfort intolerance and achievement were the most associated factors of depression. Frustration intolerance is a crucial irrational belief of IGD. It contributes to the severity of IGD and depression among individuals with IGD. The frustration intolerance, particularly for discomfort intolerance, entitlement, and achievement, should be assessed and intervened while treating individuals with IGD.

Identifying individuals in need of help for their uncontrolled gaming: A narrative review of concerns and comments regarding gaming disorder diagnostic criteria

OBJECTIVE

In 2013, the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) included the diagnostic criteria of Internet gaming disorder (IGD). Then, in 2019, the 11th Revision of the International Classification of Diseases (ICD-11) categorized gaming disorder (GD) as an addictive disorder. This review aimed to review the raised concerns, debate, and research of IGD or GD criteria and provide suggestions to resolve them.

METHODS

A narrative review was conducted, and PubMed was searched for articles mentioning concerns and research on the DSM-5 criteria for IGD, ICD-11 criteria for GD, or criteria for other synonyms, such as problematic gaming or gaming addiction. A total of 107 articles were identified.

RESULTS

Concerns were organized into three categories: conceptual framework, moral panic, and diagnostic validity. Most argumentations supported the proposition that GD and other substance use disorders have similar presentations. A clear definition of GD and adequate public education could prevent rather than exacerbate moral panic. Several researchers reported concerns regarding the nosology, diagnostic validity, and wording of each criterion. However, the threshold, five of the nine criteria with impaired function, demonstrated adequate validity in interview studies.

CONCLUSION

The current findings support the addiction framework, functional impairment, and validity of the GD criteria. However, further prospective, experimental, and clinical studies validating these findings are warranted. Moreover, an integrative review or debate conference could contribute to the organization of the available results and concept development. Aggregating adequate scientific information could allay or resolve concerns related to the diagnosis of GD.

Leptin and ghrelin concentrations and eating behaviors during the early and late luteal phase in women with premenstrual dysphoric disorder

OBJECTIVES

In this study, we evaluated the changes in leptin and ghrelin concentrations, eating behavior, depression, and impulsivity and their correlations within the luteal phase among women with premenstrual dysphoric disorder (PMDD).

METHODS

In 63 women with PMDD and 53 healthy controls, we prospectively evaluated serum levels of leptin and ghrelin, Body Mass Index(BMI), and self-reported sweet cravings, cognitive restraint, uncontrolled eating, emotional eating, depression, and impulsivity during the early luteal (EL) and late luteal (LL) phases.

RESULTS

Compared with the controls, the women with PMDD had higher BMI, higher leptin concentrations in the EL and LL phase, and leptin concentrations increased from the EL to the LL phase. However, there is no significant difference in ghrelin. Women with PMDD increased sweet cravings and uncontrolled eating from EL to LL phase. No significant correlation was observed between the EL-LL changes in leptin or ghrelin concentrations and those in eating behaviors. Both depression and impulsivity correlated with sweet craving and uncontrolled eating. Depression mediated the association between PMDD and uncontrolled eating. The BMI of women with PMDD positively correlated with their EL-LL change in leptin, and LL depression levels and emotional eating.

CONCLUSION

Young women with PMDD had higher leptin concentrations and BMI in the luteal phase. The LL leptin level was not the primary factor responsible for the increased uncontrolled eating of PMDD. Whether the increased eating and depression in the LL phase contribute to the risk of obesity or hyperleptinemia among women with PMDD need to be evaluated in the future.

The association between Emotional Regulation and Internet Gaming Disorder

PURPOSE

Lack of control over Internet gaming habits may result in negative consequences. This study aimed to evaluate the emotional regulation of adults with Internet gaming disorder (IGD) and the association of emotion regulation, depression, and hostility.

METHODS

Advertisements were used to recruit 69 young adults with IGD, 69 sex- and age-matched controls, and 69 sex- and age-matched regular gamers. The diagnosis of IGD was according to diagnostic interviews based on DSM-5 IGD research criteria. Participants completed the Affective Style Questionnaire, the center of epidemiological studies depression scale and the short-form Chinese version of Buss-Durkee Hostility Inventory.

RESULTS

In the IGD group, the emotion adjustment score was significantly lower, whereas the scores for depression, and hostility were significantly higher than in the other two groups. In addition, emotion adjustment is the most associated emotion regulation behavior of IGD, followed by emotion concealment. In IGD group, emotion adjustment had a negative correlation with depression and hostility.

CONCLUSIONS

Our study demonstrate that emotion adjustment is significantly associated with IGD. The depression and hostility mediated the association. Knowing that emotion adjustment plays a critical role in IGD, future interventions should focus on this subscale of emotion regulation.

Validity, functional impairment and complications related to Internet gaming disorder in the DSM-5 and gaming disorder in the ICD-11

BACKGROUND

Many concerns have been raised regarding the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) criteria for Internet gaming disorder and International Classification of Diseases, 11th Revision (ICD-11) criteria for gaming disorder.

AIMS

In this study, we demonstrated the diagnostic validity of each criterion for Internet gaming disorder in the DSM-5 in terms of their intensity and frequency thresholds and evaluated functional impairments, unhealthy behaviors and complications among adults with Internet gaming disorder and gaming disorder.

METHODS

We recruited 69 subjects with Internet gaming disorder, 69 regular gamers and 69 controls without regular gaming based on diagnostic interviewing conducted by a psychiatrist according to the DSM-5 Internet gaming disorder criteria.

RESULTS

Except for the 'deceiving' and 'escapism' criteria, all criteria for Internet gaming disorder had a diagnostic accuracy ranging from 84.7% to 93.5% in differentiating between adults with Internet gaming disorder and regular gamers. A total of 44 participants with Internet gaming disorder (63.8%) fulfilled the gaming disorder criteria. In addition, 89% and 100% of the Internet gaming disorder and gaming disorder groups, respectively, had academic, occupational or social functional impairment. Both the Internet gaming disorder and gaming disorder groups had higher rates of delayed sleep phase syndrome and insomnia. The gaming disorder group also had a higher obesity proportion.

CONCLUSION

The 'deceiving' and 'escapism' criteria had relatively lower diagnostic accuracy. Both the Internet gaming disorder and gaming disorder groups demonstrated functional impairments and unhealthy behaviors. They also exhibited complications, such as obesity and sleep disorders. These results support the utility of the DSM-5 Internet gaming disorder and ICD-11 gaming disorder criteria in identifying individuals who need treatment for both gaming addiction symptoms and complications resulting from the addiction.

Impact of COVID-19 on gaming disorder: Monitoring and prevention

The global coronavirus disease 2019 (COVID-19) outbreak has necessitated physical distancing, lockdown, contact tracing, and self-quarantine so as to prevent the spread of the disease. Amid the outbreak, gaming data usage has reportedly increased in the United States, and game download volume has reached a record high in Europe. Because gaming can be used to cope with the psychological stress from the outbreak, therefore mental health professionals should be aware of how increased gaming during the pandemic may contribute to risk of gaming disorder, especially if the pandemic persists. Mental health professionals should thus formulate safe social interaction alternatives for people, particularly adolescents, who have gaming disorder risk.

Early- and Late-Luteal-Phase Estrogen and Progesterone Levels of Women with Premenstrual Dysphoric Disorder

Objective/introduction: The dynamics of ovarian hormone fluctuations during the luteal phase of the menstruation cycle were previously suggested to contribute to the development of premenstrual dysphoric disorder (PMDD) symptoms, but adequate empirical evidence has not been obtained from hormone concentration studies. We prospectively evaluated estrogen and progesterone levels in the early luteal (EL) and late luteal (LL) phases in women with PMDD and the association of these levels with PMDD symptom severity. Methods: 63 women with PMDD and 53 controls without such severe symptoms were evaluated for the estrogen and progesterone levels, and PMDD severity in the EL and LL phases. Results: The results demonstrated that the women with PMDD had a lower EL-phase estrogen level than the controls. Covariant analysis demonstrated that the interaction term between EL-phase estrogen and EL-phase progesterone level was associated with PMDD severity. Among women with lower EL estrogen levels, higher EL-phase progesterone was observed among the women with PMDD versus controls. These results suggest that low EL-phase estrogen level could moderate the provoking effect of EL progesterone in women with PMDD. Overall, these data suggest a possible role of estrogen and progesterone in the development of PMDD symptoms.

The Clinical Utility of the Chen Internet Addiction Scale-Gaming Version, for Internet Gaming Disorder in the DSM-5 among Young Adults

Objectives: The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) includes the diagnostic criteria for Internet gaming disorder (IGD). This study evaluated (1) the screening, diagnostic, and prevalence-estimated cutoff points of the Chen Internet Addiction Scale–Gaming Version (CIAS-G) for IGD in the DSM-5; and (2) the differences in the CIAS-G and subscale scores among individuals with IGD, regular gamers (RGs), and other control subjects. Methods: We recruited 69 participants with IGD, 69 RGs, and 69 healthy participants based on diagnostic interviews conducted by a psychiatrist according to DSM-5 IGD criteria. All participants completed the CIAS-G and were assessed using the clinical global impression scale. Results: The optimal screening and diagnostic cutoff points were 68 or more (sensitivity, 97.1%; specificity, 76.8%) and 72 or more (sensitivity, 85.5%; specificity, 87.0%) for IGD based on DSM-5 criteria, respectively. The 76 or more cutoff point had the highest number needed to misdiagnose and was the optimal prevalence estimated cutoff point. Conclusions: The screening cutoff point could be used to identify individuals with IGD for further diagnostic interviewing to confirm the diagnosis in the clinical setting or for two-stage epidemiological evaluation. The diagnostic cutoff point provides a provisional diagnosis of IGD when diagnostic interviewing is unavailable. The prevalence-estimated cutoff point could be used to estimate the prevalence of IGD in large-scale epidemiological investigations when further diagnostic interviewing is impractical. The clinical and epidemiological utility of CIAS-G warrants further study.

Co-suppression of AtMIPS demonstrates cooperation of MIPS1, MIPS2 and MIPS3 in maintaining myo-inositol synthesis

Co-suppressed MIPS2 transgenic lines allow bypass of the embryo lethal phenotype of the previously published triple knock-out and demonstrate the effects of MIPS on later stages of development. Regulation of inositol production is of interest broadly for its effects on plant growth and development. The enzyme L-myo-inositol 1-phosphate synthase (MIPS, also known as IPS) isomerizes D-glucose-6-P to D-inositol 3-P, and this is the rate-limiting step in inositol production. In Arabidopsis thaliana, the MIPS enzyme is encoded by three different genes, (AtMIPS1, AtMIPS2 and AtMIPS3), each of which has been shown to produce proteins with biochemically similar properties but differential expression patterns. Here, we report phenotypic and biochemical effects of MIPS co-suppression. We show that some plants engineered to overexpress MIPS2 in fact show reduced expression of AtMIPS1, AtMIPS2 and AtMIPS3, and show altered vegetative phenotype, reduced size and root length, and delayed flowering. Additionally, these plants show reduced inositol, increased glucose levels, and alteration of other metabolites. Our results suggest that the three AtMIPS genes work together to impact the overall synthesis of myo-inositol and overall inositol homeostasis.

Estrogen levels, emotion regulation, and emotional symptoms of women with premenstrual dysphoric disorder: The moderating effect of estrogen receptor 1α polymorphism

BACKGROUND

This study evaluated the association between estrogen levels, emotion regulation, depression, anxiety, and stress of women with premenstrual dysphoric disorder (PMDD). We also evaluated the moderating effect of estrogen receptor (ESR) α-Xbal polymorphism on the aforementioned association.

METHODS

A total of 100 women were diagnosed with PMDD based on psychiatric interviews and a prospective investigation of 3 menstrual cycles. A total of 96 normal individuals were recruited as controls. Their estrogen levels, depression, anxiety, stress, and ESR α-Xbal polymorphism in both premenstrual and follicular phases were assessed, and these data were included in the final analysis.

RESULTS

The PMDD group had high depression, anxiety, and stress and low emotional adjusting and tolerating in the premenstrual phase. Emotional adjustment was negatively associated with depression, anxiety and stress. No association was observed between PMDD and estrogen level. However, premenstrual estrogen level was negatively correlated with anxiety and stress in women with PMDD. The association was only significant in G carriers of ESR α-Xbal, as was the difference in premenstrual emotion regulation between the PMDD and control groups.

CONCLUSIONS

The results demonstrate the association between estrogen and anxiety in PMDD, supporting the claim that women with PMDD differ in their responses to normal estrogen levels. Furthermore, this association and dysfunctional emotional regulation in PMDD existed only among the G carriers of ESR α-Xbal polymorphism. Future studies should investigate the effect of estrogen on brain functions involving emotional regulation in women with PMDD, stratified by ESR α-Xbal polymorphism.

The Altered Brain Activation of Phonological Working Memory, Dual Tasking, and Distraction Among Participants With Adult ADHD and the Effect of the MAOA Polymorphism

OBJECTIVE

The present study aimed to reveal the brain correlates of phonological working memory (WM), dual tasking, and distraction in adult ADHD combined with the effect of polymorphisms of monoamine oxidase A ( MAOA rs1137070 Asp470Asp).

METHOD

A total of 29 participants with adult ADHD and 21 controls were recruited. They completed 0-back and 2-back tasks, as wells as 2-back tasks with a dual-task effect or a distracting effect, during functional magnetic resonance imaging scanning.

RESULTS

The brain activation of WM in the bilateral inferior frontal lobe, pars opercularis, was higher among the adult ADHD group. The genotype of MAOA significantly interacted with the ADHD effect in the left inferior frontal lobe, pars opercularis. Adults with ADHD had higher activation in the left lingual area in response to the dual-tasking effect.

CONCLUSION

The MAOA polymorphism moderated the altered activation in pars opercularis for WM among adults with ADHD. The higher lingual gyrus activation might indicate that higher attention resources are demanded to sustain the dual-task function of adults with ADHD.

Emotional Regulation in Young Adults with Internet Gaming Disorder

People diagnosed with Internet gaming disorder (IGD) have been frequently reported to experience depression, anxiety, and hostility. Emotional regulation contributes to these mood symptoms. This study evaluated emotional regulation in subjects with IGD and examined relationships between emotional regulation, depression, anxiety, and hostility in young adults with IGD. We recruited 87 people with IGD and a control group of 87 people without a history of IGD. All participants underwent a diagnostic interview based on the IGD criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, and they completed a questionnaire on emotional regulation, depression, anxiety, and hostility. We found that subjects with IGD were less likely to practice cognitive reappraisal and were more likely to suppress their emotions. Linear regression revealed the higher cognitive reappraisal and lower expressive suppression associated with depression, anxiety, and hostility among subjects with IGD. The emotional regulation strategies that characterize those with IGD could be contributing factors to the depression and hostility tendencies of these people. When treating patients with IGD, in addition to providing appropriate interventions to relieve depression and hostility, practitioners should effectively assess emotional regulation strategies and provide emotional regulation therapy to prevent a vicious cycle of negative emotions.

Association between Internet gaming disorder and generalized anxiety disorder

Introduction This study evaluates the association between generalized anxiety disorder (GAD) and Internet gaming disorder (IGD) and the role of behavior inhibition in young adults. Methods We recruited 87 people with IGD and a control group of 87 people without a history of IGD. All participants underwent a diagnostic interview based on the fifth edition of Diagnostic and Statistical Manual of Mental Disorders, IGD and GAD criteria, and completed a questionnaire on behavior inhibition, depression, and anxiety. Results Logistic regression revealed that adults with GAD were more likely (odds ratio = 8.11, 95% CI = 1.78-37.09) to have IGD than those without it. The OR decreased when controlling for behavior inhibition. IGD subjects with GAD had higher depressive and anxiety score than those without GAD. Conclusions GAD was associated with IGD. Comorbid GAD can contribute to higher emotional difficulty. GAD should be well-assessed and interventions planned when treating young adults with IGD. Behavioral inhibition confounds the association between GAD and IGD. Further study is necessary to evaluate how to intervene in behavioral inhibitions to attenuate the risk of GAD and IGD comorbidity.

Altered brain correlates of response inhibition and error processing in females with obesity and sweet food addiction: A functional magnetic imaging study

BACKGROUND

The aim of the present study was to evaluate the impulsivity and brain correlates of response inhibition and error processing among females with obesity and sweet food addiction (O & SFA).

METHODS

We evaluated the response inhibition and error processing by functional magnetic resonance imaging (fMRI) in subjects with O & SFA and controls. Twenty females with O & SFA and 20 controls were recruited. All subjects performed the event-related designed Go/No-go task under fMRI and completed questionnaires related to food craving and impulsivity.

RESULTS

The O & SFA group exhibited a higher score for impulsivity than did the control group. The O & SFA also exhibited lower brain activation when processing response inhibition over the right rolandic operculum and thalamus than controls. Both O & SFA and control groups exhibited activation of the insula and caudate during error processing. The activation over the left insula, precuneus, and bilateral putamen were higher in the subjects with O & SFA than for those in the control group.

CONCLUSION

Our results support the fact that the fronto-striatal network is involved in response inhibition, and the caudate and insula contributes to error processing. Furthermore, women with O & SFA have impaired rolandic operculum when processing response inhibition and have greater insular and putamen activation in maintain their error processing function.

Association between Internet gaming disorder and adult attention deficit and hyperactivity disorder and their correlates: Impulsivity and hostility

Internet gaming disorder (IGD) and attention deficit and hyperactivity disorder (ADHD) are associated with impulsivity and hostility. This study evaluated the associations among ADHD, impulsivity, hostility, and IGD. We recruited 87 individuals with IGD and 87 controls without a history of IGD. All participants underwent a diagnostic interview based on the DSM-5 IGD criteria and DSM-IV-TR ADHD criteria and completed a questionnaire regarding impulsivity and hostility. The information from the diagnostic interviews was assessed using the clinical global impression scale. The results suggested that IGD is associated with ADHD among young adults and that young adults with both IGD and ADHD have higher impulsivity and hostility. Furthermore, impulsivity and hostility mediate the association between ADHD and IGD. Thus, ADHD is a common comorbidity of IGD among young adults, and impulsivity and hostility are major factors involved in comorbid ADHD and IGD. Young adults with ADHD should be thoroughly assessed, particularly for their impulsivity and hostility, and interventions for IGD should be developed.

Altered Functional Connectivity of the Insula and Nucleus Accumbens in Internet Gaming Disorder: A Resting State fMRI Study

AIMS

A possible addiction mechanism has been represented by altered functional connectivity (FC) in the resting state. The aim of this study was to evaluate the FCs of the insula and nucleus accumbens among subjects with Internet gaming disorder (IGD).

METHODS

We recruited 30 males with IGD and 30 controls and evaluated their FC using functional magnetic imaging scanning under resting, a state with relaxation, closed eyes, with inducement to think of nothing systematically, become motionless, and instructed not to fall asleep.

RESULTS

Subjects with IGD had a lower FC with the left insula over the left dorsolateral prefrontal cortex (DLPFC) and orbital frontal lobe and a higher FC with the insula with the contralateral insula than controls. The inter-hemispheric insula connectivity positively correlated with impulsivity. Further, they had lower FC with the left nucleus accumbens over the left DLPFC and with the right nucleus accumbens over the left DLPFC, and insula and a higher FC with that over the right precuneus.

CONCLUSION

The elevated inter-hemispheric insula FC is found to be associated with impulsivity and might explain why it is involved in IGD. The attenuated frontostriatal suggests that the emotion-driven gaming urge through nucleus accumbens could not be well regulated by the frontal lobe of subjects with IGD.

College students with Internet addiction decrease fewer Behavior Inhibition Scale and Behavior Approach Scale when getting online

INTRODUCTION

The aim of the study is to compare the reinforcement sensitivity between online and offline interaction. The effect of gender, Internet addiction, depression, and online gaming on the difference of reinforcement sensitivity between online and offline were also evaluated.

METHODS

The subjects were 2,258 college students (1,066 men and 1,192 women). They completed the Behavior Inhibition Scale and Behavior Approach Scale (BIS/BAS) according to their experience online or offline. Internet addiction, depression, and Internet activity type were evaluated simultaneously.

RESULTS

The results showed that reinforcement sensitivity was lower when interacting online than when interacting offline. College students with Internet addiction decrease fewer score on BIS and BAS after getting online than did others. The higher reward and aversion sensitivity are associated with the risk of Internet addiction.

DISCUSSION

The fun seeking online might contribute to the maintenance of Internet addiction. This suggests that reinforcement sensitivity would change after getting online and would contribute to the risk and maintenance of Internet addiction.

Commentary on: Are we overpathologizing everyday life? A tenable blueprint for behavioral addiction research. Excessive behaviors are not necessarily addictive behaviors

BACKGROUND AND AIMS

The commentary aims to provide clarity to the article "Are we overpathologizing everyday life? A tenable blueprint for behavioral addiction research."

METHODS

We provide another viewpoint for the important issues of behavior addiction.

RESULT

The course of behavior addiction should be further studied. The criteria of withdrawal and tolerance of behavior addiction are ill-defined and need to be further evaluated.

CONCLUSIONS

The etiology, course, presentation, and functional impairment of behavior addiction should be validated by evidence-based data before being defined as a disorder.

Health care utilization and expenditures of persons with diabetes comorbid with anxiety disorder: a national population-based cohort study

OBJECTIVE

The aim of this study was to investigate and compare health care utilization and expenditures between persons with diabetes comorbid with and without anxiety disorder in Taiwan.

METHODS

Health care utilization and expenditures among persons with diabetes with and without comorbid anxiety disorder in the period 2000-2004 were examined using the Taiwan's National Health Insurance claims data. Health care utilization included outpatient visits and use of hospital inpatient services, while expenditures included outpatient, inpatient and total medical expenditures. General estimation equation (GEE) models were used to analyze the factors associated with outpatient visits and expenditures, and multiple logistic regression analysis was applied to identify factors associated with hospitalization.

RESULTS

In the study period, the average number of annual outpatient visits was 43.11-50.37 and 29.82-31.42 for persons with diabetes comorbid with anxiety disorder and for those without anxiety disorder, respectively. The average annual total expenditure was NT$74,875-92,781 and NT$63,764-81,667, respectively. Controlling for covariates, the GEE models revealed that age and time were associated with outpatient visits. Income and time factor were associated with total expenditure.

CONCLUSIONS

Health care utilization and expenditures for persons with diabetes with comorbid anxiety disorder are significantly higher than those without anxiety disorder. The factors associated with health care utilization and expenditures are age, income and time.

The inhibition of proactive interference among adults with Internet gaming disorder

INTRODUCTION

Cognitive control plays a pivotal role in the mechanism of addictive behavior. The aim of the study was to evaluate the deficit in inhibition of proactive interference of Internet gaming disorder (IGD) using a directed forgetting task among young adults.

METHODS

A total of 64 participants with IGD and 69 controls were recruited on a university campus. They completed the directed forgetting task for online gaming words and neutral words.

RESULTS

The results demonstrated that the IGD group had a poorer performance on the directed forgetting task, and this represented a deficit in inhibition of proactive interference. They also had a higher tendency to remember online gaming words rather than neutral words in comparison with the control group. This demonstrated memory bias toward online gaming words.

DISCUSSION

These results suggested that more attention should be paid to deficits in inhibition of proactive interference and memory bias toward gaming content when treating subjects with IGD. Furthermore, it is essential and practical to prevent exposure to online gaming-related cues when endeavoring to control online gaming behavior.

The late-luteal leptin level, caloric intake and eating behaviors among women with premenstrual dysphoric disorder

OBJECTIVES

A marked increased in food intake in the late-luteal phase is a characteristic symptom of premenstrual dysphoric disorder (PMDD). The aim of the study was to evaluate the leptin level, caloric intake, and eating behaviors of women with PMDD across the menstrual cycle among normal-weight and overweight subjects, respectively.

METHODS

A total of 62 women with PMDD and 69 controls were recruited following psychiatric interviewing and underwent prospective investigation. The leptin level, caloric intake, and three factors related to eating behavior were assessed in both the late-luteal and follicular phases.

RESULTS

The women with PMDD had greater increases in caloric intake, sweet caloric intake, and uncontrolled eating in the late-luteal phase than the controls. Among the normal-weight women, the leptin level was negatively correlated with caloric intake. The normal-weight women with PMDD had a lower leptin level, a lower leptin/body fat percentage (BFP), a higher caloric intake, and higher uncontrolled eating and emotional eating in the late-luteal phase than the normal-weight controls. Their leptin level was correlated negatively with sweet caloric intake. On the other hand, the overweight women with PMDD had a higher leptin level than the normal-weight women with PMDD and no decline was observed in their leptin level in the late-luteal phase. There were no differences in the leptin level between the overweight women with PMDD and the overweight controls. They also had a higher sweet caloric intake and higher uncontrolled eating and emotional eating than the overweight controls.

CONCLUSIONS

A decline in the leptin level is associated with late-luteal overeating among normal-weight women with PMDD. Hyperleptinemia and a high sweet caloric intake of overweight women with PMDD should be monitored and addressed in order to attenuate the risk of leptin resistance. The detailed roles of leptin and other psycho-neuro-endocrinology factors in the mechanism of overeating among women with PMDD should be evaluated in future study.

Bidirectional associations between family factors and Internet addiction among adolescents in a prospective investigation

AIMS

This study aimed at evaluating the effect of family factors on the occurrence of Internet addiction and determining whether Internet addiction could make any difference in the family function.

METHODS

A total of 2293 adolescents in grade 7 participated in the study. We assessed their Internet addiction, family function, and family factors with a 1-year follow up.

RESULTS

In the prospective investigation, inter-parental conflict predicted the incidence of Internet addiction 1 year later in forward regression analysis, followed by not living with mother and allowance to use Internet more than 2 h per day by parents or caregiver. The inter-parental conflict and allowance to use Internet more than 2 h per day also predicted the incidence in girls. Not cared for by parents and family APGAR score predicted the incidence of Internet addiction among boys. The prospective investigation demonstrated that the incidence group had more decreased scores on family APGAR than did the non-addiction group in the 1-year follow-up. This effect was significant only among girls.

CONCLUSIONS

Inter-parental conflict and inadequate regulation of unessential Internet use predicted risk of Internet addiction, particularly among adolescent girls. Family intervention to prevent inter-parental conflict and promote family function and Internet regulation were necessary to prevent Internet addiction. Among adolescents with Internet addiction, it is necessary to pay attention to deterioration of family function, particularly among girls.

Brain correlates of response inhibition in Internet gaming disorder

AIMS

The present study aimed to evaluate the brain correlates of response inhibition among subjects with Internet gaming disorder (IGD).

METHODS

For this purpose, 15 men with IGD for at least 1 year, and 15 controls with no history of IGD were recruited to perform the Go/Nogo task under functional magnetic resonance imaging investigation. Prior to scanning, the subjects were assessed using the Chen Internet Addiction Scale and the Barrett Impulsivity Scale.

RESULTS

The control group exhibited activation of the right supplement motor area (SMA), dorsolateral prefrontal cortex, and caudate for response inhibition. However, the IGD group had a higher impulsivity and lower activity of the right SMA/pre-SMA in comparison to the control group.

CONCLUSIONS

The results obtained suggest that dysfunctional activation of the SMA for response inhibition is one of the candidate mechanisms of IGD.

Altered gray matter density and disrupted functional connectivity of the amygdala in adults with Internet gaming disorder

OBJECTIVES

The aim of this study was to evaluate the altered brain structure and functional connectivity (FC) among subjects with Internet gaming disorder (IGD).

METHODS

We recruited 30 males with IGD and 30 controls and evaluated their gray matter density (GMD) and FC using resting fMRI. The severities of IGD, gaming urge, and impulsivity were also assessed.

RESULTS

The results demonstrated that the subjects with IGD had a higher impulsivity and a greater severity of IGD. The subjects with IGD had a lower GMD over the bilateral amygdala than the controls. Further, the subjects with IGD had lower FC with the left amygdala over the left dorsolateral prefrontal lobe (DLPFC) and with the right amygdala over the left DLPFC and orbital frontal lobe (OFL). They also had higher FC with the bilateral amygdala over the contralateral insula than the controls. The FC between the left amygdala and DLPFC was negatively correlated with impulsivity. The FC of the right amygdala to the left DLPFC and orbital frontal lobe was also negatively correlated with impulsivity. Our results indicated that the altered GMD over the amygdala might represent vulnerability to IGD, such as impulsivity. Further analysis of the amygdala demonstrated impaired FC to the frontal lobe, which represents impulsivity.

CONCLUSION

The results of this study suggested that the amygdala plays a very influential role in the mechanism of IGD. Its detailed role should be further evaluated in future study and should be considered in the treatment of IGD.

Aberrant brain activation of error processing among adults with attention deficit and hyperactivity disorder

Individuals with adult attention deficit/hyperactivity disorder (ADHD) have a deficit in their cognitive control. The aim of this study was to reveal the brain correlates of the deficits in response inhibition or error processing in adult ADHD. A total of 29 adults with ADHD and 25 control individuals were recruited. They completed an event-related-design Go/No-go task under functional magnetic resonance imaging scanning. Both the ADHD group and the control group exhibited activation of the frontostriatal network when processing response inhibition. They also exhibited activation of the frontoinsula cortex and anterior cingulate in error processing. Adults with ADHD have a lower brain activation of error processing over the right inferior frontal lobe adjacent to the insula than control individuals. The altered frontoinsula cortex activation may represent the mechanism of error processing deficit among adults with ADHD.

The effect of serotonin 1A receptor polymorphism on the cognitive function of premenstrual dysphoric disorder

Estrogen and serotonin play vital roles in the mechanism of premenstrual dysphoric disorder (PMDD). Cognitive deficit in the premenstrual phase contributes to impaired life function among women with PMDD. The aim of this study was to evaluate the difficulties in cognitive control and working memory (WM) in PMDD and to explore the effects of gonadotropic hormone and polymorphism of serotonin 1A receptor (HTR1A; rs6295) on cognitive deficit in PMDD. Women with PMDD completed diagnostic interviewing, questionnaire assessment, the Go/Nogo task, 2-back and 3-back tasks, and gonadotropic hormone analysis in the premenstrual and follicular phases. Further, they were followed up for two menstrual cycles to confirm two consecutive symptomatic cycles. A total of 59 subjects with PMDD and 74 controls completed all evaluation, fulfilled the criteria, and entered into the final analysis. The results demonstrated cognitive control and WM decline in the premenstrual among women with PMDD. The G/G genotype of HTR1A (rs6295) was found to be associated with impaired WM in the premenstrual phase and premenstrual decline of cognitive function. It also contributed to the vulnerability of cognitive function to the menstrual cycle effect and PMDD effect. As the G/G genotype of HTR1A (rs6295) involves in reducing serotonin neurotransmission, our results provide insight into the serotonin mechanism of cognitive function among women with PMDD.

Altered brain activation during response inhibition and error processing in subjects with Internet gaming disorder: a functional magnetic imaging study

The aim of the present study was to evaluate the impulsivity and brain correlates of response inhibition and error processing among subjects with Internet gaming disorder (IGD). We evaluated the response inhibition and error processing by functional magnetic resonance imaging (fMRI) in subjects with IGD and controls. Twenty-six men with IGD for at least 2 years and 23 controls with no history of IGD were recruited as the IGD and control groups, respectively. All subjects performed the event-related designed Go/No-go task under fMRI and completed questionnaires related to Internet addiction and impulsivity. The IGD group exhibited a higher score for impulsivity than the control group. The IGD group also exhibited higher brain activation when processing response inhibition over the left orbital frontal lobe and bilateral caudate nucleus than controls. Both the IGD and control groups exhibited activation of the insula and anterior cingulate cortex during error processing. The activation over the right insula was lower in the subjects with IGD than the control group. Our results support the fact that the fronto-striatal network involved in response inhibition, and the salience network, anchored by the anterior cingulate and insula, contributes to error processing. Further, adults with IGD have impaired insular function in error processing and greater activation of the fronto-striatal network in order to maintain their response inhibition performance.

Gonadotrophic hormone and reinforcement sensitivity systems in women with premenstrual dysphoric disorder

AIM

Behavior inhibition and behavior approach system (BIS/BAS) determine the sensitivity to aversion and rewarding stimuli, respectively. This study aimed at evaluating the BIS/BAS of premenstrual dysphoric disorder (PMDD) and effect of estrogen and progesterone on the BIS/BAS.

METHODS

Women with PMDD without treatment and control subjects were recruited from the community. The PMDD diagnosis was based on psychiatric interviewing and the result of two-menstrual-cycle follow up. A total of 67 women with PMDD and 75 control subjects were recruited and entered the final analysis. They were evaluated with BIS/BAS scale and for estrogen and progesterone levels in both premenstrual and follicular phases.

RESULTS

The results revealed that BAS score was higher among women with PMDD in both premenstrual and follicular phases. Progesterone level negatively correlated with fun-seeking, and its change in the menstrual cycle also negatively correlated to a change in fun-seeking score among women with PMDD. Women with PMDD had a higher score in BIS in the premenstrual phase and the BIS score correlated to depression, anxiety, and hostility among them.

CONCLUSION

These results suggest reward sensitivity of women with PMDD is vulnerable to the effect of progesterone change in the menstrual cycle. Furthermore, the sensitivity to aversive stimuli plays an important role involving core symptoms of PMDD. The reinforcement sensitivity of PMDD deserves further detailed study.

The exacerbation of depression, hostility, and social anxiety in the course of Internet addiction among adolescents: a prospective study

BACKGROUND

In adolescent populations worldwide, Internet addiction is prevalent and is often comorbid with depression, hostility, and social anxiety of adolescents. This study aimed at evaluating the exacerbation of depression, hostility, and social anxiety in the course of getting addiction to Internet or remitting from Internet addiction among adolescents.

METHOD

This study recruited 2293 adolescents in grade 7 to assess their depression, hostility, social anxiety and Internet addiction. The same assessments were repeated one year later. The incidence group was defined as subjects classified as non-addicted in the first assessment and as addicted in the second assessment. The remission group was defined as subjects classified as addicted in the first assessment and as non-addicted in the second assessment.

RESULTS

The incidence group exhibited increased depression and hostility more than the non-addiction group and the effect of on depression was stronger among adolescent girls. Further, the remission group showed decreased depression, hostility, and social anxiety more than the persistent addiction group.

CONCLUSIONS

Depression and hostility worsen in the addiction process for the Internet among adolescents. Intervention of Internet addiction should be provided to prevent its negative effect on mental health. Depression, hostility, and social anxiety decreased in the process of remission. It suggested that the negative consequences could be reversed if Internet addiction could be remitted within a short duration.

Association between ADHD symptoms and anxiety symptoms in Taiwanese adolescents

OBJECTIVE

The aims of this cross-sectional study were to examine the association between significant ADHD symptoms and the four domains of anxiety symptoms on the Taiwanese version of Multidimensional Anxiety Scale for Children (MASC-T) and to examine the moderating effects of sociodemographic characteristics on this association among Taiwanese adolescents in the community.

METHOD

A total of 4,716 adolescents in Grades 7 through 12 in southern Taiwan completed the MASC-T, the ADHD Self-Rated Scale, the Mandarin Chinese version of the Center for Epidemiological Studies Depression Scale, the Rosenberg Self-Esteem Scale, and a questionnaire about sociodemographic characteristics. Multiple regression analysis was used to examine both the association of significant ADHD symptoms with four domains of anxiety symptoms on the MASC-T and the moderating effects of sociodemographic characteristics on this association.

RESULTS

The adolescents with significant ADHD symptoms had more severe total anxiety symptoms, physical symptoms, social anxiety symptoms, and separation/panic symptoms for three domains of the MASC-T but less harm avoidance than did those without significant ADHD symptoms. Age, gender, and low self-esteem had moderating effects on the association between significant ADHD symptoms and anxiety symptoms for some domains of the MASC-T.

CONCLUSION

The results of this study suggest a significant association between significant ADHD symptoms and the severity of anxiety symptoms in adolescents. Clinicians must evaluate anxiety symptoms among adolescents with ADHD and arrange comprehensive treatment programs.

Evaluation of the diagnostic criteria of Internet gaming disorder in the DSM-5 among young adults in Taiwan

The DSM-5 proposed the diagnostic criteria of Internet gaming disorder (IGD) and suggested that more evidence is necessary before it is included as a standard disorder in the DSM system. The aims of this study were to: 1) evaluate the diagnostic validity of individual criteria of IGD in the DSM-5 and the criteria of craving and irritability; 2) determine the optimal cut-off point for the IGD criteria in the DSM-5. We recruited 75 subjects with IGD, 75 without IGD, and 75 in remission from IGD based on the Diagnostic Criteria of Internet Addiction for College Students (DC-IA-C). All participants underwent a diagnostic interview based on the diagnostic criteria of IGD in the DSM-5 and completed the CIAS and QGU-B. Except for the "deceiving" and "escape" criteria, all criteria of IGD had diagnostic accuracy ranging from 77.3% to 94.7% to differentiate university students with IGD from remitted students. The criterion of craving had diagnostic accuracy of 88% and the criteria of irritability had an accuracy of 68.7%. Fulfilling 5 or more criteria of IGD in the DSM-5 was the best cut-off point to differentiate young adults with IGD from healthy or remitted users.

The association between premenstrual dysphoric disorder and internet use disorder

Premenstrual dysphoric disorder (PMDD) is an important women's mental health issue. This study aimed to investigate the association between Internet use disorder (IUD), PMDD, and their associated factors, such as stress and impulsivity. Women with PMDD (n = 79) and controls (n = 76) were recruited from the community. The diagnoses of PMDD and IUD were confirmed by psychiatric interviews. Participants were evaluated with the Chen Internet Addiction Scale, Perceived Stress Scale, and Barratt Impulsiveness Scale in both the premenstrual and follicular phases. Women with PMDD were more likely to have IUD. Women with PMDD had greater severity of IUD, perceived stress, and impulsivity than the control group in the premenstrual phase. Impulsivity mediated the association between PMDD and IUD, while both impulsivity and perceived stress mediated the association between PMDD and IUD severity. Thus, IUD should be evaluated and treated among women with PMDD, particularly for those with higher impulsivity or higher perceived stress. Strategies for stress management and counseling for impulsivity should be provided to women with PMDD, particular to those comorbid with IUD.

Depression, irritability, and anxiety in women with premenstrual dysphoric disorder

OBJECTIVE

Depression, anxiety, and irritability are the three most studied symptoms of premenstrual dysphoric disorder (PMDD). This study aimed to assess the premenstrual exacerbation of these symptoms and their role in the diagnosis or functional impairment of PMDD.

METHODS

We recruited women with PMDD not undergoing any treatment and control subjects from the community. The diagnosis of PMDD was based on a positive score on the Premenstrual Symptoms Screening Tool and confirmed by psychiatric interviews and questionnaire follow-up for three menstrual cycles. A total of 67 women with PMDD and 75 control subjects participated the survey and reach the final analysis. They complete the Center for Epidemiological Studies, the Chinese Version of the Buss-Durkee Hostility Inventory-Short Form, and the Penn State Worry Questionnaire in both the premenstrual and follicular phases.

RESULTS

Women with PMDD, but no controls, demonstrate the premenstrual exacerbation of these three symptoms. Depression was the most prominent feature of the PMDD diagnosis while irritability was most frequently associated with functional impairment.

CONCLUSIONS

Depression and irritability should be properly evaluated and treated among women with PMDD.

Brain activation deficit in increased-load working memory tasks among adults with ADHD using fMRI

Working memory (WM) is impaired among adults with attention-deficit hyperactivity disorder (ADHD). This study aimed to investigate the brain activation deficit for low-level or increased-load WM among adults with ADHD. A total of 20 adults with ADHD and controls were recruited according to diagnostic interviewing by a psychiatrist. Phonological and visual-spatial 2-back and 3-back tasks were performed under functional magnetic resonance scanning. The results demonstrated that both the adults with ADHD and the controls exhibited activation of the fronto-parietal network for WM, and the intensity was greater in the adult ADHD group. The ADHD group had higher brain activation over the bilateral anterior cingulate, left inferior frontal lobe, hippocampus, and supplementary motor area (SMA) for phonological WM than the control group. When the task loading increased from 2-back to 3-back tasks, the adults with ADHD perceived greater difficulty. The control group exhibited increased brain activation over the frontal-parietal network in response to increased phonological WM load. However, the ADHD group showed decreased brain activation over the left precuneus, insula, and SMA. Further analysis demonstrated that the ADHD group exhibited a greater decrease in brain activation over the left fronto-parietal network, including the precuneus, SMA, insula/inferior frontal lobe, and dorsolateral prefrontal cortex, than the control group. These results suggest that adults with ADHD pay more effort to low demanding phonological WM. On the other hand, brain activation of the left fronto-parietal network is impaired when the demands of WM exceed the capacity of adults with ADHD.

Brain activation for response inhibition under gaming cue distraction in internet gaming disorder

We evaluated neural substrates related to the loss of control in college students with internet gaming disorder (IGD). We hypothesized that deficit in response inhibition under gaming cue distraction was the possible mechanism for the loss of control internet use. Eleven cases of IGD and 11 controls performed Go/NoGo tasks with/without gaming distraction in the functional magnetic resonance imaging scanner. When the gaming picture was shown as background while individuals were performing Go/NoGo tasks, the IGD group committed more commission errors. The control group increased their brain activations more over the right dorsolateral prefrontal cortex (DLPFC) and superior parietal lobe under gaming cue distraction in comparison with the IGD group. Furthermore, brain activation of the right DLPFC and superior parietal lobe were negatively associated with performance of response inhibition among the IGD group. The results suggest that the function of response inhibition was impaired under gaming distraction among the IGD group, and individuals with IGD could not activate right DLPFC and superior parietal lobe to keep cognitive control and attention allocation for response inhibition under gaming cue distraction. This mechanism should be addressed in any intervention for IGD.

Brain correlates of craving for online gaming under cue exposure in subjects with Internet gaming addiction and in remitted subjects

This study aimed to evaluate brain correlates of cue-induced craving to play online games in subjects with Internet gaming addiction (IGA), subjects in remission from IGA and controls. The craving response was assessed by event-related design of functional magnetic resonance images (fMRIs). Fifteen subjects with IGA, 15 in remission from IGA and 15 controls were recruited in this study. The subjects were arranged to view the gaming screenshots and neutral images under investigation of fMRIs. The results showed that bilateral dorsolateral prefrontal cortex (DLPFC), precuneus, left parahippocampus, posterior cingulate and right anterior cingulate were activated in response to gaming cues in the IGA group and their activation was stronger in the IGA group than those in the control group. Their region-of-interest was also positively correlated with subjective gaming urge under cue exposure. These activated brain areas represent the brain circuit corresponding to the mechanism of substance use disorder. Thus, it would suggest that the mechanism of IGA is similar to substance use disorder. Furthermore, the IGA group had stronger activation over right DLPFC and left parahippocampus than did the remission group. The two areas would be candidate markers for current addiction to online gaming and should be investigated in future studies.

The brain activations for both cue-induced gaming urge and smoking craving among subjects comorbid with Internet gaming addiction and nicotine dependence

Internet gaming addiction (IGA) has been classified as an addictive disorder in the proposed DSM 5 draft. However, whether its underlying addiction mechanism is similar to other substance use disorders has not been confirmed. The present functional magnetic resonance images study is aimed at evaluating the brain correlates of cue-induced gaming urge or smoking craving in subjects with both IGA and nicotine dependence to make a simultaneous comparison of cue induced brain reactivity for gaming and smoking. For this purpose, 16 subjects with both IGA and nicotine dependence (comorbid group) and 16 controls were recruited from the community. All subjects were made to undergo 3-T fMRIs scans while viewing images associated with online games, smoking, and neutral images, which were arranged according to an event-related design. The resultant image data was analyzed with full factorial and conjunction analysis of SPM5. The results demonstrate that anterior cingulate, and parahippocampus activates higher for both cue-induced gaming urge and smoking craving among the comorbid group in comparison to the control group. The conjunction analysis demonstrates that bilateral parahippocampal gyrus activates to a greater degree for both gaming urge and smoking craving among the comorbid group in comparison to the control group. Accordingly, the study demonstrates that both IGA and nicotine dependence share similar mechanisms of cue-induced reactivity over the fronto-limbic network, particularly for the parahippocampus. The results support that the context representation provided by the parahippocampus is a key mechanism for not only cue-induced smoking craving, but also for cue-induced gaming urge.

The bidirectional interactions between addiction, behaviour approach and behaviour inhibition systems among adolescents in a prospective study

Internet addiction is a worldwide mental health problem among adolescents. This study aimed to evaluate the prediction of the Behaviour Inhibition System (BIS) and the Behaviour Approach System (BAS) on the occurrence of Internet addiction, and determine whether Internet addiction would make any difference on the development of BIS/BAS among adolescents. Adolescents in grade 7 were recruited to complete assessment for Internet addiction and BIS/BAS. Then, a follow-up was performed 1 year later. The results demonstrated that higher BAS and BAS fun seeking predicted the occurrence of Internet addiction. Adolescents with Internet addiction decreased more on BAS and BIS 1 year later than the non-addiction group. These results suggest that higher BAS and fun seeking are risk factors for Internet addiction among adolescents. Besides, interventions for Internet addiction should pay attention to the disturbed development of BAS and BIS.