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Guest Editorial
Highlighting Bipolar II Disorder
Gordon Parker, MD, PhD, DSc, FRANZCP
(PDF)

In Review
Neurobiological Findings in Bipolar II Disorder Compared With Findings in Bipolar I Disorder
Brent M McGrath, BSc, MSc, Phillip H Wessels, MD, FRCPC, Emily C Bell, BSc, MSc, Michele Ulrich, BSc, Peter H Silverstone, MB, BS, MD, MRCPsych, FRCPC
(PDF)

Bipolar II Disorder: An Overview of Recent Developments
George Hadjipavlou, MA, MD, Hiram Mok, MA, MB, BCh, BAO, FRCPC, Lakshmi N Yatham, MBBS, MRCPsych, FRCPC3 (PDF)

Review Paper
Bipolar Disorder: It’s All in Your Mind? The Neuropsychological Profile of a Biological Disorder
Gin S Malhi, BSc, MB, ChB, MRCPsych, FRANZCP, Belinda Ivanovski, Ssc Psychol, M Clin Psychol, Viktoria Szekeres, BSc,Psychol
(PDF)

Original Research
Impact of Culture on Depressive Symptoms of Elderly Chinese Immigrants
Glenda MacQueen, MD, PhD, FRCPC
Daniel WL Lai, PhD
(PDF)

Development and Reliability of a Pictorial Mental Disorders Screen for Young Adolescents
Nicole Smolla, PhD, Jean-Pierre Valla, MD, MSc, Lise Bergeron, PhD, Claude Berthiaume, MSc, Marie St-Georges, MPs
(PDF)

Command Hallucinations Among Asian Patients With Schizophrenia
Theresa MY Lee, MBBS, MMed, Siow Ann Chong, MBBS, MMed, Yiong Huat Chan, PhD, Gangaharan Sathyadevan, MBBS, MRCPsych
(PDF)

The Centre for Addiction and Mental Health Concurrent Disorders Screener
Juan C Negrete, MD, FRCPC, Jane Collins, MSc, Nigel E Turner, PhD, Wayne Skinner, MSW
(PDF)

Validation de la version française du questionnaire de Sociotropie-Autonomie de Beck et collègues
Mathilde M Husky, MSc, Olivier S Grondin, MSc, Philippe D Compagnone, PhD
(PDF)

Brief Communication
Depressive Symptoms and Alcohol Consumption Among Nonalcoholic Depression Patients Treated With Desipramine
Benjamin I Goldstein, MD, PhD, Ayal Schaffer, MD, FRCPC, Anthony Levitt, MD, FRCPC, Ari Zaretsky, MD, FRCPC, Russell T Joffe, MD, FRCPC, Virginia Wesson, MD, R Michael Bagby, PhD
Pierre Bleau, MD, FRCPC
(PDF)

Letters to the Editor
(PDF)

Safety of Clozapine in 2 Successive Pregnancies

Revisiting the Diagnostic Challenges of Secondary Mania and Bipolar Disorder in a Patient With Borderline Hyperthyroidism

Dyslipidaemia and Psychiatric Patients

Dream Contents in Patients With Major Depressive Disorder

Sensory Deprivation and Disorders of Perception

Re: The Internet’s Impact on the Practice of Psychiatry

Response: The Internet’s Impact on the Practice of Psychiatry

Denial and Avoidance in an Unusual Case of Death From Breast Cancer

Interferon-Induced Mania

Drug-Induced Psychosis After Long-Term Treatment With Levetiracetam

Priapism

An Ounce of Prevention: “COPEing with Toddler Behaviour”

Internet Gaming Addiction

Letters to the Editor

Internet Gaming Addiction

Dear Editor:
As the Internet becomes the new medium through which players play games, there is growing research on Internet addiction. Although this diagnostic entity has not gained entry into the DSM-IV, there is a need for rigorous studies through published case reports that can define this phenomenon (1). We present the case of a person with an Internet gaming addiction who responded to treatment with escitalopram. A man, aged 31 years, presented to the emergency room (ER) after his fiancee left him because of the excessive time he spent playing Everquest, an on-line fantasy role-playing game. For the past 2 years, he spent increasing time playing Everquest, sometimes stretching to 52 hours of uninterrupted play. After his fiancee complained, he tried to stop but could not, so he started playing when she slept or was away. He felt very anxious when not playing and reported severe craving-like desires to play. His only friends were those on-line. He made several unsuccessful attempts to decrease his on-line gaming. To stay awake when playing, he drank 4 to 5 pots of coffee daily. He quit his job and stopped his educational training because of his preoccupation with on-line gaming. His fiancee finally left him, and he developed depression. The patient reported poor concentration, poor sleep, low energy, and feelings hopelessness and worthlessness. As part of the evaluation, he completed the Hamilton Depression Rating Scale (HDRS) and scored 18, consistent with severe depression. He also completed the Addiction Severity Index (ASI), scoring 18, consistent with severe Internet addiction. Outpatient treatment with gabapentin 100 mg 3 times daily for anxiety and escitalopram 10 mg daily for his depression was recommended. He was also referred for individual and group therapy. However, within a month, he stopped psychotherapy and gabapentin but continued the escitalopram. His dosage was increased to 30 mg daily over 3 months. This improved his depression and reduced his urges for on-line gaming. He erased the Everquest program from his computer and resumed his job and educational training. Follow-up testing showed a an ASI for Internet addiction decreased to 3, while the HDRS decreased to 5.

Current data on Internet gaming addiction suggests that on-line fantasy gaming is associated with introversion, low empathy, low self-esteem, (2) depression, and social isolation (3). On-line games allow players to assume a false identity in a virtual world and to interact freely with strangers, which provides an escape from reality. Treatment of these individuals should target comorbid psychiatric symptoms and their addiction to on-line gaming. In the absence of established guidelines, escitalopram, a selective serotonin reuptake inhibitor that is an effective treatment for depression, may provide additional benefit for patients with Internet gaming addiction.

Funding and Support

There was no external funding received for this study. There are no conflicts of interest.

References

1. Huang MP, Alessi NE. The Internet and the future of psychiatry. Am J Psychiatry 1997;154(Suppl 6):890.

2. Douse NA, Mc Manus IC. The personality of fantasy game players. Br J Psychol 1993;84:505–9.

3. Shapira NA, Goldsmith TD, Keck PE Jr, Khosla UM, McElroy SL. Psychiatric features of individuals with problematic Internet use. J Affect Disord 2000;57:267–72.

Pirzada Sattar, MD;
Sriram Ramaswamy, MD
Omaha, Nebraska