Psychiatry and Clinical Neurosciences 2014
Letter to the Editor
Adolescent’s psychotic-like symptoms associated with Internet addiction doi:10.1111/pcn.12243
I
NTERNET ADDICTION (IA) has been temporarily listed in DSM-5 section III, and named Internet Gaming Disorder (IGD). The present unresolved problem is whether IA reflects a non-substance addictive disorder, or is a secondary disease following other psychiatric disorders.1 The complicated psychiatric comorbidity problem is that 88.3% of children and adolescents with IA have an average of two other co-occurring diagnoses. Among them, attention deficit hyperactivity disorder (ADHD) is the most commonly seen co-occurring diagnosis, with an incidence as high as 83.3%. The most serious co-occurring diagnosis was psychotic-like experiences2 or reported withdrawal psychosis after IA3,4 (one adult and one adolescent). The previous report of an adolescent introduced the psychosis but gave no possible reason for how the psychosis developed. Herein, we report the second case of adolescent psychosis after IA and suggest the possible pathogenesis. A 19-year-old boy had attention problems and had already quit school due to long-term excessive computer use and poor school performance. He had used the computer excessively for 6 months, including 3 months after his mother committed suicide due to depression. The family started to notice he had withdrawal symptoms, like psychomotor agitation, anxiety, irritability, and verbal aggression, only when he was asked to stop playing with the computer. He would spend several days continuously playing without a break, and this had negative repercussions, including lying, social isolation, fatigue and irregular daily schedule, meals, and sleep. He started having psychotic symptoms, such as suddenly running out and holding a female classmate who he had loved previously, but he refused to undergo treatment. One week before admission, he was noticed to have a perplexed facial appearance, insomnia, paranoid ideation, confusion about where a woman’s
voice was coming from, and visual hallucination. He was finally brought to the outpatient department for admission due to his abnormal running out of a room, screaming at police cars, and showing violence towards his family. We suggest: (i) his maternal depression was a genetic or biological liability that might have predisposed him to the risk of his psychosis; (ii) ADHD without treatment led him to living long-term in a biologically vulnerable or stressful state, which can be regarded as a moderator or perpetuating risk of psychosis; (iii) his malnutrition and irregular sleep due to IA was an environmental stressor that might have precipitated his becoming psychotic; and (iv) as his condition deteriorated towards psychosis over a 6-month period, his social isolation led him to use the Internet more. A formal clinical trial in the future is definitely highly recommended.
REFERENCES 1. Kratzer S, Hegerl U. [Is ‘Internet Addiction’ a disorder of its own?–a study on subjects with excessive internet use]. Psychiatr. Prax. 2008; 35: 80–83. 2. Mittal VA, Dean DJ, Pelletier A. Internet addiction, reality substitution and longitudinal changes in psychotic-like experiences in young adults. Early Interv. Psychiatry 2013; 7: 261–269. 3. Paik A, Oh D, Kim D. A case of withdrawal psychosis from internet addiction disorder. Psychiatry Investig. 2014; 11: 207– 209. 4. Mendhekar DN, Andrade C. Emergence of psychotic symptoms during Internet withdrawal. Psychiatry Clin. Neurosci. 2012; 66: 163.
Chuan-Hsin Chang5 and Yue-Cune Chang, PhD4 1 Department of Psychiatry, Mackay Memorial Hospital, 2 Department of Health Care Management, National Taipei University of Nursing and Health Sciences, 3Mackay Junior College of Medicine, Nursing, and Management, 4Department of Mathematics, Tamkang University, Taipei, Taiwan, and 5 Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, Anschutz Medical Campus, University of Colorado, Aurora, USA Email: [email protected] Received 28 June 2014; revised 10 September 2014; accepted 6 October 2014. Ruu-Fen Tzang,
MD,1,2,3
© 2014 The Authors Psychiatry and Clinical Neurosciences © 2014 Japanese Society of Psychiatry and Neurology
1
Letter to the Editor
Adolescent’s psychotic-like symptoms associated with Internet addiction doi:10.1111/pcn.12243
I
NTERNET ADDICTION (IA) has been temporarily listed in DSM-5 section III, and named Internet Gaming Disorder (IGD). The present unresolved problem is whether IA reflects a non-substance addictive disorder, or is a secondary disease following other psychiatric disorders.1 The complicated psychiatric comorbidity problem is that 88.3% of children and adolescents with IA have an average of two other co-occurring diagnoses. Among them, attention deficit hyperactivity disorder (ADHD) is the most commonly seen co-occurring diagnosis, with an incidence as high as 83.3%. The most serious co-occurring diagnosis was psychotic-like experiences2 or reported withdrawal psychosis after IA3,4 (one adult and one adolescent). The previous report of an adolescent introduced the psychosis but gave no possible reason for how the psychosis developed. Herein, we report the second case of adolescent psychosis after IA and suggest the possible pathogenesis. A 19-year-old boy had attention problems and had already quit school due to long-term excessive computer use and poor school performance. He had used the computer excessively for 6 months, including 3 months after his mother committed suicide due to depression. The family started to notice he had withdrawal symptoms, like psychomotor agitation, anxiety, irritability, and verbal aggression, only when he was asked to stop playing with the computer. He would spend several days continuously playing without a break, and this had negative repercussions, including lying, social isolation, fatigue and irregular daily schedule, meals, and sleep. He started having psychotic symptoms, such as suddenly running out and holding a female classmate who he had loved previously, but he refused to undergo treatment. One week before admission, he was noticed to have a perplexed facial appearance, insomnia, paranoid ideation, confusion about where a woman’s
voice was coming from, and visual hallucination. He was finally brought to the outpatient department for admission due to his abnormal running out of a room, screaming at police cars, and showing violence towards his family. We suggest: (i) his maternal depression was a genetic or biological liability that might have predisposed him to the risk of his psychosis; (ii) ADHD without treatment led him to living long-term in a biologically vulnerable or stressful state, which can be regarded as a moderator or perpetuating risk of psychosis; (iii) his malnutrition and irregular sleep due to IA was an environmental stressor that might have precipitated his becoming psychotic; and (iv) as his condition deteriorated towards psychosis over a 6-month period, his social isolation led him to use the Internet more. A formal clinical trial in the future is definitely highly recommended.
REFERENCES 1. Kratzer S, Hegerl U. [Is ‘Internet Addiction’ a disorder of its own?–a study on subjects with excessive internet use]. Psychiatr. Prax. 2008; 35: 80–83. 2. Mittal VA, Dean DJ, Pelletier A. Internet addiction, reality substitution and longitudinal changes in psychotic-like experiences in young adults. Early Interv. Psychiatry 2013; 7: 261–269. 3. Paik A, Oh D, Kim D. A case of withdrawal psychosis from internet addiction disorder. Psychiatry Investig. 2014; 11: 207– 209. 4. Mendhekar DN, Andrade C. Emergence of psychotic symptoms during Internet withdrawal. Psychiatry Clin. Neurosci. 2012; 66: 163.
Chuan-Hsin Chang5 and Yue-Cune Chang, PhD4 1 Department of Psychiatry, Mackay Memorial Hospital, 2 Department of Health Care Management, National Taipei University of Nursing and Health Sciences, 3Mackay Junior College of Medicine, Nursing, and Management, 4Department of Mathematics, Tamkang University, Taipei, Taiwan, and 5 Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, Anschutz Medical Campus, University of Colorado, Aurora, USA Email: [email protected] Received 28 June 2014; revised 10 September 2014; accepted 6 October 2014. Ruu-Fen Tzang,
MD,1,2,3
© 2014 The Authors Psychiatry and Clinical Neurosciences © 2014 Japanese Society of Psychiatry and Neurology
1
