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A case of problematic internet use successfully treated with an SSRI-antipsychotic combination
... One case study included an Australian adolescent [112] . Atmaca [28] To describe a case of problematic Internet use successfully treated with an SSRI-antipsychotic combination Case report SSRI-antipsychotic combination: Citalopram 20 mg/d increased to 40 mg/d within 1 wk, continued for 6 wk; then quetiapine (50 mg/d) added and increased to 200 mg/d within 4 d SCID-Ⅳ to assess Axis Ⅰ psychiatric comorbidity [29] Y-BOCS score decreased from 21 to 7 after treatment n = 1 male 23-yr old single 4 th year medical student YBOCS [30,31] Nonessential Internet use decreased from 27 to 7 h/wk; essential Internet use decreased from 4.5 to 3 h/wk Improvement maintained at 4 mo follow-up with the same medication Bernardi et al [32] To describe a clinical study of individuals with Internet addiction, comorbidities and dissociative symptoms n = 50 adult outpatients self-referred for internet overuse in Italy (age M = 23.3, SD = 1.8 yr) ...
... In five studies, psychopharmacotherapy [20,22,24,28,46] for online addictions was used. Atmaca [28] reported the case of a 23yearold male 4 th year medical student who presented with the problems of problematic Internet use and anxiety. ...
... In five studies, psychopharmacotherapy [20,22,24,28,46] for online addictions was used. Atmaca [28] reported the case of a 23yearold male 4 th year medical student who presented with the problems of problematic Internet use and anxiety. The patient was treated with a combination of selective serotonine reuptake inhibitors (SSRI) and antipsychotic medication. ...
Introduction
In 2013, the American Psychiatric Association included Internet Gaming Disorder in the appendix of the 5th edition of the DSM-5, suggesting more research is necessary for the condition to be officially accepted as mental disorder. Criticisms have emerged as to the viability, validity and reliability of the proposed condition, and researchers have pointed out that the subsuming of Internet addiction under the umbrella term of Internet Gaming Disorder (as is the case in the DSM-5) is highly problematic.
Objectives and aims
The objective of this talk is to provide a comprehensive and inclusive analysis of clinical research of Internet-use related addictions from a holistic perspective, given the ambiguity of previous research in the field.
Methods
A systematic literature review was conducted using the database Web of Science, and a total of 44 empirical and clinically relevant studies were identified.
Results
Results indicated that the published clinical research studies can be categorized into four areas, including (i) treatment seeker characteristics, (ii) psychopharmacotherapy, (iii), psychological therapy, and (iv) combined treatment, each of which will be discussed.
Conclusions
At the present day, both diagnosis and research of Internet-use disorders appears rather broad. Furthermore, there appears a need for developing a gold standard of clinical assessment. This will support the establishment of efficacious and effective treatments which need to be tailored to the individual help seekers’ needs.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
... One case study included an Australian adolescent [112] . Atmaca [28] To describe a case of problematic Internet use successfully treated with an SSRI-antipsychotic combination Case report SSRI-antipsychotic combination: Citalopram 20 mg/d increased to 40 mg/d within 1 wk, continued for 6 wk; then quetiapine (50 mg/d) added and increased to 200 mg/d within 4 d SCID-Ⅳ to assess Axis Ⅰ psychiatric comorbidity [29] Y-BOCS score decreased from 21 to 7 after treatment n = 1 male 23-yr old single 4 th year medical student YBOCS [30,31] Nonessential Internet use decreased from 27 to 7 h/wk; essential Internet use decreased from 4.5 to 3 h/wk Improvement maintained at 4 mo follow-up with the same medication Bernardi et al [32] To describe a clinical study of individuals with Internet addiction, comorbidities and dissociative symptoms n = 50 adult outpatients self-referred for internet overuse in Italy (age M = 23.3, SD = 1.8 yr) ...
... In five studies, psychopharmacotherapy [20,22,24,28,46] for online addictions was used. Atmaca [28] reported the case of a 23yearold male 4 th year medical student who presented with the problems of problematic Internet use and anxiety. ...
... In five studies, psychopharmacotherapy [20,22,24,28,46] for online addictions was used. Atmaca [28] reported the case of a 23yearold male 4 th year medical student who presented with the problems of problematic Internet use and anxiety. The patient was treated with a combination of selective serotonine reuptake inhibitors (SSRI) and antipsychotic medication. ...
... Atmaca [28] To describe a case of problematic Internet use successfully treated with an SSRI-antipsychotic combination Case report SSRI-antipsychotic combination: Citalopram 20 mg/d increased to 40 mg/d within wk, continued for 6 wk; then quetiapine (50 mg/d) added and increased to 200 mg/d within 4 d SCID-Ⅳ to assess Axis Ⅰ psychiatric comorbidity [29] Y-BOCS score decreased from 2 to 7 after treatment n = male 23-year old single 4 th year medical student YBOCS [30,3] Nonessential Internet use decreased from 27 to 7 h/wk; essential Internet use decreased from 4.5 to 3 h/wk Improvement maintained at 4 mo follow-up with the same medication Bernardi et al [32] To describe a clinical study of individuals with Internet addiction, comorbidities and dissociative symptoms n = 50 adult outpatients self-referred for Internet overuse in Italy (age M = 23.3, SD = .8 ...
... College Students' Psychological Needs and Fulfillment Scale [23] Quasi-experimental design Müller et al [24] To characterize German treatment seekers and to determine the diagnostic accuracy of a selfreport scale for Treatment of behavioural addictions SCL-90R [25] 7% met clinical IA diagnosis PHQ [26] Displayed higher levels of psychopathology, especially depressive and dissociative symptoms IA Germany Non-experimental design GAD-7 [27] Half met criteria for one further psychiatric disorder, especially depression CDS-2 [28] Level of functioning decreased in all domains AICA-S showed AICA-S [29] good psychometric properties and satisfying diagnostic accuracy (sensitivity: 80.5%; specificity: 82.4%) Müller et al [30] To compare personality profiles of a sample of patients in different rehabilitation centres Non-experimental design Addiction (AICA-S) [29] AD group: 48 male patients suffering from alcohol dependence (AD); M = 3.7 yr; SD = 9.8; range 7-65) NEO-FFI [3] After controlling for depressive symptoms, lower conscientiousness turned out to be a disorder-specific risk factor Germany BDI-II [32] Müller et al [33] To evaluate the relationships between personality traits and IGD n = 404 males aged 6 yr and above N/A AICA-S [44] IGD associated with higher neuroticism, decreased conscientiousness and low extraversion 4 groups: ...
... In five studies, psychopharmacotherapy [20,22,24,28,46] for online addictions was used. Atmaca [28] reported the case of a 23 year old male 4 th year medical student who presented with the problems of problematic Internet use and anxiety. ...
... One case study included an Australian adolescent [112] . Atmaca [28] To describe a case of problematic Internet use successfully treated with an SSRI-antipsychotic combination Case report SSRI-antipsychotic combination: Citalopram 20 mg/d increased to 40 mg/d within 1 wk, continued for 6 wk; then quetiapine (50 mg/d) added and increased to 200 mg/d within 4 d SCID-Ⅳ to assess Axis Ⅰ psychiatric comorbidity [29] Y-BOCS score decreased from 21 to 7 after treatment n = 1 male 23-yr old single 4 th year medical student YBOCS [30,31] Nonessential Internet use decreased from 27 to 7 h/wk; essential Internet use decreased from 4.5 to 3 h/wk Improvement maintained at 4 mo follow-up with the same medication Bernardi et al [32] To describe a clinical study of individuals with Internet addiction, comorbidities and dissociative symptoms n = 50 adult outpatients self-referred for internet overuse in Italy (age M = 23.3, SD = 1.8 yr) ...
... In five studies, psychopharmacotherapy [20,22,24,28,46] for online addictions was used. Atmaca [28] reported the case of a 23yearold male 4 th year medical student who presented with the problems of problematic Internet use and anxiety. ...
... In five studies, psychopharmacotherapy [20,22,24,28,46] for online addictions was used. Atmaca [28] reported the case of a 23yearold male 4 th year medical student who presented with the problems of problematic Internet use and anxiety. The patient was treated with a combination of selective serotonine reuptake inhibitors (SSRI) and antipsychotic medication. ...
To date, around 40% of the world population is online. Internet usage has grown almost six-fold over the last decade around the globe. In Korea, 96% of Internet users make use of high-speed Internet connections, in comparison to 78% in the UK and 56% in the US (2012, 2013). Since 2000, the US has more than doubled Internet access and use, and mobile Internet use increased extensively in 2011 (The Nielsen Company, 2012a). These statistics evidence that the Internet has become an integral element in today’s society. In 2012, children and adolescents in Australia spent an average of 24 hours online per month, compared with 65 hours for individuals aged 18–24 years, and 25–34 year olds spend more than 100 hours per month online (The Nielsen Company, 2012b). Accordingly, young adults are the most active Internet users and spend roughly three hours per day on the Internet (Kuss et al., 2014a).
... One case study included an Australian adolescent [112] . Atmaca [28] To describe a case of problematic Internet use successfully treated with an SSRI-antipsychotic combination Case report SSRI-antipsychotic combination: Citalopram 20 mg/d increased to 40 mg/d within 1 wk, continued for 6 wk; then quetiapine (50 mg/d) added and increased to 200 mg/d within 4 d SCID-Ⅳ to assess Axis Ⅰ psychiatric comorbidity [29] Y-BOCS score decreased from 21 to 7 after treatment n = 1 male 23-yr old single 4 th year medical student YBOCS [30,31] Nonessential Internet use decreased from 27 to 7 h/wk; essential Internet use decreased from 4.5 to 3 h/wk Improvement maintained at 4 mo follow-up with the same medication Bernardi et al [32] To describe a clinical study of individuals with Internet addiction, comorbidities and dissociative symptoms n = 50 adult outpatients self-referred for internet overuse in Italy (age M = 23.3, SD = 1.8 yr) ...
... In five studies, psychopharmacotherapy [20,22,24,28,46] for online addictions was used. Atmaca [28] reported the case of a 23yearold male 4 th year medical student who presented with the problems of problematic Internet use and anxiety. ...
... In five studies, psychopharmacotherapy [20,22,24,28,46] for online addictions was used. Atmaca [28] reported the case of a 23yearold male 4 th year medical student who presented with the problems of problematic Internet use and anxiety. The patient was treated with a combination of selective serotonine reuptake inhibitors (SSRI) and antipsychotic medication. ...
Aim:
To provide a comprehensive overview of clinical studies on the clinical picture of Internet-use related addictions from a holistic perspective. A literature search was conducted using the database Web of Science.
Methods:
Over the last 15 years, the number of Internet users has increased by 1000%, and at the same time, research on addictive Internet use has proliferated. Internet addiction has not yet been understood very well, and research on its etiology and natural history is still in its infancy. In 2013, the American Psychiatric Association included Internet Gaming Disorder in the appendix of the updated version of the Diagnostic and Statistical Manual for Mental Disorders (DSM-5) as condition that requires further research prior to official inclusion in the main manual, with important repercussions for research and treatment. To date, reviews have focused on clinical and treatment studies of Internet addiction and Internet Gaming Disorder. This arguably limits the analysis to a specific diagnosis of a potential disorder that has not yet been officially recognised in the Western world, rather than a comprehensive and inclusive investigation of Internet-use related addictions (including problematic Internet use) more generally.
Results:
The systematic literature review identified a total of 46 relevant studies. The included studies used clinical samples, and focused on characteristics of treatment seekers and online addiction treatment. Four main types of clinical research studies were identified, namely research involving (1) treatment seeker characteristics; (2) psychopharmacotherapy; (3) psychological therapy; and (4) combined treatment.
Conclusion:
A consensus regarding diagnostic criteria and measures is needed to improve reliability across studies and to develop effective and efficient treatment approaches for treatment seekers.
... В ряде исследований психофармакотерапия применялась изолированно [4,13,15,22]. Из препаратов использовались циталопрам 20-40 мг/сут в сочетании с кветиапином 50-200 мг/сут [13], эсциталопрам 10-20 мг/сут [22], флувоксамин 150-200 мг/сут, сертралин 150-200 мг/сут, флуоксетин 60 мг/сут, кломипрамин 200 мг/сут [15]. Во всех исследованиях наблюдалась редукция интернетаддиктивной симптоматики. ...
... В ряде исследований психофармакотерапия применялась изолированно [4,13,15,22]. Из препаратов использовались циталопрам 20-40 мг/сут в сочетании с кветиапином 50-200 мг/сут [13], эсциталопрам 10-20 мг/сут [22], флувоксамин 150-200 мг/сут, сертралин 150-200 мг/сут, флуоксетин 60 мг/сут, кломипрамин 200 мг/сут [15]. Во всех исследованиях наблюдалась редукция интернетаддиктивной симптоматики. ...
... 24 Pharmacological and psychotherapeutic treatments for Internet Addiction have been suggested. 30 The pharmacological treatment involves medicines such as Escitalopram, 31 Citalopram, 32 Bupropion, 22 Olanzapine, 33 Quetiapine, 34 Naltrexone, 35 Methylphenidate 36 and Memantine. 37 Cognitive Behavioral Therapy (CBT) is an approach that teaches patients to pay attention to their thoughts, feelings and behaviors and that these dimensions have a strict relationship. ...
... 38 CBT has been used to treat IA in many different ways. 22,34,35,36 Some researchers argue that the first stage of the treatment should be behavioral, taking into account situations where impulsivity is present. 39 Another step of treatment is focused on cognitive aspects of addiction, reducing maladaptive cognitions and promoting restructuring. ...
OBJECTIVE: To investigate the effectiveness of a treatment for Internet addiction and anxiety disorders, using
cognitive behavioral therapy combined with medication, and to analyze the relationship between anxiety and
Internet addiction. METHOD: An open clinical trial included 84 patients (42 in the “comorbidities” group; 42 in the “no comorbidities” group) seeking treatment for anxiety symptoms and/or Internet Addiction. The subjects responded to The Mini International Neuropsychiatric Interview 5.0; the Hamilton Anxiety Scale (HAM-A), the Hamilton Depression Scale (HDRS), Clinical Global Impressions Severity and Improvement (CGI-S and CGI-I) and the Young Internet Addiction Scale (IAT). Patients who had only Internet addiction received psychoeducation on conscious internet use and bibliotherapy; they were defined as the group without comorbidities; patients diagnosed with Internet addiction and anxiety disorder (the group with comorbidities) were forwarded for pharmacotherapy and psychotherapy. RESULTS: Both Internet Addiction and anxiety decreased after treatment; the average of Hamilton Anxiety Scale of the “comorbidities” group at the beginning was 33.9 ± 7.6, suggesting severe anxiety, and at the end of treatment it was 15.0 ± 5.1, suggesting mild anxiety and a significant improvement. The average Internet Addiction score at the beginning was 67.8 ± 9.0; at the end of the psychotherapy an average score of 37.7 ± 11.4 was registered, indicating a notable and highly significant improvement. CONCLUSIONS: The relationship between anxiety and Internet Addiction existed and was strong. Treatment significantly improved both.
... Many clinicians employ psychopharmacology to treat internet addiction although there is no solid evidence regarding the efficacy level of pharmacological treatments. Previously, the use of selective serotonin reuptake inhibitors (SSRIs) has been reported to effectively treat the psychiatric symptoms of internet addictions including depression, stress, and anxiety (Arisoy, 2009;Atmaca, 2007). One SSRI known as "Escitalopram" has been reported to show a reduction in the overall internet usage among individuals diagnosed with internet addiction (Dell'Osso et al., 2008). ...
... Dostupná literatura uvádí, že efekt při léčbě závislosti na internetu mají antidepresiva escitalopram (Sattar a Ramaswamy, 2004; Dell'Osso a kol., 2008), kombinace antidepresiva citalopramu a antipsychotika quetiapinu (Atmaca, 2007) a antidepresiva bupropionu pro nadměrné hráče online her (Han a Renshaw, 2011). 138 Adiktologickými poruchami se v tomto kontextu rozumí poruchy duševní a poruchy chování způsobené užíváním psychoaktivních látek, patologické hráčství a další příbuzné poruchy chování charakterizované chronickým průběhem, bažením, sníženou schopností abstinovat, snížením kontroly chování a sníženou schopností rozpoznávat či připouštět si problémy vznikající v důsledku vlastního chování. ...
Tato zpráva je první souhrnnou zprávou o nadužívání digitálních technologií, tj. nadměrném trávení času na internetu, zejména na sociálních sítích a hraním digitálních her, které může vést ke vzniku a rozvoji závislostí, označovaných souhrnně v této zprávě jako digitální závislosti. Zpráva kromě výskytu tohoto fenoménu v populaci shrnuje dostupné informace o zdravotních a sociálních dopadech nadužívání digitálních technologií. Součástí je základní vymezení pojmů, popis národní strategie a politiky v této oblasti a podrobně jsou prezentována zjištění populačních i dalších výběrových studií, data ze zdravotnické statistiky týkající se léčby i data ze sítě adiktologických služeb pracujících se skupinou klientů s problémy v oblasti nadužívání digitálních technologií. Prezentovaná data shrnují situaci ke konci května 2022 – popisovány jsou tedy poslední dostupné výsledky (z běžných statistik jde obvykle o údaje za r. 2021) a tam, kde jsou dostupné časové řady studií, jsou prezentovány i trendy ve vývoji situace.
This report is the first summary report on excessive use of digital technologies, i.e. excessive time spent on the Internet, especially on social media and digital (computer) games that can lead to the development of addiction, called in this report as digital addiction. The report summarizes the extent of this phenomenon in the adult and adolescent population, and available information on health and social consequences of the excessive use of digital technologies. It countains the description of the concept and definitions, description of the National Strategy and policy in this area, presents in detail the results of population and other sample surveys, treatment data from health statistics, as well as data from addictology services working with clients overusing digital technologies and at risk of digital addiction. Data presented summarize the situation as of the end of May 2022 - the latest available data from routine monitoring systems refer to 2021, and where available, time series, trends and developments are presented.
... Regarding the studies about pharmacotherapy, Kuss and Lopez-Fernandez (2016) reported a study on a single case (Atmaca, 2007) that was successfully treated with a combination of selective serotonin reuptake inhibitors (SSRI) and antipsychotic medication, leading to a symptom remission that was still evident on a 4-month follow-up. Another study replicated the use of SSRI in the treatment of Internet Addiction and Internet Gaming Disorder with apparently good results: Dell'Osso et al. (2008) found that the antidepressant was effective in reducing uncontrolled Internet use in the patient group. ...
Addiction is a chronic relapsing disorder. Despite pharmacological and psychological interventions during rehabilitation, a majority of patients still relapse. In this seventh chapter, we present neuromodulation techniques as a complementary intervention for addiction. Firstly, while deep brain stimulation (DBS) has shown promising results, its cost–benefit–risk ratio is nonetheless too high to be implemented in routine clinical care. Secondly, repeated transcranial magnetic stimulation (rTMS) and transcranial direct courant stimulation (tDCS) over the dorsolateral prefrontal cortex (DLPFC) have shown reduced craving and relapses, but the results are mixed. To improve efficacy, new perspectives envisioned that the insula could be a promising target for rTMS and DBS in combination with cognitive remediation and while participants are exposed to key conditioned stimuli. Additionally, neurofeedback could be a useful tool in teaching patients to actively regulate their neural activity, although better controlled experimental designs and rigorous measures of brain changes are needed. Despite the heterogeneity of studies, neuromodulation techniques as complementary tools to conventional care seem to constitute a turning point in the management of addictions.
... Concerning brain stimulation techniques, a 4-week Transcranial Direct Current Stimulation protocol was found to be useful for reducing gaming online and enhancing self-control, likely by improving interhemispheric balance of glucose metabolism in the Dorsolateral Prefrontal Cortex [70]. Escitalopram up to 20 mg/die (Song et al., 2016;Nam et al., 2017) Bupropion up to 300 mg/die (Han et al., 2011;Han and Renshaw., 2012;Song et al., 2016;Nam et al., 2017;Bae et al., 2018) Citalopram up to 40 mg/die + Quetiapine up to 200 mg/die (Atmaca et al., 2007) Methylphenidate up to 40 mg/die and Atomoxetine up to 60 mg/die ...
Introduction
Problematic Usage of the Internet (PUI) refers to a broad and likely heterogeneous group of Internet-related conditions associated with behavioural disturbances and functional impairment.
Methods
Within PUI several conditions have been reported, including Gaming Disorder, Shopping Addiction, Cyberchondria, Gambling Disorder, Cyberpornography Addiction and Cyberbullying. While increasing reports in the field try to define the epidemiologic and clinical boundaries of these conditions, the rapid and continuous evolution of Internet related behaviours as well as their problematic/pathological expressions are often difficult to diagnose, assess, approach with treatment interventions and follow-up.
Results
In addition, some of the PUI-related conditions show characteristics of addiction to the Internet as a preferential tool to engage in specific behaviours, while some others exclusively manifest on the Internet, making it necessary to find distinct assessment and treatment pathways.
Conclusion
The inclusion of Internet Gaming Disorder in Section III by the DSM-5 and the recognition of Gaming Disorder by the ICD-11 opened the way for a systematic clinical investigation of this and other PUI-related conditions, particularly in terms of preventive and therapeutic strategies. The present article is aimed at offering an updated clinical overview on the main expressions of PUI, focussing on the latest acquisitions in this evolving field.
... In higher education institutions, the term innovation has been perceived to refer to the changes or reforms in various domains such as educational policies, practices, academic work, curricula, assessment regimes, methods of teaching and learning, pedagogical technology, knowledge, and ideas (Cohen & Ball, 2007;Kozma, 1985;Schneckenberg, 2009;Scott, 2012;Zhu & Engels, 2014). Thus, universities mainly focus on instructional innovation approaches such as collaborative learning, cooperative learning, student-centred pedagogy, computer-supported learning, online learning, and web-based platforms (Atmaca, 2007;Brandon & Hollingshead, 1999;Ellis, Ginns & Piggott, 2009;Garrison, Kanuka, 2004;Gokhale, 1995;Wright, 2011). These approaches focus more on the active involvement of the learner, maintaining interaction with others, and the reorganization of the knowledge structures (Packer & Goicoechea, 2000), which is what Vygotsky defines as constructivism. ...
... 26 Bir olgu değerlendirilmesinde internet bağımlılığı olan genç bir hastada essitalopram tedavisine (40 mg/gün) ketiapin (200 mg/gün) eklenmesinin yoğun internet kullanımını azalttığı bildirilmiştir. 27 Bir başka olgu bildiriminde opioid bağımlılık tedavisinide kullanılan naltreksonun kompulsif siberseks davranışını azaltmada etkili olduğu bildirilmiştir. 28 Yine açık uçlu iki farklı çalışmada glutamat reseptör antagonisti olan memantinin ve opioid reseptör antagonisti naltreksonun da internette patolojik kumar oynamayı azalttığı bildirilmiştir. ...
K linik başvurusu olan çocuk ergenlerde sorunlu internet kullanımı ve ilişkili so-runlar çoğunlukla çocuk ya da ergenin kendi şikayeti olarak getirilmediği için klinisyenin alacağı ayrıntılı anamnez, aile ve okul çevresi ile yapacağı görüş-meler sorunun doğasını ve şiddetinin sağlıklı değerlendirilmesinde büyük önem taşır. Çocuk ve Ergenle öncelikle iyi bir terapötik işbirliği kurulmalı, sorununun ne kadar farkında olduğu ve tedavi işbirliği motivasyonel görüşme teknikleri ile değerlendiril-melidir. Yapılacak görüşmelerde, riskli ya da bağımlılık düzeyinde internet kullanımı-nın derecesi (kullanım üzerinde kontrol kaybı hissi, tolerans ve çekilme belirtileri, duygudurum değişiklikleri, başarısız bırakma girişimleri, sorunlu kullanıma ikincil ge-lişen sağlık sorunları vb) ve pekiştirici (olumlu ve olumsuz) faktörlerin tespit edilerek Teknoloji Bağımlılığı: Çocuk ve Ergenlerde Tedavi Yaklaşımları ve Önleyici Yöntemler Technology Addiction: Treatment Approaches and Prevention Methods ÖZET İnternetin gündelik yaşamda yaygın kullanımı, onu diğer bağımlılıklardan farklı bir yere koy-makta ve diğer bağımlılıklarda hedeflenilen tam ayıklık yerine internetin uygun işlev ve sıklıkta kulla-nımı müdahale hedeflerinin temelini oluşturmaktadır. Bağımlılık tedavi yaklaşımlarında, bağımlılık yaratan durumdan koruyucu müdahaleler internet bağımlılığı için de birincil önem taşımaktadır. Önle-yici müdahale programlarının temel amacı, bağımlılık için risk oluşturan faktörleri azaltırken bireysel ko-ruyucu faktörlerin (sosyal beceri, problem çözme, emosyon regülasyonu, bilişsel yapılandırma becerileri) geliştirilmesini sağlamaktır. Önleyici ve koruyucu müdahaleler içinde internet bağımlılığı için risk grup-larının belirlenmesi oldukça önemlidir. Çocuk ergenlerde yapılacak koruyucu müdahale programlarına çocuğun ya da ergenin aile, okul ve akran çevresinin de dahil edilmesi müdahalelerin etkinliğini güç-lendirmektedir. Bu yazıda literatürde yeni tanımlanmış davranışsal bağımlılıklar olan internet bağımlı-lığı ve internette oyun oynama bozukluğuna ilişkinin önleyici müdahaleler ve çocuk ergen yaş grubunda yapılan psikofarmakolojik ve psikoterapötik tedavi yöntemlerine ilişkin çalışmalar gözden geçirilmiştir. Anah tar Ke li me ler: İnternet bağımlılığı; internette oyun oynama bozukluğu; çocuk; ergen; ruh sağlığı ABS TRACT The widespread use of the Internet in daily life puts it in a different place from other addictions , and the use of the internet with proper function and frequency is the basis of intervention targets instead of the full abstinence. Preventive interventions in addiction treatment approaches have also primary importance for internet addiction as in non-behavioral addictions. The main purpose of preventive intervention programs are to reduce risk factors for addiction while to develop individual protective factors (social skills, problem solving, emotion regulation, cognitive restructuring skills). Identifying risk groups for internet addiction is very important in preventive interventions. Involving the family, school and peer environment in the preventive intervention programs strengthens the effectiveness of the interventions. Current review evaluates studies on preventive interventions related to in-ternet addiction and internet gaming disorder which are newly defined behavioral addictions in the literature and psychopharmacological and psychotherapeutic treatment methods in children and adolescents .
... Selective serotonin reuptake inhibitors (SSRIs) are first-line medication interventions for clinical depression and anxiety. Medication trials of the SSRI escitalopram showed reductions in PIMU [57,58]. Bupropion, an atypical antidepressant, has been shown to improve symptoms of ADHD [59]. ...
The explosion of digital technologies in the twenty-first century has transformed the ways in which youth interact with the world. Increasing numbers of adolescents are experiencing problems with sleep, school, social functioning, and other physical and mental health issues due to their excessive online activities. Studies from across the globe indicate that some adolescents are struggling with problematic interactive media use (PIMU). In particular, adolescents with attention-deficit/hyperactivity disorder (ADHD) are at a higher risk of experiencing PIMU due to their issues with attention, impulsivity, and hyperactivity. This chapter highlights research on PIMU and ADHD in adolescent patients, including the role media and technology play in their lives, other common comorbidities, and medical and therapeutic treatment strategies.
... The physiological reasons for smartphone addiction are similar to those for other types of addiction, such as a decreases in dopamine D2 receptors, the effectiveness of the receptors, or ERP (event-related Potential) brain wave responses [31]. A common example is a successful case report of prescribing a selective serotonin reuptake inhibitor (SSRI)-antipsychotic combination for a subject with high addiction levels due to frequent mutations related to serotonin transporter genes [32]. ...
As the smartphone has become an indispensable device in modern lives, consequential psychosocial problems such as smartphone addiction have been getting attention worldwide, especially regarding adolescents. Based on its positive effect on young individuals’ mental health, mind subtraction meditation has been widely applied to many school-based programs in South Korea. This study aims to identify the effects of a school program based on mind subtraction on the smartphone addiction of adolescents. A total of 49 high school sophomores, 24 from the experimental group (mean age = 16), and 25 from the control group (mean age = 16) are included in this case-control study. The experimental group is given the meditation program sessions in the morning, two times a week for 20 min per session, for a total of 12 weeks. The experimental group shows improvements regarding the ‘smartphone addiction’ section (p < 0.001), for instant satisfaction (p < 0.001) and long-term satisfaction (p < 0.001). Concerning the ‘self-control’ section and decreasing stress (p < 0.001), problem focusing (p < 0.001), and social support navigation (p = 0.018), there are improvements in these ‘stress coping strategies’ sections. This study directly shows the positive effect of mind subtraction meditation on smartphone addiction in adolescents and, thus, provides guidance to the future development of smartphone addiction prevention programs for young individuals.
... Örneğin, Citalopram ve Ketiapin ile tedavi edilen hastaların internet kullanım sürelerinde azalma görülmüştür. 45 Bu görüş ile paralel olarak DEHB'nin tedavisi için kullanılan metilfenidatların da oyun bağımlılığının şiddetini azaltmada etkili olduğunu gösteren bulgular sunulmuştur. Bir çalışmada DEHB tanısı olan bilgisayar oyun bağımlılarına sekiz haftalık metilfenidat tedavisi sonucunda internet kullanım süresinde ve oyun bağımlılığında belirgin düşüş olduğu bulunmuştur. ...
Alışkanlık ile bağımlılık arasındaki ayrımın yapılması önemlidir. Hepimizin günlük yaşamımızda bir rutin içerisinde yaptığımız, yaşamımızı olumsuz yönde etkilemeyen davranışlar vardır. Fakat klinik olarak bağımlılık, bireyin bu davranış-ları değiştirmek veya bırakmak istediğinde fiziksel ve psikolojik olarak sıkıntı içi-ne girdiği, eğitim, iş, aile veya sosyal yaşamının olumsuz yönde etkilendiği klinik durumlardır. 1 Bağımlılık denildiğinde çoğunlukla alkol, esrar, kokain, eroin gibi maddeler akla gelirken son yıllarda kumar, yemek yeme, seks, alışveriş, internet gibi davranışların da kimyasal maddelerle benzer özellikler gösterdiği tartışılmak-tadır. Kimyasal bağımlılıklarda olduğu gibi tekrarlayıcı ve artan miktarlarda bu uyaranlara maruz kalma ile zaman içerisinde bu uyaranlara yönelik isteğin şiddeti artmakta ve bu davranış ile kurulan ilişkinin özellikleri değişebilmektedir. Bu dav-ranışsal bağımlılıkların gelişmesi ile birlikte ruh halinde belirgin değişim, zihinsel meşguliyet, tolerans gelişmesi, yoksunluk belirtileri ve kişilerarası çatışmalar da artmaktadır. 2 Özellikle son yıllarda çocuk ve gençler arasında davranışsal bağımlılıkların yaygınlığı ve bağımlılığın yol açtığı olumsuz sonuçlar bu alana yönelik daha çok çalışma yapılması gerektiğini göstermektedir. Bu bölümde, Ruhsal Bozuklukların Tanısal ve Sayımsal El Kitabı 5 (DSM 5) ile daha çok tartışılmaya başlanan davranışsal bağımlılıklar ile gelişmesinde risk etmeni olduğu düşünülen dikkat eksikliği ve hiperaktivite bozukluğu (DEHB) arasındaki ilişki ele alınmıştır. Bu kapsamda bu bölümde özellikle çocuk ve ergenlik döneminde yüksek oranlarda görülen internet ve bilgisayar oyunu bağımlılığının DEHB ile ilişkisi tartışılmıştır.
... Among these changes, while some are related to macro level which refers to national/state higher education policies, governance, and structure, some are related to micro-level which refers to the teaching/learning processes and educational strategies and methods (D'Andrea, 2007). As for the latter, it includes collaborative learning, student learning and the use of educational technologies (online learning and computer supported collaborative learning; Atmaca, 2007;Gokhale, 1995). To fulfill their educational, social and economic needs in the 21 st century, higher education institutions need to respond to changing education needs, to adopt to the more flexible modes of organization and governance (Gardner, 2002). ...
With the enormous scientific and technological developments, higher education institutions are facing rapid structural, social, technological changes. Because they are considered as an important center of talent development and knowledge production and sharing for countries. To fulfill their educational, social and economic needs, higher education institutions need to respond to changing education needs, to adopt the more flexible modes of organizational culture. Organizational culture is a promotive environment which influences values, assumptions and beliefs. In an innovative culture, people can easily develop new ideas and exhibit collaboration. Therefore, this paper examines the relationship between the organizational culture features and the perceptions and student reported implementation with regard to student-centered learning, collaborative learning and use of innovative educational technologies in Turkish higher education. Four universities were involved, and 894 students responded to a questionnaire comprising three groups of questions. The three groups of questions capture (i) demographic characteristics, (ii) student perceptions of organizational culture, (iii) students’ perceptions of and responses to educational innovations comprising the following scales in a survey study. The results show that features of organizational culture affect students’ perceived need for innovation, their views about innovative approaches to instruction, responsiveness to instructional innovations and the perceived implementation level of educational innovations. In addition, differences among the institutions were examined and discussed. The study concludes that hierarchical structure, lack of open communication and autonomy, workload, lack of financial resources and support are main barriers for educational innovations in Turkish universities. It also implies to understand the link between organizational culture and educational innovations in Turkish higher education context.
... Что касается применения антипсихотиков, то можно назвать работу M. Atmaca [26], который привел данные об успешном использовании кветиапина (200 мг/сут), добавляемого к циталопраму, у 23-летнего пациента с ИА. А. Paik и соавт. ...
According to WHO consensus decision, gambling disorder, including the form of Internet addiction (IA), should be included in the section 'Impulsive disorders and behavioral addictions' of ICD-11. Population studies in the USA and Europe show the prevalence of IA from 1.5 to 8.2%, and in the countries of Southeast Asia it reaches 20-30% among young people. All this raises questions about the development of standardized approaches to the treatment and correction of this disorder. The review covers pharmacological and non-pharmacological approaches. Several studies and clinical observations have been devoted to pharmacological methods for treating IA, including the successful use of antidepressants such as escitalopram, clomipramine, and bupropion. There are data on the effectiveness of quetiapine, clonazepam, naltrexone and methylphenidate. In general, research was limited to methodological deficiencies, including small sample sizes, lack of control groups etc. Of non-pharmacological and psychotherapeutic approaches, in particular, cognitive-behavioral therapy (CBT) is the most studied. Special programs CBT are developed focused on children and teenagers. In addition to CBT, other psychotherapeutic approaches were used for the correction of IA: reality therapy, Internet interventions, acceptance and responsibility therapy, family therapy, complex methods. In many countries educational medical camps have been established (for example, sports or other outdoor activities) for adolescents with IA. Further studies in the field are needed to develop treatment approaches and diagnostic classification of IA.
... In a study of patients with internet addiction and comorbid generalized anxiety disorder or panic disorder, patients who received various psychiatrist-prescribed psychotropic medications (antidepressants, anxiolytics, stimulants, and/or antipsychotics) whereas receiving concurrent CBT experienced significant improvement in measures of both anxiety and internet addiction [43]. Other pharmacologic options that have proven effective in the treatment of various forms of PIMU include escitalopram, citalopram, bupropion, olanzapine, quetiapine, naltrexone, and memantine [44][45][46][47][48][49][50][51]. ...
Purpose of review:
To review the literature and provide a guide to assessing patients with problematic interactive media use (PIMU).
Recent findings:
0.3-1.0% of the world population meets criteria for internet gaming disorder (IGD). 26.8-83.3% of adolescents meeting criteria for internet addiction have comorbid attention-deficit/hyperactivity disorder. IGD is associated with increased anxiety and social anxiety/phobias. Group counseling, cognitive behavioral therapy, and sports intervention are associated with significant reductions in internet addiction.
Summary:
With the Diagnostic and Statistical Manual of Mental Disorders-5 inclusion of IGD under 'Conditions for Further Study' and the addition of gaming disorder to International Classification of Diseases (ICD)-11, the idea that PIMU is a mental health disorder gained traction. Although certain populations may be at increased risk, all children and adolescents should be screened for PIMU given now-normal heavy media usage rates. Effective treatment of PIMU starts with identification and management of comorbid mental and behavioral health problems. Depending on their degree of functional impairment, patients may benefit from various forms of psychotherapy with coordinated outpatient management or may warrant higher level of care in one of several established residential treatment programs. Few studies have evaluated pharmacologic approaches to treating PIMU, but some medications targeting comorbid mental and behavioral health conditions improve PIMU-related behaviors.
... В результате лечения использование Интернета значительно сократилось (в среднем с 36,8 ч до 16,5 ч в 1 нед). Кроме того, имеется сообщение [79] о случае успешного использования сходного по механизму и структуре препарата циталопрама в сочетании с атипичным нейролептиком кветиапином у онлайнового игрока с депрессией. D. Han и соавт. ...
Today, there are no standards of therapy for non-chemical (behavioral) addictions. The article examines in detail modern psychological (classes in the 12 step program groups, various psychotherapeutic interventions) and pharmacological (antidepressants, opioid receptor antagonists, normotimics, glutamatergic agents, etc.) approaches to the treatment of pathological gambling. The possibilities of therapy of love and sexual addiction are analyzed. Separately, the problems of correction of the so-called socially acceptable addictions, as well as Internet addictions, are considered. The extremely cautious tactics in the therapy of these forms is recommended, because they can transform into heavy chemical and behavioral addictions. The importance of using a number of socially acceptable addictions as substitutes for the treatment of severe forms of dependences is underlined. In conclusion, the questions of the competency of a psychiatrist-addiction specialist and a psychologist in the correction of behavioral dependencies are analyzed and indications for psychopharmacotherapy are determined.
... In one case, a reduction in time spent online has been described with citalopram administered at high doses (40 mg/day) in association with quetiapine (200 mg/day) (Atmaca, 2007). In addition, Sattar and Ramaswamy (2004) reported the efficacy of 30 mg/day of citalopram in reducing the time spent online and in improving mood symptoms. ...
The general purpose of this review is to present an updated literature overview of neurobiological/clinical aspects of Internet addiction (IA), particularly of overlaps and differences with bipolar affective disorder (BPAD). Articles with clinical/neurobiological aspects of IA or similarities/differences with BPAD as main topics, from 1990 to present and written in English language, were included. Comorbidity between IA and other psychiatric disorders, including BPAD, is common. Dysfunctions in dopaminergic pathways have been found both in IA and in mood disorders. Most of investigations in IA support a chronic hypodopaminergic dysfunctional state in brain reward circuit and an excessive reward experience during mood elevation. Neuroimaging studies show prefrontal cortex abnormalities shared between addictive and bipolar patients. BPAD and IA present numerous overlaps, such as polymorphisms in nicotinic receptors genes, anterior cingulate/prefrontal cortex abnormalities, serotonin/dopamine dysfunctions, and good response to mood stabilizers. The future is to clarify diagnostic criteria to better define the IA/BPAD relationship.
... Other isolated studies have used naltrexone, a medication that stops opioid activity, commonly used for impulse control disorders, to treat compulsive cybersexual behavior (Bostwick & Bucci 2008) or a combination of atypical antipsychotic quetiapine with to citalopram (an SSRI) to treat IA (Atmaca 2007). ...
In this digital age there is a growing importance in global research of Internet addiction. The purpose of this research study is to establish a valid instrument for measuring the addictive use of Internet. We investigated the psychometric properties of the established Young’s Internet Addiction Test (IAT) on a Macedonian population. Since its development, there has been a number of culture-specific validation studies of the IAT, but never in cultures from south-east Europe. In a sample of 322 undergraduate participants, exploratory factor analysis (EFA) determined the presence of a three factor structure of the IAT with 17 items. The three factors, “Withdrawal and social problems”, “Time management” and “Failure and neglect” explained 38.43% of the total variance with good internal consistency for the IAT (Cronbach’s a = .89) and good reliability for the factors (.65–.84). Hence, this version of the IAT is a valid instrument with sound psychometric properties for measuring Internet addiction in a sample of participants from south-east Europe and may be used for further research.
... Other isolated studies have used naltrexone, a medication that stops opioid activity, commonly used for impulse control disorders, to treat compulsive cybersexual behavior (Bostwick & Bucci 2008) or a combination of atypical antipsychotic quetiapine with to citalopram (an SSRI) to treat IA (Atmaca 2007). ...
Easy access to communication and information technologies has increased our dependence on technology for various aspects of our lives. Nevertheless, this remarkable growth of Internet Usage has been inextricably paired with a rise of excessive and dysfunctional Internet use. Conceptualized around 1996, a few years after the inception of the World Wide Web, Internet addiction has developed into a global issue influencing varying segments of the population at different levels. Despite heated debates on its addictive nature, consensus is emerging regarding the existence of this problematic behavior. In this paper we provide a comprehensive overview of the literature on Internet addiction in last 20 years. Purpose of this paper is to present crucial findings on Internet addiction to health profession. Besides numerous benefits of Internet use, the virtual environment brings various risks in every age group. The Internet is very significant in the everyday activities of children and youth and professional interventions with this age group should be specific considering their developmental characteristics. Exposure to online risks can have long-lasting and intense negative effects. Effective programs in prevention and treatment should include a multi-sectoral and interdisciplinary approach. Detail review of the symptomatology, diagnosis model an possibilities of treatment can be multiple beneficial to the health professionals and other helping professions due to actual needs for interventions in the field of the internet addiction treatment. Internet addiction is slowly becoming a societal concern as it particularly affects adolescents and children, who are more exposed and consequently more vulnerable. Findings presented in the paper can benefit in practice of treatment internet addiction and also as framework for further researches in the field.
... There are several reports on the use of selective serotonin-reuptake inhibitors (SSRIs) particularly when Internet addiction is comorbid with depression and anxiety for which SSRIs have an established place as an effective treatment [73,74]. The SSRI, escitalopram [75], nontricyclic antidepressants, bupropion [76], psycho-stimulant, methylphenidate [77], mood stabilizers [22], antipsychotic, quetiapine [78] and opioid receptor antagonist and naltrexone [79] have been trialed as treatments. However, most of these studies were quite short term and some are case reports. ...
Internet addiction (IA) was introduced as a new disorder in mid-1990s. Since then, there is growing concern about the addictive nature of the Internet. This chapter is a comprehensive review of published seminal, research and review papers, meta-analyses and book chapters/books on IA in adolescents. The conceptualization of IA, epidemiology, phenomenology, screening, diagnoses, treatment and prevention are discussed with relevant references. The concept of IA is at fetal level with no consensus on definition, norms or clinical criteria. Asian countries such as China and South Korea are affected most. A multination meta-analysis estimated an overall prevalence of 6% for IA. Most of the research identifies IA in gaming, gambling, social networking and cybersex. A few assessment tools have been used with no comparability or cultural sensitivity. Diagnostic criteria are proposed based on those used for substance abuse and pathological gambling. The treatments are mainly psychological with a lot of emphasis on cognitive behavior therapy. The Internet is a very versatile and useful tool for children and adolescents, and it is not advisable to ban it totally. The review highlights education of them on sensible Internet use and supports inclusion of IA in international disease classifications.
... Nevertheless, noncontrolled studies and case reports cite preliminary evidence for use of pharmacological treatments for PIU, primarily for Internet gaming and excessive pornography viewing. Case reports with young adults cite successful single-case use of selective serotonin reuptake inhibitors (SSRIs) (Atmaca, 2007) and naltrexone (Bostwick and Bucci, 2008), the latter being a main medication used to treat cravings among those with substance use disorders. Evidence from a ten-week, open-label trial of an SSRI followed by a nine-week, double-blind, placebo-controlled discontinuation phase reported reductions in Internet usage time per week by half among 14 adult subjects with impulsive-compulsive Internet usage disorder (Dell'Osso et al., 2008). ...
This article reviews the scientific literature on the epidemiology, prevention, and treatment of problematic Internet use (PIU) with the goal of informing Air Force policies aimed at mitigating PIU's negative impact on operations and the mental health of Airmen. The study is motivated by a recent RAND study estimating that 6 percent of Airmen have PIU. Individuals with PIU, similar to people with substance addictions, suffer from excessive and compulsive online activities, symptoms of tolerance and withdrawal, and functional impairment. PIU is also strongly associated with other mental health problems including major depression. However, at present there is no single accepted definition of PIU, and no up-to-date estimates of the prevalence of PIU in the general U.S. population are available. A range of prevention and treatment approaches have been developed, but none has been rigorously tested in clinical trials. Prevention programs rely on workplace Internet policies and strategies to help individuals self-regulate their Internet use. Treatment approaches that have proven feasible and acceptable to patients with PIU include adaptations of cognitive-behavioral therapy, an evidence-based treatment for depression and anxiety, to the specific symptoms of PIU. Based on our findings, we recommend: (1) increasing awareness of PIU among organizational leadership and mental health professionals, (2) incorporating content related to PIU into existing trainings related to mental health, (3) providing support for self-regulation of Internet use on the job by incorporating PIU management principles into Internet use policies, and (4) continuing monitoring of the emerging scientific literature on PIU.
... Given the overlap between impulsivity/compulsivity symptoms of IA and the abovementioned psychiatric conditions, it has been hypothesized that antipsychotic treatment could benefit "Internet addicted" patients. A promising case study reported the successful use of quetiapine (200 mg/day), gradually added to citalopram, in a 23 year old subject with IA (Atmaca 2007). The improvement was maintained at a 4-month follow-up. ...
The increasing number of Internet users has resulted in an increased population percentage affected by the negative effects of problematic Internet usage. To date, the management of psychopathological Internet use is not supported by extensive empirical research. No standard clinical treatment protocols for pharmacological treatment exist, and as a result, empirical or anecdotal assessments based on case studies are mainly consulted. A relevant problem in performing clinical trials is the evolving nosology, which encompasses ambiguous definitions of Internet addiction and a diversity of diagnostic, prognostic, and therapeutic criteria. The aim of this chapter is to review the current literature, to assess the extent to which specific pharmacological interventions (e.g., using antidepressants, mood stabilizers, opioid receptor antagonists, or antipsychotics) can alleviate the symptomatic burden in patients with “Internet addiction.” We also explore pharmacological interventions that target patterns of comorbidity and underlying psychopathological dimensions (e.g., addiction, impulsivity, obsessive-compulsive spectrum, bipolar spectrum, dissociation, etc.) shared with other behavioral or substance addictions.
... Besides dopamine, mounting evidence from psychopharmacology and molecular genetics suggests that serotonin may also play a crucial role in the biochemistry of Internet addiction. First evidence from the psychopharmacological treatment of Internet addicts shows some success in treating Internet addicts with selective serotonin reuptake inhibitors (e.g., Atmaca 2007;Camardese et al. 2012, see Chap. 14). ...
Mounting evidence suggests that personality plays an important role for a better understanding of Internet addiction. As twin studies have shown that both Internet addiction and personality are influenced by genetics, we highlight molecular genetics approaches to Internet addiction in this chapter too.
... Among others, these studies yielded evidence for a role of dopaminergic and serotonergic systems in Internet addiction, and of course dopamine has been implicated in all addiction. For instance, psychopharmacological studies have found that administration of selective serotonin reuptake inhibitors (SSRIs) may help in the treatment of Internet addicted patients (Atmaca, 2007). In particular, a dopaminergic linkage with Internet addiction is getting most attention, because dopaminergic bursts in striatal regions have been found to accompany craving processes (and approach motivation toward all rewards, including drugs). ...
Internet addiction represents an emerging global health issue. Increasing efforts have been made to characterize risk factors for the development of Internet addiction and consequences of excessive Internet use. During the last years, classic research approaches from psychology considering personality variables as vulnerability factor, especially in conjunction with neuroscience approaches such as brain imaging, have led to coherent theoretical conceptualizations of Internet addiction. Although such conceptualizations can be valuable aid, the research field is currently lacking a comprehensive framework for determining brain-based and neurochemical markers of Internet addiction. The present work aims at providing a framework on the molecular level as a basis for future research on the neural and behavioral level, in order to facilitate a comprehensive neurobiological model of Internet addiction and its clinical symptomatology. To help establish such a molecular framework for the study of Internet addiction, we investigated in N = 680 participants associations between individual differences in tendencies toward Internet addiction measured by the Generalized Problematic Internet Use Scale-2 (GPIUS-2) and individual differences in primary emotional systems as assessed by the Affective Neuroscience Personality Scales (ANPS). Regression analysis revealed that the ANPS scales FEAR and SADNESS were the ANPS scales most robustly positively linked to several (sub)scales of the GPIUS-2. Also the scales SEEKING. CARE and PLAY explain variance in some of the GPIUS-2 subscales. As such, these scales are negatively linked to the GPIUS-2 subscales. As the ANPS has been constructed on substantial available brain data including an extensive molecular body with respect to evolutionary highly conserved emotional circuitry in the ancient mammalian brain, the present study gives first ideas on putative molecular mechanisms underlying different facets of Internet addiction as derived from associations between tendencies toward Internet addiction and individual differences in primary emotional systems. For example, as SADNESS is linked to the overall GPIUS-2 score, and the neuropeptide oxytocin is known to downregulate SADNESS, it is conceivable that the neuropeptide might play a role in Internet addition on the molecular level. Our findings provide a theoretical framework potentially illuminating the molecular underpinnings of Internet addiction. Finally, we also present data on the ANPS and smartphone addiction at the end of the paper. Similar to the reported associations between the AN PS and the GPIUS-2, these correlations might provide an initial outline for a framework guiding future studies that aim to address the molecular basis of smartphone addiction.
... Among others, these studies yielded evidence for a role of dopaminergic and serotonergic systems in Internet addiction, and of course dopamine has been implicated in all addiction. For instance, psychopharmacological studies have found that administration of selective serotonin reuptake inhibitors (SSRIs) may help in the treatment of Internet addicted patients (Atmaca, 2007). In particular, a dopaminergic linkage with Internet addiction is getting most attention, because dopaminergic bursts in striatal regions have been found to accompany craving processes (and approach motivation toward all rewards, including drugs). ...
Internet addiction represents an emerging global health issue. Increasing efforts have been made to characterize risk factors for the development of Internet addiction and consequences of excessive Internet use. During the last years, classic research approaches from psychology considering personality variables as vulnerability factor, especially in conjunction with neuroscience approaches such as brain imaging, have led to coherent theoretical conceptualizations of Internet addiction. Although such conceptualizations can be valuable aid, the research field is currently lacking a comprehensive framework for determining brain-based and neurochemical markers of Internet addiction. The present work aims at providing a framework on the molecular level as a basis for future research on the neural and behavioral level, in order to facilitate a comprehensive neurobiological model of Internet addiction and its clinical symptomatology. To help establish such a molecular framework for the study of Internet addiction, we investigated in N = 680 participants associations between individual differences in tendencies toward Internet addiction measured by the Generalized Problematic Internet Use Scale-2 (GPIUS-2) and individual differences in primary emotional systems as assessed by the Affective Neuroscience Personality Scales (ANPS). Regression analysis revealed that the ANPS scales FEAR and SADNESS were the ANPS scales most robustly positively linked to several (sub)scales of the GPIUS-2. Also the scales SEEKING, CARE and PLAY explain variance in some of the GPIUS-2 subscales. As such, these scales are negatively linked to the GPIUS-2 subscales. As the ANPS has been constructed on substantial available brain data including an extensive molecular body with respect to evolutionary highly conserved emotional circuitry in the ancient mammalian brain, the present study gives first ideas on putative molecular mechanisms underlying different facets of Internet addiction as derived from associations between tendencies toward Internet addiction and individual differences in primary emotional systems. For example, as SADNESS is linked to the overall GPIUS-2 score, and the neuropeptide oxytocin is known to downregulate SADNESS, it is conceivable that the neuropeptide might play a role in Internet addition on the molecular level. Our findings provide a theoretical framework potentially illuminating the molecular underpinnings of Internet addiction. Finally, we also present data on the ANPS Montag et al. Primary Emotions and Internet Addiction and smartphone addiction at the end of the paper. Similar to the reported associations between the ANPS and the GPIUS-2, these correlations might provide an initial outline for a framework guiding future studies that aim to address the molecular basis of smartphone addiction.
... For the comorbid psychiatric disorders caused by problematic Internet use, Spada [20] has summarized two kinds of treatments from relative literatures published in the past decade, including pharmacological treatments and psychotherapeutic treatments. Some case studies suggested that pharmacological treatments might be beneficial as a treatment for problematic Internet use, such as quetiapine gradually added to citalopram to treat problematic Internet use, methylphenidate for the problematic Internet use cooccurring with attention-deficit/hyperactivity disorder, and bupropion improving depressive mood as well as reducing the severity of excessive online game play [26,27,28]. Cognitive behaviour therapy (CBT) has been an accepted psychotherapy approach to work on controlling symptoms caused by the problematic Internet use [29,30]. ...
Internet use has seriously affected individual health in potential and subtle ways. Past research on the subject mainly concentrated on the mental health caused by addictive use, e.g., impulse control disorders and obsessive-compulsive disorder. With the constant development of cyber technology, Internet has been an indispensable element of living and working, which can provide more convenient and efficient support and help. At the same time, the effects of Internet use more than Internet addiction on individual health cannot be ignored in living and working. This paper aims to identify the most common physical complaints associated with Internet use, and further investigate the association between the frequency of Internet use and individual physical health. Five hundred and thirteen participants completed the questionnaires by online or offline manner, which covers demographic questions and questions concerning Internet use and physical complaints. The most common complaints were involving dry eyes, decreased vision, and cervical pain. The positive pearson correlation coefficient were found between the level of physical complaints and the frequency of Internet use, place of residence and education. Especially, the higher amount of time for the Internet use is strongly associated with a higher level of physical complaints.
... Citalopram ve Ketiapin kullanımı ile bir olgu sunumunda internet kullanımında azalma saptanırken 4 aylık izlem boyunca relaps görülmemiştir (71). ...
Internet addiction, which has become a global social issue, can be broadly conceptualized as an inability to control ones use of the Internet which leads to negative consequences in daily life. Only Internet Gaming Disorder has been included in the appendix of the diagnostic and statistical manual of mental disorders fifth edition (DSM-5), but it has already been argued that Internet addiction could also comprise problematic use of other Internet applications developing an addictive behavior. This paper aims to give a current review of the gradually evolving body of literature on Internet addiction. [J Contemp Med 2016; 6(3.000): 235-247]
... Substantial addiction and IA can share the same neurobiological mechanism, so in this sense, addictive behavior medications can help other dependencies [3]. Medications such as escitalopram [48], citalopram [49], bupropion [41,50], olanzapine [51], quetiapine [52], naltrexone [53], methylphenidate [54], and memantine [55] have all been used to treat IA. ...
Background:
The growth of the Internet has led to significant change and has become an integral part of modern life. It has made life easier and provided innumerous benefits; however, excessive use has brought about the potential for addiction, leading to severe impairments in social, academic, financial, psychological, and work domains. Individuals addicted to the Internet usually have comorbid psychiatric disorders. Panic disorder (PD) and generalized anxiety disorder (GAD) are prevalent mental disorders, involving a great deal of damage in the patient's life.
Objective:
This open trial study describes a treatment protocol among 39 patients with anxiety disorders and Internet addiction (IA) involving pharmacotherapy and modified cognitive behavioral therapy (CBT).
Methods:
Of the 39 patients, 25 were diagnosed with PD and 14 with GAD, in addition to Internet addiction. At screening, patients responded to the MINI 5.0, Hamilton Anxiety Rating Scale, Hamilton Depression Rating Scale, Clinical Global Impressions Scale, and the Young Internet Addiction Scale. At that time, IA was observed taking into consideration the IAT scale (cutoff score above 50), while anxiety disorders were diagnosed by a psychiatrist. Patients were forwarded for pharmacotherapy and a modified CBT protocol. Psychotherapy was conducted individually, once a week, over a period of 10 weeks, and results suggest that the treatment was effective for anxiety and Internet addiction.
Results:
Before treatment, anxiety levels suggested severe anxiety, with an average score of 34.26 (SD 6.13); however, after treatment the mean score was 15.03 (SD 3.88) (P<.001). A significant improvement in mean Internet addiction scores was observed, from 67.67 (SD 7.69) before treatment, showing problematic internet use, to 37.56 (SD 9.32) after treatment (P<.001), indicating medium Internet use. With respect to the relationship between IA and anxiety, the correlation between scores was .724.
Conclusions:
This study is the first research into IA treatment of a Brazilian population. The improvement was remarkable due to the complete engagement of patients in therapy, which contributed to the success of the treatment from a behavioral perspective, and gave patients the confidence to continue to manage Internet use in their lives.
Video-streaming typically describes watching live or prerecorded videos online. This behavior has significantly increased over the past two years in tandem with the global COVID-19 pandemic. The literature describing this behavior is still in its infancy, therefore, it is not well-characterized and our understanding is thereby limited. Different forms of problematic video-streaming have varying prevalence rates in the literature and each requires further operationalization. Overall, the various presentations of problematic video-streaming have been found to be associated with poor mental and physical health and linked to increased impulsivity, reduced academic and work performance, and lower quality of life. This article explores the current literature surrounding the definition, prevalence, validated assessments, associated factors, motivations, and available treatments for problematic video-streaming.
This chapter reviews the current literature on internet addiction (IA) and provides a comprehensive summary regarding: (i) potential positive and negative effects of internet and technology use, (ii) main conceptual frameworks, (iii) biological bases, (iv) comorbidity factors, (v) prevalence rates, (vi) assessment methodologies, and (vii) treatment approaches. Although the current evidence suggests a relatively low prevalence rate of IA worldwide, and that several scholars remain doubtful about the validity and utility of IA as a clinical phenomenon, the existing evidence indicates that further research is required in order to facilitate greater understanding of this intricate issue and to tackle a range of challenges identified in the literature. Furthermore, the current scientific trend points toward the adoption of more specific terms that underscore the role of specific online activities in eliciting addictive usage, as opposed to the adoption of the broad and unspecific umbrella term IA.KeywordsInternet addictionProblematic internet useCompulsive internet useBehavioral addictionTreatment
Problematic Usage of the Internet (PUI) represents a spectrum of excessive online behaviors and is linked to reduced quality of life and high rates of psychiatric comorbidity, with growing demand for effective treatments. This paper provides a narrative review of pharmacological studies for PUI conducted to date. Most pharmacological treatment trials have focused on bupropion and escitalopram or involved samples with common comorbidities and used current treatments for the relevant comorbid disorders. Overall, there remains a dearth of high-quality evidence, with the current literature lacking control groups, large sample sizes, validated outcome measures, longer term treatment and follow-up periods. The literature cannot at this stage determine evidence-based pharmacological treatments for PUI.
In order to address etiologic, clinical, and treatment strategies applicable to Internet and video game addiction (IVGA), a working definition of addiction is presented and unique aspects of Internet and screen use disorders and addictive patterns are discussed. Addictions share common neurobiological mechanisms, cause, triggers, and behavioral sequelae-often presenting with similar symptomatology-although severity and impairment vary widely. This article reviews etiologic and neurobiological antecedents to Internet and video game addiction.
This chapter provides an outlook on “new addictions” in youth, specifically the technological addictions related to the use of computers and video games. The chapter will provide a brief overview of the intertwine between technological development and patterns of use of technology in youth. Successively, specific focuses will be dedicated to the two most studied forms of technological addiction: Internet Addiction (IA) and Internet Gaming Disorder (IGD), discussing the proposed diagnostic criteria and the current scientific agreement upon the two disorders. The chapter will also focus on the specific risk factors for technological addiction in youth, addressing three main branches: social functioning, personality characteristics and coping. A specific section will cover the recent advances in the research on the neurobiological correlates of new addictions. Finally, the chapter offers a brief overview on the treatment of the disorders.
The COVID-19 pandemic continues to cause an immense psychosocial strain worldwide. Excessive use of the internet during these psychologically trying times, fueled by physical isolation as a result of lockdowns, has translated into dysfunctional behaviors. A growing body of evidence suggests an unprecedented increase in internet use and consumption of online pornography during the pandemic, and possibly even directly caused by it. In this review, the authors report data from relevant sources to show the rise in pornography use during lockdowns in different countries worldwide. In addition to a brief overview of the neurobiology of internet addiction broadly and problematic online pornography use specifically, similarities with substance use disorders are explained. Further, the current status of the debate about defining diagnostic criteria is discussed. Finally, the review sheds light on the potential detrimental outcomes during the future post-pandemic “re-adaptation”, while simultaneously offering preventative and management strategies for harm reduction. The authors conclude that foresightedness with utilizing existing tools and therapies and exercising appropriate amounts of caution could go a long way in addressing the challenges that lie ahead in the post-pandemic era.
Introduction. Currently, the scale of cyber addiction, Internet addiction, gadget addiction and other non-chemical addictions associated with interactive technologies is so significant that they are singled out in a number of new addictions that significantly affect the formation of young people and society as a whole.Purpose – the analysis of empirical data on the identification of alexithymia in young men with manifestations of cyber addiction.Research methods. Bibliographic and historical analysis, psychodiagnostic (test method "Toronto Alexithymia Scale" (TAS)), mathematical and statistical.Research results. In order to carry out a detailed verification of the signs of cyber addictions, alexithymic manifestations were studied in young men with manifestations of cyber-addictions.The study involved 269 boys aged 14-21 years. This made it possible to more clearly understand the generation of manifestations of aggression, anxiety, depression, conflict and disturbances in the interpersonal communication of male cyber-addicts. According to the results of the data obtained, it was found that the majority of young men in the age category from 14 to 21 years old do not show manifestations of cyber-addictions – non-alexithymic (more than 50%), and respondents with cyber-addictions have manifestations of alexithymia in 45%-50% of respondents.Conclusions. Thus, it is possible to characterize young men with manifestations of cyber-addictions as people who mainly have manifestations of alexithymia, are incapable of reflection, are prone to the manifestation of short-term, sharply expressed in behavior emotional outbursts, the causes of which they are poorly aware of, and also have manifestations of depression and anxiety.The study made it possible to include alexithymic manifestations in research markers for the further development of psychocorrectional programs for adolescents suffering from various types of cyber-addictions.
The birth of the Internet in 1969 has changed people's lives immensely in the past 48 years. Over the years, this invention has brought people connection, information, communication, business, entertainment, and so forth; however, researchers have found the impact of the Internet's byproduct, namely Internet addiction, in the past two decades as well. It was argued that Internet addiction might be detrimental to people's mental and physical health. The problem is that Internet addiction is not clearly defined, nor has it been included in Diagnostic and Statistical Manual for Mental Disorders (DSM-5) by American Psychiatric Association. If the definition is not clear and the symptoms are varied, the treatment for Internet addiction would become an issue. In this chapter, the researcher will focus on different approaches to the treatment of Internet addiction based on research after reviewing the definitions, theories, causes, consequences, and symptoms of Internet addiction.
Internet addiction has gradually turned a medium of gaming and other leisure activities shifting from its original intention to fasten the communication and help in the researches. The excessive usage of internet and nature of its usage has been found to be similar with psycho-addictive substance addiction with similar neurobiological basis. Inclusion of gambling disorder into DSM 5 further strengthens the emerging concept of behavioral addiction. Various worldwide researches also support the upsurge of such problem. The clinical presentation and management options are mostly based on the behavioral principles learned from the substance abuse problems. However, large-scale randomized trails and epidemiological studies are definitely needed to understand this twenty-first century problem.
The invention of the internet has brought us abundant information, convenience, connection, communication, and entertainment in the past five decades. While people enjoy using the Internet, it has also triggered negative effects. Heavy internet users become lost online, some are addicted to games and social media, and others to their smartphones and online shopping. The problem is that often the Internet addicts do not know they are addicted or, even if they do know, they do not take any therapeutic approaches to improve their conditions. Internet addiction can be detrimental to a person's mental and physical health. Since the symptoms of Internet addiction are varied and the consequences can be severe, it is essential to closely examine the treatments for Internet addiction. What approaches should people take if their family members, friends, relatives, students, or themselves are Internet addicted? In this chapter, the researcher attempts to revisit and update research on definitions, theories, models, causes, consequences, symptoms, and treatment of internet addiction.
The birth of the Internet in 1969 has changed people's lives immensely in the past 48 years. Over the years, this invention has brought people connection, information, communication, business, entertainment, and so forth; however, researchers have found the impact of the Internet's byproduct, namely Internet addiction, in the past two decades as well. It was argued that Internet addiction might be detrimental to people's mental and physical health. The problem is that Internet addiction is not clearly defined, nor has it been included in Diagnostic and Statistical Manual for Mental Disorders (DSM-5) by American Psychiatric Association. If the definition is not clear and the symptoms are varied, the treatment for Internet addiction would become an issue. In this chapter, the researcher will focus on different approaches to the treatment of Internet addiction based on research after reviewing the definitions, theories, causes, consequences, and symptoms of Internet addiction.
Background
It has been reported that internet gaming disorder (IGD) and smokers with nicotine dependence (SND) share clinical characteristics, such as over-engagement despite negative consequences and cravings. This study is to investigate the alterations in the resting-state functional connectivity (rsFC) of the dorsolateral prefrontal cortex (DLPFC) observed in SND and IGD. In this study, 27 IGD, 29 SND, and 33 healthy controls (HC) underwent a resting-state functional magnetic resonance imaging (rs-fMRI) scan. DLPFC connectivity was determined in all participates by investigating the synchronized low-frequency fMRI signal fluctuations using a temporal seed-based correlation method.
Results
Compared with the HC group, the IGD and SND groups showed decreased rsFC with DLPFC in the right insula and left inferior frontal gyrus with DLPFC. Compared with SND group, the IGD subjects exhibited increased rsFC in the left inferior temporal gyrus and right inferior orbital frontal gyrus and decreased rsFC in the right middle occipital gyrus, supramarginal gyrus, and cuneus with DLPFC.
Conclusion
Our results confirmed that SND and IGD share similar neural mechanisms related to craving and impulsive inhibitions. The significant difference in rsFC with DLPFC between the IGD and SND subjects may be attributed to the visual and auditory stimulation generated by long-term internet gaming.
Video game addiction is increasingly prevalent in emerging adults and is associated with physical and psychosocial impairments. However, few evidence-based treatments for video game addiction have been identified or evaluated. Mindfulness treatment is effective for substance use disorders and behavioral addictions, and may be a promising intervention for video game addiction. This report presents theoretical support for mindfulness treatment of video game addiction, describes an adapted mindfulness treatment (i.e., Mindfulness-Oriented Recovery Enhancement (MORE)) for video game addiction, and presents case vignettes that describe preliminary effects of MORE in reducing video game addiction and increasing positive coping. Important methodological issues including conceptualization of the treatment model, feasibility of treatment manual adaptation, and promising therapeutic benefits of the MORE intervention are discussed. Our experience developing a mindfulness treatment of video game addiction may be informative to other investigators planning similar studies. In addition, this report could provide useful guidance to clinicians.
Internet addiction is a new form of dependence on equipment connected to the network. This type of addiction has many negative consequences, particularly in the area of social relations. Although a variety of methods have been presented for the treatment of this problem, they are in their beginning stages and studies are in progress in this field and secondly, they commonly ignore the effects of positive interventions in the treatment. Positive psychology interventions (PIs) refer to individual/group-based treatment methods that increase positive emotions and can enhance social relationships of individual(s). The aim of the current study is to evaluate the efficacy of a group-based PI in treating Internet addiction (IA). For this purpose, PI-based treatment sessions are designed and forty-eight internet-addicted university students are randomly assigned to an experiment group (n = 24)/control groups (n = 24). Measures of the severity of Internet use (SI), quality of relationships inventory (QRI), Bell's adjustment inventory (BI) and IA rate are assessed at baseline and after intervention. The results indicate that SI and IA rate in the experiment group are lower than those in the control group, while social adjustment and quality of relationships in the experiment group revealed an increase compared to the control group. According to the results, PI is an effective method for treating IA, specifically in mitigating Internet use and improving the quality of social relationships.
This chapter discusses the phenomenology and epidemiology of problematic Internet se (PIU). Interest in the addictive potential of Internet activities has grown in the past two decades. Problematic Internet use can be broadly defined as uncontrolled use of the Internet that leads to significant psychosocial and functional impairments. It is currently conceptualized as an impulse control disorder that may share features with substance dependence disorders. Reliable studies have estimated the prevalence in the general population to be about 1%, but higher proportions of individuals might be at risk. Comorbidities with other psychiatric disorders are common. Concerns exist regarding the appropriateness and implications of formally recognizing PIU as a distinct disorder in current diagnostic systems. Given the ever-growing exposure to the Internet, especially in younger generations, PIU might become an emerging public health problem. Further studies are greatly needed, especially those using valid measures and longitudinal designs. Neuroimaging and genetic studies should also be explored.
Over the past decade, the Internet has emerged as a seemingly indispensable part of modern life. The speeding of Internet traffic, the growing varieties of online functions, and the increasing accessibility of wireless connection all enhance Internet use and extend the Internet’s worldwide penetration. Despite the initial debate over the validity of diagnosing “Internet addiction” as a distinct disorder, it is clear from clinical experience and the literature that a significant number of individuals experience impairment in multiple realms related to overuse of the Internet. Most research has been done in Asian countries, including South Korea, Taiwan, and China, and problematic Internet use is considered one of the most serious public health issues by the governments of these countries (Block 2008). The phenomenon continues to gain attention from the mental health community in the United States. Recently, the inclusion of problematic Internet use in the forthcoming fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) has been proposed (Block 2008; Hollander, Kim, and Zohar 2007). Among many terms with slightly different connotations, Internet dependency (Scherer 1997), compulsive Internet use (Greenfield 1999), pathological Internet use (Morahan-Martin and Schumacher 2000), and compulsive computer use (Potenza and Hollander 2002) have been used. Internet addiction (Young 1996a) is commonly used for the condition. We have chosen to use “problematic Internet use” in this chapter to remain descriptive and because the term “addiction” is not included in the DSM-IV-TR (text revision) (American Psychiatric Association 2000) and has variable definitions.
Addictive behavior on the Internet is a new phenomenon in the practice of clinical psychiatrists and psychologist. It is defined as use of the Internet that creates psychological, social, school and work difficulties in a person's life. The brief academic history of addictive behavior on the Internet is accompanied by many discussions about its existence in the form of its own nosological unit or as a symptom of another mental disorder. Some professionals even suggested including it into DSM-V. This text offers theoretical overview of this topic including diagnostic guidelines, epidemiology, and co-morbidity. In addition, it presents three etiological models of the onset of the addictive behavior on the Internet - cognitive behavioral model, social skills deficit theory and interpersonal model. Attention is paid to the therapeutic approaches to this phenomenon, in particular, pharmacotherapy and psychotherapy. In the context of psychotherapy interventions is introduced cognitive behavioral therapy, reality therapy approach and family therapy. In conclusion are presented two case studies.
• The Yale-Brown Obsessive Compulsive Scale was designed to remedy the problems of existing rating scales by providing a specific measure of the severity of symptoms of obsessivecompulsive disorder that is not influenced by the type of obsessions or compulsions present. The scale is a clinician-rated, 10-item scale, each item rated from 0 (no symptoms) to 4 (extreme symptoms) (total range, 0 to 40), with separate subtotals for severity of obsessions and compulsions. In a study involving four raters and 40 patients with obsessive-compulsive disorder at various stages of treatment, interrater reliability for the total Yale-Brown Scale score and each of the 10 individual items was excellent, with a high degree of internal consistency among all item scores demonstrated with Cronbach's α coefficient. Based on pretreatment assessment of 42 patients with obsessive-compulsive disorder, each item was frequently endorsed and measured across a range of severity. These findings suggest that the Yale-Brown Scale is a reliable instrument for measuring the severity of illness in patients with obsessive-compulsive disorder with a range of severity and types of obsessive-compulsive symptoms.
Anecdotal reports indicated that some on-line users were becoming addicted to the Internet in much the same way that others became addicted to drugs or alcohol, which resulted in academic, social, and occupational impairment. However, research among sociologists, psychologists, or psychiatrists has not formally identified addictive use of the Internet as a problematic behavior. This study investigated the existence of Internet addiction and the extent of problems caused by such potential misuse. Of all the diagnoses referenced in the Diagnostic and Statistical Manual of Mental Disorders - Fourth Edition (DSM-IV; American Psychiatric Association, 1995), Pathological Gambling was viewed as most akin to the pathological nature of Internet use. By using Pathological Gambling as a model, addictive Internet use can be defined as an impulse-control disorder that does not involve an intoxicant. Therefore, this study developed a brief eight-item questionnaire referred to as a Diagnostic Questionnaire (DQ), which modified criteria for pathological gambling to provide a screening instrument for classification of participants. On the basis of this criteria, case studies of 396 dependent Internet users (Dependents) and 100 nondependent Internet users (Nondependents) were classified. Qualitative analyses suggest significant behavioral and functional usage differences between the two groups such as the types of applications utilized, the degree of difficulty controlling weekly usage, and the severity of problems noted. Clinical and social implications of pathological Internet use and future directions for research are discussed.
Over the past 15 yrs, it has been increasingly recognized that a wide range of psychiatric and neuropsychiatric disorders might be related to obsessive–compulsive disorder (OCD), and thus, together, may form a family of related disorders often referred to as obsessive–compulsive (or OCD) spectrum disorders. Disorders frequently proposed to be OCD spectrum disorders include the somatoform disorders, body dysmorphic disorder, and hypochondriasis; the eating disorders; the impulse control disorders and possible impulse control disorders such as compulsive buying, repetitive self-mutilation, severe nail biting, and compulsive skin picking; the paraphilias and nonparaphilic sexual addictions; and Tourette's syndrome and other movement disorders. In this chapter, the authors review the evidence supporting the grouping of these conditions into a family of OCD-related disorders and discuss the theoretical and clinical implications of such a grouping. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The Yale-Brown Obsessive Compulsive Scale was designed to remedy the problems of existing rating scales by providing a specific measure of the severity of symptoms of obsessive-compulsive disorder that is not influenced by the type of obsessions or compulsions present. The scale is a clinician-rated, 10-item scale, each item rated from 0 (no symptoms) to 4 (extreme symptoms) (total range, 0 to 40), with separate subtotals for severity of obsessions and compulsions. In a study involving four raters and 40 patients with obsessive-compulsive disorder at various stages of treatment, interrater reliability for the total Yale-Brown Scale score and each of the 10 individual items was excellent, with a high degree of internal consistency among all item scores demonstrated with Cronbach's alpha coefficient. Based on pretreatment assessment of 42 patients with obsessive-compulsive disorder, each item was frequently endorsed and measured across a range of severity. These findings suggest that the Yale-Brown Scale is a reliable instrument for measuring the severity of illness in patients with obsessive-compulsive disorder with a range of severity and types of obsessive-compulsive symptoms.
This paper adds further comments to a case description by Young on addictive use of the Internet. Brief comments relating to the Internet as a behavioural addiction and the problem of to what users are actually addicted, are discussed.
A factor analytic approach was used to explore possible constructs underlying so-called computer/Internet addiction. A 94-item survey was developed, from which two major and two minor factors were derived. Factor 1 focused on problematic computer-related behaviors in heavy users of the Internet, whereas Factor 2 focused on the usefulness and general purpose nature of computers and the Internet. Factor 3 isolated a combination of use of the Internet for sexual gratification and shyness/introversion, and Factor 4 focused on an absence of problems related to Internet use that were coupled with a mild aversion or a disinterest in this technology. These data support the notion that some individuals have a mixture of obsessive-like characteristics related specifically to their computer/Internet use but that, not surprisingly, they also exhibit a preference for on-line, rather than in-person, interactions.
Problematic internet use has been described in the psychological literature as 'internet addiction' and 'pathological internet use'. However, there are no studies using face-to-face standardized psychiatric evaluations to identify behavioral characteristics, psychiatric comorbidity or family psychiatric history of individuals with this behavior.
Twenty individuals with problematic internet use were evaluated. Problematic internet use was defined as (1) uncontrollable, (2) markedly distressing, time-consuming or resulting in social, occupational or financial difficulties and (3) not solely present during hypomanic or manic symptoms. Evaluations included a semistructured interview about subjects' internet use, the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders-IV (SCID-IV), family psychiatric history and the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) modified for internet use.
All (100%) subjects' problematic internet use met DSM-IV criteria for an impulse control disorder (ICD) not otherwise specified (NOS). All 20 subjects had at least one lifetime DSM-IV Axis I diagnosis in addition to their problematic internet use (mean+/-SD=5.1+/-3.5 diagnoses); 14 (70.0%) had a lifetime diagnosis of bipolar disorder (with 12 having bipolar I disorder).
Methodological limitations of this study included its small sample size, evaluation of psychiatric diagnoses by unblinded investigators, and lack of a control group.
Problematic internet use may be associated with subjective distress, functional impairment and Axis I psychiatric disorders.
Recently, atypical antipsychotics have been used for the management of the patients with refractory obsessive-compulsive disorder (OCD). The aim of the present study was to evaluate the results of quetiapine augmentation to a serotonin reuptake inhibitor (SRI) in the patients with refractory OCD. Fifty-two patients with OCD according to DSM-IV entered 3 months of an open-label phase treatment with a SRI with or without concomitant adjunctive treatment regimen. Of them, 27 patients were refractory OCD. These patients were randomly divided into two groups, SRI plus quetiapine and SRI plus placebo, for an 8-week single-blind phase. The course of OCD was evaluated by Yale-Brown Obsession-Compulsion (Y-BOCS) and Clinical Global Impression-Severity of Illness and Improvement (CGI-SI and I) Scales every other week for 8 weeks. Of the 14 patients in group I, nine (64.4%) showed significant improvement with 60% or greater improvement on the Y-BOCS and one (7.1%) partial improvement with 30% or greater improvement on the Y-BOCS, whereas no improvement was observed in group II. The addition of quetiapine to ongoing SRI therapy has been found to be effective and well-tolerated approach in patients with refractory OCD.
Since the mid-1990s, there have been frequent reports of individuals whose use of the computer and internet is problematic. Given the recent expansion and the expected increase in internet availability and usage in the coming years, it is important that healthcare professionals be informed about this behavior and its associated problems. Recently, psychological and psychiatric literature has described individuals that exhibit problematic internet use who often suffer from other psychiatric disorders. In the face of this comorbidity, it is essential to evaluate whether these individuals represent a distinct class of disorder, or a manifestation/coping mechanism related to other underlying diagnosis. In either event, problematic internet use negatively impacts social and emotional functioning. Based on the current limited empirical evidence, problematic internet use may best be classified as an impulse control disorder. It is therefore imperative that problematic internet use be appropriately identified among symptomatic individuals. For these reasons, we propose specific diagnostic criteria that will allow for consistent identification and assist in further study of this behavior.
There are few effective treatments of antisocial personality disorder (APD). Preliminary work suggests that the atypical antipsychotic quetiapine can decrease irritability, impulsivity, and aggressiveness. Data were collected from 4 patients with APD who were referred to a maximum-security inpatient psychiatric facility for pretrial evaluation and were treated with quetiapine. Quetiapine was effective in these patients as was indicated by a decrease in symptoms such as impulsivity, hostility, aggressiveness, irritability, and rage reactions. Typical dosage was 600 to 800 mg per day. Patients attributed their willingness to comply with quetiapine treatment to both the effectiveness of the drug and its favorable adverse-event profile. Quetiapine was successfully combined with mood stabilizers, particularly gabapentin, in patients with prominent affective instability. Quetiapine has demonstrated efficacy in aggression, impulsivity, and irritability and has proved to be an effective medication in these patients with APD. In addition, its favorable adverse-event profile makes patients willing to comply.
First-line treatment for obsessive-compulsive disorder (OCD) has been well-established for over a decade, although newer medications, such as citalopram and venlafaxine, have emerged to take a place among the older, more established serotonin re-uptake inhibitors (SRIs). Unfortunately, as many as 50% of all patients with OCD will have symptoms refractory to a single medication treatment trial, and a smaller percentage will remain refractory after two or more trials. The optimal dosage and duration for first-line trials have been established. Many strategies exist for patients who do not respond to first- or second-line medication trials, including behavioural therapy, switching to newer SRIs, and augmentation with additional medications. This review will focus on medication strategies for augmenting SRI treatment response in OCD treatment, including neuroleptic and serotonergic agents. Future investigations should include more controlled studies and investigate medications that are less likely to trigger extrapyramidal symptoms, diabetes mellitus and weight gain.
Serotonin reuptake inhibitors (SRIs), especially potent ones given at high doses over long periods of time, are often effective in the treatment of obsessive-compulsive disorder (OCD). However, a large percentage of patients do not respond to treatment with SRIs, and those who do respond often do not fully remit, which should be the standard goal of treatment in OCD. If a patient has been treated for several months and has not yet responded to treatment with several SRIs, the physician should perform a careful assessment of resistant and/or residual clinical symptoms and any comorbid conditions to determine which next-step treatment would be the most appropriate. One strategy for patients who have not responded to treatment with an SRI is to switch them to a serotonin-norepinephrine reuptake inhibitor, because some patients may respond better to agents that target multiple systems. Another promising approach is the augmentation of SRIs with neuroleptics. In addition, open trials have shown that intravenous (IV) clomipramine and IV citalopram may be effective in the treatment of resistant OCD. Novel pharmacotherapeutic treatments and electroconvulsive therapy have been attempted, with mixed success. Recently, researchers have been studying repetitive transcranial magnetic stimulation, vagal nerve stimulation, and neurosurgical approaches such as gamma knife capsulotomy and deep brain stimulation to learn if these procedures are effective in treating treatment-resistant OCD. Repetitive transcranial magnetic stimulation has possibilities not only as a therapy but also as an instrument that can help researchers describe the neurocircuitries involved in OCD. More results are needed before the effectiveness of the nonpharmacologic treatments for OCD can be determined.
Obsessive compulsive spectrum disorders Obsessive-compulsive disorder: theory, research, and treatment
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