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South Korea Special- Internet Gaming Withdrawal Psychosis

A Case of Withdrawal Psychosis from Internet Addiction Disorder” (Paik, 2014)

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The patient started playing in high school in a “PC Bang” (Internet Cafe) similar to this one in Korea

Journal Article Breakdown:

  • Case report published by Korean Neuropsychiatric Association 2014.
  •  25-year-old Korean male was admitted to a psychiatric inpatient unit with a psychotic episode.
  • Occurred one day after discontinuing his Internet Gaming habit.
  • Pattern of gaming eight hours a day for two years.
  • Reported somatic delusions and disorganised behavior.
  • Withdrawal symptoms described as agitation and irritability.
  • Normal brain imaging findings and laboratory tests.
  • Psychotic symptoms rapidly subsided and after four days of antipsychotic medication treatment.
  • Discharged on low dose antipsychotic maintenance.
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The patient required admission to Hanyang University Guri Hospital for treatment

Weaknesses of report:
-Only one other known case report of psychosis during Internet withdrawal.
-Unclear if the actual contents of the game or the medium of which the game was played (the Internet) contributed to psychotic symptoms.
-Differential diagnosis of bipolar disorder manic episode excluded. No elevated  mood in report but patient subjectively reported “being a god,” disinhibition and irritability (all can be features of a manic episode).

Strengths of report:
-Detailed description of Gaming habit and behaviour immediately following play cessation.
-Reported tolerance, attempt to cut down, cognitive dissonance (internal conflict), disturbed sleep-wake cycle, impairment of psycho-social function.
-Normal investigations and organic/substance cause ruled out.

What were the main findings?
-Evidence of withdrawal psychosis may provide evidence that excessive Internet use may be better explained as a behavioural addiction, rather that an impulse control disorder.

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The patient played the Korean version of the online game Lineage II.

Other Interesting aspects of the study:
-Online game was a source of self-esteem.
-Preferred speaking to people online than the real world.
-Auditory hallucinations reported may have been related to online characters.
-Delusions were related to technology use.
-Rapid symptom improvement and full recovery within 2 weeks.
-No further psychotic symptoms since discharge.

What can we learn from this?
-The concept of behavioural addictions such as Internet Gaming Disorder remains very controversial (Starcevic, 2013).
-This example of withdrawal psychosis following abrupt Internet Gaming cessation may give us some clues about non-substance addictions.
-Even if excessive Internet Gaming was not the cause for the psychosis, this example highlights the psychological vulnerability of individuals who may be excessively playing Internet Games.

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Online gaming, more than just a battle?

Source:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4023098/pdf/pi-11-207.pdf

Paik, A., Oh, D., & Kim, D. (2014). A case of withdrawal psychosis from internet addiction disorder. Psychiatry investigation, 11(2), 207-209.

Starcevic, Vladan. “Is Internet addiction a useful concept?.” Australian and New Zealand Journal of Psychiatry 47.1 (2013): 16-19.