An ad hoc symposium.
Earlier this week, a post at Psychology Today—“Computer, Video Games and Psychosis: Cause for Concern"—by child psychiatrist Victoria-Dunckley stirred up a bit of social media traffic with her contention that an excess exposure to video screens is responsible for the spread of hallucinations and other psychotic symptoms in our nation’s young. She is not calling this behavior an addiction as such, but maintains that it only happens in cases where 15-22-year olds, were “plugged in” for six or more hours each day.
Her theory: “Electronic screens, particularly interactive ones (as opposed to passive ones, like television), increase dopamine in the reward center of the brain. Dopamine is known as the brain's 'feel good' chemical, but is also related to stress, addiction, anxiety, mood, and attention. Dopamine in excess can lead to psychotic symptoms--voices, delusions, paranoia, or confusion.”
So there you have it. Feel free to comment on this assertion. All contributions welcome.
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11 comments:
Neither the Psychology Today post nor any of Dr. Dunckley's other writings (that I could find) provide any evidence that psychotic symptoms can be "attributed to, or exacerbated by, electronic screen devices."
The flawed logic states that video games cause dopamine release, and excess dopamine can cause psychotic symptoms. In favor of the former, she cites a 1998 paper by Koepp et al. The link in the post is dead, but you can still find the paper here:
http://web.archive.org/web/20050514130956/http://www.nrc-iol.org/cores/mialab/fijc/Files/2002/120402_Koepp_Nature_1998.pdf
The PET study of Koepp et al. looked at binding of 11C-labelled raclopride to dopamine D2 receptors in the striatum (reduced binding indicates increased DA release). Participants either played a video game where they could win money, or they stared at a blank screen. Guess which one resulted in decreased binding? I suspect that many activities would increase dopamine release relative to staring at a blank screen, particularly if they involve financial gain.
Anyway, even if we accept that video games cause greater DA release than doing nothing, that's a long way from saying that gaming and computer usage cause psychotic symptoms.
In fact, one study claimed that schizophrenia patients who played internet video games for 8 weeks showed an improvement in positive and extrapyramidal symptoms, relative to patients who watched DVDs for 8 weeks (Han et al., 2008). Although this study wasn't perfect, a reduction in delusions is the exact opposite of what one would predict based on Dr. Dunckley's post.
And why are laptops and iPads (and cartoons) especially blameworthy? To find out more, you need to:
"Sign up here for your FREE Save Your Child's Brain minicourse. Arm yourself with the truth about video games, and get your child's brain on track."
It comes as no surprise that this is a prelude to a paid course or a $400 initial evaluation of your child. Buyer beware!
There's so many problems here - let's get started:
The article is about "psychotic symptoms" but the only example given is -
"I hear voices at night, and sometimes I think someone’s outside my window. I know no one’s really there, but it’s still scary."
That does not sound like 'psychosis' at all. Hearing voices only at night suggests to me that they are just dreams or hypnogogic phenomena, which are normal. I often hear voices when I'm drifting off to sleep!
Thinking someone's outside your window, but knowing that they're not, is probably not a symptom either. Hasn't that happened to everyone? It's just a worry.
In her Psychology Today blog (June 30th 2012), Dr Victoria-Dunckley claimed “In my practice in the past six months, no less than five youths have reported psychotic symptoms that were attributed to, or exacerbated by, electronic screen devices.”
The real issues here are: 1) whether any psychotic experience is caused by using electronic devices (as seems to be Dunckley’s argument) or 2) incorporates aspects of the devices/game content into the content of symptom(s) e.g. hearing a sound/voice or having an odd belief linked to a computer game? Or 3) whether the individuals are even experiencing anything that might be labelled as a ‘psychotic’ rather than something quite normal?
What is presented? The case consists of quotes like “I hear voices at night, and sometimes I think someone’s outside my window,” the 19-year-old young man informed me. “I know no one’s really there, but it’s still scary.” It could be equally argued that this sounds like normal fear. I recognise that Dr Dunckley is not presenting ‘evidence’ in a paper, but she has a responsibility to her readers – she makes bold claims and offers clear guidelines about how to treat children in this context.
Dr Dunckley presents no evidence to indicate that these young individuals have psychosis, that the experiences are anything other than normal, that any experience was caused by screen use and critically, that they are ‘cured’ by removal of screen use. The apparent remittance of symptoms after removing screen use is so flawed methodologically that I wouldn’t know where to begin - a myriad of reasons could account for what seems to be remittance (including: as noted by Tal Yarkoni on Twitter, regression to the mean – especially if apparent symptoms were mild). All done, as she proudly claims, without medication – possibly because they never required medicating!
I note a small, but pertinent point to starting a story with a reference to time - these individuals could not have been seen in the last 6 months – as this blog in precisely the same form has appeared repeatedly in the past as far back as February 2011 see http://ezinearticles.com/?Computer,-Video-Games-and-Psychosis:-Cause-for-Concern&id=5763303 Minimally, Dr Dunckley could indicate that the blog is an old one and that the dates don’t actually makes sense – it would be more interesting to hear the follow-up of the individuals she describes or new cases.
What does the literature say? From a quick look, I could find no evidence of a causal link between screen use (active or otherwise) and psychosis or psychotic symptoms. There are an adult whose delusion is to think he is in a video game (Forsyth, Harland & Edwards 2001) and the authors clearly state “we are not suggesting that computer games can be the cause of psychosis; but it does seem likely that, with the growing use of computers for relaxation, game scenarios will be incorporated increasingly into delusional systems” http://jrsm.rsmjournals.com/content/94/4/184.full
As noted by Vaughn Bell and colleagues “Cultural technical innovations may have specific influences on the form, origin and content of delusional beliefs.” http://www.medicine.mcgill.ca/oslerweb/Bell2005.pdf but again there is no evidence from their review or cases, that exposure causes the symptoms or that removal or screen use (alone) cures psychotic symptoms.
Sean Spence in 1993 wrote on a case of ‘Nintendo hallucinations’, but clearly argued that “a stimulus in the environment is clearly incorporated in to the phenomenology of the psychotic process” Spence, S. A. 1993. Nintendo hallucinations: a new phenomenological entity. Irish Journal of Psychological Medicine 10: 98-99.
Finally, its nice to see that Dr Dunckley is not too worried about incipient psychosis – as she spends a bit of time on the screen herself – indeed “…15 or so hours writing, blogging, using social media for business purposed, networking, and going to educational events” http://studentdoctor.net/2012/04/20-questions-victoria-l-dunckley-m-d/
Thanks, Neurocritic, for the comments and links.
This bit would seem to be the clincher: "Sign up here for your FREE Save Your Child's Brain minicourse."
And thanks to Neuroskeptic and Keith Laws for cogent in-depth replies as well.
Here's a recent article from The Dana Foundation on this topic: http://www.dana.org/news/features/detail.aspx?id=34886
Poor Dr. Dunckley: Attacked by both the Neurocritic and the Neuroskeptic, - and Tal Yarkoni! I wouldn't want to be in her shoes... :-)
Interestingly a study on 2293 Taiwanese adolescents argues the other way round: That mental disorders are predictors for Internet addiction.
"Predictive Values of Psychiatric Symptoms for Internet Addiction in AdolescentsA 2-Year Prospective Study"
http://archpedi.jamanetwork.com/article.aspx?articleid=382237
Another longitudinal study writes "greater use of the Internet was associated with declines in participants' communication with family members in the household, declines in the size of their social circle, and increases in their depression and loneliness". http://www.ncbi.nlm.nih.gov/pubmed/9841579
With the quick glance I did I found no mention of psychotic symptoms.
"a study on 2293 Taiwanese adolescents argues the other way round: That mental disorders are predictors for Internet addiction."
Sort of like the marijuana/psychosis problem.
She would need to provide a specific mechanism that results in "increase dopamine in the reward center of the brain". Is it SDRI or VMAT or other? Or is she just making sh!t up that sounds kinda good?
Hearing/seeing things at night, while in bed (and probably drifting off i.e. at the point of sleep where you still THINK you are awake) - normal. I've never met anyone who hasn't had this at least once.
Feeling the presence of a person/entity at night (again, probably while drifting off, as above) - sleep paralysis. Happened to me all the time when I was as university. T'was the booze.
But, hey, I spent 16 hours straight playing Silent Hill 2, stopping only to grab a drink or pee, and afterwards I kept seeing enormous pyramid-headed men with giant knives following me. Because of this I ran around beating what I believed to be monsters to death with a length of steel pipe, so there may be something in this "study."
On the other hand, I may have just been still playing the game.... who knows.
People don't realize addictions can range from a variety of things: over-eating, sex addictions, t.v./videogames, drugs, et cetera. It goes on and on, and it's sad that so many of us have been through some sort of addiction- but you just have to step up and take control of YOUR life.
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