Which is more stable and specific: DSM-5 internet gaming disorder or ICD-11 gaming disorder? A longitudinal study.

AIM: The high comorbidity rates of internet gaming disorder (IGD) and gaming disorder (GD) with other psychiatric disorders are concerning. A follow-up study of gamers from clinical and nonclinical samples with and without diagnoses of IGD or GD was conducted to investigate the changes in diagnoses over a 1-year period, compare their diagnostic stability, and examine the patterns of co-occurrence between IGD and GD with other psychiatric disorders over the same period. METHODS: Baseline and 1-year follow-up data of 279 participants, including 120 problematic gaming patients and 159 gamers from the general population, were analyzed. Information on demographics, gaming habits, and self-reported psychological status was collected. Additionally, a structured interview was conducted using the Gaming Diagnostic Interview and the Mini-International Neuropsychiatric Interview. RESULTS: Although there was no significant difference between the changes in IGD/GD diagnosis during the 1-year period, 34.7% of the participants had a change in IGD diagnosis, while the number of GD cases increased to 60.4%. When evaluating the fixed effects of comorbidity on IGD and GD, attention-deficit/hyperactivity disorder had the highest odds ratio for both IGD (75.23; 95% confidence interval [CI], 10.67-530.61) and GD (117.02 × 106 ; 95% CI, 2.23 × 106 -6132.64 × 106 ). CONCLUSION: These results reveal that a GD diagnosis might be more prone to change than an IGD diagnosis. GD was also found to be more affected by comorbid psychiatric disorders.

The psychometric properties of the Nepean Belief Scale as a tool for assessing delusions in schizophrenia and related psychotic disorders.

OBJECTIVES: To examine the psychometric characteristics of the Nepean Belief Scale (NBS) in psychiatric inpatients with delusions. The NBS is a five-item, clinician-administered scale that assesses the characteristics of beliefs, i.e. conviction, fixity, fluctuation, resistance and awareness that the belief is unreasonable. METHODS: Fifty-five patients were interviewed by two clinicians, within three days of admission to an acute psychiatric unit and were assessed using the NBS, the Brown Assessment of Belief Scale (BABS), the MINI International Neuropsychiatric Interview (MINI) and the Depression Anxiety Stress Scale 21-Item Version (DASS-21). The NBS was administered after two weeks to available participants, to assess test-retest reliability. RESULTS: Results demonstrated excellent inter-rater reliability of 0.93, Cronbach's alpha coefficient for internal consistency was 0.77. The NBS was found to have good convergent validity with the BABS and good discriminant validity with the DASS. Two-week test-retest reliability suggests that the NBS is sensitive to therapeutic change. CONCLUSIONS: Advantages of the NBS include its brevity, its ability to assess belief-related insight, its clear instructions and its definitions of belief characteristics. Thus, the NBS has the potential to greatly improve our ability to more objectively assess delusional beliefs.

Benzodiazepines: it's time to return to the evidence.

SUMMARY: We propose that discussions of benzodiazepines in the current psychiatric literature have become negatively biased and have strayed from the scientific evidence base. We advocate returning to the evidence in discussing benzodiazepines and adhering to clear definitions and conceptual rigour in commentary about them.

Compulsive Health-Related Internet Use and Cyberchondria.

BACKGROUND: Cyberchondria denotes excessive and repeated online health-related searches associated with an increase in health anxiety. Such searches persist in those with cyberchondria, despite the negative consequences, resembling a pattern of compulsive Internet use. OBJECTIVES: The aim of the present study was to assess compulsive health-related Internet use in relation to cyberchondria while controlling for related variables. METHOD: Adult participants (N = 749) were recruited from an online platform. They completed questionnaires assessing the severity of cyberchondria (via the Cyberchondria Severity Scale [CSS]), compulsive Internet use adapted for online health-related seeking (via the adapted Compulsive Internet Use Scale [CIUS]), and levels of intolerance of uncertainty and anxiety, as well as depressive, somatic, and obsessive-compulsive symptoms. A logistic regression analysis was carried out to identify predictors of scores above a cutoff value on the CIUS, indicating compulsive health-related Internet use. RESULTS: The regression output showed that only the CSS total score and sex made a unique, statistically significant contribution to the model, leading to the correct classification of 78.6% of the cases. Of the CSS subscales, compulsion and distress were the most strongly associated with compulsive health-related Internet use. CONCLUSIONS: The finding that the adapted CIUS scores are associated with cyberchondria indicates that cyberchondria has a compulsive component, at least in terms of health-related Internet use. It also suggests that compulsive health-related Internet use persists despite the distress associated with this activity. Males may engage in cyberchondria more compulsively than females. These findings have implications for research and clinical practice.

Relationship between benzodiazepine prescription, aggressive behavior, and behavioral disinhibition: a retrospective study in a Swiss prison.

BACKGROUND: Benzodiazepines are commonly prescribed in prisons amidst the controversies surrounding their potential role in causing behavioral disinhibition and aggressive behavior and their association with use and trafficking of illicit and addictive substances. The present study aimed to (1) ascertain the relationship between benzodiazepine prescription (including their dosage and duration of use) and aggressive behavior and behavioral disinhibition in prison and (2) investigate whether there was an association between benzodiazepine prescription, (including their dosage and duration of use) and using and trafficking illicit and addictive substances during imprisonment. METHODS: Data were extracted from the electronic database of an "open" Swiss prison (n = 1206, 1379 measures) over a 5-year period (2010-2015). Measures included benzodiazepine prescription, duration of benzodiazepine use and mean dosage, and punishable behaviors (physical and verbal aggression, disinhibited but not directly aggressive behaviors, property damage or theft, substance-related offenses, and rule transgression). We assessed the relationship between benzodiazepine prescription and punishable behaviors after propensity score matching. Logistic regressions were also used to test the relationship of benzodiazepine use duration and dosage with punishable behaviors among participants who received benzodiazepines. RESULTS: After propensity score matching, benzodiazepine prescription was not significantly associated with any punishable behavior. Among detained persons who took benzodiazepines, there was no significant association of dosage and duration of use with offenses involving illicit or addictive substance use or trafficking. CONCLUSIONS: Our study did not empirically support the occurrence of increased aggressive or disinhibited behaviors or increased risk of substance abuse in detained persons who received benzodiazepines in prison. This suggests a need to reconsider restrictions in prescribing benzodiazepines in the prison setting.

Childhood emotional abuse and problematic social networking sites use in a sample of Italian adolescents: The mediating role of deficiencies in self-other differentiation and uncertain reflective functioning.

OBJECTIVE: Childhood emotional abuse (CEA) is associated with various negative mental health outcomes. This study aimed to investigate the association between CEA and problematic social networking site (SNS) use in a sample of Italian adolescents. DESIGN: Using structural equation modeling, the study examined whether the relationship between CEA and problematic SNS use was sequentially mediated by self-other differentiation and uncertain reflective functioning in 1308 Italian adolescents (628 males, age range 13-19 years). RESULTS: A history of CEA was positively associated with problematic SNS use. Furthermore, deficiencies in self-other differentiation and uncertain reflective functioning partially mediated the relationship between CEA and problematic SNS use. CONCLUSIONS: The present study provides additional insight into the psychological dynamics underpinning problematic SNS use among adolescents. The clinical implications of these findings are discussed.

'Things are not what they seem to be': A proposal for the spectrum approach to conspiracy beliefs.

OBJECTIVE: Conspiracy beliefs (also known as conspiracy theories) become more prominent at times of heightened uncertainty and inconsistent or conflicting explanations provided by the authorities for events like terrorist attacks or pandemics, such as COVID-19. This article aims to examine the relevance of conspiracy beliefs for psychiatry in the context of the dynamics of trust and mistrust. CONCLUSIONS: Conspiracy beliefs may be situated on a spectrum of mistrust-related phenomena, which extends from healthy scepticism to persecutory delusions. They can be conceptualised as unfounded and fixed beliefs held with strong conviction about harm inflicted by powerful groups on the community or another group of people, usually with preserved insight that these beliefs differ from those that most people have and with reasons for having such beliefs not necessarily being implausible. It is important for conspiracy beliefs to be distinguished from persecutory delusions.

Commentary: Worshipping the internet - the perils of serving an unpredictable master - a commentary on Aboujaoude and Gega (2021).

Numerous links have been established between cybertechnology and mental health problems. Although the direction of causality in the relationship between internet misuse and mental disturbance remains unclear, the cyberworld may contribute to the shaping of psychopathology in various ways. These include internet-enhanced impulsivity, disinhibition and aggression, attentional problems, difficulties in coping with online information and selective and constraining online interactions with likeminded individuals. One of the imperatives of public health is to help internet users, especially those who are vulnerable such as children and adolescents, to be aware of the risks involved in interactions with the digital technologies and educate them about circumventing the dangers and seeking help.

Recent Insights Into Cyberchondria.

PURPOSE OF REVIEW: The construct of cyberchondria was introduced relatively recently. This article aims to review the conceptualization, theoretical basis and correlates of cyberchondria, as well as its prevention and management. RECENT FINDINGS: Although there is no consensus, most definitions of cyberchondria emphasize online health research associated with heightened distress or anxiety. The two theoretical models of cyberchondria involve reassurance seeking and specific metacognitive beliefs. Cyberchondria has relationships with health anxiety, problematic Internet use and symptoms of obsessive-compulsive disorder, with public health implications pertaining to functional impairment and altered healthcare utilization. Suggestions about prevention and management of cyberchondria have been put forward, but not tested yet. Research interest in cyberchondria has steadily increased. It is uncertain whether cyberchondria can be considered a distinct entity. Future research should aim to clarify the conceptual status of cyberchondria, quantify its impact and develop evidence-based approaches for a better control of cyberchondria.

Is cyberchondria a new transdiagnostic digital compulsive syndrome? A systematic review of the evidence.

BACKGROUND: Cyberchondria (CYB) has been described relatively recently as a behaviour characterized by excessive online searching for medical information that is associated with increasing levels of health anxiety. Although CYB has received some attention from researchers, there is no consensus about many of its aspects. AIMS: We describe one of the first reported cases of a treatment-seeking patient with CYB. We review the published literature on the definition of CYB, its assessment, epidemiology, cost and burden, psychological models and mechanisms associated with CYB, relationships between CYB and mental disorders and prevention and treatment strategies. METHODS: Systematic review of all peer-reviewed papers published within the PubMed, PsycINFO, and Cochrane Library databases. RESULTS: 61 articles were selected. Nearly all the studies were descriptive and cross-sectional recruiting sample mainly from the general/university student population and collecting self-report data via online surveys. Data on epidemiology, clinical features, course, comorbidity and therapeutic interventions were scarce. CYB showed a self-reported association with health anxiety, hypochondriasis and obsessive-compulsive disorder (OCD) as well as other forms of problematic usage of the internet (PUI) The psychological mechanisms associated with CYB include low self-esteem, anxiety sensitivity, intolerance of uncertainty, pain catastrophizing and certain meta-cognitive beliefs. CONCLUSION: A working definition of CYB includes excessive online health searches that are compulsive and may serve the purpose of seeking reassurance, whilst leading to a worsening of anxiety or distress and further negative consequences. CYB represents a clinically relevant transdiagnostic compulsive behavioural syndrome, closely related to PUI and usually presenting in association with health anxiety, hypochondriasis and/or OCD. CYB is clearly in need of further study and we identify key areas for future research.

Trajectories and predictors of anxiety symptoms during pregnancy in an Australian sample.

BACKGROUND: There is a growing realisation that anxiety symptoms and disorders during pregnancy are associated with various negative outcomes. The aims of this study were to identify latent classes of anxiety symptom trajectories during pregnancy, compare anxiety levels between pregnancy trimesters and ascertain the predictors of anxiety symptom trajectories. METHODS: Two hundred pregnant women in their first trimester who attended obstetric clinics at the local hospital were recruited. Three self-report questionnaires assessing anxiety levels were administered at three time points during pregnancy. Latent class growth analysis was used to identify anxiety symptom trajectories, and logistic regression analysis was performed to ascertain the predictors of latent class membership. RESULTS: Data for analyses were available for 188 women. Two anxiety symptom trajectories were identified: a 'high-anxiety' trajectory (13.3% of participating women) and 'low-anxiety' trajectory (86.7%). This finding was consistent across all the anxiety measures used in the study. Overall, anxiety levels gradually decreased during pregnancy, with a significant decrease between the first and second trimesters on some measures. Past mental disorders and significant stressors in the preceding 6 months predicted membership in the 'high-anxiety' trajectory group. CONCLUSIONS: These findings support an early assessment of anxiety in pregnant women. If untreated, a high level of anxiety in the first trimester is likely to persist throughout pregnancy, although it may decrease somewhat. An early recognition of pathological anxiety during pregnancy allows its timely treatment and prevention of unfavourable outcomes.

A transdiagnostic perspective of constructs underlying obsessive-compulsive and related disorders: An international Delphi consensus study.

BACKGROUND: The Research Domain Criteria seeks to bridge knowledge from neuroscience with clinical practice by promoting research into valid neurocognitive phenotypes and dimensions, irrespective of symptoms and diagnoses as currently conceptualized. While the Research Domain Criteria offers a vision of future research and practice, its 39 functional constructs need refinement to better target new phenotyping efforts. This study aimed to determine which Research Domain Criteria constructs are most relevant to understanding obsessive-compulsive and related disorders, based on a consensus between experts in the field of obsessive-compulsive and related disorders. METHODS: Based on a modified Delphi method, 46 experts were recruited from Australia, Africa, Asia, Europe and the Americas. Over three rounds, experts had the opportunity to review their opinion in light of feedback from the previous round, which included how their response compared to other experts and a summary of comments given. RESULTS: Thirty-four experts completed round one, of whom 28 (82%) completed round two and 24 (71%) completed round three. At the final round, four constructs were endorsed by ⩾75% of experts as 'primary constructs' and therefore central to understanding obsessive-compulsive and related disorders. Of these constructs, one came from the Positive Valence System (Habit), two from the Cognitive Control System (Response Selection/Inhibition and Performance Monitoring) and the final construct was an additional item suggested by experts (Compulsivity). CONCLUSION: This study identified four Research Domain Criteria constructs that, according to experts, cut across different obsessive-compulsive and related disorders. These constructs represent key areas for future investigation, and may have potential implications for clinical practice in terms of diagnostic processes and therapeutic management of obsessive-compulsive and related disorders.

Role of Benzodiazepines in Anxiety Disorders.

This chapter reviews the role of benzodiazepines (BZs) in the treatment of anxiety disorders, specifically panic disorder with or without agoraphobia, generalized anxiety disorder, and social anxiety disorder (social phobia). BZs pharmacology, classification, efficacy, adverse effects, withdrawal symptoms, possible dependence, and abuse; their positioning among pharmacological treatment; and guidance on how to use them are discussed.

Symptoms of Obsessive-Compulsive Disorder during Pregnancy and the Postpartum Period: a Systematic Review and Meta-Analysis.

The main aim of this systematic review and meta-analysis was to calculate and compare the frequencies of obsessions and compulsions in women with obsessive-compulsive disorder (OCD) during pregnancy (OCD-P), the postpartum period (OCD-PP) and when they are neither pregnant nor postpartum (OCD-NPP). Fourteen studies were selected after applying the inclusion and exclusion criteria. The meta-analysis showed that aggressive obsessions were much more common in OCD-PP than in OCD-P and OCD-NPP and that washing/cleaning compulsions were less frequent in OCD-PP than in OCD-P and OCD-NPP. These differences were significant, whereas the frequencies of various obsessions and compulsions did not distinguish between OCD-P and OCD-NPP. Obsessions about accidental harm to the infant and other infant-focused obsessions, checking compulsions, self-reassurance and seeking reassurance from others were also relatively common in OCD-PP. Clinical manifestations of OCD-PP are relatively specific and differ from those of OCD-P and OCD-NPP, whereas OCD-P does not seem to have distinct clinical features. Although these findings do not necessarily suggest that OCD-PP is a distinct subtype of OCD, they have important conceptual and clinical implications.

Changing characteristics of a Psychiatric Emergency Care Centre. An eight year follow-up study.

OBJECTIVE: The objective of this study was to report changes in characteristics of admissions to an established Psychiatric Emergency Care Centre (PECC) eight years after its opening. METHOD: Key clinical characteristics of admissions to the PECC were documented for 327 patients in 2015 and compared with the 477 patients in 2007, which is when the centre first opened. The characteristics of admission were evaluated using an audit of medical records from June to December in both 2007 and 2015. RESULTS: Statistically significant differences (p<0.05) between 2007 and 2015 were: a reduction in the numbers of patients admitted with depression; a reduction in the numbers of patients diagnosed with adjustment disorder; an increase in the numbers of patients diagnosed with borderline personality disorder; a reduction in pro re nata (prn) use, including a reduction in the need for chemical restraint with midazolam and a decrease in the length of admission in the PECC. CONCLUSIONS: The significant reduction in aggression, the use of prn medication and the number of people with longer stays within the PECC support the usefulness of PECCs in relation to patient satisfaction and adherence to admission criteria policy. These factors may be considered as indicators of the efficiency of a PECC.

The rates of co-occurring behavioural addictions in treatment-seeking individuals with obsessive-compulsive disorder: a preliminary report.

Objectives: To assess the rates of co-occurring putative 'behavioural addictions' in patients with obsessive-compulsive disorder (OCD).Methods: Twenty-three international centres specialising in the treatment of OCD were invited to participate in a survey of the rates of behavioural addictions and other relevant comorbidity within their samples.Results: Sixteen of 23 (69.6%) invited centres from 13 countries had sufficient data to participate in the survey. The use of validated diagnostic tools was discrepant, with most centres relying on a 'clinical diagnosis' to diagnose behavioural addictions. The final sample comprised of 6916 patients with a primary diagnosis of OCD. The reported rates of behavioural addictions were as follows: 8.7% for problematic internet use, 6.8% for compulsive sexual behaviour disorder, 6.4% for compulsive buying, 4.1% for gambling disorder and 3.4% for internet gaming disorder.Conclusions: Behavioural addictions should be better assessed for patients with OCD. The absence of diagnostic scales developed specifically for behavioural addictions and overlapping obsessive-compulsive phenomena such as compulsive checking of information on the internet may explain the relatively high rate of problematic internet use in this sample. The study encourages better efforts to assess and to conceptualise the relatedness of behavioural addictions to obsessive-compulsive 'spectrum' disorders.

Treatments used for obsessive-compulsive disorder-An international perspective.

OBJECTIVE: The objective of this study was to characterise international trends in the use of psychotropic medication, psychological therapies, and novel therapies used to treat obsessive-compulsive disorder (OCD). METHODS: Researchers in the field of OCD were invited to contribute summary statistics on the characteristics of their samples. Consistency of summary statistics across countries was evaluated. RESULTS: The study surveyed 19 expert centres from 15 countries (Argentina, Australia, Brazil, China, Germany, Greece, India, Italy, Japan, Mexico, Portugal, South Africa, Spain, the United Kingdom, and the United States) providing a total sample of 7,340 participants. Fluoxetine (n = 972; 13.2%) and fluvoxamine (n = 913; 12.4%) were the most commonly used selective serotonin reuptake inhibitor medications. Risperidone (n = 428; 7.3%) and aripiprazole (n = 415; 7.1%) were the most commonly used antipsychotic agents. Neurostimulation techniques such as transcranial magnetic stimulation, deep brain stimulation, gamma knife surgery, and psychosurgery were used in less than 1% of the sample. There was significant variation in the use and accessibility of exposure and response prevention for OCD. CONCLUSIONS: The variation between countries in treatments used for OCD needs further evaluation. Exposure and response prevention is not used as frequently as guidelines suggest and appears difficult to access in most countries. Updated treatment guidelines are recommended.

Cyberchondria and its Relationships with Related Constructs: a Network Analysis.

Cyberchondria denotes repeated online searches for health information that are associated with increasing levels of health anxiety. The aims of this study were to apply network analysis to investigate the extent to which cyberchondria is a distinct construct, ascertain which of the related constructs have the strongest relationships with cyberchondria and investigate whether some of the symptoms of cyberchondria are more central to the construct of cyberchondria. Questionnaires assessing the severity of cyberchondria, health anxiety, obsessive-compulsive disorder symptoms, intolerance of uncertainty, problematic Internet use, anxiety, depression and somatic symptoms were administered to 751 participants who searched for health information online during a previous 3-month period and were recruited from an online crowdsourcing platform. Network analyses were used to compute the networks, perform community detection tests and calculate centrality indices. Results suggest that cyberchondria is a relatively specific syndrome-like construct, distinct from all related constructs and consisting of interrelated symptoms. It has the strongest relationships with problematic Internet use and health anxiety. No symptom of cyberchondria emerged clearly as more central to the construct of cyberchondria. Future research should aim to deepen our understanding of cyberchondria and its links with psychopathology, especially its close relationship with problematic Internet use.

Psychiatrists' treatment preferences for generalized anxiety disorder.

OBJECTIVE: The objective of this study is to ascertain psychiatrists' treatment preferences for generalized anxiety disorder (GAD) and compare them to the same psychiatrists' treatment preferences in the hypothetical scenario that treatment is to be administered to themselves as patients. METHODS: A questionnaire was completed by 221 psychiatrists from 3 Balkan countries. They were asked to indicate their treatment preferences for patients with GAD and for themselves as patients. RESULTS: A large majority of psychiatrists chose selective serotonin reuptake inhibitors/serotonin and norepinephrine reuptake inhibitors as preferred treatment option for GAD patients. Fewer psychiatrists selected benzodiazepines and pregabalin and about one third chose psychotherapy. The majority of psychiatrists chose the same treatments for their patients and for themselves, with main differences being in terms of pharmacotherapy (especially benzodiazepines) being less frequently recommended and psychotherapy being more frequently recommended as preferred treatment option for psychiatrists as patients. CONCLUSIONS: Treatment preferences for GAD by psychiatrists in the 3 West Balkan countries were mostly in accordance with treatment guidelines and treatment preferences for patients and for psychiatrists as patients were mostly concordant. However, some psychiatrists were more likely to choose pharmacotherapy for patients and psychotherapy for themselves as patients. These findings have implications for education of psychiatrists and for efforts to improve treatment guidelines and mental health services.