Digital Media and Developing Brains: Concerns and Opportunities.

Purpose of Review: The incorporation of digital technologies and their use in youth's everyday lives has been increasing rapidly over the past several decades with possible impacts on youth development and mental health. This narrative review aimed to consider how the use of digital technologies may be influencing brain development underlying adaptive and maladaptive screen-related behaviors. Recent Findings: To explore and provide direction for further scientific inquiry, an international group of experts considered what is known, important gaps in knowledge, and how a research agenda might be pursued regarding relationships between screen media activity and neurodevelopment from infancy through childhood and adolescence. While an understanding of brain-behavior relationships involving screen media activity has been emerging, significant gaps exist that have important implications for the health of developing youth. Summary: Specific considerations regarding brain-behavior relationships involving screen media activity exist for infancy, toddlerhood, and early childhood; middle childhood; and adolescence. Transdiagnostic frameworks may provide a foundation for guiding future research efforts. Translating knowledge gained into better interventions and policy to promote healthy development is important in a rapidly changing digital technology environment.

A brain imaging study of dopamine receptor D2 availability in cannabis dependent users after recovery from cannabis-induced psychosis.

There is increased risk of psychosis associated with cannabis use disorder and the interaction of THC with dopamine neurotransmission is complex. It is important to investigate the recovery from cannabis-induced psychosis and its effects on the brain's dopamine neurotransmission. This study was to evaluate dopamine receptor D2 availability in the striatum (caudate/putamen) in recently abstinent cannabis dependent users after recovery from psychosis in comparison with abstinent MDMA "ecstasy" abusers and healthy control participants. Participants were eight abstinent ex cannabis-dependent users who were treated for cannabis-induced psychosis with anti-psychotic medication and psychosocial support for 4 months in an inpatient treatment center for drug users. They were compared with nine abstinent ex MDMA "ecstasy" abusers who received medication and psycho-social treatment for 4 months at the same treatment facility and eight healthy control participants. All participants were scanned with bolus and constant infusion of [123I] Iodobenzamide (IBZM) in Single Photon Computed Tomography (SPECT). Cannabis abstinent users who were treated for cannabis-induced psychotic episodes showed no difference in dopamine D2 receptor availability in the caudate compared with abstinent MDMA "ecstasy" abusers and healthy control participants. This finding indicates minimal effects of cannabis-induced psychosis on dopamine reward mechanisms. There is evidence for reduced D2 receptor availability measures in the right putamen (uncorrected) which may indicate a residual effect of anti-psychotic medication.

Reward, motivation and brain imaging in human healthy participants - A narrative review.

Over the past 20 years there has been an increasing number of brain imaging studies on the mechanisms underlying reward motivation in humans. This narrative review describes studies on the neural mechanisms associated with reward motivation and their relationships with cognitive function in healthy human participants. The brain's meso-limbic dopamine reward circuitry in humans is known to control reward-motivated behavior in humans. The medial and lateral Pre-Frontal Cortex (PFC) integrate motivation and cognitive control during decision-making and the dorsolateral PFC (dlPFC) integrates and transmits signals of reward to the mesolimbic and meso-cortical dopamine circuits and initiates motivated behavior. The thalamus and insula influence incentive processing in humans and the motor system plays a role in response to action control. There are reciprocal relationships between reward motivation, learning, memory, imagery, working memory, and attention. The most common method of assessing reward motivation is the monetary incentive delay task (DMRT) and there are several meta-analyses of this paradigm. Genetics modulates motivation reward, and dopamine provides the basis for the interaction between motivational and cognitive control. There is some evidence that male adolescents take more risky decisions than female adolescents and that the lateralization of reward-related DA release in the ventral striatum is confined to men. These studies have implications for our understanding of natural reward and psychiatric conditions like addiction, depression and ADHD. Furthermore, the association between reward and memory can help develop treatment techniques for drug addiction that interfere with consolidation of memory. Finally, there is a lack of research on reward motivation, genetics and sex differences and this can improve our understanding of the relationships between reward, motivation and the brain.

Exercise addiction: A narrative overview of research issues.

This narrative overview summarises the work on exercise addiction (EA) over the past 12 years and exposes critical conceptual and methodological issues. More than 1000 articles exist on EA, conceptualised as uncontrolled training harming the individual. Still, EA has no clinical diagnosis criteria at this time. Research is increasing continuously, but it is stale in advancing knowledge. Scalar measurement and lack of differentiation between addictive and instrumental exercise could be reasons for insufficient progress. Exercise addiction fits in the framework of behavioural addictions, but excessive exercise patterns also co-occur with other morbidities, including eating or body-image disorders. In these cases, exercise is instrumental; it functions to achieve a non-exercise-related goal. Therefore, it is essential to separate primary from secondary EA. Based on the interactional model, significant stress and capacity-exceeding ambitions fuel primary EA, while chief motives behind secondary EA embed body image dissatisfaction and eating disorders. Few reports exist on EA's brain mechanisms, which could delay its classification as a distinct psychiatric dysfunction. Treatment of EA involves cognitive-behavioural approaches, but we know little about their effectiveness. Conceptually focussed psychophysiological research and in-depth interviews, complementing scalar data, could answer several open questions in this widely studied but relatively stagnant scholastic field.

Problematic Social Networking Site use-effects on mental health and the brain.

The association between excessive use of Social Networking Sites (SNS) and mental health is raising serious concern among health and education professionals. Problematic SNS use has been associated with an increased rate of depression, anxiety, stress, obsessive-compulsive disorder (OCD), attention-deficit/hyperactivity disorder (ADHD), and propensity to excessive alcohol use. It may also lead to vulnerability to aggression, cyberbullying and fear of missing out (FOMO). There is little evidence for cognitive impairments, but there is some preliminary event-related potentials (ERPs) evidence for inefficiency in allocating and monitoring resources and inhibitory control. Problematic SNS has been associated with the personality traits of conscientiousness agreeableness and neuroticism, and with narcissism. There is evidence for reduced sleep quality and quantity, longer sleeping latency and more sleep disturbance. The few brain imaging studies show some similarity between problematic SNS use and other addictions related to inhibitory-control mechanism, reduced gray matter volumes in the nucleus accumbens, amygdala, and the insula, suggesting rewarding effects of SNS use on the brain. Finally, there is preliminary evidence that treatment with Cognitive Behavior Therapy (CBT) can assist in short-term abstinence intervention to treat problematic SNS use. We conclude that problematic SNS use may have deleterious effects on emotional and social relationships, and more research is required on its effects on cognitive and brain function.

Excessive Smartphone Use Is Associated With Health Problems in Adolescents and Young Adults.

Background and Aims: This present paper will review the existing evidence on the effects of excessive smartphone use on physical and mental health. Results: Comorbidity with depression, anxiety, OCD, ADHD and alcohol use disorder. Excessive smartphone use is associated with difficulties in cognitive-emotion regulation, impulsivity, impaired cognitive function, addiction to social networking, shyness and low self-esteem. Medical problems include sleep problems, reduced physical fitness, unhealthy eating habits, pain and migraines, reduced cognitive control and changes in the brain's gray matter volume. In Conclusion: Excessive smartphone use is associated with psychiatric, cognitive, emotional, medical and brain changes that should be considered by health and education professionals.

Expert appraisal of criteria for assessing gaming disorder: an international Delphi study.

BACKGROUND AND AIMS: Following the recognition of 'internet gaming disorder' (IGD) as a condition requiring further study by the DSM-5, 'gaming disorder' (GD) was officially included as a diagnostic entity by the World Health Organization (WHO) in the 11th revision of the International Classification of Diseases (ICD-11). However, the proposed diagnostic criteria for gaming disorder remain the subject of debate, and there has been no systematic attempt to integrate the views of different groups of experts. To achieve a more systematic agreement on this new disorder, this study employed the Delphi expert consensus method to obtain expert agreement on the diagnostic validity, clinical utility and prognostic value of the DSM-5 criteria and ICD-11 clinical guidelines for GD. METHODS: A total of 29 international experts with clinical and/or research experience in GD completed three iterative rounds of a Delphi survey. Experts rated proposed criteria in progressive rounds until a pre-determined level of agreement was achieved. RESULTS: For DSM-5 IGD criteria, there was an agreement both that a subset had high diagnostic validity, clinical utility and prognostic value and that some (e.g. tolerance, deception) had low diagnostic validity, clinical utility and prognostic value. Crucially, some DSM-5 criteria (e.g. escapism/mood regulation, tolerance) were regarded as incapable of distinguishing between problematic and non-problematic gaming. In contrast, ICD-11 diagnostic guidelines for GD (except for the criterion relating to diminished non-gaming interests) were judged as presenting high diagnostic validity, clinical utility and prognostic value. CONCLUSIONS: This Delphi survey provides a foundation for identifying the most diagnostically valid and clinically useful criteria for GD. There was expert agreement that some DSM-5 criteria were not clinically relevant and may pathologize non-problematic patterns of gaming, whereas ICD-11 diagnostic guidelines are likely to diagnose GD adequately and avoid pathologizing.

Cannabis and Depression.

There is a growing body of evidence pointing to the co-occurrence of cannabis use and depression. There is also some evidence that the use of cannabis may lead to the onset of depression; however, strong evidence points to the inverse association; i.e. that depression may lead to the onset or increase in cannabis use frequency. Observational and epidemiological studies have not indicated a positive long-term effect of cannabis use on the course and outcome of depression. The association between cannabis use and depression may be stronger among men during adolescence and emerging adulthood and stronger in women during midlife. There is an indication for potential genetic correlation contributing to the comorbidity of cannabis dependence and major depression, namely that serotonin (5-HT) may mediate such association and there is also evidence for specific risk alleles for cannabis addiction. There is preclinical evidence that alteration in the endocannabinoid system could potentially benefit patients suffering from depression. However, the issue of using cannabis as an anti-depressant is at an early stage of examination and there is little evidence to support it. Finally, there has been little support to the notion that selective serotonin reuptake inhibitors (SSRIs) may be effective in decreasing depressive symptoms or rates of substance use in adolescents treated for depression and a co-occurring substance use disorder. In conclusion, despite methodological limitations, research in the past decades has broadened our knowledge on the association between cannabis use and depression from epidemiological, neurological, genetic, and pharmacological perspectives.

Should compulsive sexual behavior (CSB) be considered as a behavioral addiction? A debate paper presenting the opposing view.

BACKGROUND AND AIMS: Compulsive sexual behavior disorder (CSBD) has been a long debated issue. While formerly the discussion was about whether to regard CSBD as a distinctive disorder, the current debate is dealing with the classification of this phenomenon. One of the prominent voices in this field considers CSBD as a behavioral addiction and proposes CSBD to be called and diagnosed as sexual addiction (SA). This present debate paper will review the existing evidence supporting this view and it will argue against it. RESULTS: We have found that a great deal of the current literature is anecdotal while empirical evidence is insufficient. First, the reports about the prevalence of CSBD are contradictory. Additionally, the field mainly suffers from inconsistent defining criteria of CSBD and a consensus which symptoms should be included. As a result, the empirical evidence that does exist is mostly about some symptoms individually and not on the disorder as a whole construct. CONCLUSIONS: We conclude that currently, there is not enough data supporting CSBD as a behavioral addiction. Further research has to be done, examining CSBD phenomenology as a whole construct and based on a homogeneous criterion.

Psychological Support System for Hospital Workers During the Covid-19 Outbreak: Rapid Design and Implementation of the Covid-Psy Hotline.

BACKGROUND: The worldwide coronavirus outbreak has put hospital workers under extreme stress with possible mental health problems. In this context, we decided to rapidly design and implement a psychological support system for all hospital workers in Paris during the Covid-19 outbreak. METHODS: We built a hotline in 3 days using the following steps: 1) official mandate, 2) request for the creation of hotline numbers, 3) formulation of psychological intervention materials and policies, 4) call for volunteer certified psychologists, 5) call for volunteer certified psychiatrists in case of psychiatric cases, 6) creation of an anonymous and protected database, and 7) communication and regular reminders about the existence of the hotline for hospital workers. RESULTS: After the first 26 days, we received 149 calls with a mean of 5.73 calls/day (SD=3.22). The average call duration was 18.5 min (min=1; max=65min; SD=14.7), and mostly women (86%) called. The mean age was 32.7 years old (SD=11.0). Calls from hospital workers were from all professions; though mostly represented by frontline healthcare workers, non-frontline departments also called (total of 44 departments). Reasons for calling were anxiety symptoms (n=73, 49%), request for hotline information (n=31, 20.8%), worries about Covid-19 (n=23, 15.44%), exhaustion (n=17, 11.41%), trauma reactivation (n=10, 6.11%), insomnia (n=9, 6.0%), anger (n=8, 5.37%), depressive (n=6, 4.02%), and psychotic symptoms (n=3, 2.01%). Regarding referrals, 105 (70.47%) of them were referred to psychosocial, Covid, and general support. CONCLUSIONS: This psychological support system can be easily duplicated and seems to benefit all hospital professions that all appeared psychologically affected.

Chronic Use of Synthetic Cannabinoids Is Associated With Impairment in Working Memory and Mental Flexibility.

BACKGROUND: We have recently shown that chronic use of Synthetic Cannabinoids (SCs) has been associated with mood disorders and impairments in executive functions. There is also evidence indicating that chronic SC users have higher rates of comorbidity with depression and psychotic symptoms. Here, we investigate performance on executive function and emotional processing tasks in regular SC users and a measure of schizotypal traits. METHOD: Thirty chronic SC users, 32 recreational cannabis users, and 32 non-using control participants, without history of mental disorder, or current substance abuse diagnosis (mean age 26 ± 4.27 years; 85 males, 9 females), were tested in addiction treatment centers in Israel. Computerized neurocognitive function tests; the N-back task, Go/No-Go task, Wisconsin Sorting Card-like Task (WSCT), and emotional face recognition task and questionnaires of depression, anxiety and schizotypal traits and symptoms were used. RESULTS: SC users have performed worse than recreational cannabis users and non-cannabis users on the N-back working-memory task (lower accuracy) and the WSCT cognitive flexibility task. SC users showed greater schizotypal traits and symptoms compared with recreational cannabis users and non-user control participants. A positive association was found in cannabinoid-user groups between schizotypal traits and symptoms and cognitive and emotional processing measures. Finally, SC users have scored higher on depression and state-trait anxiety measures than recreational cannabis users or healthy control participants. CONCLUSIONS: Repeated use of SCs is associated with impairment in executive functions and emotional processing. These alterations are associated with depression and schizotypal traits and symptoms. This adds to existing evidence on the long-term consequences of SC drugs and their risks for mental health.

Neurobiological mechanisms underlying internet gaming disorder
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This review summarizes studies on the neurobiological correlates of internet gaming disorder (IGD), presently the most direct approach to analyzing the impact of digital technology and the internet on brain mechanisms. Brain imaging studies have shown that IGD shares, to a large extent, neurobiological alterations that are typical for other addictions, such as: (i) activation in brain regions associated with reward, as evident from cue exposure and craving studies and neurotransmitter systems studies that indicate an involvement of dopamine-mediated reward mechanisms; (ii) reduced activity in impulse control areas and impaired decision making; and (iii) reduced functional connectivity in brain networks that are involved in cognitive control, executive function, motivation, and reward. Moreover, there are structural changes, mainly reduction in gray-matter volume and white-matter density. Comorbidity studies indicate that executive control networks in attention deficit-hyperactivity disorder (ADHD) may increase the susceptibility to develop IGD. Most importantly, this review also outlines findings that show the effects of excessive use of screens, here referring to the playing of computer games, which activate many brain regions associated with cognitive, motor, and sensory function and not directly involved in other forms of addiction. This review describes and summarizes comprehensively the neurobiological correlates of addictive internet use in adolescents and young adults.
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Esta revisión resume los estudios sobre los correlatos neurobiológicos del trastorno de juego por internet (TJI), actualmente la aproximación más directa para analizar el impacto de la tecnología digital e Internet sobre los mecanismos cerebrales. Los estudios de imágenes cerebrales han demostrado que TJI comparte, en gran medida, las alteraciones neurobiológicas que son típicas de otras adicciones, tales como: (1) activación en regiones cerebrales asociadas con la recompensa, como lo demuestran los estudios de exposición a estímulos y de craving, así como los estudios de sistemas de neurotransmisores que dan cuenta de una participación de los mecanismos de recompensa mediados por la dopamina, (2) reducción de la actividad en áreas de control de impulsos y deterioro en la toma de decisiones y (3) reducción de la conectividad funcional en redes cerebrales que están involucradas en el control cognitivo, la función ejecutiva, la motivación y la recompensa. Además, hay cambios estructurales, principalmente reducción en el volumen de la materia gris y la densidad de la materia blanca. Los estudios de comorbilidad indican que las redes de control ejecutivo en el trastorno por déficit de atención con hiperactividad (TDAH) pueden aumentar la susceptibilidad a desarrollar TJI. Esta revisión, de manera importante, también describe los hallazgos que muestran los efectos del uso excesivo de pantallas (en referencia a los juegos de computador) que activan muchas regiones cerebrales asociadas con la función cognitiva, motora y sensorial y que no están directamente involucradas en otras formas de adicción. Esta revisión describe y resume exhaustivamente los correlatos neurobiológicos del uso adictivo de Internet en adolescentes y adultos jóvenes.

Analyser le trouble du jeu vidéo sur un plan neurobiologique représente actuellement la voie la plus directe pour examiner l'impact des technologies numériques et d'internet sur les mécanismes cérébraux. Nous présentons ici un résumé de ces études. Comme l'a montré l'imagerie cérébrale, des modifications neurobiologiques spécifiques du trouble du jeu vidéo sont retrouvées dans d'autres addictions : 1) une activation des régions cérébrales associées à la récompense, comme le montrent les études sur l'exposition aux stimuli et le craving (envie irrépressible) ainsi que les études sur les systèmes de neurotransmetteurs montrant une implication des circuits de récompense dopaminergiques ; 2) une activité diminuée dans les zones de contrôle des impulsions et une prise de décision altérée et 3) une connectivité fonctionnelle diminuée dans les réseaux cérébraux participant au contrôle cognitif, les fonctions exécutives, la motivation et la récompense. Des changements structurels sont également observés, principalement une diminution du volume de la substance grise et de la densité de la substance blanche. D'après des études de comorbidité, les réseaux de contrôle exécutif dans le trouble déficitaire de l'attention avec hyperactivité (TDAH) peuvent augmenter le risque de développer une addiction aux jeux vidéo. De façon plus importante encore, cette étude présente des résultats montrant les effets d'une utilisation excessive des écrans, tel le jeu sur ordinateur, qui active de nombreuses régions du cerveau associées aux fonctions cognitives, motrices et sensorielles et qui ne sont pas directement impliquées dans d'autres formes de dépendance. Cette étude décrit et résume de façon exhaustive les mécanismes neurobiologiques de l'addiction à Internet chez les adolescents et les jeunes adultes.

Personality Traits and Psychotic Proneness Among Chronic Synthetic Cannabinoid Users.

OBJECTIVE: Chronic use of synthetic cannabinoids (SCs) has been associated with a wide range of negative consequences for health including psychotic and affective disturbances. Accumulating evidence indicates that cannabinoids use may be a risk factor for schizophrenia, and chronic natural cannabis users score higher than non-users on measures of schizotypal personality traits. However, little is known regarding the personality characteristics of SC users, especially in comparison with recreational cannabis users and healthy individuals. This study aimed to examine the differences in personality characteristics and schizotypy between SC users, regular cannabis users, and non-users and to compare these measures between groups. METHODS: Forty-two chronic SC users, 39 natural cannabis users, and 47 non-using control participants, without history of mental disorder, or current substance use diagnosis (mean age 26± 4.47 years; 23 females, 105 males), completed the Big-Five Factor Inventory (BFI), the Schizotypal Personality Questionnaire-Brief (SPQ-B), substance use history, rating scales of depression and anxiety, and a demographic questionnaire. RESULTS: On the BFI, SC users scored higher than natural cannabis users and non-users on neuroticism, but lower on agreeableness and extraversion, and endorsed greater schizotypal symptoms on the SPQ-B. In addition, SC users had lower scores on conscientiousness than non-users, and natural cannabis users were more extroverted than non-users. Higher openness and lower conscientiousness predicted schizotypy for both SC and natural cannabis users. Finally, greater neuroticism predicted schizotypy for natural cannabis users, and introversion predicted schizotypy for non-users. CONCLUSIONS: These results show that chronic SC users differ from natural cannabis users and non-users on dimensions of specific personality traits and schizotypy that may indicate psychotic proneness.

Sexual addiction, compulsivity, and impulsivity among a predominantly female sample of adults who use the internet for sex.

BACKGROUND AND AIMS: Compulsive sexual behavior is characterized by extensive sexual behavior and unsuccessful efforts to control excessive sexual behavior. The aim of the studies was to investigate compulsivity, anxiety and depression and impulsivity and problematic online sexual activities among adult males and females who use the Internet for finding sexual partners and using online pornography. METHODS: Study 1- 177 participants including 143 women M = 32.79 years (SD = 9.52), and 32 men M = 30.18 years (SD = 10.79). The Sexual Addiction Screening Test (SAST), the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), Spielberger Trait-State Anxiety Inventory (STAI-T STAI-S) and Beck Depression Inventory (BDI). Study 2- 139 participants including 98 women M = 24 years (SD = 5) and 41 men M = 25 years (SD = 4). The impulsivity questionnaire (BIS/BAS), Problematic online sexual activities (s-IAT-sex) and Sexual Addiction Screening Test (SAST). RESULTS: Study 1- Multiple regression analysis has indicated that a model which included BDI, Y-BOCS, and STAI scores contributed to the variance of sexual addiction rates, and explained 33.3% of the variance. Study 2- Multiple regression analysis indicated that BIS/BAS and s-IAT scores contributed to the variance of sexual addiction rates, and explained 33% of the variance. DISCUSSION AND CONCLUSIONS: Obsessive-compulsive symptoms contributed to sexual addiction among individuals who use the Internet for finding sexual partners. Impulsivity and problematic online sexual activity contributed to ratings of sex addiction. These studies support the argument that sex addiction lies on the impulsive-compulsive scale and could be classified as a behavioral addiction.

Studies on the Relationship between Social Anxiety and Excessive Smartphone Use and on the Effects of Abstinence and Sensation Seeking on Excessive Smartphone Use.

Problematic smartphone use is the excessive use of the smartphone with negative impacts on the quality of life of the user. We investigated the association between social anxiety and excessive smartphone use. The sample consisted of 140 participants, 73 male and 67 female university students with a mean age of 26 years and 4 months (SD = 3.38), who filled in the Liebowitz Social Anxiety Scale and the Smartphone Addiction Scale (SAS). Results showed a positive association between social anxiety and excessive smartphone use. Social anxiety explained 31.5% of the variance of ratings on the SAS. A second study investigated the interaction between abstinence and sensation seeking and excessive smartphone use. The sample consisted of 60 participants, 44 female and 16 male university students. The sample was divided into two experimental conditions: 30 participants were abstinent for 1.5 h from the smartphone and 30 participants were non-abstinent. Results showed that excessive smartphone use increased in the group that abstained compared to those who did not. Secondly, participants who had high baseline sensation-seeking ratings had higher scores of excessive smartphone use after abstinence compared with those with low ratings of sensation seeking. These studies indicate the contribution of social anxiety to problematic smartphone use and how it can be exacerbated by the combination of abstinence and high sensation seeking.