Elevated social Internet use and schizotypal personality disorder in adolescents

The Relationship of Internet, Social Media, and Related Technology Use with Disease Severity and Functionality in Individuals with Serious Mental Disorders

Introduction

The purpose of this study was to assess internet, social media, and related technology use in patients with serious mental disorders, and to examine their relationship with disease severity and functionality and gain insight about the thoughts of patients with severe mental disorders on benefits and risks of social media.

Methods

The study included 150 patients with bipolar disorder and 150 patients with schizophrenia spectrum disorder (82 with schizophrenia, 56 with psychotic disorders not otherwise specified and 12 with schizoaffective disorder) in remission. Information about demographics, clinical features, the use of social media and related technologies, and opinions on social media use were obtained via a data form prepared by the clinicians. Severity of disease and symptoms were measured using the Hamilton Rating Scale for Depression, the Young Mania Rating Scale, the Brief Psychiatric Rating Scale and, the Clinic Global Impression Scale. The Functioning Assessment Short Test was used to evaluate psychosocial functioning.

Results

Among the patients who participated in the current study, 65.3% (n=196) reported internet use and, 59.7% (n=179) reported social media use. The Functioning Assessment Short Test total scores and the Clinic Global Impression Scale scores were significantly higher in patients who did not use social media than in those who did. The use of social media, mobile phones, smartphones, short message services (SMS), e-mail was significantly higher in patients with bipolar disorder than in patients with schizophrenia spectrum disorder.

Conclusion

The use of social media, Internet and mobile devices cannot be underestimated among patients with serious mental disorders.

Environmental context predicts state fluctuations in negative symptoms in youth at clinical high risk for psychosis

BACKGROUND

Negative symptoms (avolition, anhedonia, asociality) are a prevalent symptom in those across the psychosis-spectrum and also occur at subclinical levels in the general population. Recent work has begun to examine how environmental contexts (e.g. locations) influence negative symptoms. However, limited work has evaluated how environments may contribute to negative symptoms among youth at clinical high risk for psychosis (CHR). The current study uses Ecological Momentary Assessment to assess how four environmental contexts (locations, activities, social interactions, social interaction method) impact state fluctuations in negative symptoms in CHR and healthy control (CN) participants.

METHODS

CHR youth (n = 116) and CN (n = 61) completed 8 daily surveys for 6 days assessing negative symptoms and contexts.

RESULTS

Mixed-effects modeling demonstrated that negative symptoms largely varied across contexts in both groups. CHR participants had higher negative symptoms than CN participants in most contexts, but groups had similar symptom reductions during recreational activities and phone call interactions. Among CHR participants, negative symptoms were elevated in several contexts, including studying/working, commuting, eating, running errands, and being at home.

CONCLUSIONS

Results demonstrate that negative symptoms dynamically change across some contexts in CHR participants. Negative symptoms were more intact in some contexts, while other contexts, notably some used to promote functional recovery, may exacerbate negative symptoms in CHR. Findings suggest that environmental factors should be considered when understanding state fluctuations in negative symptoms among those at CHR participants.

The relationship between internet gaming disorder and psychotic experiences: cyberbullying and insomnia severity as mediators

BACKGROUND

The nature of the relationship between Internet Gaming Disorder (IGD) and psychosis is unclear so far. There is evidence that greater time spent in playing video games may expose players to both insomnia and a toxic online environment with widespread cyberbullying. These two possible consequences of IGD may, in turn, be associated with greater psychotic experiences (PE). Based on this theoretical framework, the present study proposed to contribute the body of the knowledge in this area, by testing the possible indirect effects of insomnia severity, cyber-victimization and cyberbullying in the cross-sectional association between IGD and PE in a sample of Tunisian university students.

METHOD

We conducted a cross-sectional study over 4 months (February-May 2022). The Arabic versions of the Brief Symptom Inventory, the Internet Gaming disorder-20 Test, the Insomnia Severity Index, and the Revised Cyber Bullying Inventory-II were administered to a total of 851 students (mean age = 21.26 ± 1.68 years, 53.7% females).

RESULTS

We found that 25% of students were at risk of IGD, and 1.8% had an IGD. The results of the mediation analysis showed that insomnia severity fully mediated the association between IGD and paranoid ideation. Higher IGD was significantly associated with more insomnia severity, which was, in turn, significantly associated with more paranoid ideation. Cyberbullying partly mediated the association between IGD and psychoticism. Higher IGD scores were significantly associated with more cyberbullying, which was, in turn, significantly associated with more psychoticism. Finally, greater IGD was significantly and directly associated with higher psychoticism.

CONCLUSION

Our findings suggest that insomnia and cyberbullying may be regarded as potential targets for youth mental health promotion, as well as community-focused prevention and early intervention in psychosis. More particular attention should be devoted to the huge potential for engaging in cyberbullying among online gamers. Sleep deprivation should be prevented, assessed and treated in heavy gamers.

Temporal Interactions Between Social Motivation and Behavior In Daily Life Among Individuals at Clinical High-Risk for Psychosis

BACKGROUND AND HYPOTHESES

Poor social functioning is common among individuals at clinical high-risk (CHR) for psychosis and is associated with greater likelihood of conversion. Unfortunately, processes contributing to social impairment are unclear, making social functioning difficult to improve via treatment. The current study examined whether abnormalities in social functioning result from aberrant temporal interactions between social motivation and behavior.

STUDY DESIGN

Participants included 105 individuals at CHR and 62 healthy controls (CN) who completed 6 days of ecological momentary assessment. Multilevel models examined time-lagged interactions between social behavior and motivation.

STUDY RESULTS

CHR and CN did not differ in social motivation; however, CHR were less likely to interact with family and coworkers and more likely to engage in interactions via phone and text/social media. Autocorrelations indicated that social behavior and motivation were generally consistent across time in CHR and CN groups. Time-lagged analyses indicated that both groups had an increase in social motivation across time when they were alone and a decrease in social motivation across time when they were with others. However, the relative decrease when with others and increase when alone were less robust in CHR than CN, particularly for in-person interactions. Social motivation at time t did not differentially impact social partner or modality at time t+1 in the groups.

CONCLUSIONS

Findings suggest that social behavior and motivation have different temporal interactions in CHR and CN. Psychosocial interventions may benefit from targeting the frequency of social behavior with specific partners and modalities to change social motivation.

The relationship between technology addictions and schizotypal traits: mediating roles of depression, anxiety, and stress

BACKGROUND

The way how technology addiction relates to psychosis remains inconclusive and uncertain. The present study aimed to test the hypothesis of a mediating role of depression, anxiety and stress in the association between three technology (behavioral) addictions (i.e., Addiction to the Internet, smartphones and Facebook) and psychosis proneness as estimated through schizotypal traits in emerging adults.

METHODS

A cross-sectional study was performed among non-clinical Tunisian university students (67.6% females, mean age of 21.5 ± 2.5 years) using a paper-and-pencil self-administered questionnaire.

RESULTS

Results for the Pearson correlation revealed that higher smartphone, Internet, and Facebook addictions' scores were significantly and positively correlated with each of the depression, anxiety and stress subscores; whereas depression (r = 0.474), anxiety (r = 0.499) and stress (r = 0.461) scores were positively correlated with higher schizotypal traits. The results of the mediation analysis found a significant mediating effect for depressive, anxiety and stress symptoms on the cross-sectional relationship between each facet of the TA and schizotypal traits.

CONCLUSION

Our findings preliminarily suggest that an addictive use of smartphones, Internet and Facebook may act as a stressor that exacerbates psychosis proneness directly or indirectly through distress. Although future longitudinal research is needed to determine causality, we draw attention to the possibility that treating psychological distress may constitute an effective target of interventions to prevent psychosis in adolescents with technology addictions.

Internet addiction is associated with psychological distress in highly schizotypal students

BACKGROUND

There is some limited evidence of an association between technology addictions and emergence of pre-psychotic symptoms, high psychoticism, psychotic like experiences and high schizotypy among young non-clinical adults. These addictions and their subsequent distress are likely to contribute to transition to psychosis in individuals at risk. We aimed to compare smartphone, Internet and Facebook addictions between low and high schizotypal individuals; and to explore the association between these addictions and distress in the high schizotypy group.

METHODS

From a pool of 700 students, the final sample consisted of 74 low schizotypal and 70 high schizotypal students. The Schizotypal Personality Questionnaire, the Bergen Facebook Addiction Scale, the Internet Addiction Test, the Smartphone Addiction Scale-Short Version and the Depression, Anxiety and Stress Scales.

RESULTS

Students of the high schizotypy group displayed significantly greater scores on smartphone (p < .001), Internet (p < .001) and Facebook (p = .001) addictions scales, as compared to those of the low schizotypy group. After controlling for potential confounders, Internet addiction predicted psychological distress in the high schizotypy group (R²  = 0.380, F_(13,55)  = 2.597, p < .001) and explained an additional 19.7% of variation in Depression, Anxiety and Stress Scales total scores in the final model.

CONCLUSION

Although preliminary, our findings shed light on relatively new avenues for prevention and early intervention in psychosis. It is recommended to raise awareness about Internet addiction risks, particularly among vulnerable young adults; and to find ways to turn Internet into a protective rather than stressor factor, by utilizing it as a resource in the care pathway.

Factors influencing schizotypal personality trait-dependent immersion and digital media usage: Adaptation and maladaptation

Immersion in the digital environment has been widely researched; however, the effects of adaptive and maladaptive schizotypal personality traits on immersion have received relatively little attention up till now. This study investigates the factors of personal immersion while using entertainment and digital communication applications and other variables such as problematic internet usage, and Facebook addiction. The Immersive Tendency Questionnaire was applied to measure participants' tendency to experience artistic and life-like scenarios in traditional settings (reading a book and watching a movie) and digital environments (playing computer games and using the internet). The study was conducted with 717 college students and graduate persons including, 186 males (mean age: 28.49) and 531 females (mean age: 28.4). The results show that lowered focusing abilities are directly linked with deficiencies in self-coherence, and maladaptive behavior that manifests in problematic internet and Facebook usage. Furthermore, the attention/focusing ability during immersion is accompanied by coherent self-structure and psychological well-being. Therefore, for people who have adequate focusing skills and coherent self-structure, the usage of social media and computer gaming can be considered adequate digital tools for developing their cognitive and social skills.

Mental health-related internet use by people with a diagnosis of chronic psychiatric disorder, attending community mental health centres

BACKGROUND

There is little information on Internet use for obtaining mental health information among individuals with chronic psychiatric disorders, who are receiving services from community mental health centres (CMHCs).

OBJECTIVE

To investigate the mental health information-seeking behaviour of individuals with chronic psychiatric disorders who attend CMHCs.

METHOD

This is a cross-sectional descriptive study. The data was collected by questionnaire (structured interview format) (n = 135 participants). The collected data were analysed with descriptive statistics and chi-square test.

RESULTS

It was found that 75.6% of the participants used the internet to search for information about mental health problems. Although the information retrieved from the internet was frequently or occasionally shared with the mental health team (19.6% and 40.2% of the participants, respectively), general online communication with professionals was rare (93.1% of the participants had not contacted mental health professionals).

CONCLUSIONS

Most participants looked for information about their mental health on the internet. Therefore, mental health professionals should consider how to facilitate professional-patient therapeutic communication, with acknowledged Internet use by individuals with chronic psychiatric disorders.

Users' Intention to Continue Using Online Mental Health Communities: Empowerment Theory Perspective

INTRODUCTION

Online mental health communities may provide new opportunities for rehabilitation for people with mental illness, so it is important to understand the factors that influence the continued use of online mental health communities by people with mental illness.

METHODS

From the perspective of empowerment, based on the theory of health self-efficacy and expectation confirmation, this study explored the mediating role of health self-efficacy and expectation confirmation in the empowerment process of patients in online mental health communities and users' intention to continue using online mental health communities. To verify this model, we obtained 272 valid questionnaires. The SmartPLS 3.0 software was selected for model construction and empirical analysis.

RESULTS

Health self-efficacy completely mediates the relationship between the empowerment process (i.e., emotional support, information support, helping others and sharing experiences) and users' intention to continue using an online mental health community. Expectation confirmation partially mediates the relationship between the empowerment process (i.e., information support and finding recognition) and users' intention to continue using an online mental health community.

CONCLUSION

The empowerment process is the main predictor of user health self-efficacy and expectation confirmation. This study has certain theoretical and practical significance for online mental health community research.

Reprint of: A review of negative symptom assessment strategies in youth at clinical high-risk for psychosis

Studies attempting to deconstruct the heterogeneity of schizophrenia and the attenuated psychosis syndrome consistently find that negative symptoms are a core dimension that is distinct from other aspects of the illness (e.g., positive and disorganized symptoms). Negative symptoms are also highly predictive of poor community-based functional outcomes, suggesting they are a critical treatment target. Unfortunately, pharmacological and psychosocial treatments for negative symptoms have demonstrated limited effectiveness. To address this critical unmet therapeutic need, the NIMH sponsored a consensus development conference to delineate research priorities for the field and stimulate treatment development. A primary conclusion of this meeting was that next-generation negative symptom rating scales should be developed to address methodological and conceptual limitations of existing instruments. Although second-generation rating scales were developed for adults with schizophrenia, progress in this area has lagged behind for youth at clinical-high risk (CHR) for developing psychosis (i.e. those meeting criteria for a prodromal syndrome). Given that negative symptoms are highly predictive of the transition to diagnosable psychotic illness, enhancing our ability to detect negative symptoms in CHR youth is paramount. The current paper discusses conceptual and methodological limitations inherent to existing scales that assess negative symptoms in CHR youth. The theoretical and clinical implications of these limitations are evaluated. It is concluded that new scales specifically designed to assess negative symptoms in CHR youth are needed to accurately chart mental illness trajectories and determine when, where, and how to intervene. Recent efforts to develop next-generation measures designed specifically for CHR youth to meet this urgent need in the field are discussed. These new approaches offer significant progress for addressing issues inherent to earlier scales.

Social Media and Mental Health: Benefits, Risks, and Opportunities for Research and Practice

Social media platforms are popular venues for sharing personal experiences, seeking information, and offering peer-to-peer support among individuals living with mental illness. With significant shortfalls in the availability, quality, and reach of evidence-based mental health services across the United States and globally, social media platforms may afford new opportunities to bridge this gap. However, caution is warranted, as numerous studies highlight risks of social media use for mental health. In this commentary, we consider the role of social media as a potentially viable intervention platform for offering support to persons with mental disorders, promoting engagement and retention in care, and enhancing existing mental health services. Specifically, we summarize current research on the use of social media among mental health service users, and early efforts using social media for the delivery of evidence-based programs. We also review the risks, potential harms, and necessary safety precautions with using social media for mental health. To conclude, we explore opportunities using data science and machine learning, for example by leveraging social media for detecting mental disorders and developing predictive models aimed at characterizing the aetiology and progression of mental disorders. These various efforts using social media, as summarized in this commentary, hold promise for improving the lives of individuals living with mental disorders.

A review of negative symptom assessment strategies in youth at clinical high-risk for psychosis

Studies attempting to deconstruct the heterogeneity of schizophrenia and the attenuated psychosis syndrome consistently find that negative symptoms are a core dimension that is distinct from other aspects of the illness (e.g., positive and disorganized symptoms). Negative symptoms are also highly predictive of poor community-based functional outcomes, suggesting they are a critical treatment target. Unfortunately, pharmacological and psychosocial treatments for negative symptoms have demonstrated limited effectiveness. To address this critical unmet therapeutic need, the NIMH sponsored a consensus development conference to delineate research priorities for the field and stimulate treatment development. A primary conclusion of this meeting was that next-generation negative symptom rating scales should be developed to address methodological and conceptual limitations of existing instruments. Although second-generation rating scales were developed for adults with schizophrenia, progress in this area has lagged behind for youth at clinical-high risk (CHR) for developing psychosis (i.e. those meeting criteria for a prodromal syndrome). Given that negative symptoms are highly predictive of the transition to diagnosable psychotic illness, enhancing our ability to detect negative symptoms in CHR youth is paramount. The current paper discusses conceptual and methodological limitations inherent to existing scales that assess negative symptoms in CHR youth. The theoretical and clinical implications of these limitations are evaluated. It is concluded that new scales specifically designed to assess negative symptoms in CHR youth are needed to accurately chart mental illness trajectories and determine when, where, and how to intervene. Recent efforts to develop next-generation measures designed specifically for CHR youth to meet this urgent need in the field are discussed. These new approaches offer significant progress for addressing issues inherent to earlier scales.

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.

Contribution of stress and coping strategies to problematic Internet use in patients with schizophrenia spectrum disorders

INTRODUCTION

Internet use is already high and increasing rapidly among people with psychotic disorders, but there have been few studies on problematic Internet use (PIU) among patients with schizophrenia spectrum disorders. This study aimed to measure the prevalence of PIU and identify the factors associated with PIU among patients with schizophrenia spectrum disorders.

METHODS

A cross-sectional survey was performed that included 368 outpatients with schizophrenia spectrum disorders: 317 with schizophrenia, 22 with schizoaffective disorder, 9 with schizophreniform disorder, and 20 with other schizophrenia spectrum and psychotic disorders. The severity of psychotic symptoms and levels of personal and social functioning were assessed by the Clinician-rated Dimensions of Psychosis Symptom Severity (CRDPSS) scale and the Personal and Social Performance (PSP) scale, respectively. PIU was evaluated using Young's Internet Addiction Test (IAT). Additionally, the Hospital Anxiety and Depression Scale (HADS), Perceived Stress Scale (PSS), Rosenberg Selfesteem Scale (RSES), and Brief Coping Orientation to Problems Experienced (COPE) Inventory were administered.

RESULTS

PIU was identified in 81 (22.0%) of the 368 patients with schizophrenia spectrum disorders. Subjects with PIU were significantly younger and more likely to be male. Scores on the HADS, PSS, and dysfunctional coping dimension of the Brief COPE Inventory were significantly higher, and RSES scores were significantly lower, in the PIU group. Logistic regression analysis indicated that PIU in patients was significantly associated with scores on the PSS and dysfunctional coping dimension of the Brief COPE Inventory.

CONCLUSIONS

Patients with schizophrenia spectrum disorders and PIU were significantly more likely to have high levels of perceived stress and dysfunctional coping strategies. Patients with schizophrenia spectrum disorders who also engage in PIU may benefit from interventions that help them to develop appropriate skills for coping with stress.

Social isolation in mental health: a conceptual and methodological review

PURPOSE

Social isolation and related concepts have been discussed increasingly in the field of mental health. Despite this, there is a lack of conceptual clarity and consistency in the definition and operationalisation of these terms. This review aimed to provide a clear framework for social isolation and related concepts, and to identify well-established measures in the field of mental health for each conceptual domain discussed.

METHODS

We used an iterative strategy of expert consultation and literature searching. A multi-disciplinary group of senior academics was consulted both before and after the literature searching to identify relevant terms, conceptual papers, or recommended measures. Our conceptual framework was also validated through expert consultation. We searched the Web of Science database using terms suggested by experts and subsequently identified further relevant studies through review articles and by reading full texts and reference lists of included studies. A narrative synthesis was conducted.

RESULTS

We developed a model with five domains incorporating all the concepts relevant to social isolation in regular use in the mental health research literature. These five domains are: social network-quantity; social network-structure; social network-quality; appraisal of relationships-emotional; and appraisal of relationships-resources. We also identified well-developed measures suitable for assessing each of the five conceptual domains or covering multi-domains.

CONCLUSIONS

Our review proposes a conceptual model to encompass and differentiate all terms relating to social isolation. Potential uses are in allowing researchers and intervention developers to identify precisely the intended outcomes of interventions, and to choose the most appropriate measures to use in mental health settings.

Social relationships in young adults at ultra high risk for psychosis

Studies suggest that individuals with schizophrenia have smaller social networks and less satisfying relationships. However, much is still unknown about the typical quantity and quality of social relationships in young adults during the ultra high-risk (UHR) period. Investigating these relationships holds significant importance for improving understanding of etiological processes, mapping the social environment, and highlighting treatment targets in a critical period. A total of 85 participants (44 UHR and 41 healthy controls) completed measures examining the participants' social relationships, social support, and loneliness. Mean differences between the UHR and healthy control participants and associations between social relationships and symptoms and functioning were examined. Results indicated significant differences between groups on several indices. Specifically, the UHR youth reported fewer close friends, less diverse social networks, less perceived social support, poorer relationship quality with family and friends, and more loneliness. Notably, within the UHR group, being lonely and having fewer and worse quality relationships was associated with greater symptom severity and lower overall functioning. This study suggests that youth at high-risk of developing psychosis have fewer and poorer quality social relationships. Interventions that focus on increasing the quantity and quality of young adults' social networks may be beneficial for this population.

Disintegration as an Additional Trait in the Psychobiological Model of Personality

Abstract. This meta-analytic study investigates the relations between Disintegration-like phenomena (i.e., various aspects of symptomatology with the prefix “schizo-,” both at the clinical and the subclinical level) and the traits of the Psychobiological Model of Personality (PBMP). The empirically based benchmark for assuming the distinctness of the trait Disintegration was .30. The sample included 26 manuscripts with 30 studies and 424 effect sizes. By computing inverse sampling variance weighted mean correlation coefficients under a random-effects assumption, the following associations were found between Disintegration and Harm Avoidance, Novelty Seeking, Reward Dependence, Persistence, Self-Directedness, Cooperativeness, and Self-Transcendence: .23, .04, −.15, −.02, −.23, −.16, and .17, respectively. Two variables were found to moderate the Disintegration-Self-Transcendence correlation. Despite the theoretical expectation and some empirical evidence that Self-Transcendence (and other character traits) should capture variations in Disintegration-like phenomena, our results suggest that schizo-type phenomena are not adequately covered by the PBMP.

The future of mental health care: peer-to-peer support and social media

AIMS

People with serious mental illness are increasingly turning to popular social media, including Facebook, Twitter or YouTube, to share their illness experiences or seek advice from others with similar health conditions. This emerging form of unsolicited communication among self-forming online communities of patients and individuals with diverse health concerns is referred to as peer-to-peer support. We offer a perspective on how online peer-to-peer connections among people with serious mental illness could advance efforts to promote mental and physical wellbeing in this group.

METHODS

In this commentary, we take the perspective that when an individual with serious mental illness decides to connect with similar others online it represents a critical point in their illness experience. We propose a conceptual model to illustrate how online peer-to-peer connections may afford opportunities for individuals with serious mental illness to challenge stigma, increase consumer activation and access online interventions for mental and physical wellbeing.

RESULTS

People with serious mental illness report benefits from interacting with peers online from greater social connectedness, feelings of group belonging and by sharing personal stories and strategies for coping with day-to-day challenges of living with a mental illness. Within online communities, individuals with serious mental illness could challenge stigma through personal empowerment and providing hope. By learning from peers online, these individuals may gain insight about important health care decisions, which could promote mental health care seeking behaviours. These individuals could also access interventions for mental and physical wellbeing delivered through social media that could incorporate mutual support between peers, help promote treatment engagement and reach a wider demographic. Unforeseen risks may include exposure to misleading information, facing hostile or derogatory comments from others, or feeling more uncertain about one's health condition. However, given the evidence to date, the benefits of online peer-to-peer support appear to outweigh the potential risks.

CONCLUSION

Future research must explore these opportunities to support and empower people with serious mental illness through online peer networks while carefully considering potential risks that may arise from online peer-to-peer interactions. Efforts will also need to address methodological challenges in the form of evaluating interventions delivered through social media and collecting objective mental and physical health outcome measures online. A key challenge will be to determine whether skills learned from peers in online networks translate into tangible and meaningful improvements in recovery, employment, or mental and physical wellbeing in the offline world.

Internet Addiction, Hikikomori Syndrome, and the Prodromal Phase of Psychosis

Computers, video games, and technological devices are part of young people's everyday lives. Hikikomori is a Japanese word describing a condition that mainly affects adolescents or young adults who live isolated from the world, cloistered within their parents' homes, locked in their bedrooms for days, months, or even years on end, and refusing to communicate even with their family. These patients use the Internet profusely, and only venture out to deal with their most imperative bodily needs. Although first described in Japan, cases have been described from around the world. This is the first published report from Canada. The disorder shares characteristics with prodromal psychosis, negative symptoms of schizophrenia, or Internet addiction, which are common differential or comorbid diagnoses. However, certain cases are not accompanied by a mental disorder. Psychotherapy is the treatment of choice although many cases are reluctant to present. The exact place of hikikomori in psychiatric nosology has yet to be determined. We searched Medline up to 12th May, 2015 supplemented by a hand search of the bibliographies of all retrieved articles. We used the following search terms: Hikikomori OR (prolonged AND social AND withdrawal). We found 97 potential papers. Of these 42 were in Japanese, and 1 in Korean. However, many of these were cited by subsequent English language papers that were included in the review. Following scrutiny of the titles and abstracts, 29 were judged to be relevant. Further research is needed to distinguish between primary and secondary hikikomori and establish whether this is a new diagnostic entity, or particular cultural or societal manifestations of established diagnoses.

INCREASED INTERNET USE AND POORER ABILITY TO MANAGE EMOTIONS IN YOUTH AT HIGH-RISK FOR PSYCHOSIS

The relationship between Internet use and social behavior remains unknown. However, research indicates that Internet use (IU) may have some causal role in certain types of psychopathology and overall functioning. In contrast, other work suggests that IU may be protective and buffer against social isolation. Poorer emotional processing (EP) is characteristic of schizophrenia, and these deficits are present prior to illness onset (the ultra high-risk period (UHR)). UHR adolescents/young adults also fall within an age demographic characterized by extensive IU, which suggests that evaluating a link between IU and social behavior in this population may be especially informative. The present study examined the relationship between IU and emotional processing in 98 adolescents/young adults (52 UHR youth and 46 controls). UHR youth exhibited greater problematic IU (β = − 6.49, F(1,95) = 8.79, p = 0.002) and social withdrawal/problems resulting from this use (β = − 3.23, F(1,95) = 11.43, p < 0.001), as well deficits in emotional processing in comparison to healthy peers (β = 4.59, F(1,94) = 5.52, p = 0.011). Furthermore, the social problems resulting from IU were significantly related to the ability to process emotional information in the UHR group (β = − 0.51, t(1,48) = − 2.10, p = 0.021). UHR youth showed evidence of problematic IU relative to controls, and the social problems resulting from IU related to poorer EP. Findings replicate extant research involving other psychosis risk populations, while adding information regarding how social processes may relate to IU.

Online social networking in people with psychosis: A systematic review

BACKGROUND

Online social networking might facilitate the establishment of social contacts for people with psychosis, who are often socially isolated by the symptoms and consequences of their disorder.

AIMS

We carried out a systematic review exploring available evidence on the use of online social networking in people with psychosis.

METHODS

The review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Included studies examined the use of the online social networking by people with an a priori diagnosis of psychosis (inclusive of bipolar disorder). Data from included studies were extracted and narratively synthesised.

RESULTS

A total of 11 studies, published between 2005 and 2013, reported data on online social networking in people with psychosis. People with psychosis seem to spend more time in chat rooms or playing online games than control groups. The use of other online tools, such as Facebook or communication through e-mail, is lower or the same than controls. Online social networking was used by patients with psychosis for establishing new relationships, maintaining relationships/reconnecting with people and online peer support.

CONCLUSION

Online social networking, in the form of forums or online chats, could play a role in strategies aimed at enhancing social networks and reduce the risk of isolation in this population.

What is the potential for social networks and support to enhance future telehealth interventions for people with a diagnosis of schizophrenia: a critical interpretive synthesis

BACKGROUND

Digital technologies are increasingly directed at improved monitoring, management and treatment of mental health. However, their potential contribution to social networks and self-management support for people diagnosed with a serious mental illness has rarely been considered. This review and meta-synthesis aimed to examine the processes of engagement and perceived relevance and appropriateness of telehealth interventions for people with a diagnosis of schizophrenia. The review addresses three key questions. How is the use of digital communications technologies framed in the professional psychiatric literature? How might the recognised benefits of telehealth translate to people with a diagnosis of schizophrenia? What is the user perspective concerning Internet information and communication technologies?

METHODS

A critical interpretive synthesis (CIS) of published findings from quantitative and qualitative studies of telehealth interventions for people with a diagnosis of schizophrenia.

RESULTS

Most studies were of an exploratory nature. The professional discourse about the use of different technologies was overlain by concerns with surveillance and control, focusing on the Internet as a potential site of risk and danger. The critical synthesis of findings showed that the key focus of the available studies was on the delivery of existing traditional approaches (e.g. improving medications adherence, provision of medical information about the condition, symptom monitoring and cognitive behavioural therapy). Even though it was clear that the Internet has considerable potential in terms of accessing and utilising lay support, the potential of communication technologies in mobilising of resources for personal self-management or peer support was a relatively absent or hidden a focus of the available studies.

CONCLUSIONS

Based on an interpretive synthesis of available studies, people with a diagnosis of schizophrenia or psychosis use the Internet primarily for the purposes of disclosure and information gathering. Empowerment, regulation and surveillance emerged as the key dimensions of engagement (or not) with telehealth interventions. The findings suggest that telehealth interventions are disproportionately used by particular patient groups (e.g.women, people who are employed). Further research needs to ascertain the mechanisms by which telehealth interventions may be potentially beneficial or harmful for engagement and management to people with a diagnosis of schizophrenia.

Schizotypal personality disorder

Early phenomenological descriptions of schizophrenia have acknowledged the existence of milder schizophrenia spectrum disorders characterized by the presence of attenuated symptoms typically present in chronic schizophrenia. The investigation of the schizophrenia spectrum disorders offers an opportunity to elucidate the pathophysiological mechanisms giving rise to schizophrenia. Differences and similarities between subjects with schizotypal personality disorder (SPD), the prototypical schizophrenia personality disorder, and chronic schizophrenia have been investigated with genetic, neurochemical, imaging, and pharmacological techniques. Patients with SPD and the more severely ill patients with chronic schizophrenia share cognitive, social, and attentional deficits hypothesized to result from common neurodevelopmentally based cortical temporal and prefrontal pathology. However, these deficits are milder in SPD patients due to their capacity to recruit other related brain regions to compensate for dysfunctional areas. Individuals with SPD are also less vulnerable to psychosis due to the presence of protective factors mitigating subcortical DA hyperactivity. Given the documented close relationship to other schizophrenic disorders, SPD will be included in the psychosis section of DSM-5 as a schizophrenia spectrum disorder as well as in the personality disorder section.

Internet addiction, reality substitution and longitudinal changes in psychotic-like experiences in young adults

AIM

Internet use has grown exponentially in the past decade, but there has been little systematic research to inform our understanding of how this phenomenon may relate to mental illness. Although several characteristics of individuals experiencing psychotic-like experiences (PLEs) may render this group particularly susceptible to problematic Internet use, to date there have been no studies examining Internet use in this group. Because the experience of PLEs is considered a risk "behaviour" for formal psychosis, it is crucial to understand how patterns of Internet use may be tied to the progression of illness.

METHODS

A total of 170 young adults were followed for 2 months, and grouped into those showing a steady/improved course of PLEs (PLE-Improved/Constant) and those showing an exacerbation in PLEs (PLE-Increase). Internet addiction and a factor 'Reality Substitute' were examined within and between the two groups.

RESULTS

Findings indicated that although both groups reported a similar level of Internet addiction and Reality Substitute at baseline, the PLE-Improved/Constant group showed longitudinal declines in both domains of problematic Internet usage whereas the PLE-Increase group's reported level remained constant. Further, there were moderate correlations between PLEs and domains of problematic Internet use, and the magnitude of association with Reality Substitute for the PLE-Increase group grew significantly over time.

CONCLUSION

Taken together, results implicate a close link between continued problematic Internet use and the phenomena of PLEs.

Social networking profile correlates of schizotypy

Social networking sites, such as Facebook, are extremely popular and have become a primary method for socialization and communication. Despite a report of increased use among those on the schizophrenia-spectrum, few details are known about their actual practices. In the current research, undergraduate participants completed measures of schizotypy and personality, and provided access to their Facebook profiles. Information from the profiles were then systematically coded and compared to the questionnaire data. As predicted, social anhedonia (SocAnh) was associated with a decrease in social participation variables, including a decrease in number of friends and number of photos, and an increase in length of time since communication with a friend, but SocAnh was also associated with an increase in profile length. Also, SocAnh was highly correlated with extraversion. Relatedly, extraversion uniquely predicted the number of friends and photos and length of time since communication with a friend. In addition, perceptual aberration/magical ideation (PerMag) was associated with an increased number of "black outs" on Facebook profile print-outs, a measure of paranoia. Overall, results from this naturalistic-like study show that SocAnh and extraversion are associated with decreased social participation and PerMag with increased paranoia related to information on social networking sites.

Are sedentary television watching and computer use behaviors associated with anxiety and depressive disorders?

Sedentary behaviors may be more common among persons with mental disorders and thereby result in poorer health outcomes. This study examined whether independently of general physical activity level, mental disorders are linked to two important examples of sedentary behavior: computer use and watching television. We used cross-sectional data from The Netherlands Study of Depression and Anxiety (NESDA). Our study sample consisted of 2353 participants (age 18-65) of whom 1701 had a current anxiety and/or depressive diagnosis and 652 were healthy controls. Anxiety and depression diagnoses were conducted using the DSM-IV based Composite International Diagnostic Interview. Controlling for sociodemographics and physical activity level we found that persons with a major depressive disorder (MDD) spend significantly more leisure time using the computer. We found that persons with dysthymia, panic disorder and agoraphobia spend significantly more daily hours watching television compared to controls. This study illustrates that sedentary behaviors occur more frequently among persons with a mental disorder, independent of general physical activity level.

Is an interest in computers or individual/team sports associated with adolescent psychiatric disorders?

The Internet plays a major role in adolescents' free time activities and communication nowadays. The aim here was to investigate the possibility of an association of computers and video games or sports (team, individual) with psychiatric disorders among underage psychiatric inpatients. The series of adolescents (n = 508) had been diagnosed using semistructured interviews (K-SADS-PL). The results showed that an interest in computers and video games did not increase the risk of any specific psychiatric disorder among these adolescent inpatients, but the likelihood of a substance-related disorder was statistically significantly lower among the boys with computers as a hobby. Team sports were related to increased likelihood of conduct disorder among the boys, whereas the likelihood of an affective disorder was reduced. No such association was found in individual sports or among the girls. We conclude that social contacts and peers play an important role in preventing adolescent depression.

How patients with schizophrenia use the internet: qualitative study

Background

The Internet is an important source of health information for people with psychiatric conditions. Little is known about the way patients with schizophrenia use the Internet when it comes to issues related to their illness. Data on their specific needs, difficulties, and the consequences related to Internet use are lacking.

Objective

Our objective was to investigate the nature and subjective consequences of health-related Internet use among patients with schizophrenia.

Methods

In all, 26 individual semistructured interviews were conducted and analyzed qualitatively in groups of 4 until theoretical saturation was achieved.

Results

Study results suggest that the Internet is an influential source of illness-related information for patients with schizophrenia. Many aspects of their behavior around the Internet resemble those of individuals not afflicted by mental illness. Importantly, problems specific to patients with schizophrenia were stimulus overflow, an inability to deal with the abundance of information, difficulties with concentration, lack of energy, paranoid ideas, symptom provocation, and the need to distance themselves from illness-related topics as part of the recovery process. Internet information was subjectively perceived as having the potential to significantly change patients’ attitudes toward medication and their relationships with doctors.

Conclusions

These findings provide insight into how individuals with schizophrenia handle illness-related Internet information. The data could contribute to the continuous development of Internet-based interventions and offer novel approaches to optimizing traditional treatment options.

Systematic review on Internet Support Groups (ISGs) and depression (1): Do ISGs reduce depressive symptoms?

Background

Internet support groups (ISGs) enable individuals with specific health problems to readily communicate online. Peer support has been postulated to improve mental health, including depression, through the provision of social support. Given the growing role of ISGs for both users with depression and those with a physical disorder, there is a need to evaluate the evidence concerning the efficacy of ISGs in reducing depressive symptoms.

Objective

The objective was to systematically review the available evidence concerning the effect of ISGs on depressive symptoms.

Method

Three databases (PubMed, PsycINFO, Cochrane) were searched using over 150 search terms extracted from relevant papers, abstracts, and a thesaurus. Papers were included if they (1) employed an online peer-to-peer support group, (2) incorporated a depression outcome, and (3) reported quantitative data. Studies included both stand-alone ISGs and those used in the context of a complex multi-component intervention. All trials were coded for quality.

Results

Thirty-one papers (involving 28 trials) satisfied the inclusion criteria from an initial pool of 12,692 abstracts. Sixteen trials used either a single-component intervention, a design in which non-ISG components were controlled, or a cross-sectional analysis, of which 10 (62.5%) reported a positive effect of the ISG on depressive symptoms. However, only two (20%) of these studies employed a control group. Only two studies investigated the efficacy of a depression ISG and neither employed a control group. Studies with lower design quality tended to be associated with more positive outcomes (P = .07). Overall, studies of breast cancer ISGs were more likely to report a reduction in depressive symptoms than studies of other ISG types (Fisher P = .02), but it is possible that this finding was due to confounding design factors rather than the nature of the ISG.

Conclusions

There is a paucity of high-quality evidence concerning the efficacy or effectiveness of ISGs for depression. There is an urgent need to conduct high-quality randomized controlled trials of the efficacy of depression ISGs to inform the practice of consumers, practitioners, policy makers, and other relevant users and providers of online support groups.