Internet Addiction Disorder – Case Files of Internet Addiction Disorder and Psychosis

Posted on February 19, 2018
Time to read: 7 minutes

A 17-year-old student was brought to the clinic by his parents with a one-week history of changed behaviour and unusual beliefs. He started believing that his movements and actions were controlled by an external force through his laptop and phone resulting in him stopping their use.

Also, he felt that he was being followed by an unknown group of people through electronic devices. So he was reluctant to leave the house.

He had been studying information technology and electronics for his university entrance exam and had been an academically well-performing student.

Over the last 6 months, he started using internet excessively with the intention of finding information to make a drone. Besides schooling, he avoided all other activities and spent hours in front of the laptop.

He slept only for 2-3 hours on some days because he somehow wanted to complete his wish of flying a drone created by him. His interactions with family and friends also became much less. He became agitated and irritable when his parents tried to control his internet use.

He came from a middle class closely knit family with an Asian background. Both parents were caring and showed reasonable parenting practices.

There was no significant history of medical or psychiatric illness or substance use. Also, there was no family history of psychiatric illness. He was a developmentally normal adolescent with average academic performance. He was a quiet person with few close friends who was ‘loved‘ by his teachers.

Mental state examination revealed perplexed mood, persecutory delusions, delusions of reference and delusions of control involving technological devices. He showed partial insight.

Blood investigations and neuroimaging studies did not reveal any abnormality.

He responded well to Risperidone 3 mg and was completely symptom-free by 3 weeks.

References

3. Proposed diagnostic criteria for internet addiction

Tao, R., Huang, X., Wang, J., Zhang, H., Zhang, Y. & Li, M.
(2010). Proposed diagnostic criteria for internet addiction. Addiction,
105(3), 556–564.

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  • Huu Kim Le

    Hello Dr. Malika Weerasinghe, a fascinating case report.

    I agree that there is internet use as part of a prodromal illness, but I do not think there is sufficient evidence that the young person was addicted to the internet in this case report.

    In your patient’s case his internet use was for research purposes, with access to an endless flow of information on drones. I wonder if there was a affective component to this case (for example researching or non stop writing in a manic episode of a bipolar disorder). In the past, I have need patients develop delusions regarding people hacking their Facebook game.

    In one of your references (Paik 2014) the patient in that case had prolonged use of the online game Lineage and developed internet gaming withdrawal psychosis. I too wonder if that case the patient had an affective component to their illness. Again there was quick resolution with an atypical antipsychotic in a matter of days.

    As a child and adolescent psychiatrist here in Australia, I am often treating young people who present with social phobia and school refusal. In some cases, I will diagnose them with an internet gaming disorder. Often, this is not an easy diagnosis to make because they have never attempted to cut down use before nor had any game free days to experience withdrawal symptoms. However, when restrictions are placed by their parents to their online games there is a subsequent reduction in mood and anxiety symptoms.

    I would be very interested if you could please do a follow up post of the cultural differences in the way Sri Lankans use the internet and internet games. All the best. Kim

    • Psychscenehub

      Hi Kim Reply from the author – Thank you Kim for the comment about the case report.
      Patient described in the case report did not have features suggestive of a mood disorder. Even though irritability could be a feature of mood disorder specially in young people , in this particular patient it was not persistent and was associated with attempts by his parents to control his internet use.
      Further I felt that perplexed mood on presentation and absence of grandiose themes in delusions points more towards a psychotic illness rather than a mood disorder.However I do agree that mood disorder should be considered in differential diagnosis in patients with similar presentations especially in this age group.
      Diagnosis of IAD is difficult since there is no consensus on diagnostic criteria yet. I think it’s more difficult to decide what is pathological with regard to internet use considering rapid advances and it’s integration into lives of people.
      Internet addiction was diagnosed in above patient considering Young’s criteria. However clinical scenario is complicated by the type of internet use and purpose and the absence of internet free days to experience withdrawal symptoms.
      I am interested to know the diagnostic criteria used in your setting to diagnose IAD when the use involves activities other than games. I am happy to consider your suggestions regarding the topic in the future.

    • Malika Weerasinghe

      Thank you Kim for the comment about the case report.
      Patient described in the case report did not have features suggestive of a mood disorder. Even though irritability could be a feature of mood disorder specially in young people , in this particular patient it was not persistent and was associated with attempts by his parents to control his internet use.
      Further I felt that perplexed mood on presentation and absence of grandiose themes in delusions points more towards a psychotic illness rather than a mood disorder.However I do agree that mood disorder should be considered in differential diagnosis in patients with similar presentations especially in this age group.
      Diagnosis of IAD is difficult since there is no consensus on diagnostic criteria yet. I think it’s more difficult to decide what is pathological with regard to internet use considering rapid advances and it’s integration into lives of people.
      Internet addiction was diagnosed in above patient considering Young’s criteria. However Tao’s classification has made withdrawal an essential feature and also it specifies that internet use should be non academic. DSM V does not include activities other than games and Internet gaming disorder is listed in area for further research .
      I am interested to know the diagnostic criteria used in your setting to diagnose IAD when the use involves activities other than games. I am happy to consider your suggestions regarding the topic in the future.