Game Transfer Phenomena in a Clinical Case with Psychosis and Gaming Disorder
, Annabel Callan 1, Daragh Poynton 1, Daniela Vecchio 1 and Wai Chen 1,3,4,5,6,7
Round 1
Reviewer 1 Report
The authors describe an interesting case report. I have few comments.
-Line 61 " Our case report is novel that it is the first reporting of premorbid GTP from excessive video game playing Prior to a schizophrenia diagnosis " .
Please describe the symptoms according to the diagnostic criteria of Schizophrenia you considered.
The narrative of delusions is utterly intriguing, yet it does not match the understanding of its clinical state. Was he hospitalized? Was he being treated on an outpatient basis? Did he have regular checkups? Was he taking regular therapy?
Author Response
- Please describe the symptoms according to the diagnostic criteria of Schizophrenia you considered.
Previous text in the manuscript:
"Our case report is novel in that it is the first reporting of premorbid GTP from excessive video game playing prior to a schizophrenia diagnosis. This illustrates how excessive video game playing and heightened GTP susceptibility can co-exist and perhaps influence the evolution of the symptomatology of a psychotic illness."
Updated text in the manuscript:
Line 71-75
"Our case report is novel in that it is the first reporting of premorbid GTP from excessive video game playing prior to a schizophrenia diagnosis with delusions, hallucinations, negative symptoms, disorganised speech and behaviour. This illustrates how excessive video game playing and heightened GTP susceptibility can co-exist and perhaps influence the evolution of the symptomatology of a psychotic illness."
The description case section provides more detailed information on the patient's symptomatology that supports the diagnosis of paranoid schizophrenia.
- The narrative of delusions is utterly intriguing, yet it does not match the understanding of its clinical state. Was he hospitalized? Was he being treated on an outpatient basis? Did he have regular checkups? Was he taking regular therapy?
We have added the following paragraph in the first part of the case description as a response to your questions:
Line 127-132:
“Initially, he was hospitalized and treated on an outpatient basis, but then he was discharged from his community treatment team and managed by his GP, which may have contributed to his relapse of schizophrenia. Due to the comorbid symptomatology of schizophrenia and excessive playing (hence suspected Gaming Disorder), Patient G was referred to the Gaming Disorder assessment clinic - a new consultation liaison service offered by the Alcohol and Other Drugs (AOD) team.”
Reviewer 2 Report
Thank you for sharing this interesting case. It will definitely help shed light on this novel and under-evaluated diagnosis.
A few minor comments:
1- It would be interesting to include some background about the age groups most affected in the introduction.
2- Please clarify if all the anamnestic information was collected via interview with Patient G, or if there is collateral information as well.
3- I would suggest adding details about the patient's social skills and life (to exclude autism spectrum disorder, for example) and about the chronology of past antipsychotic treatments (why was clozapine indicated?).
4- I would suggest adding recall bias and patient reliability as a limitation, depending on the full context.
5- Please add a period between the two sentences on line 175.
Author Response
1. It would be interesting to include some background about the age groups most affected in the introduction.
We have included a paragraph in the introduction discussing the age relevance.
Line 61-70
"GTP has been reported in both adults and minors video game players. The evolution of GTP from youth to adult life is unknown. Concerns are raised about young players that may be more susceptible to interpreting GTP experiences as aversive, experiencing GTP more frequently or automatically acting out actions from the game due to their executive functions in development [1]. Certainly, a comparison between young (15-17 years old) vs adult players revealed that minors showed higher scores of GTP; however, only significant differences between minors and adults have been observed with regards GTP manifesting as body sensations (e.g., having a tactile sensation associated with a game) and thought processes (e.g., mixing up video game events with actual real-life events)[2]. “
- Please clarify if all the anamnestic information was collected via interview with Patient G, or if there is collateral information as well.
We included the following paragraph in the case context and method section to make it clear how the information reported was obtained.
“The information reported was collected via various clinical interviews with the patient, including an interview via telehealth. No further collateral history was obtained.”
- I would suggest adding details about the patient's social skills and life (to exclude autism spectrum disorder, for example) and about the chronology of past antipsychotic treatments (why was clozapine indicated?).
We included the paragraph below in the section of the case description to provide more details about patient's social skills and functioning.
“Patient G had limited social connections and experienced increased social withdrawal which is consistent with negative symptoms of schizophrenia which would supercede a diagnosis of autism. He did not have any developmental social deficits as a child that would warrant and autism assessment or diagnosis.”
Regarding antipsychotic treatments. We have explained why clozapine was prescribed.
Previous text
"Patient G had trialled multiple antipsychotics over the course of his mental illness; however, often with little success. He was previously prescribed clozapine but self-ceased this due to intolerable side effects. He also has documented adverse effects to risperidone and aripiprazole at relatively low doses. Before his admission to ED, Patient G was on olanzapine 5mg nocte, which he had been compliant with."
Updated text in the manuscript:
Line 136-141
"Patient G had trialled multiple antipsychotics over the course of his mental illness; how-ever, often with little success. He documented adverse effects to risperidone and aripiprazole at relatively low doses. He was prescribed clozapine but self-ceased this due to intolerable side effects. This medicine was initially prescribed because he had tried out at least two different antipsychotic treatments unsuccessfully. Before his admission to ED, Patient G was on olanzapine 5mg nocte, which he had been compliant with”.
- I would suggest adding recall bias and patient reliability as a limitation, depending on the full context.
The following text was added in limitations:
"There are limitations of this case report that should be acknowledged."
"Lastly, the experiences reported on GTP are limited to patient recall bias and reliability."
- Please add a period between the two sentences on line 175.
The period was added. Thanks for noticing it.
Reviewer 3 Report
This is a very interesting case report, which contains very detailed description of the evolution of a psychotic process related to gaming disorder. The English is excellent as are the references and it is a valuable contriubtion to the literature.
The only issue I have is that the authors report gaming disorder as being included under conditions for further study in DSM-5. This is the case, but the name of the disorder in DSM-5 is "internet gaming disorder" not "gaming disorder." It is identified correctly as "gaming disorder" in the ICD-11. I was confused as I tried to locate gaming disorder in DSM-5. The authors should clarify that gaming disorder is labeled as "internet gaming disorder" in DSM-5.
Otherwise I have no other critisms.
Author Response
- The only issue I have is that the authors report gaming disorder as being included under conditions for further study in DSM-5. This is the case, but the name of the disorder in DSM-5 is "internet gaming disorder" not "gaming disorder." It is identified correctly as "gaming disorder" in the ICD-11. I was confused as I tried to locate gaming disorder in DSM-5. The authors should clarify that gaming disorder is labeled as "internet gaming disorder" in DSM-5.
We have updated the naming in the below text.
Previous text in the manuscript:
"The impact of GD has been extensively investigated [3,4] giving place to the recognition of GD in the 11th revision of the International Classification of Diseases (ICD-11) [5] and its inclusion in the fifth edition of the Diagnostic and statistical manual of mental disorders (DSM-5) in the section of conditions for further study [6]."
Updated text in the manuscript:
Line 37-43
"The impact of GD has been extensively investigated [3,4] giving place to the recognition of GD in the 11th revision of the International Classification of Diseases (ICD-11) [5] and its inclusion in the fifth edition of the Diagnostic and statistical manual of mental disorders (DSM-5) in the section of conditions for further study labelled as 'Internet Gaming Disorder' (IGD) [6]."
