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Journal ArticleDOI

Brain correlates of craving for online gaming under cue exposure in subjects with Internet gaming addiction and in remitted subjects

01 May 2013-Addiction Biology (Addict Biol)-Vol. 18, Iss: 3, pp 559-569
TL;DR: Brain correlates of cue‐induced craving to play online games in subjects with Internet gaming addiction, subjects in remission from IGA and controls showed that bilateral dorsolateral prefrontal cortex (DLPFC), precuneus, left parahippocampus, posterior cingulate and right anterior cingulates were activated in response to gaming cues and their activation was stronger in the IGA group than those in the control group.
Abstract: This study aimed to evaluate brain correlates of cue-induced craving to play online games in subjects with Internet gaming addiction (IGA), subjects in remission from IGA and controls. The craving response was assessed by event-related design of functional magnetic resonance images (fMRIs). Fifteen subjects with IGA, 15 in remission from IGA and 15 controls were recruited in this study. The subjects were arranged to view the gaming screenshots and neutral images under investigation of fMRIs. The results showed that bilateral dorsolateral prefrontal cortex (DLPFC), precuneus, left parahippocampus, posterior cingulate and right anterior cingulate were activated in response to gaming cues in the IGA group and their activation was stronger in the IGA group than those in the control group. Their region-of-interest was also positively correlated with subjective gaming urge under cue exposure. These activated brain areas represent the brain circuit corresponding to the mechanism of substance use disorder. Thus, it would suggest that the mechanism of IGA is similar to substance use disorder. Furthermore, the IGA group had stronger activation over right DLPFC and left parahippocampus than did the remission group. The two areas would be candidate markers for current addiction to online gaming and should be investigated in future studies.
Citations
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Journal ArticleDOI
TL;DR: An editorial reviews the DSM process and rationale for inclusion of internet gaming disorder, and it suggests directions for much needed research in this area.
Abstract: The DSM-5 is scheduled for publication in 2013, and internet gaming disorder will be included in its Section 3, the research appendix. This editorial reviews the DSM process and rationale for inclusion of this putative disorder, and it suggests directions for much needed research in this area.

465 citations

Journal ArticleDOI
TL;DR: A consensus regarding diagnostic criteria and measures is needed to improve reliability across studies and to develop effective and efficient treatment approaches for treatment seekers.
Abstract: AIM: To provide a comprehensive overview of clinical studies on the clinical picture of Internet-use related addictions from a holistic perspective. A literature search was conducted using the database Web of Science. METHODS: Over the last 15 years, the number of Internet users has increased by 1000%, and at the same time, research on addictive Internet use has proliferated. Internet addiction has not yet been understood very well, and research on its etiology and natural history is still in its infancy. In 2013, the American Psychiatric Association included Internet Gaming Disorder in the appendix of the updated version of the Diagnostic and Statistical Manual for Mental Disorders (DSM-5) as condition that requires further research prior to official inclusion in the main manual, with important repercussions for research and treatment. To date, reviews have focused on clinical and treatment studies of Internet addiction and Internet Gaming Disorder. This arguably limits the analysis to a specific diagnosis of a potential disorder that has not yet been officially recognised in the Western world, rather than a comprehensive and inclusive investigation of Internet-use related addictions (including problematic Internet use) more generally. RESULTS: The systematic literature review identified a total of 46 relevant studies. The included studies used clinical samples, and focused on characteristics of treatment seekers and online addiction treatment. Four main types of clinical research studies were identified, namely research involving (1) treatment seeker characteristics; (2) psychopharmacotherapy; (3) psychological therapy; and (4) combined treatment. CONCLUSION: A consensus regarding diagnostic criteria and measures is needed to improve reliability across studies and to develop effective and efficient treatment approaches for treatment seekers.

419 citations

Journal ArticleDOI
TL;DR: Results from functional neuroimaging and other neuropsychological studies demonstrate that cue-reactivity, craving, and decision making are important concepts for understanding Internet addiction.
Abstract: Most people use the Internet as a functional tool to perform their personal goals in everyday-life such as making airline or hotel reservations. However, some individuals suffer from a loss of control over their Internet use resulting in personal distress, symptoms of psychological dependence, and diverse negative consequences. This phenomenon is often referred to as Internet addiction. Only Internet Gaming Disorder has been included in the appendix of the DSM-5, but it has already been argued that Internet addiction could also comprise problematic use of other applications with cybersex, online relations, shopping, and information search being Internet facets at risk for developing an addictive behavior. Neuropsychological investigations have pointed out that certain prefrontal functions in particular executive control functions are related to symptoms of Internet addiction, which is in line with recent theoretical models on the development and maintenance of the addictive use of the Internet. Control processes are particularly reduced when individuals with Internet addiction are confronted with Internet-related cues representing their first choice use. For example, processing Internet-related cues interferes with working memory performance and decision making. Consistent with this, results from functional neuroimaging and other neuropsychological studies demonstrate that cue-reactivity, craving, and decision making are important concepts for understanding Internet addiction. The findings on reductions in executive control are consistent with other behavioral addictions, such as pathological gambling. They also emphasize the classification of the phenomenon as an addiction, because there are also several similarities with findings in substance dependency. The neuropsychological and neuroimaging results have important clinical impact, as one therapy goal should enhance control over the Internet use by modifying specific cognitions and Internet use expectancies.

384 citations


Cites result from "Brain correlates of craving for onl..."

  • ...…and gaming urges in excessive players have also been reported in other previous studies (e.g., Han et al., 2010b; Ko et al., 2013a; Lorenz et al., 2013) and comparisons between cue-reactivity on gaming stimuli and substance dependency (e.g., tobacco) have been discussed (Ko et al., 2013b)....

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  • ...Changes in prefrontal brain areas related to cue-reactivity and gaming urges in excessive players have also been reported in other previous studies (e.g., Han et al., 2010b; Ko et al., 2013a; Lorenz et al., 2013) and comparisons between cue-reactivity on gaming stimuli and substance dependency (e....

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  • ...…areas related to cue-reactivity and gaming urges in excessive players have also been reported in other previous studies (e.g., Han et al., 2010b; Ko et al., 2013a; Lorenz et al., 2013) and comparisons between cue-reactivity on gaming stimuli and substance dependency (e.g., tobacco) have been…...

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Journal ArticleDOI
TL;DR: This survey demonstrated that IGD is a frequently occurring phenomenon among European adolescents and is related to psychosocial problems, and the need for youth-specific prevention and treatment programs becomes evident.
Abstract: Excessive use of online computer games which leads to functional impairment and distress has recently been included as Internet Gaming Disorder (IGD) in Section III of the DSM-5 Although nosological classification of this phenomenon is still a matter of debate, it is argued that IGD might be described best as a non-substance-related addiction Epidemiological surveys reveal that it affects up to 3 % of adolescents and seems to be related to heightened psychosocial symptoms However, there has been no study of prevalence of IGD on a multi-national level relying on a representative sample including standardized psychometric measures The research project EU NET ADB was conducted to assess prevalence and psychopathological correlates of IGD in seven European countries based on a representative sample of 12,938 adolescents between 14 and 17 years 16 % of the adolescents meet full criteria for IGD, with further 51 % being at risk for IGD by fulfilling up to four criteria The prevalence rates are slightly varying across the participating countries IGD is closely associated with psychopathological symptoms, especially concerning aggressive and rule-breaking behavior and social problems This survey demonstrated that IGD is a frequently occurring phenomenon among European adolescents and is related to psychosocial problems The need for youth-specific prevention and treatment programs becomes evident

344 citations


Cites background from "Brain correlates of craving for onl..."

  • ..., specific cue-reactivity towards gamingrelated cues leading to craving and decreased cognitive control [25]) show parallels with other addictions [38, 46]....

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References
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Journal ArticleDOI
TL;DR: An issue concerning the criteria for tic disorders is highlighted, and how this might affect classification of dyskinesias in psychotic spectrum disorders.
Abstract: Given the recent attention to movement abnormalities in psychosis spectrum disorders (e.g., prodromal/high-risk syndromes, schizophrenia) (Mittal et al., 2008; Pappa and Dazzan, 2009), and an ongoing discussion pertaining to revisions of the Diagnostic and Statistical Manuel of Mental Disorders (DSM) for the upcoming 5th edition, we would like to take this opportunity to highlight an issue concerning the criteria for tic disorders, and how this might affect classification of dyskinesias in psychotic spectrum disorders. Rapid, non-rhythmic, abnormal movements can appear in psychosis spectrum disorders, as well as in a host of commonly co-occurring conditions, including Tourette’s Syndrome and Transient Tic Disorder (Kerbeshian et al., 2009). Confusion can arise when it becomes necessary to determine whether an observed movement (e.g., a sudden head jerk) represents a spontaneous dyskinesia (i.e., spontaneous transient chorea, athetosis, dystonia, ballismus involving muscle groups of the arms, legs, trunk, face, and/or neck) or a tic (i.e., stereotypic or patterned movements defined by the relationship to voluntary movement, acute and chronic time course, and sensory urges). Indeed, dyskinetic movements such as dystonia (i.e., sustained muscle contractions, usually producing twisting and repetitive movements or abnormal postures or positions) closely resemble tics in a patterned appearance, and may only be visually discernable by attending to timing differences (Gilbert, 2006). When turning to the current DSM-IV TR for clarification, the description reads: “Tic Disorders must be distinguished from other types of abnormal movements that may accompany general medical conditions (e.g., Huntington’s disease, stroke, Lesch-Nyhan syndrome, Wilson’s disease, Sydenham’s chorea, multiple sclerosis, postviral encephalitis, head injury) and from abnormal movements that are due to the direct effects of a substance (e.g., a neuroleptic medication)”. However, as it is written, it is unclear if psychosis falls under one such exclusionary medical disorder. The “direct effects of a substance” criteria, referencing neuroleptic medications, further contributes to the uncertainty around this issue. As a result, ruling-out or differentiating tics in psychosis spectrum disorders is at best, a murky endeavor. Historically, the advent of antipsychotic medication in the 1950s has contributed to the confusion about movement signs in psychiatric populations. Because neuroleptic medications produce characteristic movement disorder in some patients (i.e. extrapyramidal side effects), drug-induced movement disturbances have been the focus of research attention in psychotic disorders. However, accumulating data have documented that spontaneous dyskinesias, including choreoathetodic movements, can occur in medication naive adults with schizophrenia spectrum disorders (Pappa and Dazzan, 2009), as well as healthy first-degree relatives of chronically ill schizophrenia patients (McCreadie et al., 2003). Taken together, this suggests that movement abnormalities may reflect pathogenic processes underlying some psychotic disorders (Mittal et al., 2008; Pappa and Dazzan, 2009). More specifically, because spontaneous hyperkinetic movements are believed to reflect abnormal striatal dopamine activity (DeLong and Wichmann, 2007), and dysfunction in this same circuit is also proposed to contribute to psychosis, it is possible that spontaneous dyskinesias serve as an outward manifestation of circuit dysfunction underlying some schizophrenia-spectrum symptoms (Walker, 1994). Further, because these movements precede the clinical onset of psychotic symptoms, sometimes occurring in early childhood (Walker, 1994), and may steadily increase during adolescence among populations at high-risk for schizophrenia (Mittal et al., 2008), observable dyskinesias could reflect a susceptibility that later interacts with environmental and neurodevelopmental factors, in the genesis of psychosis. In adolescents who meet criteria for a prodromal syndrome (i.e., the period preceding formal onset of psychotic disorders characterized by subtle attenuated positive symptoms coupled with a decline in functioning), there is sometimes a history of childhood conditions which are also characterized by suppressible tics or tic like movements (Niendam et al., 2009). On the other hand, differentiating between tics and dyskinesias has also complicated research on childhood disorders such as Tourette syndrome (Kompoliti and Goetz, 1998; Gilbert, 2006). We propose consideration of more explicit and operationalized criteria for differentiating tics and dyskinesias, based on empirically derived understanding of neural mechanisms. Further, revisions of the DSM should allow for the possibility that movement abnormalities might reflect neuropathologic processes underlying the etiology of psychosis for a subgroup of patients. Psychotic disorders might also be included among the medical disorders that are considered a rule-out for tics. Related to this, the reliability of movement assessment needs to be improved, and this may require more training for mental health professionals in movement symptoms. Although standardized assessment of movement and neurological abnormalities is common in research settings, it has been proposed that an examination of neuromotor signs should figure in the assessment of any patient, and be as much a part of the patient assessment as the mental state examination (Picchioni and Dazzan, 2009). To this end it is important for researchers and clinicians to be aware of differentiating characteristics for these two classes of abnormal movement. For example, tics tend to be more complex than myoclonic twitches, and less flowing than choreoathetodic movements (Kompoliti and Goetz, 1998). Patients with tics often describe a sensory premonition or urge to perform a tic, and the ability to postpone tics at the cost of rising inner tension (Gilbert, 2006). For example, one study showed that patients with tic disorders could accurately distinguish tics from other movement abnormalities based on the subjective experience of some voluntary control of tics (Lang, 1991). Another differentiating factor derives from the relationship of the movement in question to other voluntary movements. Tics in one body area rarely occur during purposeful and voluntary movements in that same body area whereas dyskinesia are often exacerbated by voluntary movement (Gilbert, 2006). Finally, it is noteworthy that tics wax and wane in frequency and intensity and migrate in location over time, often becoming more complex and peaking between the ages of 9 and 14 years (Gilbert, 2006). In the case of dyskinesias among youth at-risk for psychosis, there is evidence that the movements tend to increase in severity and frequency as the individual approaches the mean age of conversion to schizophrenia spectrum disorders (Mittal et al., 2008). As revisions to the DSM are currently underway in preparation for the new edition (DSM V), we encourage greater attention to the important, though often subtle, distinctions among subtypes of movement abnormalities and their association with psychiatric syndromes.

67,017 citations


Additional excerpts

  • ...According to the diagnostic criteria for Internet addiction (DCIA) (Ko et al. 2009b), the core symptoms of Internet addiction are identical to diagnostic criteria for substance dependence (American Psychiatric Assn 2000)....

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Journal ArticleDOI

9,362 citations


"Brain correlates of craving for onl..." refers methods in this paper

  • ...After using a linear algorithm to convert MNIs to Talairach coordinates (Talairach & Tournoux 1998), Brodmann’s areas of significant brain activations were identified by the Talairach Daemon (Lancaster et al. 2000)....

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Journal ArticleDOI
01 Mar 2006-Brain
TL;DR: A useful conceptual framework is provided for matching the functional imaging findings with the specific role(s) played by this structure in the higher-order cognitive functions in which it has been implicated, and activation patterns appear to converge with anatomical and connectivity data in providing preliminary evidence for a functional subdivision within the precuneus.
Abstract: Functional neuroimaging studies have started unravelling unexpected functional attributes for the posteromedial portion of the parietal lobe, the precuneus. This cortical area has traditionally received little attention, mainly because of its hidden location and the virtual absence of focal lesion studies. However, recent functional imaging findings in healthy subjects suggest a central role for the precuneus in a wide spectrum of highly integrated tasks, including visuo-spatial imagery, episodic memory retrieval and self-processing operations, namely first-person perspective taking and an experience of agency. Furthermore, precuneus and surrounding posteromedial areas are amongst the brain structures displaying the highest resting metabolic rates (hot spots) and are characterized by transient decreases in the tonic activity during engagement in non-self-referential goal-directed actions (default mode of brain function). Therefore, it has recently been proposed that precuneus is involved in the interwoven network of the neural correlates of self-consciousness, engaged in self-related mental representations during rest. This hypothesis is consistent with the selective hypometabolism in the posteromedial cortex reported in a wide range of altered conscious states, such as sleep, drug-induced anaesthesia and vegetative states. This review summarizes the current knowledge about the macroscopic and microscopic anatomy of precuneus, together with its wide-spread connectivity with both cortical and subcortical structures, as shown by connectional and neurophysiological findings in non-human primates, and links these notions with the multifaceted spectrum of its behavioural correlates. By means of a critical analysis of precuneus activation patterns in response to different mental tasks, this paper provides a useful conceptual framework for matching the functional imaging findings with the specific role(s) played by this structure in the higher-order cognitive functions in which it has been implicated. Specifically, activation patterns appear to converge with anatomical and connectivity data in providing preliminary evidence for a functional subdivision within the precuneus into an anterior region, involved in self-centred mental imagery strategies, and a posterior region, subserving successful episodic memory retrieval.

4,342 citations

Journal ArticleDOI
TL;DR: When used in concert with authors' deeper knowledge of an experiment, the TD system provides consistent and comprehensive labels for brain activation foci, which is better than that of the expert group.
Abstract: An automated coordinate-based system to retrieve brain labels from the 1988 Talairach Atlas, called the Talairach Daemon (TD), was previously introduced (Lancaster et al., 1997). In the present study, the TD system and its 3-D database of labels for the 1988 Talairach atlas were tested for labeling of functional activation foci. TD system labels were compared with author-designated labels of activation coordinates from over 250 published functional brain-mapping studies and with manual atlas-derived labels from an expert group using a subset of these activation coordinates. Automated labeling by the TD system compared well with authors' labels, with a 70% or greater label match averaged over all locations. Author-label matching improved to greater than 90% within a search range of 65 mm for most sites. An adaptive grey matter (GM) range-search utility was evaluated using individual activations from the M1 mouth region (30 subjects, 52 sites). It provided an 87% label match to Brodmann area labels (B A4&B A 6) within a search range of 65 mm. Using the adaptive GM range search, the TD system's overall match with authors' labels (90%) was better than that of the expert group (80%). When used in concert with authors' deeper knowledge of an experiment, the TD system provides consistent and comprehensive labels for brain activation foci. Additional suggested applications of the TD system include interactive labeling, anatomical grouping of activation foci, lesion-deficit analysis, and neuroanatomy education. Hum. Brain Mapping 10:120 -131, 2000. © 2000 Wiley-Liss, Inc.

3,380 citations


"Brain correlates of craving for onl..." refers methods in this paper

  • ...After using a linear algorithm to convert MNIs to Talairach coordinates (Talairach & Tournoux 1998), Brodmann’s areas of significant brain activations were identified by the Talairach Daemon (Lancaster et al. 2000)....

    [...]

Journal Article
TL;DR: A toolbox called MarsBar is implemented for region of interest analysis within the SPM99 software package, which may have many advantages in terms of statistical power and the ease of interpretation of neuroimaging data.

2,987 citations