Daniele Fabio Zullino

French Validation of the Internet Addiction Test

The main goal of the present study is to investigate the psychometric properties of a French version of the Internet Addiction Test (IAT) and to assess its relationship with both time spent on Internet and online gaming. The French version of the Youngs Internet Addiction Test (IAT) was administered to a sample of 246 adults. Exploratory and confirmatory analyses were carried out. We discovered that a one-factor model of the IAT has good psychometric properties and fits the data well, which is not the case of a six-factor model as found in previous studies using exploratory methods. Correlation analysis revealed positive significant relationships between IAT scores and both the daily duration of Internet use and the fact of being an online player. In addition, younger people scored higher on the IAT. The one-factor model found in this study has to be replicated in other IAT language versions.

Why do you play World of Warcraft? An in-depth exploration of self-reported motivations to play online and in-game behaviours in the virtual world of Azeroth

Massively multiplayer online role-playing games (MMORPGs) are video games in which players create an avatar that evolves and interacts with other avatars in a persistent virtual world. Motivations to play MMORPGs are heterogeneous (e.g. achievement, socialisation, immersion in virtual worlds). This study investigates in detail the relationships between self-reported motives and actual in-game behaviours. We recruited a sample of 690 World of Warcraft players (the most popular MMORPG) who agreed to have their avatar monitored for 8months. Participants completed an initial online survey about their motives to play. Their actual in-game behaviours were measured through the games official database (the Armory website). Results showed specific associations between motives and in-game behaviours. Moreover, longitudinal analyses revealed that teamwork- and competition-oriented motives are the most accurate predictors of fast progression in the game. In addition, although specific associations exist between problematic use and certain motives (e.g. advancement, escapism), longitudinal analyses showed that high involvement in the game is not necessarily associated with a negative impact upon daily living.

Psychological predictors of problematic involvement in massively multiplayer online role-playing games: illustration in a sample of male cybercafé players

Background: Massively Multiplayer Online Role-Playing Games (MMORPGs) are video games in which a large number of players interact with one another in a persistent virtual world. MMORPGs can become problematic and result in negative outcomes in daily living (e.g. loss of control on gaming behaviors, compromised social and individual quality of life). The aim of the present study is to investigate psychological predictors of problematic involvement in MMORPGs. Sampling and Methods: Fifty-four males who played MMORPGs regularly were recruited in cybercafés and screened using the UPPS Impulsive Behavior Scale (which assesses 4 facets of impulsivity) and the Motivation to Play Online Questionnaire (which assesses personal motives to play online). Negative consequences due to excessive time spent on the Internet were assessed with the Internet Addiction Test. Results: Multiple regression analysis showed that problematic use of MMORPGs is significantly predicted by: (1) high urgency (b = 0.45), and (2) a motivation to play for immersion (b = 0.35). Conclusion: This study showed that, for certain individuals (who are characterized by a proneness to act rashly in emotional contexts and motivated to play to be immersed in a virtual world), involvement in MMORPGs can become problematic and engender tangible negative consequences in daily life.

Prevalence of pathological gambling in Switzerland after the opening of casinos and the introduction of new preventive legislation

Objective: This survey aimed to evaluate the prevalence of pathological gambling (PG) in the Swiss population in 2005 and the link between PG and alcohol abuse. This replication study made it possible to compare the prevalence rates of PG measured before and after the introduction of casinos and new preventive legislation.

Enantiomers’ potential in psychopharmacology—a critical analysis with special emphasis on the antidepressant escitalopram

Stereochemistry is now influencing most areas of pharmacotherapy, with a growing awareness in the field of psychiatry and, more specifically, depression. This is due to the fact that the enantiomers of many chiral drugs may have distinct pharmacological, pharmacokinetic and/or pharmacogenetic profiles. Consequently, in some instances there may be an advantage in using a single enantiomer over the racemic form-thus providing a basis for the development of new therapeutic agents, as well as the potential to improve current treatments. This review highlights some of the potential advantages and disadvantages that using single enantiomers might offer. The principles are exemplified through reference to the stereoselective properties of several established chiral psychotropic drugs, including thioridazine, methadone, trimipramine, mianserin, mirtazapine, fluoxetine and citalopram. Emphasis is given to the treatment of depression and how the potential of one pure enantiomer-escitalopram, the S-enantiomer of the selective serotonin reuptake inhibitor citalopram-appears to be fulfilling its preclinical promise in the clinic.

Motivations to Play Specifically Predict Excessive Involvement in Massively Multiplayer Online Role-Playing Games: Evidence from an Online Survey

Background: Several studies have linked massively multiplayer online role-playing games (MMORPGs) with possible problematic usage or internet addiction. Aims: The main goal of the present study was to assess links between motivations to play in MMORPGs and addictive involvement in such types of games. Methods: A total of 696 gamers responded to an online survey. Results and Conclusion: Five distinct motivations to play were identified in gamers: achievement, socializing, immersion, relaxing and escaping. Multiple regression analysis revealed that addictive MMORPG use patterns are predicted by achievement, escapism and socializing motives. Gender was also a significant predictor of problematic involvement in MMORPGs. Moreover, addictive MMORPG use positively correlated with the weekly time devoted to playing MMORPGs.

Internet use by patients with psychiatric disorders in search for general and medical informations.

Background Internet is commonly used by the general population, notably for health information-seeking. There has been little research into its use by patients treated for a psychiatric disorder. Aim To evaluate the use of internet by patients with psychiatric disorders in searching for general and medical information. Methods In 2007, 319 patients followed in a university hospital psychiatric out-patient clinic, completed a 28-items self-administered questionnaire. Results Two hundred patients surveyed were internet users. Most of them (68.5%) used internet in order to find health-related information. Only a small part of the patients knew and used criteria reflecting the quality of contents of the websites consulted. Knowledge of English and private Internet access were the factors significantly associated with the search of information on health on Internet. Conclusions Internet is currently used by patients treated for psychiatric disorders, especially for medical seeking information.

Does Self-Selection Affect Samples’ Representativeness in Online Surveys? An Investigation in Online Video Game Research

Background The number of medical studies performed through online surveys has increased dramatically in recent years. Despite their numerous advantages (eg, sample size, facilitated access to individuals presenting stigmatizing issues), selection bias may exist in online surveys. However, evidence on the representativeness of self-selected samples in online studies is patchy. Objective Our objective was to explore the representativeness of a self-selected sample of online gamers using online players’ virtual characters (avatars). Methods All avatars belonged to individuals playing World of Warcraft (WoW), currently the most widely used online game. Avatars’ characteristics were defined using various games’ scores, reported on the WoW’s official website, and two self-selected samples from previous studies were compared with a randomly selected sample of avatars. Results We used scores linked to 1240 avatars (762 from the self-selected samples and 478 from the random sample). The two self-selected samples of avatars had higher scores on most of the assessed variables (except for guild membership and exploration). Furthermore, some guilds were overrepresented in the self-selected samples. Conclusions Our results suggest that more proficient players or players more involved in the game may be more likely to participate in online surveys. Caution is needed in the interpretation of studies based on online surveys that used a self-selection recruitment procedure. Epidemiological evidence on the reduced representativeness of sample of online surveys is warranted.

Brief DISCERN, six questions for the evaluation of evidence-based content of health-related websites.

OBJECTIVE To extract and to validate a brief version of the DISCERN which could identify mental health-related websites with good content quality. METHOD The present study is based on the analysis of data issued from six previous studies which used DISCERN and a standardized tool for the evaluation of content quality (evidence-based health information) of 388 mental health-related websites. After extracting the Brief DISCERN, several psychometric properties (content validity through a Factor analysis, internal consistency by the Cronbachs alpha index, predictive validity through the diagnostic tests, concurrent validity by the strength of association between the Brief DISCERN and the original DISCERN scores) were investigated to ascertain its general applicability. RESULTS A Brief DISCERN composed of two factors and six items was extracted from the original 16 items version of the DISCERN. Cronbachs alpha coefficients were more than acceptable for the complete questionnaire (alpha=0.74) and for the two distinct domains: treatments information (alpha=0.87) and reliability (alpha=0.83). Sensibility and specificity of the Brief DISCERN cut-off score > or =16 in the detection of good content quality websites were 0.357 and 0.945, respectively. Its predictive positive and negative values were 0.98 and 0.83, respectively. A statistically significant linear correlation was found between the total scores of the Brief DISCERN and those of the original DISCERN (r=0.84 and p<0.0005). CONCLUSION The Brief DISCERN seems to be a reliable and valid instrument able to discriminate between websites with good and poor content quality. PRACTICE IMPLICATIONS The Brief DISCERN is a simple tool which could facilitate the identification of good information on the web by patients and general consumers.

Carbamazepine augmentation in depressive patients non-responding to citalopram: a pharmacokinetic and clinical pilot study

Citalopram is a chiral antidepressant drug. Its eutomer, S-citalopram (escitalopram), has recently been introduced as an antidepressant. In an open pilot study, four outpatients and two inpatients with a major depressive episode (ICD-10), and who were nonresponders to a 4-week pretreatment with 40-60 mg/day citalopram, were comedicated for another 4-week period with carbamazepine (200-400 mg/day). Some of the patients suffered also from comorbidities: Phobic anxiety disorder with panic attacks (n=2), generalised anxiety disorder, alcohol abuse, dependent personality disorder, hypertension (n=1). After a 4-week augmentation therapy with carbamazepine, a significant (P<0.03) decrease of the plasma concentrations of S-citalopram and R-citalopram, by 27 and 31%, respectively, was observed. Apparently, the probable induction of CYP3A4 by carbamazepine results in a nonstereoselective increase in N-demethylation of citalopram. Moreover, there was a significant (P<0.03) decrease of the ratio S/R-citalopram propionic acid derivative, the formation of it being partly regulated by MAO-A and MAO-B. Already, within 1 week after addition of carbamazepine, there was a slight but significant (P<0.03) decrease of the MADRS depression scores, from 27.0+/-7.7 (mean+/-S.D.) to 23.3+/-6.6, and the final score on day 56 was 18.8+/-10.9. The treatment was generally well tolerated. There was no evidence of occurrence of a serotonin syndrome. After augmentation with carbamazepine, treatment related adverse events were: Nausea in one case, diarrhea in one case, and rash in two cases. In conclusion, the results of this pilot study suggest that carbamazepine augmentation of a citalopram treatment in previous nonresponders to citalopram may be clinically useful, but that in addition carbamazepine can lead to a decrease of the plasma concentrations of the active enantiomer escitalopram.