Elias Aboujaoude

Assays of oxidative DNA damage biomarkers 8-oxo-2'-deoxyguanosine and 8-oxoguanine in nuclear DNA and biological fluids by high-performance liquid chromatography with electrochemical detection.

High-performance liquid chromatography with electrochemical detection is a highly sensitive and selective method for detecting oxo8dG and oxo8Gua, biomarkers of oxidative DNA damage. When employed together with the DNA isolation and monoclonal antibody-based immunoaffinity purification methods described, oxo8dG and oxo8Gua in DNA and urine can be readily detected and quantitated, offering a powerful approach for assessing oxidative DNA damage in vivo. Application of the technique to the detection of oxo8dG from DNA permits quantitation of the steady-state levels of this oxidatively modified deoxynucleoside and overcomes the detection problems associated with the extremely low levels present in DNA. In addition, the selectivity gained by this detection method eliminates the problem of separating the signal for oxo8dG from those of normal deoxynucleosides. The quantitation of oxo8dG and oxo8Gua in biological fluids is noninvasive and complements the measurement of oxo8dG in DNA by estimating the rate of oxidative DNA damage occurring within the body or in a population of cells. This analytical approach may allow one to estimate oxidative DNA damage in an animal or individual exposed to prooxidant conditions associated with lifestyle, genetic predisposition, degenerative diseases, or environmental toxins. Furthermore, these assays may allow one to assess the potentially beneficial effects of intervention strategies that protect DNA from such damage.

Potential Markers for Problematic Internet Use: A Telephone Survey of 2,513 Adults

OBJECTIVE The Internet has positively altered many aspects of life. However, for a subset of users, the medium may have become a consuming problem that exhibits features of impulse control disorders recognized in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. METHOD This is the first large-scale epidemiological study of problematic Internet use through a random-digit-dial telephone survey of 2,513 adults in the United States. Given the lack of validated criteria, survey questions were extrapolated from established diagnostic criteria for impulse control disorders, obsessive-compulsive disorder, and substance abuse. Four possible diagnostic criteria sets were generated. The least restrictive set required the respondent to report an unsuccessful effort to reduce Internet use or a history of remaining online longer than intended, Internet use interfering with relationships, and a preoccupation with Internet use when offline. RESULTS The response rate was 56.3%. Interviews averaged 11.3 minutes in duration. From 3.7% to 13% of respondents endorsed > or =1 markers consistent with problematic Internet use. The least restrictive proposed diagnostic criteria set yielded a prevalence of problematic Internet use of 0.7%. CONCLUSION Potential markers of problematic Internet use seem present in a sizeable proportion of adults. Future studies should delineate whether problematic Internet use constitutes a pathological behavior that meets criteria for an independent disorder, or represents a symptom of other psychopathologies.

Problematic Internet use: an overview.

There is wide agreement that the Internet can serve as a tool that enhances well-being. It is more difficult, however, to find consensus around the issue of problematic Internet use. That may be in part because scientific investigation has lagged far behind technological advances and media attention. The diagnostic schemas that have been proposed since 1996, and the screening tools that have been developed, stress similarities with substance use, impulse control disorders, and obsessive-compulsive disorder. Prevalence figures vary as a function of the diagnostic definition used, the age group studied, and whether the surveys were conducted online. Studies suggest high comorbidity rates with mood disorders and, among younger individuals, attention-deficit/hyperactivity disorder. Treatment should address any comorbid conditions present, as those may be causing, or exacerbating, problematic Internet use. Interventions that may specifically target problematic Internet use include cognitive behavioral therapy and selective serotonin reuptake inhibitors, but detailed guidelines must await further studies. For a medium that has so radically changed how we conduct our lives, the Internets effects on our psychology remain understudied. More research is needed into the pathophysiology, epidemiology, natural course, and treatment of problematic Internet use. In addition, the more subtle psychological changes, such as disinhibition, that seem to characterize peoples online behavior also deserve attention, even if they cannot be seen as necessarily pathological.

The prevalence of pathologic skin picking in US adults

OBJECTIVE Despite increasing recognition of the potentially severe medical and psychosocial costs of pathologic skin picking (PSP), no large-sample, randomized investigation of its prevalence in a national population has been conducted. METHOD Two thousand five hundred and thirteen US adults were interviewed during the spring and summer of 2004 in a random-sample, national household computer-assisted phone survey of PSP phenomenology and associated functional impairment. Respondents were classified for subsequent analysis according to proposed diagnostic criteria. RESULTS Of all respondents, 16.6% endorsed lifetime PSP with noticeable skin damage; 60.3% of these denied picking secondary to an inflammation or itch from a medical condition. One fifth to one quarter of those with lifetime PSP not related to a medical condition endorsed tension or nervousness before picking, tension or nervousness when attempting to resist picking, and pleasure or relief during or after picking. A total of 1.4% of our entire sample satisfied our criteria of picking with noticeable skin damage not attributable to another condition and with associated distress or psychosocial impairment. Pickers satisfying these latter criteria differed from other respondents in demographics (age, marital status) and both picking phenomenology and frequency.

Telemental health: A status update

A rather large body of literature now exists on the use of telemental health services in the diagnosis and management of various psychiatric conditions. This review aims to provide an up‐to‐date assessment of telemental health, focusing on four main areas: computerized CBT (cCBT), Internet‐based CBT (iCBT), virtual reality exposure therapy (VRET), and mobile therapy (mTherapy). Four scientific databases were searched and, where possible, larger, better‐designed meta‐analyses and controlled trials were highlighted. Taken together, published studies support an expanded role for telepsychiatry tools, with advantages that include increased care access, enhanced efficiency, reduced stigma associated with visiting mental health clinics, and the ability to bypass diagnosis‐specific obstacles to treatment, such as when social anxiety prevents a patient from leaving the house. Of technology‐mediated therapies, cCBT and iCBT possess the most efficacy evidence, with VRET and mTherapy representing promising but less researched options that have grown in parallel with virtual reality and mobile technology advances. Nonetheless, telepsychiatry remains challenging because of the need for specific computer skills, the difficulty in providing patients with a deep understanding or support, concerns about the “therapeutic alliance”, privacy fears, and the well documented problem of patient attrition. Future studies should further test the efficacy, advantages and limitations of technology‐enabled CBT, as well as explore the online delivery of other psychotherapeutic and psychopharmacological modalities.

Pulse-loaded intravenous clomipramine in treatment-resistant obsessive-compulsive disorder.

Introduction: Small studies have suggested that intravenous clomipramine (CMI) may be more effective and induce faster improvement in obsessive-compulsive disorder than do orally administered serotonin reuptake inhibitors. Objective: To test these hypotheses, we conducted a randomized, double-blind, double-dummy study of pulse-loaded intravenous versus oral CMI, followed by open-label oral CMI for 12 weeks. Methods: We enrolled a volunteer and referred group of 34 adults with a primary diagnosis of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition obsessive-compulsive disorder of ≥1-year duration and Yale-Brown Obsessive Scale score of ≥20. Eligible subjects had failed ≥2 adequate serotonin reuptake inhibitor trials. Subjects received pulse loaded CMI 150 mg by vein or by mouth on day 1 and 200 mg on day 2. Oral CMI began on day 6 at 200 mg/d and was increased by 25 mg every 4 days to 250 mg/d, as tolerated, for 12 weeks. Results: Adverse events led to one withdrawal during oral pulse loading and 5 during open-label oral treatment. Intravenous pulse loading did not induce a more rapid or greater Yale-Brown Obsessive Scale score decrease than oral pulse loading at day 6 or by week 12. Day 6 and week 12 improvement were unrelated to plasma drug or metabolite concentrations. Pulse loading itself seemed to induce more rapid and greater improvement than expected in treatment-resistant obsessive-compulsive disorder. Conclusions: Further investigation of oral pulse-loading regimens in treatment-resistant obsessive-compulsive disorder is warranted.

Cyberchondria, cyberbullying, cybersuicide, cybersex: "new" psychopathologies for the 21st century?

The Internet and related technologies permeate our everyday functioning to the extent that it has become difficult to imagine life without them. As their penetrance increases, so does discussion of, and research into, new problematic behaviours and psychopathologies, especially “Internet addiction” and “online gaming addiction”. However, cybertechnology is also reshaping “established” psychiatric disorders and phenomena, leading to symptoms and manifestations that are both familiar and novel, old and new. Of those, this paper will focus on health-related anxiety, bullying or stalking, suicide, and compulsive sexual behaviour. While far from unique, they illustrate the range of psychological functions that have been reconfigured by the digital revolution – and how simplistic a “big umbrella” approach that reduces the discussion to “technology addiction” is. CYBERCHONDRIA Cyberchondria has been defined as an excessive or repeated online searching for health-related information, which is driven by a need to alleviate distress or anxiety surrounding health, but results, instead, in their worsening (1). It is a form of reassurance-seeking behaviour. Rather than obtaining support via online interactions with similarly worried individuals, those with cyberchondria find their anxiety amplified, often because of new pathologies that they discover online and that trigger new worries. Compared with interpersonal reassurance seeking, performing online health searches can be less predictable, as the Internet is not designed to always provide relevant, accurate, non-conflicting and reassuring information (1). Therefore, information obtained online can increase uncertainty about health, perhaps ultimately leading to cyberchondria in individuals who have greater difficulty tolerating uncertainty (2). Moreover, cyberchondria may be related to a difficulty in distinguishing between credible and non-credible sources of online information. This, in turn, may relate to the individuals level of education, information-processing abilities and technological savviness. Cyberchondria has been considered a distinct mental disorder and a multidimensional concept with mistrust of medical professionals as one of its key features (3). But the term has also been used to merely denote seeking health-related information online. The prevailing view is that cyberchondria is part of hypochondriasis/health anxiety (1), but conceptual consensus is still lacking. One reason is the uncertainty about the direction of causality: do high levels of health anxiety lead to excessive online health searches (the more plausible possibility and the one that is closer to hypochondriasis/health anxiety) or does “compulsive” seeking of health information online result in heightened health anxiety? Further research is expected to shed more light on this issue. CYBERBULLYING AND CYBERSTALKING Cyberbullying has been defined as repeated hostile or aggressive behaviour against others, performed by an individual or a group using electronic or digital media and aiming to inflict harm or discomfort (4). This activity can take many different forms, including email, blogs, chat rooms, and text messaging. The various other terms proposed for this behaviour (e.g., “cyber harassment”, “cyber victimization” and “electronic aggression”) attest to its frequency. Cyberstalking, a related phenomenon, involves the repeated use of the Internet, email or other electronic communication medium to stalk another person (5), and it may be accompanied by physical stalking. Cyberbullying diverges in important ways from “traditional” bullying (6). For example, cyberbullying is not based on physical strength, but on technological proficiency or skill, which creates a new dynamic between perpetrator and victim. Also, protection against cyberbullying can be more difficult, because the perpetrator is very often anonymous. Further, the victim is no longer only reachable in the schoolyard or on the school bus, as perpetrators can now strike anywhere and anytime due to the ubiquitous nature of the Internet. Yet another difference is that the harm inflicted and the consequences such as humiliation may be known to a lot more people, because of the ease with which embarrassing information, pictures or other content can be disseminated online. Cyberbullying and cyberstalking may be a manifestation of conduct disorder, antisocial personality disorder, or various other forms of psychopathology. In addition, cyberbullying victims, perpetrators and “bully-victims” (those who “switch” from being a victim to acting as a bully) are all more prone to developing a range of psychiatric disorders and behavioural disturbances, including depression, suicidal thinking and suicide attempts (7–9). CYBERSUICIDE “Cybersuicide” has been used to describe a range of different behaviours and phenomena. A common aspect appears to be online searching for information on suicide methods. Such searches often begin by typing “best suicide methods” or “how to kill yourself” into online search engines (10). This can lead desperate individuals to pro-suicide websites, forums or bulletin boards that promote suicide as a personal choice. There, they can communicate with like-minded individuals about suicide-related issues. Such interactions may “resolve” the ambivalence inherent to suicidal thinking and persuade some that suicide is the “right” option. One potential, and particularly tragic, outcome is a “suicide pact”: an Internet-arranged agreement between two or more persons to commit suicide together at a certain place and time (11). It may be related to a power differential between its participants or to the romanticising of suicide, akin to a pact between lovers who “have” to escape an intolerable reality and an unaccepting society (12). Online suicide pacts are thought to involve socially isolated individuals with strong ambivalence about life (13). While they do not appear to be common, their prevalence seems higher in Japan (12). Another novel manifestation of the age-old suicide problem uses the Internets video-streaming abilities to deliver “webcam suicides”, or the live broadcasting of ones death using an online video service. In some instances, this involves low-lethality self-harm behaviours which may represent cries for help (12). Perhaps unsurprisingly, webcam suicides have been associated with pro-suicide online platforms but also with cyberbullying (14). CYBERSEX Cybersex is a loose term that encompasses a variety of Internet-mediated sexual activities, some of which have been regarded as pathological. Numerous definitions of cybersex have been proposed, including a suggestion that it is a variant of “Internet addiction” (15). Although the purpose of cybersex activities is to experience sexual pleasure, such activities can have an aggressive or illegal component (e.g., when children are involved). Accordingly, cybersex behaviours range from solitary acts to consensual interactions and coercive contacts (16). They can be limited to excessive viewing of pornographic material, typically accompanied by masturbation, or they can involve compulsive cruising of specialized online bulletins with the purpose of arranging offline sexual encounters. “Compulsive cybersex” or “cybersex addiction” has been described as repeated failure to control an urge to engage in sexual activities via the Internet and related technologies. This difficulty is presumed to exist because of an irresistible appeal of short-term sexual pleasure, despite the long-term negative consequences. The latter include relationship breakdown, financial problems if sex workers are involved or costly content is viewed, sexually transmitted diseases, and legal problems due to sexual harassment or sexual exploitation of minors. Whether mediated by cybertechnology or not, “hypersexuality” is a controversial entity that was not included even among the conditions for further study in the DSM-5; in contrast, the architects of the ICD-11 have already announced that there is sufficient evidence to introduce “compulsive sexual behaviour disorder” as a new diagnosis (17). OTHER CYBER-PSYCHOPATHOLOGIES? The aberrant behaviours and psychopathologies discussed above are not the only ones being reshaped online – they have only received the most attention in the literature. For example, pro-eating disorders websites (“pro-ana” and “pro-mia” sites promoting anorexia nervosa and bulimia nervosa, respectively) have well-documented negative effects on individuals with eating disorders (18), and there is even a case report of a Twitter-induced psychotic episode (19). The Internet has also been seen to encourage the emergence or magnification of certain personality traits, including narcissism, regression and impulsivity (20). Indeed, the range of psychological trouble that can result from, or be exacerbated by, our interaction with digital technology appears as vast as the Internet itself. Further research is clearly needed to better delineate those undesirable effects and to identify individuals who may be particularly vulnerable.

Internet addiction: reappraisal of an increasingly inadequate concept.

This article re-examines the popular concept of Internet addiction, discusses the key problems associated with it, and proposes possible alternatives. The concept of Internet addiction is inadequate for several reasons. Addiction may be a correct designation only for the minority of individuals who meet the general criteria for addiction, and it needs to be better demarcated from various patterns of excessive or abnormal use. Addiction to the Internet as a medium does not exist, although the Internet as a medium may play an important role in making some behaviors addictive. The Internet can no longer be separated from other potentially overused media, such as text messaging and gaming platforms. Internet addiction is conceptually too heterogeneous because it pertains to a variety of very different behaviors. Internet addiction should be replaced by terms that refer to the specific behaviors (eg, gaming, gambling, or sexual activity), regardless of whether these are performed online or offline.

Compulsive buying disorder: a review and update.

Compulsive buying disorder (CBD) refers to the chronic purchasing of unneeded or unwanted items, causing significant negative consequences. There are no established criteria for CBD, and operational definitions have relied on similarities with OCD, substance use disorders, and impulse control disorders. Compulsive buying disorder is common, affecting 5.8% of the general population, according to one study. Typically, CBD has early onset, frequent comorbidities, and a chronic course. The etiology of CBD is unknown, with biological, psychological and sociocultural factors proposed as likely contributors. Treatment data are limited and suggest addressing comorbid conditions and considering cognitive behavioral therapy, financial and family counseling, selective serotonin reuptake inhibitors, and naltrexone, among other possible interventions, to target CBD. Beyond treatment, educational, legislative and family-based public policy initiatives can likely help individuals with CBD and other excessive spenders.

The Bergen Shopping Addiction Scale: Reliability and validity of a brief screening test

Although excessive and compulsive shopping has been increasingly placed within the behavioral addiction paradigm in recent years, items in existing screens arguably do not assess the core criteria and components of addiction. To date, assessment screens for shopping disorders have primarily been rooted within the impulse-control or obsessive-compulsive disorder paradigms. Furthermore, existing screens use the terms ‘shopping,’ ‘buying,’ and ‘spending’ interchangeably, and do not necessarily reflect contemporary shopping habits. Consequently, a new screening tool for assessing shopping addiction was developed. Initially, 28 items, four for each of seven addiction criteria (salience, mood modification, conflict, tolerance, withdrawal, relapse, and problems), were constructed. These items and validated scales (i.e., Compulsive Buying Measurement Scale, Mini-International Personality Item Pool, Hospital Anxiety and Depression Scale, Rosenberg Self-Esteem Scale) were then administered to 23,537 participants (Mage = 35.8 years, SDage = 13.3). The highest loading item from each set of four pooled items reflecting the seven addiction criteria were retained in the final scale, The Bergen Shopping Addiction Scale (BSAS). The factor structure of the BSAS was good (RMSEA = 0.064, CFI = 0.983, TLI = 0.973) and coefficient alpha was 0.87. The scores on the BSAS converged with scores on the Compulsive Buying Measurement Scale (CBMS; 0.80), and were positively correlated with extroversion and neuroticism, and negatively with conscientiousness, agreeableness, and intellect/imagination. The scores of the BSAS were positively associated with anxiety, depression, and low self-esteem and inversely related to age. Females scored higher than males on the BSAS. The BSAS is the first scale to fully embed shopping addiction within an addiction paradigm. A recommended cutoff score for the new scale and future research directions are discussed.