M. Van Ameringen

Obsessive-compulsive disorder in the elderly: A report from the International College of Obsessive-Compulsive Spectrum Disorders (ICOCS)

INTRODUCTION Obsessive-compulsive disorder (OCD) is a highly disabling condition, with frequent early onset. Adult/adolescent OCD has been extensively investigated, but little is known about prevalence and clinical characterization of geriatric patients with OCD (G-OCD≥65years). The present study aimed to assess prevalence of G-OCD and associated socio-demographic and clinical correlates in a large international sample. METHODS Data from 416 outpatients, participating in the ICOCS network, were assessed and categorized into 2 groups, age<vs≥65years, and then divided on the basis of the median age of the sample (age<vs≥42years). Socio-demographic and clinical variables were compared between groups (Pearson Chi-squared and t tests). RESULTS G-OCD compared with younger patients represented a significant minority of the sample (6% vs 94%, P<.001), showing a significantly later age at onset (29.4±15.1 vs 18.7±9.2years, P<.001), a more frequent adult onset (75% vs 41.1%, P<.001) and a less frequent use of cognitive-behavioural therapy (CBT) (20.8% vs 41.8%, P<.05). Female gender was more represented in G-OCD patients, though not at a statistically significant level (75% vs 56.4%, P=.07). When the whole sample was divided on the basis of the median age, previous results were confirmed for older patients, including a significantly higher presence of women (52.1% vs 63.1%, P<.05). CONCLUSIONS G-OCD compared with younger patients represented a small minority of the sample and showed later age at onset, more frequent adult onset and lower CBT use. Age at onset may influence course and overall management of OCD, with additional investigation needed.

Manifesto for a European research network into Problematic Usage of the Internet

The Internet is now all-pervasive across much of the globe. While it has positive uses (e.g. prompt access to information, rapid news dissemination), many individuals develop Problematic Use of the Internet (PUI), an umbrella term incorporating a range of repetitive impairing behaviours. The Internet can act as a conduit for, and may contribute to, functionally impairing behaviours including excessive and compulsive video gaming, compulsive sexual behaviour, buying, gambling, streaming or social networks use. There is growing public and National health authority concern about the health and societal costs of PUI across the lifespan. Gaming Disorder is being considered for inclusion as a mental disorder in diagnostic classification systems, and was listed in the ICD-11 version released for consideration by Member States (http://www.who.int/classifications/icd/revision/timeline/en/). More research is needed into disorder definitions, validation of clinical tools, prevalence, clinical parameters, brain-based biology, socio-health-economic impact, and empirically validated intervention and policy approaches. Potential cultural differences in the magnitudes and natures of types and patterns of PUI need to be better understood, to inform optimal health policy and service development. To this end, the EU under Horizon 2020 has launched a new four-year European Cooperation in Science and Technology (COST) Action Programme (CA 16207), bringing together scientists and clinicians from across the fields of impulsive, compulsive, and addictive disorders, to advance networked interdisciplinary research into PUI across Europe and beyond, ultimately seeking to inform regulatory policies and clinical practice. This paper describes nine critical and achievable research priorities identified by the Network, needed in order to advance understanding of PUI, with a view towards identifying vulnerable individuals for early intervention. The network shall enable collaborative research networks, shared multinational databases, multicentre studies and joint publications.

INTERNET ADDICTION OR PSYCHOPATHOLOGY IN DISGUISE? RESULTS FROM A SURVEY OF COLLEGE-AGED INTERNET USERS

Purpose Internet addiction, is a term describing pathological, compulsive internet use and has an estimated prevalence of 6% among the general population and higher in students[1]. Extreme internet use may have significant public health importance as it has been attributed to several cardio-pulmonary deaths and at least one murder. While the pathological use of alcohol or drugs has been historically accepted as an addiction, questions remain concerning whether extreme internet use should be conceptualized as an addiction. The Internet Addiction Test (IAT) was developed in 1998, prior to the wide-spread use of Smartphone and other mobile devices, to detect internet addiction [2]. It is unclear whether this instrument is capable of capturing problematic modern internet use. The purpose of this study was to examine the construct of “internet addiction” in a sample of college aged internet users. Method A survey was administered to first year undergraduate students at McMaster University and posted to our centre website www.macanxiety.com . Following acknowledgment of a disclosure statement, participants completed several self-report scales detailing internet usage, symptoms of depression and anxiety, impulsiveness and executive functioning. Measures included: a short demographics questionnaire as well as a survey containing the IAT, sections from the Mini International Neuropsychiatric Interview for OCD, GAD, SAD, the Barkley Adult ADHD Rating Scale, the Barratt Impulsiveness Scale, the Depression, Anxiety and Stress Scale (DASS-21), the Barkley Deficits in Executive Functioning Scale (BDEFS) and the Sheehan Disability Scale (SDS). Individuals were also asked to complete the Dimensions of Problematic Internet Use (DPIU); a scale based on DSM-5 addiction criteria. Once the survey was complete, respondents were informed of their score and interpretation on the IAT. Results Two hundred and fifty-four participants completed all assessments. They had a mean age of 18.5±1.6 years and 74.5% were female. In total 12.5% (n = 33) met screening criteria for internet addition according to the IAT, while 107 (42%) met addiction criteria according to the DPIU. The most frequently reported dimensions of internet use where respondents had difficulty controlling their use were: video streaming services (55.8%), social networking (47.9%) and instant messaging tools (28.5%). Those screening positive on the IAT and on the DPIU had significantly higher levels of functional impairment (p  Conclusion A high proportion of the sample met criteria for internet addiction. Participants meeting criteria for internet addiction had greater levels of psychopathology and functional impairment. With the exception of instant messaging tools, none of the dimensions of internet use differed between individuals who did and did not meet internet addiction criteria on the IAT. This study highlights that problematic internet use may be more widespread than once thought. Further studies are needed to understand the relationship between problematic internet use and psychopathology.