Abstract
To the Editor
Concern remains as to the pathological effects of excessive computer and internet usage on individuals (Czincz and Hechanova, 2009). It has been reported that internet-addicted people may suffer from various psychiatric disorders (Ha et al., 2006), that heavier internet use is associated with more psychiatric symptoms (Engelberg and Sjöberg, 2004; Jang et al., 2008) and that internet addiction can develop particularly in males who have access to a home portal and use the internet for socialising and games (Tsitsika et al., 2009). These cases are presented to highlight the possibility that, in certain individuals, heavy computer and internet usage may come to be considered a risk factor for schizophrenia.
Mr AB is a 22 year old university student who presented in a psychotic state with no apparent precipitant. His school marks placed him in the top percentile of his state. There was no family history of mental illness, no illicit drug use and no head injury. He is a heavy computer user: greater than eight hours daily, since the age of seven. Over three hours daily was spent gaming. His psychosis is characterised by a delusional system in which he is under constant threat of death and is protected by a highly-trained, militant hero. This is not unlike the computer games he has played. Delusions persist despite adequate trials of four antipsychotic medications including clozapine.
Mr CD is a 20 year old dentistry student who presented with psychosis. He was the dux of his school. There was no family history of mental illness, no illicit drug use and no head injury. He relies heavily on his computer for study, socialising and entertainment having spent over twelve hours daily on the computer for over seven years. His parents reported a one year prodrome characterised by increased social withdrawal in addition to his usual computer use. His illness is characterised by persecutory delusions and bizarre behaviour. He lacks insight into his situation despite a partial response to clozapine.
Mr EF, a 24 year old intelligent male, spent more than ten hours a day for over ten years on the internet playing games in which he is ‘under attack’. His delusional system is characterised by being under attack by alien forces. His psychosis has not resolved despite numerous medication trials. In his case, however, there is a clear history of substance abuse.
These males, all in their early to mid twenties, are intelligent and suffer psychosis characterised predominantly by delusions and treatment resistance. On report, none of these males reached criteria for a premorbid personality disorder but this cannot be excluded. At present there is no evidence to suggest that heavy computer and internet use can lead to psychosis and no disease paradigm exists to propose a mechanism for such an association. The reporting of case studies over time may, however, suggest whether further investigation into this question is warranted or if this report presents a chance finding.