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Diagnostic and Statistical Manual (Fifth Edition): Caffeine Use Disorder & Internet Gaming Disorder
- 1. DSM 5: Conditions for further study Lavanya, Lehar, Natasha, Shruti, Rupali
- 2. DSM V 2013 update to APA’s Classification and Diagnostic tool. Published on May 18, 2013, superseding the DSM-IV-TR, published in 2000. Three Sections – o Section I: Describes chapter organization, change from the multiaxial system, and Section III's dimensional assessments o Section II: Covers the diagostic categories o Section III: Conditions that need additional research, a glossary of terms, and other important information
- 3. DSM V Major Changes – o No more Multiaxial Assessment System o Restructured Order of Chapters o New Diagnoses o Revised Diagnoses o Conditions for Further Study
- 4. Conditions for Further Study Proposed criteria sets for conditions on which research encouraged Set by expert consensus Intended to provide a common language for researchers and clinicians Not intended for clinical use Following conditions were included – o Attenuated Psychosis Syndrome o Depressive Episodes With Short- Duration Hypomania o Persistent Complex Bereavement Disorder o Caffeine Use Disorder o Internet Gaming Disorder o Neurobehavioral Disorder Associated With Prenatal Alcohol Exposure o Suicidal Behavior Disorder o Nonsuicidal Self-Injury
- 5. Caffeine Use Disorder Caffeine – World’s most widely used psychoactive substance Present in tea, coffee, cocoa beverages, chocolate bars, soft drinks Stimulant Legal and Unregulated Adults – Coffee Children – Soft Drinks Mood altering effects depend on the amount consumed and whether individual physically dependent or tolerant People continue to use caffeine despite medical or psychological problems to avoid withdrawal symptoms
- 6. Caffeine Use Disorder Withdrawal symptoms – o Headache o Irritability o Inability to concentrate o Drowsiness o Insomnia o Pain in the stomach, upper body, joints These may appear within 12-24 hours after discontinuation Usually last from 1-5 days
- 7. Prevelance Rate Hughes and colleague(1998) - This study found that 30% of 162 current caffeine users fulfilled the DSM IV diagnosis for Substance Dependence. Burgalassi et al. (2009) - Interviewed 58 female patients with eating disorders, 16 % of these patients met the DSM IV criteria for Substance Dependence applied to caffeine.
- 8. Comorbidity Mood disorders and other substance abuses coexist with caffeine disorders. Some studies report 50% comorbidity. Lucas et al (1990) - Tested patients with chronic schizophrenia with 10 mg/kg, which led to increased psychosis, thought disorder, unusual thought content, and euphoria- activation. In these patients, anxiety was not increased by caffeine, which may be particular to patients with schizophrenia, but may also be related to concurrent treatment with antipsychotics.
- 9. Biological Factors Genetic Factors Inducer of anxiety at higher doses (Green & Suls, 1996) Axiogenic effect influenced by individual factors Individuals with the 1976T/T genotypes for A2A adenosine receptors reported greater increases in anxiety after caffeine administration than the other genotypic groups (Alsene et al., 2003) This genotype associated with less caffeine intake (Comelis, 2007) In Western Population (Hamilton et al., 2004), but not Asians (Yamada et al., 2001)
- 10. Biological Factors Twin studies - heritability of caffeine- related traits range between 0.36 and 0.58 (Yang et al., 2010) Twin resemblance for caffeine consumption, use, intoxication, tolerance and withdrawal ascribed solely to genetic factors, with estimated broad heritabilities of between 35% and 77%. (Kendler & Prescott, 1999) The magnitude of heritability for caffeine dependence markers is similar to those for nicotine and alcohol (Kendler et al., 2008) Women with a lifetime diagnosis of caffeine dependence and a family history of alcoholism had higher levels of caffeine use and lower rates of abstinence throughout pregnancy (Svikis et al., 2005)
- 11. Biological Factors Neurotransmitters Caffeine acts as an antagonist Stimulates dopaminergic activity Paraxanthine and its effects
- 12. Psychological Factors Behavioral Factors Subjective Effects Reinforcement Conditioned Taste Preference Withdrawal Tolerance
- 13. Treatment No defined treatment option. Some researchers (Juliano et al., 2012) believe the disorder should have similar treatment approaches in the future as those people who seek treatment for substance use disorders. Switching types of drink or choosing decaffeinated drinks. Twelve-step program medical treatment for exacerbated physical issues like insomnia, hypertension etc. Juliano and colleagues reported that 47% of 258 individuals seeking treatment for caffeine use were interested in one-on- one counseling, 12% were interested in group counseling, 25% were interested in a self-help booklet, and 4% were interested in phone-based assistance.
- 14. Indian Context Not much research done in the Indian context Sharma & Poornima (2015) conducted a study on the pattern of caffeine use among teenagers in Bangalore. Findings : o Dairy Milk chocolate most frequently consumed o Espresso least frequently consumed o 54.5% expressed a strong desire to consume caffeinated products o Withdrawal symptoms, functional impairment, and craving were cited as reasons they failed to eliminate or cut back on caffeine use.
- 15. Indian Context o It includes disturbing social functioning (5.7%), family functioning (7.5%), and academic performance (7.5%). o 6.6% had a life time abstinence from caffeine products, which includes tea (4.7%), coffee, chocolate and energy drinks (18%). o They attributed its maintenance of use to personal reasons and stress (64.3%), interpersonal disturbance (30.2%), and media (7.5%). o 14.6% also had the history of use of other substances like tobacco and alcohol.
- 16. Internet Gaming Disorder Condition for Further Study in the DSM-5 (APA 2013) Persistent and recurrent use of the Internet to engage in games, often with other players, leading to clinically significant impairment or distress
- 17. Diagnostic Criteria Preoccupation with such games Withdrawal symptoms of irritability, anxiety, or sadness Development of tolerance Unsuccessful attempts to control the behavior Loss of interest in other activities Continued excessive use despite knowledge of psychosocial problems Deceiving others regarding the amount of time spent gaming Use of this behavior to escape or relieve a negative mood Jeopardizing/losing a significant relationship/job/educational opportunity
- 18. Diagnostic Criteria For a diagnosis of IGD, the DSM-5 requires at least five of the nine criteria for IGD. In contrast, it requires only two criteria for a diagnosis of substance use disorder. Internet-based gambling is not included in the diagnostic criteria IGD and casual gaming
- 19. Researc her Year Location Sample Age Prevalan ce rate ( % ) Gender Ratio Kim et al. 2006 South Korea 1573 students 15-16 1.6 F = M 1 : 1 Cao and Su 2007 China 2620 students 12-18 2.4 M > F 5 : 1 Siomos et al. 2008 Greece 2200 students 12 – 18 8.2 M > F 3 : 1 Bakken et al. 2009 Norway 3399 adults 16 – 74 1.0 M > F 2 : 1 Thomas and Martin 2010 Australi a 1326 students 15 – 54 4.6 M > F 1.5 : 1 Table showing prevalence rate and gender differences in IGD
- 20. More prevalent in Asian countries than in North America and Europe. (APA, 2013 ; Ramos et al , 2014) Table showing prevalence rate and gender differences in IGD
- 21. Comorbidity A systematic review identified 20 studies. Of all studies, 75% reported significant correlations of problematic internet use with Depression, 57% with Anxiety, 100% of the studies with symptoms of ADHD, 60% with OCD symptopms, 66% with hostility or aggression. No associations with social phobia. Asociations higher among males (Carli et al, 2013 ) IGD Depression OCD ADHD Anxiety Hostility
- 22. Biological Factors Cue-induced reactivity over the parahippocampus, anterior cingulate, precuneus, and DLPFC Higher brain activation when processing response inhibition over the left orbital frontal lobe and bilateral caudate nucleus. Additionally, activation over the right insula in response to error processing was lower in the IGD group than in the control group.(Ko et al. , 2009)
- 23. Biological Factors Impaired functional connectivity in the subcortical region (Hong et al., 2013) Increased regional homogenity over the cerebellum
- 24. Psychological Factors Cognitive-behavioural models - Davis (2001): Problematic cognitions + behaviours that intensify / maintain maladaptive responses = pathological internet use. Maladaptive cognitions Thoughts about self Thoughts about world
- 25. Psychological Factors Caplan (2010) Cognitive features Preference for online social interaction (POSI) Preoccupation
- 26. Psychological Factors Achievement, reputation and admiration from the gaming community. Escapism Modeling
- 27. Treatment Cognitive Behavior Therapy (CBT) Self-Help Programs Family Counseling and Psychological Education Therapies Following Approved Medications is recommended: Antidepressants, Anxiolytics, Mood Stabilizers, and Naltrexone.
- 28. Indian Context Goel et al (2013) conducted a study on the prevalence of internet addiction and its association with psychopathology in indian adolescents. 987 students of various faculties across the city of Mumbai were assessed with a specially constructed semi- structured performa and The Internet Addiction Test (IAT ; Young, 1998). Dukes Health Profile was used to study physical and psychosocial quality of life of students. Findings : of the total, 74.5% were moderate users. 0.7% were found to be addicts. Those with excessive use internet had high scores on anxiety and depression