Review Article

Psychopathology 2023;56:315–323 Received: March 29, 2022

Accepted: September 16, 2022
DOI: 10.1159/000527143 Published online: November 1, 2022

Gaming Disorder and Psychotic

Disorders: A Scoping Review
Maxime Huot-Lavoie a, b, c Mina Gabriel-Courval a, b Laurent Béchard b, c, d
Olivier Corbeil b, c, d Sébastien Brodeur e Charles Massé a, b Émilien Fournier b, d

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Anne Marie Essiambre f Elizabeth Anderson f Audrey Cayouette f
Isabelle Giroux f, g Yasser Khazaal h Marie-France Demers b, c, d
Marc-André Roy c, e
aFaculté de Médecine, Université Laval, Québec City, Québec, QC, Canada; bInstitut Universitaire en Santé Mentale
de Québec, Centre Intégré Universitaire de Santé et de Services Sociaux de La Capitale-Nationale Québec, Québec,
QC, Canada; cCERVO Research Center, Québec, QC, Canada; dFaculty of Pharmacy, Université Laval, Québec, QC,
Canada; eDepartment of Psychiatry et Neurosciences, Faculté de Médecine, Université Laval, Québec, QC, Canada;
fÉcole de Psychologie, Université Laval, Québec, QC, Canada; gCentre québécois d’excellence pour la prévention

et le traitement du jeu (CQEPTJ), Québec, QC, Canada; hAddiction Medicine, Department of Psychiatry, Lausanne
University Hospitals, Lausanne, Switzerland

Keywords gaps in this field. Methods: We used Levac’s six-stage meth-

Internet gaming disorder · Gaming disorder · Gaming · odology for scoping review. Two-hundred and forty-two ar-
Video games · Psychotic disorder · Schizophrenia · ticles from seven databases were identified. Eight articles re-
Psychosis spected our inclusion and exclusion criteria. Results: No
available study has assessed the prevalence or incidence of
GD among patients with PDs. The cases reported highlight
Abstract the possibility that excessive video gameplay or abrupt gam-
Background: There is a growing interest in understanding ing disruption could trigger psychosis in some patients.
the impact of video games in the clinical field, given that Conclusion: The results highlight a significant lack of knowl-
their excessive use could be associated with health issues. edge concerning PDs associated with GD as only a few re-
Particularly, gaming disorder (GD) is considered as an addic- ported cases and one empirical study exposed the potential
tive behavioral disorder. Clinicians widely recognize the co- association between those conditions.
morbidity of gaming and psychotic disorders (PDs). Further- © 2022 S. Karger AG, Basel
more, association between addictive (i.e., substance use dis-
orders) and PDs are well recognized by clinicians. It seems of
high interest to explore GD among people with PDs. To this Introduction
day, little is known about the consequences of GD in vulner-
able populations. Objectives: The aim of this scoping re- There is a growing interest in understanding the im-
view was to summarize the available research on the comor- pact of video games on mental health as their excessive
bidity between GD and PD and to identify the knowledge use is associated with health problems and severe addic-

[email protected] © 2022 S. Karger AG, Basel Correspondence to:

www.karger.com/psp Maxime Huot-Lavoie, maxime.huot-lavoie.1 @ ulaval.ca
tion [1, 2]. The estimated global prevalence of gaming ad- IGD, Internet addiction disorder, problematic Internet
diction has been reported to be 3.05% [3]. However, a use, Internet use disorder, and cyberdependance are mis-
recent literature review presented substantial variability used to describe GD. We consider all those terms in our
ranging from 0.21% to 57.5% in the general population search strategy to be as exhaustive as possible. However,
and from 3.2% to 91% in various clinical populations [4]. as this scoping review is centered on GD, we will refer to
This significant variability results from differences re- this term to ensure uniformity; however, some studies
garding the demographic characteristics of the studied cited here did not make the difference between those con-
populations as it is well known that the prevalence of cepts.
gaming-related problems is higher in the young male Even if the recognition of this diagnosis is fairly recent,
population [3–5] and from broad differences concerning GD was found to be related to multiple conditions like
the definition of gaming addiction in the scientific com- attention-deficit/hyperactivity disorder, depression, anx-
munity. iety, social phobia, impaired interpersonal relationships,
For many years, Internet addiction and gaming addic- academic difficulties, and suicidal ideation, although the
tion were considered as undifferentiated conditions. direction of the causality is uncertain in some instances
Since then, many authors supported the idea that patients [15–25]. Since research on GD has mainly focused on

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with so-called Internet addiction used the Internet as a children and adolescents thus far, it is difficult to extrap-
vehicle for more specific addictions rather than being ad- olate these results to the adult population. Furthermore,
dicted to the Internet itself [6–8]. In a study published little is known about the prevalence of GD and its conse-
before the recognition of gaming disorder (GD) in the quences in vulnerable groups, such as patients suffering
fifth revision of the Diagnostic and Statistical Manual of from a psychotic disorder (PD).
Mental Disorders (DSM-5) as “Conditions for Further PDs are characterized by abnormalities in one or more
Study,” Kim and Kim [9] claimed that “Internet users are of the following five domains: delusions, hallucinations,
no more addicted to the Internet than alcoholics are ad- disorganized thinking, abnormal motor behavior, and
dicted to bottles.” This view was also supported by EEG negative symptoms. These conditions include several
studies, suggesting that gaming addiction results from subtypes that share similar psychopathologies and are
distinct neurophysiological consequences than other considered here as one entity [26]. Some characteristics
possible Internet addictions (e.g., online gambling and of patients with PDs, particularly those with a first-epi-
pornography) [6, 10]. Also, poor impulse control and sode psychosis (FEP), may suggest that these individuals
high anxiety both seem to specifically predispose specifi- would be particularly liable to develop a GD. Indeed, both
cally to excessive gaming habits [11–13]. conditions mainly present themselves in adolescence and
As a first step to differentiate gaming addiction from young adulthood and are more frequent in the male pop-
other forms of excessive Internet use, Internet GD (IGD) ulation. Furthermore, both PD and GD have been associ-
was introduced in 2013 in the DSM-5 as a condition re- ated with substance use, social isolation, social anxiety
quiring further studies. The term IGD unfortunately disorders [27, 28]. Also, we can speculate that the FEP
failed to fully clarify the ambiguities as this term would population is at greater risk for GD due to pharmacolog-
suggest that only Internet gaming should be taken into ical treatment. Indeed, recent results have suggested that
account, whereas excessive gaming may include offline partial dopamine agonist antipsychotics may increase the
gaming as well. Gaming addiction was finally recognized risk of developing a gambling addiction [29, 30], a condi-
as an official diagnosis during the World Health Assem- tion possibly sharing pathophysiological pathways with
bly in May 2019 and is now part of the 11th edition of the GD [31]. On the other hand, it is known that excessive
Classification of Diseases (ICD-11) under the term gam- gaming may lead to neurobiological alterations typically
ing disorder. This condition is defined as a pattern of observed in other addictions (e.g., activation of brain re-
gaming behavior (“digital gaming” or “video gaming”) gion associated with rewards, reduced activation in areas
characterized by impaired control over gaming, increased involved in impulse control, cognitive control, executive
priority given to gaming over other activities to the extent function, motivation) [32, 33] and an increase in dopa-
that gaming takes precedence over other interests and mine release similar in magnitude than that induced by
daily activities, and continuation or escalation of gaming psychostimulants [34, 35]. Those modifications in brain
despite the occurrence of negative consequences [14]. functions in addition to behavioral disturbances associ-
Despite this refinement of GD definition over the years, ated with GD like sleep deprivation [36], comorbid sub-
consensus is still lacking in the literature, and terms like stance use [37], and other factors increasing liability to

316 Psychopathology 2023;56:315–323 Huot-Lavoie et al.

DOI: 10.1159/000527143
psychosis in given individuals (e.g., genetic vulnerability) Table 1. Inclusion and exclusion criteria
[38–40] could possibly contribute to the onset of psychot-
Inclusion criteria
ic episodes in vulnerable individuals. The identification
Participants: patients who presented a PD as well as psychotic
of GD comorbid to PD could lead to a better understand- symptoms associated with excessive gaming habits or GDs
ing of the mechanisms leading to a disability in PD and, Concept: articles that study any aspect of the comorbidity
thereby, to novel strategies to support recovery in the PD between GD and PD
population. To date, there are no available reviews ad- Context: open
Type of evidence: open
dressing this comorbidity. Exclusion criteria
Language not English or French
Aims of the Study Editorial, letter to the editor, nonscience publication
The aim of this scoping review was to summarize the Non-peer-reviewed literature
available research on the comorbidity between GD and Internet addiction study that did not address specifically IGD
GD study that addresses comorbidity other than PD
PD and to identify the knowledge gaps in this field re-
garding the prevalence, incidence, risk factors, and con-
sequences of GD in patients with PD. The secondary ob-

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jective was to describe the prevalence and incidence of
ticle had to be approved by two reviewers to be included in the
GD in patients with PD and psychotic symptoms. following steps, and disagreements were solved through discus-
sion between them.
After this first step, pairs of reviewers performed a second
Methods round of screening using the same inclusion and exclusion criteria.
They read the full text to determine if the article matched the cri-
We used Levac’s six-stage methodology [41] and reported the teria (see Fig. 1 PRISMA flowchart below for details).
scoping review following the PRISMA Extension for Scoping Re-
views guidelines [42]. Data Charting Process
Team members carefully read all studies included during the
Identifying the Research Questions full-text screening to extract relevant information using an extrac-
The research questions guiding the realization of this scoping tion chart.
review were developed in collaboration with clinicians specialized
in both the fields of PD (M.A.R. and M.F.D.) and GD (I.G. and Collating, Summarizing, and Reporting the Results
Y.K.). The main question was as follows: What is the state of The results were reported following the PRISMA Extension for
knowledge regarding the comorbidity between GD and PD? To Scoping Reviews guidelines [42]. A PRISMA flowchart details the
this was added one sub-question: What is the prevalence, inci- results of our research strategy, the removal of duplicates, the ad-
dence, and consequences of GD among psychotics with PDs? dition of articles from the reference’s list, the number of articles
excluded at each screening step, and the total number of publica-
Identifying Relevant Studies tions included for the extraction.
The following databases specialized in medicine and psychol-
ogy were searched for relevant studies: MEDLINE, Embase, Consultation
PsychINFO, CINAHL, Cochrane, Web of Science, and Proquest The main knowledge users are the clinicians from the Clinique
Dissertation & theses. The search strategy, built by a librarian from Notre-Dame des Victoires. A team of clinicians was implicated
Laval University in collaboration with our research team, was throughout the process, mainly in the development of the conclu-
translated into the different databases (see online suppl. material 1 sions that can be dawned from this study. This knowledge transfer
at www.karger.com/doi/10.1159/000527143 for details). We also to clinicians will ensure better practice and will help to identify
examined the reference lists of the included articles to check if we future needs. In addition, the results from this scoping review will
could find other eligible studies for the review. Considering the contribute to the recognition of a major comorbidity among pa-
scarcity of research on the subject, we have developed a very broad- tients admitted to a FEP program around the world.
spectrum research strategy that allowed us to identify all the lit-
erature that conjointly examined GD and PD.

Study Selection Results

Relevant studies were selected in two steps using Covidence
Systematic Review Software (Verital Health Innovation, Mel- As presented in the PRISMA flowchart, the search
bourne, VIC, Australia). Reviewers (M.G.C., C.M., and M.H.L.) strategy identified 242 articles from 7 databases, and 40
independently screened abstracts and titles based on inclusion and
exclusion criteria (Table 1). To ensure consistency in the criteria’s additional articles were retrieved from the references list
application, training sessions were conducted for a set of 20 cita- of the included articles. Following the title and abstract
tions before the reviewers started their independent work. The ar- screening, 34 studies were eligible and submitted to the

Gaming and Psychotic Disorders Psychopathology 2023;56:315–323 317

DOI: 10.1159/000527143
 Color version available online
Identification of studies via databases and registers

Studies identified
from:

Identification
Databases (n =242) Studies removed before screening:
References list Duplicate
revision (n = 49)
(n=40)

Studies titles and

abstracts screening Studies excluded
(n = 233) (n = 199)
Screening

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Studies excluded: (n = 26)
Studies assessed for Other comorbidity than schizophrenia and
eligibility psychotic disorder
(n = 34) (n = 17)
Internet addiction disorder
(n = 5)
Editorial, letter to editor or non-scientific
publication
(n = 2)
Studies included in Language not English or French
Included

review (n = 2)
(n = 8)

Fig. 1. PRISMA flowchart.

full-text screening. After confronting each of these arti- ed in this review show clinical associations of GD and PD
cles with the inclusion and exclusion criteria presented symptoms in a number of patients, suggesting possible
above, a total of 8 articles meeting our selection criteria concomitant conditions. Two main patterns leading to a
were selected. These articles included 6 case reports of psychotic episode in patients with excessive gaming hab-
patients presenting a GD and a psychotic episode and two its can be observed in those cases. First, for 4 patients, the
empirical studies exploring the link between PD and GD; prodromal phase of the psychotic episode consisted of a
these two groups of articles are reviewed in two separate significant increase in the gaming time. For some of these
categories. patients, the increased playtime followed the exposure to
a new type of game that allows massive multiplayer game-
Cases Description play (MMORPG). For 2 other patients, the psychotic ep-
As summarized in Table 2, 6 case reports were identi- isode followed an abrupt gaming disruption. This change
fied by the search strategy, including 4 articles reporting in gaming habits was done voluntarily in one case and
1 patient, 1 article reporting 3 patients, and one confer- imposed by the family in the other. To compare the im-
ence abstract reporting 2 patients. Since there is no avail- portance of the use of video games for each patient, the
able description of the population affected by those dis- information about gaming and the scales used to assess
orders, the patients’ age and gender were extracted for the GD were included in this table as well, and most pa-
each case. Patients were male between 15 and 26 years old. tients played MMORPGs. Finally, the treatment and re-
Additionally, the presumed psychosis-triggering event covery time is presented to get a glimpse of what has and
and the patients’ symptoms were presented to get a better has not worked to stabilize the patients.
understanding of the manifestations of these disorders
when they are comorbid. The cases of 9 patients present-

318 Psychopathology 2023;56:315–323 Huot-Lavoie et al.

DOI: 10.1159/000527143
 Table 2. Cases descriptions

Author, year Patient age Presumed psychotic Symptoms Type of game and time spent Reason for playing Treatment Scales
and gender episode-triggering playing
event

Angane et al. 20-year-old Increased playing Delusion of persecution Online RPGs and first-person To avoid a hostile Risperidone 6 mg IGDS9-SF
2021 [48] male time led to psychosis Delusion of reference shooter with violent scenarios environment at home 6 electroconvulsive therapy sessions
Auditory hallucinations for 6–8 h per day for 5 years; In Psychotic symptoms stabilized in 3 weeks
the past 3 months, increased
his gaming time up to 16 h per
day

Gaming and Psychotic Disorders

18-year-old Increased playing Delusion of persecution Internet gaming for many Because he was stuck at Olanzapine 20 mg IGDS9-SF
male time led to psychosis Delusion of reference years. In the past 2 years, home (overprotective Psychotic symptoms stabilized in 2 weeks
Thought broadcasting increased his gaming time to parents who
6–8 h a day. discouraged him to go
He then transitioned to outside)
MMORPG and started playing
14 h a day

19-year-old Increased playing Delusion of persecution Mobile video game for 3 years Not specified Olanzapine 30 mg IGDS9-SF
male time led to psychosis Delusion of reference Initially played 1–2 h per day, Psychotic symptoms stabilized in 3 weeks
Auditory hallucinations but then gradually increased to
6 h per weekday and 12 h on
weekends

Balwaik et al. 2 cases Not specified Acute psychotic MMORPGs Not specified Not specified Not specified
2020 [52] Age and sex manifestations
not specified Depressive symptoms

Bhardwaj, 2019 15-year-old It was determined Symptoms of psychosis Not specified Not specified Risperidone 4 mg Not specified
[53] male that a GD, rather Episodes of Naltrexone 50 mg
than a psychosis, unconsciousness Cognitive behavioral therapy
could better explain
the symptoms

Ghosh and 26-year-old Gaming withdrawal Auditory hallucinations A type of multiplayer online Not specified Risperidone 6 mg Young’s Internet
Sarkhel 2018 male Delusion of persecution battle arena (mobile legends) Lorazepam 2 mg addiction test
[54] Delusion of reference for 8–10 h a day in the last 2 He became restless and aggressive, and they had
years changed his medication

DOI: 10.1159/000527143
Injectable lorazepam
Injectable haloperidol
Stabilized and discharged 8 days after. Has not
presented psychosis symptoms and has not

Psychopathology 2023;56:315–323
played since

Paik et al. 2014 25-year-old Gaming withdrawal Persecutory delusion Played 5 h per day of online Gaming gave him a Quetiapine 800 mg Internet addiction
[55] male Impaired reality testing game since high school sense of satisfaction Rapid improvement of symptoms observed in disorder criteria
Auditory hallucinations Changed the type of game for and self-esteem just 4 days. Has not played video games since described by
Psychomotor agitation MMORPG and then played and has not presented signs of psychosis Goldberg
8–12 h per day for 2 years

Rizzo et al. 2015 17-year-old Increased playing Prepsychotic state MMORPG for 4 years Not specified Low doses of clozapine Not specified
[45] male time led to psychosis Hippotherapy
Occupational therapy
Group therapy
Rehabilitation
Has not played video games since and had a
decrease of psychotic symptoms

RPG, role-playing game.

319
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 Other Studies (Non-Case Report) do not have any reliable data on the prevalence of GD
Only two empirical articles addressed the comorbidity among patients with PD or on the relationship of GD with
between GD and PD. First, Chang et al. [43] recruited 104 the main symptoms of PD or on the functional conse-
participants diagnosed with schizophrenia from the Jianan quences of GD in this population.
Psychiatric Center (Taiwan). The main goal of the study Two main patterns leading to a psychotic episode in
was to investigate the potential role of GD as a mediator in patients with excessive gaming habits have been identi-
the association between self-stigma and psychological dis- fied in previously described case reports. Regarding those
tress (depression, anxiety, stress). Using multiple psycho- observations, it seems that psychotic symptoms could be
metric scales (Personal and Social Performance Scale, In- triggered by an increase in gaming time or a sudden gam-
ternet Gaming Disorder Scale-Short Form [IGDS9-SF], ing withdrawal. To our knowledge, there is no available
Self-Stigma Scale [SSS], and Depression, Anxiety, Stress explanation for those phenomena. However, some au-
Scale [DASS]), they found that IGDS9-SF scores were cor- thors from the reported literature have proposed hypoth-
related with anxiety (r = 0.220), stress (r = 0.244), DASS-21 eses that are aligned with the observations made in the
total score (r = 0.576), and SSS (r = 0.163). Moreover, they cases reported in the present review. Frist, Rizzo et al. [45]
found that self-stigma alone was associated with depres- proposed a theory in which excessive gaming could di-

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sion (r = 0.226), anxiety (r = 0.205), stress (r = 0.262), and rectly trigger a psychotic episode. Another theory brought
a DASS-21 (r = 0.693) total score. Furthermore, introduc- up by some authors is that GD could be a consequence of
ing IGDS9-SF score as a covariable reduced the strength of a PD. They proposed that patients with PDs are more
the association between self-stigma and anxiety (r = 0.058), prone to use video games to escape their reality, and it
stress (r = 0.064), and DASS-21 (r = 0.152), suggesting a could serve as a coping strategy for their symptoms. Re-
mediating effect of IGDS9-SF score on the relationship be- search by Chang et al. [43] is in favor of this theory. They
tween these variables and SSS. In other words, online gam- exposed that patients with schizophrenia experiencing
ing might be a coping strategy for schizophrenic patients self-stigma could use video games as a coping strategy to
who experience self-stigma. Based on these results, the au- decrease their depressive and anxiety symptoms, and it
thors speculated that patients could use video games to helped them connect with others. These observations
help them connecting to others through the perceived an- suggest that video game use may be beneficial for some
onymity that the Internet provides [43]. patients. Some studies on gaming motivations show that
In another study, Gauthier et al. [44] led a single-visit, escapism via video game can have multiple positive out-
multicenter study involving 235 patients aged from 12 to comes such as enjoyment, fun, and wishful thinking.
17 years who were hospitalized in four psychiatric units However, it can also lead to negative outcomes, such as
(France). The aim of their study was to determine the va- depression, time wastage, negative mood, social anxiety,
lidity between two GD scales: the IGDT-10, a self-reported loneliness, and self-discrepancy. Individual variables
scale, and the IDGT-P-10, an adapted scale developed to such as cultural context appear to act as moderators in
allow the patient’s parents to take part in the GD screening this dual outcome. A better understanding of the gamer’s
by identifying different symptoms presented by their child motivations of patients who use video games as a coping
[44]. The prevalence of GD in the adolescent psychiatric strategy could lead to targeted interventions to promote
population (n = 104) was 6% (self-reported) and 12.79% positive outcomes [46, 47]. In other cases, presented by
(reported by the parents). In this study, none of the 11 pa- Angane et al. [48], patients turned to gaming for reality
tients with PDs had a GD when using the IGDT-10, and substitution because of the distressing symptoms that
only 1 patient had a GD when using the IGDT-10-P [44]. they experienced, and progressively increased their gam-
No further analysis was conducted by this research group ing time, leading to a GD. These observations also suggest
to explore the comorbidity between GD and PD. that gaming could be beneficial for patients facing psy-
chological distress. However, it is difficult to establish the
actual consequences of gaming habits on patients’ health
Discussion since gaming could potentiate social isolation observe in
patients with FEP.
The main result from this scoping review is the dem- In addition, the types of games played in the case re-
onstration of the paucity of the literature on the comor- ports were similar, and most patients played MMORPGs.
bidity between GD and PD. Indeed, it is limited to only 6 Two patients even mentioned that they increased their
case reports and two cross-sectional studies. Hence, we playing time when they switched to this type of game.

320 Psychopathology 2023;56:315–323 Huot-Lavoie et al.

DOI: 10.1159/000527143
Thus, the practice of MMORPG is a risk factor for the often associated with a significant amount of information
development of GD and could even be associated with the in the assessment of the patient. Indeed, by questioning,
onset of psychotic episodes. The type of game could for example, the type of video game (multiplayer or solo),
therefore be a contributing factor to both GD and PD. It we can evaluate the interaction of the patient with other
is not clear whether GD can be caused by PD or vice ver- people. In addition, the time spent on the console can lead
sa. In fact, only two cross-sectional studies examined this us to understand not only the impact of the game on the
comorbidity, but such a cross-sectional study design does patient’s life but also to learn more about his lifestyle and
not allow to conclude on the causality of the link between sleep habits. As well, psychotic symptoms can be ques-
the different observations and can only consider them to tioned during pleasurable activities. For example, is the
be correlated, which might result from different relation- patient able to overcome auditory hallucinations while
ships. For instance, those conditions share multiple con- playing the console?
sequences that might be exacerbated by their simultane- Another essential element that should be addressed in
ous presence. Also, psychosis and GD could share under- future studies is that no GD measurement scale has been
lying biological, sociodemographic, or psychological validated yet for patients with PDs. The existing screen-
mechanisms that make individuals vulnerable to both pa- ing tools were developed for a general population and

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thologies. However, empirical evidence is to date insuf- consist of self-reported scales based on the DSM-5 and
ficient to identify the nature of the relationship between ICD-11 criteria, which can be difficult to interpret even
the two disorders. for patients without disabilities [50].
The limited knowledge of the pathophysiology of the
Clinical Perspective and Knowledge Gaps comorbid presence of GD is not limited to its comorbid-
Clinical experience with patients leads to further ques- ity with PDs. Indeed, the causal link between GD and
tioning of the results and to suggestions for future re- multiple psychiatric disorders is poorly understood as
search. Indeed, the current review highlights the lack of well, and further studies are needed in this area of re-
high-quality data about PDs combined with GDs. Beyond search [51].
the data collected in this review, additional clinical factors
must be considered. Indeed, patients suffering from FEP Limitations
in our setting often mentioned video games as a frequent We tried to be inclusive in our search strategy to iden-
hobby. While occupational and functional recovery is an tify as many studies as possible. However, we had to lim-
important focus of early psychosis interventions, many it our search to English and French articles due to limited
individuals spend a considerable amount of time on gam- resources. Since GD is a research field of interest in Asian
ing consoles, cell phones, or computers playing video countries, it is possible that some studies were missed.
games, and these time-consuming gaming habits seem to Finally, the data collected in this scoping review are to
persist even in patients with a formal diagnosis of schizo- be interpreted with caution. Indeed, some case reports
phrenia [49]. Some of these patients seem to have appro- were detailed in terms of the symptomatology and phar-
priate use, and some others have problematic use; it has macotherapy used, but the others were poorly document-
been proposed that video games can be used as a coping ed. Furthermore, longitudinal data on the evolution of
strategy to improve the quality of life of patients with PDs GD after the treatment of psychosis were missing. More-
experiencing self-stigma. It is possible that patients also over, the doses of antipsychotics used in the case reports
use video games to avoid other psychotic symptoms (e.g., were very high, and the evaluation of adverse effects was
lack of concentration, delusion, alogia). It would be ben- not specifically studied. In addition, patients’ diagnosis
eficial to investigate the patient’s motivations for gaming was poorly documented, and diagnostic references such
and the causal link between different psychotic symptoms as SCID or ICD were not specifically mentioned. How-
and the development of a GD. The reasons for playing ever, many clinical conditions remained clinically unusu-
video games were not reported by all patients in the previ- al. For example, a 15-year-old male who had lost con-
ous cases. However, playing to reach personal satisfaction, sciousness was associated with a diagnosis of psychosis
to increase self-esteem, and to avoid hostile environment but is less common in the usual PD presentation. In ad-
at home were expressed by 2 patients. Interestingly, those dition, many authors refer to a prodrome of psychosis but
reasons were associated with GD in previous studies. not to clinical high risk per se. In addition, the effect of
Yet, knowledge of video games is essential to today’s medication on gaming was not specifically studied. We
psychiatrists since asking questions about this sphere is also decided to include conferences abstracts in this scop-

Gaming and Psychotic Disorders Psychopathology 2023;56:315–323 321

DOI: 10.1159/000527143
ing review in order to reflect as closely as possible the Conflict of Interest Statement
knowledge currently available. These abstracts address
The authors have no conflicts of interest to declare.
similar concepts as the other articles included in the pres-
ent review. However, the lack of detail in these abstracts
limits their interpretation and the conclusions that can be
Funding Sources
drawn from them.
MHL was supported by the Frederick Banting and Charles Best
Canada Graduate Scholarship Doctoral Awards from the Cana-
Conclusion dian Institute of Health Research (FID-172598). The funder played
no role in this study, and we have no restrictions regarding the
submission of this report for publication.
In conclusion, these results highlight a significant lack
of knowledge concerning PD associated with GD. Only a
few reported cases and a single study exposed the direct
Author Contributions
association between those conditions. Future studies
should focus on (1) the prevalence, incidence, and risk Maxime Huot-Lavoie: conceptualization, methodology, for-

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factors of PDs and psychotic symptoms in patients with mal analysis, writing – original draft, and project administration.
GD; (2) the incidence of GD in patients with PDs and Mina Gabriel-Courval: formal analysis and writing – original
psychotic symptoms; and (3) the creation of GD screen- draft. Laurent Béchard, Olivier Corbeil, Sébastien Brodeur, Charles
Massé, Émilien Fournier, Anne Marie Essiambre, Elizabeth An-
ing tools adapted to patients with PDs. These findings will derson, and Audrey Cayouette: writing – review and editing.
guide the allocation of appropriate resources to support Charles Massé: formal analysis. Isabelle Giroux and Yasser Khazaal:
the recovery of these patients. conceptualization, validation, and writing – review and editing.
Marie-France Demers and Marc-André Roy: conceptualization,
methodology, resources, writing – review and editing, and super-
vision.

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