Internet Gaming Disorder and the DSM-5: Conceptualization, Debates, and Controversies

Scientific interest in behavioral addictions (such as Internet gaming disorder [IGD]) has risen considerably over the last two decades. Moreover, the inclusion of IGD in Section 3 of DSM-5 will most likely stimulate such research even more. Although the inclusion of IGD appears to have been well received by most of the researchers and clinicians in the field, there are several controversies and concerns surrounding its inclusion. The present paper aims to discuss the most important of these issues: (i) the possible effects of accepting IGD as an addiction; (ii) the most important critiques regarding certain IGD criteria (i.e., preoccupation, tolerance, withdrawal, deception, and escape); and (iii) the controversies surrounding the name and content of IGD. In addition to these controversies, the paper also provides a brief overview of the recent findings in the assessment and prevalence of IGD, the etiology of the disorder, and the most important treatment methods

IgM and IgD B cell receptors differentially respond to endogenous antigens and control B cell fate.

Naive B cells co-express two BCR isotypes, IgM and IgD, with identical antigen-binding domains but distinct constant regions. IgM but not IgD is downregulated on autoreactive B cells. Because these isotypes are presumed to be redundant, it is unknown how this could impose tolerance. We introduced the Nur77-eGFP reporter of BCR signaling into mice that express each BCR isotype alone. Despite signaling strongly in vitro, IgD is less sensitive than IgM to endogenous antigen in vivo and developmental fate decisions are skewed accordingly. IgD-only Lyn-/- B cells cannot generate autoantibodies and short-lived plasma cells (SLPCs) in vivo, a fate thought to be driven by intense BCR signaling induced by endogenous antigens. Similarly, IgD-only B cells generate normal germinal center, but impaired IgG1+ SLPC responses to T-dependent immunization. We propose a role for IgD in maintaining the quiescence of autoreactive B cells and restricting their differentiation into autoantibody secreting cells

The conceptualisation and measurement of DSM-5 Internet Gaming Disorder: the development of the IGD-20 Test

Background: Over the last decade, there has been growing concern about ‘gaming addiction’ and its widely documented detrimental impacts on a minority of individuals that play excessively. The latest (fifth) edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5) included nine criteria for the potential diagnosis of Internet Gaming Disorder (IGD) and noted that it was a condition that warranted further empirical study. Aim: The main aim of this study was to develop a valid and reliable standardised psychometrically robust tool in addition to providing empirically supported cut-off points. Methods: A sample of 1003 gamers (85.2% males; mean age 26 years) from 57 different countries were recruited via online gaming forums. Validity was assessed by confirmatory factor analysis (CFA), criterion-related validity, and concurrent validity. Latent profile analysis was also carried to distinguish disordered gamers from non-disordered gamers. Sensitivity and specificity analyses were performed to determine an empirical cut-off for the test. Results: The CFA confirmed the viability of IGD-20 Test with a six-factor structure (salience, mood modification, tolerance, withdrawal, conflict and relapse) for the assessment of IGD according to the nine criteria from DSM-5. The IGD-20 Test proved to be valid and reliable. According to the latent profile analysis, 5.3% of the total participants were classed as disordered gamers. Additionally, an optimal empirical cut-off of 71 points (out of 100) seemed to be adequate according to the sensitivity and specificity analyses carried

The Immunoglobulins of Cold-Blooded Vertebrates

Peer reviewedPublisher PD

Internet gaming disorder as a formative construct : implications for conceptualization and measurement

Background. Some people have serious problems controlling their internet and video game use. The DSM-5 now includes a proposal for ‘Internet Gaming Disorder’ as a condition in need of further study. Various studies aim to validate the proposed diagnostic criteria for Internet Gaming Disorder and multiple new scales have been introduced that cover the suggested criteria. Approach. Using a structured approach, we demonstrate that Internet Gaming Disorder might be better interpreted as a formative construct, as opposed to the current practice of conceptualizing it as a reflective construct. Incorrectly approaching a formative construct as a reflective one causes serious problems in scale development including (a) incorrect reliance on item-to-total scale correlation to exclude items and incorrectly relying on indices of inter-item reliability that do not fit the measurement model (e.g., Cronbach’s α) (b) incorrect interpretation of composite or mean scores that assume all items are equal in contributing value to a sum score, and (c) biased estimation of model parameters in statistical models. Implications. We show that these issues are impacting current validation efforts through two recent examples. A reinterpretation of Internet Gaming Disorder as a formative construct has broad consequences for current validation efforts and provides opportunities to reanalyze existing data. We discuss three broad implications for current research: (1) Composite latent constructs should be defined and used in models, (2) Item exclusion and selection should not rely on item-to-total scale correlations, and (3) Existing definitions of Internet Gaming Disorder should be enriched further

Ampk regulates IgD expression but not energy stress with B cell activation.

Ampk is an energy gatekeeper that responds to decreases in ATP by inhibiting energy-consuming anabolic processes and promoting energy-generating catabolic processes. Recently, we showed that Lkb1, an understudied kinase in B lymphocytes and a major upstream kinase for Ampk, had critical and unexpected roles in activating naïve B cells and in germinal center formation. Therefore, we examined whether Lkb1 activities during B cell activation depend on Ampk and report surprising Ampk activation with in vitro B cell stimulation in the absence of energy stress, coupled to rapid biomass accumulation. Despite Ampk activation and a controlling role for Lkb1 in B cell activation, Ampk knockout did not significantly affect B cell activation, differentiation, nutrient dynamics, gene expression, or humoral immune responses. Instead, Ampk loss specifically repressed the transcriptional expression of IgD and its regulator, Zfp318. Results also reveal that early activation of Ampk by phenformin treatment impairs germinal center formation but does not significantly alter antibody responses. Combined, the data show an unexpectedly specific role for Ampk in the regulation of IgD expression during B cell activation

The relationship between childhood trauma and Internet gaming disorder among college students: A structural equation model

open access journalBackground The aim of this study was to investigate the mechanisms of Internet gaming disorder (IGD) and the associated interaction effects of childhood trauma, depression and anxiety in college students. Methods Participants were enrolled full-time as freshmen at a University in the Hunan province, China. All participants reported their socio-demographic characteristics and undertook a standardized assessment on childhood trauma, anxiety, depression and IGD. The effect of childhood trauma on university students' internet gaming behaviour mediated by anxiety and depression was analysed using structural equation modelling (SEM) using R 3.6.1. Results In total, 922 freshmen participated in the study, with an approximately even male-to-female ratio. A mediation model with anxiety and depression as the mediators between childhood trauma and internet gaming behaviour allowing anxiety and depression to be correlated was tested using SEM. The SEM analysis revealed that a standardised total effect of childhood trauma on Internet gaming was 0.18, (Z = 5.60, 95% CI [0.02, 0.05], P < 0.001), with the direct effects of childhood trauma on Internet gaming being 0.11 (Z = 3.41, 95% CI [0.01, 0.03], P = 0.001), and the indirect effects being 0.02 (Z = 2.32, 95% CI [0.00, 0.01], P = 0.020) in the pathway of childhood trauma-depression-internet gaming; and 0.05 (Z = 3.67, 95% CI [0.00, 0.02], P < 0.001) in the pathway of childhood trauma-anxiety-Internet gaming. In addition, the two mediators anxiety and depression were significantly correlated (r = 0.50, Z = 13.54, 95% CI [3.50, 5.05], P < 0.001). Conclusions The study revealed that childhood trauma had a significant impact on adolescents' Internet gaming behaviours among college students. Anxiety and depression both significantly mediated the relationship between childhood trauma and internet gaming and augmented its negative influence. Discussion of the need to understand the subtypes of childhood traumatic experience in relationship to addictive behaviours is included

Quality Management of Emergency Room (ER) Services in the District General Hospital of Kudus

Service quality of an emergency room unit (IGD) of Kudus District General Hospital (RSUD) included human resource, policy, procedure and facility of IGD. This was not fit properly with level III IGD standard. Objective of this study was to identify service quality management of IGD including quality management process, quality of leadership, and quality of organization. This was a qualitative study using observation, focus group discussion, and in-depth interview methods. Study subjects were 13 people: four main informants, nine triangulation informants. Triangulation informants included 3 workers at IGD of RSUD Kudus, and six patient\u27s family members. Measured variables were quality management, quality of leadership, organizational quality, and service quality of IGD of RSUD Kudus. Results of this study included quality planning: the number of workers and worker\u27s competence were insufficient; no orientation guideline and transfer or workers guideline were provided; maintenance and instrument calibration were insufficient. Quality control: no evaluation of work performance was provided. Quality improvement: human resource improvement was not adequate; no training guideline was provided; no integrated budget regulation was performed; supply of facilities was not adequate. Quality of leadership: Democratic style with understandable policy was applied. Organizational quality: management experience and the competence of head of IGD were good; changes that supported IGD service quality were well accepted; Service quality of IGD, that included human resource such as chief of IGD with special criteria, was good. IGD workers with special criteria were insufficient. Facilities were insufficient. Policy and procedure were insufficient. In conclusion, the quality management process of IGD RSUD Kudus was insufficient; democratic leadership with understandable policy was applied; organizational quality was good; IGD workers were not matched with specific qualification. Suggestions: to conduct meeting to formulate clear strategic plan and clear leader policy as guidelines. It should be included in the annual working program in RSUD Kudus