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W. Scott Huddleston, PGY4 ETSU Department of Psychiatry Grand Rounds 9/9/11 Faculty Mentor: Jill McCarley, MD Slide 2 No financial bias Personal bias Im a geek I play video games, including those discussed in this presentation Slide 3 Rapidly growing userbase World of Warcraft is the largest Last released data suggested 11.4 million subscriptions Impact on Mental Health Depression Anxiety Addiction news reports Slide 4 MMOs massively multiplayer online [games] Social: Second Life Adventure: World of Warcraft Everquest Slide 5 Players create characters Gender Appearance Role Assigned tasks lead to rewards More and better items Skills Customization More heroic tasks Slide 6 Similarity to Skinner boxes Varying reward structure Less random with newer games Variable timing persists Slide 7 Thousands sharing the same environment Social aspects significant Interaction can be chat or animation based Temporary groups Permanent groups Size and explicit function varies Can persist across multiple games Slide 8 End-game at maximum level Various situations requiring varied numbers of people Two main categories Player versus player Player versus environment Slide 9 Two teams directly competing against each other Most situations have tactical objectives Points/rewards for performance Competitive sports are a decent comparison Slide 10 Different games have different specifics 10+ people Varied situations Each player has a role to fulfill Teams work together to achieve objectives without direct competition with each other Wall-climbing or ropes courses as analogue Slide 11 Slide 12 Literature survey reliant Medical literature drawn from PubMed and Psychinfo searches More MMO specific data drawn from Daedalus Project Most research into MMOs focused on Adventure rather than Social type Slide 13 2011 Norwegian survey of 2500 (816 respondents) 56.3% played video games regularly MMO players tended toward higher frequency of play Slide 14 85% or so are male Average age Males 28.3 (SD is 8.4) Females 32.5 (SD 10.0) Marital Status Males 32.6% Females 57.0% Slide 15 Playing video games can lead to increased dopaminergic receptor occupancy in the caudate Part of the reward response pathway Males have higher activity in mesocorticalimbic system than females Slide 16 Primary focus of medical literature No definitive diagnostic criteria Behavioral model similar to gambling Most proposed criteria agree: Excessive use Withdrawal symptoms Interference with daily functioning Slide 17 Disputed Ranges from 0.6% through 11.9% Discrepancies among criteria Males tend to be much more likely to develop issues Slide 18 College survey of males (2009) Little correlation between frequency of play and GPA BMI Positive correlation: Bored Lonely Stressed Slide 19 Park et al, 2010: PET imaging comparing 11 overusers vs 9 control Increased glucose metabolism Right middle orbitofrontal gyrus Left caudate nucleus Right insula Decreased metabolism Bilateral postcentral gyrus Left precentral gyrus Bilateral occipital regions Slide 20 Two recent studies by Han et al using fMRI Increased cue-induced activity in frontal-lobes Similar to findings in both traditional substance abuse and pathological gambling Genetic study (also Han) 75 control vs 79 excessive internet game players DRD2 Taq1A1 allele linked to excessive use and Slide 21