On July 15, the Bureau of disease control and prevention of the National Health Commission issued an expert consensus on the prevention and treatment of play disorders (2019 Edition) by the Psychiatry Branch of the Chinese Medical Association, the mental health branch of the Chinese Preventive Medicine Association, the psychiatrist branch of the Chinese Medical Association, the Chinese Mental Health Association and the Chinese drug abuse prevention and Control Association (hereinafter referred to as the 'consensus').
According to the 'consensus', on May 25, 2019, the World Health Assembly considered and adopted the eleventh revision of the international classification of diseases (hereinafter referred to as' ICD-11'). Among them, 'gaming disorder' as a new disease is included in the disease unit of 'disorder caused by addictive behavior'. The disease control bureau of the National Health Commission organized experts to systematically sort out the definition, clinical characteristics, evaluation, diagnosis, treatment and rehabilitation of play disorders, and formed an expert consensus.
What are the game obstacles and what are the main manifestations?
According to the definition of 'ICD-11', game disorder refers to a behavior mode of continuous or repeated use of electronic or video games, which shows that the game behavior is out of control, the game becomes a priority behavior in life, and continues the game behavior regardless of adverse consequences for a long time. The main clinical manifestations include: loss of control over the beginning, frequency, duration, end and occasion of game behavior; Games take precedence over other life interests and daily activities; Although the game has had negative consequences, it still continues to play and even increases the intensity of the game.
A number of relevant surveys and studies in China show that the prevalence of game related problems is 3.5% - 17%. Based on previous relevant research results, the average prevalence of play disorders is about 5%, and remains relatively stable.
The 'consensus' points out that play disorders can lead to physical problems, mental and behavioral problems and damage to social functions. Physical problems include lack of sleep, circadian rhythm disorder, malnutrition, gastric ulcer, seizures, etc. in severe cases, venous embolism of lower limbs can be formed due to sedentary, and even sudden death due to pulmonary embolism; Mental and behavioral problems include irritability, anxiety, aggressive words and deeds, depression, guilt, etc; The impairment of social function includes refusal to go to school and social activities, increased family conflicts, loss of important relationships, impairment of academic achievement and professional performance, etc.
Play disorders are often associated with attention deficit and hyperactivity disorder, depression, anxiety disorder, bipolar disorder, sleep disorder, personality disorder, social phobia and other mental disorders. Because its natural course has not been clearly understood, the conclusions of different studies are quite different. If there is a research report, 84% of patients are still in pathological state in the follow-up survey after 2 years; However, some studies suggest that only 26.5% of patients still have game related problems in the follow-up after 2 years, and the severity of symptoms will decrease moderately in the follow-up of 5 years.
Play disorder is related to psychological, social, biological and other factors
Studies at home and abroad show that game disorders are related to psychological, social, biological and other factors. For the clinical diagnosis of suspected patients with play disorders or high-risk individuals, standardized diagnostic guidelines are needed to ensure the accuracy of diagnosis by medical and health institutions and avoid over diagnosis.
In 'ICD-11', it is proposed that the core characteristics of game barriers are: continuous or repeated game behavior patterns, which are specifically manifested in out of control game behaviors (such as unable to control the occurrence, frequency, duration and termination time of game behaviors). Game behaviors have become life priorities, although games cause negative consequences (such as broken interpersonal relationship, occupational or academic impact, health damage, etc.) still cannot be stopped.
The game behavior pattern can be persistent or paroxysmal and last for 12 months, but if the symptoms are serious enough and meet other diagnostic points, the duration can be less than 12 months.
Game behavior patterns can lead to obvious personal, family, interpersonal relationship, academic, professional or other important functional areas. According to different game forms, game barriers include online game barriers and offline game barriers.
A three-level prevention system should be established to prevent game obstacles
In view of the 'consensus' caused by play disorders, it also puts forward suggestions on the prevention of play disorders - a three-level prevention system including universal prevention, targeted prevention, early detection and treatment should be established.
Universal prevention, including popularizing mental health knowledge to the public, widely publicizing game barrier related knowledge, improving the mental health level of the whole society and reducing the inducement of game barrier;
Targeted prevention includes taking corresponding psychological intervention measures at the individual level from the aspects of emotional regulation, cognitive control and interpersonal communication for high-risk groups prone to play disorders such as children and adolescents; focusing on the popular science publicity of mental health knowledge and coping skills for the family, school and social environment of children and adolescents, so as to improve family relations and parent-child relationship Communication skills, caring for the psychological needs of children and adolescents;
Early detection and treatment is mainly to improve the ability of children, adolescents, parents and schools to identify play disorders in the early stage. For patients with suspected play disorders, guide patients and their families to see a doctor in time, make a clear diagnosis and receive reasonable and systematic treatment.
Comprehensive treatment is helpful to improve the prognosis of patients with play disorders
'consensus' finally points out that there is no authoritative guideline for the treatment of play disorders, but many studies or clinical practices on the treatment and intervention of play disorders in recent years suggest that the comprehensive treatment combining psychosocial intervention, drug treatment and treatment of comorbidities is conducive to improving the prognosis of patients with play disorders. The main measures include:
At present, many clinical practice and research evidence suggest that social psychological interventions such as cognitive behavior therapy, motivation incentive interview and family therapy are effective in reducing out of control play behavior and promoting long-term rehabilitation;
Drug treatment. At present, there are no drugs with clinical indications for play disorders, but patients with play disorders may have mental, physical and other health problems and comorbidities, and need drug symptomatic treatment;
Physical therapy. At present, a few studies have conducted repeated transcranial magnetic stimulation and other interventions for patients with play disorders to enhance brain control function or reduce the impulse to play games, but there is still a lack of large sample consistency research.