The tentative psychiatric disorder known as Internet Gaming Disorder (IGD) is characterized by persistent and repetitive engagement with video games, often resulting in notable disruptions in daily life, work, and/or education. The American Psychiatric Association (APA) has recognized the need for additional research in this area. The literature suggests a strong correlation between IGD and attention deficit hyperactivity disorder (ADHD), as a meta-analysis suggested an 85% correlation with symptoms of ADHD. In fact, both combined type ADHD and predominantly hyperactive/impulsive ADHD are linked to IGD. This study aims to understand the neurobiological overlap between these comorbid disorders in order to best understand which treatment modalities could best help patients with either symptoms of ADHD or IGD.

Google Scholar and PubMed were explored using search terms including “IGD,” “internet gaming disorder,” “ADHD,” “attention deficit hyperactivity disorder,” and “mechanism” in various permutations. Eighteen studies were included from 58 search results that addressed IGD’s connection to ADHD and their common biological mechanisms.

Findings suggest that In individuals with Internet Gaming Disorder (IGD), there is a decrease in the functional connectivity within brain networks associated with cognitive control, executive function, motivation, and reward. Additionally, structural changes such as reduced gray-matter volume and white-matter density have been observed. Furthermore, comorbidity studies suggest that the executive control networks affected in attention deficit-hyperactivity disorder (ADHD) may increase the vulnerability to developing IGD. Another meta-analysis found that , VBM (voxel-based morphometry) analysis showed disorder-specific GMV abnormality in the putamen among IGD subjects and orbitofrontal cortex in ADHD and shared GMV in the prefrontal cortex. Functionally, fMRI analysis discovered that IGD-differentiating increased activation in the precuneus and shared abnormal activation in anterior cingulate cortex, insular, and striatum. A 119 adolescent case-control study found that after a 6-week treatment period, both groups escitalopram and bupropion demonstrated improvement across all clinical symptom scales compared to the matched control group. Moreover, the bupropion group exhibited greater enhancements in scores on the Clinical Global Impression-Severity Scale, Young Internet Addiction Scale, ADHD Rating Scale, and Behavioral Inhibition Scale compared to the escitalopram group.

The literature findings suggest that individuals with IGD exhibit reduced functional connectivity and structural changes in brain networks associated with cognitive control and reward. Comorbidity studies indicate that executive control networks affected in ADHD may contribute to the vulnerability of developing IGD. These findings are helpful in the assessment and treatment of IGD which currently does not have any official treatment recommendations.

No Funding

The DSM V-TR places video game addiction, also known as Internet Gaming Disorder (IGD) within the section that suggests the need for additional research. Simultaneously, there has been a remarkable surge in the consumption of video games, with this medium attracting more funding than ever before. Additionally, as this disorder gains increased attention from the psychiatric world, there is a lack of any formal guidelines on the treatment of IGD, or for the superiority of any specific pharmaceutical treatment. The aim of this project focuses on reviewing the neurobiological mechanisms involved in IGD in order to garner a more robust understanding of the neural pathways involved.

Google Scholar and PubMed were explored using search terms including “Internet gaming disorder,” “neurology,” “imaging,” “mechanisms,” and “comorbid” in various permutations. Thirty-seven articles were included from 100 search results that addressed IGD neural and biological mechanisms, and their potential comorbidity with other mental disorders.

The literature suggests that some of the neural findings in IGD are similar to those found in other addiction disorders, which include the following mechanisms: (i) Activation of brain regions associated with reward, as observed in cue exposure and craving studies. Neurotransmitter system studies further suggest the involvement of dopamine-mediated reward mechanisms. (ii) Decreased activity in areas responsible for impulse control and impaired decision-making. (iii) Reduced functional connectivity in brain networks related to cognitive control, executive function, motivation, and reward. Another study suggested that the severity of IGD and depression symptoms predict each other reciprocally. Neurologically, individuals with IGD exhibited enhanced rsFC between the left amygdala and the right dorsolateral prefrontal cortex, inferior frontal gyrus, and precentral gyrus compared to control participants. The baseline amygdala-frontoparietal connectivity negatively predicted the reduction in depression symptoms following a psychotherapy intervention. Other studies suggest that altered executive control mechanisms in attention deficit hyperactivity disorder (ADHD) would be a predisposition for developing IGD. Furthermore, according to the literature, it was indicated that engaging in Internet game playing was linked to reduced white matter density in brain areas responsible for decision-making, inhibiting behavior, and regulating emotions.

The literature findings regarding IGD’s neural and biological pathways, as well as the association of these findings with other disorders such as depressive disorders and ADHD reflect behavioral patterns in individuals with IGD. These mechanisms can be utilized to maximize behavioral and pharmaceutical interventions.

No Funding

Medicines routinely funded for use in Wales undergo health technology appraisal by the All Wales Medicines Strategy Group (AWMSG) or the National Institute for Health and Care Excellence (NICE). This includes pediatric license extensions (PLE) notwithstanding any existing advice in adults. A review of the PLE process was conducted with the aim of providing faster access to children’s medicines in Wales.

Data were collected for PLE appraisals of medicines previously approved for adults by the AWMSG or NICE that subsequently went through the original PLE process between January 2010 and December 2020, or a simplified PLE process between January 2021 and March 2023. Data were analyzed using descriptive statistics and a two-tailed t-test (unequal variance) to test the null hypothesis that the difference between the two means was zero. An alpha of less than 0.05 was considered significant. Feedback was obtained from relevant stakeholders including the Association of the British Pharmaceutical Industry (Wales) and the Royal College of Paediatrics and Child Health.

The AWMSG issued positive recommendations for all PLE appraisals included in the data collected, and these were endorsed by the Welsh Government. Appraisals that went through the original PLE process (n=56) took a mean 229.8 days (standard deviation 55.6), whereas those that went through the simplified PLE process (n=15) took a mean 102.6 days (standard deviation 48.1; p < 0.0001). The rapid access to children’s medicines was welcomed by the Association of the British Pharmaceutical Industry and the Royal College of Paediatrics and Child Health.

Review of the 2020 and 2023 PLE processes facilitated faster access to clinically effective and cost-effective medicines for children in Wales. In March 2023, the AWMSG and the Welsh Government reviewed these results and agreed that because all PLE medicines were approved for use within Wales irrespective of the process used, the AWMSG would no longer be required to routinely appraise PLEs.

A collaborative evaluation of remote consultations in mental health services was undertaken by mental health service providers, experts by experience, academic institutions and a Health Innovation Network in south London, UK. ‘Learning healthcare systems’ thinking was applied. Workstream 1 reviewed international published evidence; workstream 2 synthesised findings from three health provider surveys of the perceptions and experiences of staff, patients and carers; and workstream 3 comprised an electronic survey on local projects.

Remote consultations can be acceptable to patients and staff. They improve access for some while restricting access for others, with digital exclusion being a key concern. Providing tailored choice is key.

The collaboration generated learning to inform choices by healthcare providers to embed or adapt remote delivery. A key output was freely downloadable survey questions for assessing the quantity and quality of appointments undertaken by phone or video or face to face.

In response to the COVID-19 pandemic, we rapidly implemented a plasma coordination center, within two months, to support transfusion for two outpatient randomized controlled trials. The center design was based on an investigational drug services model and a Food and Drug Administration-compliant database to manage blood product inventory and trial safety.

A core investigational team adapted a cloud-based platform to randomize patient assignments and track inventory distribution of control plasma and high-titer COVID-19 convalescent plasma of different blood groups from 29 donor collection centers directly to blood banks serving 26 transfusion sites.

We performed 1,351 transfusions in 16 months. The transparency of the digital inventory at each site was critical to facilitate qualification, randomization, and overnight shipments of blood group-compatible plasma for transfusions into trial participants. While inventory challenges were heightened with COVID-19 convalescent plasma, the cloud-based system, and the flexible approach of the plasma coordination center staff across the blood bank network enabled decentralized procurement and distribution of investigational products to maintain inventory thresholds and overcome local supply chain restraints at the sites.

The rapid creation of a plasma coordination center for outpatient transfusions is infrequent in the academic setting. Distributing more than 3,100 plasma units to blood banks charged with managing investigational inventory across the U.S. in a decentralized manner posed operational and regulatory challenges while providing opportunities for the plasma coordination center to contribute to research of global importance. This program can serve as a template in subsequent public health emergencies.

Doctors completing on-call shifts at sites across a mental health trust identified a need to improve aspects of on-call work. This quality improvement project (QIP) aimed to improve response to trainee concerns arising from on-call work and support to junior doctors on-call.

A previous QIP cycle identified trainee concerns regarding on-call processes. In our first QIP cycle, surveys were sent to all consultants and SpRs working on non-residential on-call rotas, and Foundation, GP and Core Psychiatry trainees (on residential on-call rotas) in the Trust, regarding perceptions of on-call processes, senior support and on-call issues. A monthly, online forum was introduced in August 2023 to improve on-call feedback and communication. Trainees, consultants and SpRs from 2 localities were invited, along with representatives from the medical staffing team, medical education team and medical management. After 4 forums, participants who had attended an on-call forum were sent a further feedback survey collecting quantitative and qualitative data. Subsequently, forum frequency and scheduling were amended, advertisement improved, and the forum was expanded to include on-call doctors across the whole Trust.

First cycle data revealed consultant support for a regular meeting with trainees and senior colleagues to bring issues from on-calls for discussion (56% felt that an on-call forum would be helpful, 33% felt it might be helpful). Mean forum attendance was 14, with attendance from all grades. Feedback data from trainees (5 responses) was that most found the forum useful (80%); 80% felt listened to; all felt able to raise concerns, and all wanted the forums to continue. Qualitative feedback included: ‘we started a new QI project from the forum and many on-call guidelines became more defined.’ Consultant feedback (4 responses) was that most found the forums useful (75%); 100% gained a better understanding of trainee concerns; 100% thought forums should continue, although 50% thought the frequency should be reduced. Most consultants and trainees did not feel it would be useful to discuss clinical cases in the forums. Consultant qualitative feedback reported that the forum was helpful to understand trainee concerns, but there should be wider attendance.

Establishing an on-call forum was a valuable intervention for both consultants and trainees working on an on-call rota and has led to a further quality improvement project. Respondents felt that clinical supervision offered sufficient space to discuss clinical cases. Increasing trainee and consultant engagement with the forum is the next phase of this project.