Gabriel Thorens

Case report of a patient with GAD and claustrophobia who underwent exposure therapy using psilocybin-assisted psychotherapy. The patient had failed to respond to conventional psychotherapeutic treatment. After three sessions of psilocybin-assisted psychotherapy, the patient experienced a reduction in anxiety and fear associated with closed spaces, elevators, and planes. The protocol included both an imaginary exposure exercise and a classic exposure therapy in an elevator during the psilocybin-assisted psychotherapy. the patient experienced a significant improvement in his score on the Beck Depression Inventory-II (BDI-II), the State-Trait Anxiety Inventory (STAI), and the Fear Questionnaire before and after therapy. He reported a generalization of the treatment effects, feeling more relaxed and having a greater willingness to confront fearful situations. He also described a shift in his perception of fearful stimuli, which may be explained as the development of new memory representations and a major disconfirmatory experience.

Capitalizing upon the Attractive and Addictive Properties of Massively Multiplayer Online Role-Playing Games to Promote Wellbeing

Controversies remain about the validity of the diagnosis of problematic Internet use. This might be due in part to the lack of longitudinal naturalistic studies that have followed a cohort of patients who self-identify as having Internet-related problems. This retrospective study included 57 patients who consulted the Geneva Addiction Outpatient Clinic from January 1, 2007, to January 1, 2010. Patients underwent an initial clinical psychiatric evaluation that included collection of data on socio-demographics, method of referral, specific Internet usage, psychiatric diagnosis, and Internet Addiction Test (IAT) and Clinical Global Impression Scale (CGI) scores. Treatment consisted of individual psychotherapeutic sessions. Of these patients, 98% were male and 37% were 18 years or younger. Most patients were online gamers (46% playing massively multiplayer online role-playing games). The mean IAT score was 52.9 (range 20-90). Sixty-eight percent of patients had a co-morbid psychiatric diagnosis, with social phobia being the most prevalent (17.8%). Patients who remained in treatment (dropout rate 24%) showed an overall improvement of symptoms: 38.6% showed significant or average improvement on their CGI score, 26.3% showed minimal improvement, and 14% showed no change. Our results support the hypothesis that there are specific types of Internet use, with online gaming mainly affecting young male patients. As Internet addiction is not yet an official diagnosis, better instruments are needed to screen patients and to avoid false-negative and false-positive diagnoses. Successful care should integrate the treatment of co-morbid symptoms and involve families and relatives in the therapeutic process.

In December 2007, the Division of Addictology, Department of Psychiatry, Geneva University Hospitals, decided to stop prescribing disulfiram. The healthcare team’s perception of this decision was monitored. A self-administered questionnaire (31 questions) was completed by the healthcare team in June 2009 over a 3-month period to evaluate their perception of the utility of disulfiram and of the pertinence of the decision to stop prescribing it. Fifty-five participants responded (61.1%), of whom 54.1% were women (mean age = 43.7 years), 54.8% were nurses, 30.6% were medical doctors, 9.7% were social workers, and 4.8% were psychologists. Of this group, 78.7% were working on the team in December 2007. The results showed that 54.6% did not agree with the decision to stop prescribing disulfiram. Although 72.2% thought that the decision was based on evidence-based medicine (EBM), 69.1% thought that disulfiram works because of the context of administration and 69.1% because of the fear generated by its effects. Among the participants, 75.5% still believed that disulfiram is useful for some patients (76.8% at the time of the decision). Despite the fact that aversive treatment in addictology has failed to demonstrate efficacy through EBM, the perception of its utility is still strong in caregivers. Although most caregivers acknowledge that aversive treatment works mainly through psychological constraints, they do not support the fact that EBM could generate a practice change such as discontinuing the prescription of disulfiram.

Background: Football (soccer) is one of the most popular sports in the world, including Europe. It is associated with important betting activities. A common belief, widely spread among those who participate in gambling activities, is that knowledge and expertise on football lead to better prediction skills for match outcomes. If unfounded, however, this belief should be considered as a form of “illusion of control.” The aim of this study was to examine whether football experts are better than nonexperts at predicting football match scores. Methods: Two hundred and fifty-eight persons took part in the study: 21.3% as football experts, 54.3% as laypersons (non-initiated to football), and 24.4% as football amateurs. They predicted the scores of the first 10 matches of the 2008 UEFA European Football Championship. Logistic regressions were carried out to assess the link between the accuracy of the forecasted scores and the expertise of the participants (expert, amateur, layperson), controlling for age and gender. Results: The variables assessed did not predict the accuracy of scoring prognosis (R² ranged from 1% to 6%). Conclusions: Expertise, age, and gender did not appear to have an impact on the accuracy of the football match prognoses. Therefore, the belief that football expertise improves betting skills is no more than a cognitive distortion called the “illusion of control.” Gamblers may benefit from psychological interventions that target the illusion of control related to their believed links between betting skills and football expertise. Public health policies may need to consider the phenomenon in order to prevent problem gambling related to football betting.

Substance use disorders seem to be an under considered health problem amongst the elderly. The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST), was developed by the World Health Organization to detect substance use disorders. The present study evaluates the psychometric properties of the French version of ASSIST in a sample of elderly people attending geriatric outpatient facilities (primary care or psychiatric facilities).

World of Warcraft (Wow) is the leading online role playing game with an average total reaching 10 million players all over the world in December 2008. We launched an investigation to collect information and content related to alcohol mentioned in Wow. As a result we found that alcohol is depicted in a rather humorous and convivial manner. Alcohol has no central role in Wow but is present in all places in the game where you can buy food and drink and there are no warnings regarding the harmful effects of alcohol. Video games such as Wow might be a way for the alcohol industry to promote alcohol consumption and bypass legislations related to age limits and advertisement restrictions.

Topiramate is one of the currently most promising compounds in the field of addiction medicine. This paper discusses its potential utility related to a phase model of addiction development, focusing on the assumption that addiction is a continuous process involving different neurobiological pathways, depending on the stage of addiction. A specific emphasis will be made on the development of dysfunctional automatic behaviors in the late stage of addiction and the central role of glutamate and AMPA receptors. The aim is to propose that if too broad an effect of anti-addiction medication is expected (such as anti-craving, anti-relapse and preventive effects), the results might be disappointing. The speculative specific efficacy of topiramate in addiction is described.

Aims To investigate the beliefs and attitudes of Swiss general psychiatrists toward Internet addiction. Methods Ninety-fourth Swiss psychiatrists filled out a questionnaire at a conference of general psychiatry assessing their views on the concept of Internet addiction, their evaluation methods and treatment procedures they use. Results A cluster analysis revealed three groups: DISBELIEVERS (N = 20) rejected the concept of Internet addiction and its importance, not considering it a real clinical problem and consequently not considering the existence of a specific treatment. The NOSOLOGY BELIEVERS (N = 66) and NOSOLOGY/TREATMENT BELIEVERS (N = 8) assumed that Internet addiction is a real problem. While NOSOLOGY/TREATMENT BELIEVERS asserted the availability of effective treatment (mainly psychological), NOSOLOGY BELIEVERS were less affirmative regarding treatment. Conclusion Thought the concept of Internet addiction is largely acknowledged as a clinical reality by Swiss psychiatrists, routine screening and treatment remain uncommon, mainly due to the belief that efficient treatment is still lacking.