Use of Naltrexone in Internet Gaming Disorder

INTRODUCTION: Internet Gaming Disorder (IGD) is a condition characterised by maladaptive use of internet for playing video games having negative consequences on individual’s functioning. DSM-5 includes IGD under conditions proposed for further study while ICD-11 proposes a diagnosis of Gaming Disorder (GD). Prevalence varies from 0.2% to 34%. The literature about treatment of IGD is limited to few studies of bupropion, escitalopram & naltrexone (only case report). We present a case of IGD treated with naltrexone along with CBT. CASE DETAILS: A 15-year-old male, presented with complaints of increased time spent on playing computer games, decline in academics and personal care, irritability when not allowed to play games and difficulty in stopping playing games once initiated since last 1 ½ years. Diagnosis of IGD was considered. Internet Gaming Disorder Scale – Short Form (IGDS9-SF) score was 37. Naltrexone was initiated along with CBT. Adolescent showed improvement and IGDS9-SF score decreased to 20 over a period of 3 months. Adolescent is maintaining improvement on follow up. CONCLUSION: Currently, prevalence & treatment of IGD are topics of interest for clinicians worldwide. The limited literature shows partial response to bupropion and escitalopram. The adolescent in our case responded well to naltrexone. The possible neurobiology, role of opioid receptors and naltrexone in IGD is discussed. Future studies regarding neurobiology and pharmacological treatment of IGD may be considered. Clozapine Resistant Schizophrenia augmented with Electroconvulsive Therapy-a Case Report Dr.B.Ramachandrababu pg Dr Ahalya Asst professor Dr poornachandrika professor Dr pp kannan professor. INTRODUCTION: schizophrenia patients with poor response to antipsychotics and even clozapine need Electro convulsive therapy for augumentation to get adequate therapeutic response. CASE REPORT: Mr S,48yrs male brought by his brother on oct2020 with complaints of talking to self,poor self care,reduced sleep and appetite, withdrawn from others,sudden screaming outbursts,irritability, continues illness from 2013 with waxing and waning course with no significant improvement to antipsychotics on examination Patient ambulant,unkempt and untidy with poor rapport,restricted affect, communicate with gestures,paucity of thought and Auditory hallucinations.His initial BPRS 72 and BUSH FRANCIS catatonic score 26 patient treated with Lorazepam and antipsychotics In adequate dose and duration[T.Risperidone 6mg,T.Haloperidol 20 mg,T.Aripiprazole 20 mg,T.Olanzepine 20 mg] shows poor response,later T.Clozapine alone and with atypical antipsychotic augumentation [risperidone and amisulpride] had mild improvement with BPRS 54, BFCS 18.But soon patient relapsed On Feb 2021,along with clozapine–modified bitemporal Electro convulsive therapy given at 6 sittings.patient shows significant reduction in psychotic and catatonic symptoms with BPRS 32 and BFCS 14 after ECT, another 6 sittings of ect given at august 21, patient shows significant improvement with BPRS18 and BFCS < than 10.so planned maintanance ect initially once in a week for 6 weeks then once in two weeks. Now his catatonic or negative or psychotic symptoms significantly improved.now he helping in ward works,had good self care and goes ITC regularly