JRSM >
Volume 94, Number 4 >
Pp. 184-185
Heathfields, 30 Denmark Road, Gloucester GL1 3HZ, UK
1
University of Bristol Division of Psychiatry, 41 St Michael's Hill, Bristol
BS2 8DZ
2
Psychopharmacology Unit, School of Medical Sciences, University of Bristol,
Bristol BS8 1TD
Correspondence to: Dr Rachel Forsyth E-mail: samnbunny{at}cableinet.co.uk
Patients with schizophrenia have described being controlled by and entwined with the Internet1,2, and others have perceived themselves to be characters in a film, with life played out for the cameras3. We have found no report of a computer game as the basis for a delusion.
CASE HISTORY
A young man was admitted from prison to a psychiatric facility after reports that he had been acting in a bizarre manner. He had been arrested for stealing motor vehicles and assaults with weapons. At interview he was found to be experiencing the delusion that he was a player inside a computer game (adult-certificate game, widely available) in which points are scored for stealing cars, killing assailants and avoiding police vehicles. Psychotic symptoms had emerged slowly over two years. His family had noticed him becoming increasingly withdrawn and isolated from social activities. He developed delusions that strangers were planning to kill him and also experienced auditory hallucinations, constantly hearing an abusive and derogatory voice. Previously a computer enthusiast, he began to play computer games incessantly. He felt that the games were communicating with him via the headphones. In a complex delusional system he came to believe he was inside one of these games and had to steal a car to start scoring points. He broke into a car and drove off at speed, believing he had `invulnerable' fuel and so could not run out of petrol. To gain points he chose to steal increasingly powerful vehicles, threatening and assaulting the owners with weapons. Later he said he would have had no regrets if he had killed someone, since this would have increased his score.
After arrest and while in prison he continued to believe he was in the game, despite initial medication. When he was admitted to hospital six weeks later, part of ward management was to deny him access to computer games. Nothing abnormal was found on physical examination, blood investigations, drug screen, electroencephalography or a computed tomographic brain scan. Paranoid schizophrenia was diagnosed and he responded well to further treatment with antipsychotic medication.
COMMENT
Schizophrenia is characterized by abnormalities of thinking, perception and emotion.4 Paranoid schizophrenia is the commonest subtype and initial symptoms typically include bizarre delusions, auditory hallucinations and interference with thinking. In the chronic form, blunting of emotion, social withdrawal and avolition can become more obvious. Age at onset is usually the late twenties or early thirties with equal distributions between the sexes. Current cultural beliefs have been consistently found to determine the content of delusions in schizophrenia5. Often the background is religious (`I am God') but a common secular delusion is that of being pursued by secret agents.
In this report we are not suggesting that computer games can be the cause of psychosis; but it does seem likely that, with the growing use of computers for relaxation, game scenarios will be incorporated increasingly into delusional systems. A worrying aspect is that, in many of these games, points are scored for acting violently or even killing. If the game is transposed into the real word by a delusional state, the risk of subsequent violence is high—particularly if violence is not perceived to be illegal or morally wrong.
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