ATTITUDE OF SCHIZOPHRENICS TO COMPUTER VIDEOGAMES.

Trabajo publicado en la revista Psychopathology.

Sergio Samoilovich, Ph.D.*; Carlos Riccitelli M.D.; Adriana Schiel M.Sc.; Agustín Siedi, M.D.

Fundación de Investigaciones Psiquiátricas Pueyrredón 2478  4º "C" (1119) Buenos Aires, Argentina. Running head: Schizophrenics and videogames.

Acknowledgement: We thank the help of Dr. Ricardo Picasso of the José T. Borda Neuropsychiatric Hospital - Buenos Aires.

*: Research Fellow of the National Scientific and Technological Research Council of Argentina (CONICET).

                                                                     ABSTRACT.

            We investigated the initial attitude of 10 chronic, defected schizophrenic patients to a computer videogame session. Six of them enjoyed the experience and wanted to repeat it. Cooperation and performance were compared between videogames and a standard psychometric test (WAIS). Videogame performance correlated with the execution test IQ more than with the verbal test IQ. Computer games could be useful in these patients for evaluation of attitudes and responses, psychologic testing, motivation and reward.

                                                                 INTRODUCTION.

            With the increasing use of personal computers, the psychology of computing shows as a broad, new field of research. Psychiatric patients can have interaction with the machine through data collection [1], testing [2] and even psychotherapy [3]. Computer assisted interviewing can be accepted by patients and their relatives, in spite of initial resistance [1]. In patients  with attention difficulties, computer videogames improved scanning and tracking abilities [4]. Computer videogames were informally used in a psychiatric service to facilitate communication with nursing personnel [5]. Videogames can trigger epileptic seizures [6] and cause overt pathologic addiction [7], but these adverse effects are relatively rare.

            Psychologic factors that define acceptance or rejection of computers are little known, in spite of the wide computerizing trend in modern society. Chronic schizophrenics have low volition, low communication and spontaneous activity levels. If they were attracted to videogames as most normal individuals are, it could be given diagnostic and therapeutic roles: evaluation of attitudes and responses, psychologic testing, motivation and reward. It is not known whether schizophrenics have a particular attitude to computer games, or if addiction and adverse effects can occur. Here we report the initial attitude of a group of chronic schizophrenic inpatients to computer videogames.

                                                         MATERIALS AND METHODS.

  Patients:

            Patients were selected in a male chronic case unit of the José T. Borda Neuropsychiatric Hospital in Buenos Aires. They all had chronic schizophrenia with defect. They were compensated with standard maintenance medication of neuroleptics and ansiolytics. This unit is open but the patients have little chance for contact with the outside world. None of them had ever used videogames before.

            Three subjects were used as a control for the videogames sessions: a doctor, a nurse and a psychologist.

Interview:

            We evaluated the clinical condition, focusing on activity, volition and initiative levels. A standard psychometric test (WAIS, [8]) was used for testing verbal and execution IQ.

Computer videogame session:

            Individual play sessions took place. An IBM compatible monochrome computer was loaded with Pacman, Breakout and Tetris, three popular games chosen for being simple and visually attractive. One researcher explained and demonstrated each game and invited the subject to play while other took notes. At the end of the session, every patient was asked: Did you like the games? Dig you ever saw anything like this? Can you describe the games? Would you like to play some other time?.

Collaboration and performance:

            We rated collaboration with WAIS test and with the videogames session between 0 (no cooperation) and 5 (active participation). Performance in the WAIS test is expressed as an IQ. Videogame performance was rated from 0 (no cooperation) and 5 (average score in the game).

                                                                        RESULTS.

            The results of the WAIS test are shown in Figures 1 and 2. Only five out of ten (5/10) patients did cooperate until completion of the test. Results were consistent with chronic schizophrenia with different degrees of defect.

            Patients cooperated better with videogames than with the psychometric test or with the daily activities in their unit. Attitude of patients towards videogames was positive, sometimes with spontaneous comments and questions reflecting surprise or enthusiasm. We did not observe adverse reactions as a result of the game session.  

            Performance in videogames was poor: either they did not understand the purpose of the game, did not relate the keyboard input with the monitor output, or forgot the functions of the keys. They also had trouble describing the games after playing with them. Videogame performance showed good correlation with the execution part of the WAIS test, and poor correlation with the verbal part of the test, or with age.

            The three control subjects actively collaborated in the game session. Contrary to the schizophrenic patients they looked anxious and pressured to win when confronted with the machine.

                                                                     DISCUSSION.

              These results show that chronic schizophrenic patients can get interested in videogames more than in other games or activities.

            Compared to a standard psychometric test, videogames allowed a shorter and easier evaluation of psychomotor activity. Repeated evaluation by videogames or videogame-like tests will probably be welcome by the subjects, thus allowing the measure of learning curves and the effect of therapy.

            The videogames used here required visual and motion coordination, speed, attention, concentration, anticipation  and planning. All these abilities were diminished in our subjects. It is possible to choose videogames requiring different abilities, or to design them specifically for testing purposes. As testing methods, videogames are unique: they all have a build-in scoring method, are self-administered, and have automatic change of difficulty level.

            Four subjects showed no interest in repeating the game session, but did not cooperate with the psychometric test either. None of the patients looked anxious or frightened by the computer.

Color and sound could further increase the attractive of videogames for abulic patients.

            Considered as labor or game therapy, the games were attractive, safe and easy to monitor, even in defected patients. The value of continued use of videogames in individual or group sessions merits to be investigated.

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