de Investigaciones Psiquiátricas
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).
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.
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 , testing  and even
psychotherapy . Computer assisted interviewing can be accepted by patients
and their relatives, in spite of initial resistance . In patients
with attention difficulties, computer videogames improved scanning and
tracking abilities . Computer videogames were informally used in a
psychiatric service to facilitate communication with nursing personnel .
Videogames can trigger epileptic seizures  and cause overt pathologic
addiction , 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.
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
Three subjects were used as a control for the videogames sessions: a
doctor, a nurse and a psychologist.
We evaluated the clinical condition, focusing on activity, volition and
initiative levels. A standard psychometric test (WAIS, ) 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).
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.
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
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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