Methods

Study design

This is a prospective multicenter cohort study, akin to our previous work [49], aiming to enroll a total of 800 patients who have been diagnosed with FEP and with follow-up periods of up to 3 years. The recruitment process began on November 1st, 2019, and will extend until November 1st, 2023. Throughout this period, all individuals admitted at the two designated sites will undergo comprehensive GD assessments by clinicians upon admission and subsequently every 6 months, using a specialized screening procedure developed exclusively for this study. During this follow-up period, that will conclude on May 1st 2024, the research team will extract independent variables from the patients’ medical records.

Study settings

This study is being conducted within 2 specialized programs for individuals experiencing FEP in the province of Quebec, Canada. These programs, which operate at multidisciplinary clinics, admit annually approximately 200 patients presenting a FEP. The patients are accompanied for up to 3 years on a case management approach that involves close collaboration between a psychiatrist and a designated case manager, who assumes the responsibility of overseeing and coordinating the patient’s care and services, and could include either psychologist, social works, occupational therapists, nurses and specialized educators.
Patients are also offered family intervention, individual psychotherapy and community outreach services during their follow-up period. The case managers offer an extensive systematic clinical follow-up, employing standardized questionnaires and involving input from the patients’ family members. All relevant clinical data derived from these activities are extensively documented in the patients’ medical records. No consent to participate in the study is required given the lack of any contact between the patients and the research staff.

Participants

During the recruitment period, all patients admitted at the two study sites will be included in the study. Clinic admission prerequisites necessitate individuals to be within the age range of 18 to 35 years, hold a primary diagnosis of FEP according to DSM-5 criteria (encompassing both affective and nonaffective psychoses, along with substance-induced psychotic disorder), and exhibit limited exposure to continuous antipsychotic treatment (i.e., six months or less). The only exclusions criteria are related to admittance criteria in the clinics, specifically, organic psychosis and moderate/severe intellectual disability.

Variables

The primary outcome is the prevalence of a GD diagnosis based on ICD-11 criteria established by the treating psychiatrist. As mentioned earlier, the evaluation of this outcome is conducted by the case managers and treating psychiatrists utilizing a specialized GD screening procedure designed explicitly for this study in collaboration with experts in GD and FEP. It is a 3-step procedure that includes: 1) a questionnaire for assessing video gaming habits (frequence and duration of gaming session) , 2) an evaluation of the severity of the gaming habits using theInternet Gaming Disorder Scale – Short Form (IGDS9-SF)[50] , and 3) a diagnostic interview assessing the ICD-11 gaming addiction diagnosis criteria. The patients’ case managers conduct the initial two steps, while the treating psychiatrist oversees the final step. The results of this procedure are documented in the patients’ medical records and subsequently extracted by the research staff. Variables that are related to the clinical manifestations of the FEP are documented using three standardized scales rated by treating psychiatrists every 6 months as part of the patients’ systematic follow-up. These variables are recorded in the patients’ medical files and extracted by the research staff. The severity of psychotic symptoms is measured using the “Positive and Negative Syndrome Scale ” (PANSS), which is a routinely used measure that allows clinicians to monitor the progression of symptoms in patients with psychotic disorders [51]. The PANSS-6, a shortened version that has excellent convergent validity with the original PANSS, will be used in this study [52]. The severity of the FEP will also be assessed using the “Clinical Global Impression – Severity ” (CGI-S) scale, which quantifies the clinical presentation of the disease using simple score ranging between 0 and 7[53, 54]. CGI-S scores have good correlation with PANSS scores [55]. Finally, the individual’s functioning level will be evaluated using the “Social and Occupational Functioning Assessment Scale ” (SOFAS), a graded 0-100 scale quantifying patients’ social and occupational functioning [56].
The research staff will extract various independent variables from the patients’ medical records, encompassing socio-demographic factors (such as sex at birth, gender identity, ethnicity, employment status, education level, relationship status, living arrangements, and criminal history) and other clinical variables (including the primary DSM-5 psychiatric diagnosis, comorbid DSM-5 psychiatric diagnoses, psychiatric hospitalizations, community treatment order, and medication treatment, which comprises antipsychotics and other psychotropic drugs like antidepressants, benzodiazepines, hypnotics, mood stabilizers, and psychostimulants). Regarding medication information, both current (during the follow-up period) and past (prior to admission in the clinics) medication details will be collected, encompassing dosages, frequency, and route of administration. A patient will be considered exposed to a medication after receiving it for more than one month (or one injection in the case of long-acting injectable antipsychotics). Medications administered on an as-needed basis will not be included in the analysis.