Discussion

This aims to improve our understanding of the relationship between GD and PD. It will be the first empirical study that explores this comorbidity, which has only been previously discussed in a few case reports. The results will not only confirm or refute the association between GD and PD, but also provide a more detailed description of the factors linking these two conditions and their consequences.
A notable strength of this study is the systematic screening procedure of GD that has been developed, which eliminates any detection bias and improves sensibility. All patients newly admitted to either of the two participating FEP programs will undergo the same screening process, irrespective of their disease progression and treatment history. This systematic approach is particularly crucial given the limited knowledge about the consequences of GD, which may be underestimated by both patients and clinicians. On completion of the study, the screening procedure for is expected to be implemented across all FEP programs in Quebec, and potentially in other regions in Canada as well.
The study’s large sample size and extended follow-up duration are also significant strengths, ensuring sufficient statistical power to generate meaningful findings. The lack of a consent requirement, combined with the diverse areas served by the two participating FEP programs, including urban and rural areas, ensures that the sample is representative of the FEP population in Quebec. Consequently, the findings are expected to be generalizable to all FEP programs in the province.
By collecting variables that are routinely documented by clinicians as part of their systematic clinical follow-up, the ecological validity of this study is further strengthened. The close collaboration between our research team and clinicians facilitates knowledge transfer and improves the quality of patient care.
The primary limitation of this research project lies in its dependence on clinician cooperation in adhering to the GD screening procedure, as we have no control over their clinical practices and prescribing patterns. However, we have implemented a monitoring committee to assess clinicians’ adherence to the GD screening process on a regular basis. Furthermore, all new clinicians joining the study receive comprehensive training in the utilization of this procedure. By considering these methodological aspects collectively, we anticipate that the results will substantially enhance our understanding of this understudied comorbidity.

Abbreviations

FEP: First-episode psychosis; GD: Gaming Disorder; DSM-5: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition; ICD-11: International Classification of Diseases, 11thEdition; PANSS: Positive and Negative Syndrome Scale; CGI: Clinical Global Impression Scale; SOFAS: Social and Occupational Functioning Assessment Scale; REDCap: Research Electronic Data Capture

Aknowledgements

The authors are thankful to the clinical staff working at the 2 study sites for their precious collaboration and their unwavering dedication to patients’ recovery.

Authors contributions

MHL conceptualized the study, developed the screening and assessment procedure for GD implemented it at both study sites, wrote the original draft, reviewed, and edited the final draft. CD and OC wrote the original draft, reviewed and edited the final draft. OC, LB, EF, SB, AME, CD contributed to data collection, reviewed and edited the final draft. CT managed the grant funding and coordinated research activity. ZAAH and JR reviewed the final draft for accuracy, clarity, coherence. AAB supervised the conduct of the study at site #2. YK and IG provided input in developing the screening and assessment procedure for GD, critically reviewing and editing the original draft. MAR and MFD supervised the conduct of the study at site #1, supervised all stages of the study, and critically reviewed and edited the original draft. MFD coordinated responsibility for the grant funding. All authors reviewed and approved the final draft.

Funding

This project is supported by a Mitacs Grant (IT34510). MHL is also supported by the Frederick Banting and Charles Best Canada Graduate Scholarship Doctoral Awards from the Canadian Institute of Health Research (FID-172598). The funders played no role in this study, and we have no restrictions regarding the submission of this protocol for publication.

Data availability

Not applicable.