Bipolar Duygudurum Bozukluğunda Problemli İnternet Kullanımı: Klinik Bir Risk Alanı
Özet
Bu bölüm, bipolar duygudurum bozukluğunda (BDB) problemli internet kullanımını (PİK) güncel literatür ışığında klinik bir risk alanı olarak ele almaktadır. İlk olarak PİK’in tanımı, kavramsal çerçevesi, nosolojik tartışmaları, nörobiyolojik ve bilişsel mekanizmaları ile epidemiyolojik özellikleri gözden geçirilmektedir. Ardından BDB bağlamında PİK’in klinik önemi; bipolar alt tipler, dijital davranış profili, dürtüsellik, duygu düzenleme güçlükleri, ödül sistemi işlevleri ve eşlik eden risk faktörleri üzerinden tartışılmaktadır. Bölümde, problemli internet kullanımının yalnızca yoğun ekran süresi ile sınırlı olmadığı; uyku bozuklukları, işlevsellik kaybı, anksiyete, travmatik yaşantılar ve tedavi uyumu gibi klinik alanlarla çok boyutlu ilişkiler taşıdığı vurgulanmaktadır. Ayrıca klinik değerlendirme, izlem, psikoeğitim, psikososyal müdahaleler ve dijital fenotipleme gibi güncel yaklaşımlar ele alınmaktadır. Mevcut kanıtlar, PİK’in bipolar bozuklukta bağımsız bir tanı kategorisinden çok, klinik seyri ve yaşam kalitesini etkileyebilecek transdiyagnostik bir risk alanı olarak değerlendirilmesinin daha uygun olduğunu düşündürmektedir.
This chapter examines problematic internet use (PIU) in bipolar disorder (BD) as a clinically relevant risk domain within the framework of current literature. It begins by outlining the definition of PIU, its conceptual and nosological considerations, as well as its neurobiological, cognitive, and epidemiological characteristics. The chapter then explores the clinical relevance of PIU in BD, focusing on bipolar subtypes, digital behavior patterns, impulsivity, emotion regulation difficulties, reward system sensitivity, and associated risk factors. Particular emphasis is placed on the notion that problematic internet use extends beyond excessive screen time and should instead be understood as a multidimensional behavioral pattern linked to sleep disturbances, functional impairment, anxiety symptoms, traumatic experiences, and treatment adherence. In addition, contemporary approaches to clinical assessment and follow-up are discussed, including psychoeducation, psychosocial interventions, and emerging digital phenotyping strategies. Overall, current evidence suggests that PIU in bipolar disorder is best conceptualized not as an independent diagnostic category but as a transdiagnostic clinical risk domain that may influence illness course, relapse vulnerability, and quality of life.
Referanslar
Grande I, Berk M, Birmaher B, et al. Bipolar disorder. The Lancet. 2016;387(10027):1561–1572. doi:10.1016/S0140-6736(15)00241-X.
de Azevedo Cardoso T, Kochhar S, Torous J, et al. Digital tools to facilitate the detection and treatment of bipolar disorder: Key developments and future directions. JMIR Mental Health. 2024;11:e58631. doi:10.2196/58631.
Baloğlu M, Şahin R, Arpaci I. A review of recent research in problematic internet use: Gender and cultural differences. Current Opinion in Psychology. 2020;36:124–129. doi:10.1016/j.copsyc.2020.05.008.
Dahl D, Bergmark KH. Problematic internet use: A scoping review of longitudinal research on a contemporary social problem, 2006–2017. Nordic Studies on Alcohol and Drugs. 2020;37(6):497–525. doi:10.1177/1455072520941997.
Gioia F, Rega V, Boursier V. Problematic internet use and emotional dysregulation among young people: A literature review. Clinical Neuropsychiatry. 2021;18(1):41–54. doi:10.36131/cnfioritieditore20210104.
Oliva V, Fico G, De Prisco M, et al. Bipolar disorders: An update on critical aspects. The Lancet Regional Health – Europe. 2024;48:101135. doi:10.1016/j.lanepe.2024.101135.
Carmassi C, Bertelloni CA, Cordone A, et al. Problematic use of the internet in subjects with bipolar disorder: Relationship with posttraumatic stress symptoms. Frontiers in Psychiatry. 2021;12:646385. doi:10.3389/fpsyt.2021.646385.
Oluğ ST, Balaban ÖD, Gül Ö, et al. The relationship of internet, social media, and related technology use with disease severity and functionality in individuals with serious mental disorders. Archives of Neuropsychiatry. 2024;61:1–9. doi:10.29399/npa.28315.
Montag C, Elhai JD. Discussing digital technology overuse in the context of addiction: A closer look at problematic internet use. Current Opinion in Psychology. 2020;36:44–48. doi:10.1016/j.copsyc.2020.04.006.
Brand M, Wegmann E, Stark R, et al. The interaction of person–affect–cognition–execution (I-PACE) model for addictive behaviors: Update, generalization, and future directions. Neuroscience and Biobehavioral Reviews. 2020;104:1–10. doi:10.1016/j.neubiorev.2019.08.032.
Ko CH, Liu TL, Wang PW, et al. Altered brain activation during response inhibition and error processing in subjects with internet gaming disorder. Journal of Psychiatric Research. 2021;138:1–9. doi:10.1016/j.jpsychires.2021.03.012.
Volkow ND, Koob GF, McLellan AT. Neurobiologic advances from the brain disease model of addiction. The New England Journal of Medicine. 2016;374(4):363–371. doi:10.1056/NEJMra1511480.
Yuan K, Qin W, Liu Y, et al. Internet addiction: Neuroimaging findings. Communicative & Integrative Biology. 2011;4(6):637–639. doi:10.4161/cib.17871.
Pan YC, Chiu YC, Lin YH. Systematic review and meta-analysis of the epidemiology of internet addiction. Neuroscience and Biobehavioral Reviews. 2020;118:612–622. doi:10.1016/j.neubiorev.2020.08.013.
Cheng C, Li AY. Internet addiction prevalence and quality of (real) life: A meta-analysis of 31 nations across seven world regions. Cyberpsychology, Behavior, and Social Networking. 2014;17(12):755–760. doi:10.1089/cyber.2014.0317.
Ioannidis K, Treder MS, Chamberlain SR, et al. Problematic internet use as an age-related multifaceted problem: Evidence from a two-site survey. Addictive Behaviors. 2018;81:157–166. doi:10.1016/j.addbeh.2018.02.017.
Dalbudak E, Evren C. The relationship of internet addiction severity with attention deficit hyperactivity disorder symptoms in Turkish university students. Psychiatry Research. 2014;219(3):577–582. doi:10.1016/j.psychres.2014.06.036.
Dong H, Yang F, Lu X, et al. Internet addiction and related psychological factors among children and adolescents during the COVID-19 epidemic. Frontiers in Psychiatry. 2020;11:751. doi:10.3389/fpsyt.2020.00751.
Elhai JD, Levine JC, Dvorak RD, et al. Problematic smartphone use: A conceptual overview and systematic review of relations with anxiety and depression psychopathology. Journal of Affective Disorders. 2017;207:251–259. doi:10.1016/j.jad.2016.08.030.
Lam LT. Internet gaming addiction, problematic use of the internet, and sleep problems: A systematic review. Current Psychiatry Reports. 2014;16(4):444. doi:10.1007/s11920-014-0444-1.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Washington, DC: American Psychiatric Association; 2013.
American Psychiatric Association. DSM-5-TR: Diagnostic and Statistical Manual of Mental Disorders. 5th ed., text revision. Washington, DC: American Psychiatric Association; 2022.
World Health Organization. International Classification of Diseases 11th Revision (ICD-11). Geneva: World Health Organization; 2019.
Young KS. Internet addiction: The emergence of a new clinical disorder. CyberPsychology & Behavior. 1998;1(3):237–244. doi:10.1089/cpb.1998.1.237.
Demetrovics Z, Szeredi B, Rózsa S. The three-factor model of Internet addiction: The development of the Problematic Internet Use Questionnaire. Behavioral Research Methods. 2008;40(2):563–574. doi:10.3758/BRM.40.2.563.
Chen SH, Weng LJ, Su YJ, et al. Development of a Chinese Internet Addiction Scale and its psychometric study. Chinese Journal of Psychology. 2003;45:279–294.
Saccaro LF, Amatori G, Cappelli A, et al. Portable technologies for digital phenotyping of bipolar disorder: A systematic review. Journal of Affective Disorders. 2021;295:323–338. doi:10.1016/j.jad.2021.08.052.
Antosik-Wójcińska AZ, Dominiak M, Chojnacka M, et al. Smartphone as a monitoring tool for bipolar disorder: A systematic review including data analysis, machine learning algorithms and predictive modelling. International Journal of Medical Informatics. 2020;138:104131. doi:10.1016/j.ijmedinf.2020.104131.
Liu JY, Xu KK, Zhu GL, et al. Effects of smartphone-based interventions and monitoring on bipolar disorder: A systematic review and meta-analysis. World Journal of Psychiatry. 2020;10(11):272–285. doi:10.5498/wjp.v10.i11.272.
Anmella G, Faurholt-Jepsen M, Hidalgo-Mazzei D, et al. Smartphone-based interventions in bipolar disorder: Systematic review and meta-analyses of efficacy (ISBD Big Data Task Force). Bipolar Disorders. 2022;24(6):580–614. doi:10.1111/bdi.13243.
Lagan S, Ramakrishnan A, Lamont E, et al. Digital health developments and drawbacks: A review and analysis of top-returned apps for bipolar disorder. International Journal of Bipolar Disorders. 2020;8(1):39. doi:10.1186/s40345-020-00202-4.
Patoz MC, Hidalgo-Mazzei D, Pereira B, et al. Patients’ adherence to smartphone apps in the management of bipolar disorder: A systematic review. International Journal of Bipolar Disorders. 2021;9(1):19. doi:10.1186/s40345-021-00224-6.
Keramatian K, Chithra NK, Yatham LN. The CANMAT and ISBD guidelines for the treatment of bipolar disorder: Summary and a 2023 update of evidence. Focus. 2023;21(4):344–353. doi:10.1176/appi.focus.20230009.
Park JH, Fernando K, Lee JG, et al. Global perspectives on bipolar disorder treatment: In-depth comparative analysis of international guidelines for medication selection. BJPsych Open. 2024;10(3):e75. doi:10.1192/bjo.2024.27.
Miklowitz DJ, Efthimiou O, Furukawa TA, et al. Adjunctive psychotherapy for bipolar disorder: A systematic review and component network meta-analysis. JAMA Psychiatry. 2021;78(2):141–150. doi:10.1001/jamapsychiatry.2020.2993.
Sá RRC, Coelho S, Parmar PK, Johnstone S, Kim HS, Tavares H. A systematic review of pharmacological treatments for internet gaming disorder. Psychiatry Investigation. 2023;20(8):696–706. doi:10.30773/pi.2022.0297.
Goulding EH, Dopke CA, Rossom R, et al. Effects of a smartphone-based self-management intervention for individuals with bipolar disorder on relapse, symptom burden, and quality of life: A randomized clinical trial. JAMA Psychiatry. 2023;80(2):109–118. doi:10.1001/jamapsychiatry.2022.4304.
Referanslar
Grande I, Berk M, Birmaher B, et al. Bipolar disorder. The Lancet. 2016;387(10027):1561–1572. doi:10.1016/S0140-6736(15)00241-X.
de Azevedo Cardoso T, Kochhar S, Torous J, et al. Digital tools to facilitate the detection and treatment of bipolar disorder: Key developments and future directions. JMIR Mental Health. 2024;11:e58631. doi:10.2196/58631.
Baloğlu M, Şahin R, Arpaci I. A review of recent research in problematic internet use: Gender and cultural differences. Current Opinion in Psychology. 2020;36:124–129. doi:10.1016/j.copsyc.2020.05.008.
Dahl D, Bergmark KH. Problematic internet use: A scoping review of longitudinal research on a contemporary social problem, 2006–2017. Nordic Studies on Alcohol and Drugs. 2020;37(6):497–525. doi:10.1177/1455072520941997.
Gioia F, Rega V, Boursier V. Problematic internet use and emotional dysregulation among young people: A literature review. Clinical Neuropsychiatry. 2021;18(1):41–54. doi:10.36131/cnfioritieditore20210104.
Oliva V, Fico G, De Prisco M, et al. Bipolar disorders: An update on critical aspects. The Lancet Regional Health – Europe. 2024;48:101135. doi:10.1016/j.lanepe.2024.101135.
Carmassi C, Bertelloni CA, Cordone A, et al. Problematic use of the internet in subjects with bipolar disorder: Relationship with posttraumatic stress symptoms. Frontiers in Psychiatry. 2021;12:646385. doi:10.3389/fpsyt.2021.646385.
Oluğ ST, Balaban ÖD, Gül Ö, et al. The relationship of internet, social media, and related technology use with disease severity and functionality in individuals with serious mental disorders. Archives of Neuropsychiatry. 2024;61:1–9. doi:10.29399/npa.28315.
Montag C, Elhai JD. Discussing digital technology overuse in the context of addiction: A closer look at problematic internet use. Current Opinion in Psychology. 2020;36:44–48. doi:10.1016/j.copsyc.2020.04.006.
Brand M, Wegmann E, Stark R, et al. The interaction of person–affect–cognition–execution (I-PACE) model for addictive behaviors: Update, generalization, and future directions. Neuroscience and Biobehavioral Reviews. 2020;104:1–10. doi:10.1016/j.neubiorev.2019.08.032.
Ko CH, Liu TL, Wang PW, et al. Altered brain activation during response inhibition and error processing in subjects with internet gaming disorder. Journal of Psychiatric Research. 2021;138:1–9. doi:10.1016/j.jpsychires.2021.03.012.
Volkow ND, Koob GF, McLellan AT. Neurobiologic advances from the brain disease model of addiction. The New England Journal of Medicine. 2016;374(4):363–371. doi:10.1056/NEJMra1511480.
Yuan K, Qin W, Liu Y, et al. Internet addiction: Neuroimaging findings. Communicative & Integrative Biology. 2011;4(6):637–639. doi:10.4161/cib.17871.
Pan YC, Chiu YC, Lin YH. Systematic review and meta-analysis of the epidemiology of internet addiction. Neuroscience and Biobehavioral Reviews. 2020;118:612–622. doi:10.1016/j.neubiorev.2020.08.013.
Cheng C, Li AY. Internet addiction prevalence and quality of (real) life: A meta-analysis of 31 nations across seven world regions. Cyberpsychology, Behavior, and Social Networking. 2014;17(12):755–760. doi:10.1089/cyber.2014.0317.
Ioannidis K, Treder MS, Chamberlain SR, et al. Problematic internet use as an age-related multifaceted problem: Evidence from a two-site survey. Addictive Behaviors. 2018;81:157–166. doi:10.1016/j.addbeh.2018.02.017.
Dalbudak E, Evren C. The relationship of internet addiction severity with attention deficit hyperactivity disorder symptoms in Turkish university students. Psychiatry Research. 2014;219(3):577–582. doi:10.1016/j.psychres.2014.06.036.
Dong H, Yang F, Lu X, et al. Internet addiction and related psychological factors among children and adolescents during the COVID-19 epidemic. Frontiers in Psychiatry. 2020;11:751. doi:10.3389/fpsyt.2020.00751.
Elhai JD, Levine JC, Dvorak RD, et al. Problematic smartphone use: A conceptual overview and systematic review of relations with anxiety and depression psychopathology. Journal of Affective Disorders. 2017;207:251–259. doi:10.1016/j.jad.2016.08.030.
Lam LT. Internet gaming addiction, problematic use of the internet, and sleep problems: A systematic review. Current Psychiatry Reports. 2014;16(4):444. doi:10.1007/s11920-014-0444-1.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Washington, DC: American Psychiatric Association; 2013.
American Psychiatric Association. DSM-5-TR: Diagnostic and Statistical Manual of Mental Disorders. 5th ed., text revision. Washington, DC: American Psychiatric Association; 2022.
World Health Organization. International Classification of Diseases 11th Revision (ICD-11). Geneva: World Health Organization; 2019.
Young KS. Internet addiction: The emergence of a new clinical disorder. CyberPsychology & Behavior. 1998;1(3):237–244. doi:10.1089/cpb.1998.1.237.
Demetrovics Z, Szeredi B, Rózsa S. The three-factor model of Internet addiction: The development of the Problematic Internet Use Questionnaire. Behavioral Research Methods. 2008;40(2):563–574. doi:10.3758/BRM.40.2.563.
Chen SH, Weng LJ, Su YJ, et al. Development of a Chinese Internet Addiction Scale and its psychometric study. Chinese Journal of Psychology. 2003;45:279–294.
Saccaro LF, Amatori G, Cappelli A, et al. Portable technologies for digital phenotyping of bipolar disorder: A systematic review. Journal of Affective Disorders. 2021;295:323–338. doi:10.1016/j.jad.2021.08.052.
Antosik-Wójcińska AZ, Dominiak M, Chojnacka M, et al. Smartphone as a monitoring tool for bipolar disorder: A systematic review including data analysis, machine learning algorithms and predictive modelling. International Journal of Medical Informatics. 2020;138:104131. doi:10.1016/j.ijmedinf.2020.104131.
Liu JY, Xu KK, Zhu GL, et al. Effects of smartphone-based interventions and monitoring on bipolar disorder: A systematic review and meta-analysis. World Journal of Psychiatry. 2020;10(11):272–285. doi:10.5498/wjp.v10.i11.272.
Anmella G, Faurholt-Jepsen M, Hidalgo-Mazzei D, et al. Smartphone-based interventions in bipolar disorder: Systematic review and meta-analyses of efficacy (ISBD Big Data Task Force). Bipolar Disorders. 2022;24(6):580–614. doi:10.1111/bdi.13243.
Lagan S, Ramakrishnan A, Lamont E, et al. Digital health developments and drawbacks: A review and analysis of top-returned apps for bipolar disorder. International Journal of Bipolar Disorders. 2020;8(1):39. doi:10.1186/s40345-020-00202-4.
Patoz MC, Hidalgo-Mazzei D, Pereira B, et al. Patients’ adherence to smartphone apps in the management of bipolar disorder: A systematic review. International Journal of Bipolar Disorders. 2021;9(1):19. doi:10.1186/s40345-021-00224-6.
Keramatian K, Chithra NK, Yatham LN. The CANMAT and ISBD guidelines for the treatment of bipolar disorder: Summary and a 2023 update of evidence. Focus. 2023;21(4):344–353. doi:10.1176/appi.focus.20230009.
Park JH, Fernando K, Lee JG, et al. Global perspectives on bipolar disorder treatment: In-depth comparative analysis of international guidelines for medication selection. BJPsych Open. 2024;10(3):e75. doi:10.1192/bjo.2024.27.
Miklowitz DJ, Efthimiou O, Furukawa TA, et al. Adjunctive psychotherapy for bipolar disorder: A systematic review and component network meta-analysis. JAMA Psychiatry. 2021;78(2):141–150. doi:10.1001/jamapsychiatry.2020.2993.
Sá RRC, Coelho S, Parmar PK, Johnstone S, Kim HS, Tavares H. A systematic review of pharmacological treatments for internet gaming disorder. Psychiatry Investigation. 2023;20(8):696–706. doi:10.30773/pi.2022.0297.
Goulding EH, Dopke CA, Rossom R, et al. Effects of a smartphone-based self-management intervention for individuals with bipolar disorder on relapse, symptom burden, and quality of life: A randomized clinical trial. JAMA Psychiatry. 2023;80(2):109–118. doi:10.1001/jamapsychiatry.2022.4304.
