Gaming Disorder in First Episode Psychosis: Prevalence and Impact on Symptomatology and Functioning in a Prospective...

First-episode psychosis (FEP) often coincides with comorbidities that hinder recovery. Gaming disorder (GD) has emerged as a potential concern; however, data on its prevalence and clinical impact in FEP populations remain limited. We hypothesized that GD would be more prevalent among individuals with FEP than in the general population and associated with more severe psychotic symptoms and poorer functional outcomes.

In this prospective cohort study, 284 consecutive patients aged 18-35 years admitted to an Early Intervention Service in Quebec, Canada, were assessed for GD using International Classification of Diseases-11 criteria, with up to 24 months follow-up. Psychotic symptoms and functioning were measured at baseline and at 6-month intervals using the Positive and Negative Syndrome Scale-6 items (PANSS-6) and the Social and Occupational Functioning Assessment Scale (SOFAS).

Gaming disorder was present in 7.04% (95% CI: [4.35%, 10.67%]) of the sample, exceeding the 3.3% general population estimates. Among the 105 patients who reported gaming at least monthly, those with GD (n = 20) more often played Massively Multiplayer Online Role-Playing Games, while non-GD gamers (n = 85) preferred action-adventure games. GD was associated with significantly higher PANSS-6 scores (P = .04), driven by elevated negative symptoms (P = .04). SOFAS scores were consistently lower among individuals with GD, with effect sizes increasing over time.

Gaming disorder is a prevalent and clinically meaningful comorbidity in FEP, linked to greater negative symptom burden and functional impairment. These findings support the need for systematic GD screening in early psychosis services and highlight the importance of developing tailored interventions.