Doctors discuss gaming addictions

Dr. Ryan Edwards

In June 2018, the World Health Organization released its 11th International Classification of Diseases (ICD) book. For the first time, gaming addiction will be listed as a mental health condition. The book describes it as a pattern of persistent or recurrent gaming behavior so severe that it takes “precedence over other life interests.” The classification suggest that abnormal gaming behavior should be in evidence over a period of a year for a diagnosis to be assigned but added that the period might be shortened if symptoms are severe. Symptoms include impaired control over gaming (frequency, intensity, duration), increased priority given to gaming, and continuation or escalation of gaming despite negative consequences.

“Everybody has been seeing this coming for a long time,” said Dr. Ken Zoucha, Addiction Division Director at UNMC. “It doesn’t surprise me at all. I think this gaming thing is going to end up also being related to electronic devices, the internet, and social media. Everybody can see this coming, and we are watching people who are spending hours and hours all night on the internet.”

UNMC Child and Adolescent Psychiatrist Dr. Ryan Edwards said gaming addiction is still a controversial diagnosis, but parents should still make sure their children aren’t spending too much time on gaming.

‘If parents have concerns that their children are dropping friends or dropping activities and instead playing video game too much,” Dr. Edwards said. “They should be evaluated to see if there are no other metal health disorders contributing. Often times, kids who come in for complaints of internet addiction often times have underlying symptoms of anxiety or depression. It’s rarely just an internet gaming addiction. If we see an internet gaming addiction, we make sure there are not other mental health concerns.”

According to the World Health Organization, the inclusion of gaming disorder will allow treatment programs to be developed for people dealing with the addiction.

Dr. Zoucha said despite the increased discussion and treatment for gaming addictions, people should still be able to play games.

“People enjoy games and they still go to work, take care of their family, and live their lives constructively,” Dr. Zoucha said. “But when we see symptoms affecting lives, we should get those people help.”

SPOTLIGHT: Andrea Rayner

Adult Crisis Unit and ECT Manager

Andrea Rayner started with Nebraska Medicine in Geriatric Psychiatry in July 1999. In 2003, Nebraska Medicine opened a small 10-bed adult unit, and Andrea was hired for that unit. After working on her masters, she became the unit manager for ACU and ECT in 2004.

What do you enjoy about working with the ACU and ECT?
I enjoy many aspects of working on the ACU and in ECT. The staff is great and we have terrific teamwork. Many of us have worked so long together that we have awesome relationships. We are able to trade off difficult assignments and there is a feeling of accomplishment each and every day. We have some of the highest Press Ganey survey results in the hospital even with a difficult patient population. Our patients will run up and hug us in other areas of the hospital when they see us! I feel that I am a part of a team that provides extraordinary care. I try to lead by example. I’m not afraid to jump in and help with patient care. I keep my feet wet and practice my nursing skills every other day in ECT (electroconvulsive therapy). I love seeing the patients getting better. Sometimes, I feel like I’m too busy and I try to give up working in ECT but I miss it too much. We build relationships with these patients and their families and they rely on our smiling faces when they come for their treatments.

What do your jobs entail?
Besides my managerial job duties, the jobs I enjoy entail taking care of the patients. On the ACU I lead groups explaining patient rights, teaching as well as assisting with discharge planning to the patients. I basically help with whatever the staff needs me to help with. In ECT I have more of a direct role in patient care. I assist with vital signs, starting IVs (I’m not very good), accessing ports, performing all of the duties in the treatment room, assisting with anesthesia as well as admitting and discharging patients.

Why did you go into the area of Psychiatry?
I went into Psychiatry because I have always been fascinated with mental illness. I tend to see the good in people and I think it is interesting to meet people who have overcome diversities or who are in a difficult spot recover quickly and get back on with their lives. I have good communication skills, I am approachable and it called out to me. I’ve always been a good listener and a quiet, shy person and perhaps that has helped me in my career choice. I won the Daisy Award twice which was completely unexpected. I felt that I was simply doing my job but somehow I made a connection with some special people along the way.

What are some of your hobbies?
Not much time for that! Two middle schoolers, Husker football, reading, concerts, pets and whatever else life throws at me that week

Learning the Lifespan

Fourth-year medical student Andrew Reuss sees patients at HICSA.

Sometimes it can be tough for a medical student to choose a specific area of psychiatry. To help with the decision, UNMC offers a four-week elective, which touches on four common areas of psychiatry.

Fourth-year medical students registered for the Lifespan elective will spend a week in the child and adolescent division, a week working with women’s health/perinatal care providers, a week helping patients on the adult psychiatry floor, and a week working with geriatric patients at the Home Instead Center for Successful Aging (HICSA) building. Students will have the opportunity to work with faculty and therapists in evaluating and treating patients. The Lifespan elective allows the students an opportunity to expand their psychiatric knowledge and skills with patients of all ages.

Andrew Reuss registered for the elective and just finished the four-week course with a week at HICSA.

“It’s crazy when you think about how much there is to go into being a psychiatrist, so I think this elective did a good job at providing me a general overview,” Reuss said. “Now, whoever comes through the clinic, I will feel comfortable working with them, kids and up.”

Reuss said he enjoyed the elective, especially working at HICSA with Dr. Thomas Magnuson.

“It was a really organized clerkship,” he said. “When I started, they had me scheduled for four weeks out. It was my responsibility to check my schedule and see who I would be seeing the following day, and if I did that, everything went smoothly.”

Fellow fourth-year Ian Parsley signed up for the Lifespan elective because he wanted more outpatient experience.

“I felt it would give me a lot of good exposure to outpatient psychiatry,” Parsley said. “I thought it was a great opportunity because I would get to work with adults, and get to work with pediatrics. I would see the entire spectrum.”

Parsley plans to go into research, possibly studying a patients first encounters with psychosis.


1991 UNMC Graduate returns to UNMC as Addiction Division Director

Dr. Ken Zoucha has returned to UNMC.

The 1991 University of Nebraska Medical Center graduate has been hired as the Director of the Addiction Division of the Psychiatry Department. When Dr. Zoucha considered applying for the new position, he remembered his time at UNMC.

“I just loved this place when I was here training,” said Dr. Zoucha, who also worked at UNMC as a resident in pediatrics. “I really enjoyed the educational environment. And every time I would come back here, come for conference or to see friends, it felt like home.”

Dr. Zoucha started as Addiction Division Director on August 1, 2018. Dr. Zoucha says he has a couple goals for the addiction division. First, he wants to develop a health service based on addiction medicine and solidify a consult/liaison service for inpatients with substance use disorders.

Dr. Zoucha will also tie UNMC and Nebraska Medicine’s addiction services with local substance abuse programs at Centerpointe Campus for Hope and the Stephen Center.

“I’m working to make connections with those folks who provide services, such as opioid treatment programs,” Dr. Zoucha said.

Additionally, Dr. Zoucha has begun plans to add an addiction medicine fellowship and an executive addiction fellowship.

“Our goal is to have the fellowships begin in the fall of 2019 or the fall of 2020,” he said.

Zoucha was a volunteer faculty member at UNMC from 1992-2010.

“I’m thrilled to be back here. I have a lot of good memories from my time at UNMC,” Dr. Zoucha said.