* Indian Journal of Psychiatry, 2002,44(3)293-296 •INTERNET DELUSION' RESPONSIVE TO COGNITIVE THERAPY HARPREET S. DUGGAL, JAGADHEESAN K. & S. HAQUE NIZAMIE ABSTRACT Delusions are known to be influenced by the popular media, the sociopolitical undercurrents and also by the scientific innovations. Internet is one such modern communication tool, which can easily be incorporated into the delusional system of patients by virtue of its semblance to some psychopathologicalphenomena. We describe a patient with paranoid schizophrenia who developed a delusion about the Internet controlling him but showed a good response to cognitive therapy. Keywords: Internet, delusions, cognitive therapy Internet has had a compelling influence on psychiatry. While some authors have eulogized its role in psychiatry in that it has simplified and automated the tasks of caring for patients (Huang & Alessi, 1996), others have been less generous about its impact on this clinical discipline. The later is exemplified by the much talked about syndrome of "Internet addiction', which in future, according to some authors, may even enter as a nosological entity in the diagnostic systems (Belsare et al., 1997; Stein, 1997). Adding to the downside of the Internet are the increasing number of reports of it being incorporated into the delusional system of psychiatric patients and also the development of de novo Internet delusions in previously healthy individuals (Kobayashi et al., 2001). However, this is in tandem with the knowledge that the content of delusions is influenced by the prevailing sociopolitical situation, the scientific innovations and also the popular media (Sher, 2000). We report a patient with paranoid schizophrenia who developed Internet delusion but fortunately showed a good response to cognitive therapy (CT). CASE REPORT The patient, a 31-year-old married male, was diagnosed with paranoid schizophrenia of ten years duration. He was educated till 10th standard and hailed from a lower-middle socioeconomic family with a suburban background His illness was characterized by persistent persecutory delusions, delusions of control, auditory and olfactory hallucinations and somatic passivity and these had remained mostly unchanged during the course of illness. A predominant theme underlying his psychopathology was his belief that he was being persecuted by his sister-in-law. He had failed trials with a number of conventional antipsychotics and thus clozapine was started but titration above 250 mg per day was precluded by EEG abnormalities. Over the last one year the patient had additionally developed the delusion that his sister- in-law, through the Internet, was controlling his thoughts and actions and also making him laugh and cry against his wishes. He elaborated that she would command the computer to send voices 293