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Dr Forsyth and colleagues describe a patient with delusional involvement in a computer game scenario (April 2001 JRSM, pp. 184-185). Such cases may be understood within a broader context—the content of psychotic phenomenology incorporating elements of the patient's psychosocial environment, while the form of a psychotic symptom (e.g. ‘delusion’) represents an underlying biological ‘signal’1,2. In 1993 we reported a patient with paranoid schizophrenia whose auditory hallucinations derived from a computer game. These hallucinations underwent delusional interpretation, the patient believing that they ‘meant’ she was homeless3. In that report we predicted that ‘similar cases will arise as video games become more widely accessible’3.