OBJECTIVE:The aim of the present study was to provide clinical consensus and evidence regarding initial treatment strategies for the pharmacological treatment of social anxiety disorder (SAD) in Korea.METHODS:We prepared a questionnaire to derive a consensus from clinicians regarding their preference for the pharmacological treatment of SAD in Korea. Data regarding medication regimens and psychotropic drugs used during initial treatment, the doses used, and the pharmacological treatment duration were obtained. Responses were obtained from 66 SAD experts, and their opinions were classified into three categories (first-line, second-line, third-line) using a chi-square analysis.RESULTS:Clinicians agreed upon first-line regimens for SAD involving monotherapy with selective serotonin reuptake inhibitors (SSRIs) or the serotonin-norepinephrine reuptake inhibitor (SNRI) venlafaxine, or combined therapy using antidepressants with betablockers or benzodiazepines on a standing or as-needed basis. First-line psychotropic drug choices for initial treatment included the following: escitalopram, paroxetine, sertraline, venlafaxine, and propranolol. The medication dosage used by domestic clinicians was found to be comparable with foreign guidelines. Domestic clinicians tended to make treatment decisions in a shorter amount of time and preferred a similar duration of maintenance treatment for SAD when compared with foreign clinicians.CONCLUSION:This study may provide significant information for developing SAD pharmacotherapy guidelines in Korea, especially in the early stage of treatment.

Objective The pathophysiology of social anxiety disorder (SAD) is not yet well understood, but previous research has suggested that oxytocin is associated with social behavior and may play a role in human anxiety states and anxiety-related traits. The aim of this study was to investigate the possible relationship between social anxiety symptoms and plasma oxytocin levels. Methods Twenty-three male patients with SAD and 28 healthy male controls participated in this study. All participants were assessed using the Mini International Neuropsychiatric Interview (MINI) and the Liebowitz Social Anxiety Scale (LSAS). Multivariate regression analysis was performed to identify associations between plasma oxytocin levels and SAD. Results In multiple regression models, after controlling for age and years of education, we found that higher oxytocin levels were significantly associated with higher total LSAS scores (R-2=0.157, coefficient=0.145, 95% CI=-0.0005-0.291, p=0.051) and fear subscale scores (R-2=0.134, coefficient=0.083, 95% CI=0.007-0.159, p=0.034) in the SAD group. Conclusion In this study, increased plasma oxytocin levels were associated with higher social anxiety symptoms among SAD patients, but not among controls. This might be because among SAD patients, higher oxytocin (OT) secretion is an insufficient compensatory attempt to reduce social anxiety symptoms.

Objective: Social anxiety disorder (SAD) shows relatively delayed responses to pharmacotherapy when compared to other anxiety disorders. Therefore, more effective early therapeutic decisions can be made if the therapeutic response is predictable as early as possible. We studied whether the therapeutic response at 12 weeks is predictable based on the early improvement with escitalopram at 1 week.Methods: The subjects were 28 outpatients diagnosed with SAD. The subjects took 10-20 mg/day of escitalopram. The results of the Liebowitz social anxiety scale (LSAS), Hamilton anxiety rating scale, and Montgomery-Asberg depression rating scale were evaluated at 0, 1, 4, 8, and 12 weeks of treatment. Early improvement was defined as a >= 10% reduction in the LSAS total at 1 week of treatment, and endpoint response was defined as a >= 35% reduction in the LSAS total score. The correlation between clinical characteristics and therapeutic responses was analyzed by simple linear regression. The correlation between early improvement responses and endpoint responses was analyzed by multivariate logistic regression analysis and receiver operating characteristic curves.Results: When we adjusted the influence of a >= 35% reduction in the LSAS total endpoint score on a >= 10% reduction of the LSAS total score at 1 week of treatment for the patients' age, the early improvement group at 1 week of treatment was expected to show stronger endpoint responses compared to the group with no early improvement.Conclusion: The results suggest that a >= 10% reduction in the LSAS total score in a week can predict endpoint treatment response.

MethodsZZA total of 49 women in the late luteal phase participated in this study. The psychiatric symptoms were assessed by Hamilton Rating Scale for Depression, State Trait Anxiety Inventory, and Menstrual Distress Questionnaire. Eating symptoms were assessed using the Dutch Eating Behavior Questionnaire and cocoa intake experiment. Estradiol, progesterone, and leptin were collected through venous blood.

Background: Longer treatment duration is important for the successful treatment of gambling disorder (GD). This retrospective study investigated the factors and interventions that might enhance treatment duration in GD patients in South Korea.Methods: A total of 758 outpatients with a primary diagnosis of GD, who were treated in a clinical practice from 2002 to 2011, were assessed by retrospective chart review. We compared the treatment duration according to pharmacotherapy and group cognitive behavioral therapy (CBT).Results: Pharmacotherapy contributed to a longer duration of treatment maintenance, despite the patients' gambling severity (p < 0.001). Participation in group CBT (p < 0.001) and antidepressants (p = 0.009) were associated with a longer treatment duration after adjusting for age, depression, and gambling severity. The treatment maintenance duration was the longest in those receiving combined antidepressant pharmacotherapy and group CBT (F = 35.79, p < 0.001).Conclusions: Group CBT and antidepressants seem to enhance treatment follow-up duration in GD patients. Additional studies are needed to advance GD prevention and treatment strategies.

Background and Aims To date, few studies have examined the clinical manifestation of disordered gamblers in financial markets. This study examined the differences in the clinical and treatment-related features of gambling disorder between financial markets and horse races. Methods Subjects who met the DSM-IV criteria for pathological gambling (PG) and who sought treatment were assessed by retrospective chart review. One hundred forty-four subjects were included in this sample, which consisted of the following groups: financial markets (n = 45; 28.6%) and horse races (n = 99; 71.4%). Results Multiple similar manifestations were found between the groups, including severity of PG, age of PG onset, amounts of gambling debts, drinking days per week, depressive mood, duration of seeking treatment after the onset of PG, and treatment follow-up duration. However, disordered gamblers who invested in the financial market were significantly more likely to be educated (p = 0.003), live with their spouses (p = 0.007), have full-time jobs (p = 0.006), and they were more likely to participate in the first type of gambling than the horse races group (p<0.001). Furthermore, the financial markets group received the anti-craving medication less often than the horse races group (p = 0.04). Discussion and Conclusions: These findings suggest that disordered gamblers in financial markets show different socio-demographic, clinical and treatment-related features compared with the horse race gamblers, despite a similar severity of gambling disorder. Understanding these differential manifestations may provide insight into prevention and treatment development for specific types of gambling.

The menstrual cycle is an example of a human infradian rhythm, but an altered sleep-wake cycle or a disrupted circadian rhythm can change the regularity of the menstrual cycle. In this study, we investigated whether an irregular menstrual cycle is associated with polymorphisms in the CLOCK (3111T > C) and/or PER3 (variable number tandem repeat, VNTR) genes, which are known to have an impact on the circadian rhythm. One hundred ninety-seven postmenarchal, adolescent girls from two girls' high schools in Seoul, Korea, were studied. All participants were requested to complete the Perceived Stress Scale (PSS), the State-Trait Anxiety Inventory (STAI), and the Beck Depression Inventory (BDI) to assess the emotional distress that might cause menstrual irregularity. Every participant donated a blood sample from which DNA was extracted and genotyped for the CLOCK 3111T > C and PER3 VNTR polymorphisms. A significant association was found between the CLOCK 3111T > C genotype and irregular menstrual cycles. Subjects with the 3111T > C genotype had a high risk of an irregular menstrual cycle compared with 3111T/T homozygous subjects (odds ratio [OR] = 2.88; 95% confidence interval [CI]: 1.26-6.55). When multivariate logistic regression analysis was performed to adjust for age, PSS, STAI, BDI and BMI, subjects with the 3111T > C polymorphism showed a significantly increased OR for irregular menstrual cycles (OR = 3.09; 95% CI: 1.32-7.21). There was no significant association between the PER3 VNTR polymorphism and the irregularity of the menstrual cycle (p > 40.05). The results of this study suggest that the CLOCK 3111T > C polymorphism could be an independent risk factor for irregular menstrual cycles, irrespective of psychological distress and endocrine or metabolic conditions, and could be used as a molecular marker for gynecological studies on this aspect.

The aim of this study was to examine the patterns of use and perceived helpfulness of self‐help interventions for depressive symptoms and sub‐threshold depression in Korean samples drawn from the general population, patients with depression, and psychiatrists. A total of 1000 adults from the community, 114 patients with sub‐threshold or mild depression, and 201 psychiatrists were asked to complete questionnaires about the use and helpfulness of 20 self‐help interventions for depression chosen via the Delphi method. Psychiatrists (82.6%) and the general population (67.2%) were more likely to prefer self‐help methods than were patients with depressive disorders (28.4%). Lifestyle change and psychological approaches were the preferred interventions among those with depressive disorders. Although the general population was more likely to prefer to use health supplements and dietary interventions, the perceived helpfulness of these approaches was generally lower than that of the other interventions. Although self‐help strategies have been widely used, psychiatrists, patients with depression, and the general population differ with respect to their preferred intervention. Members of the general population were more likely than were psychiatrists and patients to use not consensually accepted interventions. The evidence‐based use of self‐help strategies for depression should be promoted by providing information about their effectiveness. Copyright © 2014 John Wiley & Sons, Ltd.

명지병원 신경과*, 아주대학병원 정신건강의학과†, 명지병원 정신과‡, 공공의료사업단§, 예술치유센터¶ The Effect of Group Musical Therapy on Depression and Activities on Daily Living in Patients with Cognitive Decline Hyun Jeong Han, M.D.*, Sang Joon Son, M.D.†, Juwon Ha, M.D.‡, Jee Hee Lee§, Sun Ae Kim, RN*, So Young Lee, Ph.D. Department of Neurology*, Myongji Hospital, Goyang; Department of Psychiatry†, Ajou University School of Medicine, Suwon; Department of Psychiatry‡, Department of Public Health and Healthcare Service§, Center of Arts and Healing¶, Myongji Hospital, Goyang, Korea

OBJECTIVES:This study examined differences in the clinical and treatment-related features of pathological gambling (PG) on the basis of the age of PG onset among pathological gamblers who sought treatment. METHODS:A total of 702 male outpatients with a primary diagnosis of PG and who were treated in a clinical practice were assessed by retrospective chart review. We selected the age of 25 years and younger as the threshold for "group 1." We then stratified the participants into 4 groups on the basis of the age of PG onset in 10-year intervals. Analysis of covariance with a covariant of age and the Pearson χ test were used for analyses. RESULTS:We found that the earlier-onset gamblers were less likely to be escape type (P < 0.05), used significantly more Internet-based gambling (P < 0.001), and were less likely to engage in nonstrategic gambling (P < 0.05) than the later-onset gamblers. In addition, the earlier-onset gamblers took anticraving medication, such as naltrexone, significantly more often (P < 0.05), and sought treatment significantly more slowly after the onset of PG than the later-onset group (P < 0.01). Regarding adherence to treatment, however, there was no significant difference among the 4 groups on the basis of the age of PG onset. CONCLUSIONS:The age of PG onset is associated with several important clinical and treatment features. More studies are needed to advance prevention and treatment strategies for each age group.

Objectives: This study examined differences in the clinical and treatment-related features of pathological gambling (PG) on the basis of the age of PG onset among pathological gamblers who sought treatment. Methods: A total of 702 male outpatients with a primary diagnosis of PG and who were treated in a clinical practice were assessed by retrospective chart review. We selected the age of 25 years and younger as the threshold for “group 1.” We then stratified the participants into 4 groups on the basis of the age of PG onset in 10-year intervals. Analysis of covariance with a covariant of age and the Pearson χ2 test were used for analyses. Results: We found that the earlier-onset gamblers were less likely to be escape type (P < 0.05), used significantly more Internet-based gambling (P < 0.001), and were less likely to engage in nonstrategic gambling (P < 0.05) than the later-onset gamblers. In addition, the earlier-onset gamblers took anticraving medication, such as naltrexone, significantly more often (P < 0.05), and sought treatment significantly more slowly after the onset of PG than the later-onset group (P < 0.01). Regarding adherence to treatment, however, there was no significant difference among the 4 groups on the basis of the age of PG onset. Conclusions: The age of PG onset is associated with several important clinical and treatment features. More studies are needed to advance prevention and treatment strategies for each age group.

Objective With respect to the pharmacotherapy of social anxiety disorder (SAD), it has been suggested that treatment duration is an important factor that can significantly predict responses. The present study aimed to compare the treatment adherence of SAD patients who were taking either SSRIs or reversible inhibitors of MAO-A (moclobemide) by measuring treatment duration and all-cause discontinuation rates of pharmacotherapy in a natural clinical setting. Methods We retrospectively analysed the data of 172 patients diagnosed with SAD. Depending on their medication, we divided the patients into two groups, SSRI (n=54) or moclobemide (n=118). The expected number of all-cause discontinuation every 2 weeks after starting treatment was calculated by life table survival methods. A multi-variable Cox proportional hazard regression was used to analyze the potential influence of explanatory variables. Results Treatment duration was significantly longer in the SSRI group [46.41±56.96, median=12.0 (weeks)] than in the moclobemide group [25.53±34.74, median=12.0 (weeks), Z=2.352, p=0.019]. Overall, all-cause discontinuation rates were significantly lower with SSRIs (81%) than moclobemide (96%, χ2=4.532, p=0.033). Conclusion The SSRI group had a longer treatment duration and lower all-cause discontinuation rate than moclobemide. Further, only the type of medication had a significant effect on all-cause discontinuation rates and therefore, we could predict better treatment adherence with the SSRIs in the treatment of SAD.

Jin-Seong Park, MD, Juwon Ha, MD, Sewon Lim, MD, PhD, Tae-Suk Kim, MD, PhD, Jee Hyun Ha, MD, PhD, Jong-Woo Paik, MD, PhD, Boung Chul Lee, MD, PhD, Byeong Moo Choe, MD, PhD, Kang-Joon Lee, MD, PhD, Sung-Wan Kim, MD, PhD, Jong-Chul Yang, MD, PhD, Young-Hoon Ko, MD, PhD and Kang-Seob Oh, MD, PhD 1 Department of Psychiatry, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea Department of Psychiatry, The Catholic University of Korea College of Medicine, Seoul, Korea Department of Psychiatry, School of Medicine, Konkuk University, Seoul, Korea Department of Psychiatry, School of Medicine, Kyung Hee University, Seoul, Korea Department of Psychiatry, Hallym University College of Medicine, Seoul, Korea Departments of Psychiatry, Dong-A University College of Medicine, Busan, Korea Department of Psychiatry, Ilsanpaik Hospital, Inje University College of Medicine, Goyang, Korea Department of Psychiatry, Chonnam National University Medical School, Hwasun, Korea Department of Psychiatry, Chonbuk National University Medical School, Jeonju, Korea Department of Psychiatry, Korea University College of Medicine, Seoul, Korea

Jin-Seong Park, MD, Juwon Ha, MD, Sewon Lim, MD, PhD, Tae-Suk Kim, MD, PhD, Jee Hyun Ha, MD, PhD, Jong-Woo Paik, MD, PhD, Boung Chul Lee, MD, PhD, Byeong Moo Choe, MD, PhD, Kang-Joon Lee, MD, PhD, Sung-Wan Kim, MD, PhD, Jong-Chul Yang, MD, PhD, Young-Hoon Ko, MD, PhD and Kang-Seob Oh, MD, PhD 1 Department of Psychiatry, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea Department of Psychiatry, The Catholic University of Korea College of Medicine, Seoul, Korea Department of Psychiatry, School of Medicine, Konkuk University, Seoul, Korea Department of Psychiatry, School of Medicine, Kyung Hee University, Seoul, Korea Department of Psychiatry, Hallym University College of Medicine, Seoul, Korea Departments of Psychiatry, Dong-A University College of Medicine, Busan, Korea Department of Psychiatry, Ilsanpaik Hospital, Inje University College of Medicine, Goyang, Korea Department of Psychiatry, Chonnam National University Medical School, Hwasun, Korea Department of Psychiatry, Chonbuk National University Medical School, Jeonju, Korea Department of Psychiatry, Korea University College of Medicine, Seoul, Korea

Objective : Individuals with anxiety disorders experience a wide range of time to seeking treatment (TST) as well as various comorbid mental disorders. The present study examined the TST in social anxiety disorder (SAD) and panic disorder. This study aimed to find out the influence of comorbid menta...