Reactive disorder is a group of diagnosis with a definitely known etiology and whose etiological factor is essential to the diagnosis. In DSM system, such reactive disorders are listed as adjustment disorder, acute stress disorder, brief psychotic disorder with marked stressor and posttraumatic stress disorder (PTSD). However, a growing number of individuals is suffering from a prolonged feeling of embitterment after exceptional negative life events and this condition could be diagnosed neither PTSD nor adjustment disorder nor depressive disorder in the context of DSM-IV diagnostic system. This clinical condition can be described as 'posttraumatic embitterment disorder' (PTED). PTED is a reactive disorder triggered by exceptional, though normal negative life events such as conflict in the workplace, unemployment, death of a relative, divorce, severe illness, or experience of loss or separation. The common feature of such events is that they are experienced as unjust, as a personal insult, accompanied by psychological violation of basic beliefs and values. The central psychopathological response pattern in PTED is a prolonged feeling of embitterment. In particular, the core emotion of embitterment can lead to the rejection of treatment. Therefore, "wisdom therapy" as a new treatment approach specifically designed for PTED has been developed. It is assumed that many patients suffering from PTED are often misunderstood and misdiagnosed. This review would help to introduce PTED into the clinical field in psychiatry.

Objective : Despite the high prevalence and clinical importance of panic disorder, studies on the clinical characteristics and course of panic disorder are relatively rare. This study is a multi-center, and retrospective study to examine the clinical characteristics and course of Korean panic disorder patients who visit university hospital. Methods : The study subjects were panic disorder patients who had visited the psychiatric outpatient clinics of 8 university hospitals in South Korea from January to December in 2008. Finally, 238 panic patients were included in this study. Their medical charts were retrospectively reviewed and reassessed by experienced psychiatrists to examine their clinical characteristics, demographic data and clinical course in repose to pharmacotherapy. Results : Among the 238 patients (121 males vs. 117 females), the mean age of disease onset was $41.3{\pm}12.7$ years and female patients showed 5 years older age of disease onset, compared with male patients. The mean score of PSR scale was $4.5{\pm}1.0$ at the first visit, reflecting a 'marked' level of severity of illness and impairment in functioning. Only 110 patients (46.4%) completed the whole follow up visits, whereas 128 patients (53.6%) dropped out during the treatment. After $17.7{\pm}0.5$ months of mean follow up period, the mean score of PSR scale at the last visit was reduced into $2.1{\pm}0.9$, reflecting a 'residual' severity of illness and impairment in functioning. The cumulative recovery rate was 62.1% in the completer group, whereas that of the drop-out group was 47.7%. Conclusions : The mean age of disease onset in Korean panic disorder patients who had visited university hospital was about 10 years older than that of Western panic disorder patients in previous studies, and the Korean panic disorder patients who had visited university hospital showed a relatively higher cumulative recovery rate. These differences might result from an ethnic difference in clinical characteristics and course in response to pharmacotherapy of panic disorder.

Objective : Panic disorders are frequently accompanied by major depressive disorder (MDD). There is insufficient information about which clinical factors in panic disorder are associated with comorbid MDD. The aim of this study is to identify clinical factors related with comorbid MDD in patients with panic disorder. Methods : Two experienced psychiatrists diagnosed panic disorder based on DSM-IV criteria. This diagnosis in the 275 subjects was confirmed again by Mini-International Neuropsychiatric Interview (MINI). Lifetime comorbid psychiatric diagnoses were examined by MINI. The Hamilton Depression Scale (HAMD), Hamilton Anxiety Scale (HAMA) and Panic Disorder Severity Scale (PDSS) were used to assess the severity of depressive, anxiety and panic symptoms. Results : The result of MINI showed that 95 patients (34%) with panic disorder satisfied the diagnosis of MDD. Multivariate logistic regression model showed that comorbid generalized anxiety disorder (GAD) and the symptom of "fear of losing control or going crazy" were associated with MDD in patients with panic disorder. In female patients, the "chills or hot flushes" symptom was also associated with comorbid MDD. Conclusion : These results showed that coexisting GAD and certain symptoms of panic are associated with comorbid MDD.

Objectives : This study aimed to investigate the associations between physical disorders and prevalent/incident suicidal ideation in a community dwelling older population aged 65 years or over. Methods : 1204 people aged 65 years or over evaluated at baseline. Suicidal ideation was identified using the questions from the community version of the Geriatric Mental State Schedule ("GMS B3"). Reported physical disorders covering 11 common and generally chronic health problems were ascertained. Covariates included were depression, age, gender, years of education, accommodation status, past occupation, and current occupation. Of 1066 without suicidal ideation at baseline, 805 (76%) were followed 2 years later, and incident suicidal ideation was evaluated. Results : Prevalent suicidal ideation was significantly associated with 4 of 11 physical disorders: eyesight problems, persistent cough, heart disease and paralysis or weakness in one leg or arm. Incident suicidal ideation was associated with 3 physical disorders: asthma, high blood pressure and paralysis or weakness in one leg or arm. Both prevalent and incident suicidal ideation were significantly associated with increased number of physical disorders. Conclusions : Certain physical disorders were comorbid and precipitating factors of suicidal ideation in elders. And appropriate intervention and treatment of physical disorders might prevent suicidal ideation in elderly.

Objective : This study was aimed to discover the correlation between those getting tattoos and their psychopathology relating to their delinquent behavior and emotional problems. Methods : Data for this study was collected from 19-year-old men who were receiving a physical examination for conscription at the Military Manpower Administration. 400 data sheets were collected among them. All of the subjects were evaluated on the following measures : sociodemographic variants, Juvenile delinquency scale, State-trait anger expression inventory, Beck depression inventory, State-trait anxiety inventory, and Positive affect and negative affect schedule. Results : In comparison with those without tattoos, those with a tattoo scored higher in the scales that were related to delinquency, anger, depression, and negative emotion. Furthermore, there were positive correlations between the number of tattoos and the scores for the Juvenile delinquent tendency and behavior scale as well as on the, State-trait anxiety scale. Conclusion : Those with tattoos had experienced anger, anxiety and depression more strongly in comparison with those without tattoos. These results recommend that tattooed males should be evaluated more on their regarding psychopathology compared to those without tattoos.

Objective : Social Phobia is associated with extensive disability and reduced quality of life. The concept of 'social self' is a representation of the self-reflected in the eyes of others, and is recruited during self-face recognition, which is closely related to self-esteem. The aim of this study was to identify the relationship of face recognition for self and others using measures of social anxiety and self-esteem in patients with social phobia. Methods : Twenty-seven patients with social phobia and twenty-three normal controls were evaluated with scales of self-esteem, depression, anxiety and other psychiatric symptoms. All participants completed the self-face recognition task. Nine self-faces, nine other faces and eighty-one morphed faces were presented randomly for each trial. The participants were instructed to make a decision as to whether the stimuli were self-face or not. The responses and reaction times were recorded during the task. Results : There were no group differences of the morphing composition at the recognition start point as self-face. In patients with social phobia, the mean reaction time at the start point of recognizing as a self-face was 1,037.6 ms, which was significantly longer than that of normal controls (911.3 ms, p<0.05). Patients with social phobia showed a significant negative correlation between the mean reaction time and the severity of depression when the stimuli were recognized as a self-face (r=-0.421, p<0.05). Conclusion : A difficulty in attention rather than avoidance may be an important factor of face recognition in patients with social phobia. When considering self-face recognition in such patients, many factors, such as anxiety, depression, working memory and theory of mind, need to be considered.

Objective : The amygdala has been considered to be a critical region in the pathophysiology of social anxiety disorder, but subregional connectivity pattern has not been examined yet despite lots of previous functional neuroimaging studies. Methods : Resting-state functional magnetic resonance imaging data was obtained in 19 patients with social anxiety disorder and 20 normal controls, and default mode functional connectivity with each of basolateral, centromedial and superficial areas of the amygdala was measured and compared between the two groups. Results : Differential amygdala-based networks between the two groups were distributed to all over the brain. In particular, however, a bias on the amygdala-cingulate pathway was observed in the superficial amygdala only. Connectivity strengths between the superficial amygdala and perigenual anterior cingulate cortex were correlated with scores of social interaction and avoidance. Conclusion : Our findings provide new insights into understanding of the intrinsic cognitive bias model of social anxiety disorder. An abnormality in superficial amygdala-anterior cingulate connectivity may influence on cognitive processing of socially-relevant information in social anxiety disorder.

Objective : The purpose of this study is to develop the one-session positive psychology based strength enhancing workshop and verify effect of this program. This program is composed of lecture based on positive psychology and activities for identifying and utilizing personal character strengths. Methods : Total 81 participants were participated in this study. Positive Resources Test was assessed the change of personal positive resources at pre-, post program and subjective satisfaction for the workshop was measured at the post program. Repeated-t test was performed to identify the effect of this program. Results : Among the positive resources, satisfaction with life, positive affect, gratitude, acceptance, personal growth, efficacy, flow, resilience, hope, spirituality are significantly increased after program. Conclusion : Although this study is a single-session program without control group for comparison, it is meaningful to try a short-term intervention concise the program consisting of more than 8 sessions. This study will be based on the future development a variety of positive interventions.

Objective : To obtain the incidence rate of anxiety disorders among the active duty Korean military personnel, who visited the military hospitals from 2011 to 2013, this descriptive epidemiological study was performed. Methods : After acquiring the data for the anxiety disorders from Defense Medical Statistics Information System, the annual incidence rates were analyzed by forces, position status, and specific disease entities. Results : One thousand, nine hundred and thirteen (1,913) active duty male military personnel were diagnosed with any kinds of anxiety disorders in their first visit to the psychiatric outpatient department (OPD). The total OPD visit counts were 7,870 during the same period. Anxiety disorder, NOS was the most frequent disorder, followed by panic disorder. While the incidence rate for anxiety disorder, NOS decreased, panic disorder displayed increasing tendency. Stress-related disorders and obsessive-compulsive disorder were positioned third and fourth, respectively, for the number of first visit and they both showed decreasing tendency in annual incidence rates. Social anxiety disorder, specific phobias, generalized anxiety disorder (GAD) and mixed anxiety-depressive disorder followed next. The annual incidence rates for anxiety disorders showed decreasing tendency, particularly evident in army soldiers. However, naval officers showed higher anxiety disorder incidence rate compared to those of the army and the air forces. Conclusion : Comparing to general population, panic disorder was higher while specific phobias and GAD were lower in the Korean military. It is interesting to observe higher incidence rate for anxiety disorder in naval officers and warrants further evaluation.