Anxiety and anxiety disorders are related to many neurotransmitters, such as norepinephrine, serotonine, dopamine, glutamate, and Gamma-aminobutyric acid (GABA). GABA, the main inhibitory neurotransmitter of the CNS, is known to counterbalance the action of the excitatory neurotransmitters and control anxiety. GABA acts on 3 GABA receptor subtypes, $GABA_A$, $GABA_B$, and $GABA_C$. $GABA_A$ and $GABA_c$ receptors are oligomeric transmembrane glycoproteins composed of 5 subunits that are arranged around a central chloride channel. $GABA_B$ receptor comprises two 7-transmembraneis-spanning proteins that are coupled to either calcium or potassium channel via G proteins. This article highlights neurobiological interactions between anxiety and GABA system.

Depression, anxiety and stress are important components of theories of pathological gambling and are often foci of treatment with patients with gambling problems. In the present review we attempt to examine the relationship between anxiety, depression, stress and pathological gambling. Although the previous studies on this subject are limited and the relationship is unclear and complex, our review on the previous studies and clinical experiences on this subject could offer new insights for the assessment and treatment of pathological gamblers.

Objective : This study was designed to examine the volumetric abnormality of orbitofrontal cortex (OFC) and its change after 2 years of pharmacotherapy in obsessive compulsive disorder (OCD) patients. Method : Volumetric magnetic resonance imaging studies were conducted in 15 OCD patients and 13 normal volunteers. For 2 years, all patients took at least one serotonin reuptake inhibitor and atypical antipsychotics were used as an augmentation therapy in most patients. The follow-up MRI studies were conducted after the pharmacotherapy and OFC volumes were measured by the manual region of interest method. Results : Bilateral OFC volumes of 15 OCD patients were significantly greater than those of the normal volunteers before the treatment. After 2 years of the treatment, significant decrease was observed in bilateral OFC volumes of OCD patients to the extent that left OFC volume of OCD patients was not different from that of the normal volunteers. Conclusion : This finding suggests that OFC is directly related to the pathophysiology of obsessive compulsive disorder.

Object : Since autonomic nerve system dysfunction was known as the mechanism of panic disorder, many researchers used heart rate variability (HRV) as means of measuring autonomic nerve function of patients with panic disorder. We aimed to examine the effect of paroxetine medication for 3 months on symptom improvement and change of heart rate variability of the patients with panic disorder. Methods : The subjects were patients with panic disorder who visited the psychiatric outpatient clinic of Samsung Medical Center in Seoul. We included panic disorder patients who were aged from 20 to 50 and in normal BMI range (from 18 to 30) to minimize the effect of age and weight on HRV data. We excluded the patients with EKG abnormalities, hypertension or other major psychiatric disorders. They took 20-40 mg paroxetine medication a day for 3 months. Alprazolam was used only during the first month to control the acute panic symptoms and was tapered off after that. We measured the acute panic inventory (API), Hamilton rating scale for anxiety and depression (HAM-A & HAM-D), Spielberger state-trait anxiety inventory (STAIS, STAIT), and Beck depression inventory (BDI) in order to assess clinical improvement of the patients. And we measured time and frequency domain HRV in the resting, standing and cognitive stress states to assess the change of HRV. All measurements were done before and after paroxetine treatment. Result : After paroxetine medication, patients showed significant improvement in all psychiatric scales. In time domain of HRV, standard deviations of all R-R intervals (SDNN) were significantly increased in all states. In frequency domain of HRV, the ratio of high frequency to total power (HF/TP) in the standing state was significantly increased. Conclusion : After 3 months paroxetine medication, panic disorder patients showed significant clinical improvement and change in HRV data such as SDNN in all states and HF/TP ratio in the standing state. This result suggests that paroxetine medication is effective for the improvement of autonomic nerve system dysfunction in panic disorder patients.

Objectives : Only a few prospective studies of panic disorder are available. This study investigated naturalistic outcome of panic disorder patients at twelve months after the initial diagnosis. Methods : A total of 84 subjects were diagnosed with panic disorder by diagnostic interview, Structured Clinical Interview for DSM-IV (SCID-IV) and Anxiety Disorder Interview Schedule for DSM-IV (ADISIV). Among them, 80 subjects could be evaluated by means of Panic Disorder Severity Scale (PDSS) at follow-up interview after twelve months. Treatment continuation was also examined at follow-up interview. Results : At initial intake, 80 patients were classified into 22% with mild, 33% with moderate-to-marked, and 45% with severe symptoms on the basis of their PDSS total score. At twelve months, 20% of patients reached remission, 65% had mild and 15% had moderate-to-marked symptoms. Initial panic symptom severity, presence of agoraphobia, panic symptom duration before diagnosis, number of comorbid Axis I disorders were associated with significantly higher PDSS total score at twelve months. Forty six percent of total patients continued medication and 23% have stopped treatment by clinician's recommendation and 31% have selfdiscontinued their medication. At twelve months, all three groups were improved but self-discontinuation group had significantly higher PDSS total score. Conclusion : In the one-year naturalistic outcome study of panic disorder patients, high percentage of patients achieved remission or had mild symptoms.

Objectives : We performed this '2006 Korean Anxiety Research' to understand the actual state about Korean anxiety and get the basic data for mental health promotion. Methods : Semistructured questionnaire and Beck Anxiety Inventory -Korean version (BAI) were administered to total 1,000 adults (20-69 years old 501 male & 499 female adults living in Seoul and 5 metropolitan cities in Korea) on March 20th~31st, 2006. Results : Anxious subjects by the total score of BAI was 3.3%. But the responders the item 'I am in the anxious state' was 25% among total subjects. 6% (n=59) among total subjects were the responders experienced the anxiety requiring usually the counselling or treatment. The frequency of their anxiety was most commonly 1 to 2 times/month. The main causes of their anxiety were 'their health problems or illness', 'economic difficulty', 'interpersonal conflicts'. But 'help by health professional' among their usual anxiety reduction methods' was only 15% among them. Only 19% among them were under the treatment of anxiety. Only 27% among 48 subjects not under the treatment of anxiety had a desire for the anxiety treatment in the near future. Conclusion : Some people in the anxious state impairing their daily lives were not yet under the treatment. And most of them had no desire for the anxiety treatment. Therefore we will systematically plan the further health education on the anxiety-related problems for the Korean mental health promotion and the quality of life.

Objective : We examined the putative association between the psychological symptoms and hypoxemia in hospitalized pneumoconiosis patients. Methods : One hundred and nine hospitalized pneumoconiosis patients were divided into two groups according to their level of hypoxemia (PaO2); hypoxemic group consisted of 47 patients with PaO2 lower than 80 mmHg, and comparative group consisted of 62 patients with higher than 80 mmHg. All of them were interviewed with the Hamilton Depression Rating Scale (HAM-D), and completed the Symptom Checklist-90items-Revised (SCL-90-R) and the State-Trait Anxiety Inventory (STAI). The medical data (PaO2, PaCO2, Hb, and Hct), number of hospital days and socio-demographic data as well as scores of the three psychological measurements were compared between the two groups. Results : Hypoxemic patients with lower PaO2 showed higher scores in the HAM-D (p=0.01) and stateanxiety subscale of the STAI (p<0.05). Values of hemoglobin and hematocrit were negatively correlated with levels of trait-anxiety (p<0.05). Thirty patients (27.5%) of total subjects suffered from depression (higher than 18 in the HAM-D), and 46.8% of hypoxemic patients were depressed, whereas 12.9% of comparative group patients were depressed (p=0.01). Conclusion : These results suggest that depression and anxiety might be associated with the hypoxemic mechanism in pneumoconiosis patients.

Objective : In this study, we investigated the prevalence of depression and its impact on the healthrelated Quality of life (HRQoL) of the patients with End-Stage Renal Disease (ESRD) on Hemodialysis. Method : The Quality of life (QOL) of patients was evaluated by HRQoL Questionnaire, "Medical Outcome Survey 36-Item Short Form Health Survey Korean Version (SF-36-K)". The patients on Hemodialysis in ESRD, were chosen from the hemodialytic room at Wonkwang University and Jeongeup-Asan Hospital. The number of patients was 95 (64 from Wonkwang University Hospital and 31 from Jeongeup-Asan Hospital) and all of them were above 19 years old. We performed various investigations to find a statistical correlations between HRQoL and physical & psychosocial factors such as the demographic characteristics, clinical characteristics (hemoglobin level and albumin level etc), and the score of Beck's depressive inventory (BDI). Results : The HRQoL value of patients on hemodialysis in ESRD is far poorer than the HRQoL reference value of Koreans and Americans, who are in normal healthly. The prevalence of depressive symptoms by BDI of the ESRD patients on hemodialysis is 68.6%, and age and depression have negative correlations with HRQoL of the patients. However, education level, serum albumin level, and social support have positive correlations with HRQoL. The patient group with depression has significantly poorer HRQoL than the group without depression. Conclusion : The HRQoL of ESRD patients on hemodialysis is not good in both physical and mental aspects. The prevalence of depression is very high and depression has negative impact of HRQoL of patients. Based on our study, it is essential to accompany with therapeutic Strategy to improve the HRQoL of ESRD patients on hemodialysis.

Objectives : This study aimed to investigate the therapeutic effect of combined biofeedback training with pharmacotherapy for patients with anxiety disorder. Methods : 12 patients with panic disorder and generalized anxiety disorder were enrolled this study. They were tested for State Trait Anxiety Inventory-State (STAI-S), State Trait Anxiety Inventory-Trait (STAI-T), Beck's Depression Inventory (BDI) and Symptom CheckList-90-Revision Somatization (SCL-90-R-SOM) before and after the biofeedback training program. Results : The score of STAI-T (p=0.023) and BDI (p=0.0018) were the significantly decreased after the biofeedback training program. In Female group, the score of STAI-T (p=0.028), STAI-S (p=0.028) and BDI (p=0.009) were significantly decreased after the biofeedback training program. In the group which age is lower than 40 years old, the score of BDI (p=0.046) were significantly decreased after the biofeedback training program. In Panic disorder group, the score of STAI-S (p=0.046) were significantly decreased after the biofeedback training program. Conclusion : The result of this study is useful for the treating the anxiety disorder patients using the biofeedback training program.

People who were exposed to chronic interpersonal traumas in their early life consistently demonstrate complex psychological disturbances and many of them meet the criteria for proposed diagnosis of complex posttraumatic stress disorder (complx PTSD). The author reports a case of the successful sequential integrative treatment mainly composed of eye movement desensitization and reprocessing (EMDR) in a complex PTSD patient. The patient did not respond to the previous treatment with psychotropic medications and supportive psychotherapy. Twelve sessions of EMDR and three sessions of supportive psychotherapy were done for the patient. Psychological assessments were performed before starting the treatment and a week after completing the treatment. After the treatment, the patient improved on all the psychological scales and behavioral measures. This case suggests that the sequential integrative treatment mainly composed of EMDR may be effective for complex PTSD patients.