Depression and anxiety disorders are common psychiatric illnesses whose etiology remains partially understood. The etiology of depression and anxiety disorders is multi-factorial, and abnormalities in neurotransmitter, neuroendocrine system, and brain activation have been implicated in those conditions. However, the pathophysiology of depression and anxiety disorder is certainly not well understood, and some patients with depression or anxiety disorders do not respond to antidepressant therapy. Recently, immunological factors such as cytokines are known to be closely related to central nervous system as well as depression and anxiety disorders. This review highlights recent progress in understanding the function of cytokines in depression and anxiety disorders.

Objectives : The authors sought to examine the differences in the number of P300 detected by subjects in experimental and control groups when exposed to relevant stimuli. In addition, the authors tried to determinethe subjects' reaction time when asked to respond to relevant stimuli. Methods : The subjects were 20 informed female volunteers aged 22-38 years (median age : 24). Relevant stimuli (concealed information) were created by unknowingly exposing the two groups to obscene pictures and semantic questions. The number of P300 detected and the length of reaction time were compared between the two groups. Results : Contrary to theauthors' expectations, there were no significant differences in the number of P300 detected or in the length of reaction time between the two groups. Conclusions : These results indicate that, unlike a polygraph test, concealed information tests adopting P300 and reaction time as major physiological responses ofsubjects exposed to meaningful personal information might not serve as a valid practical tool in the field of criminal psychology. However, further studies involving a greater number of subjects are needed before a final conclusion regarding the validity of this new type of concealed information test can be drawn.

Objective : Brief screening for anxiety symptoms in clinical practice can further facilitate the diagnosis and evaluation of anxiety disorders. This study examined the factorial validity of the Korean version of the State-Trait Inventory (STAI)-Form X, one of the most frequently used self-report questionnaires for anxiety. Methods : Data from the STAI and Beck Depression Inventory were obtained from a consecutive sample of 200 outpatients diagnosed with DSM-IV anxiety disorders at a psychiatric unit of a university hospital. The factor structures of the State and Trait Scales were assessed using exploratory factor analysis. Results : Three-factor components, including 'State anxiety present', 'State anxiety absent' and 'Selfconfidence', were extracted from the State Scale, explaining 59% of the total variance. A four-factor solution involving 'Trait anxiety and depression present', 'Trait anxiety and depression absent', 'Anxiety proneness' and 'Stability' (59% of total variance) was extracted from the Trait Scale. The internal consistency of the STAI and factors were satisfactory. There were significant correlations between depressive symptoms and factors of the STAI. Conclusion : The STAI-form X showed factorial validity for Korean patients with anxiety disorders. However, our finding that this anxiety scale also measures depressive symptoms should be interpreted with caution.

Objective : This study investigated the temperament and character traits associated with suicide attempts in patients with mood disorders. Methods : The temperament and character inventory (TCI) was administered to 150 patients who visited psychiatric clinics seeking treatment for mood symptoms. The patients were divided into three groups as follows : non-suicide ideation, suicide ideation and suicide attempt. We also gathered socio-economic data in order to rule out confounding variables. MANOVA was performed to analyze differences in personal temperament and character scores on the TCI between the three groups. Results : The self-directedness and cooperativeness subscales of the TCI are most influenced by the clinical symptoms rated by Beck Suicide Ideation Scale and Hamilton Depression Rating Scale. In the temperament scale, the suicide attempt group scored higher on the novelty seeking and harm avoidance items than the other two groups. The specific temperaments associated with suicidal behavior in patients with depression are impulsivity (NS2) and anticipatory anxiety or pessimism (HA1). Conclusion : In this study, we found that more risky patients who had previously attempted suicide had a temperament of impulsivity or pessimism. This finding suggests that a more cautious approach is needed to assess mood disorder patients with impulsive or pessimistic temperaments in order to prevent suicide attempts.

PTSD 환자들에서 성별에 따른 증상의 차이를 보기 위한 본 다기관 연구에서, 여성은 남성에 비해 재경험, 회피 항목에서 높은 빈도와 심각도를 보였다. 즉 과도한 기억과 각성, 만성적인 회피로 이어지는 PTSD 발생 과정에서 남, 녀간 차이가 있을 수 있다는 것을 시사하며, 앞으로 이를 확인하기 위한 연구가 더욱 필요할 것이다.

Objective : This study examined whether major depressive disorder patients with anxiety traits displayed abnormal electroencephalographic (EEG) alpha asymmetries. Methods : Resting EEG was recorded in 11 outpatients with major depressive disorder (6 of whom had a high anxiety trait while 5 exhibited a low anxiety trait) and 6 controls. Results : In contrast to the controls, within the major depressive disorder patient group, comorbid anxiety disorder showed alpha asymmetry indicative of less activation over right than over left temporal sites. Patients diagnosed with major depressive disorder but no anxiety disorder showed a reduced temporal alpha asymmetry, supporting the potential importance of evaluating anxiety in studies of regional brain activation, in depressed patients. Conclusion : These findings suggest that anxiety is associated with brain hypoactivation, especially with right temporal hypoactivation.

Objective : The purpose of this study was to investigate the relationship between the pattern of computer game play and emotional and behavioral characteristics of 5th and 6th grade elementary school children in Jeonju city. Methods : Fifth and sixth graders from two elementary schools (N=413, M=214, F=199) were chosen to participate in this study. The participants completed self-report questionnaires designed by the authors, and were also evaluated based on a computer game addiction scale, state-trait anxiety inventory for children, children's depression inventory and Piers-Harris children's self-esteem scale. The parents of the participants determined the disruptive behavior rating scale of the participants. Results : Positive links were reported between the pattern of computer game play (years of computer game experience, average length of each computer game play session, average time spent on computer game play per day, and average frequency of computer game play per week) and scores of computer game addiction scale. In addition, significant correlation was found between the internalized problems of children (trait anxiety, state anxiety, depression, and self-esteem), and computer game addiction scale score, among both sexes (p<0.01). There were significant correlations between game addiction scale score and inattention (p<0.01) as well as total attention deficit hyperactivity disorder (ADHD) score (p<0.05) in girls. Conclusion : Our findings suggest that computer game addiction is related to symptoms of internalizing, particularly to the trait anxiety. Significant positive correlations between game addiction scale score and externalized behavioral problems were found only in girls.

Objective : Evidence from recent studies supports the role of genetic factors in the development of Posttraumatic Stress Disorder (PTSD). The primary aim of this study is to investigate the association between the dopamine D2 receptor (DRD2) TaqI A polymorphism and PTSD. The second aim is to examine the association between the DRD2 TaqI A polymorphism and clinical symptoms in patients with PTSD. Methods : We recruited 189 Vietnam veterans for participation in this study, among whom 99 were PTSD patients and 90 were control subjects. The presence of the DRD2 TaqI A polymorphism was determined by polymerase chain reaction (PCR). Several standardized research scales were used in the clinical assessment of PTSD, including the Combat Exposure Scale (CES), Clinician Administered PTSD Scale (CAPS), Beck Depression Inventory (BDI), and Clinical Global Impression (CGI). Results : There was no significant difference in the distribution of the DRD2 genotype, frequency and prevalence of the A1 allele, or the frequency of heterozygotes between the patients with PTSD and the controls. In the PTSD group, the patients with the A1 allele (A1A1, A1A2) scored higher on the CAPS-total (p=0.044), CAPS-avoidance symptoms (p=0.016) and BDI (p=0.024) than those without the A1 allele (A2A2). Conclusion : We could not find an association between the dopamine D2 receptor (DRD2) TaqI A polymorphism and PTSD. However, the A1 allele of DRD2 seemsto influence avoidance symptoms in patients with PTSD.

Objective : Although cognitive-behavior therapy (CBT) is effective in patients with panic disorder, its the-rapeutic mechanism of action in the brain remains unclear. This study was performed to investigate regional blood flow changes associated with successful completion of CBT in drug-naive patients with panic disorder. Method : The regional blood flow in 4 patients with panic disorder was compared to that in 11 healthy controls before and after a 12-week group CBT using $^{99m}Tc$-ECD SPECT imaging. Psychopathology was assessed using Panic Disorder Severity Scale. Data were analyzed using software for statistical parametric mapping (SPM2). Results : Before CBT, significantly decreased blood flow was found in the parietal and occipital area in panic patients than normal volunteers. In all the patients who showed remission after CBT, increased blood flow was detected in the right cingulate gyrus, left lingual gyrus, and left superior parietal lobule, whereas decreased blood flow was seen in the left inferior temporal gyrus. Conclusion : These results suggested that CBT is effective for panic disorder and change the activity of cingulate gyrus and left temporal gyrus, a part of the brain areas associated with fear in panic disorder.

저자들은 심한 수면 무호흡증을 가진 성인 남자에서,CPAP 치료 후 조증 및 경조증 삽화가 유발된 증례를 보고하였다. 본 증례는 정신과적 병력 및 가족력이 없던 환자에게서 CPAP 치료 후 조증 삽화와 경조증 삽화가 연속해서 유발된 첫 번째 보고이다. 환자는 CPAP 치료 시작 직후부터 약 한달 동안 기분 고양감과 목적지향 활동의 증가를 보이다가 2~3일만에 정신병적 증상이 동반된 조증 삽화를 보였다. 또한 퇴원 후 투약을 지속하면서 다시 CPAP치료를 한 직후 경조증 삽화로 추정되는 일련의 기분 및행동 변화가 나타났다. 따라서 이 환자의 조증 삽화와 경조증 삽화로 추정되는 기분 변화는 CPAP 치료로 유발되었을 가능성이 있다고 판단되었다. 폐쇄성 무호흡증이 심하여 CPAP 치료가 처방되는 경우에 임상의들은 정신과적 질환의 기왕력이나 위험 인자가 없는 환자에서도 조증상태가 발생할 수 있는 가능성에 대해 유의하여야 하고, 주기적으로 객관적인 척도를 사용하여 기분 변화 정도를 점검할 필요가 있다. 특히 CPAP 사용 후 특별한 이유 없이 행동 변화나 기분 고양의 정도가 심해질 때는 조증 가능성을 의심해 보아야 할 것으로 사료된다.