Biomedical subjects

Suck Won Kim

Publications and source records attributed to Suck Won Kim.

At least 19 recordsLinked to original sources

PubMed2006

Pathological gambling and mood disorders: clinical associations and treatment implications.

BACKGROUND: The rapidly expanding gambling business has resulted in an increasing number of gamblers, and the problem is likely to get worse in the future. Traditionally, mood and gambling symptoms have been known to overlap. In the present review we attempt to examine the diagnostic associations and implications for treatment. METHOD: Selected published papers on the frequencies of mood disorders among patients who have gambling disorder or gambling disorder among patients who have mood disorder have been reviewed. Recently emerging new treatment methods for gambling disorder have been reviewed and a brief summary has been added. RESULTS: SCID based study results show a close link between gambling and mood disorders. The prevalence of manic disorder reaches to approximately one fourth of the pathological gambling disorder population. The prevalence of depression is much higher, reaching to over half of the population in some studies. LIMITATIONS: The studies included in the present paper involve inpatients, outpatients, subjects recruited through advertisements and prison populations. Thus the data need to be interpreted as such. Standardized assessment instruments are not used in all studies. Methodological issues such as primary or secondary nature of depression have not been addressed adequately in these studies. The findings, however, offer new insights for the assessment and treatment of complicated gambling disorder cases. CONCLUSIONS: A high prevalence rate of manic and depressive disorders has been recorded among pathological gambling disorder patients. A rational treatment approach to each defined subset of complicated gambling disorder is discussed.

Bipolar Disorder↗

PubMed2006

Update on pathological gambling.

Pathological gambling (PG) is a significant public health concern associated with high rates of psychiatric comorbidity and mortality. Although research into the biology of PG is still in an early stage, recent advances in our understanding of motivation, reward, and addiction have provided substantial insight into the possible pathophysiology of this disorder. In addition, over the past 5 years, extraordinary progress has been made in the area of clinical research examining treatments for PG. Although PG is a disabling disorder that continues to represent a clinical challenge for the healthcare professional, our current knowledge of pharmacotherapy and psychosocial interventions offers potentially effective treatment options.

Behavior, Addictive↗

PubMed2006

Alcohol craving in outpatients with alcohol dependence: rate and clinical correlates.

OBJECTIVE: The present study was undertaken to assess the rate and severity of alcohol craving symptoms among registered alcohol-dependent patients at a Veterans Affairs outpatient clinic. We also examined the relationship between alcohol craving and the clinical characteristics of alcohol-dependent patients. METHOD: Participants included 101 alcohol-dependent veterans enrolled in an outpatient addiction clinic. Alcohol craving was measured by the Penn Alcohol Craving Scale. Alcoholism severity and clinical characteristics were assessed with the Addiction Severity Index, Timeline Followback method, and other instruments. Three alcohol-craving groups (low, moderate, and high) were identified and compared using their demographic and clinical characteristics. Multiple regression analysis was performed to evaluate the relationship between the potential predictors and alcohol craving. RESULTS: The rate of alcohol craving was as follows: low craving (46%), moderate craving (29%), and high craving (25%). When these three craving groups were compared using univariate analyses, patients with higher alcohol craving had significantly higher alcohol composite scores (last 30 days) and severe alcohol dependence (last 1 year). In multiple regression analysis, the model explained 50% of the variance in alcohol craving, with alcoholism severity (42%), withdrawal symptoms (5%), and depression (3%) as significant predictors. CONCLUSIONS: Patients in an outpatient treatment setting had a wide range of alcohol cravings. Level of alcohol craving was directly associated with several increased indices of alcohol- and non-alcohol-related morbidity.

Alcoholism↗

PubMed2006

Medication management of pathological gambling.

Pathological gambling has received little attention from clinicians and researchers despite prevalence rates similar to or greater than those of schizophrenia and bipolar disorder. This article summarizes the phenomenology and associated psychopathology of this public health problem and presents results of studies of 3 types of pharmacological agents used to treat this disorder: serotonin reuptake inhibitors, opioid antagonists, and mood stabilizers.

Disruptive, Impulse Control, and Conduct Disorders↗

PubMed2004

Preliminary validity and reliability testing of a structured clinical interview for pathological gambling.

The psychometric properties of a clinician-administered, DSM-IV-based, structured clinical interview for pathological gambling (SCI-PG) were examined. Seventy-two consecutive subjects requesting treatment for gambling problems were administered the SCI-PG. Reliability and validity were determined. Classification accuracy was examined using longitudinal course of illness. The SCI-PG demonstrated excellent inter-rater and test-retest reliability. Concurrent validity was observed with the South Oaks Gambling Screen (SOGS). Discriminant validity was observed with measures of anxiety and depression. The SCI-PG demonstrated both high sensitivity and specificity based on longitudinal assessment. The SCI-PG demonstrated excellent reliability and validity in diagnosing PG in subjects presenting with gambling problems. These findings require replication in other groups to examine their generalizability.

Demography↗

PubMed2004

A possible association of recurrent streptococcal infections and acute onset of obsessive-compulsive disorder.

Rheumatic fever is an immunologically mediated disease that follows infection by group A beta-hemolytic Streptococcus (GABHS). In rheumatic fever, antibodies generated against GABHS cross-react with the heart, joints, skin, and other sites, inducing an inflammatory, multisystem disease. Brain tissue-specific antibodies have been demonstrated in a subset of children with Sydenham chorea (a component of the Jones criteria for the diagnosis of rheumatic fever), and most Sydenham chorea patients manifest obsessive-compulsive symptoms very similar to those in traditional obsessive-compulsive disorder. The parallels drawn from the paradigm of Sydenham's chorea to Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS) is an area of active controversy. Newly emerging information on the role of GABHS superantigens in the pathogenesis of rheumatic fever is of particular interest. In this article, we review the microbial characteristics of GABHS and the subsequent immune responses to GABHS as a possible etiology of PANDAS.

Antibodies, Monoclonal↗

PubMed2003

Advances in the pharmacological treatment of pathological gambling.

In the present paper we discuss the current status of drug treatment for pathological gambling and the scientific rationales underlying the various pharmacological approaches. Specifically, we summarize the treatment study results of serotonin reuptake inhibitors, mood stabilizers, opioid antagonists, and atypical antipsychotics in pathological gambling. We also discuss dosage strategies, the duration of treatment, issues surrounding medication compliance, and approaches to treatment-refractory pathological gambling, such as pharmacological and behavioral augmentation.

Antimanic Agents↗

PubMed2003

Perceived stress in kleptomania.

Kleptomania, defined as the recurrent failure to resist the impulse to steal, is associated with significant functional impairment. We hypothesized that people with kleptomania would report elevated levels of perceived stress. Sixteen subjects with DSM-IV kleptomania were administered the Perceived Stress Scale (PSS) and compared with 20 subjects with DSM-IV major depressive disorder (MDD). Change in PSS scores in response to treatment and the relationship between PSS scores and severity of kleptomania symptoms were analyzed. The subjects with kleptomania had a significantly greater mean baseline PSS score than the 20 subjects with MDD (t = 8.55, df = 34, p = .000). PSS scores were significantly correlated with severity of kleptomania symptoms (r = .71, p = .002), even when controlling for comorbid diagnoses (r = .67, p = .006). PSS scores significantly decreased during the course of treatment (t = 9.31, df = 15, p = .000). People with kleptomania have higher levels of perceived stress than people with MDD, and the perceived stress decreases as the kleptomania symptoms are treated.

Adult↗

PubMed2003

Paroxetine treatment of pathological gambling: a multi-centre randomized controlled trial.

Previous studies have suggested the efficacy of serotonergic agents in the treatment of pathological gambling. The aim of the present study was to determine whether treatment with paroxetine in a large sample of subjects with pathological gambling would effectively diminish the severity of gambling symptoms. A 16-week, double-blind, placebo-controlled trial was conducted at five outpatient academic research centres in two countries (USA and Spain). Seventy-six outpatients (mean age 45.4+/-10.6 years; 30 women, 46 men) with pathological gambling were randomized to acute treatment with paroxetine in flexible daily dosages of 10-60 mg/day (n=36) or placebo (n=40). The primary outcome measure was the Clinical Global Impressions scale. Both the paroxetine- and the placebo-treated groups demonstrated comparable improvement at 16 weeks (59% response rate in the paroxetine group, 49% rate in the placebo group; chi squared=0.737; d.f.=1; P=0.390). Paroxetine consistently resulted in a greater percentage of responders at each study visit compared to placebo but failed to demonstrate statistical superiority to placebo on scores on the Clinical Global Impressions scale, the Yale-Brown Obsessive-Compulsive Scale Modified for Pathological Gambling, or the Gambling Symptom Assessment Scale. High rates of symptom improvement were observed in pathological gamblers receiving either paroxetine or placebo after 16 weeks. Paroxetine consistently demonstrated an advantage over placebo on the Clinical Global Impressions scale; however, a larger sample size may have registered significant differences.

Adolescent↗

PubMed2002

Body dysmorphic disorder in patients with anorexia nervosa: prevalence, clinical features, and delusionality of body image.

OBJECTIVE: The prevalence of body dysmorphic disorder in patients with anorexia nervosa is unknown. We hypothesized that body dysmorphic disorder would be underdiagnosed in patients with anorexia nervosa and that comorbidity with body dysmorphic disorder would result in greater overall dysfunction. METHOD: Forty-one patients with DSM-IV anorexia nervosa completed the Body Dysmorphic Disorder Questionnaire, a self-report screen for body dysmorphic disorder. A follow-up interview was conducted using a reliable clinician-administered semistructured diagnostic instrument for DSM-IV body dysmorphic disorder. Delusionality about appearance was assessed using a validated semistructured interview. Comorbid DSM-IV diagnoses, number of hospitalizations and suicide attempts were obtained by means of a detailed diagnostic interview. RESULTS: Sixteen (39%) of the 41 patients with anorexia nervosa were diagnosed with comorbid body dysmorphic disorder unrelated to weight concerns. The anorexia nervosa patients with body dysmorphic disorder had significantly lower overall functioning and higher levels of delusionality than the anorexic patients without body dysmorphic disorder. DISCUSSION: These preliminary results suggest that body dysmorphic disorder may be relatively common among patients with anorexia nervosa. The presence of comorbid body dysmorphic disorder may indicate a more severe form of illness.

Adolescent↗

PubMed2002

Parental bonding in pathological gambling disorder.

The purpose of this study was to examine the role of perceived parenting behavior in the childhood of patients with pathological gambling disorder (PGD). Thirty-three outpatient subjects with DSM-IV pathological gambling disorder, and no other current Axis I disorders, completed the Parental Bonding Instrument (PBI), which measures subjects' recollections of parenting on dimensions of care and protection. PBI scores of pathological gamblers were compared to normal controls. Subjects with PGD had significantly lower maternal and paternal care scores than the control subjects (22.6 +/- 8.9 vs. 26.9 +/- 7.3 on maternal care [p = 0.010], and 17.4 +/- 9.6 vs. 23.8 +/- 7.6 on paternal care [p = 0.001]). In terms of parental bonding patterns based on a combination of care and protection, the pathological gamblers reported low rates of optimal parenting and high rates of neglectful parenting. These preliminary findings suggest that neglectful parenting appears to be associated with pathological gambling disorder.

Adult↗

PubMed2002

Effectiveness of pharmacotherapy for pathological gambling: a chart review.

Although pathological gambling is a relatively common disorder, there exists only limited information regarding the effectiveness of pharmacotherapy for this illness. This study examines which medications may be effective, dose and duration of medication trials needed to achieve response, and possible predictors of response. Using a chart review, 50 adult outpatients with DSM-IV pathological gambling treated in clinical practice were assessed regarding response to a variety of medications, including augmentation strategies, and response to concomitant psychotherapy. All subjects received pharmacotherapy for gambling symptoms. Thirty-nine (78%) achieved response to medication treatment. Mean duration of treatment needed for response was 104.9 +/- 85.0 days. Of those treated with an adequate trial of naltrexone as monotherapy, 90.9% were responders, whereas only 45.5% of those treated with an adequate trial of an SSRI achieved response. Patients with poorer social and occupational functioning due to urges and thoughts about gambling were less likely to respond to medication. These findings from a clinical setting suggest that a majority of pathological gamblers improve with medication treatment. Naltrexone, or augmentation of naltrexone with an SSRI, appears to be most effective in relieving gambling symptoms.

Adult↗

PubMed2002

An open-label study of naltrexone in the treatment of kleptomania.

BACKGROUND: The present study was designed to test the short-term efficacy and safety of naltrexone in the treatment of kleptomania. METHOD: 10 subjects (7 women, 3 men) who fulfilled DSM-IV criteria for kleptomania and were free from other Axis I diagnoses by the Structured Clinical Interview for DSM-IV screening participated in a 12-week naltrexone open-label trial. Kleptomania symptom change was assessed with the Clinical Global Impressions scale (both severity and improvement measures), Sheehan Disability Scale (SDS), Global Assessment of Functioning (GAF), and Kleptomania Symptom Assessment Scale. Side effects were monitored weekly, and liver function tests were administered every 2 weeks. RESULTS: Naltrexone reduced urges to steal and stealing behavior. Subjects showed significant improvement (p < .005) over the 11-week treatment period in all measures compared with measures taken at baseline. Seven subjects (70.0%) were very much improved and 2 (20.0%) were much improved at study end. Subjects also reported overall significant improvement in social and occupational functioning as determined by both the GAF and the SDS (p < .000). Men responded to naltrexone as well as women. The mean naltrexone dose required for effective symptom control was 145 mg/day. Nausea was common during the first week of treatment. Five subjects (50.0%) reported previous trials of medication and cognitive-behavioral therapy without any effect on kleptomania symptoms. CONCLUSION: The present findings provide evidence that naltrexone may be effective in the treatment of kleptomania. The present report is preliminary. Further studies are needed to confirm these findings.

Adult↗

PubMed2002

A double-blind placebo-controlled study of the efficacy and safety of paroxetine in the treatment of pathological gambling.

BACKGROUND: This randomized, double-blind, placebo-controlled study investigated the efficacy and tolerability of paroxetine in the treatment of pathological gambling. METHOD: Patients fulfilling DSM-IV criteria for pathological gambling and scoring > or = 5 on the South Oaks Gambling Screen were enrolled if no other Axis I disorder was present. A 1-week placebo run-in phase was followed by 8 weeks' treatment with paroxetine or placebo. The initial paroxetine dose of 20 mg/day could be increased after week 2 by 10 mg/week to a maximum of 60 mg/day. Changes in clinical status were assessed using the Gambling Symptom Assessment Scale (G-SAS) and the Clinical Global Impressions scale (CGI). Treatment-emergent symptoms were assessed weekly. RESULTS: Forty-five patients were included in an intent-to-treat analysis (N = 23 paroxetine, N = 22 placebo). Statistically significantly greater reductions in the total score of the G-SAS were observed in the paroxetine group compared with the placebo group at weeks 6 through 8 (p = .003, .003, and .042, respectively). Improvement on the CGI was also significantly greater in the paroxetine than in the placebo group at the same timepoints (p = .033, .014, and .025, respectively). A significantly greater proportion of patients in the paroxetine group were responders at weeks 7 and 8 (p = .011 and .010, respectively). CONCLUSION: The results of this trial indicate that paroxetine may be effective in the treatment of pathological gambling. There were no unexpected side effects from this treatment. However, additional studies with larger patient samples and a longer treatment phase are required to establish conclusively the efficacy and safety of paroxetine for this indication.

Disruptive, Impulse Control, and Conduct Disorders↗

PubMed2002

Pathological gambling. Current status and new treatments.

In this paper we describe the current status of problem gambling in Minnesota and summarize the emerging drug treatments for pathological gambling disorder (PGD). A brief clinical description of PGD is followed by a summary of published drug treatment outcomes and the basic principles of medication treatment in office practice.

Behavior, Addictive↗

PubMed1998

Effect of ondansetron, a 5-HT3 receptor antagonist, on the dynamic association between bulimic behaviors and pain thresholds.

Thresholds for detection of both pressure and thermal pain are elevated in patients with bulimia nervosa. The present study was aimed at determining (1) if pressure pain detection thresholds (PDT) varied dynamically with the primary disease symptoms of binge eating and vomiting and (2) if the elevation in PDT was effected by treatment with ondansetron (ONDAN), a 5-HT3 receptor antagonist. PDT was defined as the mean of the minimal amount of pressure (measured in g) perceived as painful when exerted by a 1 mm2 blunted point onto the center of the ventral surface of the ungual phalanx of digits 2-5 of the non-dominant hand. Fourteen female patients with severe bulimia nervosa (currently >seven binge/vomit episodes per week; > 2 years illness duration) served as participants. PDT were evaluated at weekly intervals during the course of ongoing treatment studies (double-blind and 'open' label) investigating the therapeutic effects of ONDAN. Data were analyzed by random regression analyses, allowing for the repeated-measures and non-orthogonal design. Data collected from 14 patients under the no-drug condition indicated that PDT increased over the interval between binge/vomit episodes, with significant elevations occurring at times when patients had naturally exceeded their average inter-binge interval. Eleven of these 14 patients underwent 4 weeks of ONDAN treatment. Under this drug condition, the time since the last binge/vomit episode was no longer a significant predictor of PDT. These patients also experienced a significant reduction in the frequency of bulimic behaviors, a finding reported in detail elsewhere. The above finding from untreated patients support the involvement of a common underlying mechanism driving both the increase in pain detection thresholds and the occurrence of the next bulimic episode. This possibility is further supported by the findings that ONDAN treatment is associated with a significant moderation of both variables. The effect of ONDAN may be mediated by blockade of afferent vagal neurotransmission, although other mechanisms must be considered.

Adult↗

PubMedDate not supplied

Retrospective review of treatment retention in pathological gambling.

Although research on pathological gambling is increasing, there are few studies examining correlates of treatment retention. In the current study, 50 outpatients with a primary DSM-IV diagnosis of pathological gambling treated in a clinical practice were assessed by chart review. Standard scales were used to rate subjects at baseline and at 2-month intervals. Subjects who dropped out of treatment were contacted by telephone to determine reasons for discontinuation of treatment. The mean duration of follow-up was 360.4 +/- 352.2 days. Twenty-four (48%) of the subjects discontinued treatment, including 14 (36.8%) of those subjects who were responders (defined as Clinical Global Impression [CGI] scale of "very much" or "much" improved) during at least one assessment point. Of those who discontinued treatment, 41.7% reported missing the thrill of gambling and 20.8% reported feeling certain that they could win and relieve financial burdens. Predictors of treatment continuation were responding to treatment within 8 weeks (odds ratio [OR], 6.00; 95% confidence interval [CI], 1.13 to 32.00; P =.04) and having a supportive environment (OR, 22.99; 95% CI, 5.04 to 104.76; P <.001). We conclude that a large percentage of patients with pathological gambling discontinue treatment. Predictors of treatment continuation may have clinical importance. Prospective longitudinal studies are needed to further elucidate the course of pathological gambling.

Adult↗

PubMedDate not supplied

Quality of life in kleptomania and pathological gambling.

The current study was constructed to examine the similarities and differences in the quality of life of patients with kleptomania and pathological gambling (PG). Thirty patients with kleptomania, 43 with PG, and 30 normal control subjects were assessed with the Quality of Life Inventory that assesses self-reported satisfaction with life. Both patients with kleptomania and PG had significantly lower quality of life scores than normal control subjects ( t = 7.32; df = 58; P < .001; t = 7.32; df = 71; P < .001, respectively). These results suggest that patients with kleptomania and pathological gamblers have notably poor quality of life.

Adult↗