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Objectives Adult attention-deficit/hyperactivity disorder (ADHD) is an important mental health problem that needs resolution, especially considering the high rates of ADHD continuation from childhood to adolescence/adulthood and the high prevalence of ADHD in adults. Adults with ADHD have lifelong negative impacts and require close monitoring with long-term follow-up. Hence, the establishment of a Korean practice parameter for adult ADHD is necessary to minimize discontinuation of treatment and enable information sharing among Korean mental health professionals. Methods The Korean practice parameter was developed using an evidence-based approach consisting of expert consensus survey coupled with literature review. Results According to the expert consensus survey, the most commonly used diagnostic methods were clinical psychiatric interview (20.66%) and self-report scales (19.25%) followed by attention (14.71%) and psychological tests (14.24%). Key evaluation instruments currently available in Korea are the World Health Organization Adult ADHD Self-Report Rating Scale, Korean Adult ADHD Rating Scale, Diagnostic Interview for ADHD in Adults, Barkley Deficits in Executive Functioning Scale for adults, Comprehensive Attention Test, Conners' Continuous Performance Test, and the subtests of Wechsler Adult Intelligence Scale, Digit Span and Letter-Number Sequencing. Although pharmacotherapy is recommended as the first-line of treatment for adult ADHD, we recommend that it be followed by a multimodal and multidisciplinary approach including psychoeducation, pharmacotherapy, cognitive behavior therapy and coaching. Conclusion The Korean practice parameter introduces not only general information for the diagnosis and treatment of adult ADHD on a global scale, but also the process of diagnosis and treatment options tailored to the Korean population.

Objective: There is an updated conceptualization of whole-lifespan attention-deficit hyperactivity disorder (ADHD), promoted by awareness of probable persistence of impairment into adulthood. We investigated cognition trajectories from adolescence to mid-adulthood in ADHD. Method: Data of 240 patients with ADHD and 244 healthy controls (HCs) were obtained; clinical symptoms and neuropsychological functions were assessed using the various tests. Results: Compared to HCs, patients with ADHD except 35 to 44 age interval showed lower full scale intelligence quotient. They showed decreased verbal comprehensive scores except in the 35 to 44 age interval and working memory scores in all intervals. In the Comprehensive Attention Test, patients with ADHD showed increased working memory error frequencies except in the 15 to 17 age interval and divided attention omission error in all intervals. Conclusion: Adults with ADHD showed deficits not in simple attention but in complex attention, including divided attention and working memory.

The differences in prevalence, natural history, and disease progression between Internet gaming disorder (IGD) and substance use disorder contribute to the controversy over IGD as a diagnosis under substance-related and addictive disorders.The purpose of the current study was to assess the temperament and character of subjects with IGD in comparison with those with alcohol dependence (AD).Temperament and character were assessed using Cloningernt temperament and character inventory (TCI). The severity of IGD or AD, depressed mood, anxiety, attention and impulsiveness were assessed using each of the six scales.Among patients with AD, after controlling for other variables, the severity of AD was positively correlated with harm avoidance (HA) score and depressed mood. Among patients with IGD, after controlling for other variables, the severity of IGD was positively correlated with novelty seeking (NS) score, impulsiveness and attention.There were significant differences in temperament and character between the IGD and AD groups as measured using the TCI. These results suggest that IGD and AD need to be categorized separately in a diagnostic classification system and benefit from different treatment approaches.

This study investigated protective and risk factors for depressive mood and anxiety against occupational stress, including temperament character and coping strategy, among civil servants. We administered a questionnaire that included demographic factors and psychological scales to 1197 Korean civil servants. High levels of occupational stress, temperaments of novelty seeking and harm avoidance, a character of cooperativeness, and using emotion-focused coping were risk factors for depressive mood, while living with a partner, having a character of self-directedness, and using problem-focused strategies were protective factors. Additionally, female gender, high level of occupational stress, and temperaments of novelty seeking and harm avoidance were risk factors for anxiety, while having a character of self-directedness was a protective factor. Assessment of temperament character and training on effective coping strategies may help address depressive mood and anxiety for civil servants.

Aim We compared the efficacy of bupropion and escitalopram treatments in Internet gaming disorder (IGD) patients. Methods We recruited 119 adolescents and adults with IGD. We treated these participants for 6 weeks in three groups as follows: 44 participants were treated with bupropion SR (bupropion group), 42 participants were treated with escitalopram (escitalopram group), and 33 patients without any medication were observed in the community (observation group). At baseline and at the 6-week follow-up visit, all subjects were evaluated using the Clinical Global Impression-Severity Scale, the Young Internet Addiction Scale, the Beck Depression Inventory, the ADHD Rating Scale, and the Behavioral Inhibition and Activation Scales. Results Both the escitalopram group and the bupropion group showed improvement on all clinical symptom scales after 6 weeks of treatment compared to the observation group. Additionally, the bupropion group showed greater improvement on scores for the Clinical Global Impression-Severity Scale, the Young Internet Addiction Scale, the ADHD Rating Scale, and the Behavioral Inhibition Scale than the escitalopram group. Conclusion Both bupropion and escitalopram were effective in treating and managing IGD symptoms. Moreover, bupropion appeared to be more effective than escitalopram in improving attention and impulsivity in IGD patients. In addition, attention and impulsivity seem to be important for the management of IGD.

Objective Recent studies of online game addiction have suggested that social interaction and impulsivity are critical factors for the etiology and progress of online game addiction. We hypothesized that the genre of the online game is associated with impulsivity and sociality in individuals with online game addictions. Methods In total, 212 patients with problematic online game playing were divided into four groups by game genre: 1) massive multiplayer online role playing game (MMORPG), 2) real-time strategy (RTS), 3) first-person shooter (FPS), and 4) other. Their symptoms and characteristics were assessed using 8 scales and 2 tests to estimate self-esteem, impulsiveness, comorbidity, social interaction status, and cognitive function. Results The mean social anxiety score was highest in the MMORPG group and lowest in the FPS group. The mean self-esteem score was highest in the RTS group. Social anxiety score was positively correlated with Internet addiction score in the MMORPG group, and the self-esteem score was positively correlated with Internet addiction score in the RTS group. Conclusion The genre of online game was not associated with impulsivity, but social anxiety status varied significantly with game genre, and differences in social anxiety were especially pronounced in patients playing the MMORPG (highest social anxiety) and FPS (lowest social anxiety) game genres. In addition, self-esteem was highest in the RTS game genre.

A cyber crime has been evolving, as other crimes have. Beyond physical damages such as financial crimes in the cyber world, it has evolved into psychological forms like cyber-bullying. In today's crimes, measures that consider psychological effects of crimes are highly regarded in that fear of crime is considered as well as visible crimes. Accordingly, cyber bullying, which causes psychological damages, needs to be treated very importantly. Because the characteristics of cyber crime is caused by different circumstances from the real world, measures should be taken in different aspects. Rather than physical damages, which can be found in the conventional crimes, cyber crimes cause psychological damages, so the effect that has on inflicting should be specified. Especially, in the environment that virtual reality is ubiquitous through smart phones, it is very difficult to establish measures by considering all the causes of general cyber crimes. Therefore, this study estimated what affects cyber bullying by focusing on personalized faith factor among social bond theory, which can control cyber crimes. As a result, self-controling faith was verified to have a negative effect on cyber bullying, so faith is a very important factor in personalized environment. Thus, it is suggested that the characteristics of cyber space and education of humanism, which can affect individuals' faith should be emphasized.

Theta-phase gamma-amplitude coupling (TGC) between slow and fast oscillations is considered to represent cortico-subcortical interactions. The purpose of this electroencephalographic (EEG) study was to evaluate the diagnostic utility of TGC by comparing the power spectra and TGC at rest between ADHD and control children. Nineteen-channel EEGs were recorded from 97 volunteers (including 53 subjects with ADHD attending a camp for hyperactive children). The EEG power spectra and TGC data were analyzed. Analysis of covariance (ANCOVA) was conducted on the quantitative EEG results between the groups to adjust for sex. Receiver operator characteristic (ROC) analysis was conducted to examine the discriminating ability of each parameter for ADHD diagnosis. The ADHD group exhibited significantly decreased TGC in multiple areas, including frontal (Fp1, F3, F7, F6), temporal (T3), and occipital (O2) areas, compared with the control group. The ROC analysis performed on the TGC data generated the most accurate result among the EEG measures, with an overall classification accuracy of 71.7%. TGC, which reflects the degree of neuronal interactions between functional systems, provides information about an individual's attentional network. Therefore, resting-state TGC is a promising neurophysiological marker of ADHD in children.

Psychopathological conditions are the strongest predicting factors for online game addiction.Sex is a risk factor for online game addiction.Decreased self-esteem is associated with online game addiction. Online gaming addiction has been increasingly recognized as a mental disorder. However, the predictive factors that lead to online gaming addiction are not well established. The aim of this study was to identify factors that may influence the development of online gaming addiction. A total of 263 patients with problematic online gaming addiction (255 males (97%) and 8 females (3%), age: mean=20.4?5.8years) and153 healthy comparison subjects (118 males (77%) and 35 females (23%), age: 21.2?5.5years, range) were recruited for participation in the current study. Hierarchical logistic regression analyses among each set of variables were conducted. Individual factors (sex and age), cognitive factors (IQ and perseverative errors), psychopathological conditions (ADHD, depression, anxiety, and impulsivity), and social interaction factors (family environment, social anxiety, and self-esteem) were evaluated in a stepwise fashion. All four factors were associated with online gaming addiction, with psychopathological conditions being the strongest risk factors for the addiction. Individual factors, psychological factors, and social interactions were associated with the development of pure online gaming addiction. As before, psychological factors (attention, mood, anxiety and impulsivity) were the strongest risk factors for online gaming addiction in patients with pure online gaming addiction. Psychopathologies, including ADHD and depression, were the strongest factors associated with the development of online gaming addiction in individuals.

The Continuous Performance Test (CPT) is a valuable tool for assessing behavior in attention-deficit/hyperactivity disorder (ADHD). Quantitative electroencephalography (QEEG) is a promising tool for the diagnosis of ADHD. Recently, theta-phase gamma-amplitude coupling (TGC) measurement has received attention because it is a feasible method of assessing brain function. We investigated the relationship between CPT performance and EEG measures such as TGC and theta and gamma activity. EEGs were recorded from 68 volunteers from a camp for hyperactive children using a 19-electrode system. Their TGC, theta and 40 Hz gamma activity were estimated and compared with results obtained on the Korean ADHD Rating Scale (KARS) and the Intermediate Visual and Auditory (IVA) CPT. The results demonstrated significant negative partial correlations between TGC and the IVA CPT, such as the Response Control Quotient (RCQ) and Attention Quotient (AQ). TGC successfully identified the level of dysfunctional interaction of the attention/arousal system at a multi-scale large network level. It is thought that as the TGC increases, the efficacy of the system is very low or dysfunctional. Compensatory hyper-arousal patterns of the dysfunctional attention/arousal system may account for this effect. TGC is a promising neurophysiological marker for ADHD behavior in children.

Objective This study investigated the clinical utility of quantitative electroencephalography (QEEG) and the Integrated Visual and Auditory Continuous Performance Test (IVA + CPT) as auxiliary tools for assessing Attention Deficit Hyperactivity Disorder (ADHD). Methods All of 157 subjects were assessed using the Korean version of the Diagnostic Interview Schedule for Children Version IV (DISC-IV). We measured EGG absolute power in 21 channels and conducted IVA + CPT. We analyzed QEEG according to the Hz range: delta (1–4 Hz), theta (4–8 Hz), slow alpha (8–10 Hz), fast alpha (10–13.5 Hz), and beta (13.5–30 Hz). To remove artifacts, independent component analysis was conducted (ICA), and the tester confirmed the results again. Results All of the IVA + CPT quotients showed significant differences between the ADHD and control groups. The ADHD group showed significantly increased delta and theta activity compared with the control group. The z -scores of theta were negatively correlated with the scores of IVA + CPT in ADHD combined type, and those of beta were positively correlated. Conclusions IVA + CPT and QEEG significantly discriminated between ADHD and control groups. The commission error of IVA + CPT showed an accuracy of 82.1%, and the omission error of IVA + CPT showed an accuracy of 78.6%. Significance The IVA + CPT and QEEG are expected to be valuable tools for aiding ADHD diagnosis accurately.

Background and objective Attention-deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder hypothesized to involve impaired visuospatial working memory (VSWM). However, there are few studies utilizing neuropsychological tests to measure VSWM in ADHD adolescents. The Rey–Osterrieth complex figure test (ROCF) is commonly used as a neuropsychological test to assess visuospatial working memory for individuals with ADHD. We assessed working memory using the ROCF test on a digital Galaxy tablet with the technically new Gaussian filter method. Methods Thirty adolescents with ADHD and 30 healthy control adolescents were recruited for participation in the current study. All adolescents were assessed with K-WISC-IV, Children's depression inventory, and the Korean ADHD rating scale. All adolescents were asked to copy the ROCF from paper onto a Galaxy tablet screen using a wireless pen. Results There was a significant difference in representative value of the deviation of the original images from template images (R-value) in copy and delayed recall between ADHD adolescents and healthy adolescents. There was no significant difference in R-value of immediate recall between ADHD adolescents and healthy adolescents. In all adolescents (ADHD and healthy) and ADHD adolescents, the R-value of copy was negatively correlated with visuospatial index and working memory index, and the R-value of delayed recall was negatively correlated with WMI. The R-value of copy and delayed recall was positively correlated with K-ARS in all adolescents and ADHD adolescents. Conclusions ADHD adolescents showed differences in the R-values of copy and delayed recall in the digital ROCF version compared to healthy adolescents. The digital ROCF assessment tool can represent different patterns of visuospatial working memory abilities in ADHD adolescents compared to healthy adolescents.

Introduction This article aims to assess the efficacy and safety of atomoxetine in Korean adults with attention-deficit hyperactivity disorder (ADHD). Methods This post hoc double-blind, placebo-controlled study of atomoxetine (40–120 mg/day) over 10 weeks in adults with ADHD at 45 Japanese, Korean, and Taiwanese study sites focused on patient data from Korea (atomoxetine, n = 37; placebo, n = 37). Primary efficacy outcome was change in baseline-to-endpoint Conners' Adult ADHD Rating Scale-Investigator-rated: Screening Version (CAARS-Inv:SV) Total ADHD Symptoms score. Secondary efficacy outcomes included changes in Adult ADHD Quality of Life (AAQoL) total, Behavior Rating Inventory of Executive Function-Adult Version Self-Report (BRIEF-A:Self-Report), and Clinical Global Impression-ADHD-Severity (CGI-ADHD-S) scale scores. Results Atomoxetine-treated patients demonstrated a mean 18.9-point reduction in CAARS-Inv:SV total ADHD Symptoms score, compared with the 7.45-point reduction in placebo-treated patients (P ≤ 0.01). Significantly greater improvement was found for atomoxetine versus placebo in CGI-ADHD-S (P ≤ 0.01), BRIEF-A:Self-Report global executive composite (P ≤ 0.05), and metacognition index (P ≤ 0.01) executive function scores. Nausea, decreased appetite, and dry mouth were reported with significantly greater frequency by atomoxetine-treated patients, and only one placebo-treated patient discontinued because of adverse event. A 2.1-kg reduction in weight and a 7.5-beat/minute increase in pulse rate were observed in atomoxetine-treated patients. Discussion These data support a significant benefit of 80- to 120-mg once daily atomoxetine versus placebo for treatment of ADHD in adult Korean patients. A high placebo response rate was observed in this adult Korean sample; a higher discontinuation rate was also observed in atomoxetine-treated patients. These observations warrant further investigation.

The purpose of the current study was to evaluate the efficacy of cognitive behavioral therapy (CBT) in combination with bupropion for treatment of problematic on-line game play in adolescents with co-morbid major depressive disorder. Sixty-five depressed adolescents with excessive on-line game play were randomly assigned to a CBT group (CBT-Med group (N=32)) or a clinical control group (Med group (N=33)). Measures of severity of internet use, depressive symptoms, anxiety symptoms, life satisfaction and school adaptation were assessed at baseline, after the 8week intervention, and at the end of a 4week follow-up post-treatment period. Young Internet Addiction Scale scores in the CBT-Med group were reduced compared to those of the Med group, but there was no significant difference in the change of depression scores between two groups. The mean anxiety scores in the CBT-Med group did not change while those in the Med group were increased. The mean life satisfaction scores in the CBT-Med group were increased compared to those of the Med group. CBT in combination with bupropion may be effective for the treatment of depressed adolescents with on-line game addiction, particularly in reducing on-line game play and anxiety, as well as in improving life satisfaction.

：Students in the 7th to 12th grades at 23 secondary schools participated in the current study during the fall of 2009. Sub-jects completed the self-report form of the Adolescent Mental Health and Problem Behavior Screening Questionnaire-II (AMPQ-II) and Symptom Checklist-90 Revised (SCL-90-R). In addition, relevant teachers used the teachers’ rating scale of the AMPQ-II to report their students’ status. Differences in the number of bullied students between teachers’ recognition and students’ report were explored.

Several studies have suggested that addictive disorders including substance abuse and pathologic gambling might be associated with dysfunction on working memory and prefrontal activity. We hypothesized that excessive online game playing is associated with deficits in prefrontal cortex function and that recovery from excessive online game playing might improve prefrontal cortical activation in response to working memory stimulation.Thirteen adolescents with excessive online game playing (AEOP) and ten healthy adolescents (HC) agreed to participate in this study. The severity of online game play and playing time were evaluated for a baseline measurement and again following four weeks of treatment. Brain activation in response to working memory tasks (simple and complex calculations) at baseline and subsequent measurements was assessed using BOLD functional magnetic resonance imaging (fMRI).Compared to the HC subjects, the AEOP participants exhibited significantly greater activity in the right middle occipital gyrus, left cerebellum posterior lobe, left premotor cortex and left middle temporal gyrus in response to working memory tasks during baseline measurements. After four weeks of treatment, the AEOP subjects showed increased activity within the right dorsolateral prefrontal cortex and left occipital fusiform gyrus. After four weeks of treatment, changes in the severity of online game playing were negatively correlated with changes in the mean β value of the right dorsolateral prefrontal cortex in response to complex stimulation.We suggest that the effects of online game addiction on working memory may be similar to those observed in patients with substance dependence.

We evaluated whether a brief 3-week family therapy intervention would change patterns of brain activation in response to affection and gaming cues in adolescents from dysfunctional families who met criteria for on-line game addiction. Fifteen adolescents with on-line game addiction and fifteen adolescents without problematic on-line game play and an intact family structure were recruited. Over 3 weeks, families were asked to carry out homework assignments focused on increasing family cohesion for more than 1 hour/day and 4 days/week. Before therapy, adolescents with on-line game addiction demonstrated decreased activity as measured by functional magnetic resonance imaging (fMRI) within the caudate, middle temporal gyrus, and occipital lobe in response to images depicting parental affection and increased activity of the middle frontal and inferior parietal in response scenes from on-line games, relative to healthy comparison subjects. Improvement in perceived family cohesion following 3 weeks of treatment was associated with an increase in the activity of the caudate nucleus in response to affection stimuli and was inversely correlated with changes in on-line game playing time. With evidence of brain activation changes in response to on-line game playing cues and images depicting parental love, the present findings suggest that family cohesion may be an important factor in the treatment of problematic on-line game playing.

Objectives：This study was conducted to investigate the prevalence of victims of bullying and the demographic characteristics of victims, and their related psychopathology, in a Korean nationwide sample of youths in middle and high school over a one month period. Methods：During the autumn of 2009, students in the 7th to 12th grades at 23 secondary schools participated in a nationwide, cross-sectional study. The study subjects completed the Adolescent Mental Health and Problem Behavior Screening Questionnaire-II (AMPQ-II) and Symptom Checklist-90-Revision (SCL-90-R). Based on the data acquired, descriptive statistics, correlation coefficients and multiple logistic regression analysis were performed. Results：Among the 3364 participants, 2272 (67.54%) completed the questionnaire. The prevalence of victimization was 28.9%. Male gender was positively associated with victimization, and grade level was negatively related to victimization. The AMPQ-II bullying score (Factor 4) was significantly (p＜.001) and positively correlated to the AMPQ-II student total score (r=0.50), Worry and thought (Factor 1 ; r=0.38), Mood and suicide (Factor 2 ; r=0.31), Academic and Internet-related problems (Factor 3 ; r=0.24), Rule violations (Factor 5 ; r=0.23), and AMPQ-II teacher total score (r=0.11). Somatization (r=0.23), Obsessive-compulsive behavior (r=0.24), Interpersonal sensitivity (r=0.30), Depression (r=0.33), Anxiety (r=0.26), Hostility (r=0.30), Phobic anxiety (r=0.22), Paranoid ideation (r=0.36), and Psychoticism (r=0.31) results from the SCL-90-R were also found to be positively related to the AMPQ-II bullying score, and remained significant after adjusting for age and gender. A total of 26% of the victims reported suicidal ideations as compared to 9% of non-victims over the month prior to the evaluation (χ2=119.595, df=1, p＜.001). The multiple logistic regression analysis indicated that the AMPQ-II bullying score significantly increased the risk of suicidal ideation [Exp(b)=1.55, df=1, p＜.001] after adjusting for age and gender. Conclusion：School bullying was highly prevalent among Korean middle and high school students. This study provided strong evidence that suicidal ideation and psychopathology were serious problems among the victims of bullying.

Objectives:The definition of a hidden youth is a young person who has completely withdrawn from society and shut him - self or herself away for more than 3 months. Those pathologically-withdrawn youths have become a burden not only to society but also to the family. However, screening of these hidden youths cannot be done easily. This study focused on developing a primary effective screening tool for these hidden youths. Methods:The 42 participants of this study were parents of hidden youths that are between 8 to 25 years old. They were se- lected from from mental health centers and psychiatric clinics around Seoul and Gyeonggi Province. We also recruited 239 par- ents of middle and high school students in the Seoul metropolitan area for a control group. In order to decide the concurrent validi- ty of this questionnaire, we used the Symptom Checklist-90-Revision, Children's Depression Inventory, Beck Depression Inven- tory, Social Anxiety Scale for Children-Revised, Social Anxiety and Distress Scale, Avoidant Personality Disorder Scale, and State- Trait Anxiety Inventory for Children. SPSS version 12.0 was used for statistical analysis. Results:Cronbach's alpha values, the reliability coefficient to represent internal consistency, were between 0.396 and 0.935, which showed relatively high internal consistency for this questionnaire. The test-retest coefficient was between 0.68 and 0.78, which was a statistically significant result. In a factor analysis, 4 factors such as avoidance, withdrawal, isolation, and apathy were extracted. In a concurrent validity test with SCL-90-R, the isolation factor showed a statistically-significant relationship with a phobic- anxiety sub-scale, and avoidance and withdrawal sub-scales were remarkably correlated with the interpersonal sensitivity sub-scale. Conclusion:Since the questionnaire for socially withdrawn youths has achieved statistically-satisfactory reliability and va- lidity, it will be a useful method to screen for hidden youths in educational, community, and clinical settings.

Objective A number of studies about attention-deficit/hyperactivity disorder (ADHD) and Internet video game play have examined the prefrontal cortex and dopaminergic system. Stimulants such as methylphenidate (MPH), given to treat ADHD, and video game play have been found to increase synaptic dopamine. We hypothesized that MPH treatment would reduce Internet use in subjects with co-occurring ADHD and Internet video game addictions. Methods Sixty-two children (52 males and 10 females), drug-naive, diagnosed with ADHD, and Internet video game players, participated in this study. At the beginning of the study and after 8 weeks of treatment with Concerta (OROS methylphenidate HCl, Seoul, Korea), participants were assessed with Young's Internet Addiction Scale, Korean version (YIAS-K), Korean DuPaul's ADHD Rating Scale, and the Visual Continuous Performance Test. Their Internet usage time was also recorded. Results After 8 weeks of treatment, the YIAS-K scores and Internet usage times were significantly reduced. The changes in the YIAS-K scores between the baseline and 8-week assessments were positively correlated with the changes in total and inattention scores from the Korean DuPaul's ADHD Rating Scale, as well as omission errors from the Visual Continuous Performance Test. There was also a significant difference in the number of omission errors among non–Internet-addicted, mildly Internet addicted, and severely Internet addicted participants. Discussion We suggest that Internet video game playing might be a means of self-medication for children with ADHD. In addition, we cautiously suggest that MPH might be evaluated as a potential treatment of Internet addiction.

Introduction Dopamine receptor polymorphisms have been associated with specific patterns of novelty seeking (NS) temperamental nature and frontal executive function. In addition, carriers of dopamine receptor type 2 (DRD2)–TaqI A1 have been hypothesized to be potentially vulnerable to addictive behaviors. In the present study, the association between dopamine D2 polymorphisms, NS, and frontal executive function was studied. Methods Thirty-seven methamphetamine (MA)–dependent subjects and 40 healthy comparison subjects participated in the current study. The severity of addiction, NS temperament, and frontal executive functions were measured using the Addiction Severity Index, the NS subscale in the Temperament and Character Inventory, and the Wisconsin Card Sorting Test, respectively. All subjects were genotyped with regard to DRD2-TaqI polymorphisms. Results The prevalence of DRD2-TaqI A1 allele polymorphisms was greater in the MA-abuser group than in the comparison group. Patients with MA dependence also had higher NS characteristics and high scores in total trials, errors, and perseverative errors of the Wisconsin Card Sorting Test than comparison subjects. Within patients with MA dependence, the subgroup of DRD2-TaqI A1 carrier had greater NS scores relative to those without, whereas there was only a trend level of lower frontal executive function in the first subgroup. Conclusion In the present study, the MA-dependent patients with DRD2-TaqI A1 allele had significantly greater NS scores and lower frontal executive function with a trend level than those without. These preliminary results suggest that MA-dependent patients may have the possibility of genetic and biogenic vulnerability to MA.

Objective Functional imaging studies of panic disorder subjects suggest an increased activation of the cingulate regions of the brain. Aim of the current study was to explore the white matter connectivity differences between subjects with panic disorder and healthy comparison subjects. Method Structural white matter connectivity, as determined from fractional anisotropy (FA) values obtained by diffusion tensor imaging, was assessed for anterior and posterior cingulate regions in 24 panic disorder patients and 24 age and sex-matched healthy comparison subjects. Results Subjects with panic disorder exhibited significantly greater FA values in left anterior and right posterior cingulate regions (by 13.3% and 19.6%, respectively) relative to comparison subjects. White matter connectivity for these two cingulate regions was also positively correlated with clinical severity, as determined by Panic Disorder Severity Scale. FA values in left anterior cingulate region negatively correlated with the time of Trail Making Tests and positively with Digit Symbol Substitution Test. Conclusions Findings suggest a potential ‘enhancement’ in white matter connectivity in left anterior and right posterior cingulate regions in panic disorder, and that these changes may play an important role in mediating clinical symptoms of panic disorder.

Introduction Social network analysis has emerged as a promising tool in modern social psychology. This method can be used to examine friend-based social relationships in terms of network theory, with nodes representing individual students and ties representing relationships between students (e.g., friendships and kinships). Using social network analysis, we investigated whether greater severity of ADHD symptoms is correlated with weaker peer relationships among elementary school students. Methods A total of 562 sixth-graders from two elementary schools (300 males) provided the names of their best friends (maximum 10 names). Their teachers rated each student’s ADHD symptoms using an ADHD rating scale. Results The results showed that 10.2% of the students were at high risk for ADHD. Significant group differences were observed between the high-risk students and other students in two of the three network parameters (degree, centrality and closeness) used to assess friendship quality, with the high-risk group showing significantly lower values of degree and closeness compared to the other students. Moreover, negative correlations were found between the ADHD rating and two social network analysis parameters. Conclusion Our findings suggest that the severity of ADHD symptoms is strongly correlated with the quality of social and interpersonal relationships in students with ADHD symptoms.

This study was done to evaluate the therapeutic effects of naltrexone on smoking behaviors and to measure the changing of brain substances for elucidating the mode of action by naltrexone. Twenty-five voluntarily participated healthy male smokers were randomly assigned to naltrexone group or placebo group for 2 weeks. In this study, naltrexone group showed significant reduction in daily cigarette consumption amount, the expiratory CO levels, brief questionnaire for smoking urge (B-QSU) score, and FTQ score. However, only 2 subjects in naltrexone group quitted smoking completely at 4th week. Plasma levels of pituitary hormones (ACTH, cortisol, and prolactin) and endogenous opioids (β-endorphin and dynorphin A) were checked weekly before and after the ‘provocation and smoking coupled’ stimulus once in a week for 3 weeks. In naltrexone group, pituitary hormones showed upward tendencies even though only the prolactin had statistical significance. However, β-endorphin and dynorphin A were not significantly different between the two groups. It was suggested that naltrexone made effects on hypothalamo–pituitary–adrenocortical axis activity as well as smoking behavior. However, the meaning of these endocrinal changes by naltrexone is not conclusive, whether it is beneficial or aversive.

The incidence of aggressive behavior in patients with schizophrenia is higher than in the general population. Among particular gene polymorphisms posited to be involved in psychiatric disorders, the catecholamine-O-methyltransferase (COMT) and serotonin transporter (5-HTTPR) genes have been the focus of recent research on aggression. In this study, we hypothesized that both the COMT and the 5-HTTPR genotypes may be dependent on and related to aggression in Korean patients with schizophrenia. The subjects were 168 unrelated male schizophrenic patients diagnosed according to DSM-IV. Among two psychiatric hospital staff and medical university students, 158 unrelated male subjects with no lifetime history of psychiatric disorders were recruited to establish the COMT and 5-HTTPR genotype distribution in the general population. All episodes of aggression from the last discharge to readmission were rated. The Total Overt Aggression Scale (OAS) score (sum of the scores of all episodes of aggression), highest OAS score (highest individual episode score, 0-16), OAS category, and OAS category score (mean score within each category) were recorded. There were statistically significant effects of COMT genotype on the mean OAS 4 (physical aggression against other people) score and the highest OAS score. The most predictive was the OAS 4 score. There was a statistically significant effect of 5-HTTPR genotype on mean total score. Thus, the COMT gene is associated with the severity of aggression and with physical aggression against other people, whereas the 5-HTTPR gene is associated with the summary score of all episodes of aggression.

To clarify the role of catechol-O-methyltransferase (COMT) polymorphism in panic disorder (PD), we investigated a large group of Korean PD patients (N = 178) and controls (N = 182) using a case-control study. We also assessed the response to paroxetine treatment and other clinical variables in the PD patients. The increase in the COMT(L) allele was not statistically significant in PD (p = 0.104). However, compared with the sum of the other genotypes, the frequency of the L/L genotype was significantly higher in PD (p = 0.042). The odd ratios (ORs) also indicated a significant effect of the homozygosity for the COMT(L) allele on an increased risk for PD (OR=2.38; 95% CI 1.03-5.51). In addition, patients with L/L genotype had higher trait-anxiety levels (p = 0.030) and poorer treatment response to paroxetine than those with other genotypes (p = 0.002). Our results suggest that the COMT L/L genotype is associated with PD and the genetic variant of the COMT enzyme may be related to the clinical severity and treatment response to paroxetine in PD.

The authors have investigated the effect of naltrexone (NTX) on lowering the urge of alcohol drinking and the action mechanism of NTX. Fifteen healthy male social drinkers voluntarily participated. The experimental method was a double-blind, placebo-controlled cross-over design. To eliminate NTX effect, 1 week washout cross-over interval was taken. Subjects ingested NTX, 50 mg/day, or placebo for 1 week. Then, the alcohol (0.5 ml/kg) challenge test was done in the evening. Blood samples were taken immediately before drinking, at 20 min and at 60 min after alcohol drinking. Plasma beta-endorphin, plasma ACTH and serum cortisol levels were checked. Subjects completed self-report questionnaires such as the visual analog scales of drink urge and the alcohol sensation scales at regular intervals. In the case of NTX pretreatment, the subjects reported significantly (P=.013) less urge to drink alcohol on the self-reporting urge scales, especially at postdrinking 20 min and 60 min than placebo pretreatment. After alcohol challenge, the subjects reported significantly more dizziness (P=.015) in the case of NTX pretreatment, and reported less mood elevation trend, though not significant (P=.052). Basal plasma beta-endorphin levels were not different, but in the case of NTX pretreatment, the increasing degree of plasma beta-endorphin during 20 min after alcohol challenge was significantly (P=.039) higher than with placebo pretreatment. This results show that the NTX reduced the urge to drink alcohol with the mechanism of partially blocking the opioid positive reward system and partially mimicking the alcohol effect.

The aim of the current study was to evaluate the quantitative electroencephalography (QEEG) characteristics of patients with un-medicated schizophrenia (SPR) and to investigate the diagnostic utility of QEEG in assessing such patients during resting conditions. The subjects included 90 patients with schizophrenia and 90 normal controls. Spectral analysis was performed on the absolute power of all of the electrodes across five frequency bands following artifact removal. We conducted a repeated-measures ANOVA to examine group differences within the five frequency bands across several brain regions and receiver operator characteristic (ROC) analyses to examine the discrimination ability of each frequency band. Compared with controls, patients with schizophrenia showed increased delta and theta activity and decreased alpha 2 activity, particularly in the frontocentral area. There were no significant differences in the alpha 1 and beta activity. The ROC analysis performed on the delta frequency band generated the best result, with an overall classification accuracy of 62.2%. The results of this study confirmed the characteristics of the QEEG power in un-medicated schizophrenia patients compared with normal controls. These findings suggest that a resting EEG test can be a supportive tool for evaluating patients with schizophrenia.

Recent brain imaging studies suggested that both the frontal and temporal cortices are important candidate areas for mediating the symptoms of internet addiction. We hypothesized that deficits of prefrontal and temporal cortical function in patients with on-line game addiction (PGA) would be reflected in decreased levels of N-acetyl aspartate (NAA) and cytosolic, choline containing compound (Cho). Seventy three young PGA and 38 age and sex matched healthy control subjects were recruited in the study. Structural MR and (1)H MRS data were acquired using a 3.0 T MRI scanner. Voxels were sequentially placed in right frontal cortex and right medial temporal cortices. In the right frontal cortex, the levels of NAA in PGA were lower than those in healthy controls. In the medial temporal cortex, the levels of Cho in PGA participants were lower than those observed in healthy controls. The Young Internet Addiction Scale (YIAS) scores and perseverative responses in PGA were negatively correlated with the level of NAA in right frontal cortex. The Beck Depressive Inventory (BDI) scores in the PGA cohort were negatively correlated with Cho levels in the right temporal lobe. To the best of our knowledge, this is the first MRS study of individuals with on-line game addiction. Although, the subjects with on-line game addiction in the current study were free from psychiatric co-morbidity, patients with on-line game addiction appear to share characteristics with ADHD and MDD in terms of neurochemical changes in frontal and temporal cortices.

5Laxtha Incorporated, Daejeon, Republic of Korea ObjectiveaaAttention deficit hyperactivity disorder (ADHD) symptoms are associated with the deficit in executive functions. Playing Go involves many aspect of cognitive function and we hypothesized that it would be effective for children with ADHD. MethodsaaSeventeen drug naive children with ADHD and seventeen age and sex matched comparison subjects were participated. Participants played Go under the instructor’s education for 2 hours/day, 5 days/week. Before and at the end of Go period, clinical symptoms, cognitive functions, and brain EEG were assessed with Dupaul’s ADHD scale (ARS), Child depression inventory (CDI), digit span, the Children’s Color Trails Test (CCTT), and 8-channel QEEG system (LXE3208, Laxtha Inc., Daejeon, Korea). ResultsaaThere were significant improvements of ARS total score (z=2.93, p

Introduction Theta-phase gamma-amplitude coupling (TGC) measurement has recently received attention as a feasible method of assessing brain functions such as neuronal interactions. The purpose of this electroencephalographic (EEG) study is to understand the mechanisms underlying the deficits in attentional control in children with attention deficit/hyperactivity disorder (ADHD) by comparing the power spectra and TGC at rest and during a mental arithmetic task. Methods Nineteen-channel EEGs were recorded from 97 volunteers (including 53 subjects with ADHD) from a camp for hyperactive children under two conditions (rest and task performance). The EEG power spectra and the TGC data were analyzed. Correlation analyses between the Intermediate Visual and Auditory (IVA) continuous performance test (CPT) scores and EEG parameters were performed. Results No significant difference in the power spectra was detected between the groups at rest and during task performance. However, TGC was reduced during the arithmetic task in the ADHD group compared with the normal group (F = 16.70, p < 0.001). The TGC values positively correlated with the IVA CPT scores but negatively correlated with theta power. Conclusions Our findings suggest that desynchronization of TGC occurred during the arithmetic task in ADHD children. TGC in ADHD children is expected to serve as a promising neurophysiological marker of network deactivation during attention-demanding tasks.

ObjectivesZZHigh uric acid level is related to increased locomotor activities and refractory mood swings. The purpose of this study is to examine the correlation between clinical symptoms of mania, serum uric acid level, and quantitative electroencephalography (QEEG) findings. MethodsZZTwenty-four patients with bipolar disorder and 24 healthy control subjects agreed to participate in the study. When they were hospitalized, the degree of clinical symptoms, uric acid level in blood, and brain QEEG were measured. ResultsZZThe bipolar disorder group showed higher scores on the Young Mania Rating Scale (YMRS ; z=6.02, p

OBJECTIVE To examine the short-term efficacy and tolerability of aripiprazole for children and adolescents with Tourette's disorder. METHOD This 10-week multicenter, double-blind, randomized, placebo-controlled trial was conducted from August 2008 to April 2010. Children and adolescents (aged 6-18 years) with a DSM-IV diagnosis of Tourette's disorder and a Yale Global Tic Severity Scale total tic score of 22 or more were randomly assigned (1:1 ratio) to placebo or aripiprazole. The primary outcome measure was mean change from baseline in the total tic score on the Yale Global Tic Severity Scale (last observation carried forward). Assessments of safety and tolerability included spontaneously reported adverse events, extrapyramidal symptoms, serum prolactin level, metabolic variables, and other laboratory evaluations. RESULTS Of 61 subjects, 89% completed the study. Patients who received aripiprazole demonstrated a significant reduction from baseline to end of study on the mean (SD) total tic score of the Yale Global Tic Severity Scale compared to those who received placebo (-15.0 [8.4] and -9.6 [8.8], respectively, P=.0196). Response rate on the Tourette's Syndrome Clinical Global Impression-Improvement was 66% and 45% in the aripiprazole and placebo groups, respectively. Mean decrease in the Tourette's Syndrome Clinical Global Impression-Severity of Illness score was significantly different between the groups (P=.0321). In general, aripiprazole was well tolerated and there were no early discontinuations due to adverse events. The incidence of treatment-emergent adverse events between the groups was not significantly different (P=.7550). While aripiprazole decreased serum prolactin concentration (P

The purpose of the current study was to evaluate possible overlapping substance abuse and internet addiction in a large, uniformly sampled population, ranging in age from 13 to 18 years. Participants (N=73,238) in the current study were drawn from the 6th Korea Youth Risk Behavior Web-based Survey (KYRBWS-V) for students from 400 middle schools and 400 high schools in 16 cities within South Korea. Of adolescent internet users, 85.2% were general users (GU), 11.9% were users with potential risk for internet addiction (PR), and 3.0% were users with high risk for internet addiction (HR). There was a difference in the number of students with alcohol drinking among the GU, PR, and HR groups (20.8% vs 23.1% vs 27.4%). There was a difference in the number of students who smoked among the GS, PR, and HR groups (11.7% vs 13.5% vs 20.4%). There was a difference in the number of students with drug use among the GU, PR, and HR groups (1.7% vs 2.0% vs 6.5%). After adjusting for sex, age, stress, depressed mood, and suicidal ideation, smoking may predict a high risk for internet addiction (OR=1.203, p=0.004). In addition, drug use may predict a high risk for internet addiction (OR=2.591, p

Excessive internet video game play (EIGP) has emerged as a leading cause of behavioral and developmental problems in adolescents. Recent research has implicated the role of striatal dopaminergic system in the behavioral maladaptations associated with EIGP. This study investigates the reward-dependence characteristics in EIGP adolescents as it potentially relates to genetic polymorphisms of the dopaminergic system and temperament. Seventy-nine male EIGP adolescents and 75 age- and gender-matched healthy comparison adolescents were recruited. Associations were tested with respect to the reward-dependence (RD) scale in Cloninger's Temperament and Character Inventory and the frequencies of 3 dopamine polymorphisms: Taq1A1 allele of the dopamine D2 receptor (DRD2 Taq1A1) and Val158Met in the Catecholamine-O-Methyltransferase (COMT) genes. The Taq1A1 and low activity (COMT) alleles were significantly more prevalent in the EIGP group relative to the comparison group. The present EIGP group had significantly higher RD scores than controls. Within the EIGP group, the presence of the Taq1A1 allele correlated with higher RD scores. Our findings suggest that EIGP subjects have higher reward dependency and an increased prevalence of the DRD2 Taq1A1 and COMT alleles. In particular, the DRD2 Taq1A1 allele seems to be associated with reward dependence in EIGP adolescents.

Virtual reality (VR) is an evolving technology that is being applied to treat a wide range of medical and psychiatric diseases. A virtual reality therapy (VRT) with multisensory stimulation has been applied to patients with alcohol dependence (ADP). We hypothesized that the VRTP for alcohol dependence would reduce the craving for alcohol and increase alpha wave activity in frontal areas of individuals with ADP. Twenty ADP and eighteen ADP were exposed to a series of 10 VRTP sessions (VRTP-ADP) and cognitive behavioral therapy (nVRTP-ADP), respectively. Fifteen healthy controls were exposed to VRTP for comparing the changes of craving and EEG during all three phases of VRTP. The VRTP-ADP exhibited a greater decrease in craving after the 10th VRTP session, when compared to the nVRTP-ADP. Compared to the healthy control subjects, VRTP-ADP group showed higher magnitude of the change in craving throughout VRTP sessions. These results suggest that VRTP may be useful as an adjunct to treating alcohol dependence but may also serve as an evaluation tool to identify high-risk patients.

Introduction Excessive internet use (EIU) has been reported to be comorbid with depression and the manifestation of its symptoms. This study examines the characteristics of excessive internet users that are similar to those of patients with depressive disorders in terms of serotonin transporter gene expression and harm avoidance. Methods 91 male adolescents with EIU and 75 healthy comparison subjects were recruited. Between group comparisons were made on genetic polymorphisms of the serotonin transport gene and with respect to novelty seeking and harm avoidance (HA) of Cloninger's Temperament Character Inventory. Results The homozygous short allelic variant of the serotonin transporter gene (SS-5HTTLPR) is more frequent in the EIU group (χ2 = 4.38, df = 1, p

Major depressive disorder and alcohol dependence are common and serious mental illnesses. There is a great interest in discovering useful treatments for both mood symptoms and alcohol abuse in those patients with depressive disorders and comorbid alcohol dependence. The primary purpose of this study was to evaluate the effectiveness and tolerability of mirtazapine for the treatment of patients with alcohol dependence comorbid with a depressive disorder in an open label, naturalistic multicentre treatment setting. The 17-item Hamilton Depression Rating Scale (HDRS), the Hamilton Anxiety Rating Scale (HARS) and the Clinical Global Impression-Severity (CGI-S) scale were measured at baseline and at weeks 4 and 8 for the assessment of treatment effectiveness. Alcohol craving was measured using the Obsessive Compulsive Drinking Scale (OCDS) and the Visual Analog Scale for Craving (VAS). This study showed a statistically significant reduction of the scores on the HDRS (13.9+/-7.3, p

We assessed catechol-O-methyltransferase (COMT) polymorphism in 132 first-onset schizophrenic patients and 80 healthy controls. The relationship between COMT polymorphism and cognitive function, aggression and psychiatric symptoms was tested in the schizophrenic group. COMT L carrier had higher digit span score and lower similarity score than COMT H homozygote. COMT L carrier had higher attention and delusion scores and lower inappropriate affect scores than COMT H homozygote. Attention and delusion scores of COMT L allele were higher than COMT H allele. COMT L group had higher aggression than COMT H homozygote. Our results support the theory that COMT L allele was related with increased tonic dopamine activity and cognitive 'stability', which may induce cognitive inflexibility in schizophrenia.

Purpose This study was designed to construct a structural model for explaining negative outcomes of anger in female adolescents. Method Data was collected by questionnaires from 199 female adolescents ina female high school in Seoul. Data analysis was done with SAS for descriptive statistics and a PC-LISREL Program for Covariance structural analysis. Result The fit of the hypothetical model to the data was moderate, thus it was modified by excluding 7 paths and adding free parameters to it. The modified model with the paths showed a good fit to the empirical data(chi2=5.62, p=.69, GFI=.99, AGFI=.97, NFI=.99, NNFI=1.01, RMSR=.02, RMSEA=.00). Trait anger, state anger, and psychosocial problems were found to have a significant direct effect on psychosomatic symptoms. State anger, psychosocial problems, and learning behaviors were found to have direct effects on depression of female adolescents. Conclusion The derived model is considered appropriate for explaining and predicting negative outcomes of anger in female adolescents. Therefore, it can effectively be used as a reference model for further studies and is a suggested direction in nursing practice.

1 Department of Psychiatry, Chung-Ang University College of Medicine, Chung-Ang University Hospital, Seoul, Korea Department of Psychiatry, Gongju National Hospital, Gongju, Korea Graduate School, Chung-Ang University, Seoul, Korea Department of Psychiatry, Seoul National University College of Medicine, Seoul, Korea Uimyung Research Institute for Neuroscience, Samyook University, Seoul, Korea Igonggam Psychiatric Clinic, Busan, Korea

Jun Won Kim, MD, Hyun Jin Kim, MD, Doug Hyun Han, MD, PhD, Young Sik Lee, MD, PhD, Kyung Joon Min, MD, PhD, Kounseok Lee, MD and Jaewon Lee, MD Department of Psychiatry, Gongju National Hospital, Gongju, Korea Graduate School, Chung-Ang University, Seoul, Korea Department of Psychiatry, College of Medicine, Chung-Ang University, Seoul, Korea Department of Psychiatry, Samsung Medical Center, Seoul, Korea Department of Psychiatry, Gangnam Eulji Hospital, Eulji University, Seoul, Korea

컴퓨터와 초고속 인터넷 사용이 보편화된 요즘 비디오게 임은 이미 젊은층에게는 일상생활의 한 부분이 되어버렸다. 1998년 9월 공개된 리니지를 통하여 우리나라는 온라인 게 임 강국의 발을 내디뎠으며, 대한민국 게임백서에 의하면 국내 게임 시장의 규모는 온라인 게임이 단연 압도적이다. 각종 해외보고서에 따르면 대한민국의 온라인 게임 매출은 2012년 현재, 10조 원으로 글로벌 시장 점유율은 6위 수준인 5.9%에 이르고 있다. 온라인 게임을 즐기고, 온라인 게임에 몰두하는 사람들이 늘어남에 따라, 온라인 게임의 폭력성에 대한 우려가 높아지고 있다. 1993년 Motal Kombat 비디오게임이 미국에서 등장 이후 폭력적 비디오게임이 전세계 게임시장을 지배해왔고 1999 년 4월 폭력적 비디오게임 Doom에 빠진 2명의 콜로라도 컬 럼바인 고등학생의 학내 총기난사 사건이 도화선이 되어 폭 력적 비디오게임에서의 공격성은 실제 생활에서 공격행동으 로 표출될 수 있다는 우려가 만연되기 시작하였다. 심지어 비폭력적 게임 역시 생리각성을 높이고 게임에 졌을 때 분노 폭발을 초래한다는 부정적 견해도 등장하였다. 최근 컴퓨터 기술의 발달로 인한 음향효과나 그래픽 선명 도의 향상은 게임을 더욱 사실적으로 묘사하여 가상과 현실 간의 간극이 점차 줄어들게 되었다. 또, 최근 몇 년 간 온라인 게임을 하던 사람들이 부모를 폭행하거나 존속살인을 저지 른 사건들이 발생하면서, 온라인 게임이 심각한 사회 폭력 문 제를 유발할 것이라는 시각이 당연히 받아들여지고 있다. 하지만 이런 예상들에 대한 과학적 근거는 아직 미비한 상 태이며 이에 대한 지속적인 연구가 진행되고 있다. 이에 본 연구팀은 현재까지 발표된 인터넷 비디오게임과 공격적 성 향에 관한 연구 결과를 중립적 시각에서 정리해 보았다.

1 Department of Psychiatry, Gongju National Hospital, Gongju, Korea Chung-Ang University Graduate School, Seoul, Korea Department of Psychiatry, College of Medicine, Chung-Ang University, Seoul, Korea 4 Department of Psychiatry, Institute of Behavioural Science in Medicine, Yonsei University College of Medicine, Seoul, Korea 6 Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

MethodsZZA total of 107 adolescent patients with on-line game addiction were enrolled in an online game clinic and research center, OO hospital. In order to rule out psychiatric Axis I comorbidity, all participants were interviewed by a psychiatrist. In addition, their symptoms were assessed using the Young Internet Assessment Scale-Korean (YIAS-K), Korean Attention-Deficit Hyperactivity Disorder (ADHD) Rating Scale, Child depression index, Aggression scale extracted from Korean child behavior checklist, and Behavioral inhibition system (BIS)/Behavioral activation system (BAS). The participants were classified according to three groups ; pure on-line game addiction group (pure-Game), on-line game addiction with attention-deficit hyperactivity syndrome (ADHD-Game) group, and on-line game addiction with depression group (Dep-Game).