An 11-year-old girl previously treated for tinea capitis presented a 3-month history of continuous decrease in hair density on the vertex, frontal, and parieto-temporal areas of the scalp. Hair pull test was negative. Trichoscopic findings showed black dots, micro-exclamation point hairs, regrowing vellus hair, and zigzag hairs. Histopathology showed CD3+ peribulbar lymphocytic infiltrates and occasional eosinophils around the anagen hair follicle consistent with a non-scarring alopecia. A diagnosis of diffuse alopecia areata was made. Patient was given methylprednisolone (0.5 mg/kg/day) for 2 weeks and noted marked increase in hair density except on focal areas of the scalp. Patient eventually admitted to occasional hair pulling. Trichoscopy revealed trichoptilosis, V-sign, tulip hairs, and multiple broken hairs of varying length while a second biopsy showed trichomalacia and pigment casts consistent with trichotillomania. In this case, where co-existence of alopecia areata and trichotillomania is considered to be uncommon, trichoscopy proved to be an important tool in differentiating hair disorders with similar presentation. Knowing key features of hair diseases can help elucidate the diagnosis when presented with an atypical case.
Alopecia Areata ; Trichotillomania

Rapunzel syndrome is caused by gastric trichobezoar with extended tail and small bowel obstruction. Patients with gastric trichobezoar can be asymptomatic until the bezoar increases in size. We report a case of a girl who visited the emergency department with abdominal pain. She was finally diagnosed with Rapunzel syndrome that causes multiple small bowel intussusceptions associated with trichophagia. Surgery was needed to reduce the multiple intussusceptions, and to remove the large trichobezoar. This case highlights to consider the possibility of Rapunzel syndrome when diagnosing the main cause of intussusceptions.
Abdominal Pain ; Bezoars ; Emergency Service, Hospital ; Female ; Humans ; Intestinal Obstruction ; Intussusception ; Pica ; Tail ; Trichotillomania

PURPOSE: The purpose of this study was to examine the association of multiple addiction risks with life satisfaction, depression, and suicidal ideation in Korean adults. METHODS: This study was descriptive correlational. Data were collected in 800 adults (405 males, 395 females) aged 20 to 69 years recruited using the proportional allocation in a city on April 2017. The structured questionnaire consisted of the Alcohol Use Disorders Identification Test, the Internet Addiction Proneness Scale for adults, the Problem Gambling Severity Index, the Drug Screening Inventory, the Korean version of the Satisfaction with the Life Scale, the Patient Health Questionnaire-9, and the Scale for Suicidal Ideation. RESULTS: Adults with multiple addiction risks had a low level of life satisfaction (p=.003) and high levels of depression and suicidal ideation (p<.001) compared to other participants. Multiple addiction risks were associated with low life satisfaction (β=.12), high depression (β=.21), and suicidal ideation (β=.20). Significant factors of life satisfaction were low suicidal ideation, a simple functioning job, high level of education, and unemployment status. CONCLUSION: Multiple addiction risks are associated with life satisfaction, depression, and suicidal ideation. The comprehensive mental health assessment for multiple addictions should precede the development of preventive multidimensional interventions.
Adult ; Behavior, Addictive ; Depression ; Drug Evaluation, Preclinical ; Education ; Gambling ; Humans ; Internet ; Male ; Mental Health ; Personal Satisfaction ; Suicidal Ideation ; Unemployment

OBJECTIVE: Impulse control disorders (ICDs) in Parkinson's disease (PD) are mostly related to dopamine replacement therapy (DRT); however, drug-naïve PD patients have also frequently experienced impulsivity. This phenomenon makes clinicians hesitate treating patients with DRT. In this study, we assessed the effect of impulsivity on quality of life (QOL) in drug-naïve PD patients. METHODS: Two hundred three newly diagnosed, nonmedicated PD patients were enrolled, and they received structured clinical interviews, physical examinations and validated questionnaires to evaluate motor and nonmotor symptoms and QOL. Impulsivity was evaluated using the Questionnaire for Impulsive-Compulsive Disorders in Parkinson's Disease-Rating Scale (QUIP-RS). RESULTS: Thirty-eight patients (18.7%) had impulsivity with QUIP-RS scores ≥ 1 and 4 patients (2.0%) were diagnosed with combined ICDs. Motor and nonmotor symptoms were significantly correlated with the Parkinson's Disease Questionnaire-39 summary index. Female sex and QUIP-RS scores were also correlated with QOL in drug-naïve PD patients. CONCLUSION: The results of the present study showed that impulsivity negatively influences QOL in early drug-naïve PD patients. In addition, more severe motor and nonmotor symptoms were also associated with lower QOL. Such findings complicate treatment but provide valuable information for managing early PD.
Disruptive, Impulse Control, and Conduct Disorders ; Dopamine ; Female ; Humans ; Impulsive Behavior ; Parkinson Disease ; Physical Examination ; Quality of Life

INTRODUCTIONLiterature has shown that individuals with various psychiatric disorders experience a lower quality of life (QoL). However, few have examined QoL across disorders. The current study explored differences in QoL and symptom severity across 4 psychiatric diagnostic groups: anxiety disorders (including obsessive compulsive disorder [OCD]), depressive disorders, schizophrenia, and pathological gambling.

MATERIALS AND METHODSData analysed was from a previous study that examined the prevalence of hoarding symptoms among outpatients (n = 500) in a tertiary psychiatric hospital in Singapore. Measures utilised included the Beck Anxiety Inventory (BAI), Beck Depression Inventory-II (BDI-II) and Quality of Life Enjoyment and Satisfaction QuestionnaireShort Form (Q-LES-Q-SF). Sociodemographic information and details on type and number of comorbidities were also collected.

RESULTSThe depressive disorder group had the highest level of depressive and anxiety symptoms and the lowest QoL whereas; the schizophrenia group had the lowest level of depressive symptoms and the highest QoL. Age and employment status were the only sociodemographic correlates which were significantly associated with QoL. After controlling for sociodemographic factors, only the type of mental disorder was found to have a significant effect in explaining BAI, BDI-II and Q-LES-Q-SF.

CONCLUSIONFindings offer insight in terms of the burden associated with the various disorders.

Adult ; Anxiety Disorders ; epidemiology ; psychology ; Comorbidity ; Cost of Illness ; Demography ; Depressive Disorder ; epidemiology ; psychology ; Female ; Gambling ; epidemiology ; psychology ; Humans ; Male ; Middle Aged ; Outpatients ; psychology ; statistics & numerical data ; Psychiatric Status Rating Scales ; Quality of Life ; Schizophrenia ; diagnosis ; epidemiology ; Singapore ; epidemiology ; Socioeconomic Factors

OBJECTIVE: In Korea, online board games, such as “flower cards,” are played using virtual money. In contrast, Internet-based gambling (ibGambling) concerns the use of real money to gamble online. We hypothesized that online board gamers using virtual money show less risky behaviors than do gamblers who use real money, and that, in regard to psychological aspects, online board gamers are less depressed and more introverted than online gamblers are. METHODS: For this study, 100 online board gamers, 100 ibGamblers, 100 offline gamblers (offGamblers), and 100 age- and sex-matched healthy controls were recruited by an online research company. Gambling behavior and self-efficacy were assessed using the Korean Gambling Behavior Scale-high/low factors (KGBS-H/L) and the Gambling Abstinence Self-efficacy Scale (GASS). Additionally, introversion, depression, and mania tendency were assessed. RESULTS: Online board gamers had good intentions gaming, as evidenced by their higher KGBS-L scores than ibGamblers and offGamblers, and they showed less risky behaviors, as evidenced by their lower KGBS-H scores than offGamblers. Additionally, online board gamers were less introverted than ibGamblers and less depressed than offGamblers. CONCLUSION: Online board gaming could be a gateway to the world of gambling (ibGambling or OffGambling). However, the higher tendency of online board gamers to engage in good intentioned gaming could help prevent online board gaming from progressing to online or offline gambling.
Bipolar Disorder ; Depression ; Gambling ; Intention ; Introversion (Psychology) ; Korea

OBJECTIVE: Trichotillomania is a relatively common illness whose neurobiology is poorly understood. One treatment for adult trichotillomania, n-acetyl cysteine (NAC), has antioxidative properties, as well as effects on central glutamatergic transmission. Preclinical models suggest that excessive oxidative stress may be involved in its pathophysiology. METHODS: Adults with trichotillomania provided a blood sample for analysis of compounds that may be influenced by oxidative stress [glutathione, angiotensin II, ferritin, iron, glucose, insulin and insulin growth factor 1 (IGF1), and hepcidin]. Participants were examined on symptom severity, disability, and impulsivity. The number of participants with out-of-reference range oxidative stress measures were compared against the null distribution. Correlations between oxidative stress markers and clinical measures were examined. RESULTS: Of 14 participants (mean age 31.2 years; 92.9% female), 35.7% (n=5) had total glutathione levels below the reference range (p= 0.041). Other oxidative stress measures did not have significant proportions outside the reference ranges. Lower levels of glutathione correlated significantly with higher motor impulsiveness (Barratt Impulsiveness Scale sub-score) (r=0.97, p=0.001). CONCLUSION: A third of patients with trichotillomania had low levels of glutathione, and lower levels of glutathione correlated significantly with higher motor impulsiveness. Because NAC is a precursor for cysteine, and cysteine is a rate limiting step for glutathione production, these results may shed light on the mechanisms through which NAC can have beneficial effects for impulsive symptoms. Confirmation of these results requires a suitable larger follow-up study, including an internal normative control group.
Adult ; Angiotensin II ; Cysteine ; Ferritins ; Follow-Up Studies ; Glucose ; Glutathione ; Humans ; Impulsive Behavior ; Insulin ; Iron ; Neurobiology ; Oxidative Stress* ; Reference Values ; Trichotillomania*

PURPOSE: The purpose of this study was to test the mediating effect of depression on the relationship between gambling severity and cognitive distortion in Koreans with a gambling disorder. METHODS: Secondary data from a comprehensive assessment of problematic gambling between 2015 and 2017 on Korea Center on Gambling Problems were used. The subjects in this study were 254 Koreans with that gambling disorder. Data were collected with self-report structured questionnaires which included individual characteristics, the Korean version of Problem Gambling Severity Index, the Center for the Epidemiologic Studies Depression, and the Gambling Related Cognitions Scale. Data were analyzed by using descriptive statistics, independent t-test, one-way ANOVA with the Scheffé test, Pearson's correlation coefficients, and a mediation analysis of the Baron and Kenny method with the SPSS 22.0 program. RESULTS: Significant correlations emerged among the three variables, gambling severity, depression, and cognitive distortion. Depression exerted a partial mediating effect (β=.20, p < .001) on the relationship between gambling severity and cognitive distortion (Sobel test: z=2.33, p=.012). CONCLUSION: Based on this study's findings, nursing intervention programs focused on managing gambling severity and decreasing depression are highly recommended to alleviate cognitive distortion in people with a gambling disorder.
Cognition ; Depression ; Epidemiologic Studies ; Gambling ; Korea ; Methods ; Negotiating ; Nursing ; Statistics as Topic

BACKGROUND: The purpose of this study is to investigate relationship between the horse racing addiction and the health status indicators. METHODS: Surveys were conducted with visitors of the Korea Racing Association in Gyeonggi-do, from September 1 to September 24, 2017. We used the questionnaire, which contains questions to assess the horse racing addiction, mood depression, health-related quality of life, smoking amount, alcohol dependency, etc. Survey data were analyzed through t-test, chi-square test, logistic regression analysis, and multiple regression analysis by SPSS program (IBM Corp., Chicago, IL, USA). RESULTS: The pathological gambling group was 47.5% (n=38) of the visitors, and they showed a different racecourse use behavior compared to the normal group. In addition, we found that the pathological gambling group had a significantly different health-related quality of life score and a depression score from the normal group, and that the addiction score and the depression score had a linear correlation. CONCLUSIONS: Among the racecourse visitors, the ratio of the pathological gambler was considerably high, and the pathological gambling group showed different health-related quality of life score and a depression score compared to the normal group; especially, the depression score has a significant correlation with horse racing addiction. Therefore, the horse racing association and the health authorities should recognize the seriousness of the horse racing addiction, make an effort to select high risk users, and prepare a program to prevent pathological gambling.
Continental Population Groups ; Depression ; Gambling ; Gyeonggi-do ; Health Status Indicators ; Horses ; Humans ; Korea ; Logistic Models ; Quality of Life ; Smoke ; Smoking

PURPOSE: A mediated model of Korean college students' problem gambling based on Blaszczynski and Nower's pathway model is developed and tested to explore mediating roles of self-control and irrational gambling beliefs in the association between emotionally vulnerable variables and problem gambling. METHODS: 273 student participants recruited from 4 universities in Seoul and Gyeonggi, Korea responded. Data were collected with a structured self-report questionnaire comprising measures of problem gambling, depression, anxiety, coping styles, irrational gambling belief, and self-control. RESULTS: The modified research model provides a reasonable fit to the data. Depression, anxiety, reflective coping, irrational beliefs, and self-control turned out to have direct effects on problem gambling, while indirect effects were reported in some suppressive and reactive styles. These predictors account for 38% of the college students' problem gambling. CONCLUSION: The findings suggest that developing intervention programs for reducing depression, anxiety, irrational gambling beliefs, and increasing reflective coping and self-control are needed to prevent Korean college students' problem gambling.
Anxiety ; Depression ; Gambling ; Gyeonggi-do ; Humans ; Korea ; Models, Structural ; Negotiating ; Self-Control ; Seoul