Objective : Reduced resting heart rate variability (HRV) is well-documented in anxiety and mood disorders; however, limited research exists on HRV reactivity during emotional processing. This study examined HRV reactivity to angry faces in social anxiety disorder (SAD) patients and its association with symptom severity. Methods : Twenty-six SAD patients and 35 controls participated. HRV was measured using the root mean square of successive differences (RMSSD). RMSSD reactivity was calculated by subtracting RMSSD during angry and neutral face processing from baseline RMSSD. Group differences in RMSSD reactivity and its relationship with social anxiety symptoms were analyzed. Results : SAD patients exhibited lower RMSSD reactivity compared to controls during both angry (t_54.829=3.03, p=0.004) and neutral face processing (t_52.877=2.18, p=0.034). In the SAD group, RMSSD reactivity during angry face processing significantly explained variance in performance avoidance subscale scores of the Liebowitz Social Anxiety Scale (R²=0.208, β=-0.456, F_1,23=6.054, p=0.022). Conclusion : Reduced HRV reactivity in SAD may reflect impaired autonomic flexibility and difficulty responding to emotionally relevant stressors. Lower HRV reactivity is associated with greater symptom severity, specifically performance-related avoidance, highlighting HRV's potential as a physiological marker for identifying specific symptoms in SAD.

Objective : This study aimed to identify the factors that predict anger reaction as well as investigate the mediation effect of anxiety and depression between body dissatisfaction and anger reaction. Methods : A sample of 467 young adults completed Body Shape Questionnaire-8B, Eating Disorder Inventory-2-Drive for Thinness, Beck Depression Inventory, State-Trait Anxiety Inventory, and Reaction Inventory to Measure to Anger. Results : The factors that were examined for their potensial ability to predict anger reaction were drive for thinness and trait anxiety. Regarding the mediation effect of anxiety and depression between body dissatisfaction and anger reaction were found to be significant, and in terms of the direct effect, depression had no indirect effect, while trait anxiety had an indirect effect. Conclusion : The findings show that body dissatisfaction can cause anger reaction either directly or indirectly through trait anxiety, and there is a need for future research targeting various clinical groups.

Objective : To evaluate the association between suicidality with violent hostility and psychopathology in schizophrenia. Methods : Seventy nine schizophrenic patients were interviewed and evaluated regarding their psychopathology with Positive and Negative Symptom Scale (PANSS). Suicidal attempt number, suicidality (ideation, plan or attempts), and hostility with violent acts in patients were also investigated. Results : In schizophrenic patients, suicidal attempts were significantly correlated with positive symptoms (r=0.336, p=0.002) and general symptoms (r=0.26, p=0.021). Their suicidality was also significantly correlated with all psychopathology (p=0.000). In addition, their hostility was associated with psychopathology, especially in those with positive symptoms (r=0.29, p=0.01). Conclusion : Suicidal attempts and violent behaviors showed association with psychopathology in schizophrenia. This suggests that symptoms of schizophrenia need to be treated as early as possible.

Objective : The Korean Association of Anxiety Disorders developed Korean guidelines for the treatment of generalized anxiety disorder (GAD) 2024. In this paper, we discussed the consensus among psychiatrists specializing in anxiety disorders, regarding initial and maintenance treatment strategies for pharmacological treatment of GAD in Korea. Methods : The executive committee developed questionnaires on treatment strategies for patients with GAD, based on previous treatment guidelines and academic articles published internationally and in Korea. Sixty-two experts responded to the questionnaires. The consensus of expert opinions was classified into three categories (first-line, second-line, and third-line choices) using the chi-square test and 95% confidence intervals. Results : Combination of antidepressants and anxiolytics was recommended as treatments of choice (ToC), and antidepressant single pharmacotherapy as first-line strategies for initial treatment of GAD. Several SSRI, SNRI, and mirtazapine were preferred from among many antidepressants, and, among anti-anxiety drugs, clonazepam, alprazolam, buspirone, and lorazepam were first preferred. In the case of maintenance treatment of GAD, antidepressant single pharmacotherapy was selected as ToC and first-line strategies. In addition, it was reported that the preference for atypical antipsychotics was high not only in the initial but also in the maintenance treatment stage as antidepressants and atypical antipsychotics combination treatment maintained the top second-line strategies. Patients were typically examined every four weeks during treatment, to review effectiveness and side effects of the drug. Pharmacotherapy was generally continued for one year or more. Conclusion : This study is based on the clinical experience of Korean experts regarding pharmacological treatment strategies for patients with GAD, and and it is expected to be helpful in presenting the basis and plan for GAD treatment in clinical practice.

Objective : This study aimed to establish a consensus on treatment strategies for psychological therapy in generalized anxiety disorder (GAD) as outlined in the 2024 Korean guidelines for treating GAD. Methods : The executive committee developed questionnaires on treatment strategies for patients with GAD based on previous treatment guidelines and academic articles published internationally and in Korea. Sixty-two experts responded to questionnaires developed. The consensus of expert opinions was classified into three categories (first-line, second-line, and third-line choices) using chi-square test and 95% confidence intervals. Results : Findings of this study suggest that individual cognitive behavioral therapy (CBT), group CBT, mindfulness-based cognitive therapy (MBCT), acceptance and commitment therapy (ACT), and applied relaxation are appropriate psychotherapies for GAD. Additionally, it is recommended to initiate CBT early when treating GAD, with eight treatment sessions being the most preferred for both individual and group CBT. Conclusion : This expert consensus survey reflected clinical experiences of Korean practitioners. Results of this study provide valuable insights for Korean clinicians when implementing psychotherapy for GAD.

Objective : This study aimed to establish expert consensus on treatment strategies for generalized anxiety disorder (GAD) when treatment response is insufficient and when comorbid conditions are present as part of developing the 2024 Korean guidelines for the treatment of GAD. Methods : The executive committee developed a questionnaire based on existing international and Korean treatment guidelines and academic literature. Sixty-five experts participated in a survey. Responses were analyzed using chi-squared test and 95% confidence intervals to determine the level of consensus. Treatment strategies were categorized into first-line, second-line, and third-line choices. Results : For patients with an insufficient treatment response, combining pharmacotherapy and psychotherapy was the most preferred first-line strategy. Experts recommended switching to or augmenting with a different class of antidepressants, adding benzodiazepines or azapirones, and augmenting with atypical antipsychotics as first-line pharmacotherapy adjustments. Suitable psychotherapies included cognitive behavioral therapy (CBT), mindfulness-based cognitive therapy (MBCT), acceptance and commitment therapy (ACT), and applied relaxation. For patients with comorbid conditions such as depression, other anxiety disorders, or alcohol and substance use disorders, a combination of pharmacotherapy and psychotherapy was also the most preferred first-line treatment. In these cases, the use of antidepressants alone or in combination with benzodiazepines, azapirones, or atypical antipsychotics was recommended. Conclusion : This expert consensus reflects current clinical practices and experiences in Korea, providing valuable insights for clinicians treating GAD patients who have insufficient treatment responses or comorbidities. Findings of this study emphasize the importance of a multimodal treatment approach, including both pharmacotherapy and psychotherapy. They also offer specific recommendations for adjusting treatment strategies in these complex cases.