Case Report DOI 10.3349/ymj.2009.50.3.441 pISSN: 0513-5796, eISSN: 1976-2437 Yonsei Med J 50(3): 441-444, 2009 Changes of Functional MRI Findings in a Patient Whose Pathological Gambling Improved with Fluvoxamine Sang-Keun Chung,1 Il-Han You,2 Gwang-Hyun Cho,3 Gyung-Ho Chung,4 Young-Chul Shin,5 Dai-Jin Kim,6 and Sam-Wook Choi7 1 Department of Psychiatry, Chonbuk National University Medical School, Jeonju; 2 Department of Diagnostic Radiology, Mirae Hospital, Gimje; 3 Department of Diagnostic Radiology, Shinsegae Hospital, Gimje; 4 Department of Diagnostic Radiology, Chonbuk National University Medical School, Jeonju; 5 Department of Psychiatry, Sungkyunkwan University School of Medicine, Kangbuk Samsung Hospital, Seoul; 6 Department of Psychiatry, College of Medicine, Catholic University of Korea, Bucheon; 7 Department of Psychiatry, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, Korea. Legalized gambling is a growing industry, and is probably a factor in the presently increasing prevalence of pathological gambling. We present a case of a 36-year-old pathological gambler who was treated with fluvoxamine, a selective serotonin reuptake inhibitor, and who was assessed by functional MRI before and after drug administration. During activation periods, the pathological gambler was shown cards as stimuli, and fMRI results in several brain regions showed differential effects before and after medication and a maintenance period. This case demonstrates that the treatment response to fluvoxamine in a pathological gambler was observed not only by subjective self-report, but also by objective fMRI results. Therefore, fMRI may be a useful tool in the diagnosis and prediction of treatment response in patients afflicted with pathological gambling. Key Words : Fluvoxamine, functional MRI, pathological gambling Received: July 31, 2007 Revised: October 12, 2007 Accepted: October 12, 2007 Corresponding author: Dr. Sam-Wook Choi, Department of Psychiatry, Ulsan University Hospital, University of Ulsan College of Medicine, 290-3 Jeonha-dong, Dong-gu, Ulsan 682-714, Korea. Tel: 82-52-250-8818, Fax: 82-52-232-3309 E-mail: peaceinu@yahoo.co.kr © Copyright: Yonsei University College of Medicine 2009 INTRODUCTION Pathological gambling has been classified as an impulse control disorder or an obsessive-compulsive spectrum disorder.1,2 It is a debilitating disorder with a chronic and progressive course, and co-morbid psychiatric conditions are common in pathological gamblers. However, despite estimates of significant prevalence and associations with adverse consequences, relatively little is known about pathological gambling, particularly its neurobiological underpinnings.3 Gamblers Anonymous is the most popular intervention for problematic gambling. The literature suggests that cognitive-behavioral therapy, pharmacotherapy, and family therapy may be useful in the treating the disorder.4 Among pharmacothe- rapies, several studies have suggested the efficacy and tolerability of the selective serotonin reuptake inhibitor (SSRI), especially fluvoxamine, in the treatment of pathological gambling.5 We hypothesized that functional MRI (fMRI), which has been shown to provide some clues to the underlying neurobiology of pathological gambling,6 might be useful in monitoring the results of pharmacotherapy. Herein, we report a patho- logical gambling patient whose improvement with fluvoxamine treatment was monitored by using fMRI. Yonsei Med J http://www.eymj.org Volume 50 Number 3 June 2009 441