Sang-Keun Chung, et al. the serotonergic system has been linked to impulsive and compulsive traits in pathological gamblers.8 In addition, serotonin is associated with behavioral initiation and disin- hibition, which may disrupt one’s ability to stop gambling, thus playing an important role in the gambling cycle.9,10 Ventral prefrontal regions may be an important interface between the cognitive and emotional components of risk- taking behaviors.11 Also, functional imaging studies using infusions of nicotine or cocaine have shown associations between the rewarding effects of these drugs and the neu- rons in the nucleus accumbens, brainstem, amygdala, and prefrontal cortices.12,13 These regions may be linked to the addictive symptoms of pathological gambling. In our case, the significant decrease in the generally activated regions after administration of fluvoxamine coincided with the decreased desire to gamble, despite subjective measures of a slightly depressive mood according to BDI. It should be demonstrated in further studies whether the significant decrease of activation in different brain regions is correlated with the therapeutic effects of fluvoxamine. Examination of the neural correlates of treatment of pathological gambling with selective serotonin reuptake inhibitors seems particularly intriguing because of data sug- gesting the efficacy and tolerability of these drugs in the short-term treatment of pathological gambling, and because of the effects of these drugs on cortico-basal-ganglionic- thalamic activity in OCD.14,15 In this case, the responses to pharmacotherapy with fluvoxamine in a patient suffering from pathological gam- bling were observed not only by symptomatic self-report, but also by the objective measure of brain functional MRI. However, a question of whether the improvement of patho- logical gambling symptoms in this case was secondary to improvement of a co-morbid condition remains unanswered. Furthermore, fMRI findings could not be evaluated on the basis of precise correlation between regions showing differ- ences and symptoms of pathological gambling. In spite of these limitations, the present study combined brain fMRI and pharmacotherapeutical findings of pathological gamb- ling, providing an indication of the usefulness of fMRI as a diagnostic tool and predictor of treatment response in a pathological gambler. More research testing this hypothesis may deepen our knowledge about the prevention, diagnosis, and treatment of pathological gambling. REFERENCES 1. Potenza MN, Kosten TR, Rounsaville BJ. Pathological gambling. JAMA 2001;286:141-4. 2. Blanco C, Moreyra P, Nunes EV, Sáiz-Ruiz J, Ibánez A¨ . Pathologi- cal gambling: addiction or compulsion? Semin Clin Neuropsychi- atry 2001;6:167-76. 3. Potenza MN. The neurobiology of pathological gambling. Semin Clin Neuropsychiatry 2001;6:217-26. 4. Petry NM, Armentano C. Prevalence, assessment, and treatment of pathological gambling: a review. Psychiatr Serv 1999;50:1021-7. 5. Hollander E, DeCaria CM, Finkell JN, Begaz T, Wong CM, Cart- wright C. A randomized double-blind fluvoxamine/placebo crossover trial in pathologic gambling. Biol Psychiatry 2000;47:813-7. 6. Potenza MN, Leung HC, Blumberg HP, Peterson BS, Fulbright RK, Lacadie CM, et al. An FMRI Stroop task study of ventromedial prefrontal cortical function in pathological gamblers. Am J Psyc- hiatry 2003;160:1990-4. 7. Choi WC, Kim KB, Oh DY, Lee TK. A preliminary Study on standardization of Korean form of South Oak Gambling Screening. J Korean Acad Addict Psychiatry 2001;5:46-52. 8. Pallanti S, Bernardi S, Quercioli L, DeCaria C, Hollander E. Sero- tonin dysfunction in pathological gamblers: increased prolactin response to oral m-CPP versus placebo. CNS Spectr 2006;11:956-64. 9. Hollander E, Buchalter AJ, DeCaria CM. Pathological gambling. Psychiatr Clin North Am 2000;23:629-42. 10. Blanco C, Orensanz-Munoz ¨L, Blanco-Jerez C, Saiz-Ruiz J. Pathological gambling and platelet MAO activity: a psychobiolo- gical study. Am J Psychiatry 1996;153:119-21. 11. Bechara A, Damasio AR, Damasio H, Anderson SW. Insensitivity to future consequences following damage to human prefrontal cortex. Cognition 1994;50:7-15. 12. Stein EA, Pankiewicz J, Harsch HH, Cho JK, Fuller SA, Hoffmann RG, et al. Nicotine-induced limbic cortical activation in the human brain: a functional MRI study. Am J Psychiatry 1998;155:1009-15. 13. Breiter HC, Gollub RL, Weisskoff RM, Kennedy DN, Makris N, Berke JD, et al. Acute effects of cocaine on human brain activity and emotion. Neuron 1997;19:591-611. 14. Potenza MN, Fiellin DA, Heninger GR, Rounsaville BJ, Mazure CM. Gambling: an addictive behavior with health and primary care implications. J Gen Intern Med 2002;17:721-32. 15. Saxena S, Rauch SL. Functional neuroimaging and the neuroana- tomy of obsessive compulsive disorder. Psychiatr Clin North Am 2000;23:563-86. 444 Yonsei Med J http://www.eymj.org Volume 50 Number 3 June 2009 444