Obsessive compulsive disorder with child & adolescent onset (C-OCD) is not a rare disorder. Though OCD patients with prepubertal onset is scarce, the prevalence of OCD with postpubertal, adolescent onset reach nearly that of adult OCD. In clinical features, C-OCD resemble adult OCD. However, the other features of pediatric OCD are different from those of adult OCD. The sex ratio of pediatric OCD is male dominant and C-OCD show high comorbid rate with tic disorder, which is not prevailing in adult OCD. Family data analysis of tic disorder and C-OCD reveal the close genetic linkage between two disorders. Neuroimaging studies of C-OCD indicate very consistent findings in basal ganglia volume change (usually reduction of striatum) that may not be so consistent in adult OCD. SSRIs are less effective in C-OCD and combined therapy with antipsychotics is more frequently needed than adult OCD. In conclusion, child and adolescent OCD can be a distinctive subtype of OCD that is different from adult OCD in many ways.
Adolescent* ; Adult ; Antipsychotic Agents ; Basal Ganglia ; Child* ; Epidemiology ; Genetic Linkage ; Humans ; Male ; Neurobiology ; Neuroimaging ; Obsessive-Compulsive Disorder* ; Prevalence ; Sex Ratio ; Statistics as Topic ; Tic Disorders

OBJECTIVE: This community based study was conducted to evaluate the association between pre- and perinatal factors and symptoms of ADHD. METHOD: 1800 children from 10 elementary schools in an urban community were recruited by randomized sampling method. We evaluated the symptoms of ADHD by Child Behavior Check List, Disruptive behavior disorder scale from 2 sources (parent & teacher). A thorough evaluation of perinatal problems was carried out. Data were analyzed by appropriate statistical method using SPSS 10.0 window version. RESULT: In the pre- & peri-natal events, boy, low SES, use of forceps, emotional stress, prolonged labor time and postpartum depression were significantly more frequent in attention deficit group compared to normal group. After controlling sex and SES, further analyses we revealed emotional stress, prolonged labor, and postpartum depression as risk factors of ADHD symptoms. CONCLUSION: These findings implied that pre- & perinatal biological and environmental risk factors could be symptom risk factors of the attention deficit hyperactivity disorder. Further research should prove the etiological association of these factors.
Attention Deficit and Disruptive Behavior Disorders ; Attention Deficit Disorder with Hyperactivity ; Child ; Child Behavior ; Depression, Postpartum ; Female ; Humans ; Male ; Pregnancy* ; Risk Factors* ; Stress, Psychological ; Surgical Instruments

The use of the antipsychotic drug, one of the most frequently prescribed drugs in child & adolescent psychiatry, has been limited because of the diverse serious side effects and questionable safety. Since 1990, however, the atypical antipsychotics have been used much more than before due to lower extrapyramidal side effects and tardive dyskinesia. The use of atypical antipsychotics has rapidly increased in the treatment of autistic disorder and mental retardation with behavioral problems. In addition, the indication of atypical antipsychotics has expanded to the tic disorder (chronic tic disorder, tourette's disorder) and child onset obsessive compulsive disorder. Recently, the use of atypical antipsychotics in the treatment of the dispruptive behavior disorder (conduct disorder, oppositional defiant disorder) and severe ADHD with violent episode has been rapidly and dramatically increased. However, In Korea there is no systemic review paper about the clinical use of atypical antipsychotics in the field of child & adolescent psychiatry. The author reviewed the clinical use of risperidone, which has been most widely and frequently used and researched in the child & adolescent psychiatry. Although there are some limitations, I hope this paper can give the reasonable and useful clinical guideline to the clinicians dealing with child & adoles-cent psychiatric patients.
Adolescent ; Adolescent Psychiatry* ; Adolescent* ; Antipsychotic Agents ; Autistic Disorder ; Child* ; Hope ; Humans ; Intellectual Disability ; Korea ; Movement Disorders ; Obsessive-Compulsive Disorder ; Risperidone* ; Tic Disorders

OBJECTIVES: We conducted this study to investigate the parental attitude toward their children wiht idiopathic convulsive disorder and to compare it with that of parents with healthy children. METHODS: The parents of children with convulsive disorder were recruited from the outpatient department of pediatric neurology in Seoul National University Hospital in Korea. We excluded patients with mental retardation, pervasive developmental disorder and overt organic brain pathology. The parents of normal students were chosen as control group. Children's sex, age, achievement and socioeconomic status were matched. The author interviewed all the children and their parents and obtained the developmental history and family information. 'Questionnaire for adult's attitude toward children with convulsive disorder' was used to obtain the data about the ideas about epileptic children and their family members from both parents of epileptic and normal children. RESULTS: First, parents of epileptic children worried too much about the possibility that convulsion made serious damage on physical status of patients. 25% of them believed that even single convulsion could lead to sudden death. Second, as the causes of convulsive disorder, the parents chose brain damage brain pathology worries of children mode of parenting worries of family genetic origin in order of frequency. 40% of them had false concepts that the way of rearing and childen's psychological problems might cause the convulsive disorder. Third, according to the answers of parents of epileptic children, more than 60% of children with convulsive disorder had cognitive, emotional, behavioral and learning problems. Fourth, parents of epileptic children reported behavioral change, emotional disturbance and attentional problems as result of adverse effect of medication. Fifth, Many parents of epileptic children had difficulties in explaining the disease and reasons of taking medication to patients. Sixth, Many parents of epileptic children worried about marriage and employment and reported the several limitations of social lives of parents and patients. The parents of healthy children had more tendency to believe that the convulsive disorder could be one of genetic diseases than parents of epileptic children. They chose the brain pathology-genetic originmode of parenting-brain damage-worries of children-worries of family as the causes of convulsive disorder in order of frequency. The parents of healthy children had overcare about the limitations of children's social activity and difficulties of parents and family members of epileptic children. CONCLUSION: This study revealed the parents of epileptic children had some overcares and misbelieves about their children's disorder. Also, the parents of healthy children had more distorted ideas about the causes of the convulsive disorder and its impact on epileptic children and their family members. So the mental health professionals should prepare and conduct the comprehensive and effective educational programs for the parents and public members.
Affective Symptoms ; Brain ; Brain Diseases ; Child* ; Death, Sudden ; Employment ; Humans ; Intellectual Disability ; Korea ; Learning ; Marriage ; Mental Health ; Neurology ; Outpatients ; Parenting ; Parents* ; Seizures ; Seoul ; Social Class

Tics are brief, rapid and repetitive movement and sounds that are either simple or complex in presentation. Tics can be preceded by a premonitory urge (sensation) that decreases after tic is completed. The fourth edition of Diagnostic Statistical Manual of Mental Disorder (DSM- IV) includes diagnoses for Tourettes disorder, chronic motor or vocal tic disorder, transient tic disorder and tic disorder not otherwise specified (Table 1) according to the duration of tic symptoms and degree of complexity. The purposes of treatment of tic disorders must be set up based on the comprehensive evaluation of developmental profiles, strength, weakness, family situation, and school adaptation status. The family education must be included early in treatment process and psychosocial treatment including the cognitive behavioral therapy will be needed to develop and maintain the self-efficacy in controlling the tic symptoms. The most effective and efficient method for the reduction of tic symptoms, however, are drug treatment. The pharmacotherapy is usually one component of treatment for chronic tic disorder and Tourettes disorder. The gold standard for tic reduction is the dopaminergic receptor blocking agent (or antipsychotic agent, neuroleptics). The primary drugs are haloperidol, pimozide, and risperidone. Among theses, risperidone will be the primary choice because of its low side effect profiles, esp, neurologic side effects. In the near future, the studies on the efficacy of the olanzapine, quetiapine and ziprasidone will be more reported. As second line drugs, clionidine, guanfacine, nicotine related drugs can be considered.
Cognitive Therapy ; Diagnosis* ; Drug Therapy ; Education ; Guanfacine ; Haloperidol ; Humans ; Mental Disorders ; Nicotine ; Pimozide ; Risperidone ; Tic Disorders* ; Tics ; Tourette Syndrome

OBJECTIVE: To investigate the characteristics of subjects with sub-threshold mild ADHD symptoms from community samples from the views of demographic factors, socio-school function, comorbidity, character trait and family function. METHOD: The subjects were selected randomly from primary schools in Jinju. They were composed of 702 students attending ordinary school and living with parents. Based on scores from 2 scales and report from teachers in charge, they were divided into three groups; definite ADHD group (29), mild ADHD group (136) and control group (542). They were evaluated through DBDS, CBCL, FACES-III, Family APGAR, CCI by parents. Data analyses were performed by PC version SPSS. RESULTS: Compared with the definite ADHD group, the mild ADHD group showed significantly lower scores in anxious/depressive symptoms, social immaturity, aggression, ODD score, although they scored higher compared to the control group. In withdrawal, somatic complaints, thought disorder, delinquency, internalizing symptoms and novelty seeking score, the mild group was similar to the definite group. The mild group, however, had mild functional impairment in socio-school activities, family function. Distribution of frequency in SES was almost same in the mild and the control group. CONCLUSION: This study implies that children with mild ADHD symptoms seem to have diverse comorbid psychiatric disorders. Careful psychiatric attention must be paid to this group to improve their functional impairment and to prevent further functional decline.
Aggression ; Child* ; Comorbidity ; Demography ; Gyeongsangnam-do ; Humans ; Parents ; Statistics as Topic ; Weights and Measures

OBJECTIVES: We conducted this study to find out topographic change of cerebral perfusion during methylphenidate(abbr: MPH) treatment and to compare between the change of SPECT and clinical improvement in subjects with attention deficit hyperactivity disorder(abbr: ADHD). METHODS: By DSM-IV criteria, we selected 32 pure ADHD patients through various assessment scales, psychometric tools and neuropsychological battery. All the patients were studied by 99m Tc-HMPAO brain SPECT, before MPH treatment and after 6 week treatment. Using image subtraction method, we obtained(+)/(-)NDR parametric image in each patient. RESULTS: When the change of brain SPECT and clinical improvement were compared, matching rate, senstivity and specificity between them were 81.1%, 85.3% and 75.2%. Increased cerebral blood flow in (+)NDR parametric image was found in frontal lobe, caudate nucleus and thalamus, especially in Right hemisphere. CONCLUSION: These findings indicated that MPH improved cerebral blood flow in fronto-caudato-thalamic areas, which have been known as region associated with pathophysiology of ADHD
Brain ; Caudate Nucleus ; Child* ; Diagnostic and Statistical Manual of Mental Disorders ; Frontal Lobe ; Humans ; Perfusion ; Psychometrics ; Sensitivity and Specificity ; Thalamus ; Tomography, Emission-Computed, Single-Photon* ; Weights and Measures

OBJECTIVE: This study was conducted to test the hypothesis that children with Attention Deficit Hyperactivity Disorder(ADHD) might have distinctive findings from normal controls in brain Single Photon Emission Computed Tomography(SPECT) and to figure out the possible pathophysiology of this disorder. METHOD: By DSM-IV criteria, we selected 21 pure ADHD through various assessment scales, psychometric tools and neuropsychological battery. All the patients were studied by 99m Tc-HMPAO Brain SPECT. Three transaxial brain slices delineating anatomically defined region of interest at approximately 2, 4, 6cm above the orbitomeatal line were used with the average number of counts for each region of interest normalized to the area of cerebral maximal uptake. Eleven normal controls were recruited from age, sex, IQ- matched children whose previous SPECT findings had been normal. RESULT: Comparing ADHD group and control, we found highly significantly decreased cererbral blood flow in both frontal lobes, caudate nuclei and thalamus in ADHD group. Addtionally, ADHD group showed reduction of blood flow in some parietal and temporal lobe areas compared with normal group, but the statistical significance in parietal and temporal areas was vanished after Bonferrroni correction due to multiple comparison. CONCLUSION: These findings implied that the rCBF reduction in ADHD in frontal lobe, caudate and thalamic areas might be related with the pathophysiogy of ADHD.
Brain ; Child* ; Diagnostic and Statistical Manual of Mental Disorders ; Frontal Lobe ; Humans ; Psychometrics ; Rabeprazole ; Temporal Lobe ; Thalamus ; Tomography, Emission-Computed, Single-Photon* ; Weights and Measures

OBJECTIVES: We conducted this study to investigate the extent of psychopathology in chronic epileptic children compared to normal controls. METHODS: The participating patients were recruited from the patients attending the epilepsy clinic of department of pediatric neurology in Seoul National University Hospital in Korea. We excluded seizure disorders associated with mental retardation, pervasive developmental disorder or brain organic pathology. As the control group, normal students whose sex, age, IQ, achievement and socioeconomic status were matched to patients were sellected. The authors interviewed the children and their family members and obtained the developmental history and family infor-mation. We used the following 5 scales to assess psychological and behavioral problems Each scale was standardized and its validity and reliability were confirmed in previous study. Parent rating scales: Yale children's inventory, Disruptive behavior disorder scale, Children's self rating scales: Children's depression inventory, Spielberger's state-trait anxiety anxiety. Piers-Harris self-concept inventory. RESULTS: Compared to normal controls, depression and anxiety scores were increased and self-concept score was decreased in patient group. The prevalence of ADHD, conduct disorder and ODD estimated by parental report was higher in patient group than control group. CONCLUSION: According to this study, chronic epileptic children showed diverse emotional and behavioral problems and needed urgent professional psychiatric help.
Anxiety ; Attention Deficit and Disruptive Behavior Disorders ; Brain ; Child* ; Conduct Disorder ; Depression ; Epilepsy ; Humans ; Intellectual Disability ; Korea ; Neurology ; Parents ; Pathology ; Prevalence ; Psychopathology* ; Reproducibility of Results ; Seoul ; Social Class ; Weights and Measures

OBJECTIVES: The definition of a hidden youth is a young person who has completely withdrawn from society and shut himself 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 selected from from mental health centers and psychiatric clinics around Seoul and Gyeonggi Province. We also recruited 239 parents of middle and high school students in the Seoul metropolitan area for a control group. In order to decide the concurrent validity 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 validity, it will be a useful method to screen for hidden youths in educational, community, and clinical settings.
Adolescent ; Anxiety ; Apathy ; Child ; Depression ; Humans ; Mass Screening ; Mental Health ; Parents ; Personality Disorders ; Reproducibility of Results ; Surveys and Questionnaires