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REFERENCE LINKING PLATFORM OF KOREA S&T JOURNALS
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Journal of the Korean Academy of Child and Adolescent Psychiatry
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Korean Academy of Child and Adolescent Psychiatry
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Volume & Issues
Volume 14, Issue 2 - Dec 2003
Volume 14, Issue 1 - Jun 2003
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NEW DRUG THERAPY IN CHILD AND ADOLESCENT PSYCHIATRY-NEW LONG-ACTING PSYCHOSTIMULANTS
Choi, Sung-Ku ;
Journal of the Korean Academy of Child and Adolescent Psychiatry, volume 14, issue 1, 2003, Pages 3~11
Attention-deficit/Hyperactivity disorder(ADHD) is the most common psychiatric disorder of childhood and among the most prevalent chronic health conditions affecting school-aged children. Children with ADHD experience significant functional problems, such as school difficulties, academic underachievement, troublesome interpersonal relationships with family members and peers, and low self-esteem. The most widely used pharmacological treatments for ADHD are psychostimulants, such as methylphenidate and amphetamine salts. These medications provide clinical efficacy by increasing the availability of catecholamines, primarily dopamine, in the frontal lobe of the brain. immediate-release(IR) formulations of sychostimulants were among the most effective psychotrophic medications in the psychopharmacological treatment. However, there are some limitations of IR formulations：the short half-life and duration of efficacy, which result in the need for multiple daily dosing and the poor compliance. These limitations have led to the development of once-daily, extended-release(ER) formulations of methylphenidate and amphetamine salts. However, these ER formulations may not be as immediately helpful to ADHD children due to delayed onset of action and the acute tolerance which is the failure to sustain the efficacy with the same concentration of drug as the initial stage of medication. OROS-methylphenidate(Concerta
) given once a day produces an ascending-pattern plasma drug level generated by the osmotically released, timed drug-delivery system. These new formulations of the psychostimulants have been shown to be a useful alternative to old stimulant medications through the evidence by the clinical trials.
NEW ANTIDEPRESSANTS IN CHILD AND ADOLESCENT PSYCHIATRY
Lee, Soo-Jung ;
Journal of the Korean Academy of Child and Adolescent Psychiatry, volume 14, issue 1, 2003, Pages 12~25
Objectives：As increasing number of new antidepressants have been being introduced in clinical practice, pharmacological understanding has been broadened. These changes mandate new information and theories to be incorporated into the treatment process of children with depressive disorders. In light of newly coming knowledge, this review intended to recapitulate the characteristics of new antidepressants and to consider the pivotal issues to develope guidelines for the treatment of depression in childhood and adolescence. Methods：Searching the Pub-Med online database for the articles with the key words of 'new', 'antidepressants' and 'children' ninety-seven headings of review articles were obtained. The author selected the articles of pertinent subjects in terms of either treatment guideline or psychopharmacology of new antidepressants. When required, articles about the clinical effectiveness of individual antidepressants were separatedly searched. In addition, the safety information of new antidepressants was acquired by browsing the official sites of the United States Food and Drugs Administration and Department of Health and Human Services. Results：1) For the clinical course, treatment phase, and treatment outcome, the reviews or treatment guidelines adopted the information from adult treatment guidelines. 2) Systematic and critical reviews unambiguously concluded that selective serotonin reuptake inhibitors(SSRIs) excelled tricyclic antidepressants( TCAs) for both efficacy and side effect profiles, and were recommend for the first-line choice for the treatment of children with depressive disorders. 3) New antidepressants generally lacked treatment experiences and randomized controlled clinical trials. 4) SSRIs and other new antidepressants, when used together, might result in pharmacokinetic and/or pharmacodynamic drug-to-drug interaction. 5) The difference of the clinical effectiveness of antidepressants between children and adults should be addressed from developmental aspects, which required further evidence. Conclusion：Treatment guidelines for the pharmacological treatment of childhood and adolescence depression could be constructed on the basis of clinical trial findings and practical experiences. Treatment guidelines are to best serve as the frame of reference for a clinician to make reasonable decisions for a particular therapeutic situation. In order to fulfill this role, guidelines should be updated as soon as new research data become available.
NEW DRUG THERAPY IN CHILD AND ADOLESCENT PSYCHIATRY ATYPICAL ANTIPSYCHOTICS
Bahn, Geon-Ho ;
Journal of the Korean Academy of Child and Adolescent Psychiatry, volume 14, issue 1, 2003, Pages 26~35
Conventional antipsychotics are commonly used to treat children and adolescents suffered from schizophrenia to other neuropsychiatric conditions. Regrettably, studies for typical antipsychotics report high rates of sedation, orthostatic hypotension, and extrapyramidal side effects. Over the past few years, atypical antipsychotics have been prescribed for use in adults with psychotic symptoms. Child psychiatrists have begun using these drugs to children and adolescents hoping safe and better alternatives to the conventional antipsychotics. However, there is not enough short-term and almost no long-term data about atypical antipsychotics for pediatric patients. Therefore, the purpose of this article is to review what is known about the use of the atypical antipsychotics in young patients. To do so, an appropriate approach to the use of these drugs in child and adolescent patients my be offered.
PSYCHOPHARMACOLOGY OF ADHD WITH COMORBID DISORDERS
Cho, In-Hee ;
Journal of the Korean Academy of Child and Adolescent Psychiatry, volume 14, issue 1, 2003, Pages 36~52
Attention deficit/hyperactivity disorder is one of the most comminly treated conditions in the child psychiatric units and results in substantial impairment in peer, family and academoc functioning. For 70% to 80% of children with a diagnosis of ADHD, stimulant tratment results in successful improvement of the core ADHD symptoms. However, children with ADHD have high level of comorbidity and may respond differently from children with ADHD without comorbidity. Therefore they may need specific treatment plan. We reviewed efficacy and safety of prescribed medication for treating children with ADHD, the relationship between ADHD and the comorbid conditions and treatment algorithm projects of ADHD with/without comorbid conditions performed Korean and American child psychiatrists. Our main objective is to increase the uniformity of treatment and improve the clinical outcomes of children with comorbid ADHD.
DRUG THERAPY FOR DEVELOPMENTAL DISORDER PATIENTS WITH SELF-MUTILATION
Kim, Bong-Seog ;
Journal of the Korean Academy of Child and Adolescent Psychiatry, volume 14, issue 1, 2003, Pages 53~63
The autistic disorder is identified as an independent clinical entity, since the first description of Leo Kanner. The etiologies of the autistic disorder are almost unclear and the autistic disorder has several abnormalities in aspect of morphology and function of brain. Self-mutilation is observed in the low functioning autistic patients, and early treatment for self mutilation are needed in order not to be chronic. This article reviewed the drugs for the several symptoms of the autistic disorder, especially for self-mutilation. The serotonin reuptake inhibitors does not have clear primary anti-aggressive effects. The dopamine blockers have considerable effects in order to decrease aggression and self injury, and the risperidone is most recommended because of side effects of conventional drugs. The naltrextone does not have consistent study results yet. The clonidine has aggression-decreasing effect. Also lithium is effective on the treatment for aggressive and self-injurious behaviors. And the anticonvulsants including carbamazepine are effective on aggressive explosive behaviors. In the future the pharmacotherapy for self-mutilation will be advanced through stalbe diagnosis and measurement of treatment response.
THERAPEUTIC APPROACHES FOR TREATMENT RESISTANT OBSESSIVE-COMPULSIVE DISORDER IN CHILDREN AND ADOLESCENTS
Suh, Hyun-Ju ; Kim, Boong-Nyun ;
Journal of the Korean Academy of Child and Adolescent Psychiatry, volume 14, issue 1, 2003, Pages 64~80
Although obsessive-compulsive disorder(OCD) affects children, adolescents, and adults whether its juvenile(dhild and adolescent) and adult forms are different subtype of a disorder remains unknown. But there are increasing findings that suggest that juvenile OCD may be unique subtype of the disorder. One proposed subtype is the childhood OCD associated with high comorbidity of tic disorder and increased familial loading for OCD or tic disorder. The other proposed subtype is the childhood OCD and/or tic disorder occuring in association with streptococcal infection(PANDAS). These two subtypes of OCD are unlikely to respond to SSRI due to possible different pathphysiological mechanism. So this paper reviews the characteristics of OCD and therapeutic approaches for treatment resistant OCD in childhood and adolescence. Considering the likely heterogeneity of OCD, the possibility that juvenild OCD may be a variant of the disorder can have important clinical and scientific implications because it may further our understanding of this disorder, its etiology, and perhaps its treatment.
STANDARDIZATION OF WORD/NONWORD READING TEST AND LETTER-SYMBOL DISCRIMINATION TASK FOR THE DIAGNOSIS OF DEVELOPMENTAL READING DISABILITY
Cho, Soo-Churl ; Lee, Jung-Bun ; Chungh, Dong-Seon ; Shin, Sung-Woong ;
Journal of the Korean Academy of Child and Adolescent Psychiatry, volume 14, issue 1, 2003, Pages 81~94
Objectives：Developmental reading disorder is a condition which manifests significant developmenttal delay in reading ability or persistent errors. About 3-7% of school-age children have this condition. The purpose of the present study was to validate the diagnostic values of Word/Nonword Reading Test and Letter-Symbol Discrimination Task for the purpose of overcoming the caveats of Basic Learning Skills Test. Methods：Sixty-three reading-disordered patients(mean age 10.48 years old) and sex, age-matched 77 normal children(mean age 10.33 years old) were selected by clinical evaluation and DSM-IV criteria. Reading I and II of Basic Learning Skills Test, Word/Nonword Reading Test, and Letter-Symbol Discrimination Task were carried out to them. Word/Nonword Reading Test：One hundred usual highfrequency words and one hundred meaningless nonwords were presented to the subjects within 1.2 and 2.4 seconds, respectively. Through these results, automatized phonological processing ability and conscious letter-sound matching ability were estimated. Letter-Symbol Discrimination Task：mirror image letters which reading-disordered patients are apt to confuse were used. Reliability, concurrent validity, construct validity, and discriminant validity tests were conducted. Results：Word/Nonword Reading Test：the reliability(alpha) was 0.96, and concurrent validity with Basic Learning Skills test was 0.94. The patients with developmental reading disorders differed significantly from normal children in Word/Nonword Reading Test performances. Through discriminant analysis, 83.0% of original cases were correctly classified by this test. Letter-Symbol Discrimination Task：the reliability(alpha) was 0.86, and concurrent validity with Basic Learning Skills test was 0.86. There were significant differences in scores between the patients and normal children. Factor analysis revealed that this test were composed of saccadic mirror image processing, global accuracy, mirror image processing deficit, static image processing, global vigilance deficit, and inattention-impulsivity factors. By discriminant analysis, 87.3% of the patients and normal children were correctly classified. Conclusion：The patients with developmental reading disorders had deficits in automatized visuallexical route, morpheme-phoneme conversion mechanism, and visual information processing. These deficits were reliably and validly evaluated by Word/Nonword Reading Test and Letter-Symbol Discrimination Task.
ANXIOUS-DEPRESSIVE ATTRIBUTES TO SUICIDAL IDEA OF ADOLESCENTS
Jin, Yong-Tak ; Ha, Eun-Hye ; Song, Jung-Eun ; Park, Eun-Young ; Choi, Tae-Kyou ; Song, Dong-Ho ;
Journal of the Korean Academy of Child and Adolescent Psychiatry, volume 14, issue 1, 2003, Pages 95~102
Objectives：This study was aimed at examining the emotional predictors of adolescent suicidal ideas in a community. Methods：The subjects were 1909 middle and high school students(936 males, 973 females) in Koyang-shi. We evaluated all subjects using Center for Epidemiologic Study for Depression(CES-D), Revised Children's Manifest Anxiety Scale(RCMAS), Korean-Youth Self Report(K-YSR), Psychological Self-1 of Offer's Self Image Questionnaire(PS-1 of OSIQ) and Suicide Ideation Questionnaire (SIQ). We compared the PS-1 of OSIQ scores of Anxious-depressive group(above cut-off points of CES-D, RCMAS and K-YSR) to those of control group, and conducted correlation analysis and stepwise multiple regression analysis to all subjects. Results：The number of anxious-depressive group was 126(6.58%) among 1909 subjects with significant gender difference(M：F ratio 1：1.5). Both PS-1 of OSIQ and SIQ scores were significantly higher in Anxious-depressive group than in control group. There were significant correlations among the scales：CES-D, RCMAS, A/D of K-YSR, PS-1 of OSIQ and SIQ. Through stepwise multiple regression analysis, we found that significant predictors of suicidal idea were CES-D, RCMAS and A/D of K-YSR. Conclusion：Anxious-depressive adolescents may be the high-risk group for suicidality and need preventive interventions of suicidality in a community.
A PILOT STUDY FOR STANDARDIZATION OF BERKELEY PUPPET INTERVIEW - SYMPTOMATOLOGY & PARENT-CHILD RELATIONSHIP SCALE
Shin, Min-Sup ; Son, Jung-Woo ; Cho, Soo-Churl ; Kim, Boong-Nyun ; Kim, Soo-Kyoung ;
Journal of the Korean Academy of Child and Adolescent Psychiatry, volume 14, issue 1, 2003, Pages 103~111
Objectives：BPI was developed for assessing young children's perceptions. Using an interactive techniques for interviewing children, the BPI blends structured and clinical interviewing technique. Present study was to evaluate the reliability, validity and the clinical utility of Berkeley Puppet Interview(BPI) for young children aged 4 to 7. Methods：Subjects consisted of 37 children(boy20, girl 17) between the age of 4 and 7 who visited the child-psychiatry outpatient division of children's hospital in Seoul and Chungju. The measures used in this study BPI-S(symptomatology) and BPI-PC(parent-child relationship). BPI was translated into Korean by three clinical psychologists. To examine the reliability, Chonbach's alpha were calculated and to examine the validity, correlation coefficients were calculated on BPI-S & K-CBCL. Results：BPI-PC's Cronbach's alpha was 0.86 and BPI-S's Cronbach's alpha was 0.74. Correlation between the internalizing scale of BPI-S and that of K-CBCL was 0.477 and correlation between the internalizing scale of BPI-S and the externalizing scale of K-CBCL was -0.431, suggesting the validity of BPI-S. Conclusion：These results show that BPI-S & BPI-PC may be useful tool for young children's diagnostic interview.
STUDY ON THE RELATIONSHIP BETWEEN ONTOGENY OF SEROTONIN SYSTEM AND PSYCHOPATHOLOGY IN CONDUCT DISORDER
Shin, Sun-Woong ; Shin, Min-Sup ; Hwang, Jun-Won ; Kim, Boong-Nyun ; Cho, Soo-Churl ;
Journal of the Korean Academy of Child and Adolescent Psychiatry, volume 14, issue 1, 2003, Pages 112~122
Objectives：Considerable data indicate that diminished serotonergic activity is related to aggressive behavior. In order to understand the biological etiology in conduct disorder, we studied the relationships of plasma serotonin and 5-HIAA levels in conduct disorders to measures of aggression, violation of rules and oppositional defiant behavior. Methods：Subjects were selected from inpatients and outpatients department of the Division of Child and Adolescent Psychiatry of Seoul National University Hospital. 41 conduct disorders(18 childhoodonset type, 23 adolescent-onset type) and 23 normal controls were included in this study. For the assessment of aggression, rule violation and oppositional behavior, parents completed the rating scale for conduct disorder and oppositional behavior based on the DSM-IV diagnostic criteria. Plasma serotonin and 5-HIAA levels were determined by HPLC with electrochemical detection. Results：1) Plasma 5-HT and 5-HIAA levels were not significantly different among childhood-onset conduct disorder, adolescent-onset conduct disorder and normal control subjects. 2) No significant correlations were found between plasma 5-HT levels and aggression or rule violation. 3) Plasma 5-HT levels showed significant positive correlations with oppositional behavior both in childhood-onset conduct disorder and adolescent-onset conduct disorder. 4) Age-related changes were not found in plasma 5-HT and 5-HIAA levles. Conclusion：Our findings do not support the hypothesis that dysregulation of serotonergic function may be associated with aggresson. Instead, our data suggest that serotonergic function is more closely related with oppositional behavior than aggression.
A CASE OF CORENELIA DE LANGE SYNDROME WITH MENTAL RETARDATION AND AUTISTIC DISORDER
Kim, Se-Joo ; Choi, Nak-Kyoung ; Song, Jung-Eun ;
Journal of the Korean Academy of Child and Adolescent Psychiatry, volume 14, issue 1, 2003, Pages 123~127
Cornelia de Lange syndrome is a dysmorphogenic disorder characterized by multiple congenital abnormalities, mental retardation, growth retardation and neurodevelopmental abnormalities. Diagnosis for the Cornelia de Lange syndrome is dependent on the clinical observation because neither definite biological marker nor definite chromosomal abnormality have been investigated. Clinical observation is important for the diagnosis, so we report a case of Corenelia de Lange syndrome with mental retardation and autistic disorder. The patient is a 6-year old girl. Her motor development and language development have been delayed. She could say no meaningful word and understood simple command partially. She showed poor eye contact and poor emotional interaction. Social interaction was impaired and she Showed stereotypic behaviors. Thus we diagnosed her as mental retardation with autistic disorder. She had vesicoureteral reflux, frequent upper respiratory infection and pneumonia. She had experienced febrile convulsions 4 times. She had short stature, confluent eyebrows, long eyelashes, and upturned nose with anteverted nostrils. She also showed low hairline and hypertrichosis in body and extremities. Her finger was short. In this case, we diagnosed Cornelia de Lange syndrome by her characteristic face, hypertrichosis and medical and behavioral problems that were frequently showed in this syndrome.