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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 6, Issue 1 - Dec 1995
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BORDERLINE DISORDER OF CHILDHOOD : 8 CASES
Hong, Kang-E ; Lee, Jeong-Seop ; Shin, Min-Sup ;
Journal of the Korean Academy of Child and Adolescent Psychiatry, volume 6, issue 1, 1995, Pages 3~17
The so-called borderline children are characterised by disturbances in the sense of reality and interpersonal relationships, lack of control, fluctuation of functioning, uneven development and excessive anxiety. But the concept of borderline disorder of childhood is very difficult to define and diagnose in current classification system. The present study adapted the consensus symptoms in borderline children by Bemporad and Vera eight cases aged 7-11 were examined in 37 variables. Results are as follows 1) All subjects are boys and girl hardly be diagnosis n current diagnostic system and have many concurrent diagnoses. Common chief complaints in the sense of reality. 2) In KEDI-WISC test, the borderline children showed average intelligence, but performance IQ tends to be higher than verbal IQ. In Rorscharch test, they showed high thought disorder index, emotional instabilities and aggressive impulses. The results of TOVA suggested attentional deficit in half of the subjects. The organicity is not prominent. 3) Many of the borderline children were unwanted baby. Although primary care takers of all the subjects were their mothers there were moderate problems in caring attitude of their children and marital relationship with their husband. Sccioeconomic status was generally below middle class. Most of all subjects have delayed language development, but have overcome subsequently. Many subjects were rejected by peers because of their aggression. 4) The first visit of the subjects was about 6 years of age. Average duration of treatment was 2 years. All of them were treated in the outpatient basis except one. The effect of pharmacotherapy was doubtful and the necessity of long term play therapy was suggested. Although there were many limitations of method in present study, it was suggested that further research is needed for diagnostic criteria, epidemiology and treatment.
CLINICAL CATEGORIES OF ADOLESCENT BORDERLINE STATE
Hong, Kang-E ; Jeon, Seong-Ill ; Shin, Min-Sup ;
Journal of the Korean Academy of Child and Adolescent Psychiatry, volume 6, issue 1, 1995, Pages 18~33
The Purpose of this article is to identify the specific characteristics of borderline disorder in adolescence to conceptualize the borderline state as an adolescent process different from borderline personality disorder in adult, and to classify them according to it's unique clinical feature, porcess and outcome. The development of borderline disorder in adolescent, epidemiology, comorbid disorders and differential diagnosis, pre-existing sub-classification systems, and etiology in theories of psychodynamics, biological theories, experimental studies, and follow-up studies are reviewed. The authors conceptualize the adolescent borderline state include all clinical states generated by re-emergence of unresolved rapproachement conflicts in adolescent, and propose that there are four subgroups in adolescent borderline state. (1) Borderline state as an adolescent process. (2) Borderline state associated with psychotic disorders (3) Borderline state as an initial stnge of typical borderline personality disorder (4) Borderline state associated with organic problems. Conceptually, borderline state in adolescence is not a simple continuation of primary failure of separation-individuation but a struggle for mastering unresolved separation-individuation conflicts in adolesance i.e., the second separation-individuation state, and if it fails this time, the struggle might continue into adult life as borderline personality disorder.
BORDERLINE PERSONALITY DISOREDER IN ADOLESCENTS
Jang, Kyung-June ; Chung, Jea-Yun ;
Journal of the Korean Academy of Child and Adolescent Psychiatry, volume 6, issue 1, 1995, Pages 34~42
Borderline personality disorder in adolescents present with suicide attempts or gestures, and they are characterized by the same patterns of splitting, devaluation, manipulation, need-gratifying object relations, impulsivity, and ego deficits that are finds in borderline adults, Symptomatolgy are depression, anxiety, identity crisis, and occasionally antisocial behavior in borderline personality disorder in adolescents. These findings should be differentiated to normal stormy adolescents. Theses borderline personality disorder in adolescents are known about the instability of object relations, labile affect, splitting, and psychotic episode in severe stress. According to thses finding, schizophrenia, mood disorder, schizoptypal personality disorder, paranoid personality disorder could be differentiated. Etiology is complex including psychodynamic, genetic, familial factor. Treatments are individual psychotherapy, group therapy, and pharmacotherapy. The continuity or discontinuity of borderline states from childhoon to adult life is controversy.
THERAPY FOR ADOLESCENTS WITH BORDERLINE DISORDER
Lee, Dong-Soo ;
Journal of the Korean Academy of Child and Adolescent Psychiatry, volume 6, issue 1, 1995, Pages 43~46
Like each treatment for the psychiatric patients psychotherapeutic approach for the adolescent borderline patients is case by case. However some principles are derived from the characteristics of the adolescent psychology. As they put it adolescence is psychologically 'the second individuation period'. Both sexual dvive and aggressive drive are aggrevated, and 'the actual object' like parent are to be separated. Given that borderline patients are weak in their egos and show poor indentity formation 'analytic supportive psychotherpay' would be more effective than analysis itself.
PLASMA DOPAMINE-BETA-HYDROXYLASE ACTIVITY IN TOURETTE'S DISORDER AND CHRONIC MOTOR TIC DISORDER
Cho, Soo-Churl ; Suh, Yoo-Hun ;
Journal of the Korean Academy of Child and Adolescent Psychiatry, volume 6, issue 1, 1995, Pages 47~55
To elucidate the biochemical etiology. 1) plasma dopemine-beta-hydroxylase activity was measured and 2) the correlation between age and DBH activity was examined in 30 Tourette's disorder, 19 chronic motor tic disorder, and 24 controls. The results are summarized as follows : 1) The mean plasma DBH activity in Tourette's disorder was significantly elevated compared to normal groups, but significant differences in DBH activity between Tourette's disorder and chronic motor tic disorder, and between chronic motor tic disorder and normal control group were not found. 2) In all three groups, the significant positive correlations between age and plasma DBH activity found. These findings support the hypothesis of a possible involvement of brain catecholamine dysfunction in the production of Tourette's disorders, and this dysfunction might be due to the increased dopaminergic and decreased noradrenergic function. Future research should be focused on the mechanism of functional abnormalities of DBH.
FAMILY DYNAMICS OF INCEST PERCEIVED BY ADOLESECENTS
Kim, Hun-Soo ; Shin, Hwa-Sik ;
Journal of the Korean Academy of Child and Adolescent Psychiatry, volume 6, issue 1, 1995, Pages 56~64
Family is a primary unit of the major socialization processing for children. Parents among the family members are one of the most important figures from whom the child and adolescent acquire a wide variety of behavior patterns, attitudes, values and norms. An organization of family members product family structural functioning. Abnormal family structure is one of the most important reference models in the learning of antisocial patterns of behavior. Therefore incest and child sexual abuse including spouse abuse, elderly abuse, and neglect occurs in the abnormal family structural setting. In particular, incest, a specific form of sexual abuse, was once thought to be a phenomenon of great rarity, but our clinical experiences, especially over the past decade, have made us aware that incest and child sexual abuse is not rare case and on the increasing trend. Therefore, the aim of this study was to determine the family problem and dynamics of incest family, and character pattern of post-incest adolescent victim in Korea. A total of 1,838 adolescents from middle and high school(1,237) and juvenile correctional institute(601) were studied, sampled from Korean student population and adolescent delinquent population confined in juvenile correctional institutes, using proportional stratified random sampling method. The subjects' ages ranged from 12 to 21 years. Data were collected through questionnaire survey. Data analysis was done by IBM PC of Behavior Science Center at the Korea university, using SAS program. Statistical methods employed were Chi-square, principal component analysis and t-test etc. The results of this study were as follows ; 1) Of 1,071 subjects, 40(3.7%) reported incest experiences(sibling incest : 1.6% ; another type of incest : 2.1%) in their family setting. 2) The character pattern of post-incest adolescent victim was more socially maladjusted, immature, impulsive, rigid, anxious and dependent than non-incest adolescent. Also they showed some problem in academic performance and their assertiveness. 3) The other family members of incest family revealed more psychological and behavioral problem such as depression, alcoholism, psychotic disorder and criminal act than the non-incest family, even though there is no evidence of the context between them. 4) The family dynamics of incest family tended to be dysfunctional trend, as compared with non-incest family. It showed that the psychological instability of family member, parental rejection toward their children, coldness and indifference among family member and marital discordance between the parents had significant correlation with incest.
COMPARISON OF THE TREATMENT EFFECTS BETWEEN MEDICATION ONLY AND MEDICATION-PLUS-PARENT TRAINING IN ADHD CHILDREN
Shin, Min-Sup ; Oh, Kyung-Ja ; Hong, Kang-E ;
Journal of the Korean Academy of Child and Adolescent Psychiatry, volume 6, issue 1, 1995, Pages 65~73
We conducted the comparative study of the effects of the parent training combined with medication and the medication only on 23 ADHD children with the age from 5 to 11(body 22, girl 1). Mothers of combined treatment group(parent training+medication) attended, the parent training program once a week for 8 consecutive weeks and booster session 1 month later. Children of both groups were assessed twice before and after treatment using the various using scales and TOVA to evaluate the treatment effects. The results of present study showed the greater effectiveness of the medication+parent training over the medication only in reducing the parenting stress of mothers as well as the inattention and behavioral problems of ADHD children. In medication only group while the scores of mother's rating did not change significantly after treatment, those of teacher's rating and TOVA tend to be decreased to normal range. These results suggested that methylphenidate is effective on improving attentional problems of ADHD children, but not on behaviral problems at home. These results mean that parent training is needed for reducing behavioral problems of ADHD children, negative interactions in mother-child relation, and parenting stress as well as maxmizing medication effect.
CLINICAL CHARACTERISTICS AND TREATMENT COURSES OF THE CHILDREN WITH SELECTIVE MUTISM
Chung, Sun-Ju ; Hong, Kang-E ;
Journal of the Korean Academy of Child and Adolescent Psychiatry, volume 6, issue 1, 1995, Pages 74~89
Selective mutism is a childhood condition defined by persisten failure to speak in specific social situation when speaking is expected, dispite preserved ability to comprehend spoken language and speak. Present study is to investigate clinical characteristics, treatment method and outcome of 23 children who were diagnosed as selective mutism by DSM-IV criteria at the child psychiatry ouptatient department of SNUH. The results were as follows : 1) The Sex ratio was 1: 4.8, female dominant Mear age of onset was 33 years old and mean age of first referral was 7.7 years old. 2) 22% of subjects had perinatal problem such as low birth weight, preterm birth, 26% of the subjects have history of delayed language development. There are subjects who had been separated with mam caretaker before 3 years old(26%) and who experienced physical or psychological trauma before 3 years old(26%). A few subjects had enurests(30%) and encoprests(4%). 3) Many subjects(65%) had symbiotic relationship with their mother. These families consist of dominant, verbally aggressive mother and passive father. Parents of 39% of all subjects were judged to have definite psychopathology(social phobic, depression, hysterical trait or alcohol problem) 26% of all subject, were reported physically abused. 4) The personality trait of the subjects were frequently described as follows(in order of frequency) ; Shy(100%), anxious(83%), stubborn(83%)m rigid and tense posture(78%), immature(65%) overdependent(65%), irritable(52%), manipulative(39%), depressive(39%). 5) The mean performance IQ of 16 subjects by KEDI-WISC was 88.3 Among them, the subjects with IQ below 69 were seven and those with IQ above 70 were nine. When comparing these two group(Mental retardation group vs Normal IQ group), we could find some difference in language development, personality trait, family dynamics and treatment outcome. 6) Among several treatment methods for selective mutism, play therapy was the most frequently used method(65%). Other commonly used treatment methods were pharmacotherapy(21%), behavioral therapy(8%), combined therapy(play therapy+pharmacotherapy+family therapy+behavioral therapy)(12%), 7) Regarding the outcome of treatment 8.6% was evaluated as Excellent, 30.4% as Good, 52% as Fair, 8.7% as Poor at the tinic of treatment. At follow up interview 21.7% was evaluated Excellent, 13% as Good, 21.7% as Fair, 34.8% as Poor. 8) We classified all subjects by Havden's 4 subtype. Symbiotic mutism was most common(65%) and other subtypes are Speech phobic mutism(8.6), Reactive mutism(13%) and Passive-aggressive mutism(30%).
RELATIONS BETWEEN SHYNESS AND INTERPERSONAL VARIABLES - FOCUSING ON SOCIAL SKILL AND MOTIVATION FACTOR -
Kim, Guen-Young ; Yoon, Gene ;
Journal of the Korean Academy of Child and Adolescent Psychiatry, volume 6, issue 1, 1995, Pages 90~99
This study was intended to investigate the effects of shyness, which is regarded as one of the former and comprehensive factors of social anxiety disorder, on interpersonal relationship. Particularly, the relations among Social Skill Factor, Motivation Factor, and Shyness were examined in order to verify a conventional belief('the most shy people have both low social skill and high motivation.') 497 middle school students(231 males and 266 females) in seoul were administrated with Snyder's Self-Monitoring Scale and Shyness Scale, and Peer-Group Popularity was measure. The results are : 1) the lower social skill is and hight Motivations is the more he or she is shy. 2) influence of Social Skill Factor is greater than that of Motivation Factor. 3) interaction effect among sex, shyness, and peer-group popularity was found.
EFFECTS OF INTERPERSONAL COGNITIVE PROBLEM SOLVING SKILLS TRAINING ON ADOLESCENTS WITH MILD MENTAL RETARDATION
Oh, Kyung-Ja ; Lee, Mi-Seon ;
Journal of the Korean Academy of Child and Adolescent Psychiatry, volume 6, issue 1, 1995, Pages 100~108
The purpose of the present study was to examine whether Interpersonal Cognitive Problem Solving(ICPS) skill training would enhance interpersonal solving skills and behavioral adjustment of mildly mentally retarded adolescents in the junior and high school. The program used in the present study was shortened and adapted for mildly retarded adolescents from Shure and Spivack(1982) program which was developed to improve the adjustment of children in the intermediate grades 5-6. The subjects were 22 mildly retarded adolescents, and they were assigned to either the experimental(11) or the control group(11). The experimental group were given ICPS training 4 times a week over a period of 8 weeks with a total of 32 sessions in all. The results showed a significant improvement of alternative thinking and consequential thinking in the experimental group compared with the control group. With regard to behavioral ratings by the parents and teachers, there were no significant differences between the groups. The results indicated that the training was effective in increasing the ability to generate alternative solutions and to predict consequences, but the significant improvement of interpersonal cognitive problem solving skills did not lead to noticeable improvement in behavioral adjustment. It was suggested that a longer training period for over-learning, concomitant parent education program, and more behaviorally oriented social skill training combined with the cognitive approach would yield significant training effects, maintenance and transfer.
THE EFFECT OF FACIAL SCREENING ON PICA TREATMENT IN A CHILD WITH SEVERE RETARDATION
Chung, Bo-In ;
Journal of the Korean Academy of Child and Adolescent Psychiatry, volume 6, issue 1, 1995, Pages 109~115
The main purpose of this study was to treat pica in a 2.8 year old child with severe mental retardation along with autistic tendencies. His developmental age ranged from 12 to 15 month on the DDST and he had no means of communication. He was on Tegretol 200mg for seizure control. His pica involved thumb sucking, putting toys into his mouth, and licking furniture wherever he went Besides pica, he had a rumination problem. The treatment strategies for his pica consisted of two phases : In phase 1, The child was taught toy play through a 3-step guided compliance training, while his pica and rumination behaviors were recorded to investigate whether active toy play could effect any change in the untreated pica and rumination behaviors of this child. In phase 2, a facial screening was used as a means to control his pica, while his rumination was recorded to see whether controlling his pica could bring any change in the untreated ruminating behavior. The results showed that the facial screening was very effective in decreasing his pica from an average of 18.6 times per 15 minute in the baseline to 2.3 times post-treatment. Response covariation was observed across pica and rumination while toy play compliance training alone was being conducted, and covariation across rumination was observed while pica alone was being treated with facial screening.
CASE STUDY : FLUOXETINE INDUCED MANIA IN A SCHIZOPHRENIC PATIENCT AND REVIEW OF LITERATURES
Kim, Bung-Nyun ; Cho, Soo-Churl ;
Journal of the Korean Academy of Child and Adolescent Psychiatry, volume 6, issue 1, 1995, Pages 116~122