Journal of the Korean Academy of Child and Adolescent Psychiatry
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v.16
no.1
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pp.124-131
/
2005
Childhood and adolescent onset-bipolar disorders have higher rate of comorbidity with anxiety disorders as well as attention deficit hyperactivity disorder and conduct disorder. Obsessive compulsive disorder, social phobia, panic disorder, and separational anxiety disorder are common comorbid anxiety disorders with bipolar disorders in child and adolescent. Prospective and reliable data on temporal and causal relationship between the onset of bipolar disorders and the onset of comorbid anxiety disorders are still in debate. The authors report 2 adolescent cases with antidepressant induced-manic episodes with preceding anxiety symptoms. The authors suggest careful prescription of antidepressants for anxiety disorders, even for those who do not have definite past history or family history of bipolar disorders. Further comprehensive and prospective studies are requested for the temporal relationship and pharmacological guideline for comorbid bipolar disorders and anxiety disorder in child and adolescent.
This study examined the effectiveness of the Filial Therapy program for children with Separation Anxiety Disorder (SAD). Subjects were 8 mother-child dyads each in the experimental and comparison groups. Mann-Whitney U-test and the Wilcoxon Matched-Pairs Signed-Ranks Test were performed following the therapeutic program. After application of the Filial Therapy program, results showed that, compared to the control group, (1) parents of SAD children in the experimental group significantly increased their level of empathic interactions with their children. AND (2) the experimental group children significantly reduced level of somatic complaints, anxious/depressed, and social problems. Conclusions were that Filial Therapy is an effective program for improvement of parent-child relationship of SAD children but not for changing problem behavior of SAD children.
Journal of the Korean Academy of Child and Adolescent Psychiatry
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v.6
no.1
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pp.34-42
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1995
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.
Authors report a case of separation anxiety disorder, which developed as a side effect during haloperidol treatment of Tourette syndrome(TS). In this case, 14 years old boy developed attention deficit symptoms during his infancy. At 4th grade of primary school, he developed vocal tic, motor tic, and coprolalia. With 5mg/day of haloperidol treatment his symptoms of TS were subsided. During the treatment, he developed features of separation anxiety disorder, including dependence, pleading, clinging, and sadness. Symptoms of attention deficit and separation anxiety disorder were improved by 25mg/day of imipramine treatment. During haloperidol treatment of TS, careful observation may be needed whether separation anxiety disorder-like symptom develops.
Seperation anxiety disorder(SAD) is characterized by excessive anxiety about being apart from the individuals to whom a child is most attached. We noticed a case of a 13 year old boy's SAD with symptoms of nausea/vomiting, stomachache, school refusal, and severe weight loss. His mother was overanxious and overdependent but her dependency was frustrated due to family problem. We investigated this case from a point of developmental aspect and family dynamics and tried to attempt therapeutic approach.
Journal of the Korean Academy of Child and Adolescent Psychiatry
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v.9
no.2
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pp.237-246
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1998
Objectives and Methods:This study investigated clinical characteristics, treatment modality, outcome of 57 children and adolescent inpatients(male 53, female 4) who were diagnosed as pervasive developmental disorder(PDD) by DSM-Ⅳ criteria recent five years. Results:1) The mean age at admission was $96{\pm}28.2$ months, and the mean age at which they first visited treatment facility was $52{\pm}26.6$ months. The mean hospitalization period was $43.7{\pm}31.3$ days. 2) Diagnosis:Twenty-seven(47.4%) of subjects met DSM-Ⅳ criteria for PDD NOS. Fifteen (26.3%) met for autistic disorder, nine(15.8%) met for Asperger's syndrome, and two(3.5%) met for childhood disintegrative disorder. 3) Comorbid diagnosis:The most common comorbid dignosis was attention deficit hyperactivity disorder(23.8%). 4) IQ test:IQ test for twenty-eight subjects was possible. The Average of the subjects was $70{\pm}27.5$. Fifteen(53.6%) of the subjects were approximate or under 70. 5) Neurology Abnormality:EEG findings of eleven(21.2%) subjects were abnormal, brain CT or MRI findings of eight subjects(21.6%) were abnormal. 6) Family Hx:Depressive disorder were found in Eight mothers(14%). Familial loading was found in twenty families(35.1%), and familial loading of PDD was found in three(5.3%). Conclusion:The most important thing for the management of PDD is early detection and early treatment. To do so, multidisciplinary team approach should be emphasized.
The sleeplessness in childhood is quite different from that in adulthood in terms of causes, developmental process, and treatment. Sleep behavior in childhood is strongly influenced by parental personality and familial and cultural background. In understanding and management of sleeplessness of children, it is especially important to understand the separation anxiety and the ways of its management in bedtime because bedtime routine with children one of separation process from parents. Co-sleeping, parental intervention, transional object and bedtime routines can be appeared in order to reduce the anxiety from bedtime separation. Causes of sleeplessness in infant and toddler are bad sleep-onset association, nocturnal drinking, colic, and food allergy. In preschool and school aged children, limit-setting sleep problem and fears and nightmare can be causes of sleeplessness. When good sleep environment and habits are established sound sleep and more mature personality can be developed.
The purpose of this study was to examine the oral symptoms, self-rated systemic health state and oral health status of industrial workers in a bid to provide some information on oral health education geared toward industrial workers. The subjects in this study were 294 workers who got a medical checkup in Korea Industrial Health Association in North Gyeongsang Province. Those who felt less inconveniences in the oral cavity led a better quality of life related to oral health in every area except physical handicaps (p<.001, p<.01). The men's OHIP-14 was higher than the women's, and the younger workers led a better quality of life related to oral health in the area of social separation(p<.01), and the married ones did in the area of physical handicaps, mental disorder and social separation(p<.05). And the workers whose household income was larger lived a better quality of life related to oral health in the areas of Psychological discomfort, physical handicaps, mental disorder, social disorder and social separation(p<.05). Those who found themselves to be generally in good health(p<.001, p<.05) and whose subjective oral health state was led a better quality of life in every area(p<.001, p<.05). The findings of the study showed that there were differences in the quality of life according to awareness of oral symptoms, general health status and oral health state.
Journal of the Korean Academy of Child and Adolescent Psychiatry
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v.1
no.1
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pp.117-129
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1990
35 children(17 boys, 18 girls) with Recurrent Abdominal pain(RAP) without apparent organic causes, referrd from pediatric department of Seoul National University Children's Hospital were studied during 1988. 7. 1 ${\sim}$ 1989. 2. 28. The aims of this study are to examine clinical characteristics of the patients with RAP, to find possible factors influencing the onset and the course of the disorder, to evaluate the psychological status and the relationship with psychiatric diagnoses. The study subjects were compared with the age and sex matched control subjects on measures of social and school functioning, family-environment, behavior traits by CBCL and parent-environment rating scale. All patients and their mothers were interviewed by a child psychiatrist. The results were as follows ; 1) Abdominal pain was found to be more frequent when with a care taker, and related with traumatic life stresses such as separation from parents, death of family members. 2) Family members of the patients with RAP also had a high rate of a history of gastrointestinal dysfunctions with could not be attributed to organic etiologies. 3) Among 35 patients with RAP, 16 were diagnosed as psychiatric disorders. They were adjustment disorders (4), overanxious disorders (4), depression (2), tic disorders (2), attention deficit disorders (2), separation anxiety disorders (1), enuresis (1). 4) On CBCL, the patients with RAP were more internalized, socially less competent and less active compared with the control subjects. 5) According to the parent-environment rating scale, the patients with RAP had more conflicts with their parents about control issues. Family members of the patients with RAP were socially less competent and less abjustable. The parents of the patients with RAP were more affectionate and spent more time with their children but they were unfair and vague on instruction and discipline.
A theroretical study was made on the psychodynamism of somatoform disorder. Somatoform disorder is caused by a defense mechanism of somatization. Somatization is the tendency to react to stimuli(drives, defenses, and conflict between them) physically rather than psychically(Moore, 1990). Ford(1983) said it is a way of life, and Dunbar(1954) said it is the shift of psychic energy toward expression in somatic symptoms. As used by Max Shur(1955), somatization links symptom formation to the regression that may occur in response to acute and chronic conflict. In the neurotic individual psychic conflict often provokes regressive phenomena that may include somatic manifestations characteristic of an earlier developmental phase. Schur calls this resomatization. Pain is the most common example of a somatization reaction to conflict. The pain has an unconscious significance derived from childhood experiences. It is used to win love, to punish misdeeds, as well as a means to amend. Among all pains, chest pain has a special meaning. Generally speaking, 'I have pain in my chest' is about the same as 'I have pain in my mind'. The chest represent the mind, and the mind reminds us about the heart. So we have a high tendency to recognize mental pain as cardiac pain. Kellner(1990) said rage and hostility, especially repressed hostility, are important factors in somatization. In 'Psychoanalytic Observation on Cardiac Pain', psychoanalyst Bacon(1953) presented clinical cases of patients who complained of cardiac pain in a psychoanalytic session that spread from the left side of their chests down their left arms. The pain was from rage and fear which came after their desire to be loved was frustrated by the analyet. She said desires related to cardiac pain were dependency needs and aggressions. Empatic relationship and therapeutic alliances are indispensable to psychotherapy in somatoform disorder. The beginning of therapy is to discover a precipitating event from the time their symptoms have started and to help the patient understand a relation between the symptom and precipitating event. Its remedial process is to find and interpret a intrapsychic conflict shown through the symptoms of the patient. Three cases of somatoform disorder patients treated based on this therapeutic method were introduced. The firt patient, Mr. H, had been suffering from hysterical aphasia with repressed rage as ie psychodynamic cause. An interpretation related to the precipitating event was given by written communication, and he recovered from his aphasia after 3 days of the session. The second patient was a dentist in a cardiac neurosis with agitation and hypochondriasis, whose psychodynamism was caused by a fear that he might lose his father's love. His symptom was also interpreted in relation to the precipitating event. It showed the patient a child-within afraid of losing his father's love. His condition improved after getting a didactic interpretation which told him, to be master of himself, The third patient was a lady transferred from the deparment of internal medicine. She had a frequent and violent fit of chest pains, whose psychodynamic cause was separation anxiety and a rage due to the frustration of dependency needs. Her symptom vanished dramatically when she wore a holler EKG monitor and did not occur during monitoring. By this experience she found her symptom was a psychogenic one, and a therapeutic alliance was formed. later in reguar psychotherapy sessions, she was told the relaton between symptoms and precipitating events. Through this she understood that her separation anxiety was connected to the symptom and she became less terrifide when it occurred. Now she can travel abroad and take well part in social activities.
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