• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• v.16 no.2
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• pp.173-182
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• 2005

This review is a clinical and research update of recent literature related to childhood onset schizophrenia (with an onset of psychosis by age 12). Childhood onset schizophrenia(COS) is a rare disorder, but that may represent a more homogeneous patient population in which to search for risk or etiologic factors of schizophrenia. These overview data show that COS shares the same clinical and neurobiological features as later onset forms of the disorder. Compared with later onset schizophrenia, however, this subgroup of patients appear to have more severe premorbid neurodevelopmental abnormalities, more cytogenic abnormalies, poor outcome, and potentially greater family histories of schizophrenia and associated spectrum disorders. Future studies of this subgroup may provide important clues as to the genetic basis for schizophrenia and how gene products influence certain feature of the disease, such as age of onset and mode of inheritance.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• v.16 no.2
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• pp.219-230
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• 2005

Objectives : This study was designed to compare the demographic data, clinical characteristics, developmental delay, and psychological tests between childhood-onset and adolescent-onset schizophrenic in-patients. Methods Medical records of the 17 childhood-onset (very early onset) Schizophrenia and 16 adolescent-onset (early onset) Schizophrenia in-patients were reviewed. Sex, age, psychiatric past history, prodromal symptoms and period, subtype, co-morbid disease, developmental delay, prescribed drug and dosage, treatment response, intelligence quotient (IQ), and Rorschach test were evaluated. Results : The mean admission age of childhood-onset (very early onset) group and adolescent-onset (early onset) group were 12.69$({\pm}2.34)$ and 15.13$({\pm}1.04)$ years. The mean onset age of childhood-onset(very early onset) group and adolescent-onset (early onset) group were 10.79$({\pm}1.95)$ and 14.46$({\pm}0.82)$ years. The mean prodromal period of childhood-onset (very early onset) group and adolescent-onset (early onset) group were 15.94$({\pm}12.33)$ and 8.06$({\pm}6.10)$ month. The time to remission period of childhood-onset (very early onset) group and adolescent-onset (early onset) group were 50.58$({\pm}24.67)$ and 30.06$({\pm}18.04)$ days. Longer time to remission period in childhood-osnet (very early onset) group was associated with earlier age of onset. The mean of total IQ, performance IQ, verbal IQ were at an average level. Discussion : Childhood-onset (very early onset) group and adolescent-onset (early onset) group Schizophrenia had different clinical and psychological features including prodromal period, and IQ subtests.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• v.11 no.2
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• pp.262-281
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• 2000

We focused on the peer relationship of adolescent patients with schizophrenia, which usually occurs around puberty. Reviewing cases with schizophrenia and the literature extensively, we had come to the conclusion as follows；1) the most robust predictors among factors influencing the prognosis of schizophrenia are premorbid interpersonal relationship and adaptive functions. 2) Especially teachers’ reports about school life and peer relationship during school life are useful for predicting the occurrence of schizophrenia in adolescents. We described characteristic and behavioral childhood features which are important in pathogenesis of schizophrenia, based on high-risk studies and long term follow-up studies. Also, pathological profiles of the interpersonal relationship and pathology in adulthood were presented. We tried to integrate various aspects of interpersonal and social weaknesses of schizophrenics applying 'primary and secondary socialization' concept. Finally, five cases of adolescent schizophrenics were described briefly and proposal for the early detection and intervention for risk factors was introduced.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• v.9 no.2
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• pp.180-189
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• 1998

Objects：This study is investigated to compare psychopathology and their perceived parental rearing pattern of the children of schizophrenic mother with those of normal control group. The correlation were also assessed between perceived parenting style and problem behaviour Method：Thirty children(age 12-18) of schizophrenic mother and normal control subjects completed self-report questionnaires containing child·adolescent behaviour problem check list(K-CBCL) and Parental bonding instrument(PBI). Result：The result were as follow in the children of schizophrenic mother：1) the mean score of problem behaviour significantly higher than normal control group. 2) Parenting style was perceived to be less caring and more overprotective than in the control subject. 3) there was positive correlation between maternal overprotection and problem behaviour and negative correlation between maternal care and problem behaviour. Conclusion：We succeed in identify that the children of schizophrenic mother have more problems in social adjustment than normal control subjects. Parental rearing style are thought to be significantly negativistic in the children of schizophrenic mother. It is guessed that less caring and more overprotective rearing style of schizophrenic mother could have influence on problem behaviours of their children.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• v.9 no.1
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• pp.26-33
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• 1998

Object：The authors compared the attention-deficit hyperactivity(ADH) symptoms in childhood of adult male patients with bipolar disorder, schizophrenia and normal control subjects and attempted to find out whether attention-deficit hyperactivity disorder and bipolar disorder are related each other. Method：The authors compared ADH symptoms in childhood assessed with Wender Utah Rating Scale(WURS), selected 25 items of WURS(WURS-25), and Parent Rating Scale(PRS), and compared them between 26 bipolar, 29 schizophrenic, and 27 normal control subjects. Result：The subjects with bipolar disorder had significantly higher mean score of WURS compared with normal control group(One-way ANOVA, duncan test, WURS：DF=2, F=3.77 p=0.027), and the differences between the mean scores of WURS-25 and PRS of bipolar subjects and the other two groups were also highly significant(One-way ANOVA, Duncan test, WURS-25：DF=2, F=4.24 p=0.0178, PRS：DF=2, F=13.97 p<0.001). The mean scores of WURS, WURS-25, and PRS of schizophrenic subjects were higher than those of normal control group, though not significant. WURS and PRS were correlated for subjects with bipolar disorder(r=0.7495) and the normal control(r=0.5305), and there was no correlation for schizophrenic subjects. Conclusion：The ADH symptoms in childhood were much more evident for adult bipolar subjects than schizophrenic and normal control subjects. And these results are very suggestive that there might be some relationship between bipolar disorder and attention-deficit hyperactivity disorder and these two disorders might have a shared common pathophysiology which needs further study.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• v.9 no.1
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• pp.34-46
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• 1998

This study was designed to develop the scale of paternal parenting attitudes which has become an area of interest in child fostering study recently. Considering various factors extracted from previous Korean and foreign studies, the authors constructed a questionnaire composed of total 57 questions. It was applied to 126 mothers from families with no psychiatric patient in Seoul and Pusan who had at least onechild older than age 12 by random sampling. Then the authors extracted the factors which were able to compose the scale and evaluated the concurrent reliability. Also the authors selected mothers of 47 schizophrenic patients and 29 bipolar I patients diagnosed with the criteria of DSM-IV who have treated in Seoul National Mental Hospital and 46 controls which consisted of randomly selected mothers from normal families for the discriminative validity test. The results were as follows. The authors extracted 5 subscales of active participation, democratic guidance, warmth, hostility, devotion for education and Cronbach’s ${\alpha}$ value of each subscale which shows its internal consistency was .82, .78, .65, .78, .61 respectively. In the discriminative validity test, all subscales except ‘devotion for education’ subscale significantly discriminated between fathers of schizophrenics and control group. Furthermore ‘active participation’ subscale and ‘warmth’ subscale showed significant difference between fathers of control group and resting both father group of schizophrenics and biopolar I patients.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• v.12 no.2
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• pp.256-262
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• 2001

Objective：The enlargement of the lateral ventricle is well established finding in adult-onset schizophrenia, but in the patients with early-onset psychotic disorder(EOPD) is still controversal. To identify structural abnormalities of the lateral ventricle in patients with EOPD and difference of the brain developmental course in EOPD group, planimetrical assessment of the lateral ventricle was conducted by means of retrospective quantitative neuroimaging. Methods：The brain MR images of 14 patients with EOPD(mean age $14.0{\pm}2.1$ years) who met the DSM-III-R diagnostic criteria for schizophrenia and bipolar disorder and 24 control subjects with simple headache(mean age $10.0{\pm}2.1$ years) were collected. Single best view for the lateral ventricle, one axial slice was selected for analysis. MR images were redigitalized with flatbed scanner and data were analyzed with NIH IMAGE software. Results：In the patients with EOPD, there were significant correlations between aging and lateral ventricular sizes and between aging and ventricular brain ratio(VBR). The statistical significance of normal asymmetry of the lateral ventricle was not observed for the EOPD group. The EOPD group had larger lateral ventricular sizes and VBR than control group, but these results were not statistically significant. Conclusion：These findings suggest that the brain abnormalities in patients with EOPD progress from the earlier course of the disorders and the course of brain development in EOPD group is different from control group.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• v.16 no.2
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• pp.239-250
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• 2005

Objective : The purpose of this study was obtaining data on the efficacy and safety of risperidone in child and adolescent psychiatric patients. Method : Thirty one children and adolescents (males n=18, females n=13, age ranged from 5.4 to 17.3 years) treated with risperidone were selected among child and adolescent psychiatric inpatients of Seoul National University Hospital from January, 2001 to June, 2002, and charts for them were reviewed retrospectively. Results : The primary psychiatric disorders treated with risperidone were schizophrenia and other psychosis, bipolar I disorder with psychotic features, Tourette's disorder, autism spectrum disorders, mixed receptive and expressive language disorder, attention deficit-hyperactivity disorder, conduct disorder and obsessive-compulsive disorder. twelve of these had comorbid mental retardation. Primary target symptoms of risperidone were psychotic symptoms (n=13 or $41.9\%$), behavioral symptoms (n=10 or $32.3\%$) including aggression, impulsivity, hyperactivity, stereotypy nonresponsive to other psychiatric treatments, and chronic and severe tics (n=8, $25.8\%$). The efficacy of risperidone was measured by clinical global improvement (CGI) for target symptoms, $67.7\%$ of subjects showed moderate or marked improvements and its therapeutic effect appeared to be maintained during at least 7.5 months. Mean daily dosage of risperidone was $0.05{\pm}0.01mg/kg$, the group with psychotic symptoms had significantly higher mean daily dosage (0.07mg/kg) compared with other two groups (0.04mg/kg) with behavioral symptoms or tics. A variety of adverse events were reported in this study : weight gain (n=23) most commonly reported, extrapyramidal symptoms (n=15), autonomic symptoms (n=6), sedation (n=5) and symptoms related to hyperprolactinemia (n=2) etc. Although there was no drug change related to the adverse events of risperidone, and $90\%$ of subjects at their last visits were maintained on it, thus its tolerability appeared good. Conclusions Results suggest that risperidone may be relatively safe and effective drug in managing a wide variety of child and adolescent psychopathologies such as psychotic symptoms, behavioral symptoms including aggression, impulsivity, hyperactivity and stereotypy nonresponsive to other psychiatric treatments, and chronic and severe tics. Controlled and long-term studies of efficacy and safety of risperidone treatment for children and adolescents are recommended in the future.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• v.9 no.1
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• pp.54-66
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• 1998

Objectives：This study was to investigate the impact of parental psychiatric disorder on offspring's depression, anxiety, self concept, perception of familial relationship compared with offspring of normal control. In offsprings of parents with psychiatric disorder, this study explored whether their psychopathology, self concept, and perception of familial relationship were influenced by parent’s sex, onset time of parent’s psychiatric disorder and parent’s psychiatric diagnosis. Methods：52 offsprings aged 10-18 years of 39 psychiatric outpatient were surveyed from June, 1997 to April, 1998 and completed several questionnaaire, including Korean from of the Family Environment Scale, Korean form of the State-Trait Anxiety Inventory for Children, Korean form of Kovac’s Children’s Depression Inventory, and Korean form of Piers-Harris Children’s Self-Concept Scale. Their score was compared with offsprings’ of normals. In offsprings of parents with psychiatric disorder, they were compared according to parent’s sex, onset time of parent's psychiatric disorder and parent’s psychiatric diagnosis. Results：The results were as follows：1) Offsprings of parents with psychiatric disorder reported higher level of state anxiety and lower level of the FES expressive subscale than offsprings of normals(p<0.05). But they reported higher level of PHCSCS intellectual & school status subscale and popularity subscale than normals(p<0.05). 2) There were no differences in anxiety, depression, self concept, and perception of familial relationship between patient’s sex. 3) Offsprings less than 3 years old when parent’s psychiatric disorder had developed showed higher level of trait anxiety and lower level of FES control subscale than offsprings more than 3 years old (p<0.05). 4) There were no diferences in anxiety, depression, self concept, and perception of familial relationship between patient’ diagnostic groups(schizophrenia spectrum disorder-mood disoderneurosis). Conclusion：The finding indicated that self reported scale of anxiety and depression showed no significant difference between offsprings of psychiatric patients and offsprings of normals. In offsprings of parents with psychiatric disorder, parent’s sex and psychiatiric diagnosis had no influence on offspring’s psychopathology. But the offspring’s age(before 3 years old) when the parent’s psychiatriric disorder developed had influence on higher level of offspring’s trait anxiety. For further high risk group study, direct interview and evaluation of parent-child agreement or teacher-child agreement will be needed in longitudinal study.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• v.18 no.1
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• pp.31-37
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• 2007

Objectives : A voxel based investigation of cerebral blood flow was conducted to identify functional differences during resting state between children with early-onset schizophrenia and normal controls. Methods : 19 children and adolescents with early-onset schizophrenia(8 boys and 11 girls, mean age $14.0{\pm}1.7$ years old) and 17 comparison children(13 boys and 4 girls, mean age $11.0{\pm}1.9$ years old) were examined by HMPAO-SPECT. The SPECT images were compared using statistical parametric mapping analyses, controlling for age and sex. Results : Increased cerebral blood flow in left medial and inferior frontal gyrus, right superior and middle frontal gyrus, both inferior temporal gyrus, and right cerebellar tonsil was found in children and adolescents with early-onset schizophrenia compared to control subjects. In addition, decreased cerebral blood flow in right thalamus, left posterior cingulate gyrus, right anterior cingulate gyrus and relatively wide areas from left medical frontal gyrus to superior parietal lobule were found in children and adolescents with early-onset schizophrenia compared to control subjects. Conclusion : The results of the current study provide additional evidences for brain areas involving the onset of schizophrenia in early age.