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CHILDHOOD TRAUMA：PSYCHIATRIC OVERVIEW (아동기 외상의 정신과적 개관)

Han, Sung-Hee
- Journal of the Korean Academy of Child and Adolescent Psychiatry
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- v.13 no.1
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- pp.3-14
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- 2002
Childhood psychic trauma appears to be a crucial factor in the development of serious disorders both in childhood and in adulthood. Traumatized children show strong tendency to revisualize or re-feel a traumatic events. Play and behavioral reenactments are frequent manifestations of both the single blow and the long-standing traumas in childhood. Those children who suffer the results of single, intense terror appear to exhibit detailed memory, retrospective reworkings and misperceptions. In long-standing or repetitive trauma, children would show psychic numbing, self-hypnosis, dissociation and rage. Child's brain is undergoing critical and sensitive periods of differentiation. During this time, developing central nervous system is exquisitely sensitive to stress. Stressor-activated neurotransmitters and hormones can play major roles in neurogenesis, migration, synaptogenesis, and neurochemical differentiation. Internal opiate system operates in some trauma and causes the victim to fail to respond, to avoid, to shut off feelings. Evidence is also accumulating in traumatology that dysfuntion of locus coeruleus and ventral tegmental neucleus system leads to catecholamine receptors hypersensitivity. This change result in hypervigilance, increased startle, affective lability, and increased autonomic nervous system hyperreactivity. Another site of action of trauma on the brain is hypothalamic-pituitary-adrenal axis. Individuals with PTSD do not have enough cortisol to halt the alarm reaction. When children are exposed to long-standing extreme events, massive attempts to protect the psyche and to preserve the self are put into gear. These developmental traumas mobilize various kinds of defense mechanisms. Massive denial, dissociation, self anesthesia, identification with aggressor and aggression turned against the self often lead to profound character changes in the youngsters.
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TIC DISORDER AND OBSESSIVE COMPULSIVE DISORDER IN CHILDHOOD (틱 장애 및 소아기 발병 강박 장애)

Hong, Hyun-Ju;Song, Dong-Ho
- Journal of the Korean Academy of Child and Adolescent Psychiatry
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- v.16 no.2
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- pp.183-191
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- 2005
Tic disorder including Tourette's disorder is a neurodevelopmental disorder that appears in childhood and characterized by the presence of motor and vocal tics. Childhood-onset obsessive-compulsive disorder (OCD) is suggested to be a phenomenologically and etiologically distinct subtype of OCD, bearing a close genetic relationship to tic-disorders. Tourette's disorder and OCD are comorbid in $40-75\%$ of patients initially diagnosed with either disorder. Basal ganglia and cortico-striato-thalamic circuits are implicated in the pathophysiology of both disorders and these disorders have similar clinical features. Over the past decades, the progress in research on Tourette's disorder and OCD has been extraordinary. This review describes some of important insights from these work, involving these areas : 1) clinical implication 2) genetics and epidemiology 3) brain imaging study 4) neuroche-mistry 5) pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection (PANDAS).
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A Model based Vocational Evaluation for People with Psychiatric Disabilities (정신장애인 직업재활모델과 직업평가 - 직업기능척도 개발을 위한 예비연구 -)

Lee, Seong-Gyu;Kim, Sang-Hee
- Korean Journal of Social Welfare
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- v.54
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- pp.123-147
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- 2003
It is well known that one of essential features of psychiatric disability is vocational impairment. Since the year of 2000 when psychiatric disability was declared as one of disability categories in Korea, vocational rehabilitation programs have been actively administered. At this point, it is compelling that vocational evaluation serves as a means of screening out the most promising candidates, identifying their vocational deficits and strengths, designing the individualized vocational interventions, and evaluating vocational outcomes. Still, vocational evaluation for people with psychiatric disabilities has been more problematic than for any other group with disabilities. The authors argued that vocational evaluation for people with psychiatric disabilities should be based on a certain vocational rehabilitation model to address those problems. It is because there exists an indispensible relationship between the vocational rehabilitation model and vocational evaluation. In other words, the main purposes, measurement time points, and focus of vocational evaluation may depend on which of vocational rehabilitation models to make a choice of. In addition, the vocational rehab model(i.e., vocational readiness model or graduation model) underlying traditional vocational evaluation does not seem to work for people with psychiatric disabilities. Authors argued that accelerating model fits for psychiathric characteristics which are often unpredictable and turbulent. As a preliminary step of developing vocational functioning instrument incorporating the demand characteristics of the accelerating model, post-hoc analyses were done on data from a vocational functioning measure and the results were critically examined from viewpoints of accelerating model. For these purposes, discussions were made about a) general functioning of vocational evaluation, (b) relation between vocational rehabilitation model and vocational evaluation, (c) the reasons why the accelerating model is more appropriate to the characterstics of psychiatric clients than the graduation model, (d) post-hoc analytic results reviewed from viewpoints of accelerating model-based vocational evaluation This study is significant in that it attempted model-based, model-specific vocational evaluation as a preliminary step for developing vocational functioning assessment instruments ill future.
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