• Journal of Oriental Neuropsychiatry
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• v.23 no.4
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• pp.69-94
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• 2012

Objectives : The goals of the present study are to assess children with tic disorders, their clinical characteristic and to prove the effectiveness of herbal treatments of tic disorders. Methods : The present study was conducted from January 2006 to April 2011, with 200 out-patient children between the age of 6 to 12 diagnosed with tic disorder (after excluding 10 children who could not be clearly diagnosed) at the "H'herbal medicine clinic located in Seoul. Of these 200 children, we have evaluated the epidemiology and clinical manifestation, and analyzed the results of herbal medicine treatments. Results : 1. Among the children diagnosed with tic disorder, TTD was most prevalent (43.3%) and males were more likely than females to express tics (5.45:1). Children with TD sought help significantly later (average age of 9.03 years) than the other types. 2. The analysis results of herbal medicine treatments are as follows. Compared to the pre-treatment assessment, children who received herbal medicine treatment for more than three months (n=52) showed a marked decrease in symptoms of motor tics (the number of motor tics, frequency, severity, complexity) and vocal tics (the number of vocal tics, frequency, severity), in the impairment level of combined tics (motor and vocal tics together) and in the overall score. Conclusions : In conclusion, we apprehended demographic and clinical characteristics of tic disorder patients who visited a Korean traditional medicine clinic by analyzing the psychological assessment results. Furthermore, we identified the effectiveness of herb formula in tic disorder.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• v.4 no.1
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• pp.68-78
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• 1993

The pathophysiology and neural mechanism involved in Tourette's and chronic motor tic disorder are highly controversial. In order to investigate the functional abnormalities of brain. In Tourette's and chronic motor tic disorder, 42 children with Tourette's and chronic motor disorder underwent single photon emission computed tomography(SPECT) using Tc-99m-HM-PAO. The results are summarized as follows : 1) 31.0% (13/42) of this series revealed perfusion defect in cerebral cortex. 2) 4.8% (2/42) revealed perfusion defect in basal ganglia. 3) 4.8(2/42) revealed perfusion defect in thalamus. 4) 16.7%(7/42) showed perfusion defect in cerebellum. 5) The frequency of abnormal perfusion showed no significant difference between tic with and without attention deficit hyperactivity disorder. 6) The frequency of abnormal perfusion showed no significant difference between Tourette's and chronic motor tic disorder. These findings support the hypothesis of a possible involvement of brain dysfunction in the production of Tourette's and chronic motor tic disorder, and quantification of blood flow and co-registration with magnetic resonance imaging will increase the validity of this study.

• Journal of Families and Better Life
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• v.31 no.5
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• pp.47-63
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• 2013

This study deals with a counseling case in which a mother requested counseling due to the problems of her daughter, who suffers from multiple tic disorder. The participants of this study included five family members (grandmother, father, mother and two female children) and a total of 23 sessions were held from September 2006 to December 2007. Additional counseling ($24^{th}$ counseling session) was conducted on April 1st, 2009. The data was based on recorded transcripts and notes from 24 family therapy sessions. The study used a constant comparative analysis, which uses matrix and network display as an analysis method suggested by Miles&Huberman(1994). The characteristics of the family of origin and the indifference of the husband had caused the wife stress. The couple had frequent conflicts due to dysfunctional communication methods, a clash of values, sexual dissatisfaction, and a lack of communication. This marital conflict became the primary factor of the daughter's multiple tic disorder. Intervention of the family therapist resulted in the setting of treatment goals based on MRI's communication theory and Bowen's family systems theory in order to solve the problem of the daughter's multiple tic disorder. Also, the therapist's intervention techniques included exploring experiences with the family of origin, shedding light on the multigenerational transmission process, exploring dysfunctional attempts at solutions, the therapist's self-disclosure, providing similar cases, dealing with resistance, and suggesting a new communication method. To solve the problem, the therapist helped the family separate the daughter spatially from her parents. Therefore, the therapist's intervention helped reduce the daughter's tics and improve relationships among the family.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• v.12 no.1
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• pp.103-114
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• 2001

Tourette's disorder is a disease which manifests one or more motor tics and vocal tics for more than a year. Chronic motor tic or vocal tic disorders are characterized by only one kind of tics for more than a year. We intended to investigate the clinical characteristics of the patients with chronic motor tic disorders or Tourette's disorders who had admitted from May 1, 1998 to May 1, 1999 to Seoul National University Hospital Child and Adolescent Psychiatry ward. In addition, we compared the clinical characteristics of the patients in order to elucidate the relationship between the two disorders. The patients with learning disabilities were selected as controls. There was no statistically significant difference between the onsets of the patients with chronic motor tic disorders(n=13, $7.3{\pm}2.5$ years), and Tourette's disorder(n=39, $7.2{\pm}2.2$ years), but with learning disability($4.2{\pm}1.9$ years). Also, the patients with chronic motor tic disorder and Tourette's disorder showed similar age at admission($11.7{\pm}2.7$ versus $11.5{\pm}2.6$ years), duration of admission($5.7{\pm}5.4$ versus $11.0{\pm}8.7$ weeks), mothers' ages at child birth($27.3{\pm}2.9$ versus $28.3{\pm}6.7$ years old),and fathers' age at child birth($32.2{\pm}3.2$ versus $33.3{\pm}5.2$ years old). We observed that those who had learning disabilities were alike in those aspects, except for age at visit to clinic($9.8{\pm}3.2$ years old). Family history of psychiatric illnesses(24.1% versus 46.2%), recognized precipitating factors(11.1% versus 35.7%) and response to pharmacological treatments(77.8% versus 76.9%) of the patients with chronic motor tic disorders and Tourette's disorders were observed and no differences were found. Comorbid patterns of diseases were noted. Intrafamilial conflicts were more common in the patients with learning disabilities than those with chronic tic disorders or Tourette's disorders. Precipitating factors were observed more frequent in chronic tic disorder and Tourette's disorder than learning disability. Neurocognitive profiles were investigated, and verbal IQs of the patients with chronic motor tic disorder, Tourette's disorder and learning disability were $92.3{\pm}10.7$, $94.7{\pm}14.9$, $94.3{\pm}13.8$, performance IQs $93.0{\pm}20.5$, $97.5{\pm}13.0$, $95.0{\pm}16.9$ and full-scale IQs $91.9{\pm}20.1$, $95.8{\pm}14.5$, $93.9{\pm}15.1$, respectively, which were found to be not significantly different. No difference was found in structural neurological abnormalities and EEG profiles. The patients with learning disabilities showed more common Bender-Gestalt test abnormalities. In conclusion, we have not found any affirmative clues for the division of chronic motor tic disorder and Tourette's disorder in clinical perspective.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• v.6 no.1
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• pp.47-55
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• 1995

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.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• v.12 no.1
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• pp.149-156
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• 2001

After the fact that obsessive-compulsive symptoms or tic symptoms are common in Sydenham's chorea which is a sequale of rheumatic fever produced by group A beta-hemolytic streptococcus was reported, the association between group A beta-hemolytic streptococcus and a subgroup of obsessivecompulsive disorder(OCD) or tic disorder has been attentioned. This subgroup shared a unique clinical course, characterized by an abrupt onset of symptoms and/or dramatic exacerbations. And this subgroup was distinguished by pre-pubertal onset of symptoms, neurological abnormalities(choreiform movements and a unique pattern of motoric hyperactivity), as well as by relapsing and remitting symptom course. Acronym PANDAS(pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection) was used to denote a subgroup of OCD or tic disorder patients with these clinical characteristics. Then, there was a report suggesting that PANDAS category include some of attention-deficit/hyperactivity disorder(ADHD) and were two case reports of anorexia nervosa and body dysmorphic disorder with characteristics of PANDAS. This case is a patient who developed normally until age of 7, but after pharyngeal inflammation with high fever, he showed disturbance of cognition, social relationship, and language and communication, as well as tic symtoms and abnormal movement on face, hand, and foot. We report this case with review of literatures, because we think that this case belongs to the PANDAS category. Based on this observation, we suggest that PANDAS category include some of childhood disintegrative disorder as well as OCD, tic disorder, and ADHD.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• v.19 no.2
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• pp.112-119
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• 2008

Objectives : This study was conducted to examine whether there are qualitative differences in attention problem among children with various psychiatric disorders, including attention-deficit hyperactivity disorder (ADHD), depressive disorder, anxiety disorder, and tic disorder using clinical ADHD diagnostic system (ADS) T-scores. Methods : The subjects were 794 outpatient children aged from 5 to 15 years, including 540 children with ADHD, 95 children with depressive disorder, 86 children with anxiety disorder, and 73 children with tic disorder. Clinical T-scores on the ADS were calculated using the mean and standard deviations of four ADS variables for the ADHD group. Results : All four groups had T-scores on the ADS in the abnormal range. However, when comparing the clinical T-scores, the children with depressive and anxiety disorders performed better than the children with ADHD. We also found that although the four groups seemed to be similar in terms of clinical T-scores for omission and commission errors, there were significant differences in clinical T-scores for reaction time and the standard deviation of response time (RT) between the ADHD and other groups. Conclusions : We concluded that inattention and impulsivity might not be specific only to ADHD and that the clinical T-scores of RT and standard deviation of RT on the ADS could be used to discriminate between ADHD and other clinical groups.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• v.7 no.1
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• pp.77-91
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• 1996

In order to elucidate the biological etiology and the effects of comorbidity on biological variables in tic disorders, plasma serotonin (5-hydroxlfryptamine, 5-HT) and 5-hydroxy- indoleacetic acid (5-HIAA) we.e measured in 87 tic disorders and 30 control subjects. The 87 tic disorder were composed of 45 Tourette's disorder(TS), 22 chronic motor tic disorders (CMT) and 20 transient tic disorders (TTD). Among these patients,43 patients were pure tic disorder (PT), 28 subject also had attention deficit hyperactivity disorder (T+ADHD) and 16 subjects had obsessive compulsive disorders (T+ OCD) as comorbid disorders. The results are summarized as follows : 1) Plasma 5-HT levels showed significant positive correlations with plasma 5-HIAA levels (Pennon r=0.77, p<0.05). 2) Plasma 5-HT and 5-HIAA levels showed no significant correlation with age in tic disorders. 3) Plasma 5-HIAA and 5-HT levels showed no significant correlations with age in control subjects. 4) There was significant difference in plasma 5-HT levels among TS, CMT, TTD and control groups (ANOVA F=34.48, df=3, 113, p<0.01), and post-hoc test using Scheffe method showed significant differences between control and TS, control and CMT, control and ITD groups. But, post-hoc test showed no significant differences between TS and CMT, TS and TTD, CMT and TTD groups. 5) There was significant difference in plasma 5-HIAA levels among TS, CMT, TTD and control groups (ANOVA F=26.48, df=3, 113, p<0.01), and post-hoc test using Scheffe method showed significant differences between control and TS, control and CMT, control and TTD groups. But, post-hoc test showed no significant differences between TS and CMT, TS and TTD, CMT and TID groups.f) There was significant difference in plasma 5-HT and 5-HIAA levels among PT, T+ADHD, T+OCD and contol groups (ANOVA 5-HT, F=37.59, df=3, 113, p<0.01, 5-HIAA, F=27.37, df=3, 113, p<0.01), and post-hoc test using Scheffe method showed signiscant differences between control and PT, control and T+ADHD and control and T+OCB. But, post-hoc test showed no significant differences between PT and T+ADHD, PT and T+ OCD and T+ADHD and T+ OCD. These results show that decreased 5-HT and 5-HIAA levels may play a role in the genesis of tic disorders, but these findings have no significant correlations with the severity of tic disorders. And the comorbid disorders of tics may have minimal effects on the biochemical abnormalities. Future studies must be focused on the effects of serotonin agonists and antagonists on tic disorders and molecular biological methodology may enhance to elucidate the mechanisms of these abnormal findings.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• v.19 no.3
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• pp.147-155
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• 2008

Objectives: The purpose of this study was to evaluate the efficacy and tolerability of osmotic release oral system-methylphenidate (OROS-MPH) in children with attention-deficit hyperactivity disorder (ADHD) and comorbid psychiatric disorders. Methods: This was an 8-week open label study of OROS-MPH monotherapy. The subjects were 113 children with ADHD aged 6-12 years. Outcome measures were the Korean version of the parent ADHD Rating Scale (K-ARS), Korean version of the Conners Parent Rating Scale (K-CPRS), Clinical Global Impression-Severity and Clinical Global Impression-Improvement. Side effects were monitored using Barkley's Side Effect Rating Scale. We compared the change-over-time in the mean scores of the outcome measure according to the comorbidity of disruptive behavior disorder, depressive disorder, anxiety disorder, and tic disorder. Results: The mean K-ARS and K-CPRS scores were significantly decreased, regardless of the comorbidity. The mean doses of OROS-MPH and dropout rate did not differ significantly according to comorbidity. The OROS-MPH was well tolerated, regardless of the comorbidity. However, children with tic disorder reported a higher frequency of tics or nervous movements between the $2^{nd}\;and\;8^{th}$ week than those without tic disorder. Conclusion: The OROS-MPH is effective for decreasing the symptoms of ADHD, and it is well tolerated, even by patients with comorbid psychiatric disorders.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• v.7 no.1
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• pp.68-76
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• 1996

30 DSM-III or DSM-III-R tic patients were assessed by hospital records and Yale Global Tic Severity Scale to study the common characteristics, clinical course and longterm outcome of tic disorders after 3.1-18.1 years, 73.3% of the patients(treated or untreated) have recovered or partially improved. Identifical precipitating factors were found in 9 patients. Associated disorders were ADHD, sleep disorder, and so on. The outcome according to age of onset, duration of follow-up and diagnoses have no statistically significance. Increased age at follow up was influenced improvement of tic symptoms, though statistically not significant(p=0.327). These results suggest that the outcome of tic disorder is not ominous and they are relatively good social adjustment inspite of carrying the tic symptoms. But this study has some limitations such as retrospective study and sample size. Studies designed prospectively with large sample would be needed to generalize theses results.