Resilience / 中南大学学报(医学版)

OBJECTIVES@#There are almost one million families who lost their only child in China, and 65.6% of them had severe and long lasting depression and needed timely psycho-intervention. This study aims to explore the relationship among resilience and its influential factors, and to compare their effect on depression.@*METHODS@#A total of 212 only-child loss person in 9 administrative regions in Changsha were assessed by using Connor-Davidson Resilience Scale, Zung Self-rating Depression Scale, Simplified Coping Style Questionnaire, Simplified Eysenck Personality Questionnaire, Social Support Rating Scale, and General Self-efficacy Scale. A hypothetical model was tested based on Kumpfer resilience framework and stress-coping theory.@*RESULTS@#The influential factors of resilience were: positive coping (the total effect value was 0.480), support utilization (the total effect value was 0.359), neuroticism (the total effect value was -0.326), negative coping (the total effect value was 0.279), extraversion (the total effect value was 0.219), and objective support (the total effect value was 0.077). The process of individual-environment interaction showed a greater impact on resilience, which had a direct effect on depression (the total effect value was -0.344, 67.1%), and also indirect effect through self-efficacy (the total effect value was -0.169). The total effect of resilience accounted for 20.1% of the total effect of all variables.@*CONCLUSIONS@#Resilience mainly impacts depression directly, and can negatively predict depression in only-child loss parents. Resilience, located before self-efficacy, is a significant stress mediating variables. Personality traits and support utilization indirectly impact resilience via negative and positive coping. The key to promote the reorganization of resilience is the process of individual-environmental interaction, involving support utilization, positive coping, and some sorts of negative coping strategies, which plays an important role in developing a resilience intervention program and can improve the depression of the only-child loss person.

Trends in Intervention Study for Childhood Obesity in Korea

PURPOSE: The purpose of this study was to identify trends in intervention studies on childhood obesity in Korea. METHODS: From 1996, when the first research paper on childhood obesity intervention was published, to 2015, 192 published papers were analyzed using descriptive statistics. RESULTS: The number of studies increased sharply between 1996 and 2007, but declined slightly from then. The majority of studies involved only children as intervention participants. Most were elementary students, and overweight and obese children. Exercise therapy was the most common type of intervention. Parental participation was found in 35 studies, while teacher's participation was found in only one study. In many studies physiological indicators were used as measurement variables, but follow-up was done in only 10 studies. Finally, only a few studies applied a conceptual framework, while a quasi-experimental research design was used for most studies. CONCLUSION: Examination of trends in intervention studies on childhood obesity in Korea, shows there has been a quantitative increase but not enough improvement in terms of the quality of interventions. Findings in the present study suggest that it is necessary to seek diversity in terms of study participants, interventions and evaluation method along with quality improvement in research methodology.

Socioeconomic Impacts of Gluten-Free Diet among Saudi Children with Celiac Disease / 대한소아소화기영양학회지

PURPOSE: To determine the socio-economic impact of gluten free diet (GFD) on Saudi children and their families. METHODS: A cross-sectional study was conducted in which an online questionnaire was sent to all families registered in the Saudi celiac patients support group. We included only children (age 18 years of age and younger) with biopsy-confirmed celiac disease (CD). RESULTS: A total of 113 children were included in the final analysis, the median age was 9.9 years; 62.8% were females. One hundred (88.5%) of the participating families reported that GFD food was not easily available in their areas, 17% of them reported that it was not available at all in their area. One hundred and six (93.8%) reported that the price of GFD food was very expensive and 70 (61.9%) families that the diet was heavily affecting their family budget. Significant social difficulties were reported among the participating families and their children including interference with the child's interaction with other children (49.6%), the families' ability to attend social gatherings (60.2%), the families' ability to eat in restaurants (73.5%), and the families' ability to travel (58.4%). CONCLUSION: There is significant negative socio-economic impact of GFD on children with CD & their families. Health care providers should be aware of these psycho-social difficulties and be well trained to provide a proper education and psychological support for these patients and their families.

Compared Effectiveness of 10-Session Social Skill Training for Korean Early Elementary School Children in Two Groups Diagnosed as Pure ADHD and ADHD with Comorbidity

OBJECTIVES: Children with attention-deficit hyperactivity disorder (ADHD) have problems in social interactions. We compared the effect of 10-session social skill training (SST) among two groups, children with pure ADHD, and those with ADHD with comorbidity. METHODS: Consecutive 10-session SST was conducted for 34 children from 2006 to 2012. There were 22 children with pure ADHD (male 20, female 2), and 12 children suffering from ADHD with comorbidity (male 11, female 1). All children took medication as prescribed by their doctors before the start of SST. The Child Behavior Checklist (CBCL), the Korean Personality Inventory for Children (K-PIC), the Conner's Rating Scale, the ADHD Rating Scale, and the Home Situation Questionnaire were completed by mothers before and after the SST. All children completed the Child Depression Inventory, the Stat-Trait Anxiety Inventory for Children, the Self-Concept Scale and the ADHD Diagnostic System before and after the SST. RESULTS: Only children with pure ADHD showed improvement in anxiety and self-concept in scales rated by children. In the CBCL rated by parents, the pure ADHD group and the ADHD with comorbidity showed improvement in both externalizing and internalizing subscales. In the K-PIC rated by parents, the pure ADHD group showed improvement in most outcomes and ADHD with comorbidity showed positive change in verbal development. CONCLUSION: These results suggest that SST has significant positive effects on both the pure ADHD and ADHD with comorbidity group. Further research is needed in order to target diverse comorbidity groups with ADHD to improve the effectiveness of the SST.

O complexo fraterno: reflexões acerca do ciúme e da inveja entre irmãos / The fraternal complex: reflections about jealousy and envy among siblings

Em psicoterapia de orientação analítica e psicanálise, entende-se o complexo fraterno como um conjunto organizado de desejos hostis e amorosos que a criança experimenta em relação aos seus irmãos. A compreensão do complexo de Édipo pode ser complementada pelo entendimento das repercussões que a fratria insere na dinâmica familiar. Reúne desde os aspectos amorosos e as identificações até a ambivalência e a consolidação da raiva e da inveja. Este trabalho destina-se a uma revisão sobre o tema complexo fraterno e suas repercussões na formação do ciúme e da inveja, discutindo algumas teorias de autores clássicos e contemporâneos acerca desse tema, contextualizando com uma vinheta clínica.(AU)

In psychoanalytic psychotherapy and in psychoanalysis, the fraternal complex is understood as an organized group of loving and hostile wishes that the child experiences in relation to their siblings. Understanding the Oedipus complex can be complemented by understanding the impact that the phratry inserts in family dynamics. It comprises a large scope of aspects, from loving and identification to ambivalence and consolidation of anger and envy. This work propose a review on the fraternal complex and its impact on jealousy and envy formation. It discuss some theories of classical and contemporary authors on this subject, and contextualize with a clinical vignette.(AU)

Clinical Study of Alopecia Areata in Children during the Five Years (2007~2012) / 대한피부과학회지

BACKGROUND: Alopecia areata (AA) is a non-scarring, autoimmune, inflammatory hair loss on the scalp and/or body. This disease affects both adults and children but there are limited data on AA in children than AA in adults. OBJECTIVE: The purpose of this retrospective study is to evaluate the clinical characteristics, disease associations and psychosomatic dynamics of pediatric AA for the past 5 years. METHODS: A retrospective study was performed on 120 out-patients under 14 years old who are diagnosed as alopecia areata in the department of dermatology from March, 2007 to February, 2012. RESULTS: The proportion of pediatric group in total alopecia areata was 20.2% (120/595). According to clinical records, the alopecia areata were of 111 patients (79.9%) followed by those with alopecia universalis (4 patients; 2.8%) and alopecia totalis (5 patients; 3.6%). The ratio of males (57 patients; 47.5%) to females (63 patients; 52.5%) was 1 : 1.11. Alopecia areata was seen most frequently in the school age group (69 patients; 57.5%) and the duration period was less than one year in most cases (79.2%). Family history of alopecia areata was observed in 10.8% (13/120). The only child or eldest child being overloaded with homework and has deficient parent-child relationships including familial discord was accounted as the most susceptible group. A multiple bald patch was 51.4% in alopecia areata and the most common associated disease was atopic dermatitis (26 patients; 21.7%). CONCLUSION: We observed several clinical features of the pediatric AA, including epidemiology, clinical characteristics and disease associations. This study provided useful data for future research regarding AA in children.

Situações familiares na obesidade exógena infantil do filho único / Family situations in the childhood obesity of the only child

Este é um trabalho qualitativo cujo objetivo foi aprofundar a compreensão da dinâmica familiar de filhos únicos obesos na infância. Crianças de oito famílias participaram do estudo: quatro meninos e quatro meninas, entre 7 e 10 anos, de grupo socioeducacional alto e baixo com avaliação nutricional para obesidade: IMC acima do percentil 97. Foram aplicados no domicílio os seguintes instrumentos: entrevista semiestruturada, teste projetivo Scenotest e avaliação nutricional. A análise apoiou-se na teoria das configurações vinculares (Berenstein e Puget). Os resultados apontaram dinâmicas familiares envolvendo contextos de natureza social, cultural e histórica da sociedade que parecem favorecer ambas as condições: a da obesidade infantil e a de filho unigênito. Elementos sociais enfatizando o individualismo se refletem em nível familiar e íntimo. Assim, a criança pode vir a encontrar, logo ao nascer, condições propiciadoras para que a vinculação básica com a figura materna não se processe de modo pleno, ocasionando deslocamento de parte do que não recebe para a satisfação no alimento. Além disso, a cultura do consumo interfere no modo e tipo de alimentação oferecida, na ludicidade e da sociabilidade infantil, assim como o estreitamento das possibilidades vinculares: intrapessoais, interpessoais, transpessoais, acrescentando-se o fato de não ter irmãos. Esse estudo mostrou que, embora nem todo filho único seja obeso e nem todo obeso seja filho único, uma condição pode ser facilitadora da outra na medida em que a situação sociocultural-histórica da sociedade de consumo hipermoderna parece direcionar a família a ambas as condições.

Práticas educativas parentais em relação ao filho único e ao primogênito / Parental child-rearing practices in respect of only children and first born

O objetivo deste estudo foi examinar eventuais diferenças das práticas educativas parentais em relação a filhos únicos e primogênitos de famílias com dois filhos. Participaram 12 famílias com filho único e 10 com dois filhos, emparelhadas conforme o nível socioeconômico, idade e gênero das crianças. A idade dos filhos únicos variou entre 4,6 e 6,1 anos (M=5,5, DP=0,51) e a dos primogênitos entre 4,3 e 6,3 anos (M=5,1, DP=0,78). Mães e pais dos dois grupos responderam a uma entrevista sobre práticas educativas parentais, cujas respostas foram submetidas à análise de conteúdo. O teste do qui-quadrado revelou diferença marginalmente significativa somente nas práticas maternas e paternas em relação ao filho único. Verificou-se semelhança nas práticas educativas entre mães e pais em ambos os grupos. Os resultados foram discutidos à luz da literatura, buscando entender os fatores que podem contribuir para explicar semelhanças das práticas educativas utilizadas para filhos únicos e primogênitos.

The aim of this study was to examine potential differences in parental child-rearing practices in respect of only children and first born of families with two children. Twenty-two families participated in this study, 12 with only children and 10 families with two children. Families were matched according to socioeconomic level, age and the children's sex. The age of the only children ranged from 4.6 to 6.1 years (M=5.5, SD=0.51) and the first born were aged from 4.3 to 6.3 years (M=5.1, SD=0.78). Mothers and fathers in both groups were interviewed about parental child-rearing practices and their responses were content-analyzed. The hypothesis of the study was not supported. According to the chi-square test, only marginally significant differences were obtained in maternal and paternal child-rearing practices in respect of the only child. Results indicated agreement between the mothers' and the fathers' child-rearing practices in both groups. Issues described as determinants of childrearing practices are discussed, taking into consideration the role of the family in child development.

Filhos cuidadores: escolha, mudanças e desafios / Child caregivers: choice, changes and challenges

O presente estudo tem como objetivo verificar o motivo que levou os filhos a se tornarem cuidadores dos seus pais idosos dependentes, analisando ainda se houve ou não alguma expectativa destes, ao assumirem a tarefa de cuidar. Observou-se que grande parte dos filhos não esperavam que se tornariam cuidadores, e assumiram o papel, alguns por serem filhos únicos; outros ainda por proximidade física.

This study aims to determine what prompted children to become caretakers oftheir elderly and dependent parents and investigates whether there is some expectation asthey take over the task of caring. It was observed that most children did not expect to becomecaretakers and assumed the role due to being only children, and others due to physicalproximity.

Medida de energia total do leite materno de mães de trigêmeos, gêmeos e filhos únicos / Total energy supplied by the human milk from mothers of triplet, twin and single neonates

OBJETIVO: Comparar a energia total do leite materno de mães de trigêmeos, gêmeos e filhos únicos. MÉTODOS: Estudo transversal e controlado feito com mães usuárias do banco de leite do Hospital Israelita Albert Einstein. Foram analisadas seis amostras de leite materno de mães de trigêmeos, 13 de gêmeos e 17 de filhos únicos, coletadas sob paramentação, conforme normas técnicas da Rede Brasileira de Bancos de Leite Humano. A análise foi realizada por meio do teste de crematócrito e os resultados submetidos à análise de variância de Kuskal-Wallis. RESULTADOS: A energia total do leite materno de mães de trigêmeos apresentou mediana de calorias maior (651kcal/L), quando comparada à do leite de mães de filhos únicos (560kcal/L) (p<0,05). O leite das mães de gêmeos e o de mães de filhos únicos não foram diferentes. Os trigêmeos apresentaram peso ao nascer menor (mediana 1344g) em relação aos filhos únicos (1975g) (p<0,01). Não foi observada diferença estatística em relação à idade gestacional e à idade materna entre os três grupos de neonatos. CONCLUSÕES: Pode-se concluir que o presente estudo, o primeiro na literatura sobre o tema, apontou para a presença de maior valor de energia total no leite de mães de recém-nascidos trigemelares. Futuros estudos são necessários para elucidar os mecanismos envolvidos nesse achado.

OBJECTIVE: To compare the total energy of the human milk of mothers of triplets, twins and single-children. METHODS: A cross-sectional and controlled study with mothers from the Human Milk Bank of Hospital Israelita Albert Einstein was performed. Six samples of triplet, 13 of twin and 17 of only-child mother's milk were analyzed. The milk samples were collected according to the Brazilian Human Milk Banks Network techniques and procedures and were analyzed by creamatocrit method. The results were compared by Kruskal-Wallis variance test. RESULTS: The total milk energy from triplets mothers was statistically higher (median - 651kcal/L) than single-child mothers (560kcal/L) (p<0.05). The milk of twin mothers and of single child mothers, regarding energy content, were similar. The triplet neonates presented lower birth weight (median-1344g) when compared to single neonates (1975g) (p<0.01). There was no significant difference among the studied groups regarding maternal age and gestational age. CONCLUSIONS: The present study, the first addressing this subject in literature, indicates a higher value of total energy in milk from triplets' mothers. However, further studies are necessary to clarify the mechanisms of this finding.

Relations between Worry, Attachment Styles and Perceived Parental Rearing in Primary School Children

BACKGROUND: Worry, a core feature of anxiety disorder, is shown in not only children with anxiety disorder but also normal children. This study was conducted to determine the relationship between worry and family environment factors, especially, perceived parental rearing and attachment styles among children. METHODS: Five hundred and nine children participated in this study among 549 children in third, fourth, fifth and sixth grades in two primary schools located in Seoul and Seongnam from October 2007 to December 2007. Forty children did not agree with participation (rejection rate: 7.3%). Their degrees of worry, attachment styles and perceived parental rearing were investigated with questionnaires. RESULTS: The reliability of a questionnaire asking children's worry, PSWQ-C and a questionnaire asking perceived parental rearing, modified EMBU-C was appropriate with internal consistency (Cronbach's alpha of PSWQ-C: 0.92, Cronbach's alpha of modified EMBU-C: 0.68~0.89). Around 22.4% of children had insecure attachment (avoidant or ambivalent attachment) and scores of worry were high in both girls and boys. When children perceived their parental rearing behavior as anxious rearing, they were classified to have ambivalent attachment in many cases by themselves. And when they perceived the rearing as rejection many of them were classified to have avoidant or ambivalent attachment by themselves. Worry showed a significantly negative correlation in the cases where children answered their perceived parental rearing as emotional warmth and showed a significantly positive correlation with rejective and anxious rearing. CONCLUSION: This study found that children's worry was closely related with their perceived parental rearing and attachment styles. If the children's attachment, which has been developed while they have grown up, was insecure and they did not perceive parental rearing as emotional warmth, the intensity of worry, a core symptom of anxiety disorder, increased.

An epidemiological study on domestic violence in Hunan, China / 中华流行病学杂志

<p><b>OBJECTIVE</b>To investigate the prevalence of domestic violence (DV) in Hunan.</p><p><b>METHODS</b>Using a multi-stage sampling strategy, 9451 households involving 32 720 persons in urban, rural and industrial areas in Hunan, China were studied. Multiform clue investigation and face-to-face interviews were combined to investigate the prevalence of DV.</p><p><b>RESULTS</b>A lifetime prevalence of DV was reported by 1533 households (16.2%). A total of 1098 households (11.6%) reported at least one incident of DV in the previous year. Both lifetime and 12-month prevalence of DV varied significantly by geographic setting (P < 0.01). The lifetime prevalence abuse rates were: spousal 10.2%, child abuse 7.8%, and elder 1.5%. With regard to household structure, the lifetime prevalence of DV was highest among those remarried families (21.0%), followed by married couples with one child and extended families with several generations living together (20.1% and 20.0%, respectively). The highest rate of spousal abuse was found among remarried families (14.7%), while child and elder abuse was most prevalent among extended families (12.4% and 4.1%, respectively).</p><p><b>CONCLUSIONS</b>The findings suggested that although the prevalence of DV in Hunan was modest compared to Western countries, it remained a serious public health problem affecting over 1 in 10 households. Furthermore, the prevalence of various types of DV varied by geographic setting and family structure, suggesting that diverse geographic setting and family constellations carried different risk and protective features.</p>

Study on self-consciousness of children with learning disabilities and related factors / 生物医学与环境科学（英文）

<p><b>OBJECTIVE</b>To study the self-consciousness of children with learning disabilities (LD) and to identify related factors.</p><p><b>METHODS</b>Five hundred and sixty pupils graded from 1 to 6 in an elementary school were investigated. According to the pupil rating scale revised screening for learning disabilities (PRS), combined Raven's test (CRT) and achievement of main courses, 35 of 560 pupils were diagnosed as LD children. Thirty-five children were selected from the average children and 35 from advanced children in academic achievement equally matched in class, gender, and age with LD children as control groups. The three groups were tested by Piers-Harris children's self-concept scale. Basic information of each subject was collected by self-made questionnaire.</p><p><b>RESULTS</b>Compared with the average and advanced children, LD children got significantly lower scores in self-concept scale. Based on logistic regression analysis, 3 factors were identified, including family income per month, single child and delivery model.</p><p><b>CONCLUSION</b>The results suggest that self-consciousness of children with LD is lower than that of normal children.</p>

Airway Expandible Metallic Stent Implantation in Children with Tracheal or Bronchial Stenosis / 소아과

PURPOSE: In adults, endoscopic tracheobronchial balloon dilatation and stenting have become valuable methods to establish and maintain an adequate airway lumen when tracheomalacia or neoplastic growth compromise the airways. But in children, only a few cases were reported due to technical problems. We report six children who were treated with stent implantation and describe the use and safety of airway stents. METHODS: Six patients with severe airway obstruction were treated. We investigated the underlying medical problems, stenotic site, symptomatic improvement and complications, and the size and location of stent. RESULTS: The median age of the six patients was 21 months. Three of them were mechanically ventilated and one had an endotracheal tube to maintain the patency of airway. Diagnoses were:congenital tracheal stenosis with or without bronchomalacia, granulation tissue formation after right upper lobectomy by bronchial carcinoid or after prolonged intubation, endobronchial tuberculosis, and airway compression by mediastinal undifferentiated sarcoma. Nitinol stents were implanted in the airway guided by bronchoscopy and fluoroscopy simultaneously. Three cases were placed in trachea, the others were in the bronchus. After stent implantation, all patients showed marked improvements of their airway obstructive symptoms. Four patients are doing well, although two expired due to underlying diseases. Four patients had granulation tissue formation around stents, but that was tolerable after removing the stent. CONCLUSION: We suggest that the use of expandible metallic stent implantation can offer safe therapeutic option even in extremely severe, life threatening and inoperable airway stenosis in children.

Características de comportamento do filho único vs filho primogênito e não primogênito / Behavioral characteristics of the only child vs first-born and children with siblings

OBJETIVO: Avaliar o impacto de ser filho único sobre as caraterísticas de relacionamento com amigos e pais, desempenho escolar, comportamento social e sexual. MÉTODOS: Realizou-se um estudo, incluindo um total de 360 adolescentes identificados no terceiro ano do ensino médio de uma escola privada de Porto Alegre, em 2000 e 2001. Adolescentes do sexo masculino e feminino, com idade entre 15 e 19 anos foram selecionados para participar de um estudo transversal. Um questionário anônimo, pré-testado e auto-administrado foi preenchido em sala de aula com dados demográficos, educação dos pais, ordem de nascimento (filho único, primogênito e não primogênito), tabagismo, consumo de bebidas alcoólicas, uso de drogas ilícitas, desempenho escolar, comportamento social e sexual e outras características. RESULTADOS: Identificaram-se 8 por cento de adolescentes filhos únicos, 35 por cento primogênitos e 57 por cento não primogênitos em uma amostra socioeconomicamente homogênea. Comportamento social, relacionamento com os pais e amigos, prática de esportes, tabagismo e uso de drogas não se associaram com ordem de nascimento. Os filhos únicos menos freqüentemente relataram intoxicação alcoólica (39 por cento) comparativamente aos primogênitos (68,9 por cento; p=0,03) e adolescentes com irmãos (72,3 por cento; p<0,001). Filhos únicos obtiveram melhor desempenho escolar do que os filhos com irmãos (p=0,03). Comportamento sexual diferenciou os filhos únicos devido à idade mais precoce com que iniciaram a atividade sexual e pela menor taxa de auto-identificação como heterossexual, a qual persistiu mesmo após controle para fatores de confusão comparativamente a filhos não primogênitos (p=0,038). CONCLUSÕES: Nossos achados sugerem que ser filho único não está associado com pior desempenho em diversas áreas do desenvolvimento. O impacto da presença de irmãos no desenvolvimento da identificação sexual deve ser explorado em trabalhos futuros.

Chlid Abuse in High-risk Group / 간호학회지

PURPOSE: The purpose of this study was to provide basic data on preventive child abuse program development. METHOD: Data were collected on 105 high-risk families of child abuse intervention was obtained from their main child rearer who raised the child under 18 years, olds during 10 months period from May, 2000 to March 2001. RESULT: The results were as follows : 1. Child abuse occurred in the subject's home, in the case of mild child abuse, 'throwing an object at the child' had the highest percentage 39.1%, in severe child abuse, 'rod, stick, belt, broom beating or using a variety of objects such as' had the highest percentage 49.5%, and in very severe child abuse, 'hospitalized by belting' had the highest percentage 3.8%. 2. The degree of child abuse potential showed high risk child abuse score with a mean of 213.3. The degree of beliefs in corporal punishment showed that subjects perceived corporal punishment of children positively with a mean of 32.2. 3. With respect to the child abuse potential, there were significant correlations with the subjects' age (r=.294, p=.002), education level (r=-.442, p=.000), and family income (r=-.355, p=.000). CONCLUSION: From this study not only child abuse occurrence but also child abuse potential were severely increased in poor livelihood families. Therefore to the high risk group, individual preventive approach must be applied.

The prevalence and risk factors of childhood obesity in elementary students in Seoul

BACKGROUND: The purpose of this study was to provide useful information for prevention and management of childhood obesity in a school-based setting. METHODS: One thousand and 981 elementary children from 2 different elementary schools in Seoul were studied. The survey concerning the risks of childhood obesity was carried out by having parents answer a questionnaire. RESULTS: The prevalence of childhood obesity was 18.1% showing significantly higher rate in boys than in girls (P<0.05). It was found that obese children had a higher intake of fish and meat (P<0.05) and a lower intake of vegetables compared to the non-obese group (P<0.05). Obesity was more prevalent among children who frequently skipped breakfast (P<0.05) and also more prevalent among an only child (P<0.05). The obese children significantly spent more time watching TV (P<0.05). There was a higher family history of obesity, hypercholesterolemia and DM in the obese group (P<0.05). The factors which significantly attributed to childhood obesity were birth weight, parenteral BMI, and father's age (P<0.05). CONCLUSION: The prevalence of childhood obesity was 18.1%. There was a statistically significant correlation between childhood obesity and gender, eating habit, time spent on watching TV, number of siblings, birth weight, parenteral BMI, father's age and family history such as obesity, hypercholesterolemia and DM.

A Case of Fluoxetine-induced Mania & Suicidal Ideation in Obsessive-Compulsive Disorder

The fluoxetine is one of the most frequently prescribed drugs for the treatment of depression and obsessive-compulsive disorder(OCD). This has been know as one of the most safest medication. But since the advent of this drug, there have been several reports of side effects-the mania and suicidal ideation-encountered during coadministration of fluoxetine with or without other psychotropic drugs. We experienced a case of 20 years old male OCD patient who developed into abrupt manic state and also was preoccupied with intense suicidal ideation following fluoxetine use. He was a only child in his family and his father had a history of alcoholism about 15 years ago. Our patient's obsessive-compulsive symptoms have been occured since puberty. His OCD symptoms and anxiety were aggravated since joining the army. Beside these facts, we could not find any other psychiatric history such as depressive disoder and bipolar disorder. We used the fluoxetine starting dosage of 20mg and increased to 40mg at second week. About 3 weeks after the treatment, he developed sudden manic symptom and more aggravated suicidal ideation without any OCD symptoms. He felt vitalized and energetic without having enough sleep and food. These symptoms were ceased over two weeks by stopping medication. Up to this point, the reason why fluoxetine induces mania and suicidal preoccupation is unclear. But somehow the fluoxetine has effects on serotonin receptor and serotonin-dopamine regulations, thus we could make an assumption that fluoxetine can induce mania, extrapyramidal symptoms(EPS) and suicidal ideation in some part of the serotonin unbalanced patients. We think this would be the first report to remark on fluoxetine's suicidal and manic side effects in Korea. So here we present the case with the summary of reviewed articles.

Psychologic Disorders Among Pediatric In Patients

The clinical records of fourty-one children with psychologic disorders who were admitted to Department of Pediatrics, Seoul National University Hospital from July 1976 to June 1981 were analysed. The results were as follows: 1. The patients consisted of 21 boys and 20 girls. 2. According to the order of birth, the first born and only child accounted for 43.8% of total children with psychogenic problem. 3. Adbominal pain was the most common somatic complaint among 41 children c psychosocial problem. 4. There were various organic lesions suspected on admission. 5. During hospitalization, many studies other than routine laboratory examination were performed and consultations to other specialities were requested. 6. Parent-child interation such as overprotection, oversolicitude, overrestriction(prohibition), overindulgence, and confliction parental attitude was the most common etiologic (psychogenic) factors in cases of children with psychogenic problem. 7. Diagnostic clues most frequently obtained were progression(31.7%) which was not deteriorationg and recurrent or occurring frequently only at time of stress. 8. Conversion reaction was the most common final diagnosis among 41 children with psychogenic problem.

Psychologic Disorders Among Pediatric Outpatients (Part I)

One hundred and twenty-seven children with psychologic problems were encountered by the author at twice weekly morning walk-in clinics of the pediatric department of Seoul National University Hospital during the nine months period from January through September 1980. Diagnostic clues for psychogenic origin of various somatic complaints were obtained from complete history taking, thorough physical examination, tests and laboratory procedures as indicated, and psychologic assessment of the patients as well as their family. There were more boys than girls with sex ratio of 2.2 to 1. Distribution of children with psychosocial problem according to age and sex revealed that peak incidence for boys and girls was at ten years and six, respectively. Number of children with psychogenic problem according to the order of birth(rank) showed that the first born and only child accounted 40.2 per cent of total children with psychogenic problem. One boy including only child type of and position in sibship accounted for 24.4 per cent of all children with psychologic problem. Frequency and prercentage of various somatic complaints among one hundred and twenty-seven children with psychosocial problem revealed as follows: abdominal pain; cough; headache; pollakiruria, enuresis and dysuria, vomiting and nausea; dizziness, chest pain, fatigability, hyperpnea, hyperventilation and sigh; anorexia, weight loss and poor weight gain, and others in decreasing order as shown in table 5. There were sixteen children with facial tics and five children with conversion reactions. Distribution of various somatic complaints and problems according to age of children revealed that abdominal pain peaked at nine years of age and both headache and facial tics were distributed throughout school age period. The most frequently obtainable etiologic psychogenic factors in cases of children with psychogenic problem were sibling relationship such as rivalry, jealousy, bickering, quarreling and spacing of siblings less than two years which accounted for 29.1 per cent of cases, followed by parent-child interaction such as overprotection, oversolicitude, over-restriction(prohibition), overindulgence and conflicting parental attitude in 27.6 per cents; frustration such as unfulfilled wish and unacceptable demand in 17.3 per cent;marital discord(parental conflict) such as divorce, separation and mother dominating over father in 12.0 per cent; separation anxiety such as transplantation(change in residence, change in schools, immigration) and death of family in 8.7 per cent; ecomomic status such as financial stress and inadequate sleeping arrangement in three; physical handicaps such as short stature and alopecia in two; and factors outside home such as poor school performance and unsatisfactory peer group interaction in two.