Korean Standardization of Parent Temperament Questionnaire for Children / 신경정신의학

OBJECTIVES: One of the factors that obstructs active progress of the temperament study in Korea is lack of the standardized assessment tools. Therefore, this study was designed and conducted for the purpose of Korean standardization of "Parental Temperament Questionnaire(PTQ)", which was developed by Thomas and Chess, to assess the temperament of children between the ages of 3 and 7 years through parental questionnaire. METHOD: The samples consisted of 1,175 children who were attending nurseries nationwide. PTQ was translated into Korean language by the authors and distributed to the parents of these children, along with "Toddler Temperament Scale(TTS)" and "Yale Child Inventory(YCI)" which had been previously standardized by different investigators. The reliability and validity of the Korean version of PTQ were tested. RESULTS: Test-retest reliability, item-category correlations and internal consistency of the Korean version of PTQ were generally satisfactory. Correlations between the perceived temperament and the rated temperament were statistically significant in all temperamental categories except distractibility. The correlation between PTQ and TTS was statistically significant in all categories. The 9 categories of PTQ correlated variously with 11 subscales of preschool behavioral assessment of YCI. CONCLUSIONS:The Korean version of PTQ is a standardized tool to assess the temperament of children between ages 3 and 7 years, which will be a useful basic tool for the study of temperament of Korean children.

Cognitive Dysfunctions in Positive and Negative Schizophrenic Patients with or without Tardive Dyskinesia / 신경정신의학

OBJECTIVE: The goal of this study was to examine cognitive dysfunctions in positive and negative schizophrenic patients and investigate the effect of tardive dyskinesia on cognitive dysfunctions in them. METHODS: Thirty two schizophrenic patients with tardive dyskinesia and thirty two schizophrenic patients without tardive dyskinesia as a control group were selected some psychiatric inpatients at a lunatic asylum and the cognitive dysfunctions of these patients were assessd with some neuropsychological tests including KWIS test, Grooved Pegboard test, Trail making test A and B, Wisconsin card sorting test, and Wechsler memory scale test. From these patients, we classified eighteen schizophrenic patients as a positive syndrome group and twenty five patients as a negative syndrome group with positive and negative syndrome scale and compared the results of neuropsychological tests between these two groups. RESULTS: Patients without tardivc dyskinesia showed better performances than those with tardive dyskinesia on picture completion subtest of KWIS. Positive schizophrenic patients showed better performances than negative schizophrenic patients on comprehension subtest of KWIS and trail making test A. CONCLUSION: Negative schizophrenic patients showed frontal lobe dyfunction and more memory impairment than positive schizophrenic patients. In conclusion, negative syndrome of schizophrenia is significantly associated with cognitive dysfunctions although tardive dyskinesia is not.

Antipsychotics Maintenance Therapy of Schizophrenic Patients: A Survey on the Psychiatrists' Practice in Extended Seoul Metropolitan Areas / 신경정신의학

We investigated the actual status of antipsychotics maintenance therapy(AMT) for schizophrenic patients through a mail survey sent to psychiatrists practicing in Seoul and Kyonggj province who had no less than two years of psychiatric expertise and who were below fifty years of age. Out of 453 questionnaires sent, 215 completed questionnaires were returned (response rate 47%). The majority of respondents considered pharmacotherapy as the most important longterm treatment strategy for schizophrenia. Haloperidol was selected by the majority as their first choice neuroleptics. The proposed mean daily maintenance dosage was 383+/-229(75-1250)mg in chlorpromazine equivalent. The mean duration of AMT was 1.8+/-1.0(0.25-7.5)years after the first episode and 3.6+/-1.8(0.5-10)years after multi-episodes. Psychotherapy was regarded as more important by the resident psychiatrists group than by the certified psychiatrists. There were preferential differences for a particular treatment strategy, dosage and duration of AMT among the different clinics. A great number of respondents(93%) regarded long-term continuous maintenance as their major AMT policy, Only a few respondents(4.3%) were satisfied with the established guidelines for AMT in treatment of schizophrenia. The results show considerable variations in psychiatrists opinions on AMT which was influenced by grades of expertise of the clinician and the working environment of the clinic or the hospital. To decrease these variabilities and make clinically useful guidelines, it will be necessary' to do further pharmacoepidemiological studies as well as other types of related clinical research.

Acute PTSD in Survivors of a Building Collapse Accident in Seoul: A Preliminary Study on Incidence, Predictors and Pattern of Symptom Changes / 신경정신의학

OBJECTIVE: This is a prospective clinical study on survivors of the collapse accident of a major department store building occurred in Seoul in lune 1995 to investigate the incidence of acute PTSD, to identify risk factors affecting the severity of PTSD symptoms, and to evaluate the pattern of symptom changes over time. METHOD: Thirty-two victims were interviewed with modified Korean version of the PTSD-I(DSM-III-R) to determine the severity of symptoms and diagnosis of PTSD. Degrees of anxiety and depression were measured with Hamilton's Anxiety Scale(HAS) and Depression Scales(HDS) respectively. Subjects were assessed in series at one month(time point 1) and three month(time point 2) from the time the accident occurred. RESULTS: The incidence of PTSD in the subjects over the 3 months was 41% using by full criteria and 48% by partial criteria. Regression analysis at the time point 1, the HDS score, which was partially related with death of accompanied persons(friends/relatives/colleagues), contributed significantly to the PTSD-I variances. At the time point 2, loss of consciousness contributed significantly to the variance of the PTSD-1, HDS and HAS scores. Between tire point 1 and time point 2, the overall severity of PTSD symptoms far all the subjects has remained almost unchanged. However, re-experience and hyperarousal symptoms were improved in comparison with avoidance symptoms, although not statistically significant. CONCLUSIONS: This study result show a high risk of developing PTSD and partial PTSD among the building collapse victims. The death of accompanied person, severity of depression and loss of consciousness are all regarded as major factors affecting the severity of PTSD. Of PTSD symptom clusters, avoidance symptoms are likely to be less changeable than reexperience and hyperarousal symptoms over time.

Association between Alcohol Dependence and the Al Allele of the Dopamine D2 Receptor Gene TaqI A RFLP in Korean Population / 신경정신의학

OBJECTIVES: The existence of an allelic association between alcohol dependence and the TaqI 1 AI allele at the D, dopamine receptor(DRD2) locus has been proposed but still remains controversial. The purpose of the present study was to examine the allelic association of alcohol dependence and the TaqI A polymorphism of DRD2 gene in ethnically homogenous Korean population. METHODS: The subjects were 59 male patients diagnosed as alcohol dependence(DSM-RT) and the controls were 74 nonalcoholic male volunteers screened for alcohol problems in their 2nd degree relatives. The severity of alcohol dependence was estimated by the number of items of diagnostic level 1 of the Major Criteria for the Diagnosis of Alcoholism by National Council on Alcoholism(NCA). Genotyping was done by polymerase chain reaction(FCR) and the electrophoresis of the FCR products digested by TaqI RESULTS: The frequency of the A1 allele in alcoholic group(0.45) was higher than that in control group(0.34) but there was no significant difference between them(x2=2.98, p=0.08). The frequency of A1 allele in 47 more severe alcoholic patients who met five or more items of Major Criteria for the Diagnosis of Alcoholism by NCA was 0.48 and it was significantly higher compared with that in control group (x2=4.21, p=0.04). In less severe alcoholic patients, the frequency of A1 allele(0.33) was similar to that in control group(x2=0.04, p=0.85). The proportions of subjects with more severe alcoholism in the patients with A1A1, A1A2, and A2A2 were 92%, 77%, and 73%, respectively. CONCLUSION: An allelic association of more severe alcoholic subgroup and the TaqI Al allele of Da dopamine receptor gene was supported in Korean population. It is suggested that the TaqI A1 allele is related to or has a linkage disequilibrium with a genetic factor which may be one of the risk factors for susceptibility to more severe alcoholic subgroup in multifactorial-threshold etiologic model.

Temperamental Characteristics of Asthmatic Children in Korea / 신경정신의학

The objective of this study was to determine temperamental characteristics of children with bronchial asthma. An earlier preliminary study(Kim SP, Ferrara A, Chess S, 1980) results show that the asthmatic children, as a group, are significantly different from two other control groups (I. children with eczema, allergic rhinitis, or both without asthma: II. normal healthy children in their temperamental profile). The parents of 85 Korean children with bronchial asthma, ages 3 to 7 years, completed the Korean version of Parental Temperamental Questionnaire developed by Thomas and Chess. The data collected were of ordinal type, ranked from 1 to 7 and the non-parametric Mann-whitney U Test was utilized. Any child with a suspected history or diagnosis of premature birth, organic brain syndrome, mental retardation, childhood psychosis, congenital physical anomaly, hereditary disease or any other medical or surgical conditions, other than asthma, requiring continuous physicians care was excluded from the study population. The results showed that asthmatic female children were characterized by lower adaptability and lower threshold of responsiveness. And 22% of asthmatic children were of the difficult type, compared to 11% of normal children. Both groups were statistically different In terms of temperamental constellation. The findings strongly suggest the existence of a distinct temperamental profile of asthmatic children. Early detection of the profile may be of great value for parents and child health care providers in understanding the asthmatic children's correct developmental needs and in determining appropriate parenting approaches for the chronically ill children at the risk of behavioral disorders.

A Study on the Comparison of Disease Status between Foreign Patients and Korean Patients / 한국역학회지

The objective of this study is to identify any differences in disease status between foreign patients staying in Korea and Korean patients. The study results are : First, more foreign stayers than Korean in their 20's and 30's seek medical services but those after age of 60 show the opposite pattern. This difference seems to feflect cultural difference in the concept of medical services and health seeking behavior. Second, foreign pateints were much more frequently(almost threee times) diagnosed as having an acute disease, and the fact that the most common diseases were "diseases of the respiratory system" can suggest the seriousness of air pollution problem in Korea. And, the fact that foreign stayers, especially those from developed countries, tend to take more periodic general physical examina-tion indicated that their health maintenance efforts place emphasis on prevention. Foreign patients seek more medical services during the spring and summer time when compared to Korean patients, and Korean patients visited the clinic more frequently during the autum time. Also, the review of the number of outpatients seeking medical services and the average duration of outpatient follow-up mainten-ance after discharge suggest that foreigners suffer less severe diseases than Koreans do. Finally, in contrast to the usual practice of Koreans of coming to the center without prior calling for reservation, most foreign patients tend to make reservations before coming(usually a day before) in general. This is also reflective of cultural difference related to the way of utilizing medical services.