The Differences of Psychopathology and Executive Functions According to Intelligence Level in Children with Attention Deficit Hyperactivity Disorder / 신경정신의학

To investigate psychopathology and executive functions of attention deficit hyperactivity disorder (ADHD) children according to intelligence level, this study included 197 ADHD children who visited the outpatient department of neuropsychiatry of YeungNam University Medical Center, from July 2000 to June 2002. The children were divided into groups based on their intelligence levels. They were compared by the Personality Inventory for Children (PIC), Conncers' Continuous Performence Test (CPT), and Wisconsin Card Sorting Test (WCST). There were significant differences in PIC, on the subscales of verbal development, socialization and autism. In the CPT, there was no significant difference. In the WCST, there were significant differences in the total number of errors, the number of perseverative errors, the number of completed categories and the number of trials needed to complete the first category. Considering these results, the intelligence level of ADHD children is related to their disabilities and behavioral symptoms. Executive functions such as abstract thinking, categorization, working memory and flexibility had significant relationship to the intelligence levels of ADHD children. Therefore, the intelligence level of children with ADHD influences the higher executive functions of regulating attention and information processing rather than attentional functions and capacity alone.

The Comparison of MMPI and Neuropsychological Tests according to Degree of Subjective Symptom Complaints in Patients with Traumatic Head Injury / 신경정신의학

OBJECTIVES: The purpose of this study was to investigate the clinical characteristics of "fake bad" and "fake good" patients with traumatic head injury in neuropsychological tests. METHODS: We measured subjective symptoms by SCL-90-R and objective symptoms by McBride obstacle-valuation measure. The patient was divided into three groups according to differences between subjective and objective symptoms. We also examined their intelligence, memory, clinical characteristics, using K-WAIS, K-MAS, MMPI. RESULTS: The group who overly expressed their subjective symptoms has its psychotic symptom exaggeratingly measured, so it will be helpful to be careful to such over-expressed symptoms in those who present a psychotic symptom in a clinical view-point. An K-WAIS measurement among those who exaggerated their subjective symptoms showed less value than the actual one, which weakens the reliability of this intelligent test. Rather, for that group, the result of K-MAS can be used with a confidence in the estimation of their severity of symptoms. CONCLUSION: MMPI and neuropsychological tests are helpful to understand characteristics between subjective symptoms and objective disabilities of patients with traumatic head injury.

Objections to Professional School of Medicine

No abstract available.

Patient-Centeredness in Faculties, Residents and Medical Students / 신경정신의학

INTRODUCTION: The nature of doctor-patient relationship has changed. We performed this study to investigate the patient centeredness and influencing variables in medical faculties, residents and medical students. METHOD: The subjects were 56 medical students, 62 residents and 103 faculties in university and general hospitals. The sociodemographic data, frequency of receiving doctor-patient relationship lectures, the job satisfaction scale (JS), the patient practitioner orientation scale (PPOS), the authoritarian personality scale (AP) were items assessed. RESULT: The AP were inversely correlated with total scores of the PPOS in medical students, residents, and faculties. The scores of JS were correlated with total scores, and the care subscale of the PPOS in medical students. The group received doctor-patient relationship lecture showed higher scores of the PPOS than unexposed group. Female faculties showed higher scores of the care subscale of the PPOS than male counterparts. The scores of care subscale of the PPOS of the women doctors who have children were higher than those who do not have children. CONCLUSION: The authoritarian personality trait is correlated with the doctor/disease centeredness in medical students and doctors. The experience of learning about doctor-patient relationship is positively related to the patient centeredness. The job satisfaction, sex, and children bearing may be correlated with the patient centeredness under the certain circumstances.

A Study on Reliability and Validity of the Korean Version of Spiritual Well Being Scale / 신경정신의학

OBJECTIVES: The study is to test reliability and validity of the Korean version of spiritual well being scale which is devised by Paloutzian and Ellison. METHODS: The spiritual well being scale was translated into Korean by two psychiatrist and 131 Christians rated the Korean version of spiritual well being scale. For test-retest reliability, 80 telephone counsellor trainee rated it again after one week interval and statistical analysis was done with the collected data. RESULT: Correlation coefficients were regarded to have good test-retest reliability. Cronbach alpha value of total score, and religious well being subscale and existential well being subscale were significantly high. Among demographic factors, health(healthier) factors, is related with significantly high score of spiritual well-being scale(SWS). Period(over 30year) of christianity showed significant discriminative score of SWS. Factor analysis for validity showed 5 subgroups which were correlated with religious well-being scale(RWS) and existential well-being scale(EWS). 1st subgroup of RWS is related with educational factor, 2nd subgroup of RWS is related with health foactor, 3rd subgroup of RWS is related with personal relationship with God especially, 4th subgroup of EWS is related with health factor and 5th subgroup of EWS is related with reality oriented view. CONCLULSION: The Korean version of SWS which is consisted of RWS and EWS was proved to be a reliable and valid instrument of assessment of spirituality.

The Comparison of Intelligence Efficacy According to Methylphenidate Administration in Attention Deficit Hyperactivity Disorder(ADHD) Patients / 영남의대학술지

BACKGROUND: The causes of ADHD(attention deficit hyperactivity disorder) are various, it is impossible to understand the whole characteristics of ADHD, only with simple intellignece testing scales. We compared cognitive characteristics of ADHD group with normal controls with Korean Kaufman Assessment Battery for Children(K-ABC), It is well known to evaluate neuropsychological and cognitive aspects of the children. MATERIALS AND METHODS: Age and sex matched 40 ADHD patients and 40 normal controls tested with the K-ABC. Each subscales compared between pre-treatment patients and controls, pre-treatment and post-treatment in patient group, post-treatment patients and controls. RESULTS: Significant differences are ovserved in sequential processing, simultaneous processing, cognitive processing and achievement between pre-treatment patients and controls, and in gestalt closure between pre-treatment and post-treatment patients group. But there are no significant differences between pre-treatment patients and controls in gestalt closure and reading/decoding. CONCLUSIONS: Methylphenidate improved the scores of simultaneous scale, which means improvement of executive functions such as divided attention, analysis and organization. Methylphenidate also reduced distractibility.

Effect of Repeated Stress on the Antioxidant Activities of Brain / 대한정신약물학회지

OBJECTIVES: Behavioral stress has been suggested as one of important factors which destruct the physiologic antioxidant system. Studies about antioxidant activity changes in brain by repeated stress may be valuable data in the clarification of pathogenesis and development of treatment modalities for the psychologic stress-induced somatic disease. METHODS: We examined, therefore, immobilization stress -induced antioxidant defense chages in the rat brain. Superoxide dismutase, glutathione peroxidase and, glutathione reductase activities were measured in the dissected specimens of the cerebral cortex, hippocampus, striatum, brain stem, cerebellum and hypothalamus of adult male Sprague-Dawley rats subjected to 2 hour immobilization stress for 14 consecutive days. RESULTS: In this study, immobilization inhibited glutathione peroxidase and glutathione reductase activities in striatum and hypothalamus than any other brain regions. CONCLUSION: These results suggest that striatum and hypothalmus are subject to strong pro-oxidant impacts arising at the repeated immobilization stress.

Application of Stop-Signal Task for Evaluation of Children with Attention Deficit Hyperactivity Disorder / 신경정신의학

OBJECTICES AND METHODS: The purpose of this study was to examine availabilities of stop-signal task as a screening test for ADHD and as a research tool. Stop-signal task was applied to 40 ADHD patients and 18 normal children. Followings are the results of this study. RESULTS: There were significant differences between ADHD group and control group in ZRFT, mean delay x block and primary-RT of stop-signal task performance(p<0.05). There was no significant difference in results of continuous performance test. SSRT of stop-signal task had significant correlation with hit reaction time of continuous performance test, and primary-RT and primary-SD with attentiveness and hit reaction time of continuous performance test. There was no significant correlation between scores of ADDES-HV and stop-signal task performance. In change of primary-SD according to intelligence, primary-SD decreased as intelligence increased but made plateau after IQ 110, and in change of SSRT according to age, SSRT decreased as intelligence increased but made plateau after 10 year-old. In discriminant ability, mean delay x block and primary-RT showed highest discriminant ability (each 75%). In addition P-inhibit showed 63.89%, SSRT showed 58%, ZRFT showed 67%, and primary-SD showed 58% in discriminant ability. There was no significant difference in stop-signal task performance between ADHD with hyperactivity and ADHD without hyperactivity. CONCLUSION: In this point of view, stop-signal task was proved to be a useful research tool for attention deficit hyperactivity disorder as well as useful screening test tool.

Glial Peripheral Benzodiazepine Receptor Mediates the Relief of Acute Stress-Induced Anxiety in Rats / 신경정신의학

OBJECTIVES: Peripheral benzodiazepine receptor has been suggested to be associated with the relief of anxiety response induced by stresses. This study was designed to observe the anxiolytic activity of peripheral benzodiazepine receptor. METHODS: Male Sprague-Dawley rats, weighing 200-250g were forced to suffer an immobilization stress for 2 hours. The level of anxiety by immobilization was performed by an elevated plus maze and was evaluated by the number of [3H]Ro5-4864 binding sites in the olfactory bulb. RESULTS: Saturation experiments followed by scatchard anlayses of the results showed that the density of peripheral benzodiazepine receptor increased and the affinity of the peripheral benzodiazepine receptor remained unchanged. It was found that there was no significant change in the cerebral cortex. Pretreatment with clonazepam, a central benzodiazepine receptor agonist, before an immobilization stress abolished the anxoius response on the performance of plus maze. In this group, upregulation of peripheral benzodiazepine receptor of olfactory bulb was not observed. Ro5-4864, a peripheral benzodiazepine receptor agonist, elicited an increase of anxiolytic response on the performance of plus maze. Progesterone, a precursor of neuroactive steroid, also increased anxiolytic response on the performance of plus maze. Pretreatment with PK11195, a peripheral benzodiazepine receptor antagonist, abolshed the anxiolytic effect of progesterone. CONCLUSIONS: From these results, it could be concluded that peripheral benzodiazepine receptor is closely associated with the relief of acute stress induced anxiety response via an increase of synthesis of neuroactive steroid.

The Effect of Repeated Stress on the Modulation of Neuroactive Steroids at the GABAA-Benzodiazepine Receptor Complex in Rats / 신경정신의학

OBJECTIVES: Pregnanolone is a potent positive modulator of the gamma-aminobutyric acid(GABA) response that enhances the binding of [3H]flunitrazepam to the GABA A receptor. Recently, it was reported that chronic treatment with pregnanolone uncouples allosteric interactions between steroid and benzodiazepine recognition sites. The present study was designed to assess the effect of repeated stress on the modulation of neuroactive steroids on the GABA A receptor. METHODS: The effect of steroids on the ligands binding to GABA A receptor was investigated using cerebral cortices of unstressed and repeatedly immobilized rats. Male Sprague-Dawley rats, weighing 200-250g were forced to suffer an immobilization stress for 2 hours. RESULTS: Pregnanolone enhanced the binding of [3H]flunitrazepam to GABA A receptor in both of unstressed and repeatedly stressed rats. However, repeatedly stressed rats showed significantly higher values in EC50 and lower values in E max of enhancement binding of [3H]flunitrazepam than those of unstressed rats. CONCLUSIONS: From these findings, it can be concluded that repeated stress reduced the positive modulation of neuroactive steroid on the GABA A-receptor complex.

The Diagnostic Availability of Continuous Performance Test in Children with Attention Deficit Hyperactivity Disorder / 신경정신의학

OBJECTIVES: The purpose of this study was to examine the diagnostic availability of CPT in children with ADHD, and, what factors are affected to CPT results in the diagnosis of ADHD. METHODS: CPT, ADHD scales (ADDES-HV), K-ABC were administered to 68 ADHD patients and 30 normal elementary school students as the control group. Also, ages and sex are controlled between two groups. RESULTS: In the differences of the results of CPT between ADHD patients and normal subjects, attentiveness and risk taking are significantly different (p<0.05). In the differences of the results of CPT between ages in ADHD patients, usually as more aged children are better performances in CPT. Also, in the differences of the results of CPT between intelligence in ADHD patients, usually as higher intelligent children are better performances in CPT. There are no differences of the results of CPT between types of ADHD in ADHD patients. In the differences of the results of CPT between sex in ADHD patients, commission error, hit reaction time standard error, variability of standard error, and attentiveness are significantly different between male and female patients (p<0.05). The correlations between ADHD scales and the results of CPT show that inattention subscale is significantly related to hit, omission error, hit reaction time standard error, and variability of standard error. In the discriminant ability between ADHD patients and normal children by the results of CPT, accuracy rates are more than 50% in all results of CPT. Especially, the accuracy rate of hit reaction time standard error, and the accuracy rate of variability of standard error, and also, the accuracy rate of attentiveness are more than 60%. CONCLUSION: In this point of view, this study suggest that CPT is relatively valuable method in the diagnosis of ADHD. For instances, CPT is more likely to screen the ADHD from normal children, or to use as assisted method of diagnosis of ADHD in clinical settings.

The Study of Reliability and Validity of Attention Deficit Disorder Evaluation Scale-School Version(ADDES-SV) / 영남의대학술지

The purpose of this study was to examine the reliability and validity of attention deficit disorder evaluation scale-school version(ADDES-SV). Between October 1996 and November 1996, ADDES-SV was administered to 263 elementary school students in the second grade and between Jun 1996 and October 1996, 28 attention deficit hyperactivity disorder patients. In the reliability test, the test-retest reliability coefficient was significantly high and that of inattention was 0.88, that of impulsivity was 0.80, that of hyperactivity was 0.83 and total score was 0.83. In the reliability test by internal consistancy, the Cronbach alpha coefficient was significantly high and that of inattention was 0.98, that of impulsivity was 0.87, that of hyperactivity was 0.87(p<0.05). The half-sprit reliability coefficient by first-second half method showed high correlation and that of inattention was part 1: 0.96, part 2: 0.96 impulsivity was part 1: 0.95, part 2: 0.93, hyperactivity was part 1: 0.92, part 2: 0.94(p<0.05). Inter-rater reliability by pearson correlation coefficient was significantly high and that of inattention was 0.92, that of impulsivity was 0.87, that of hyperactivity was 0.89 and total score was 0.89. The concurrent validity between ADDES-SV and CAP scale was 0.85 in attention deficit hyperactivity disorder patient group and 0.79 in normal control group(p<0.05). In discriminant validity test between attention deficit hyperactivity disorder patient group and normal control group, the patient group showed higher score(p<0.05). The total discriminant capacity of the patient group in ADDES-SV was 94.6%. In this point of view, ADDES-SV scale showed high reliability and validity in applying to Korean subjects and was proved to be the useful screening test tool for attention deficit hyperactivity disorder research.