Developmental Psychopathologies of Nine Preschool Children, Experiencing Single, Severe Trauma / 신경정신의학

OBJECTIVES: It has been known that children reved symptoms of Posttraumatic Stress Disorder (PTSD) after experiencing traumas similar to adults. But there are a few studies regarding the psychopathologies of PTSD in preschool children. Considering more active brain and psychological development in preschool children, it is expected that trauma of preschool children causes more serious psychopathologies than those of children with older ages or adults. This study aims to investigate psychopathologies of 9 preschool children experiencing a single, severe trauma, specifically in the respect of PTSD diagnosis. METHODS: Nine preschool children, 3-5 years old, experiencing physical injuries caused by attack from a psychotic patient during lunch time at kindergarten, were evaluated for clinical diagnoses through semi-structured interviews using Kiddie-Schedule for Affective Disorders and Schizophrenia (K-SADS) and Research Diagnostic Criteria (RDC for Kiddies) of PTSD for preschool children. RESULTS: Five (56% by DSM-IV) and Six (67%, by RDC) out of 9 children were diagnosed as to have PTSD. Among those children with PTSD, four (44%) showed Separation Anxiety Disorder (SAD) and one (17%) showed Major Depressive disorder (MDD) as comorbid diagnoses. On subclinical level, two of 9 children (22%) suffered from separation anxiety, seven (78%) from aggressive behaviors, and two (22%) from depressive mood. Sleep disturbances (89%) and reexperiencing of trauma (89%) were the most prominent symptoms of PTSD in preschool children. CONCLUSION: While preschool children showed profiles of PTSD symptoms similar to those of adults, it was critical to use more developmentally sensitive diagnostic tools for a better detection of psychopathologies. Young children experiencing severe trauma showed other comorbid psychopathologies along with PTSD. For proper diagnosis and intervention, it is important to make an accurate clinical diagnosis based on developmentally appropriate diagnostic process and tools.

The Study of Somatosensory Evoked Potentials in the Patients with Cerebrovascular Disease Associated with Senory Deficit

Somatosensory evoked potentials(SEPs) has been an important part of electrodiagnosis and has been utilized as a clinical diagnostic technique in various neurological disease. The purpose of this study was to evaluate the utility of SEPs in the analysis of sensory deficit as an objective method. The test was performed on the two groups of patients with cerebrovascular disease associated with motor and sensory impairment (grouip A) and pure motor impairment (group B), and then the results are compared with that of normal age-matched group. The results are as follows: 1. There is no significant difference in the abnormalities of N9 and N14 component between group A and B (P>0.05). 2. There is no significant difference in the decreased amplitude of N20 component (P>0.05), but there is a significant difference in the delayed peak latency or absent wave of N20 component(P<0.01) between group A and B. 3. There is a significant difference in the increased central conduction time between group A and B (P<0.01). 4. Although the difference is not significant statistically, there are more abnormalities of N20 or central conduction time in the intact hemispheres in group A than group B after stimulation of the median nerves of the affected sides.

2 Families of Charcot-Marie-Tooth Disease

These are 2 cases report of the Characot-Marie-Tooth disease. One patient is a 21 year-old female with gait ataxia, foot drop, muscular atrophy in the both feet, pes cavus and equinovarus. On family history, her older and younger brothers and younger sister showed same symptoms and signs which is rather milder. On neurologic examination, there were atrophy, high arched feet, and steppage gait. There were decreased pain, temperature and touch sensation, and absence of position and vibration, and absence of DTR in lower extremities. On sensory nerve conduction velocity study, the amplitude of evoked action potential is very low. On motor NCV, there are markedly prolonged distal latency and markedly decreased conduction velocity. On EMG study, there are dencervated potentials at rest and reduced interference pattern at maximal contraction. The other patient is 62 year-old female with gait disturbance, foot drop, muscular atrophy in the both feet, pes cavus and equinovarus. On family history, her father, 2 younger brothers and her 3 nephews showed same degree or rather mild degree of symptoms and signs. The findings on physical, neurologic examination and EMG with NCV study are compatible with Charcot-Marie-Tooth disease.