ABSTRACT
OBJECTIVE: Attention deficit hyperactivity disorder (ADHD) is frequently comorbid with a variety of psychiatric disorders. Among them, bipolar disorder (BPD) has especially attracted growing interest. This is partly due to the fact that early onset BPD has been frequently misdiagnosed as ADHD because of symptomatic overlap. The aim of the present study is to find the differences in demographic data and clinical features of ADHD+BPD and ADHD in children and adolescents. METHOD: Children and adolescents patients participating in the present study have been enrolled at the child psychiatric clinic since 2004. 14 patients meeting the DSM-IV criteria for ADHD+BPD and 19 patients meeting the criteria for ADHD and 15 healthy comparison subjects were recruited. All groups were evaluated through the Schedule for Affective disorders and Schizophrenia for School-Age Children-Present and Life Time version-Korean version (K-SADS-PL-K). Demographic data and clinical characteristics of the subjects were also collected. Parents were asked to complete the Child Behavior Check List (CBCL) and the Toddler Temperamental Scale (TTS) clinical ratings were obtained using the Young Mania Rating Scale (YMRS), the Children's Depression Iventory (CDI) and the Dupaul ADHD scale. Clinical variables between ADHD+BPD and ADHD were analyzed using the Mann-Whitney U test. YMRS, CDI, Dupaul ADHD scale (inattention and hyperactivity), CBCL, and TTS among the three groups were analyzed using the Kruskal-Wallis test with post-hoc Mann-Whitney U test. RESULTS: 1) ADHD+BPD group had an earlier onset age of ADHD than ADHD group 2) ADHD+BPD group had more co-morbid psychiatric disorders than ADHD group. 3) Compared to ADHD group, ADHD+BPD had more psychiatric family history, especially mood disorders. 4) ADHD+BPD group had prodromal symptoms such as irritability, anger dyscontrol and academic dysfunction, compared to ADHD group who rarely showed prodromal symptoms. 5) ADHD+BPD group had higher ADHD scores than the ADHD group in the Dupaul ADHD inattentive scale. 6) In global functions of CBCL, ADHD+BPD group showed more impaired functions at home and school than ADHD group. 7) In Attention diagnostic system (ADS), ADHD+BPD group had more omission and commission errors than ADHD group, especially in the visual system. 8) In the subtests of the IQ profile, ADHD+BPD group had lower arithmetic and block design scores than ADHD group. CONCLUSION: Clinicians have to rule out underlying bipolarity in children and adolescents with ADHD who show earlier age of onset and severe clinical features. Bipolarity should be explored intensively in ADHD children and adolescents who have early onset of symptoms and severe functional impairment.
Subject(s)
Adolescent , Child , Humans , Age of Onset , Anger , Appointments and Schedules , Attention Deficit Disorder with Hyperactivity , Bipolar Disorder , Child Behavior , Depression , Diagnostic and Statistical Manual of Mental Disorders , Mood Disorders , Parents , Prodromal Symptoms , Schizophrenia , TemperamentABSTRACT
The status and function of family plays the key role in the maintenance, aggravation and recovery of adolescent internet addiction. Especially, the secure attachment and open communication between parents and adolescents can prevent the situation from getting worse. Given the adequate supervision, support and relationship in the family, the adolescents can be immunized against internet addiction. Internet addicts have diverse underlying psychopathologies, such as attention deficit hyperactivity disorder, impulse control disorder, depressive-anxiety disorder, and socialization deficit. The management of the internet addicts needs a holistic approach including medication for the underlying psychopathology, family therapy, cognitive behavioral therapy, and educational therapy. In this review article, the authors describe the family education, family therapy and multidisciplinary-integrative inpatient treatment for the adolescent internet addicts.
Subject(s)
Adolescent , Humans , Attention Deficit Disorder with Hyperactivity , Cognitive Behavioral Therapy , Education , Family Therapy , Inpatients , Internet , Organization and Administration , Parents , Psychopathology , SocializationABSTRACT
OBJECTIVES: In the present study, we investigate the association between homozygosity of the 4-repeat allele (4/4) at the DRD4 and the response to the treatment with MPH in Korean children with ADHD. METHODS: The present study included 71 children with ADHD (8.231.78 years) from two children's psychiatric clinics in South Korea. All drug-naive children with ADHD were treated with MPH for about 8 weeks. The subjects who showed improvement of over 50% compared with the baseline ARS score after 8 weeks of treatment were termed as the 'good response' group. The subjects who showed an improvement of less than 50% were considered as the 'poor response' group. After genotyping for DRD4 were performed, we investigated correlation between homozygosity for 4-repeat allele at DRD4 and the response to MPH treatment. RESULTS: We found that while 79.5% (31/39) of the subjects with homozygosity of 4-repeat allele at DRD4 showed good response to MPH treatment, 68.8% (22/32) of the subjects without homozygosity of 4-repeat allele at DRD4 showed poor response to MPH treatment according to ARS scores assessed by their parents (chi2=16.762, df=1, p<0.01). We also found that while 61.5% (24/39) of the subjects with homozygosity of4-repeat allele at DRD4 showed good response to MPH treatment, 87.5% (28/32) of the subjects without homozygosity of the 4-repeat allele at DRD4 showed poor response to MPH treatment according to ARS scores assessed by their teachers (chi2=17.698, df=1, p<0.01). CONCLUSION: Our findings support an association between the homozygosity of 4-repeat allele and a good response to MPH in ADHD of Koreans.
Subject(s)
Child , Humans , Alleles , Dopamine , Korea , Methylphenidate , Parents , Receptors, Dopamine D4ABSTRACT
Neuropathological deficits are an etiological factor in Tourette syndrome (TS), and implicate a network linking the basal ganglia and the cerebrum, not a particular single brain region. In this study, the volumes of 20 cerebral and cerebellar regions and their symmetries were measured in normal boys and TS boys by brain magnetic resonance imaging. Brain magnetic resonance images were obtained prospectively in 19 boys with TS and 17 age-matched normal control boys. Cerebral and cerebellar regions were segmented to gray and white fractions using algorithm for semi-automated fuzzy tissue segmentation. The frontal, parietal, temporal, and the occipital lobes and the cerebellum were defined using the semiautomated Talairach atlas-based parcellation method. Boys with TS had smaller total brain volumes than control subjects. In the gray matter, although the smaller brain volume was taken into account, TS boys had a smaller right frontal lobe and a larger left frontal lobe and increased normal asymmetry (left>right). In addition, TS boys had more frontal lobe white matter. There were no significant differences in regions of interest of the parietal, temporal, or the occipital lobes or the cerebellum. These findings suggest that boys with TS may have neuropathological abnormalities in the gray and the white matter of the frontal lobe.
Subject(s)
Adolescent , Child , Humans , Male , Analysis of Variance , Case-Control Studies , Cerebellum/pathology , Frontal Lobe/pathology , Intelligence , Korea , Magnetic Resonance Imaging , Regression Analysis , Tourette Syndrome/pathologyABSTRACT
OBJECTIVES: The purpose of the study was to examine the relationships between temperament and character dimensions and family environments, and to investigate the influences of those factors on the antisocial personality traits in delinquent adolescents. METHODS: The subjects consisted of 160 male adolescents detained at the public prosecutor's office on the suspicion of crimes. To assess personality dimensions and family environmental factors, the Temperament and Character Inventory(TCI) and the Family Environment Scale(FES) were completed. Antisocial personality traits were assessed by the number of antisocial personality disorder symptoms of the Personality Disorder Questionnaire-Revised. RESULTS: Most of the TCI dimensions except Reward Dependence(RD) were highly correlated with the subscales of FES. Among temperament dimensions, Novelty Seeking(NS) and Persistence(P) were significantly affected by Organization, and Harm Avoidance(HA) was influenced by Expressiveness of FES. Self-Directednss(SD) was best predicted by Organization and Achievement-Orientation. While the Independence had significant effect on Cooperativeness, Expressiveness and Achievement-Orientation best predicted the level of Self-Transcendence(ST). On factor analysis, NS, HA, SD and ST were allocated to the same factors with subscales of FES. The level of antisocial personality trait was best predicted by NS, P and SD scores of TCI, and conflict subscale scores of FES. CONCLUSION: The findings of this study suggest that not only the character dimensions but also the temperament dimensions have close relationships with family environmental factors, and that the antisocial personality traits of delinquent adolescents may developed by the interaction between temperament/character dimensions and family environments.
Subject(s)
Adolescent , Humans , Antisocial Personality Disorder , Crime , Personality Disorders , Reward , TemperamentABSTRACT
OBJECTIVE: The aim of this study is to porve the hypothesis that the etiological neuropathological defects of the Tourette's Disorder (TD) lie in a network linking the basal ganglia and the cerebrum, not at a particular single brain region. In this study, the volumes of 10 cerebral and cerebellar regions and their symmetries were measured in normal boys and TD boys by brain magnetic resonance imaging. METHODS: Brain magnetic resonance images were obtained prospectively, controlled for confounding variables(handedness, drug-effect, effect of comorbid psychiatric disorders), in 19 boys with TD and 17 age-matched normal control boys. The frontal, parietal, temporal, and the occipital lobes and the cerebellum were defined using the semi-automated Talairach atlas-based parcellation method. RESULTS: Although the smaller brain volume was taken into account, boys with TD had larger frontal lobes and reduced normal asymmetry (right>left). There were no significant differences in the regions of interest of the parietal, temporal, or the occipital lobes or the cerebellum. CONCLUSION: These findings suggest that boys with TD may have neuropathological involvement in the frontal lobe. And this findings also support the hypothesis of abnormality in Cortical-Striatal-Thalamo-Cortical (CSTC) circuitry as an etiological factors of the Tourette's Disorder.
Subject(s)
Basal Ganglia , Brain , Cerebellum , Cerebrum , Frontal Lobe , Magnetic Resonance Imaging , Occipital Lobe , Prospective Studies , Rabeprazole , Tourette SyndromeABSTRACT
OBJECTIVE: To find out the distinctive topographic EEG profiles of subject with attention deficit hyperactivity disorder comparing with age & sex matched control. METHOD: The quantitative electroencephalographies(QEEGs) of 20 drug-naive ADHD patients without any other psychiatric diagnosis were analyzed and compared to age and sex-matched controls using spectral analysis. RESULTS: 1) Slow waves(delta and theta) bipolar relative powers of the diverse areas in both hemispheres increased in drug-free ADHD patients, compared to controls. 2) Delta and theta bipolar relative powers of localized centro-temporal areas in left hemispheres increased in drug-free ADHD patients compared to controls. 3) Interhemispheric coherence and asymmetry are increased in diverse areas in ADHD patient compared to controls. CONCLUSION: We confirmed QEEG abnormalities in pure ADHD patients, especially in frontal and parietal areas. These results are compatible with other structural and functional imaging studies of ADHD.
Subject(s)
Humans , Attention Deficit Disorder with Hyperactivity , Electroencephalography , Mental Disorders , RabeprazoleABSTRACT
OBJECTIVES: This study aimed to planimetrically measure the corpus callosum, cerebellum, pons and thalamus in the boys with autistic disorder and developmental language disorder. METHODS: The midsagittal brain MR images of 8 autistic and 8 developmental language disorder subjects who met the DSM-III-R diagnostic criteria and 10 comparison subjects were collected. MR images were redigitalized with flatbed scanner and the data were analyzed with NIH IMAGE 1.61 software. Pixel counting and area measurements were done. The corpus callosum was divided into seven regions and the cerebellar vermis was divided into three regions. RESULTS: In autistic subjects, the rostrum of corpus callosum was found to have significantly smaller area than comparison and developmental language disorder subjects. In developmental language disorder subjects, the thalamus was significantly larger than comparison subjects. The cerebellar vermis and pons did not differ among three groups. CONCLUSION: The rostrum of the corpus callosum in autistic disorder was significantly smaller. This finding supports the theory of abnormal prefrontal lobe development in autistic disorder.
Subject(s)
Autistic Disorder , Brain , Cerebellum , Corpus Callosum , Language Development Disorders , Pons , ThalamusABSTRACT
OBJECTIVES: This study was carried out to develop the Korean form of Yale Global Tic Severity Scale(YGTSS)-family & clinical rating version. The severity of motor and phonic tics was rated according to five separate dimensions : number, frequency, intensity, complexity,and interference. METHODS: The Korean form of YGTSS was applied to 100 children who visited psychiatric outpatient clinic with chief complaints of tic symptom. Together with YGTSS, Clinical Global Impression for Tourette's syndrome(CGI-TS), Obsessive-Compulsive disorder(CGI-OCD), At tention-Deficit/Hyperactivity Disorder(CGI-ADHD) were administered to all subjects for examining convergent and discriminant validities. RESULTS: We could confirm high internal consistency, convergent and discriminant validities and interrater reliability of YGTSS by analysing data from 100 children with tic disorder. In factor analysis, items were clusterd to 2 factors which were identical motor and phonic tic subscales. CONCLUSION : The results of this study indicate that the Korean form of YGTSS is a reliable and valid rating scale for rating tic symptom severity. It can be used to evaluate tic symptom objectively and to quantify the tic severity in the studies for tic disorder.
Subject(s)
Child , Humans , Ambulatory Care Facilities , Reproducibility of Results , Tic Disorders , TicsABSTRACT
By means of retrospective quantitative neuroanatomic imaging, the authors assessed the corpus callosum and the lateral venticle in the boys with attention deficit hyperactivity disorder (ADHD). The midsagittal cross-sectional area of the corpus callosum, divided into seven regions, and the axial ventricle-brain ratio were measured from magnetic resonance images of 18 boys with ADHD and 15 comparison boys. Two anterior regions, the menu and the rostral body, were found to have significantly smaller areas in the ADHD boys. There was no significantly difference in ventricle-brain ratio between ADHD and comparison boys. This finding supports the theory of abnormal frontal lobe development in ADHD.