Psychiatric disorders in children at one year after the tsunami disaster in Thailand.

BACKGROUND: The tsunami that struck Thailand on 26th December 2004 was the greatest natural disaster in the country's history. It left in its wake unprecedented damage and destruction. Children suffered the loss of parents or guardians, and survivors were left to cope with psychological trauma of the disaster OBJECTIVE: To assess the psychiatric disorders in tsunami victim children at one year after the event. MATERIAL AND METHOD: A cross sectional study was done. One thousand three hundred and sixty-four students from 2 schools were enrolled. Three tests were used according to the students' grades, pediatric symptoms checklist, Childhood Depressive Inventory and the Revised Child Impact of Events scale (CRIES). Psychiatric disorders were diagnosed by child and adolescent psychiatrists, using criteria from the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM IV). Analysis data by using SPSS version 10.0 and Chi-square test. The results were presented as percentage and p-value. RESULTS: Psychiatric disorders were found in 142 students or 10.4 percents of all students at one year after the tsunami disaster. Not all the students who had psychiatric disorders developed them as the result of the tsunami disaster However, ninety students or 6.3 percent of all the students did have psychiatric disorders resulting from the tsunami disaster The most common psychiatric problem was post traumatic stress disorder Ten percent of grade 4-6 students and 11 percent of grade 7-9 students had psychiatric disorders. The prevalence was lower in kindergarten and grade 1-3 students of which the percentage was 2.3 and 3.8 respectively. CONCLUSION: The prevalence of psychiatric disorders at 1 year after the tsunami disaster was 10.4 percent of all the students or 33.1 percent of victims. The prevalence of psychiatric disorders in grade 4-6 and 7-9 students was higher than in kindergarten and grade 1-3 students. The most common psychiatric problem is post traumatic stress disorder.

Assessment of psychopathological consequences in children at 3 years after tsunami disaster.

BACKGROUND: At 1 year after the Tsunami disaster, 30% of students in two high risk schools at Takuapa district of Phang Nga Province still suffered from post traumatic stress disorder (PTSD). The number ofpatients was sharply declined after 18 months. The psychological consequences in children who diagnosed PTSD after the event were reinvestigated again at 3 years, as there were reports of significant comorbidity and continuing of subsyndromal post traumatic stress symptoms in children suffered from other disasters. OBJECTIVE: To assess psychological outcomes and factors contributed at 3-year follow up time in children diagnosed PTSD at 1-year after the Tsunami disaster MATERIAL AND METHOD: There were 45 students who were diagnosed PTSD at 1-year after the disaster At 3-year follow up time, clinical interview for psychiatric diagnosis was done by psychiatrists. RESULTS: 11.1% of students who had been diagnosed as PTSD at 1-year after Tsunami still had chronic PTSD and 15% had either depressive disorder or anxiety disorder 25% of students completely recovered from mental disorders. Nearly 50% ofstudents were categorized in partial remission or subsyndromal PTSD group. Factors which influenced long-term outcomes were prior history of trauma and severe physical injury from the disaster. CONCLUSION: Although the point prevalence of PTSD in children affected by Tsunami was declined overtime, a significant number of students still suffer from post traumatic stress symptoms, depressive disorder or anxiety disorder which need psychological intervention.

Parents' common pitfalls of discipline.

BACKGROUND: Problems of discipline are common among parents. These may be the results of the parents' pitfalls in disciplining their children. OBJECTIVE: To find out common pitfalls of parents in disciplining their children. MATERIAL AND METHOD: Parents of students with ages ranged between 60-72 months old in Bangkok-Noi district, Bangkok, were selected by random sampling. Total number of 1947 children ages between 60-72 months were recruited. Parents of these children were interviewed with a questionnaire designed to probe into problems in child rearing. There hindered and fifty questionnaires were used for data analyses. RESULTS: Parents had high concerns about problems in discipline their children and needed support from professional personnel. They had limited knowledge and possessed lots of wrong attitude towards discipline. Common pitfalls on the topics were problems in, 1) limit setting 2) rewarding and punishment 3) supervision on children watching TV and bedtime routines. CONCLUSION: Parents of children with ages 60-72 months old in Bangkok-Noi district, Bangkok, had several common pitfalls in disciplining their children, including attitude, knowledge and practice.

Factitious disorder with abdominal pain and multiple surgical operations: A case report.

Factitious disorder is characterized by physical or psychological symptoms that a person intentionally produces or feigns to pretend to be sick although not for external benefits such as financial compensation. As a result of the difficulty in diagnosing the disorder, its prevalence is relatively rare. The definite diagnosis and its proper management is important, particularly in preventing unneeded medical procedures as well as reducing stress in these patients’ families and reducing cost of management. We report a 17-year-old woman who presented to the Department of Surgery with severe abdominal pain and underwent her 5th abdominal operation due to provisional diagnosis of gut obstruction. The surgeon found only some fibrosis which could not explain her severe abdominal pain. After the operation, she still had abdominal pain, distension and intermittent fever although no source of infection nor physical illness could be found to explain this. Psychiatric consultation was came out because of her disturbed behavior and because she was uncooperative. We found that she had been admitted to several hospitals more than 50 times and had undergone 4 major operations in the past 4 years because of her abdominal pain. Surprisingly she was not distressed at all despite these chronic physical illnesses. After close observation by ward nurses, her persistent fever finally disappeared. We transferred her to our psychiatric ward and gave one of serotonin-specific reuptake inhibitors (SSRIs) which is effective in treating compulsion as well as depression, together with family counseling and individual psychotherapy. Finally she confessed that she feigned the symptoms, so we could make the definite diagnosis of factitious disorder with predominantly physical signs and symptoms.

Hyperventilation syndrome and family therapy: A case report.

Hyperventilation syndrome usually occurs in patients who have psychological and/or psychosocial stress(es). Hyperventilative patients breathe rapidly and deeply for several minutes, feel light-headed, and then faint because of cerebral vasoconstriction and a respiratory alkalosis. Other symptoms such as paresthesias and carpopedal spasm, may be presented. Conventional treatment consists of instruction or retrataining regarding particular symptoms and how they are evoked by hyperventilation so that patients can consciously avoid precipicular symptoms. Breathing into a paper bag can abort the attack. Reassurance, supportive psychotherapy and antianxiety medication are also indicated. As far as we know, there has been no report about treating hyperventilation syndrome with family therapy. We report here on a 13-year-old adolescent girl who presented with a history of multiple hyperventilation syndrome attacks in four months precipitated with psychosocial stressors and a family problem. Her symptoms had not been recovered by conventional treatment. Family therapy was given to the patient and her family for one session. After the treatment, her symptoms were cured, she and her family understood and solved the problem. She has been healthy and can study well.