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.

Thyrotropin screening for congenital hypothyroidism in Queen Sirikit National Institute of Child Health, Thailand (during year 1995-2000).

OBJECTIVES: To detect newborns with congenital hypothyroidism (CH) by TSH screening and to treat the affected infants as early as possible. To find the incidence of CH in neonates born at Rajavithi Hospital from 1995 to 2000. The effects of thyroid pathology, ages at the initiation of treatment, associated conditions, and severity of CH on the intellectual outcome of the patients were also analyzed. STUDY DESIGNS: Thyrotropin (TSH) screening for CH in Queen Sirikit National Institute of Child Health was done in neonates born at Rajavithi Hospital from 1995 to 2000. Infants with elevated TSH level of greater than 25 mU/L were recalled for tests including serum T4, TSH and roentgenogram of bone age. Infants with CH were treated with levothyroxine 10-12 Ug/Kg/day: growth and development, serum T4, TSH were followed-up every 3 months for at least 2 years to keep serum T4 between 10-14 Ug/dL and serum TSH below 6 mU/L. Levothyroxine was discontinued for 4 weeks when the infants were over 2 years old. Serum T4, TSH, thyroid scan, and uptake were then performed on these infants. The patients must be euthyroid at the time of the intelligence testing. The Stanford Binet or Vineland Social Maturity scale was used to evaluate the patient's intelligence between the ages of 2 and 5 years. RESULTS: From 1995 to 2000, 62,681 neonates were screened for CH. The incidence of CH was 1:4,178 live births. The sex ratio female: male 2:1. Fifteen infants with CH were started on levothyroxine 10-12 Ug/Kg/day orally once a day. The age of initiation of treatment was between 2-8 weeks. There were 4 patients with lingual thyroid, 4 patients with thyroid hypoplasia, 2 patients with thyroid aplasia and one patient with organification defect. The average intelligence score was 93.8. The factor that significantly affected the intellectual outcome of the patients was associated with adverse conditions such as prematurity with complications, epilepsy and family disruption (p<0.05).