A Survey on the Status of Hospital-Based Early Intensive Intervention for Autism Spectrum Disorder in South Korea

OBJECTIVES: Early intensive interventions are very important for children with autism spectrum disorder. We examined the actual conditions of hospital-based early intensive interventions for autism spectrum disorder in Seoul, in order to help develop and implement an evidence-based early intensive intervention model for use in Korea. METHODS: Nine hospital-based institutes running an early intensive intervention program for children with autism spectrum disorder responded to a questionnaire in September 2014. They provided a brief introduction to their program, explained its theoretical bases, and reported the number of children, their age, intervention time, duration and so on. RESULTS: In the majority of the institutions, the intervention was provided for over 20 hours every week, and the theoretical bases included various applied behavioral analysis (ABA) methods and other therapies (language and occupational therapy). The therapist-child ratio ranged from 1:1 to 5:3. Various types of therapists were involved, including behavioral analysts, special education teachers and (or) language pathologists. There was only one clinic where the behavioral analyst was the main therapist. Usually, the intervention was terminated just before the child entered elementary school. The main merit of the hospital-based intervention in our survey was the effectiveness of the multi-disciplinary intervention plan and its other merits were the accuracy of the diagnosis, its ability to be combined with medicine, and so on. CONCLUSION: The current hospital-based early intensive intervention programs provide interventions for over 20 hours per week and employ multidisciplinary approaches. However, there are very few institutes for children with autism and very few intervention specialists and specialist education courses in the country. We need more educational programs for intervention therapists and have to try to develop policies which encourage the implementation of an evidence-based early intensive intervention program nationwide.

Neurocognitive Function and Health-Related Quality of Life in Pediatric Korean Survivors of Medulloblastoma

The neurocognitive function and quality of life of 58 Korean survivors of childhood medulloblastoma were assessed after surgery, cranial radiation and chemotherapy. All patients were evaluated with a battery of neurocognitive function tests and the Pediatric Functional Assessment of Cancer Therapy-Brain Tumor Survivors, which consists of self-report questionnaires on quality of life. The mean full-scale intelligence quotient (IQ), verbal IQ, and performance IQ scores were 90.2, 97.1, and 84.16, respectively. The mean memory quotient (MQ) score was 86.78, which was within 1 standard deviation of the average score of 100. Processing speed, attention, and executive function showed mild to moderate deficits. Intelligence, memory, executive function, visuospatial function, and simple motor function were significantly lower in the patients diagnosed before 8 years of age compared with those diagnosed after 8. The cognitive deficits in the patients diagnosed at younger ages might be related to earlier exposure to craniospinal irradiation and chemotherapy. The patient and parent proxy evaluations of attention, fine motor function, and quality of life did not differ. We found significant neurocognitive changes in a wide range of neurocognitive functional domains in Korean survivors of childhood medulloblastoma. Long-term follow-up studies of survivors of childhood medulloblastoma beginning at the time of their first diagnosis are required to better understand the deficits exhibited by survivors of childhood medulloblastoma, so that intervention strategies and treatment refinements that reduce the long-term neurocognitive decline can be developed.

Validation of Pediatric Functional Assessment of Cancer Therapy Questionnaire (Version 2.0) in Brain Tumor Survivor Aged 13 Years and Older (Parent Form)(PedsFACT-BrS Parent of Adolescent)

OBJECTIVE: The aim of this study was to evaluate the reliability and validity of the Pediatric Functional Assessment of Cancer Therapy Questionnaire Brain Tumor Survivor (version 2.0) Aged 13 years and older (Parent Form) (pedsFACT-BrS parent of adolescent). METHODS: The pedsFACT-BrS parent of adolescent was translated and cross-culturally adapted into Korean, following standard Functional Assessment of Chronic Illness Therapy (FACIT) methodology. The psychometric properties of the pedsFACT-BrS parent of adolescent were evaluated in 170 brain tumor patient's mothers (mean age=43.38 years). Pretesting was performed in 30 mothers, and the results indicated good symptom coverage and overall comprehensibility. The participants also completed the Child Health Questionnaire Parent Form 50 (CHQ-PF-50), Neuroticism in Eysenck Personality Questionnaire, and Karnofsky score. RESULTS: In validating the pedsFACT-BrS parent of adolescent, we found high internal consistency, with Cronbach's alpha coefficients ranging from 0.76 to 0.94. The assessment of test-retest reliability using intraclass correlation coefficient revealed satisfactory values with ICCs ranging from 0.84 to 0.93. The pedsFACT-BrS for parent of adolescent also demonstrated good convergent and divergent validities when correlated with the Child Health Questionnaire Parent Form 50 (CHQ-PF-50) and the Neuroticism in Eysenck Personality Questionnaire. The pedsFACT-BrS parent of adolescent showed good clinical validity, and effectively differentiated between clinically distinct patient groups according to the type of treatment, tumor location, shunt, and Karnofsky score of parent proxy report. CONCLUSION: We confirmed that this reliable and valid instrument can be used to properly evaluate the quality of life of Korean adolescent brain tumor patients by their parents' proxy report.

Genetic and expression alterations in association with the sarcomatous change of cholangiocarcinoma cells

Cholangiocarcinoma (CC) is an intrahepatic bile duct carcinoma with a high mortality rate and a poor prognosis. Sarcomatous change/epithelial mesenchymal transition (EMT) of CC frequently leads to aggressive intrahepatic spread and metastasis. The aim of this study was to identify the genetic alterations and gene expression pattern that might be associated with the sarcomatous change in CC. Previously, we established 4 human CC cell lines (SCK, JCK1, Cho-CK, and Choi-CK). In the present study, we characterized a typical sarcomatoid phenotype of SCK, and classified the other cell lines according to tumor cell differentiation (a poorly differentiated JCK, a moderately differentiated Cho-CK, and a well differentiated Choi-CK cells), both morphologically and immunocytologically. We further analyzed the genetic alterations of two tumor suppressor genes (p53 and FHIT) and the expression of Fas/FasL gene, well known CC-related receptor and its ligand, in these four CC cell lines. The deletion mutation of p53 was found in the sarcomatoid SCK cells. These cells expressed much less Fas/FasL mRNAs than did the other ordinary CC cells. We further characterize the gene expression pattern that is involved in the sarcomatous progression of CC, using cDNA microarrays that contained 18,688 genes. Comparison of the expression patterns between the sarcomatoid SCK cells and the differentiated Choi-CK cells enabled us to identify 260 genes and 247 genes that were significantly over-expressed and under-expressed, respectively. Northern blotting of the 14 randomly selected genes verified the microarray data, including the differential expressions of the LGALS1, TGFBI, CES1, LDHB, UCHL1, ASPH, VDAC1, VIL2, CCND2, S100P, CALB1, MAL2, GPX1, and ANXA8 mRNAs. Immunohistochemistry also revealed in part the differential expressions of these gene proteins. These results suggest that those genetic and gene expression alterations may be relevant to the sarcomatous change/EMT in CC cells.

A Lateralizing Ability of the Wechsler Memory Scale-III in Patients with Mesial Temporal Lobe Epilepsy / 대한간질학회지

PURPOSE: The Wechsler Memory Scale-III (WMS-III) including new visual memory tests was developed to overcome the limitation of WMS-Revised (WMS-R). We examined the utility of the WMS-III in predicting laterality of memory impairment in patients with mesial temporal lobe epilepsy (MTLE). METHODS: We included 49 consecutive patients with unilateral MTLE who had left hemisphere dominance for language by WADA test and underwent temporal lobectomy. Methods of analysis included evaluation of group means on the various indexes and subtest scores of WMS-III, the use of ROC curves, an examination of Auditory-Visual Index (AVI) discrepancy scores and correlation analysis between AVI discrepancy scores and age, onset age of patients. RESULTS: 1) Patients with left MTLE had significantly lower scores on several scores and indexes compared to those with right MTLE. 2) In analysis of ROC curves, the area under the curve and the suggested cutting score were 0.696 and 4 (a sensitivity 0.704, a specificity 0.727) for immediate AVI discrepancy score and 0.702 and 5 (a sensitivity 0.556, a specificity 0.773) for delayed one, respectively. 3) In right MTLE, there was a tendency for linear correlation between AVI discrepancy scores and age at onset. CONCLUSIONS: Overall, WMS-III has limited value in identifying particular memory deficits associated with either left or right temporal lobe dysfunction. AVI discrepancy scores may be more useful to predict right hemispheric dysfunction rather than left ones.

Wisconsin Card Sorting Test Performance in Mesial Temporal Lobe Epilepsy / 대한간질학회지

PURPOSE: To investigate the origin of frontal lobe dysfunction identified by the Wisconsin Card Sorting Test (WCST) in mesial temporal lobe epilepsy (MTLE). METHODS: We included 85 patients with unilateral MTLE and 34 patients with neocortical temporal lobe epilepsy (NTLE). We included only MTLE patients who postoperatively became seizure free at least for 1 year. Comparisons were made on the WCST performance between MTLE and NTLE and between preoperative and postoperative test in MTLE. Standardized regression based (SRB) methodology was used for correcting test-retest bias. RESULTS: 1) There were no significant differences in frontal lobe dysfunction defined as more than 17 perseverative errors between MTLE (64%) and NTLE (76%). 2) No significant differences in WCST performance between MTLE and NTLE were noted, except in categories completed (p=0.05). NTLE achieved significantly fewer categories than MTLE. 3) The proportions of patients with MTLE who postoperatively showed a clinically meaningful improvement on WCST performance were higher than those who displayed a significant decline. In case of perseverative responses, 52% of patients with MTLE postoperatively showed an improvement whereas 18% displayed a decline. 4) Postoperatively, mean values of perseverative responses and total errors were significantly decreased (p<0.05). 5) Significant negative correlations were found between preoperative WCST performance and postoperative SRB change scores for WCST (r=-0.3~-0.4, p<0.05). CONCLUSIONS: Our results could not be explained by any one of 'neural noise' or 'hippocampal' hypothesis. Our data suggest that poor WCST performance in patients with MTLE might be attributed to dysfunction of neural system including both hippocampus and frontal lobe cortex. Further studies are needed to make new hypothesis.

The Reliability and Validity of Korean QOLIE-31 in Patients with Epilepsy / 대한간질학회지

BACKGROUND: To develop a Korean version of the QOLIE-31 and to confirm its psychometric properties. METHODS: The QOLIE-31 was adapted to Korean language through a translation-back translation procedure. Data were collected from 397 adult epilepsy patients. Patients were administered the Quality of Life in Epilepsy Inventory-31 (QOLIE-31), Korean Wechsler Intelligence Scale (KWIS), the Functional Assessment of Cancer Therapy-General (FACT-G), state scale of the State-Trait Anxiety Inventory (STAI), and the Center for Epidemiological Studies-Depression Scale (CES-D). We assessed internal consistency and test-retest reliabilities and construct validity. RESULTS: Cronbach's alpha ranged from 0.69 to 0.86, and test-retest reliability was between 0.50 and 0.71, demonstrating that the items of OOLIE-31 are internally consistent and temporally stable. Pearson's correlations among the QOLIE-31 and emotional well-being, state anxiety, and depressive symptoms were high. Most QOLIE-31 sub-scales discriminated well between patients according to seizure frequency, number of antiepileptic drugs, employment, economic status and depressive symptoms. CONCLUSION: The Korean version of the QOLIE-31 was reliable, and showed construct validity comparable with the original U.S version. Results confirmed that the QOLIE-31 can be applied as one of the specific measures of quality of life in Korean epilepsy patients.

The Social Stigma of Epilepsy in Korea / 대한간질학회지

BACKGROUND: To study social stigma of people with epilepsy (PWE) in Korea, focusing on which factors are associated with social stigma. METHODS: Data were collected from 400 adult epilepsy patients (51% male, mean age:32.9 years, range:19-64 years). Patients were recruited from 10 epilepsy centers in Korea. Clinical information about seizures was obtained by neurologists and the other information was collected by using self-completed questionnaires including stigma of epilepsy scale and several scales or questions. RESULTS: Thirty one percent of PWE felt stigmatized by epilepsy, 9% of them highly so. The presence of stigma of epilepsy was associated with duration of epilepsy, seizure remission or frequency, generalized tonic clonic seizures in the last 2 years, seizure-related injuries in the last year, the actual discrimination from society, all subscales of QOLIE-31, education, introverted and neurotic personality, helplessness, control, and confidence in problem solving, anxiety and depression, and self-esteem. Multivariate analysis identified discrimination from society, introverted personality, problem solving control, and emotional subscale of QOLIE-31. CONCLUSION: Our data showed the prevalence of social stigma of PWE in Korea might be not high unexpectedly and suggested that the actual discrimination from society and patients' coping style including personality might be important in feeling social stigma of epilepsy. Our results would be basic information for the further studies to clarify the causative factors to generate the stigma of epilepsy.

Neuropsychological Characteristics of Mesial Temporal Lobe Epilepsy: Lesion Laterality-Sex Interaction

BACKGROUND: Memory changes and its predictors after anterior temporal lobectomy (ATL) were investigated. A standardized regression-based (SRB) outcome methodology was used, accounting for the effects of practice and preoperative memory functions. METHODS: Consecutive 45 ATL patients (male 22) with mesial temporal sclerosis (dominant 21) who became seizure-free for at least 1 year postoperatively were included in the study. Wechsler Memory Scale-Revised(WMS-R) was performed pre- and postoperatively. Memory changes were estimated using SRB norms and then were correlated with age of onset, seizure duration, chronological age, seizure risk factors, and preoperative memory function. RESULTS: 1) The majority of cases (76~84%) showed no significant memory changes. Significant declines in verbal memory were noted for 8 (18%) out of 45 ATL patients whereas significant declines in visual memory were found in only 2 (4%). There were no differences in memory changes according to lesion laterality. 2) Later age at onset, shorter duration of epilepsy, absence of history of infection or febrile convulsion were significantly related to verbal memory decrease after ATL. 3) Using SRB methodology, adequacy of preoperative memory performance was correlated with decrease in visual memory but not in verbal memory, even if absolute change scores between pre-and postoperative values were associated with preoperative performances in both verbal and visual memory. CONCLUSIONS: Although group variability of memory outcome after ATL using WMS-R was not found to be significant, considerable individual variability of memory outcome after ATL was found along with significant predictors of postoperative verbal memory decrease. (J Korean Neurol Assoc 19(3):219~225, 2001)

Neuropsychological Characteristics of Mesial Temporal Lobe Epilepsy:Lesion Laterality-Sex Interaction

BACKGROUND: We investigated the neuropsychological features of laterality-sex interactions in mesial temporal lobe epilepsy (MTLE), using a broad and comprehensive neuropsychological test battery. METHODS: Eighty-nine consecutive patients (female 46) with MTLE (left 46) were included in the study. They underwent anterior temporal lobectomy and became seizure-free for at least one year postoperatively. All patients had a language dominancy in the left hemisphere. The following neuropsychological tests including : Korean Wechsler Intelligence Scale (KWIS), Wechsler Memory Scale-Revised (WMS-R), Wisconsin Card Sorting Test (WCST), and Color Trails Test (CTT), were performed preoperatively. Each variable of the neuropsychological tests were analyzed with regard to laterality-sex interactions. RESULTS: General memory, verbal memory, and delayed recall of WMS-R and a executive function measured by WCST were significantly decreased in patients with left MTLE compared to those with right MTLE. However, this laterality effect especially on verbal memory and some variables of WCST including the number of category completed was observed only in female patients. Interference index of CTT had a tendency to be increased in the male patients with right MTLE. The intelligence scale of KWIS was not correlated with lesion laterality or sex. CONCLUSIONS: Laterality-sex interactions were evident for verbal memory and an executive function in female patients with MTLE. Further studies need to be done on these neuropsychological features. (J Korean Neurol Assoc 19(2):132~138, 2001)

Neuropsychological Characteristics of Mesial Temporal Lobe Epilepsy:Lesion Laterality-Sex Interaction

BACKGROUND: We investigated the neuropsychological features of laterality-sex interactions in mesial temporal lobe epilepsy (MTLE), using a broad and comprehensive neuropsychological test battery. METHODS: Eighty-nine consecutive patients (female 46) with MTLE (left 46) were included in the study. They underwent anterior temporal lobectomy and became seizure-free for at least one year postoperatively. All patients had a language dominancy in the left hemisphere. The following neuropsychological tests including : Korean Wechsler Intelligence Scale (KWIS), Wechsler Memory Scale-Revised (WMS-R), Wisconsin Card Sorting Test (WCST), and Color Trails Test (CTT), were performed preoperatively. Each variable of the neuropsychological tests were analyzed with regard to laterality-sex interactions. RESULTS: General memory, verbal memory, and delayed recall of WMS-R and a executive function measured by WCST were significantly decreased in patients with left MTLE compared to those with right MTLE. However, this laterality effect especially on verbal memory and some variables of WCST including the number of category completed was observed only in female patients. Interference index of CTT had a tendency to be increased in the male patients with right MTLE. The intelligence scale of KWIS was not correlated with lesion laterality or sex. CONCLUSIONS: Laterality-sex interactions were evident for verbal memory and an executive function in female patients with MTLE. Further studies need to be done on these neuropsychological features. (J Korean Neurol Assoc 19(2):132~138, 2001)

The Influence of IMF-related Economic Stress upon Mental Health / 신경정신의학

This study was designed to investigate the influence of the so-called IMF-related economic stress upon the mental health and to analyze the process of the influence. As the possible variables moderating the stress process, social resource, problem solving style, and hopelessness were included. 221 male and female subjects were recruited according to the intensity of economic stress and classified into four groups(employees of solid companies, employees of the companies at risk, short-term unemployed and long-term unemployed). Relevant measures including economic stress scale, selected SCL-90R subscales(somatization, depression, hostility, anxiety), social support scale, problem-solving scale, and job hopelessness scale were administered. As assumed, it was proved that economic stress had adverse effects on the mental health. In addition to this basic causal relationship, moderating effects of several variables were found as follows: First, social support had the buffering effect upon the economic stress. That is, strong social support played the role suppressing the development of psychiatric symptoms under high stress. Second, men were more vulnerable to the adverse effects of economic stresses than women. Third, economic stresses had influence on the helplessness concerning the problem solving. However other problem solving strategies such as creative style, approach style, avoidance style, etc were proven to have no relationship with the economic stress. Fourth, in the analysis of unemployed group, it was found that hopelessness mediates the relationship between economic stress and mental health. In conclusion, the clinical implications of such findings in economic stress process were discussed and several limitations and the suggestions for future researches were also addressed.

The Patterns of Personality and Anger Expression in the Patients with Colorectal Cancer / 신경정신의학

OBJECTIVES: Although previous studies have suggested that Type 1 or Type C personality may be associated with the development of cancer, the results have not been consistent. There have been some evidences that repression, denial, or non-expression of anger are related with the incidence of colorectal cancer. However, according to the results of recent researches, aggressive hostility was related to the development of colorectal cancer. This study attempted to delineate psychological characteristics or personality patterns of the patients with colorectal cancer based on multidemensions of anger and Type 1 personality for cancer development. METHOD: The subjects were composed of 35 patients with colorectal cancer and 37 normal controls. Grossarth-Maticek personality questionnaire and the Spielberger state-trait anger expression inventory were administered. RESULTS: In comparison with the normal control group, the colorectal cancer patient group showed significantly higher scores on anger experience, angry temperament and state anger but no significant differences on Type 1 personality scale and other subscales. In the discriminant analysis patients and control groups were classified by means of state anger, angry temperament, angry reaction, anger-in, anger-out and anger control variables. When angry temperament variable was selected as a discriminant variable, 65.8% of cases had been correctly classified. CONCLUSIONS: These results suggested the relationship between the disposition to experience and express anger without particular provocation and the development of cancer.

Neurobehavioral Psychometry and Functional Outcome in Traumatic Brain Injured Patients

OBJECTIVE: To identify the neurobehavioral impairment in the traumatic brain injured (TBI) patients and to determine the relationship between the neurobehavioral impairment and functional recovery. METHOD: We analyzed and compared Functional Independence Measure (FIM) scores and neurobehavioral psychometry results in 16 patients with severe TBI. The neurobehavioral psychometry tests included Minimental Status Examination (MMSE), Galvestone Orientation and Amnesia Test (GOAT) as screening tools, Korean Wechsler Intelligence Scale (KWIS) for intelligence, Wechsler Memory Scale-Revised (WMS-R) test for memory function, Color Trail test (CTT) 1 and 2 for attention and concentration, Grooved Pegboard Test (GPT) and Finger Tapping Test (FTT) for motor function, Wisconsin Card Sorting Test (WCST) for executive function, and Symptom Checklist-90-Revision (SCL-90-R) for personality. RESULTS: At discharge, neurobehavioral psychometry of the TBI patients showed impairment of the attention and concentration as demonstrated by severe and moderate impairment in CTT 1 and CTT 2, repectively. Memory disturbance was also noted by the result of mental retardation in WMS-R. But GOAT and MMSE showed normal, KWIS was below average. Motor dysfunction was seen in GPT and FTT and mild executive dysfunction in WCST. Functional recuperation was influenced by attention and concentration, as the FIM score has significant correlation with CTT 1 and FTT. CONCLUSION: The TBI patients have the pervasive neurobehavioral impairment, especially severe dysfunction in the memory, attention and concentration. And functional recovery was significantly correlated with attention. The neurobehavioral psychometry will be useful in neurobehavioral evaluation in TBI patients. A further prospective study using Neurobehavioral psychometry would bring a more precise and valuable information.

The Psychosocial Characteristics Influencing the Selection of Complementary Medicine / 신경정신의학

This study examined the characteristics of people who have preference for complementary medicine and also the psychosocial factors that are related to the selection of complementary medicine. Two-hunred subjects recruited from the community were included in this study. Demographic variables, medical service characteristics, health locus of control, social support, coping style, and personality charateritics such as self-esteem, neuroticism, and hypochondriasis were measured. It turned out that nearly 80% of the subjects had already experienced at least one alternative therapy in the past. However, past expeiece was not significant in predicting future complementary medicine usage. People who were older in age, had more information about complementary medicine, used active-behavioural coping styles, and had internal locus of control were more likely to use complementary medicine in the future. Recommenations for furthur research is indicated.

Reviews on the Psychological Variables Concerning the Successful Adjustment in Medical Colleges / 한국의학교육

In this article, we critically reviewed various literatures on stress and adjustment in medical schools as a preliminary work for the future empirical study. We adopted Biopsychosocial Model as the frame of reference, which considers not only the relationship between stressor and psychological distress, but also their interaction with moderating variables such as psychosocial resources and vulnerabilities. According to the model, three important aspects of medical school stress were reviewed: 1) the types of medical school stresses, 2) the adverse effects of stressors on the adjustment such as depression, anxiety, physical symptoms, drug abuse, eating problem, attrition, change of attitude and personality, etc, 3) the moderating effects of various vulnerabilities and resources including Type A behavior pattern, masculinity/femininity, locus of control, optimism, anger expression, coping style, social support, and study skills on the suppression or development of psychological distress. Investigating the moderating variables in particular may have great clinical implications since these variables are closely related to the psychological factors concerning successful adjustment in medical school. Conclusions drawn from this review suggests several directions of future research. First, a comprehensive study which covers the whole process of medical school stress is recommended. Longitudinal design will be more suitable for dealing with the developmental features of medical education. Finally, the severity of medical school stress must be compared with the stress of general colleges and other professional graduate schools. This article is expected to provide some theoretical basis for future studies regarding the successful adjustment in the medical school, the development of preventive intervention programs and the reform of medical education systems.

Sociodemographic Characteristics, Attitudes and Personal Values of the Applicants at a College of Medicine of University / 한국의학교육

Group characteristics(sociodemographic characteristics, attitudes and personal values) of the successful applicants of 1997 at Ulsan College of Medicine were compared with those of the unsuccessful ones. The principal data were the responses of pre-entrance examination questionnaire survey were administered to all applicants. The results were presented the headings of 1) sociodemographic characteristics, 2) financial status, 3) goals of college life, 4) reasons to choose university of Ulsan College of Medicine, 5) personal values. The results of the present study may serve as the basic data to make comprehensive and systematic plans for the adjustment of medical students in the future.

Korean standardization study of the vienna test system for clinical use(I) : Standard progressive matrices test of students in Seoul / 신경정신의학

No abstract available.