Clinical Usefulness of Korean Version of Older Adult Behavior Checklist in Screening for Diverse Psychopathology of Cognitive Impairment

OBJECTIVE: This study aimed to investigate the differences of results of Older Adult Behavior Checklist (OABCL) in subjects with dementia, mild cognitive impairment (MCI), and normal group. METHODS: The data was composed of 42 patients with MCI, 71 patients with dementia, and 111 randomly collected participants who were recruited for standardization of Korean version of Achenbach System of Empirically Based Assessment Older Adult Forms. Medical records, results of OABCL, neuropsychological tests, activities of daily living scale, and clinical dementia rating scale of the subjects were retrospectively analyzed to find significant factors in distinguishing the groups. RESULTS: In dementia group, almost of the empirically base problem scales and Diagnostic and Statistical Manual of Mental Disorders (DSM)-oriented scales showed significantly higher scores than MCI or normal groups. MCI group also showed higher scores in several empirically base problem and DSM-oriented scales than normal group. Also, functional impairment, memory/cognition, thought problems, irritable/disinhibited scales of empirically base problem and depressive, dementia, psychotic problems DSM-oriented scales significantly predict in distinguishing the three groups. CONCLUSION: The results implicated that OABCL is not only useful in assessing cognition decline but also in investigating psychological and behavioral problems of older adults.

The Validity of Korean Ages and Stages Questionnaires (K-ASQ) in Korean Infants and Children

PURPOSE: As a preliminary study on the development of a new developmental screening tool, this study examined the validity of the Korean Ages and Stages Questionnaires (K-ASQ). METHODS: The clinical sample included a total of 218 Infants and children at 30, 36, 60 months of age, who were diagnosed with developmental disorders. Age- and sex-matched normal controls were selected from a national large-scale K-ASQ database. Sensitivity, specificity, and accuracy were calculated in different age and diagnosis groups, and receiver operating characteristic (ROC) curve analysis was performed as well. In addition, concurrent validity was analyzed for the clinical sample by comparing the K-ASQ with other reference scales. RESULTS: The sensitivity, specificity, and accuracy of the K-ASQ were above fair (0.82-0.96) overall, however they varied depending on age and diagnosis groups. Specifically, the sensitivity at 60 months was relatively low (0.65). Especially, the discrimination sensitivity for the language delay group was poor at 60 months (0.42). ROC analysis showed that the overall discrimination capacity was above fair in all 5 domains [area under the curve (AUC): 0.74-0.98]. However, there were some domains and age groups with relatively poor discrimination capacity. In terms of concurrent validity, the correlations between the K-ASQ domains and reference scale subscales were statistically significant overall, but weak in some domains. CONCLUSION: The overall discrimination capacity and concurrent validity of the K-ASQ were above fair, but there were some domains, age, and diagnosis groups in which the K-ASQ was not successful in identifying potentially developmentally challenged children. These findings suggested the need for the development of a new developmental screening test tool, which is suitable for Korean infants & children.

The Appropriateness of the Items of Korean Ages and Stages Questionnaires (K-ASQ) Developmental Screening Test in Korean Infants and Children

PURPOSE: Since National Health Screening Program for Infants and Children in Korea started from November, 2007, the need to design a new tool that can timely identify infants and chlildren with possible delayed development has been emphasized. The developmental screening devices currently used in Korea are mostly adapted from foreign tests and could be considered inappropriate for children growing in a different cultural background. Therefore, we assessed the appropriateness of Korean-Ages and Stages Questionnaires (K-ASQ) items in Korean infants and children, as a preliminary study to develop a new developmental screening test tool. METHODS: Data on K-ASQ tests that were performed in multicenters as a National Health Screening Program in Korea were analyzed to measure (1) the item difficulty and norm relevance (2) the goodness of fit for factor structure (3) the sensitivity of item for developmental evaluation. A total of 1,696 subjects, 877 boys (51.7%) and 819 girls (48.3%) were studied and with about 50 boys and 50 girls for each age of months, the sample was relatively evenly distributed. RESULTS: Analysis of K-ASQ data showed that (1) The subjects scored higher when compared to the K-ASQ's original criteria. (2) The suitability of confirmative factor structure was insufficient, especially problem solving [x2=41.063, P<0.01, CFI (Comparative Fit Index)=0.929, TLI (Turker-Lewis index)=0.834, RMSEA (Root Mean Square Error Approximation)=0.152] and personal-social domains (x2=55.208, P<0.01, CFI=0.817, TLI=0.573, RMSEA=0.182). (3) Some questions did not show significant difference in the sensitivity of item for developmental evaluation among monthly age groups. CONCLUSION: According to the analysis of previous K-ASQ data, the appropriateness of the questionnaires is good in general, but some questions of problem-solving and personal social domains are not appropriate. We suggested the development of a new developmental screening test tool, which is suitable for Korean infants and children.

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.

Development of a Child Problem-Behavior Screening Test / 신경정신의학

OBJECTIVES: Purpose of this study was to develop a test screening children's emotional and behavioral problem. METHODS: Child Problem-Behavior Screening Test (CPST) is a brief behavioral screening questionnaire that can be completed by parents or teachers. The 2nd to 4th graders (N=970) of the two elementary schools in Seoul, Korea, participated in the study. Parents and teachers completed a CPST and parents completed Child Behavior Checklist-Korean version (K-CBCL). The Reliability and validity of the CPST was evaluated by comparing with K-CBCL and by performing the factor analysis, t-test and correlation analysis. RESULTS: Internal Consistency of CPST was relatively good (Cronbach's alpha; Parent=.846, Teacher=.834). The result of factor analysis shows that the CPST has a four-factor structure, representing 'externalizing problem', 'internalizing problem', 'physical health problem' and 'cognitive problem'. In the parent's and teacher's CPST, total variance of the four factor was 37.8% and 43.8%, respectively. There were significant correlations among subscales of parent's CPST and K-CBCL. CPST effectively distinguished children with psychiatric problems from children without psychiatric problems. CONCLUSION: The results support that the test developed in this study is efficient to identify the children's emotional and behavioral problmes. This study also proves the usefulness of the CPST as a promising screening test of child problem behavior for large epidemiological study. In the future, a study to standardize this test is necessary, and from this, the cut-off score and norms should be developed.

Predicting Variables of Violent Behavior in Schizophrenic Patients / 신경정신의학

OBJECTIVES: This study aims to investigate the variables predicting violent behavior in schizophrenic patients. METHODS: Subjects were 65 schizophrenic patients diagnosed according to DSM-IV. Schizophrenic symptom and the insight of patients were evaluated with the Postive and Negative Syndrome Scale (PANSS) and the Scale of Unawareness of Mental Disorder (SUMD). Violent behaviors were evaluated with the Modified Overt Aggression Scale (MOAS). The State Trait Anger Expression Inventory (STAXI) and the Symptom Checklist-90-Reversion (SCL-90-R) self-reported measures were used for the evaluation of anger state & trait, and general psychopathology. Statistic method used in analized variables were stepwise multiple regression and discriminant analysis as well as t-test. RESULTS: Anger out style, hostility and trait anger variables were extracted as the significant predictors in stepwise multiple regression (37%). Emotion and attitude factors related to anger were more powerful predictor than symptom factors. These three variables could discriminate between violent group and nonviolent group in 72.4%. CONCLUSION: Violent behavior of schizophrenic patients could be predicted more accurately by stable factors such as attitude and emotion related to anger than by symptom factors.

Neurocognitive Subtypes of Schizophrenia: with Emphasis on Frontal Lobe Functions / 신경정신의학

OBJECTIVES: This study was designed to identify frontal lobe dysfunctions of schizophrenic group and to classify into subtypes accordingly. METHODS: Four neuropsychological tests (Wisconsin Card Sorting Test (WCST), Word Fluency Test, Ruff Figural Fluency Test and Grooved Pegboard Test) were administered to 93 schizophrenia or schizophreniform patients diagnosed with the Korean version of SCID. Ten measures (WCST Total Number of Errors, WCST Number of Categories Completed, WCST Conceptual Level Responses, WCST Trials to Complete First Category, WCST Perseverative Responses, GPT Dominant Hand RT, GPT Nondominant Hand RT, Letter Fluency raw score, Category Fluency raw score, RFFT Total Unique Designs) from the four tests were selected by statistical procedure. Latent factors embedded in the frontal lobe function of schizophrenic patients were extracted from the factor analysis, and hierarchical and K-means clustering procedures were used to identify subtypes. To examine the differences among the subtypes, demographic variables, K-WAIS and PANSS were used. RESULTS: (1) The subjects in this study showed significant impairments in the four neuropsychological tests. (2) Through factor analysis, three factors were extracted: Conceptualization, Motor and Fluency. (3) Three cluster solution was considered optimal by cluster analysis. The preserved cluster (n=42) comprised of patients who showed relatively high function in all three factors. This group showed relatively higher function than the other two clusters. However, even the performance of the preserved cluster was 1SD below the norm of the normal people. The conceptualization deficit cluster (n=25) comprised of patients with deficit in conceptualization function. This group was characterized by the clinical symptoms of poor impulse control and active social avoidance suggesting a deficit in the ability to actively organize stimuli utilizing the feedback from the external environment. And finally, the fluency deficit cluster (n=19) showed impairment in fluency. This group was characterized by impairments in the use of abstract-symbolic thinking and the ability to pay attention to relevant stimuli suggesting a severe deficit in the efficiency and flexibility of information withdrawal. These three subtypes didn't differ significantly in age, duration of illness and current dosage of antipsychotics. However, the three groups differed significantly in years of education, IQ and on five items of PANSS. CONCLUSION: This study shows that schizophrenia can be characterized by frontal lobe dysfunctions and divided into three subtypes according to the profile of the frontal lobe dysfunctions. These neurocognitive heterogeneity of schizophrenia, not related to age, duration of illness and dosage of antipsychotic, suggest that different strategies need to be developed in diagnosing and planning rehabilitation programs for schizophrenc patients.

Child-rearing Practices and Psychological Disorders in Children: Cross-Cultural Comparison of Korea and Australia

The present study was designed to explore cultural differences in the relationship between parenting behaviors and psychological adjustment of the child. Mother-son interaction behaviors of 37 Korean boys (11 with Anxiety Disorder, 10 with Externalizing Disorders and 16 Non-clinical boys) and 54 Australian boys (20 with Anxiety Disorder, 17 with Externalizing Disorders and 17 Non-clinical boys) between the ages of 7 and 15 were compared in terms of parental negativity and involvement. The results indicated that Korean mothers displayed more overall negativity and lower overall involvement than Australian mothers. Furthermore, anxiety diagnosis was associated with low maternal involvement in the Korean subjects, while in the Australian subjects, high maternal involvement was associated with clinical status in the child.

Model Development of School Mental Health Service: 1. A School-Based Study on the Emotional and Behavioral Problems of Elementary Students / 신경정신의학

As an initial step for promoting a mental health service for elementary school children, a school-based epidemiologic study on children's mental problems and their social background was conducted. The subjects were 3,021 students from 20 elementary schools in a rural community in Korea. The epidemiologic study consisted of two stages, initial screening using the Child Behavior Check List(CBCL) and a structured psychiatric evaluation. After the study, we received feedback from teachers and parents. The results were as follows: 1) Initially, 251(8.3%) students with total CBCL score higher than 54 were selected as problem children. Among the 251 students, only 31 had completed a structured psychiatric evaluation, and 71%(22 students) of them met the DSM-III-R citeria of psychiatric disorders. 2) Attention deficit hyperactivity disorder was the most common problem in both sexes, followed by oppositional defiant disorder in males and depression and anxiety disorder in females. Other students also had borderline intellectual functioning, learning disorders, somatoform disorder, sleep disorder and obsessive-compulsive disorder 3) The socio-environmental factors that were significantly related with mental health problems were poor economic status and little education in parents, no family religion, and children living with their maternal grandmother or with a single parent. Students who had mental problems also showed low levels of social competence. 4) The feedback from parents and teachers showed that the stigma of mental disorders, limitations of available time, and a poor understanding and lack of knowledge on the par of parents and teachers were the major obstacles in mental health service. Based on these results, the future direction of research and practice of school mental health was discussed.

Model Development of School Mental Health Service: 2 Model Development of School Mental Health Service in Korean Urban Communities / 신경정신의학

This research was aimed at developing a model for school mental health service. Subjects were students at two elementary schools located in an urban community. The goals of the study included, 1) early detection and intervation in children with mental health problems, 2) developing educational programs for parents and teachers ; 3) developing programs linking mental health resources in the community with the school system(school consultation, telephone counselling, and group activities for high risk-students). Subjects wars 1,732 students at 2 primary schools in a community of Seoul. Problem children were selected through screening with CBCL and were examined by psychiatrists. The results were as follows: 1) Of 1,732 students, nearly 8% had mental health problems. The parents of the students with mental health problems were urged to seek psychiatric care. However, only 8% of them had a positive response. On the other hand, telephone counselling was preferred and 40% of them said they had visited a psychiatric clinic. 2) Regarding the education of parents, they preferred telephone counselling and written information to direct counselling or participating in education programs. In most cases, they avoided talking about their children's problems. 3) Teachers showed a good sense for ducting children's mental health problems, but they suffered from a fueling of helplessness because of lack of knowledge and skills. 4) Special education programs were needed f)r students with serious behavior problems. Group activities, which were directed by college student volunteers, had been proved to be effective in helping children with high risks. 5) This suggests that the stigma for mental disorder is still an obstacle in mental health service and that fechers need on-going systemic education on children's mental health since college period. Based on these study results, the authors suggest a model of school mental health service linking the school system, family(parents) and professional mental health resources in the community.