The Concept and Historical Background of Custody Evaluation

This article reviews a wide range of literature on the standards and process of child custody evaluation in the US, and proposes custody evaluation standards appropriate to Korea. Custody evaluation refers to the process of making psychiatric and psychological evaluations of each parent and the child during a custody dispute and presenting to the family court a report of custody evaluation with the aim of safeguarding the best interests of the child. In the past, it was thought that children arethe fathers’ possessions or that younger children should be raised by the mother; however, currently, custody rights are evaluated in accordance with the principle of the best interests of the child. The principle is all-encompassing and vague and hence, the court makes increasingly more requests to mental health professionals for custody evaluation. Since the Seoul Family Court introduced the expert consultation system in 2017, the involvement of mental health professionals in child custody decisions has increased in Korea. Custody evaluators should try to be neutral and find the objective facts, keeping in mind that their role is to aid the court in making a custody decision.

Custody Evaluation Process and Report Writing

As in western countries, divorce rates in South Korea have recently been rising, and family disruption has become one of serious social problems. Parents are able to express their opinions and wishes confidently, but the thoughts and wishes of children, especially infants and young children, tend to be ignored. Children can also experience several emotional and behavioral problems during the process of and after their parents’ divorce. When South Korean family courts determine custody arrangements, they typically do not have a systematic strategy and process based on custody evaluation to help children and their parents overcome conflicts and build healthy parent-child relationships after divorce. Furthermore, under the current court system, it is difficult for mental health specialists and child psychiatrists to intervene in familial conflicts as mediators or therapists during the course of divorce proceedings. Acknowledging these limitations, the South Korean family court system implemented a formal program for custody evaluations by child psychiatrists and psychologists in 2017. However, they have faced challenges such as a shortage of experienced specialist and lack of a training system or instruments for evaluation. In this paper, the authors aim to share professional knowledge of and experiences with aspects of the custody evaluation process, such as indications, procedures, methods, psychological tests, resources, and final report writing, to better serve children and their parents undergoing a painful divorce process.

Custody Evaluation in High-conflict Situations Focused on Domestic Violence and Parental Alienation Syndrome

In a divorced family, child-centered custody evaluation is essential to ensure the child’s best interests and healthy adaptation. A mental health professional’s role and involvement are required in gaining an in-depth understanding of various environments and dynamics surrounding the child and family. Domestic violence, including child abuse and intimate partner violence (IPV) or parental alienation syndrome (PAS), is often observed in cases of custody evaluation in high-conflict divorced families, sometimes accompanied by allegations.Such cases warrant an extremely careful approach by the evaluator, who needs to be competent in interpreting the familial dynamics based on a reasonable context understanding. Genuine professionalism is a must for a custody evaluator to best help the child and carry out a high-quality custody evaluation process, and evaluators need to be ready for this task through adequate preparation and empowerment. This article is devoted to examining custody evaluation in divorced families in cases of IPV, child abuse, and PAS.

The Concept and Historical Background of Custody Evaluation

This article reviews a wide range of literature on the standards and process of child custody evaluation in the US, and proposes custody evaluation standards appropriate to Korea. Custody evaluation refers to the process of making psychiatric and psychological evaluations of each parent and the child during a custody dispute and presenting to the family court a report of custody evaluation with the aim of safeguarding the best interests of the child. In the past, it was thought that children arethe fathers’ possessions or that younger children should be raised by the mother; however, currently, custody rights are evaluated in accordance with the principle of the best interests of the child. The principle is all-encompassing and vague and hence, the court makes increasingly more requests to mental health professionals for custody evaluation. Since the Seoul Family Court introduced the expert consultation system in 2017, the involvement of mental health professionals in child custody decisions has increased in Korea. Custody evaluators should try to be neutral and find the objective facts, keeping in mind that their role is to aid the court in making a custody decision.

Custody Evaluation Process and Report Writing

As in western countries, divorce rates in South Korea have recently been rising, and family disruption has become one of serious social problems. Parents are able to express their opinions and wishes confidently, but the thoughts and wishes of children, especially infants and young children, tend to be ignored. Children can also experience several emotional and behavioral problems during the process of and after their parents’ divorce. When South Korean family courts determine custody arrangements, they typically do not have a systematic strategy and process based on custody evaluation to help children and their parents overcome conflicts and build healthy parent-child relationships after divorce. Furthermore, under the current court system, it is difficult for mental health specialists and child psychiatrists to intervene in familial conflicts as mediators or therapists during the course of divorce proceedings. Acknowledging these limitations, the South Korean family court system implemented a formal program for custody evaluations by child psychiatrists and psychologists in 2017. However, they have faced challenges such as a shortage of experienced specialist and lack of a training system or instruments for evaluation. In this paper, the authors aim to share professional knowledge of and experiences with aspects of the custody evaluation process, such as indications, procedures, methods, psychological tests, resources, and final report writing, to better serve children and their parents undergoing a painful divorce process.

Custody Evaluation in High-conflict Situations Focused on Domestic Violence and Parental Alienation Syndrome

In a divorced family, child-centered custody evaluation is essential to ensure the child’s best interests and healthy adaptation. A mental health professional’s role and involvement are required in gaining an in-depth understanding of various environments and dynamics surrounding the child and family. Domestic violence, including child abuse and intimate partner violence (IPV) or parental alienation syndrome (PAS), is often observed in cases of custody evaluation in high-conflict divorced families, sometimes accompanied by allegations.Such cases warrant an extremely careful approach by the evaluator, who needs to be competent in interpreting the familial dynamics based on a reasonable context understanding. Genuine professionalism is a must for a custody evaluator to best help the child and carry out a high-quality custody evaluation process, and evaluators need to be ready for this task through adequate preparation and empowerment. This article is devoted to examining custody evaluation in divorced families in cases of IPV, child abuse, and PAS.

Genetic Variation of SCN5A in Korean Patients with Sick Sinus Syndrome

BACKGROUND AND OBJECTIVES: Due to recent studies that have shown an association between the genetic variation of SCN5A and sick sinus syndrome (SSS), we sought to determine if a similar correlation existed in Korean patients with SSS. SUBJECTS AND METHODS: We enrolled 30 patients with SSS who showed a sinus pause (longer than 3.0 s) in Holter monitoring, in addition to 80 controls. All exons including the putative splicing sites of the SCN5A gene were amplified by polymerase chain reaction and sequenced either directly or following subcloning. Wild-type and single nucleotide polymorphisms were expressed in human embryonic kidney cells, and the peak sodium current (I(Na)) was analyzed using the whole-cell patch-clamp technique. RESULTS: A total of 9 genetic variations were identified: 7 variations (G87A-A29A, IVS9-3C>A, A1673G-H558R, G3823A-D1275N, T5457C-D1819D, T5963G-L1988R, and C5129T-S1710L) had been previously reported, and 2 variants (A3075T-E1025D and T4847A-F1616Y) were novel; the potential structural effects of F1616Y were analyzed in a three-dimensional model of the SCN5A domain. Patch-clamp studies at room temperature demonstrated that the peak I(Na) was significantly increased by 140% in HEK cells transfected with F1616Y compared with wild-type (-335.13 pA/pF+/-24.04, n=8 vs. -139.95 pA/pF+/-23.76, n=7, respectively). Furthermore, the voltage dependency of the activation and steady-state inactivation of F1616Y were leftward-shifted compared with wild-type (V(h) activation=-55.36 mv+/-0.22, n=8 vs. V(h) activation=-44.21 mV+/-0.17, n=7; respectively; V(h) inactivation=-104.47 mV+/-0.21, n=7 vs. V(h) inactivation=-84.89 mV+/-0.09, n=12, respectively). CONCLUSION: F1616Y may be associated with SSS.

Anger Assessment Using State-Trait Anger Expression Inventory in Middle-School Students in Korea and Association with Depression

OBJECTIVES: The purpose of this study was to assess anger of middle school adolescents in an urban community using State-Trait Anger Expression Inventory (STAXI)-Korean and Korean Child Behavior Checklist (K-CBCL), and to determine whether specific anger expression of adolescents is associated with certain psychopathology including depression. METHODS: Data were collected from 395 middle school students and their parents in Incheon city. The students completed the STAXI, Children's Depression Inventory, Korean version of Mood disorder Questionnaire, and Conners-Wells' Adolescent Self-Report Scale (Short Form), and their parents completed the K-CBCL. RESULTS: No significant correlation was observed between aggression subscale K-CBCL and each scale of the STAXI, except anger out (r=0.704). The scores for STAXI total and respective scales were significantly higher for female students than male students. A stepwise logistic regression model was used to explore the possible predictors for depression in adolescents and lower anger control and higher anger suppression were found to be predictors for depression in adolescence. CONCLUSION: There is a possibility of a large discrepancy between anger that the adolescents actually feel and parents' judgment of their children's anger. It must be considered in assessment of adolescent anger and use of further structured interviews is necessary. In addition, it may be useful to consider the anger expression style in adolescents who report depressive symptoms.

Penile Herpes Zoster / 대한피부과학회지

No abstract available.

Onychomycosis Caused by Chaetomium globosum

Onychomycosis is usually caused by dermatophytes, but some nondermatophytic molds and yeasts are also associated with invasion of nails. The genus Chaetomium is a dematiaceous nondermatophytic mold found in soil and plant debris as a saprophytic fungus. We report the first Korean case of onychomycosis caused by Chaetomium globosum in a 35-year-old male. The patient showed brownish-yellow discoloration and subungual hyperkeratosis on the right toenails (1st and 5th) and left toenails (1st and 4th). Direct microscopic examination of scraping on the potassium hydroxide preparation revealed septate hyphae and repeated cultures on Sabouraud's dextrose agar (SDA) without cycloheximide slants showed the same fast-growing colonies, which were initially velvety white then turned to dark gray to brown. However, there was no growth of colony on SDA with cycloheximide slants. Brown-colored septated hyphae, perithecia and ascospores were shown in the slide culture. The DNA sequence of internal transcribed spacer region of the clinical sample was a 100% match to that of C. globosum strain ATCC 6205 (GenBank accession number EF524036.1). We confirmed C. globosum by KOH mount, colony, and light microscopic morphology and DNA sequence analysis. The patient was treated with 250 mg oral terbinafine daily and topical amorolfine 5% nail lacquer for 3 months.

Localized Epidermolysis Bullosa Acquisita Limited to the Face / 대한피부과학회지

No abstract available.

Periocular Tinea Caused by Trichophyton rubrum / 대한피부과학회지

No abstract available.

A Clinico-mycological Study of Onychomycosis with Dermatophytoma / 대한의진균학회지

BACKGROUND: Although there have been many studies about onychomycosis, the study about onychomycosis with dermatophytoma has not been reported yet in Korea. OBJECTIVE: The purpose of this study was to investigate the clinical characterictics and treatment strategies of the onychomycosis with dermatophytoma compare with the other onychomycosis. METHODS: In the 5-year period 2007-2011, we reviewed forty five patients with toenail onychomycosis with dermatophytoma, proven by direct potassium hydroxide examination. The etiological agents were identified by cultures on Sabouraud's dextrose agar with and without cycloheximide. To confirm dermatophytoma, we performed histopathologic evaluation of the nail plate by nail clipping. RESULTS: Toenail onychomycosis with dermatophytoma were 2.9% of all onychomycosis. Among the age groups, the incidence rate was highest in the sixties (24.4%). The ratio of male to female patients was 1:1.1. The frequency of associated disease was highest in diabetes mellitus (17.7%). The right great toenail was most common affected nails. Distal and lateral subungual onychomycosis (88.9%) was the most common clinical type. The round lesion was most common clinical features of affected area (66.7%), followed by linear lesion (33.3%). Trichophyton rubrum was most common etiological agent (57.8%). The partial removal of the tonail combined with oral and topical antifungal agent was most common in treatment of onychomycosis with dermatophytoma. CONCLUSION: Because of the increase in onychomycosis with dermatophytoma, and its relative resistance to the conventional treatment of onychomycosis, we suggest the need of a careful mycological examination to diagnose the dermatohpytoma in patients with onychomycosis, and we also propose more aggressive treatment strategy is required to treat dermatophytoma.

Localized Skin Infection Caused by Fusarium oxysporum / 대한의진균학회지

Fusarium(F.) species are hyalohyphomycetes isolated from plants, soil and air. Fusarium species can cause disseminated infections with involvement of multiple organs and numerous skin lesions in immunocompromised patients. And they can also cause local skin infections of trauma site. We report a case of localized skin infection by F. oxysporum in a 63-year-old immunocompetent woman. She presented with multiple, mild pruritic, 1.5 x 1.5 cm-sized, erythematous maculopapules on the left cheek after cosmetic procedure 4 months ago. Histopathologically, suppurative granulomatous inflammation, fungal elements were observed in dermis. Fungal culture on Sabouraud's dextrose agar showed rapid growing, whitish, cottony colonies at 25degrees C for 1 week. Numerous fusoid macroconidia were observed in slide culture by light microscopy. The nucleotide sequences of the internal transcribed spacer (ITS) region of clinical sample identical to that of F. oxysporum CID 220 strain (GenBank accession number HQ829117.1). The patient had been treated with itraconazole for 6 months. The skin lesion was improved. There was no recurrence 6 months after treatment.

Anti-p200 Pemphigoid / 대한피부과학회지

Anti-p200 pemphigoid is an autoimmune subepidermal bullous disease characterized by circulating and tissue-bound autoantibodies directed against a 200 kD protein of the human dermis. We report a 78-year-old male who was presented with bullous eruptions on the trunk, extremities, which clinically resemble bullous pemphigoid, epidermolysis bullosa aquisita, linear IgA dermatosis or dermatitis herpetiformis. Oral muscosa of the lower lip was also affected. Histopathological examination of a skin biopsy specimen from the trunk revealed subepidermal blister and infiltration predominantly by neutrophils. Direct immunofluorescence revealed linear deposits of IgG, C3 and IgA at the basement membrane zone. Indirect immunofluorescence using salt-split skin showed that IgG antibodies bound on the dermal side. Immunoblotting with dermal extracts showed that the patient's IgG autoantibodies reacted with a 200 kD protein. The patient showed good response to dapsone.

Genetic Analysis of SCN5A in Korean Patients Associated with Atrioventricular Conduction Block

Recent several studies have shown that the genetic variation of SCN5A is related with atrioventricular conduction block (AVB); no study has yet been published in Koreans. Therefore, to determine the AVB-associated genetic variation in Korean patients, we investigated the genetic variation of SCN5A in Korean patients with AVB and compared with normal control subjects. We enrolled 113 patients with AVB and 80 normal controls with no cardiac symptoms. DNA was isolated from the peripheral blood, and all exons (exon 2-exon 28) except the untranslated region and exon-intron boundaries of the SCN5A gene were amplified by multiplex PCR and directly sequenced using an ABI PRISM 3100 Genetic Analyzer. When a variation was discovered in genomic DNA from AVB patients, we confirmed whether the same variation existed in the control genomic DNA. In the present study, a total of 7 genetic variations were detected in 113 AVB patients. Of the 7 variations, 5 (G87A-A29A, intervening sequence 9-3C>A, A1673G-H558R, G3578A-R1193Q, and T5457C-D1819D) have been reported in previous studies, and 2 (C48G-F16L and G3048A-T1016T) were novel variations that have not been reported. The 2 newly discovered variations were not found in the 80 normal controls. In addition, G298S, G514C, P1008S, G1406R, and D1595N, identified in other ethnic populations, were not detected in this study. We found 2 novel genetic variations in the SCN5A gene in Korean patients with AVB. However, further functional study might be needed.

Genetic Analysis of SCN5A in Korean Patients Associated with Atrioventricular Conduction Block

Recent several studies have shown that the genetic variation of SCN5A is related with atrioventricular conduction block (AVB); no study has yet been published in Koreans. Therefore, to determine the AVB-associated genetic variation in Korean patients, we investigated the genetic variation of SCN5A in Korean patients with AVB and compared with normal control subjects. We enrolled 113 patients with AVB and 80 normal controls with no cardiac symptoms. DNA was isolated from the peripheral blood, and all exons (exon 2-exon 28) except the untranslated region and exon-intron boundaries of the SCN5A gene were amplified by multiplex PCR and directly sequenced using an ABI PRISM 3100 Genetic Analyzer. When a variation was discovered in genomic DNA from AVB patients, we confirmed whether the same variation existed in the control genomic DNA. In the present study, a total of 7 genetic variations were detected in 113 AVB patients. Of the 7 variations, 5 (G87A-A29A, intervening sequence 9-3C>A, A1673G-H558R, G3578A-R1193Q, and T5457C-D1819D) have been reported in previous studies, and 2 (C48G-F16L and G3048A-T1016T) were novel variations that have not been reported. The 2 newly discovered variations were not found in the 80 normal controls. In addition, G298S, G514C, P1008S, G1406R, and D1595N, identified in other ethnic populations, were not detected in this study. We found 2 novel genetic variations in the SCN5A gene in Korean patients with AVB. However, further functional study might be needed.

Anti-p200 Pemphigoid / 대한피부과학회지

Anti-p200 pemphigoid is an autoimmune subepidermal bullous disease characterized by circulating and tissue-bound autoantibodies directed against a 200 kD protein of the human dermis. We report a 78-year-old male who was presented with bullous eruptions on the trunk, extremities, which clinically resemble bullous pemphigoid, epidermolysis bullosa aquisita, linear IgA dermatosis or dermatitis herpetiformis. Oral muscosa of the lower lip was also affected. Histopathological examination of a skin biopsy specimen from the trunk revealed subepidermal blister and infiltration predominantly by neutrophils. Direct immunofluorescence revealed linear deposits of IgG, C3 and IgA at the basement membrane zone. Indirect immunofluorescence using salt-split skin showed that IgG antibodies bound on the dermal side. Immunoblotting with dermal extracts showed that the patient's IgG autoantibodies reacted with a 200 kD protein. The patient showed good response to dapsone.

Analysis of Heavy Metals in the Hair of Children with Attention-Deficit Hyperactivity Disorder and Tourette's Syndrome

OBJECTIVES: The purpose of this study was to examine the association of exposures to heavy metals with positive diagnosis for attention-deficit hyperactivity disorder (ADHD) and Tourette's syndrome (TS). METHODS: Study participants included 27 children diagnosed with ADHD (9.9+/-2.9 years of age), 21 diagnosed with Tourette's disorder (10.7+/-2.2 years of age), and 45 normal control children (9.6+/-0.5 years of age). A Perkin-Elmer mass spectrometer was used to measure the concentrations of 5 heavy metals (Pb, Cd, U, Be, Hg) in hair samples obtained from each participant. Each heavy metal concentration was compared among the groups by use of a Kruskal-Wallis test. RESULTS: The levels of lead (p=.006) and cadmium (p=.037) observed in the hair of children diagnosed with ADHD were significantly higher than those found in the control subjects. There were no significant differences observed for heavy metal levels when comparing TS and control subjects. CONCLUSION: We confirmed that lead exposure is a risk factor for ADHD. We also identified that cadmium may be a new candidate risk factor for manifestation of ADHD. We did not find an association between heavy metals and manifestation of TS.

Kerion Celsi Caused by Trichophyton verrucosum Probably Transmitted from Cattle / 대한의진균학회지

Kerion celsi is a severe inflammatory type of tinea capitis that presents as an inflammatory, boggy mass with broken hairs and hair loss. It is usually occurred in children between the age of 4 and 14 years that caused by zoophilic or geophilic pathogens such as Microsporum(M.) canis, Trichophyton(T.) mentagrophytes, T. verrucosum, M. gypseum, T. verrucosum was chiefly found from cattle which infect the human through direct contact. We report a case of kerion celsi caused by T. verrucosum probably transmitted from cattle in a 3-year-old boy. The patient had a solitary, tender, 6.0 x 5.5 cm sized, erythematous boggy plaque and pustules with hair loss on the right side of occipital scalp for 2 weeks. Chains of chlamydoconidia were observed in KOH mount and slide culture by light microscopy. The nucleotide sequence of internal transcribed spacer (ITS) region for clinical isolate was identical to that of T. verrucosum strain IFM 57570. He was treated with 125 mg of terbinafine daily for 12 weeks and short term therapy of low dose of prednisolone. Skin lesion was cured without recurrence.