Factors Affecting Adherence to Pharmacotherapy in Children with Attention-Deficit Hyperactivity Disorder:A Retrospective Study

OBJECTIVES: To identify the factors affecting long-term adherence to methylphenidate treatment in children with attention-deficit hyperactivity disorder (ADHD). METHODS: A retrospective medical record review of 239 ADHD patients (mean age 9.3+/-2.6 years, range 6.0-17.4 years) who had visited the child and adolescent psychiatry clinic at a university hospital, in Seoul, Korea from March 2005 to February 2008. Subjects were diagnosed as ADHD based on the criteria set forth in the Diagnostic and Statistical Manual of Mental Disorders 4th edition, text revision version (DSM-IV-TR) and underwent neuropsychological tests including the continuous performance test (CPT). Treatment discontinuation was defined as the last prescription date when the medication possession rate (MPR) became less than 0.80. Subjects were divided into three groups and labeled as Group I, non-adherence without pharmacotherapy, Group II, non-adherence with short-term pharmacotherapy, and Group III, adherence with long-term pharmacotherapy. RESULTS: Ninety (37.7%) patients were grouped as non-adherent (Groups I+II) and 149 (62.3%) as adherent (Group III). The adherence group exhibited lower intelligence, higher symptom severity, and a higher number of comorbid psychiatric disorders than controls. The use of stimulants was significantly associated with long-term adherence to treatment. Additionally, the duration of interval between the date of the first visit and the date of the first prescription was positively associated with long-term adherence. CONCLUSION: About two-thirds of patients diagnosed as ADHD adhered to the treatment six months after the first visit. With respect to patient evaluation and the development of treatment strategies, factors affecting early drop-out and longer follow-up must be considered.

Reliability and Validity of the Korean Version of Severe Mini-Mental Status Examination (SMMSE-K) / 신경정신의학

OBJECTIVES: We developed the Korean version of Severe Mini-Mental Status Examination (SMMSE-K) which is a brief cognitive test for the severely demented patients. METHODS: The translation was carried out keeping the basic structure of the English version Severe Mini-Mental Status Examination (SMMSE). The SMMSE-K, Korean version of Mini Mental State Examination (MMSE-KC), and Clinical Dementia Rating (CDR) were administered to 84 Alzheimer's disease (AD) patients and 36 cognitively normal elderly subjects. For evaluating the reliability of the SMMSE-K, Cronbach alpha coefficient, inter-rater reliability, and test-retest reliability were examined. For confirming the validity of the SMMSE-K, the correlations of the SMMSE-K with MMSE-KC and CDR were examined, and factor analysis was performed using principal component analysis with Varimax rotation. RESULTS: SMMSE-K was found to have a high internal consistency (Cronbach alpha coefficient=0.906, p<0.01), inter-rater reliability (Pearson correlation coefficient=0.980, p<0.01) and test-retest reliability (Pearson correlation coefficient=0.940, p<0.01). Performances on the SMMSE-K and MMSE-KC were found to correlate significantly in the subjects with CDR of 2 (Pearson correlation coefficient=0.827, p<0.001) and 3 (Pearson correlation coefficient=0.929, p<0.001). In the subjects with CDR of 3, the MMSE-KC showed a floor effect (2.93+/-3.21), whereas the SMMSE-K did not (11.00+/-8.48). Exploratory factor analysis yielded two factors (automatic informational processing, controlled informational processing) accounting for 76.1% of the total variance. CONCLUSION: The SMMSE-K was found to be a reliable and valid test for assessing the cognition of severely demented patients.

Intensive Psychotherapy Training in Korean Psychiatric Residency Programs

OBJECTIVE: The authors investigated the current practice of intensive psychotherapy by residents in the department of psychiatry. METHODS: We mailed a questionnaire to 126 fourth-year psychiatry residents in order to obtain data on their clients' sociodemographic characteristics, the settings in which psychotherapy is being conducted, the effects of psychotherapy, the difficulties associated with psychotherapy, the state of supervision and the level of clients' satisfaction. RESULTS: Approximately 51.5% of the residents completed the questionnaires. The average number of clients was 4.9+/-3.8, the average number of psychotherapy sessions was 26.2+/-20.1, and 69.4% of the residents had performed insight-oriented psychotherapy. Approximately 69.8% of the fourth-year residents had received some form of supervision, and 58.7% agreed to increase the frequency of supervision. Approximately 74.2% of the cases were supervised. The average number of supervisions per case was 9.2+/-10.5. CONCLUSION: The setting in which psychotherapy is conducted, number of clients, and type of supervision varied greatly among the training institutes surveyed. Based on these findings, we expect to create better psychotherapy training programs for psychiatric residents.

A Case of Septo-Optic Dysplasia

The association of abnormalities of the optic nerves, optic chiasm, and optic tracts with anomalies of the midline structures in the brain-an absent septum pellucidum etc was reported and called "septo-optic dysplasia". Also, it was noted that septo-optic dysplasia could be associated with hypopituitary dwarfism. It occurs more commonly in first born children and children born to young or diabetic mothers. We report a case of septo-optic dysplasia with literature, who had complained of severe visual impairment associated with nystagmus, bilateral optic nerve hypoplasia, absent septum pellucidum, and normal range of hormone studies.

Biopsy Findings of Conjunotival Goblet Cell Densities Around The Pterygium

The goblet cell population of the conjunctiva reflects the degree of the differentiation or maturation of the conjunctival epithelium, which in turn reflects the overall health of the ocular surface. The authors observed the conjunctival goblet cell counts in the 25 eyes with pterygium stained with Periodic acid-Schiff(PAS) and Hematoxylin-Eosinophil(H-E) stain for the evaluation of the conjunctival health state in the presence of pterygium, and compared conjunctival goblet celli counts in the eyes with pterygium with that in the normal 20 eyes. The distribution of conjunctival goblet cells was evaluated in observing the bulbar conjunctival cell counts at 12, 3, 6, 9 o'clock site in enucleated eyes due to phthisis bulbi. There was significant decrease(P<0.01) in the conjunctival goblet cell counts in the eye with pterygium, and was many difference in the individual cases. Mean goblet cell counts in the normal subjects was 6.6/mm. The number of goblet cells was highest in the nasal side, followed by inferior, superior, and temporal side.