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.

Assessment of psychopathological consequences in children at 3 years after tsunami disaster.

BACKGROUND: At 1 year after the Tsunami disaster, 30% of students in two high risk schools at Takuapa district of Phang Nga Province still suffered from post traumatic stress disorder (PTSD). The number ofpatients was sharply declined after 18 months. The psychological consequences in children who diagnosed PTSD after the event were reinvestigated again at 3 years, as there were reports of significant comorbidity and continuing of subsyndromal post traumatic stress symptoms in children suffered from other disasters. OBJECTIVE: To assess psychological outcomes and factors contributed at 3-year follow up time in children diagnosed PTSD at 1-year after the Tsunami disaster MATERIAL AND METHOD: There were 45 students who were diagnosed PTSD at 1-year after the disaster At 3-year follow up time, clinical interview for psychiatric diagnosis was done by psychiatrists. RESULTS: 11.1% of students who had been diagnosed as PTSD at 1-year after Tsunami still had chronic PTSD and 15% had either depressive disorder or anxiety disorder 25% of students completely recovered from mental disorders. Nearly 50% ofstudents were categorized in partial remission or subsyndromal PTSD group. Factors which influenced long-term outcomes were prior history of trauma and severe physical injury from the disaster. CONCLUSION: Although the point prevalence of PTSD in children affected by Tsunami was declined overtime, a significant number of students still suffer from post traumatic stress symptoms, depressive disorder or anxiety disorder which need psychological intervention.

Behavioral problems of epileptic children at Queen Sirikit National Institute of Child Health.

BACKGROUND: Neurological diseases and psychiatric problems were cloudily related. Many patients with epilepsy had associated problems such as Learning disorders (LD) or Attention deficit hyperactivity disorder (ADHD). Evaluation and treatments of these behavioral and learning problems should be, therefore, included in management of patients with epilepsy in order to improve their quality of life. OBJECTIVE: To study behavioral, learning problems that indicate ADHD in epileptic children. MATERIAL AND METHOD: These was cross sectional study in 100 epileptic children, age 6- 11-years-old who visited Neurological Clinic at Queen Sirikit National Institute of Child Health. The patients were assessed with Thai Youth Checklist (TYC), IOWA screening test for ADHD and questionnaires concerning learning area. The data was analyzed in Chi-square, using SPSS program. RESULTS: The prevalence of behavioral problems in epileptic children was 57 percent. The prevalence of moderate to severe ones which should be treated and related to complex partial seizure was 32 percent. The prevalence of learning problems was 23 percent. Most were found in higher classes. The prevalence of behaviors that indicate ADHD was 23 percent from TYC and 58 percent from IOWA screening test for ADHD. There was relationship of behaviors that indicate ADHD and the severity of epilepsy. The prevalence of delinquent behavior was 24 percent and social problems were 32 percent respectively. Correlation of behavioral problems and social skills (p = 0.027), good manner toward parents (p = 0.015) and helping house chores (p = 0.016) were significantly different. However there was no significantly different between behavioral problems and age of onset as well as duration of epileptic symptom, frequency of seizures in the past 6 months, EEG results and combination of medication. CONCLUSION: The epileptic children had high risks of behavioral and learning problems; they may be prevented by intensive evaluation, proper interventions, adequate counseling, proper medication, parental training and proper rehabilitation.

Post traumatic stress disorder in children after tsunami disaster in Thailand: 2 years follow-up.

BACKGROUND: On December 26, 2004, the tsunami destroyed many families, communities, and residential areas. Adverse psychological impact on children and adolescents due to a natural disaster of this magnitude has never been reported in Thailand's history particularly as Post-Traumatic Stress Disorder (PTSD). OBJECTIVE: Investigate clinical symptoms and develop a 2-year monitoring and intervention program for PTSD in children affected by the December 26, 2004 tsunami natural disaster The study period started six weeks after the event and was completed after two years. MATERIAL AND METHOD: One thousand six hundred and twenty five surviving students from two schools in Takuapa district, Phang-nga Province, were enrolled. Screening tests using Pediatric symptom checklists, Childhood depressive intervention (CDI), and Revised child impact of events scales (CRIES) were done. Psychiatric evaluations were done by child and adolescent psychiatrists. Post Traumatic Stress Disorder (PTSD) was diagnosed using criteria from Diagnostic and Statistical Manual of Mental Disorders, 4th edition. RESULTS: The prevalence of PSTD in the affected students were 57.3, 46.1, 31.6, 10.4, and 7.6% at 6 weeks, 6 months, 1 year, 1 1/2 years, and 2 years, respectively. The female: male ratio was 1.7:1. The peak age was 9-10 years old. Threatened situations were studied. Of the 176 students who risked their lives in the waves, 48 (27.3%) suffered from PTSD. Meanwhile, of the 1314 students who were not hit by the waves but were among affected friends and relatives, 42 students (3.1%) suffered from PTSD. The prevalence of PTSD in those hit by the waves were significantly higher than those who were not [p-value < 0.01, RR = 5.16 (4.04-.6.6)]. CONCLUSION: The prevalence of PSTD in children who suffered from the tsunami disaster was as high as 57.3% at six weeks after the incident. It declined sharply at two years (7.6%) with the help of integrated welfare. The children continue to get financial, rehabilitation, and mental health support to prevent long-term adverse outcomes.

Trend study of autistic spectrum disorders at Queen Sirikit National Institute of Child Health.

BACKGROUND: Increases in the incidence and prevalence of autistic spectrum disorders have been reported recently in the United States and Europe, but there are only a few reports on the trend of this problem in Thailand. OBJECTIVES: To study trend in autistic spectrum disorder patients and to find the factors that correlate with the incidence of this disorder at Queen Sirikit National Institute of Child Health. MATERIAL AND METHOD: A hospital-based prospective trend study was conducted in patients aged less than 12 years old, who attended the Child and Adolescent Department, Queen Sirikit National Institute of Child Health, Bangkok, form January 1998 to December 2002. Autistic spectrum disorders were defined as autistic disorder pervasive developmental disorder-not otherwise specified (PDD-NOS), and Asperger's disorder Related factors were recorded and analyzed Aged-adjusted incidence rate in both sexes and proportion rates of related factors were calculated by using the direct method Standard t-test and correlation coefficient were performed to test for statistically significant difference in the prevalence rate in each group. RESULTS: There were 610 new patients aged less than 12 years who displayed behavior consistent with autistic spectrum disorders. The increasing trend in the incidence of autistic spectrum disorder is observed (r = 0. 935, p = 0. 02). The incidence rate of autistic spectrum disorders among out patients less than 12 years has increased from 1.43 per 10, 000 in 1998 to 6.94 per 10, 000 in 2002. The correlation factors "an only one child in the family" is observed (r = 0.9, p = 0.038). CONCLUSION: During the 5 years of the study, a significant increase in the incidence of autistic spectrum disorders was observed at Queen Sirikit National Institute of Child Health. Increase in the incidence of ASD in this center cannot explain by any solid evidence from the present study.

Enuresis in children 5-15 years at Queen Sirikit National Institute of Child Health.

A cross-sectional descriptive study was conducted to compare 179 enuretic and 811 non-enuretic patients at Queen Sirikit National Institute of Child Health from July 1998 through December 1998. The objective was to study the epidemiology, risk factors, behavioral and learning problems associated with enuresis in children 5-15 years old. Chi-squared analysis was used. The prevalence of primary, secondary and total enuresis was 15.4, 2.7 and 18.1 per cent respectively in 5-15 year old children. Of these, 88.5 per cent had nocturnal enuresis, 0.6 per cent had diurnal enuresis, 10.6 per cent had diurnal and nocturnal enuresis. Risk factors which significantly correlated with enuresis were the history of bed-wetting in the parents/sibling and inconsistent toilet training. We found that enuresis was not related to sex, birth order, LBW, socioeconomic, marital and parental educational status. Fifty-eight per cent of the parents thought that the enuretic problem needed further treatment.