• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• v.14 no.1
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• pp.64-80
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• 2003

Although obsessive-compulsive disorder(OCD) affects children, adolescents, and adults whether its juvenile(dhild and adolescent) and adult forms are different subtype of a disorder remains unknown. But there are increasing findings that suggest that juvenile OCD may be unique subtype of the disorder. One proposed subtype is the childhood OCD associated with high comorbidity of tic disorder and increased familial loading for OCD or tic disorder. The other proposed subtype is the childhood OCD and/or tic disorder occuring in association with streptococcal infection(PANDAS). These two subtypes of OCD are unlikely to respond to SSRI due to possible different pathphysiological mechanism. So this paper reviews the characteristics of OCD and therapeutic approaches for treatment resistant OCD in childhood and adolescence. Considering the likely heterogeneity of OCD, the possibility that juvenild OCD may be a variant of the disorder can have important clinical and scientific implications because it may further our understanding of this disorder, its etiology, and perhaps its treatment.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• v.15 no.2
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• pp.143-151
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• 2004

Objectives : Child and adolescent onset obsessive compulsive disorder(C-OCD) is known to be associated with poor drug response, high comorbid rate and strong genetic tendencies. Till now studies for C-OCD have been very rare in Korea. We conducted this study to investigate the informations about clinical features, familial psychiatric loading, treatment profiles and course of server C-OCD from the retrospective analysis of inpatient data of Seoul National University Children's Hospital. Method : Retrospective chart review and data analysis was performed. Twenty(male 16 : female 4) patients with final C-OCD diagnosis by DSM-IV at discharge from 1994 to 2002 were found and their medical chart, psychological data, family interview data and nursing reports were collected and analyzed. Results : 1) The sex ratio of C-OCD was male dominant(4:1). 2) Phenomenological, most common obsession was pathologic doubt, contamination fear, followed by aggressive obsession, need for symmetry, sexual obsession, most common compulsion was checking and washing, followed by breathing, movement, symmetry, repetitive asking, hoarding, mental compulsion. 3) Most common comorbid diagnosis was depression. Other axis-I diagnosis associated OCD were anxiety disorder, tic disorder, conduct and oppositional defiant disorder and psychosis. 4) Regarding psychiatric familial loadings, 17 patients(85%) had relatives with psychiatric disorders, OC-spectrum disorders(OCD or OCPD) were found in 9 patients(45%). 5) The majority of patients(75%) have received SSRI and antipsychotics treatment. The response rate above 'moderate improved" by CGI was 75%. 6) During follow-up period in outpatient clinic, five patients(25%) showed continuous complete remission, 10 patients (50%) did residual symptoms with chronic course. Conclusion : This seems to be the first systemic investigation of severe pediatric OCD patients in Korea. The children & adolescents with severe OCD in inpatient-setting showed the high comorbid rate, familial psychiatric loading, and combined pharmacotherapy with antipsychotics, As for symptoms, high rate of aggressive-sexual obsession and atypical compulsions like breathing and moving was reported in this study. Severe pediatric OCD patients, however, responded well to the combined SSRI and antipsychotics regimen.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• v.4 no.1
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• pp.164-172
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• 1993

By observing the psychotherapy process expressed by an adolescent with obssessive compulsive disorder, the author suggests that the main problem of OCD is not merely a product of an unconscious process as traditionally thought, but a learned problem solving process as a method surviving the more realistic conflicts, and therefore the treatment should be directed to more or less conscious and realistic issues and conflicts, family therapy should be offered too.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• v.16 no.2
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• pp.183-191
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• 2005

Tic disorder including Tourette's disorder is a neurodevelopmental disorder that appears in childhood and characterized by the presence of motor and vocal tics. Childhood-onset obsessive-compulsive disorder (OCD) is suggested to be a phenomenologically and etiologically distinct subtype of OCD, bearing a close genetic relationship to tic-disorders. Tourette's disorder and OCD are comorbid in $40-75\%$ of patients initially diagnosed with either disorder. Basal ganglia and cortico-striato-thalamic circuits are implicated in the pathophysiology of both disorders and these disorders have similar clinical features. Over the past decades, the progress in research on Tourette's disorder and OCD has been extraordinary. This review describes some of important insights from these work, involving these areas : 1) clinical implication 2) genetics and epidemiology 3) brain imaging study 4) neuroche-mistry 5) pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection (PANDAS).

• Korean Journal of Psychosomatic Medicine
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• v.31 no.2
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• pp.142-148
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• 2023

Objectives : The purpose of this study is to investigate the relationships between premonitory urge, tic severity, and comorbidities in children and adolescents with chronic tic disorders. Methods : In this study, scales for tic symptoms, premonitory urge, obsessive-compulsive symptoms, and ADHD symptoms were repeatedly measured twice in 26 children and adolescents aged 10 to 18 years with chronic tic disorders. Correlations between scales were confirmed through repeated measures correlation analysis, and causal relationships between scales were confirmed through regression analysis using a linear mixed model. Results : The degree of premonitory urges showed a significant positive correlation with the severity of tic symptoms, the severity of obsessive-compulsive symptoms, and the severity of ADHD symptoms. The ADHD symptoms showed a significant positive correlation with the severity of tic symptoms. These results were the same even in children and adolescents with tic disorders who were not diagnosed with obsessive-compulsive disorder. Additionally, premonitory urges were found to have a significant positive effect on the severity of tic symptoms. Conclusions : These results may be helpful in treating tic disorders and can be used in future tic disorder research considering developmental trajectory.

• Proceedings of the KAIS Fall Conference
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• 2011.05b
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• pp.773-776
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• 2011

본 연구에서는 남녀 중고등학생을 대상으로 그들의 휴대전화 문자메시지 사용 실태 및 몰입 정도가 자신의 심리와 어떠한 관계가 있는지를 분석하는데 그 목적을 두고 있다. 분석결과, 문자 메시지를 사용하는 빈도가 높을수록 부적응/일탈 정도가 높아지는 것으로 나타났으며, 메시지 사용수준이 중간인 집단과 높은 집단은 낮은 집단에 비해 강박/집착 정도가 높은 것으로 나타났고,. 메시지 사용수준이 중간인 집단과 높은 집단이 낮은 집단에 비해 금단 정도가 높은 것으로 나타났다. 즉 문자 메시지를 많이 사용하는 청소년은 적게 사용하는 청소년에 비해 부적응/일탈정도가 높고, 강박/집착정도도 높고, 또한 금단정도가 높아 문자 메시지가 청소년의 정신 병리적 장애를 초래하는 것으로 나타났다. 또한 문자 메시지를 사용하는 빈도가 높은 집단이 낮은 집단이나 중간인 집단에 비해 혼미성이 매우 높게 나타났다. 이는 문자 메시지를 많이 사용하는 청소년은 적게 사용하는 청소년에 비해 혼미성이 높다는 것을 시사한다. 마지막으로 몰입정도의 세 가지 구성개념인 부적응/일탈, 강박/집착, 금단요인이 자기 통제 능력의 구성개념인 착각성 및 혼미성과의 상관이 유의하게 나타났다. 이는 휴대전화 문자메시지과다사용으로 청소년들이 건강한 성장을 하는데 악영향을 미치고 있음을 알 수 있다.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• v.16 no.1
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• pp.124-131
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• 2005

Childhood and adolescent onset-bipolar disorders have higher rate of comorbidity with anxiety disorders as well as attention deficit hyperactivity disorder and conduct disorder. Obsessive compulsive disorder, social phobia, panic disorder, and separational anxiety disorder are common comorbid anxiety disorders with bipolar disorders in child and adolescent. Prospective and reliable data on temporal and causal relationship between the onset of bipolar disorders and the onset of comorbid anxiety disorders are still in debate. The authors report 2 adolescent cases with antidepressant induced-manic episodes with preceding anxiety symptoms. The authors suggest careful prescription of antidepressants for anxiety disorders, even for those who do not have definite past history or family history of bipolar disorders. Further comprehensive and prospective studies are requested for the temporal relationship and pharmacological guideline for comorbid bipolar disorders and anxiety disorder in child and adolescent.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• v.12 no.1
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• pp.149-156
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• 2001

After the fact that obsessive-compulsive symptoms or tic symptoms are common in Sydenham's chorea which is a sequale of rheumatic fever produced by group A beta-hemolytic streptococcus was reported, the association between group A beta-hemolytic streptococcus and a subgroup of obsessivecompulsive disorder(OCD) or tic disorder has been attentioned. This subgroup shared a unique clinical course, characterized by an abrupt onset of symptoms and/or dramatic exacerbations. And this subgroup was distinguished by pre-pubertal onset of symptoms, neurological abnormalities(choreiform movements and a unique pattern of motoric hyperactivity), as well as by relapsing and remitting symptom course. Acronym PANDAS(pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection) was used to denote a subgroup of OCD or tic disorder patients with these clinical characteristics. Then, there was a report suggesting that PANDAS category include some of attention-deficit/hyperactivity disorder(ADHD) and were two case reports of anorexia nervosa and body dysmorphic disorder with characteristics of PANDAS. This case is a patient who developed normally until age of 7, but after pharyngeal inflammation with high fever, he showed disturbance of cognition, social relationship, and language and communication, as well as tic symtoms and abnormal movement on face, hand, and foot. We report this case with review of literatures, because we think that this case belongs to the PANDAS category. Based on this observation, we suggest that PANDAS category include some of childhood disintegrative disorder as well as OCD, tic disorder, and ADHD.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• v.11 no.1
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• pp.60-69
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• 2000

Objective：This study was carried out to evaluate the reliability and validity of the Korean form of the Children's Yale-Brown Obsessive Compulsive Scale(CY-BOCS). Method：Forty-two children with obsessive-compulsive disorder(OCD)(31 boys and 11 girls, aged 7 to 18 years) were assessed with CY-BOCS. Interrater agreement was assessed by two raters in subsample(n=20). discriminant and convergent validity were assessed by comparing CY-BOCS scores to Clinical Global Impression-OCD(CGI-OCD), Leyton Obsessional Inventory-Child Version (LOI-CV), State-Trait Anxiety Inventory for Children(STAI-C), and Child Depression Inventory(CDI). Results：Internal consistency was high, measuring 0.86 for the 10 items and total score. The intraclass correlations for the CY-BOCS total, obsession, and compulsion scores were 0.94, 0.94, 0.84, suggesting excellent interrater agreement for subscale and total scores. The CY-BOCS total score showed highest correlation with CGI-OCD(r=0.88), and significant correlation with LOI-CV(r=0.51), Trait Anxiety score(r=0.43), and CDI scores(r=0.49), but it was not correlated with State-Anxiety score(r=0.25). Conclusion：The results of this study indicate that the Korean form of CY-BOCS is a reliable and valid scale for rating obsessive-compulsive symptom severity.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• v.9 no.2
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• pp.209-217
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• 1998

Object：The purpose of this study was to investigate that infection with group $A[{\beta}]$ hemolytic streptococcus may associate the mechanisms that cause or exacerbate the tic symptoms in some cases of Tourette's disorder Method：Fourteen cases with abrupt worsening of tics participated in this study：10 males,4 females. The subjects were divided into two groups composing of the group with increasing level of ASO titer and the group with normal level of ASO titer. The subjects were administered Yale Global Tic Severity Scale(YGTSS). Result：The global severity scores and overall TS impairment rating scores of YGTSS in the group with increasing level of ASO titer were more higher than in the group with normal level of ASO titer Conclusion：These results suggest that increasing level of ASO titer, resulting from group $A[{\beta}]$ hemolytic streptococcal infection has affected worsening the tic symptoms in Touette's disorder.