• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• 제17권1호
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• pp.27-31
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• 2006

연구목적 : Streptococcus 감염에 취약한 생물학적 지표라고 알려진 D8/17 항체가 PANDAS로 의심되는 뚜렛장애 환자에서 높은지를 알아보고, 뚜렛장애군 중 D8/17 양성반응 여부에 따라 임상경과에 차이가 있는지를 알아보고자 본 연구를 시행하였다. 방 법 : PANDAS가 의심되는 뚜렛장애 소아환자 9명과 비교 대상으로 틱증상이 없이 일관되게 지속적으로 주의력결핍 과잉 행동장애를 보이는 2명의 소아를 택하여 B 임파구 D8/17 항원 양성반응 비율과 혈청 ASO 농도를 비교분석하였다. 결 과 : PANDAS가 의심되는 9명의 뚜렛장애 소아의 경우 평균 77.9%($50.9{\sim}100%$) D8/17 B임파구 양성 비율을 보여 비교대상인 2명의 ADHD(24.8%, 53.7%) 보다 의미 있게 높았다. 뚜렛장애 중 90% 이상의 높은 양성비율을 보이는 경우가 4예 (44..4%)였다. 특히 모녀 뚜렛장애인 경우 각각 98.4%, 99.0%라는 높은 수치를 보였다. 뚜렛장애의 심한 정도와 D8/17 양성 임파구 비율간에 의미있는 상관관계는 없었다. ASO titer와D8/17양성 임파구 비율간에 통계적으로 의미 있는 상관관계는 없었지만 뚜렛장애 66.7%에서 100IU/ml 이상을 보였다. 결 론 : 상기결과를 종합하여 볼 때 일부 뚜렛장애 환자의 경우 streptocooccus 감염과 연관된 PANDAS일 가능성이 충분히 있다고 판단되었다.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• 제8권1호
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• pp.92-100
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• 1997

뚜렛장애는 운동틱과 음성틱이 복합적으로 나타나는 만성적인 질환으로써 임상적인 특성, 동반된 행동상의 문제들에 대해 전세계적으로 많은 연구가 이루어지고 있다. 이 연구의 목적은 한국의 뚜렛장애 환자의 임상적인 특성과 동반된 행동상의 특징을 비교적 다수 환자집단을 대상으로 연구한 것이다. 연구대상은 157명의 뚜렛장애 환자로서 1988년부터 1994년까지 연세대학교 정신과 뚜렛클리닉을 방문한 환자들이었다. 진단을 위해 DSM-III-R의 진단기준을 사용하였다. 인구학적 자료, 증상, 경과 등 임상적인 특성, 가족력 및 과잉행동, 강박성, 충동성, 야뇨증, 자기파괴행동, 수면장애 등 동반된 행동상의 특징은 본 연구를 위해 고안된 반구조화된 설문지와 전반적 임상적 인상(global clinical impression)을 이용해 평가하였다. 연구결과는 다음과 같다. 환자들의 평균연령은 14.49(${\pm}7.99$)세였다. 남자가 138명(87.9%), 여자는 19명(12.1%)으로 남녀의 성비가 약 7：1의 비율로 남자가 많았다. 133명(84.7%)은 오른손잡이였고 24명(15.3%)은 양손잡이거나 왼손잡이였다. 평균발병연령은 8.85(${\pm}4.56$)세였고 발병연령의 범위는 2세에서 16세였다. 반수 이상의 환자가 6세에서 10세 사이에 발병하는 양상을 보였다. 발명연령에 있어 두번의 높은 발병빈도가 관찰되었는데 처음에는 6세경에 높은 양상을 보였고 이후 10세 무렵에 다시 한번 높은 발병빈도가 관찰되었다. 이러한 경향은 남녀간에 공통적이었다. 처음 증상중 가장 흔한 것은 눈깜박임으로 55% 이상의 환자에서 나타났다. 다음으로는 고개 돌리기, 음성틱 등이었다. 환자들이 발병후 내원할 때까지 보였던 모든 틱증상의 빈도를 보면 전체 환자중 129명(82.2%)에서 눈깜박임이 있었고 91명(57.9%)이 고개짓, 83명(52.7%)이 어깨 움추리기 혹은 돌리기, 51명(32.6%)이 팔흔들기가 있었다. 101명(64.3%)은 증상이 신체의 상부에서 하부로 향했고 25명(15.9%)은 신체의 하부에서 상부로 증상이 진행하는 양상을 보였다. 나머지는 음성틱과 고개돌리기가 비슷한 시기에 나타나는 등 증상의 진행방향에서 상향성 혹은 하향성을 정하기 어려운 환자들이었다. 환자의 아버지중 19명(12%)이 강박장애의 병력이 있었고 17명(10.6%)은 틱장애의 병력이 있었다. 반면, 환자의 어머니중 7명(4.5%)이 강박장애의 병력이 있었고 4명(2.5%)은 틱장애의 병력이 있었다. 환자중 118명(75.1%)에서 과잉행동이 동반되었고 95명(60.5%)에서 강박증상이 동반되었고 55명(35.0%)에서 자기파괴적인 행동이 있었으며 46명(29.3%)에서 충동성이 동반되었고 35명(22.3%)에서 유뇨증이 관찰되었다. 환자의 발병연령과 내원시 연령, 병의 이병 기간, 강박증상의 정도 사이에 통계적으로 유의한 양성의 상관관계가 있었고 과잉행동성과 음성의 상관관계가 있었다. 과잉행동성과 충동성, 강박성, 야뇨증, 자기파괴적 행동사이에 통계적으로 유의한 양성의 상관관계가 있었다. 환자의 강박증상의 정도와 과잉행동성, 수면장애, 자기파괴적 행동 사이에 통계적으로 유의한 양성의 상관관계가 있었다. 본 연구 결과 저자들은 외래에 내원한 뚜렛장애 환자의 임상적 특성이나 동반된 행동상 문제들이 이전 연구와 크게 상이하지 않음을 확인할 수 있었으며 발병연령이 어릴수록 과잉행동성이 심했으며 발병연령이 늦을수록 강박성이 심했다. 과잉행동성과 충동성, 강박성, 야뇨증, 자기파괴적 행동 등은 상호 높은 관련성이 있었다.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• 제21권3호
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• pp.133-140
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• 2010

Tic disorders, including Tourette syndrome, are known as neurobiologic disorders and as such, much emphasis has been placed on isolating genetic determinants. Although previous reports involving studies of discordance among monozygotic twins have shown the importance of genetic predisposition, they have also supported a role for environmental factors in the development of tic disorders. Therefore, it is important to consider that both genetic and environmental factors contribute to their clinical expression. The goal of this article was to review recent reports regarding the role of environmental factors in development and progression of tics. Specific environmental factors associated either with a more severe course of illness or improved outcomes were discussed. Given that accumulating evidence had suggested the usefulness of behavior therapies in the suppression of tic disorders, particular emphasis was placed on the impact of several contextual factors.

• 턱관절균형의학회지
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• 제10권1호
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• pp.12-20
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• 2020

Objectives: Tourette syndrome (TS) is a disease that occurs evenly in many social classes. Despite the long experience of drug treatment, the preference is low due to various side effects. The aim of this study was to discover herbal medicine resources through network pharmacology analysis predicted to be useful for Tourette syndrome. Methods: We used Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform (TCMSP) to identify herbal medicines that can be used for TS by using network pharmacology research methods and to predict the mechanism of action. After evaluating compounds of each identified herb, molecular target proteins and mechanisms of action were analyzed, focusing on compounds that are likely to exhibit clinical activity in consideration of the pharmacokinetic parameters of these individual compounds. Results: Fifty nine ingredients such as atropine, veraguensin, and nuciferin among the compounds contained in 48 types of medicinal herbs such as Daturae Flos (洋金花), Salviae Radix (丹参), and Nelumbinis Plumula (蓮子心) act on the D(2) dopamine receptor, which is a protein involved in the development of TS. It has been found that atropine, veraguensin, and nuciferin are highly likely to exhibit activity by acting on the G protein-coupled receptor signaling pathway. Conclusions: It can be used in conjunction with non-invasive treatment means such as FCST Yinyang Balancing Appliance with herbal therapy to bring about a significant therapeutic effect, and it will be possible to develop a treatment that can replace drug therapy used in Western medicine.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• 제31권3호
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• pp.146-153
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• 2020

Objectives: This study aimed to evaluate the reliability and validity of the Korean Form of the Premonitory Urge for Tics Scale (K-PUTS). Methods: Thirty-eight patients with Tourette's disorder who visited Jeonbuk National University Hospital were assessed with the K-PUTS. Together with the PUTS, the Yale Global Tic Severity Scale (YGTSS), the Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS), the attention-deficit/hyperactivity disorder (ADHD) rating scale (ARS), and the Adult ADHD Self-Report Scale (ASRS) were implemented to evaluate concurrent and discriminant validity. Results: The internal consistency of items on the PUTS was high, with a Cronbach's α of 0.79. The test-retest reliability of the PUTS, which was administered at 2 weeks to 2 months intervals, showed high reliability with a Pearson correlation coefficient of 0.60. There was a significant positive correlation between the overall PUTS score and the YGTSS score, showing concurrent validity. There was no correlation between the PUTS, CY-BOCS, and ASRS scores, demonstrating the discriminant validity of the PUTS. Factor analysis for construct validity revealed three factors: "presumed functional relationship between the tic and the urge to tic," "the quality of the premonitory urge," and "just right phenomena." Conclusion: The results of this study indicate that the K-PUTS is a reliable and valid scale for rating premonitory urge of tics.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• 제4권1호
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• pp.124-132
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• 1993

45명의 틱 증상을 보인 아동들의 임상적 양상을 검토하였고 형제순위별로 나눠 비교하였다. 성비는 14:1로 남자가 압도적으로 많았고 형제순위로는 맏이가 46.7%, 막내가 33.3%. 외동아 15.6%, 쌍생아 4.4%로 맏이가 많았다. 기질성 시사소견은 37.8%에서, 초기발달 이상은 71.1%, 가족관계의 이상이 89.9%에서 보였고 동반 증상들로는 주의력결핍 과잉운동장애 46.7%, 강박장애 17.7%, 격려불안은 24.4%, 범불안, 수면불안은 17.8%, 신체화 증상 및 아뇨가 각각 13.3%, 말더듬 8.9% 외에 분뇨, 우울증 등을 보여 총 84.4%에서 최소한 하나 이상의 동반된 문제를 가졌다. 형제별로 나눠 특징을 비교했을 때 발병 시기에서 현저한 차이를 보였는데 막내 유형은 입학과 연관된 시기에 발병율이 의미있게 높았다.(p<0.01) 쌍생아의 경우는 저 출생체중아가 환아였다. 이들 소견을 종합해볼 때 틱 및 뚜렛 장애의 발현에는 선천적 기질적 요인뿐 아니라 상당한 환경적인 요인이 작용한다고 보겠다.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• 제32권2호
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• pp.51-62
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• 2021

Objectives: Tic disorder is a neurodevelopmental disorder characterized by multiple involuntary movements of muscles or vocalization. Although tic symptoms subside as the patient ages, some patients suffer from significant functional impairments related to severe tic symptoms. This manuscript aimed to review the latest scientific evidences for the effect of cognitive-behavioral interventions on tic disorder. Methods: The relevant studies were identified by searching medical research databases. We focused our search on studies published between 2000 and 2020 in order to reflect the latest scientific evidence. A total of 821 articles were identified in the initial database search and 27 articles were finally included for the review after the exclusion of duplicated and irrelevant articles. Results: Behavioral therapies including habit reversal training, Comprehensive Behavioral Intervention for Tics, and exposure and response prevention were the most widely studied interventions for tic disorder and are recommended as first-line treatments for tic disorders with high confidence. Cognitive psychophysiologic approaches were also reported to be effective. Conclusion: Further studies are needed to support the future treatment of tics with low-cost and more widely available treatments, in order to ensure better treatment outcomes.

• 대한한방소아과학회지
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• 제28권3호
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• pp.85-101
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• 2014

Objectives The purpose of this study is to report test results in eight tic disorder children using Sensitiv $Imago^{TM}$. Methods Eight tic disorder children were tested using Sensitiv $Imago^{TM}$. Also, they were diagnosed with tic disorders by DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, $4^{th}$ edition) and we evaluated tic disorder cases by Yale Global Tic Severity Scale (YGTSS). Results In 8 cases, 1 case was transient tic disorder, 3 cases were Tourette's disorder and 4 cases were unspecified tic disorder. In the result of Sensitiv $Imago^{TM}$, 4 cases showed the lowest score at filter ${\sharp}5^*$ and 4 cases showed the lowest score at filter ${\sharp}6^*$ in [Express Monitoring] of [Review of System Disorders of Homeostasis]. Filter #5 includes urogenital organs, liver, gallbladder, kidneys, urinary bladder and ureter and Filter #6 stands for organs of immune and respiratory systems. Conclusion We report test results in eight tic disorder children using Sensitiv $Imago^{TM}$. Further studies about the principle, repeatability, reproducibility of Sensitiv $Imago^{TM}$ are needed.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• 제34권1호
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• pp.37-44
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• 2023

Objectives: Tic disorders are highly heritable; however, growing evidence suggests that environmental factors play a significant role in their pathogenesis. Studies on these factors have been inconsistent, with conflicting results. Therefore, this study aimed to examine the associations of pre- and perinatal exposure to Tourette syndrome (TS) or chronic tic disorders (CTD) in Korean school-aged children. Methods: This case-control study used data from a large prospective cohort study. The primary outcome was TS/CTD diagnosis according to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) criteria and Kiddie-Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version-Korean Version. Demographic, pre-, and perinatal information was obtained from the maternal questionnaires. Data between the TS/CTD and control groups were compared using the chi-squared or Student's t-test, as appropriate. Two-step logistic regression analyses were used to test the association between TS/CTD and pre- and perinatal risk factors. Results: We included of 223 children (78 with TS/CTD and 145 controls). Significant differences in the demographic data between the two groups were observed. The male sex ratio, mean parental age, parental final education level, and family history of tics were included as confounders. In the final adjusted multivariable model, TS/CTD was significantly associated with antiemetic exposure during pregnancy (odds ratio [OR]=16.61, 95% confidence interval [CI] 1.49-185.22, p=0.02) and medically assisted reproduction (OR=7.89, 95% CI 2.28-27.28, p=0.01). Conclusion: Antiemetic exposure and medically assisted reproduction are significantly associated with the risk of TS/CTD. These results should be replicated in future prospective and gene-by-environment studies.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• 제24권3호
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• pp.151-156
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• 2013

Objectives : It has been reported that higher percentage of B cells react with monoclonal D8/17 antibody in patients with rheumatic fever, childhood onset obsessive-compulsive disorder, Tourette's disorder, or prepubertal anorexia nervosa. The purpose of this study is to replicate the previous studies in a Korean young population with tic disorder and to identify any relationship between D8/17 and clinical symptoms. Methods : The binding of D8/17 to B cells was determined in patients with tic disorder (N=21) and healthy controls (N=9) by Fluorescence-Activated Cell Sorter analysis. Results : In the sample examined by this study, the average percentage of B cells expressing D8/17 in tic disorder was 2.05%; healthy controls was 3.15%. No statistically significant differences were found in the mean percentages of D8/17 between the two groups. Conclusion : The expression of D8/17 in B cells was very low in this study. No subjects with tic disorder or healthy controls was above 12% in D8/17 positive proportion. Further studies, including higher number of patients and control group members, should be performed.