Ki Chung Paik

1-Hz low frequency repetitive transcranial magnetic stimulation in children with Tourette's syndrome.

The aim of the current study was to assess the efficacy of repetitive transcranial magnetic stimulation (rTMS) over the supplementary motor area (SMA) of the cortex to children with Tourettes syndrome (TS), if rTMS over the SMA had positive effects on ameliorating tics. We designed a pilot open label 12 weeks cohort study to assess the efficacy of rTMS with TS at specific regions. We administered rTMS over SMA with slow frequency to children with TS. We examined 10 male children (mean age 11.2 ± 2.0 years) diagnosed with TS according to the Diagnostic and Statistical Manual of Mental Disorders version IV and Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version. Children with TS were treated with active rTMS to the SMA for 10 daily sessions (1 Hz, 100% of motor threshold, and 1200 stimuli/day). All subjects completed the study with no side effects and no worsening of ADHD or depressive and anxiety symptoms. Tic symptoms improved significantly over the 12 weeks of the study. Statistically significant reductions were seen in the Yale Global Tourettes Syndrome Severity Scale (YGTSS) and Clinical Global Impression (CGI). Low-frequency rTMS over the SMA appears to be effective in children with TS. Further studies using repetitive transcranial magnetic stimulation in TS are warranted, using blinded, balanced, and parallel designs. rTMS over the SMA to children with TS might result in a significant clinical improvement and a normalization of both the hemisphere hyperexcitability.

Reliability and validity of the Korean version of the Impact of Event Scale-Revised

OBJECTIVES The aim of this study was to explore the reliability and validity of the Impact of Event Scale-Revised Korean version (IES-R-K), a self-report scale for assessment of posttraumatic stress disorder (PTSD). METHODS The original Impact of Event Scale-Revised was translated into Korean, and the comparability of content was verified through back-translation procedures. This multicenter study included 93 patients with PTSD, 73 nonpsychotic psychiatric patients, and 88 healthy controls drawn from 18 hospitals across the country. The subjects were assessed using IES-R-K, Clinician-Administered PTSD Scale (CAPS), Beck Depression Inventory, and State Trait Anxiety Inventory (STAI; state anxiety subscale [STAI-S], trait anxiety subscale [STAI-T]) scales. RESULTS In the reliability test, Cronbach alpha coefficient and test-retest reliability were .93 and 0.91, respectively, indicating that the IES-R-K has good internal consistency. One-way analysis of variance revealed significant differences in IES-R-K scores among the patients with PTSD, nonpsychotic psychiatric patients, and healthy controls (F = 139.1, P < .001). Duncan post hoc test showed the significant differences among the 3 groups. To assess the validity of the IES-R-K, correlation coefficient between the IES-R-K and CAPS, STAI-S, and STAI-T was calculated. We found that there was a relatively high degree of correlation between the IES-R-K and CAPS (r = 0.92, P < .001). However, there was a relatively less degree of correlation between STAI-S and STAI-T and IES-R-K (r = 0.30, P < .001). Taken these together, IES-R-K showed good discriminant validity. CONCLUSION The IES-R-K showed good reliability and validity for the assessment of PTSD symptom severity. The IES-R-K is a useful instrument for assessing PTSD symptoms in Korea.

Association of the DAT1 polymorphism with attention deficit hyperactivity disorder (ADHD): a family-based approach.

The dopamine transporter gene (DAT1) is of particular interest in the genetic study of attention deficit hyperactivity disorder (ADHD), because psychostimulants interact directly with the dopamine transporter protein. Association between ADHD and the 10‐repeat allele of a 40 base pair (bp) variable number of tandem repeats (VNTR) polymorphism of DAT1 was first reported in 1995 [Cook et al. (1995); Am J Hum Genet 56:993–998]. Subsequently, several investigators have also confirmed this association, although others reported conflicting results. We analyzed the DAT1 polymorphism in a sample of 33 Korean probands with a Diagnostic and Statistical Manual of Mental Disorders version IV (DSM‐IV) diagnosis of ADHD and found evidence of increased transmission of the 10‐repeat allele using transmission disequilibrium test (TDT) (P = 0.001; OR = 7.88, CI = 2.20–28.29). These data support the role of DAT1 in ADHD susceptibility among Asian populations.

The associations between ADHD and asthma in Korean children

BackgroundThe aim of this study was to investigate the associations between attention deficit hyperactivity disorder (ADHD), the most common neuropsychiatric disorder in school children, and childhood allergic disease by evaluating their respective prevalence.MethodsSubjects were comprised of first and second grade students in twenty two elementary schools in a city in the Republic of Korea. The mode of measurement for ADHD was based on DSM-IV from clinical interviews conducted by child psychiatrists. Along with the diagnostic interviews, we also used the epidemiological questionnaires, Computerized Attention Deficit-Hyperactivity Disorder Diagnostic System, the abbreviated Conner’s Parent Rating Scale (CPRS), and DuPaul’s ADHD Rating Scales. Allergic conditions, such as asthma, have been separately evaluated based on the questionnaire items whose validity and reliability were proved by the International Study of Asthma and Allergies in Children (ISAAC). All questionnaires were completed by the subjects’ parents.ResultsThe lifetime prevalence rate of asthma in ADHD patients was 36.6%, compared to a prevalence of 24.3% in control subjects. The lifetime prevalence rate of allergic rhinitis in ADHD patients was 59.0%, compared to a prevalence of 47.0% in control subjects. Statistically significant difference has been found between the two groups. In the logistic regression model of the ADHD and the control group, the relative risk of asthma was 1.60 times higher (confidence interval 1.301-1.964), the relative risk of allergic rhinitis was 1.38 times higher (confidence interval 1.124-1.681), which showed statistical significance.ConclusionsThe findings of this study suggest significant association between ADHD and childhood asthma and allergic rhinitis. Therefore, appropriate evaluation and treatment are needed for asthmatic children with attention-deficit symptoms, or allergic rhinitis with ADHD. Besides, further research is needed to determine the etiological approach towards ADHD, asthma, and allergic rhinitis.

Association between catechol-O-methyltransferase gene polymorphism and attention-deficit hyperactivity disorder in Korean population.

Recently, the relationship between allele frequency distribution and attention-deficit hyperactivity disorder (ADHD) has been actively studied. In Korea, the relationship between the genetic type and alleles for catechol-O-methyltransferase (COMT) gene has been studied in ADHD patients. ADHD was diagnosed in 60 patients according to the Diagnostic and Statistical Manual of Mental Disorders Version IV (DSM-IV) diagnostic criteria and Schedule for Affective Disorders and Schizophrenia for School-Age Children--Present and Lifetime Version (K-SADS-PL), and they were selected for the study. For the control group, normal volunteers were chosen. Blood samples were taken from the 160 subjects. DNA was extracted from blood lymphocytes, and PCR was performed for COMT NlaIII VNTR polymorphism. For the case-control analyses, allele and genotype frequencies were compared using the chi(2) method. When the ADHD group and the normal control group were compared, significant difference was seen on the COMT genetic type, but was not seen on the allele distribution. As a result, it is viewed that there is no relationship between ADHD and the COMT gene, but final decision is indefinite.

Study on the Health Status of the Residents near Military Airbases in Pyeongtaek City

OBJECTIVES We conducted an epidemiologic survey to evaluate the effect of the aircraft noise exposure on the health of the residents near the military airbases in Pyeongtaek City. METHODS The evaluation of environmental noise level, questionnaire survey, and health examination were performed for 917 residents. The study population consisted of four groups: subjects who lived in the village close to the fighter airbase (high exposure), subjects who lived along the course of fighters (intermediate exposure), and subjects near a helicopter airbase, and the control group. RESULTS The prevalence of the aircraft noise related accident and irritable bowel syndrome in the exposure groups were higher than that of the control group. The risks of noise induced hearing loss, hypertension and diabetes mellitus were higher in the exposed groups than in the control group. The prevalence of anxiety disorder and primary insomnia were higher in the exposed groups than in the control group. Prevalence odd ratios of the risk for primary insomnia after adjusting age, sex, agricultural noise, and occupation were 4.03 [95% confidence interval (95% CI) 1.56-10.47] for the subject near the helicopter airbase, 1.23 (95% CI 0.40-3.76) for those intermediately exposed to fighter noise, and 4.99 (95% CI 2.14-11.64) for those highly exposed to fighter noise. CONCLUSIONS The results of the present study suggest that the aircraft noise may have adverse effects on hearing function, cardiovascular health and mental health. Therefore, it seems to be needed to take proper measures including the control of the aircraft noise and the management of the exposed peoples health.

Prevalence of Attention-Deficit/Hyperactivity Disorder and its Comorbidity among Korean Children in a Community Population

The aim of this study was to determine the prevalence of attention deficit hyperactivity disorders (ADHD) in children according to socio-demographic factors and the distribution of ADHD subtypes in a community in Korea. A screening survey using the Korean version of ADHD Rating Scale (K-ARS) was conducted between 2007 and 2008, and clinical interviews by a pediatric psychiatrist were performed for selected children between 2009 and 2010. A total of 49,573 elementary school students, between ages of 7 and 12, constituted the target population, among which 38,365 students (77.2%) and respective parents gave consent to participate. Of the participants, 200 screened children were clinically examined to confirm the diagnosis of ADHD. We estimated the prevalence of ADHD and its comorbidity in the population, after adjusting for nonresponse and nonparticipation. The prevalence of ADHD was 11.7% in boys and 5.2% in girls, with an overall prevalence of 8.5%. The combined type of inattentive and hyperactive was the most frequent at 4.7% of the whole population. Children were more likely to have ADHD if their parents were separated and had less education. Most commonly combined comorbidity was autism spectrum disorder (ASD) (10.1%). The prevalence of ADHD in the school-aged population is an essential information for improving the quality of public health mental services for evaluation and treatment of ADHD.

COMT gene polymorphism association and drug response in Tourette syndrome.

Departments of Psychiatry, Diagnostic and Evaluation, College of Medicine, Dankook University, Cheonan, Cell Biology Laboratory, Korean Research Institute of Bioscience and Biotechnology, Daejeon, Department of Anatomy and Cell Biology, College of Medicine, Dong-A University, Busan, Department of Psychiatry, College of Medicine, Chonbuk National University, Chonju and Department of Psychiatry, College of Medicine, Korea University, Seoul, South Korea Correspondence to Myung Ho Lim, MD, Department of Psychiatry, College of Medicine, Dankook University, Cheonan, South Korea Tel: + 82 41 5503945; fax: + 82 41 5613007; e-mail: paperose@dku.edu

The Symptom Trajectory of Attention-Deficit Hyperactivity Disorder in Korean School-Age Children

Objective We aimed to investigate symptom trajectory of attention-deficit hyperactivity disorder (ADHD) in Korean school-age children. Methods Four hundred fifty six elementary school children were enrolled when they were in 1st grade and assessed once per year until 4th grade. Symptom severity was assessed by parents using the Korean version of the ADHD rating scale (K-ARS). High-risk was defined as a K-ARS score >18; 377, 325, and 284 children participated in the subsequent assessments. Symptom trajectory was analyzed using a mixed-model approach consistent with the longitudinal nature of the present study including missing data. Results K-ARS scores demonstrated significant main effects of time (F=35.33; p<0.001), sex (F=20.77; p<0.001), and first-year high-risk group (F=240.90; p<0.001). It also demonstrated a significant time×first-year high-risk group interaction effect (F=38.14; p<0.001), but not a time×sex interaction effect. Conclusion K-ARS scores demonstrated a tendency to decline with aging. Individuals in the high-risk group demonstrated earlier declining tendency than those in the non-high risk group. Although total K-ARS scores differed significantly between the sexes at all assessments, the declining pattern between both sexes did not differ significantly. Further studies including larger sample sizes, diagnostic interviews, and complete data sets are needed to confirm findings of the present study.

How Does Low Socioeconomic Status Increase Blood Lead Levelsin KoreanChildren

Although studies have shown that a low socioeconomic status (SES) is associated with high blood lead levels (BLLs) in children, the mechanism underlying this observation is not well known. To determine how SES influences BLLs via environmental factors in Korean children, we conducted a population-based cross-sectional study of 4744 children aged 5–13 years. Questionnaires on sociodemographic information, environmental factors, and food consumption were administered to the children’s parents. BLLs in the study subjects were measured.The complete set of hypothesized associations was assessed using regression analysis and structural equation modeling. SES was associated with high BLLs. The total effects of nutritional factors, lead in the air and total length of nearby roads, and agriculture on BLLs were −0.062 (p < 0.001), 0.068 (p = 0.005), and 0.038 (p = 0.035), respectively. The direct effects of playing outdoors and SES on BLLs were 0.113 (p < 0.001) and −0.111 (p < 0.001), respectively. Although playing outdoors had a greater direct effect on BLLs than did SES, the total effect of SES (standardized β = −0.132, p < 0.001) was greater than that of other sources owing to indirect effects (β = −0.020, p = 0.004). A low SES was a major risk factor for elevated BLLs via environmental factors.