Panom Ketumarn

Randomized Controlled Trial of Group Cognitive Behavioural Therapy for Post-Traumatic Stress Disorder in Children and Adolescents Exposed to Tsunami in Thailand.

BACKGROUND Post-traumatic stress disorder (PTSD) is a common and debilitating consequence of natural disaster in children and adolescents. Accumulating data show that cognitive behavioural therapy (CBT) is an effective treatment for PTSD. However, application of CBT in a large-scale disaster in a setting with limited resources, such as when the tsunami hit several Asian countries in 2004, poses a major problem. AIMS This randomized controlled trial aimed to test for the efficacy of the modified version of CBT for children and adolescents with PSTD. METHOD Thirty-six children (aged 10-15 years) who had been diagnosed with PSTD 4 years after the tsunami were randomly allocated to either CBT or wait list. CBT was delivered in 3-day, 2-hour-daily, group format followed by 1-month posttreatment self-monitoring and daily homework. RESULTS Compared to the wait list, participants who received CBT demonstrated significantly greater improvement in symptoms of PTSD at 1-month follow-up, although no significant improvement was observed when the measures were done immediately posttreatment. CONCLUSIONS Brief, group CBT is an effective treatment for PTSD in children and adolescents when delivered in conjunction with posttreatment self-monitoring and daily homework.

Prevalence of post-traumatic stress disorder in students 23 months after tsunami.

OBJECTIVE To study the prevalence of post-traumatic stress disorder (PTSD) in the 4th-9th grade students in an affected school 23 months after tsunami. METHOD Two-stage screening procedure was used in a diagnostic study designed to identify post-traumatic stress disorder in the 4th-9th grade students in a school in Takaupa district, Phang Nga province, 23 months after the 2004 tsunami. Impact of Events Scale (IES) was used as a screening questionnaire in the first stage. In the second stage, the students were assessed by a psychiatrist to identify PTSD according to DSM-IV criteria. SPSS 10.0, inferential statistics and Chi-square test were used to analyze the data. RESULT A total of 436 students participated in the study. Forty of them were diagnosed with PTSD. The prevalence of PTSD was 15.1%. The sensitivity, specificity and negative predictive value of IES were 0.75, 0.54 and 0.92 respectively. CONCLUSION The prevalence of PTSD in students in a school 23 months after tsunami was 15.1%.

Antipsychotic-induced paroxysmal perceptual alteration in a patient with major depressive disorder

toma is a catecholamine-releasing tumor of the sympathetic nervous system that causes hypertension, sweating, and palpitation. Moreover, fever has been commonly observed in patients with pheochromocytoma. Thus, although these two disorders have similar manifestations, the similarities between the symptoms of the two conditions have not yet been reported. Here I report a case of MC wherein the manifestations mimicked those of pheochromocytoma. The patient has provided written informed consent for the publication of this letter. A 38-year-old male schizophrenia patient had been treated with antipsychotic drugs. Immediately before admission to Jichi Medical University Hospital, the productivity of his business had declined; consequently, a contract to sell his shop was scheduled to be signed on 23 March. On the evening of 22 March, however, he suddenly became stuporous and was admitted to the emergency department. On admission his systolic blood pressure was 184 mmHg and pulse rate was 120/min. Subsequently, he exhibited alternating stupor and excitement, blood pressure fluctuations, tachycardia, urinary incontinence, profuse diaphoresis, tremor, and increased muscle tone. Although he was afebrile on admission, his body temperature increased to 38.3°C on 29 March. Blood examination indicated a serum creatine phosphokinase level of 1040 IU/L and a white blood cell count of 12 200/mL. The thyroid hormone levels were within the normal range. The C-reactive protein level was not indicative of the presence of an infection. Pheochromocytoma was initially suspected. Twentyfour hour urine sample indicated high levels of adrenaline (24.0 mg/day; normal range: 3–15 mg/day), noradrenaline (312.7 mg/day; normal range, 26–121 mg/day), and vanillylmandelic acid (6.7 mg/day; normal range, 1.4–5.1 mg/day). Abdominal computed tomography (CT) and echography, however, were normal. Hence, the diagnosis of pheochromocytoma was ruled out, and he was diagnosed with MC. Electroconvulsive therapy (ECT) was initiated on 29 March. After the completion of the fourth ECT session, his psychiatric and physical symptoms were resolved. In the case of this patient, pheochromocytoma was ruled out on the basis of imaging. It is sometimes difficult to distinguish MC from pheochromocytoma on biochemistry. Nevertheless, it is suggested that pheochromocytoma is unlikely in most patients showing small increases in the levels of catecholamines and metabolites (<2–3-fold the upper reference limits). The following diagnostic criteria for MC were proposed: acute and severe catatonia along with stupor or excitement, hyperthermia ( 38.0°C), tachycardia ( 120 beats/min) or hypertension ( 150/100 mmHg), and increased muscle tone. The symptoms exhibited by the present patient fulfilled these criteria. These manifestations are also evidenced in cases of neuroleptic malignant syndrome (NMS). MC, however, manifests as psychomotor agitation, stupor, and negativism more frequently. Lead-pipe rigidity, a characteristic symptom of NMS, was not observed in the present patient. Accordingly, I consider MC as the more appropriate diagnosis in the current case. MC and pheochromocytoma are lethal unless recognized and appropriately treated; moreover, the treatments required for both are different. Therefore, clinicians should be educated regarding MC, which is a psychiatric disorder that has various physical manifestations and mimics the presentation of pheochromocytoma.