| A Clinical Study of Tic Disorder in Korea. |
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Kang E Hong |
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Divi&ion of Child and Addescent Psychiatry Seoul National University Hospital |
| Tic 장애의 임상적 고찰 및 치료 |
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홍강의 |
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서울대학교 병원 소아정신과 |
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| Abstract |
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30 patients diagnosed as having tic disorder at the Child Psychiatry clinic of Seoul National University Hospital were studied in terms of sex, age, onset, precipitating factors,characteristics of the patients and family dynamics. A short term follow up study wascarried out regarding the outcomes of the symptom and the changes in attitudes and beha-viors of patients and parents. The results are as follows：1.30 patients represent 4% of all child psychiatry outpatients referrals of 15 months duration 2. 24 wei-e boys and 6 were girls. The mean age of onset was 7.9 and the meanage at the time of referal was 9.6, Therefore, the mean duration of the disorder was 1 year and 7 months 3.Among 30 patients, 14 had tic symptom less than a year (transient) and 14 more than
a year (chronic) and two were diagnosed as Tourette* sadisorder 4.More than 10 kinds of tics were reported and observed, and the average number of tics was 3 for each patient. Most frequent tics were eye blinking (67%), vocal tic (40%) head shaking(37%) facial muscle twitching(27%) and shoulder shrugging(23%). There were also
tic of whole body (20%), extremety(20%)> dry coughing, nose, mouth coproralia and head nodding. Even diaphragm was involved in two cases 5.3 definite precipitating factors were identified. (1) pressure to study hard(ll) (2) fear of physical assault(6) and (3) parents marital discord (4) 6.Most of the patients were tense, inhibited and unable to express feelings and lacking spontaneity. However, most of them had underlying emotional conflicts, especilally repressed anger and aggression directed to parents who were characterized by overcontrol or overpro-tection, ambitions and inability to understand the child’s emotional needs. These personality characteristics of the patients and their parents support the clinical impression that tic is
not only neurotic symptom in the sense that it is an symbolic expression of repressed anger and aggression, but also psychosomatic symptom in the sense that tic, a contracture of muscles is a real but maladaptive hysiological response of angef and aggression of an individual. 7.A short term treatment follow up of 18 patients indicated that 14 experienced disappearance or marked improvement and 4 remained about same or worse. Besides tic symptoms, parents reported several changes in the patients expression and spontaneity, better interaction with peers, better performance in school. Parents alo reported their own attitudinal changes in the direction of less control and punishmen, and increased praise 8. It is concluded that tic disorder is common among a children and mostly transient response to increased tension and pressure from the environment. However when it became prolonged and severe, a clinician should carefully evaluate the patient’s underlying
emotional conflicts and parental psychopathology and actively intervene the whole family.
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| Key Words:
Tic, Tourette disorder, incidence, precipitating factor, inhibited angry child,
controlling mother ifamily, dynamic, medication and psychotherapy
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