Kano Yukiko, Ohta Masataka, Nagai Yoko, Scahill Lawrence
Department of Child Psychiatry, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkuyo-ku, Tokyo, Japan.
Brain Dev. 2010 Mar;32(3):201-7. doi: 10.1016/j.braindev.2009.01.005. Epub 2009 Feb 28.
The purpose of this study was (1) to document cases of Tourette syndrome (TS) with comorbidities such as obsessive-compulsive symptoms (OCS) and hyperkinetic disorder (HD), and (2) to examine differences in clinical characteristics between TS patients with OCS and HD and those without these comorbidities. The subjects in the study were 88 Japanese TS patients (67 males and 21 females; mean age: 15.2years) who were treated by 31 clinicians including psychiatrists and pediatricians. Data on tic symptoms, comorbidities and severity were scrutinized. OCS were present in 42.0% of the subjects, while HD accounted for 28.4%. In the TS+OCS and/or HD group, coprophenomana, impulsiveness/aggression, school refusal, self-injurious behaviors (SIB), and clumsiness were significantly more frequent than in the TS-only group. Also, tic symptoms and impairment during the worst period was significantly severer in the TS+OCS and/or HD than in the TS-only group. When the age-matched TS+all OCS group (i.e., the young TS+OCS and TS+OCS+HD group) was compared with the TS-only group, it was found that the rates of impulsiveness/aggression, school refusal and SIB were significantly higher and the degree of global severity was significantly more intense in the young TS+all OCS group than in the TS-only group. The impact to clinical characteristics of TS from OCS was suggested to be slightly greater than that from HD. There was little ethnic difference in TS pathogenesis in terms of the impact of comorbidities. Further investigation is required to gain deeper insights into the relationships between TS, OCD or OCS and HD.
（1）记录患有共病（如强迫症状[OCS]和多动障碍[HD]）的抽动秽语综合征（TS）病例；（2）检查患有OCS和HD的TS患者与未患有这些共病的TS患者在临床特征上的差异。该研究的受试者为88名日本TS患者（67名男性和21名女性；平均年龄：15.2岁），他们由包括精神科医生和儿科医生在内的31名临床医生进行治疗。对抽动症状、共病和严重程度的数据进行了仔细审查。42.0%的受试者存在OCS，而HD占28.4%。在TS + OCS和/或HD组中，秽亵行为、冲动/攻击行为、拒学、自伤行为（SIB）和笨拙比仅患有TS的组更为常见。此外，TS + OCS和/或HD组在最严重时期的抽动症状和损害比仅患有TS的组明显更严重。当将年龄匹配的TS + 所有OCS组（即年轻的TS + OCS和TS + OCS + HD组）与仅患有TS的组进行比较时，发现年轻的TS + 所有OCS组的冲动/攻击行为、拒学和SIB发生率显著更高，整体严重程度也比仅患有TS的组更强烈。提示OCS对TS临床特征的影响略大于HD。就共病的影响而言，TS发病机制在种族方面差异不大。需要进一步研究以更深入地了解TS、强迫症或OCS与HD之间的关系。
