Department of Neuroscience, University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND 58202-9037, USA.
J Psychosom Res. 2009 Dec;67(6):515-23. doi: 10.1016/j.jpsychores.2009.08.002.
A study of the shared phenomenology between Tourette syndrome (TS) and schizophrenia.
An illustrative case report is presented. We used a chart review of 399 clinically ascertained patients with TS to identify 10 cases meeting criteria for schizophrenia. From our 10 patients, salient clinical characteristics were then tabulated. We then extracted similar clinical characteristics from a previously published series of patients with comorbid TS and schizophrenia in order to combine cases and allow for a comparison between childhood-onset schizophrenia (COS), adolescent-onset schizophrenia (AdolOS), and adult-onset schizophrenia (AduOS) cases in these groups.
We found 10 cases of schizophrenia (all were males) in the 399 TS patients for a prevalence rate of 2.5% (95% CI 0.96-4.04). Mean age of tic onset for TS diagnostic criteria ranged from 2-14 years with a mean of 8.2 years. The mean age of diagnosis for schizophrenia was 14.2 (range 9-23 years). We found six cases of schizophrenia with onset of positive psychotic symptoms by 13 years of age, two cases with onset after 13 years of age and before 18 years of age, and two cases with onset after 18 years of age. Attention deficit hyperactivity disorder was present at a higher rate (70%) than one would expect in a clinically ascertained group of patients with TS. Comparison between COS, AdolOS and AduOS in our pooled cases noted a sex bias skewed toward males. Catatonic symptoms may be more likely in child or adolescent onset cases and negative symptoms more likely in AduOS cases.
The 2.5% prevalence of schizophrenia in our TS sample exceeds the 1% expected rate of schizophrenia in the general population (chi-square=9.14; P=.0025). The six cases of COS (before 13 years of age) exceeds the expected rate of 1-2 per 100,000 (chi-square=4499; P=.0001). The 752-fold increase in observed rates of comorbid TS and COS over expected rates suggests a role for unknown common underlying etiologic factors. Based on clinical features, patients with TS and comorbid COS, AdolOS, or AduOS do not have different conditions. We conclude with suggestions for further research.
研究图雷特综合征（TS）和精神分裂症之间的共同现象学。
呈现一个说明性的病例报告。我们使用对 399 例临床确诊的 TS 患者的图表回顾，确定了 10 例符合精神分裂症标准的病例。从我们的 10 名患者中，然后列出了显著的临床特征。然后，我们从先前发表的一组患有共病 TS 和精神分裂症的患者系列中提取了类似的临床特征，以便将病例合并，并允许对这些组中的儿童发病精神分裂症（COS）、青少年发病精神分裂症（AdolOS）和成年发病精神分裂症（AduOS）病例进行比较。
我们在 399 例 TS 患者中发现了 10 例精神分裂症（均为男性），患病率为 2.5%（95%CI 0.96-4.04）。TS 诊断标准的抽动发作平均年龄为 2-14 岁，平均为 8.2 岁。精神分裂症的平均诊断年龄为 14.2 岁（9-23 岁）。我们发现 6 例精神分裂症患者在 13 岁前出现阳性精神病症状，2 例在 13 岁后至 18 岁前发病，2 例在 18 岁后发病。注意力缺陷多动障碍（ADHD）的发生率（70%）高于在临床确定的 TS 患者群体中预期的发生率。我们在合并病例中对 COS、AdolOS 和 AduOS 进行比较，发现存在男性偏倚的性别偏差。在儿童或青少年发病的病例中，可能更容易出现紧张症症状，而在 AduOS 病例中，可能更容易出现阴性症状。
我们的 TS 样本中精神分裂症的 2.5%患病率超过了一般人群中 1%的精神分裂症预期发生率（卡方=9.14；P=.0025）。在 6 例 COS 病例（13 岁前）中，超过了预期的每 10 万人中 1-2 例的发生率（卡方=4499；P=.0001）。观察到的 TS 和 COS 共病的发病率与预期发病率相比增加了 752 倍，表明存在未知的共同潜在病因因素。基于临床特征，患有 TS 和共病 COS、AdolOS 或 AduOS 的患者并没有不同的病情。我们最后提出了进一步研究的建议。
