Vloet Jennifer A, Herpertz-Dahlmann Beate, Hahn Freya, Häusler Martin, Holtkamp Kristian
Klinik für Kinder- und Jugendpsychiatrie und -psychotherapie, Universitätsklinikum der RWTH Aachen, Aachen.
Z Kinder Jugendpsychiatr Psychother. 2010 May;38(3):161-8. doi: 10.1024/1422-4917/a000029.
Sydenham's chorea is the most frequently acquired movement disorder in childhood and is characterized by involuntary and abrupt movement patterns. Some patients also show neuropsychiatric dysfunctions and psychiatric disorders, including anxiety, obsessive-compulsive disorders and tic disorders. In contrast, the association with psychotic symptoms has been reported very rarely up to now (n=4, two case reports, one prospective and one retrospective study). We report on a 12-year-old girl with acute paranoid hallucinatory symptoms and choreiform movements. Whereas her paranoid-hallucinatory symptoms responded to antipsychotic therapy, the negative symptoms and choreiform movement patterns only disappeared during additional prednisolone treatment. After tapering prednisolone, her negative symptoms and the choreiform movements reappeared. Dysfunctions of the corpus striatum have been linked to the pathogenesis of schizophrenia. This striatal dysfunction may secondarily affect working memory and the prefrontal cortex, resulting in impaired cognitive flexibility. Choreiform movements in chorea minor are attributed to dysfunction of the basal ganglia based on post-streptococcal autoimmune-mediated mechanisms. Huntington's disease and Wilson's disease are movement disorders caused by basal-ganglia dysfunction and are also associated with psychotic symptoms. In the present case, the association of psychotic and choreiform symptoms might be caused by dysfunction of the basal ganglia. The negative symptoms may result from disturbances of the prefrontal cortex impaired by basal-ganglia dysfunction.
Sydenham舞蹈病是儿童期最常见的后天性运动障碍，其特征为不自主的突发运动模式。一些患者还表现出神经精神功能障碍和精神疾病，包括焦虑症、强迫症和抽动障碍。相比之下，到目前为止，与精神病性症状的关联报道非常罕见（n = 4，两篇病例报告，一篇前瞻性研究和一篇回顾性研究）。我们报告了一名12岁女孩，她有急性偏执性幻觉症状和舞蹈样动作。她的偏执性幻觉症状对抗精神病药物治疗有反应，而阴性症状和舞蹈样动作模式仅在加用泼尼松龙治疗期间消失。泼尼松龙减量后，她的阴性症状和舞蹈样动作再次出现。纹状体功能障碍与精神分裂症的发病机制有关。这种纹状体功能障碍可能继发影响工作记忆和前额叶皮质，导致认知灵活性受损。小舞蹈病中的舞蹈样动作基于链球菌感染后自身免疫介导的机制，归因于基底神经节功能障碍。亨廷顿舞蹈病和威尔逊病是由基底神经节功能障碍引起的运动障碍，也与精神病性症状有关。在本病例中，精神病性症状和舞蹈样症状的关联可能是由基底神经节功能障碍引起的。阴性症状可能是由基底神经节功能障碍导致的前额叶皮质功能紊乱所致。
