Birmingham and Solihull Mental Health NHS Foundation Trust, Department of Neuropsychiatry, The Barberry, National Centre for Mental Health, Birmingham, UK.
J Psychiatr Res. 2013 Sep;47(9):1259-63. doi: 10.1016/j.jpsychires.2013.05.019. Epub 2013 Jun 13.
Non-obscene socially inappropriate symptoms (NOSIS) in Tourette syndrome (TS) include urges to make insulting remarks about a person's physical characteristics (e.g. "big nose") and other socially disruptive behaviors (e.g. shouting "bomb" at an airport). We aimed to explore the characteristics of NOSIS in TS, and determine whether individuals who experienced NOSIS reported differences to those who did not in terms of quality of life (QoL) and common clinical symptoms. Finally we aimed to identify significant predictors of the presence of NOSIS. Patients were sixty patients with TS from a specialist outpatient clinic. They completed clinical measures assessing NOSIS, QoL, tic severity, premonitory urges for tics, depression, anxiety, obsessions and compulsions, attention problems, coprophenomena and conduct problems. Two-thirds of our sample admitted experiencing urges to make socially inappropriate remarks and/or carry out socially inappropriate actions. However, not all urges led to actions. Obsessions, attention problems, coprolalia and conduct problems were all significantly more common in patients with NOSIS than those without. Moreover, the presence of NOSIS was associated with significantly poorer QoL, and higher scores on measures of tic severity, obsessive-compulsive symptoms, attention problems and premonitory urges. However, only the presence of coprolalia and severity of obsessive-compulsive symptoms and premonitory urges were significant predictors of the presence of NOSIS. Our findings may imply that elevated self-consciousness and obsessionality could comprise risk factors for the development of NOSIS. As NOSIS exert a specific detrimental impact on QoL, these symptoms should be employed as a marker of therapeutic efficacy.
图雷特综合征（TS）中的非淫秽社交不当症状（NOSIS）包括有侮辱他人身体特征（例如“大鼻子”）和其他社交破坏行为（例如在机场大喊“炸弹”）的冲动。我们旨在探索 TS 中 NOSIS 的特征，并确定经历 NOSIS 的个体与未经历 NOSIS 的个体在生活质量（QoL）和常见临床症状方面是否存在差异。最后，我们旨在确定 NOSIS 存在的显著预测因素。
患者为来自专科门诊的 60 名 TS 患者。他们完成了评估 NOSIS、QoL、抽搐严重程度、抽搐前冲动、抑郁、焦虑、强迫症和强迫行为、注意力问题、共病现象和行为问题的临床测量。我们的样本中有三分之二的人承认有过发表不适当言论和/或做出不适当行为的冲动。然而，并非所有冲动都会导致行动。强迫症、注意力问题、共病现象和行为问题在 NOSIS 患者中比在无 NOSIS 患者中更为常见。此外，NOSIS 的存在与 QoL 显著降低，抽搐严重程度、强迫症状、注意力问题和前冲动评分显著升高有关。然而，只有共病现象和强迫症状和前冲动的严重程度是 NOSIS 存在的显著预测因素。
我们的发现可能意味着自我意识和强迫性增强可能是 NOSIS 发展的风险因素。由于 NOSIS 对 QoL 产生特定的不利影响，因此这些症状应作为治疗效果的标志物。
