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[神经发育障碍中的运动障碍。抽动和刻板动作]

[Motor disorders in neurodevelopmental disorders. Tics and stereotypies].

作者信息

Eirís-Puñal Jesús

机构信息

Complejo Hospitalario Universitario de Santiago de Compostela, 15706 Santiago de Compostela, Espana.

出版信息

Rev Neurol. 2014 Feb 24;58 Suppl 1:S77-82.

Abstract

Tics are repetitive, sharp, rapid, non-rhythmic movements or utterances that are the result of sudden, abrupt and involuntary muscular contractions. Stereotypies are repetitive, apparently impulsive, rhythmic, purposeless movements that follow an individual repertoire that is specific to each individual and that occur under a variable time pattern, which may be either transient or persistent. Both are included in the Diagnostic and statistical manual of mental disorders, fifth edition (DSM-5), among the neurodevelopmental disorders, and together with coordination development disorder go to make up the group of motor disorders. For tics, the categories of 'Tourette's disorder', 'chronic motor or vocal tic disorder' and 'unspecified tic disorder' have been maintained, whereas the category 'transient tics' has disappeared and 'provisional tic disorder' and 'other specified tic disorders' have been incorporated. Within stereotypic movement disorder, the DSM-5 replaces 'non-functional' by 'apparently purposeless'; the thresholds of the need for medical care are withdrawn and replaced with the manual's standard involvement criterion; mental retardation is no longer mentioned and emphasis is placed on the severity of the stereotypic movement; and a criterion concerning the onset of symptoms and specifiers of the existence or not of self-injurious behaviours have been added, together with the association with genetic or general medical diseases or extrinsic factors. Moreover, a categorisation depending on severity has also been included.

摘要

抽动是重复性的、突然的、快速的、无节律的运动或发声,是突然、急剧且不自主的肌肉收缩的结果。刻板动作是重复性的、明显冲动性的、有节律的、无目的的运动,遵循个体特有的模式,在可变的时间模式下发生,可能是短暂的或持续的。在《精神疾病诊断与统计手册》第五版(DSM-5)中,抽动和刻板动作都被纳入神经发育障碍,与协调发育障碍共同构成运动障碍组。对于抽动,“抽动秽语综合征”“慢性运动或发声抽动障碍”和“未特定的抽动障碍”类别得以保留,而“短暂性抽动”类别消失,“临时抽动障碍”和“其他特定的抽动障碍”被纳入。在刻板运动障碍中,DSM-5用“明显无目的”取代了“无功能”;取消了医疗护理需求的阈值,代之以手册的标准纳入标准;不再提及智力发育迟缓,重点放在刻板运动的严重程度上;增加了关于症状发作以及是否存在自伤行为的说明标准,以及与遗传或一般医学疾病或外部因素的关联。此外,还包括了根据严重程度进行的分类。

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