Silvestri Paola R, Chiarotti Flavia, Baglioni Valentina, Neri Valeria, Cardona Francesco, Cavanna Andrea E
Department of Pediatrics and Child Neuropsychiatry, Sapienza University, Rome, Italy.
Department of Cell Biology and Neuroscience, National Institute of Health, Rome, Italy.
Eur J Paediatr Neurol. 2017 May;21(3):468-474. doi: 10.1016/j.ejpn.2016.12.006. Epub 2016 Dec 18.
Gilles de la Tourette syndrome (GTS) is a childhood-onset neuropsychiatric disorder characterised by multiple tics and often associated with behavioural problems. Although there is evidence of significantly reduced self-esteem in children and adolescents with GTS, little is known about perceived self-concept and its clinical determinants at the transition age between adolescence and adulthood. We therefore set out to investigate self-concept in a clinical sample of young patients with GTS at this crucial age for personal development.
In addition to standard demographic and clinical data, we collected self-ratings using a standardised battery of psychometric instruments, as well as the Multidimensional Self Concept Scale, a comprehensive questionnaire developed to assess self-concept in subjects aged 9- to 19 years, tapping into the social, competence, affect, academic, family, and physical domains.
We found that patients diagnosed with at least one co-morbid psychiatric disorder ("GTS-plus" phenotype) reported significantly lower self-concept than patients with "pure GTS", whereas tic-related variables had no impact on self-concept. Anxiety symptoms were the main determinants of self-concept, especially trait anxiety with regard to social and affective domains. Affective symptoms could also have a negative impact on the physical, affective, competence, and social domains of self-concept.
Routine screening for anxiety and affective symptoms should be recommended in all patients with GTS seen at transition clinics from paediatric to adult care, in order to implement effective treatment interventions whenever possible.
抽动秽语综合征（GTS）是一种起病于儿童期的神经精神障碍，其特征为多种抽动症状，且常伴有行为问题。尽管有证据表明患有GTS的儿童和青少年自尊显著降低，但对于处于青春期与成年期过渡阶段的患者，其自我概念认知及其临床决定因素却知之甚少。因此，我们着手在这个对个人发展至关重要的年龄段，对一组患有GTS的年轻患者进行自我概念调查。
除了标准的人口统计学和临床数据外，我们还使用一套标准化的心理测量工具以及多维自我概念量表收集自评数据。多维自我概念量表是一份综合问卷，旨在评估9至19岁受试者的自我概念，涉及社会、能力、情感、学业、家庭和身体等领域。
我们发现，被诊断患有至少一种共病精神障碍（“GTS加”表型）的患者报告的自我概念显著低于“单纯GTS”患者，而与抽动相关的变量对自我概念没有影响。焦虑症状是自我概念的主要决定因素，尤其是在社会和情感领域的特质焦虑。情感症状也可能对自我概念的身体、情感、能力和社会领域产生负面影响。
对于在从儿科到成人护理的过渡诊所就诊的所有GTS患者，应建议进行焦虑和情感症状的常规筛查，以便尽可能实施有效的治疗干预措施。
