Fründt Odette, Woods Douglas, Ganos Christos
Department of Neurology (OF, CG), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; and Department of Psychology (DW), Marquette University, Milwaukee, WI.
Neurol Clin Pract. 2017 Apr;7(2):148-156. doi: 10.1212/CPJ.0000000000000348.
To summarize behavioral interventions for the treatment of primary tic disorders.
Although tics were attributed to a disordered weak volition, the shift towards neurobiological models of tic disorders also transformed nonpharmacologic treatment practices. Current international guidelines recommend habit reversal training, comprehensive behavioral intervention, and exposure and response prevention as first-line therapies for tics. Appropriate patient selection, including age and presence of comorbidities, are salient clinical features that merit consideration. Evidence for further behavioral interventions is also presented.
Currently recommended behavioral interventions view tics as habitual responses that may be further strengthened through negative reinforcement. Although availability and costs related to these interventions may limit their effect, Internet-based and telehealth approaches may facilitate wide accessibility. Novel nonpharmacologic treatments that take different approaches, such as autonomic modulation or attention-based interventions, may also hold therapeutic promise.
总结治疗原发性抽动障碍的行为干预措施。
尽管抽动曾被归因于意志薄弱紊乱，但向抽动障碍神经生物学模型的转变也改变了非药物治疗方法。当前国际指南推荐习惯逆转训练、综合行为干预以及暴露与反应阻止疗法作为抽动的一线治疗方法。适当的患者选择，包括年龄和共病情况，是值得考虑的显著临床特征。还介绍了进一步行为干预的证据。
目前推荐的行为干预措施将抽动视为可能通过负强化进一步强化的习惯性反应。尽管这些干预措施的可及性和成本可能会限制其效果，但基于互联网和远程医疗的方法可能有助于广泛普及。采用不同方法的新型非药物治疗，如自主神经调节或基于注意力的干预，也可能具有治疗前景。
