Marwitz Leonie, Pringsheim Tamara
Department of Clinical Neurosciences, Psychiatry, Pediatrics and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta.
J Can Acad Child Adolesc Psychiatry. 2018 Jan;27(1):15-21. Epub 2018 Jan 1.
Tourette syndrome (TS) is often co-morbid with attention deficit hyperactivity disorder (ADHD) and obsessive compulsive disorder (OCD). Studies of TS, anxiety and depression have found variable results depending on study methodology and sample characteristics. Our aim was to examine the clinical utility of routine screening for anxiety and depression in children with TS.
Using a clinic-based sample, we evaluated the proportion of children with TS meeting diagnostic criteria for ADHD, OCD, generalized anxiety disorder (GAD), separation anxiety disorder (SAD), and major depressive disorder (MDD); the frequency of above average anxiety and depressive symptoms using the Multidimensional Anxiety Scale for Children (MASC) and the Children's Depression Inventory (CDI); and the association between diagnoses and symptom severity.
One hundred twenty six children were included (mean age 10.7 years). The most common comorbid disorder was ADHD (37%), followed by GAD (21%), OCD (10%), MDD (2%) and SAD (2%). On the MASC, the separation anxiety/panic subscale score was higher than all other subscale scores (p<0.0001). Clinically significant anxiety symptoms were present in 20% of the sample based on the MASC Anxiety Disorders Index, while 6% were identified as potentially clinically depressed based on the CDI Total Score. Yale Global Tic Severity Scale scores were positively correlated with total scores on the MASC (r=0.22, p=0.03) and CDI (r=0.37, p=0.0002).
Routine screening children with TS for anxiety is warranted given the rate of comorbidity. Screening for depression in TS will have a higher yield in adolescents, adults, and children with more severe tics.
抽动秽语综合征（TS）常与注意力缺陷多动障碍（ADHD）和强迫症（OCD）共病。关于TS、焦虑和抑郁的研究结果因研究方法和样本特征而异。我们的目的是检验对TS患儿进行焦虑和抑郁常规筛查的临床实用性。
我们使用基于门诊的样本，评估符合ADHD、OCD、广泛性焦虑障碍（GAD）、分离性焦虑障碍（SAD）和重度抑郁症（MDD）诊断标准的TS患儿比例；使用儿童多维焦虑量表（MASC）和儿童抑郁量表（CDI）评估高于平均水平的焦虑和抑郁症状的频率；以及诊断与症状严重程度之间的关联。
共纳入126名儿童（平均年龄10.7岁）。最常见的共病是ADHD（37%），其次是GAD（21%）、OCD（10%）、MDD（2%）和SAD（2%）。在MASC量表上，分离焦虑/惊恐分量表得分高于所有其他分量表得分（p<0.0001）。根据MASC焦虑障碍指数，20%的样本存在具有临床意义的焦虑症状，而根据CDI总分，6%被确定为可能存在临床抑郁。耶鲁综合抽动严重程度量表得分与MASC总分（r=0.22，p=0.03）和CDI总分（r=0.37，p=0.0002）呈正相关。
鉴于共病率，对TS患儿进行焦虑常规筛查是必要的。对TS患儿进行抑郁筛查在青少年、成年人以及抽动更严重的儿童中会有更高的检出率。
