Department of Psychiatry, UCLA Semel Institute for Neuroscience and Human Behavior, 760 Westwood Plaza, rm 67-463, Los Angeles, CA 90024, USA.
Department of Psychiatry, UCLA Semel Institute for Neuroscience and Human Behavior, 760 Westwood Plaza, rm 67-463, Los Angeles, CA 90024, USA; Division of Child and Adolescent Psychiatry, Johns Hopkins School of Medicine, Baltimore, MD, USA.
Psychiatry Res. 2018 Mar;261:464-472. doi: 10.1016/j.psychres.2017.12.066. Epub 2018 Jan 2.
This paper examined neurocognitive functioning and its relationship to behavior treatment response among youth with Tourette's Disorder (TD) in a large randomized controlled trial. Participants diagnosed with TD completed a brief neurocognitive battery assessing inhibitory functions, working memory, and habit learning pre- and post-treatment with behavior therapy (CBIT, Comprehensive Behavioral Intervention for Tics) or psychoeducation plus supportive therapy (PST). At baseline, youth with tics and Attention Deficit Hyperactivity Disorder (ADHD) exhibited some evidence of impaired working memory and simple motor inhibition relative to youth with tics without ADHD. Additionally, a small negative association was found between antipsychotic medications and youth's performance speed. Across treatment groups, greater baseline working memory and aspects of inhibitory functioning were associated with a positive treatment response; no between-group differences in neurocognitive functioning at post-treatment were identified. Within the behavior therapy group, pre-treatment neurocognitive status did not predict outcome, nor was behavior therapy associated significant change in neurocognitive functioning post-treatment. Findings suggest that co-occurring ADHD is associated with some impairments in neurocognitive functioning in youth with Tourette's Disorder. While neurocognitive predictors of behavior therapy were not found, participants who received behavior therapy exhibited significantly reduced tic severity without diminished cognitive functioning.
本研究在一项大型随机对照试验中，考察了抽动障碍（TD）青少年的神经认知功能及其与行为治疗反应的关系。参与者被诊断为 TD，在接受行为治疗（CBIT，全面行为干预治疗抽动）或心理教育加支持性治疗（PST）前后，完成了一项简短的神经认知测试，评估抑制功能、工作记忆和习惯学习。在基线时，伴有注意力缺陷多动障碍（ADHD）的抽动青少年在工作记忆和简单运动抑制方面表现出一些受损的证据，而不伴有 ADHD 的抽动青少年则没有。此外，还发现抗精神病药物与青少年的表现速度之间存在负相关。在各个治疗组中，更大的基线工作记忆和抑制功能方面与积极的治疗反应相关；治疗后未发现神经认知功能存在组间差异。在行为治疗组中，治疗前的神经认知状态不能预测治疗结果，治疗后神经认知功能也没有显著变化。研究结果表明，抽动障碍青少年共患 ADHD 与某些神经认知功能受损有关。虽然没有发现行为治疗的神经认知预测因素，但接受行为治疗的参与者的 tic 严重程度显著降低，而认知功能没有下降。
