Black Kevin J, Kim Soyoung, Schlaggar Bradley L, Greene Deanna J
Departments of Psychiatry, Neurology, Radiology and Neuroscience, Washington University in St. Louis School of Medicine, St. Louis, MO 63110, USA.
Departments of Psychiatry and Radiology, Washington University in St. Louis School of Medicine, St. Louis, MO 63110, USA.
J Psychiatr Brain Sci. 2020;5. doi: 10.20900/jpbs.20200012. Epub 2020 May 27.
We report on the ongoing project "The New Tics Study: A Novel Approach to Pathophysiology and Cause of Tic Disorders," describing the work completed to date, ongoing studies and long-term goals. The overall goals of this research are to study the pathophysiology of Provisional Tic Disorder, and to study tic remission (or improvement) in a prospective fashion. Preliminary data collection for the project began almost 10 years ago. The current study is nearing completion of its third year, and has already reported several novel and important results. First, surprisingly, at least 90% of children who had experienced tics for only a mean of 3 months still had tics at the 12-month anniversary of their first tic, though in some cases tics were seen only with remote video observation of the child sitting alone. Thus almost all of them now had a DSM-5 diagnosis of Tourette's Disorder or Persistent (Chronic) Tic Disorder. Baseline clinical features that predicted 12-month outcome included tic severity, subsyndromal autism spectrum symptoms, an anxiety disorder, and a history of 3 or more phonic tics. Second, we found that poorer tic suppression ability when immediately rewarded for suppression predicted greater tic severity at follow-up. Third, striatal volumes did not predict outcome as hypothesized, but a larger hippocampus at baseline predicted worse severity at follow-up. Enrollment and data collection continue, including functional connectivity MRI (fcMRI) imaging, and additional analyses are planned once the full sample is enrolled.
我们报告了正在进行的项目“新抽动研究：抽动障碍病理生理学与病因的新方法”，描述了迄今为止已完成的工作、正在进行的研究以及长期目标。本研究的总体目标是研究暂时性抽动障碍的病理生理学，并以前瞻性方式研究抽动症状的缓解（或改善）情况。该项目的初步数据收集工作始于近10年前。当前研究已接近第三年尾声，且已报告了多项新颖且重要的结果。首先，令人惊讶的是，至少90%仅平均经历过3个月抽动症状的儿童在首次出现抽动症状的12个月纪念日时仍有抽动症状，不过在某些情况下，只有通过远程视频观察孩子独自坐着时才能看到抽动症状。因此，他们几乎所有人现在都被诊断为符合《精神疾病诊断与统计手册》第5版（DSM - 5）标准的妥瑞氏症或持续性（慢性）抽动障碍。预测12个月结果的基线临床特征包括抽动严重程度、亚综合征自闭症谱系症状、焦虑症以及3种或更多发声性抽动的病史。其次，我们发现，当因抑制抽动而立即得到奖励时，抑制能力较差预示着随访时抽动严重程度更高。第三，纹状体体积并未如假设那样预测结果，但基线时较大的海马体预示着随访时严重程度更差。招募和数据收集工作仍在继续，包括功能连接磁共振成像（fcMRI），计划在纳入完整样本后进行更多分析。
