Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA.
Child Psychiatry Hum Dev. 2021 Oct;52(5):761-771. doi: 10.1007/s10578-020-01085-3. Epub 2020 Oct 23.
Individuals with Tourette's Disorder and Persistent Tic Disorders (TD) often experience premonitory urges-aversive sensations that precede tics and are relieved by tic expression. Given its role in the neurobehavioral model of TD, understanding factors that influence premonitory urges and associated relief can advance understanding of urge phenomenology and optimize treatments for individuals with TD. This study examined whether the novel construct of urge intolerance-difficulty tolerating premonitory urges-predicted tic severity and tic-related disability. Participants included 75 youth with TD and their caregivers. Assessments characterized tic severity, premonitory urge, distress tolerance, internalizing symptoms, and tic-related disability. Structural equation modeling revealed that higher levels of urge intolerance predicted greater levels of tic-related disability. Furthermore, the relationship between urge intolerance and tic-related disability was more robust for youth with clinically-elevated levels of internalizing symptoms. While further investigation is needed, urge intolerance represents a promising treatment target to improve tic-related disability in youth with TD.
患有妥瑞氏症和持续性抽动障碍（TD）的个体经常会经历预感冲动——一种在抽动前出现的令人不适的感觉，通过抽动表达可以得到缓解。鉴于预感冲动在 TD 的神经行为模型中的作用，了解影响预感冲动和相关缓解的因素可以促进对冲动现象学的理解，并优化 TD 患者的治疗方法。本研究探讨了预感冲动不耐受这一新颖结构——难以忍受预感冲动——是否可以预测抽动严重程度和与抽动相关的残疾。参与者包括 75 名患有 TD 的青少年及其照顾者。评估包括抽动严重程度、预感冲动、耐受力、内化症状和与抽动相关的残疾。结构方程模型显示，较高水平的预感冲动不耐受预示着与抽动相关的残疾程度更高。此外，对于具有临床显著内化症状水平的青少年，预感冲动不耐受与与抽动相关的残疾之间的关系更为稳健。虽然还需要进一步的研究，但预感冲动不耐受代表了一种有前途的治疗目标，可以改善患有 TD 的青少年与抽动相关的残疾。
