Isaacs David A, Riordan Heather R, Claassen Daniel O
Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, United States.
Department of Pediatrics, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, United States.
Front Psychiatry. 2021 Mar 10;12:619854. doi: 10.3389/fpsyt.2021.619854. eCollection 2021.
Tics are the hallmark feature of Tourette syndrome (TS), but psychiatric and sensory symptoms are widely prevalent and increasingly recognized as core manifestations of the disorder. Accumulating evidence suggests that these psychiatric and sensory symptoms exert greater influence on quality of life (QOL) than tics themselves. However, much remains uncertain about determinants of QOL in TS due to the complexity of the clinical presentation. Here, we sought to clarify the association between health-related QOL (HRQOL) and common psychiatric and sensory symptoms in adults with TS and other chronic tic disorders. To do so, we prospectively recruited 52 patients from a tertiary care clinic to complete self-report measures assessing HRQOL (Gilles de la Tourette-Quality of Life Scale, GTS-QOL), depression (Patient Health Questionnaire-9, PHQ-9), anxiety (Generalized Anxiety Disorder Scale-7, GAD-7), obsessive-compulsive symptoms (Dimensional Obsessive-Compulsive Scale, DOCS), attention deficit hyperactivity disorder symptoms (Adult ADHD Self-Report Screening Scale for DSM-5, ASRS-V), and premonitory urge (Premonitory Urge to Tic Scale, PUTS). All participants were also administered the Yale Global Tic Severity Scale (YGTSS) to quantify tic severity. Using correlational analysis and multivariable linear regression modeling, we found that GTS-QOL score was significantly associated with scores from all other rating scales, with the exception of the PUTS. GTS-QOL was most strongly associated with PHQ-9, followed by ASRS-V, GAD-7, DOCS, and YGTSS total tic score. The regression model including these five independent variables, as well as sex, explained 79% of GTS-QOL score variance [ = 29.6, < 0.001]. Specific psychiatric symptoms differentially impacted physical, psychological, and cognitive HRQOL. Systematic assessment of psychiatric comorbidities is imperative for clinical care and clinical research efforts directed at improving QOL in adults with chronic tic disorders.
抽动是图雷特综合征（TS）的标志性特征，但精神症状和感觉症状广泛存在，并且越来越被认为是该疾病的核心表现。越来越多的证据表明，这些精神症状和感觉症状对生活质量（QOL）的影响比抽动本身更大。然而，由于临床表现的复杂性，关于TS患者生活质量的决定因素仍有很多不确定之处。在此，我们试图阐明患有TS和其他慢性抽动障碍的成年人中，健康相关生活质量（HRQOL）与常见精神症状和感觉症状之间的关联。为此，我们从一家三级护理诊所前瞻性招募了52名患者，以完成自我报告测量，评估HRQOL（图雷特生活质量量表，GTS-QOL）、抑郁（患者健康问卷-9，PHQ-9）、焦虑（广泛性焦虑障碍量表-7，GAD-7）、强迫症状（维度强迫量表，DOCS）、注意力缺陷多动障碍症状（成人注意力缺陷多动障碍自我报告筛查量表，用于DSM-5，ASRS-V）以及抽动前冲动（抽动前冲动量表，PUTS）。所有参与者还接受了耶鲁全球抽动严重程度量表（YGTSS）以量化抽动严重程度。通过相关性分析和多变量线性回归建模，我们发现GTS-QOL评分与所有其他评定量表的评分均显著相关，但PUTS除外。GTS-QOL与PHQ-9的相关性最强，其次是ASRS-V、GAD-7、DOCS和YGTSS抽动总分。包含这五个自变量以及性别的回归模型解释了GTS-QOL评分方差的79%[F = 29.6，P < 0.001]。特定的精神症状对身体、心理和认知HRQOL有不同影响。对于旨在改善慢性抽动障碍成年人生活质量的临床护理和临床研究工作而言，系统评估精神共病至关重要。
