Miguel E C, Coffey B J, Baer L, Savage C R, Rauch S L, Jenike M A
Department of Psychiatry, Massachusetts General Hospital, Boston, USA.
J Clin Psychiatry. 1995 Jun;56(6):246-55.
Recent evidence suggests that obsessive-compulsive disorder (OCD) and Tourette's disorder are related and have overlapping clinical features. The purpose of this study was to test the following hypotheses regarding intentional repetitive behaviors in these two disorders: (1) In OCD without comorbid Tourette's, they are preceded by cognitive phenomena and autonomic anxiety, but not sensory phenomena, and (2) in Tourette's without comorbid OCD, they are preceded by sensory phenomena, but not cognitive phenomena nor autonomic anxiety.
Fifteen adult OCD outpatients without tics and 17 adult Tourette's outpatients without OCD were evaluated with a structured interview. Questions assessed cognitive, sensory, and affective experiences related to intentional repetitive behaviors.
Five of 17 Tourette's subjects were excluded because they had only unintentional or occasionally intentional tics. All OCD patients reported some cognitions preceding their intentional repetitive behaviors, whereas only 2 of 12 Tourette's patients reported cognitions. In comparison, all Tourette's patients reported sensory phenomena preceding repetitive behaviors, and none of the OCD patients reported such sensations. In addition, 13 OCD patients reported at least mild autonomic anxiety associated with their repetitive behaviors, whereas no Tourette's patients reported such symptoms.
Intentional repetitive behaviors in OCD differ from those in Tourette's and are associated with cognitive and autonomic phenomena. Sensory phenomena preceded intentional repetitive behaviors in Tourette's but not in OCD patients. The dimensions examined in this study (cognition, sensory phenomena, and autonomic anxiety) may represent valid clinical factors for characterization of repetitive behaviors in OCD and Tourette's.
最近的证据表明，强迫症（OCD）和抽动秽语综合征相关，且具有重叠的临床特征。本研究的目的是检验关于这两种疾病中有意重复行为的以下假设：（1）在无共病抽动秽语综合征的强迫症中，有意重复行为之前存在认知现象和自主神经焦虑，但不存在感觉现象；（2）在无共病强迫症的抽动秽语综合征中，有意重复行为之前存在感觉现象，但不存在认知现象和自主神经焦虑。
对15名无抽动症状的成年强迫症门诊患者和17名无强迫症的成年抽动秽语综合征门诊患者进行结构化访谈评估。问题涉及与有意重复行为相关的认知、感觉和情感体验。
17名抽动秽语综合征患者中有5名被排除，因为他们只有无意或偶尔有意的抽动。所有强迫症患者均报告在有意重复行为之前有一些认知，而12名抽动秽语综合征患者中只有2名报告有认知。相比之下，所有抽动秽语综合征患者均报告在重复行为之前有感觉现象，而无强迫症患者报告有此类感觉。此外，13名强迫症患者报告至少有与重复行为相关的轻度自主神经焦虑，而无抽动秽语综合征患者报告有此类症状。
强迫症中的有意重复行为与抽动秽语综合征中的不同，且与认知和自主神经现象相关。感觉现象先于抽动秽语综合征中的有意重复行为，而强迫症患者中则不然。本研究中所考察的维度（认知、感觉现象和自主神经焦虑）可能是表征强迫症和抽动秽语综合征中重复行为的有效临床因素。
