Swedo S E, Leonard H L
Child Psychiatry Branch, National Institute of Mental Health, Bethesda, Md. 20892.
J Clin Psychiatry. 1994 Mar;55 Suppl:32-7.
Recent investigations of childhood-onset obsessive compulsive disorder (OCD) and pediatric movement disorders such as tics, Tourette's syndrome (TS), and Sydenham's chorea suggest that these disorders may be related. Although comorbid obsessive-compulsive symptoms have long been recognized in individuals with TS, more recent studies have demonstrated that tics and TS are surprisingly common in children with primary OCD, and further, that the two disorders seem to have a common genetic vulnerability. Obsessive-compulsive symptoms are also manifest in Sydenham's chorea, a neurologic variant of rheumatic fever in which antistreptococcal antibodies are thought to cross-react with neuronal tissue, particularly within the basal ganglia, and cause inflammatory changes resulting in neuropsychiatric symptomatology. The frequent comorbidity of OCD and Sydenham's chorea and similar postulates of basal ganglia dysfunction for both disorders suggest that Sydenham's chorea may serve as a medical model for OCD. Of note, however, is that the medications (e.g., neuroleptics) that are effective in treating this and other movement disorders are distinctly different from those that are efficacious for OCD (e.g., serotonin reuptake blockers). Examinations of the similarities and differences among these various neuropsychiatric conditions may lead to greater understanding of the pathophysiology of OCD and offer further insights into the etiology and treatment of this troubling disorder.
近期对儿童期起病的强迫症（OCD）以及小儿运动障碍（如抽动、妥瑞氏综合征（TS）和 Sydenham 舞蹈病）的研究表明，这些疾病可能存在关联。尽管长期以来人们已认识到 TS 患者存在共病的强迫症状，但最近的研究表明，抽动和 TS 在原发性 OCD 儿童中出奇地常见，此外，这两种疾病似乎具有共同的遗传易感性。强迫症状在 Sydenham 舞蹈病中也有表现，Sydenham 舞蹈病是风湿热的一种神经学变体，其中抗链球菌抗体被认为与神经元组织发生交叉反应，特别是在基底神经节内，并引起炎症变化，导致神经精神症状。OCD 与 Sydenham 舞蹈病的频繁共病以及两种疾病类似的基底神经节功能障碍假说表明，Sydenham 舞蹈病可能是 OCD 的一种医学模型。然而，值得注意的是，有效治疗这种及其他运动障碍的药物（如抗精神病药物）与对 OCD 有效的药物（如 5-羟色胺再摄取阻滞剂）明显不同。对这些各种神经精神疾病之间异同的研究可能会加深对 OCD 病理生理学的理解，并为这种令人困扰的疾病的病因和治疗提供进一步的见解。
