Nishida H, Shinbo Y, Motomura H
Kuramitsu Clinic, Faculty of Medicine, Kyushu University.
Seishin Shinkeigaku Zasshi. 1994;96(1):26-47.
There is no established theory on pathogenesis of Tourette's syndrome, but recently, a theory of the British school of behaviorism; 'transient tics' and the more serious case, Tourette's syndrome which ensues on the fixation of the startle reflex, have received attention. So we determined, whether pathogenesis and symptoms of Tourette's syndrome could be systematically explained by "the startle reflex theory". Authors assumed that the startle reflex was composed of two divided actions, a series of muscular movements which started with eye blinks and terminated in the flexion of lower limbs (the primary startle reflex system), and more purposeful and complicated actions which occasionally arose from these movements (the secondary startle reflex system). On the basis of this supposition, we considered simple tics which are usually called "tics", those are the manifestation of astonishment by the primary startle reflex system, and complex tics; echo phenomena, coprolalia, complex movements, and so on, which are said to be pathognomonic of Tourette's syndrome, are the expression of amazement by the secondary startle reflex system. Furthermore, we formulated a hypothesis that in the latter case, the secondary startle reflex system contains the senses of orientation and defense, and the defense mechanism which is innately imprinted in common throughout human race, and covered through individual development, is released and fixed in the form of complex movements or echo phenomena in an emergency, such as astonishment. To discuss further, we determined Latah reaction minutely (especially in "Imu" of the Ainu race in Japan) in which intricate symptoms had been suggested as one of the senses of defense, were closely related to Tourette's syndrome. For more concrete study, we presented two severe cases of Tourette's syndrome. Considering the circumstances mentioned above, pathogenesis and symptoms of Tourette's syndrome could be explained by the startle reflex theory. Finally, we analyzed several psychiatrical syndromes which were provoked by astonishment, we concluded that it was necessary to emphasize Tourette's syndrome was only a part of those more comprehensive syndromes which could be called "startle syndromes".
目前尚无关于抽动秽语综合征发病机制的确立理论，但最近，英国行为主义学派的一种理论；“短暂性抽动”以及更严重的情况，即因惊吓反射固定而引发的抽动秽语综合征，受到了关注。因此，我们确定抽动秽语综合征的发病机制和症状是否可以通过“惊吓反射理论”得到系统解释。作者假设惊吓反射由两个分开的动作组成，一系列从眨眼开始并以下肢屈曲结束的肌肉运动（初级惊吓反射系统），以及偶尔从这些运动中产生的更具目的性和复杂性的动作（次级惊吓反射系统）。基于这一假设，我们认为通常被称为“抽动”的简单抽动是初级惊吓反射系统惊讶的表现，而复杂抽动；模仿现象、秽语症、复杂动作等，这些被认为是抽动秽语综合征的特征性表现，是次级惊吓反射系统惊讶的表达。此外，我们提出了一个假设，在后一种情况下，次级惊吓反射系统包含定向和防御的感觉，以及人类共有的、通过个体发育被掩盖的先天防御机制，在诸如惊讶等紧急情况下，以复杂动作或模仿现象的形式释放并固定下来。为了进一步讨论，我们详细研究了拉塔病反应（特别是日本阿伊努族的“伊穆”），其中复杂的症状被认为是防御感觉之一，与抽动秽语综合征密切相关。为了进行更具体的研究，我们展示了两个严重的抽动秽语综合征病例。考虑到上述情况，抽动秽语综合征的发病机制和症状可以通过惊吓反射理论来解释。最后，我们分析了由惊讶引发的几种精神综合征，我们得出结论，有必要强调抽动秽语综合征只是那些更全面的综合征的一部分，这些综合征可以被称为“惊吓综合征”。
