Mendez M F, Mirea A
Department of Neurology, University of California at Los Angeles and West Los Angeles VA Medical Center, 90073, USA.
Mov Disord. 1998 Sep;13(5):825-8. doi: 10.1002/mds.870130512.
Stereotypic movement disorders (SMD) such as head-banging, which are common among children with mental retardation or pervasive developmental disorders, may also occur in intellectually normal adults. We report a 27-year history of daily head-banging with self-injury in a 49-year-old man with normal cognition. The patient had no personal or family history of Tourette's syndrome, tic disorder, obsessive-compulsive disorder (OCD), or mental retardation. The frequency of his stereotypical head-banging increased with anxiety, loud noises with startle, and boredom. He reported a sense of pleasure from his head-banging, and the frequency of this behavior decreased when he was treated with the opioid antagonist naltrexone. Although not diagnostic, the self-stimulatory or pleasurable component of head-banging, body-rocking, thumb-sucking, and other SMD may help distinguish them from tics, Tourette's syndrome, OCD, and deliberate self-harming behavior. This report reviews the disorders associated with SMD and discusses the potential mechanisms for these behaviors. The treatment of SMD includes drugs that work through opioid, serotonergic, or dopaminergic systems.
刻板运动障碍（SMD），如撞头，在智力发育迟缓或广泛性发育障碍的儿童中很常见，在智力正常的成年人中也可能出现。我们报告了一名49岁认知正常男性有27年每日撞头并伴有自我伤害行为的病史。该患者没有抽动秽语综合征、抽动障碍、强迫症（OCD）或智力发育迟缓的个人或家族史。他刻板撞头的频率会因焦虑、伴有惊吓反应的巨响和无聊而增加。他称撞头能带来愉悦感，当使用阿片类拮抗剂纳曲酮治疗时，这种行为的频率降低。尽管不能作为诊断依据，但撞头、身体摇晃、吮拇指及其他SMD的自我刺激或愉悦成分可能有助于将它们与抽动、抽动秽语综合征、OCD及故意自我伤害行为区分开来。本报告回顾了与SMD相关的疾病，并讨论了这些行为的潜在机制。SMD的治疗包括作用于阿片类、5-羟色胺能或多巴胺能系统的药物。
