抽动障碍患儿的行为问题及其个性特征

背景儿童心理行为障碍性疾病影响儿童的生长发育中行为及个性特征的形成.目的探讨抽动障碍患儿的心理行为问题及个性特征.设计以抽动障碍儿童为观察对象,健康儿童为对照组的调查分析.单位黑龙江省大庆油田总医院集团儿科.对象选择2003-02/2004-12在黑龙江省大庆油田总医院集团儿科门诊就诊的符合抽动障碍诊断的患儿110例(患儿组),男92例,女18例.以不同表现形式又分为3组,短暂性抽动障碍组46例,慢性抽动或发声障碍组34例,抽动-秽语综合征组30例.入选病例均为新诊断病例,未服用任何其他药物,排除颅内器质性疾病.选择同期本院健康体检儿童30人为对照组,年龄7～14岁,男24例,女6例.以上参与者监护人均知情同意.方法①采用Achenbach儿童行为量表筛查儿童的社交能力和行为能力(包括13条行为问题.每一条行为问题有一个分数称为粗分,113条的粗分称为总粗分.按照年龄把113条行为问题归纳为9个因子,即体诉、交往不良、强迫性、违纪、多动、分裂样、不成熟、敌意性、攻击性,把每一因子所包括条目的粗分加起来,就是这个因子的分数),将因子分与文章选择定的健康的行为正常儿童为对照,判断该儿童是否具有该项行为异常,各因子分与健康对照越接近,该方面的行为问题越少,社会能力越强.②采用儿童艾森克个性问卷{4个人格类型的基本维度为内外向型、神经质、精神质、一个效度量表(掩饰性).掩饰性维度标准分＞70表示评定无效,神经质维度标准分＞61.5表示神经质非常明显,内外向、神经质维度标准分＞56.7表示情绪不稳定或有此倾向,内外向维度标准分＞56.7,神经质维度标准分＜43.3为(外向)多血质气质类型或具有多血质倾向,神经质维度、内外向维度标准分均＜43.3为(内向)黏液质气质类型或具有黏液质倾向,内外向维度标准分＜43.3,神经质维度标准分＞56.7为抑郁质气质类型或具有抑郁质倾向}评估患儿的个性特征,并与健康对照组比较.主要观察指标两组Achenbach儿童行为量表、艾森克个性问卷评分结果比较.结果110例抽动障碍患儿和健康儿童30人均完成调查.①抽动障碍患儿的Achenbach儿童行为量表总分高于对照组(t=3.12～8.60,P＜0.01);其中短暂性抽动障碍组多动因子分明显高于对照组(t=2.01,P＜0.05);慢性抽动或发声障碍及抽动-秽语综合征组抑郁/焦虑、交往不良、强迫行为、社交退缩、多动、攻击性因子分均高于对照组(t=2.11～7.65,P＜0.05～0.01),3种类型抽动障碍患儿社会功能维度中活动情况、社交情况、学校情况因子分及社会能力总分均明显低于对照组(t=1.97～7.31,P＜0.05～0.01).②艾森克个性问卷中神经质和精神质分量表总分高于对照组(t=2.76～4.32,P＜0.05～0.01),而掩饰性量表总分低于对照组(t=3.49～6.38,P＜0.05).结论抽动障碍患儿存在较多行为问题、个性缺陷,社会能力低;在抽动障碍各型中,短暂性抽动障碍的患病率相对较高,且行为异常的因子其他两型,只存在多动因子的异常;慢性抽动障碍和抽动-秽语综合征患儿较短暂性抽动障碍患儿存在更多的行为因子异常.

Behavior disorders and personality in children with tic disorders

BACKGROUND:Psychological disorder and behavior disorders can affect the development of behavior and personality in children.OBJECTIVE:To investigate the behavior disorders and the personality in children with tic disorders (TD).DESIGN:A comparative investigation between TD children and the healthy controls.SETTING:It was conducted at the Department of Pediatrics,Daqing Oil Felid General Hospital in Heilongjiang ProvincePARTICIPANTS:Totally 110 outpatients including 92 males and 18females, diagnosed as TD at the Department of Pediatrics, Daqing Oil Felid General Hospital,were selected (TD group) from February 2003 to December 2004.According to the clinical manifestations,they were divided into transient tic disorder group (46 cases),chronic motor/vocal tic disorder group (34 cases) and Tourette Syndrom (TS) group(30 cases).All the patients were newly diagnosed without any medication and intracranial organic diseases. Meanwhile,30 children with normal physical examination findings, between the ages of 7 and 14,24 males and 6 females, were selected as controls. Informed consents were obtained from guardians of all the participants.used to measure the children's social skills and behaviors (It contains a 113-item behavior problems scale. According to the children's ages,the items were classified into 9 factors,including somatic complains,poor social skills,compulsions,undisciplined,hyperactivity,Asperger syndrome,immaturity,hostility and aggressiveness.The scores of referring items constitute the total score of each factor).Comparison of these scores between patients and healthy controls is helpful to determine if a factor in affected children is abnormal. The closer the relationship between the patients and the controls is, the less behavioral problems Personality Questionnaire (EPQ) was adopted in this study to evaluate the personality in the patients compared to healthy controls.{There were four major dimensions of personality including introversion/extraversion,neuroticism,psychoticism and validity questionnaire (construct validity).When the validity score was over 70,it represented that the EPQ was invalid.An over-61.5 neuroticism score represented an apparent neuroticism tendency. Once the neuroticism score and introversion/extraversion score were over 56.7,mental instability or instable tendency could be suspected. When introversion/extraversion score was over 56.7and the neuroticism (extraversion) score was less than 43.3,it represented a sanguine personality or such tendency. When both of the neuroticism score and introversion/extraversion score were less than43.3 (introversion),it revealed a phlegmatic personality or such tendency. And when the introversion/extraversion score was less than43.3 with neuroticism score over 56.7,it represented a melancholic personality or such tendency.}MAIN OUTCOME MEASURES:Comparison of Achenbach's CBCLand EPQ between patients and healthy controls .RESULTS:Totally 110 TD patients and 30 healthy children completed the control group (t=3.12-8.60, P ＜ 0.01).The hyperactivity score in the transient tic group was significantly higher than that in the control group (t=2.01, P ＜ 0.05). In the chronic motor tic disorder group and the TS group,the scores of depression/anxiety,poor social skills,compulsions,social withdrawal,hyperactivity and aggression were all higher than those in the control group(t=2.11-7.65, P ＜ 0.05-0.01).In all of these three TD groups, score factors relating to social functions,such as movements, social skills and school life were apparently lower than those in the control group (t= 1.97-7.31, P ＜ 0.05-0.01).(t=2.76-4.32, P ＜ 0.05-0.01), while the score of validity questionnaire was lower than that in control group (t=3.49-6.38, P ＜ 0.05).CONCLUSION:It reveals that TD patients have many behavioral problems,personality defects and poor social skills. Of all the TD groups,the transient tic group has a higher occurrence rate of disease and only one abnormal factor, hyperactivity. While,the chronic motor tic disorder group and the TS group have more abnormal behavioral factors.