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抽动障碍(tic disorders,TD)由Itard(1825年)首先描述,随后由Gilles de la Tourette(1885年)首次报道,是指于儿童和青少年时期起病,以运动性抽动(motor tics)和(或)发声性抽动(vocal tics)为特征的神经精神疾病[1-2]。半数以上TD存在共患病,近年来发病有增多趋势。现将TD诊断要点简述如下。1临床特征1.1起病年龄TD起病年龄为2～21岁;男性明显多于女性,男女之比为(3～5):1;多见于学龄前期和学龄期儿童,以5～10岁最多见[3]。TD患儿的病情通常在10～12岁最严重。     

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抽动障碍(tic disorders,TD)是儿童期常见的一种慢性心理行为疾病,临床可分为3种类型:短暂性TS、慢性运动或发声TD、Tourette综合征(TS)即发声与多种运动联合TD,其中以TS最为典型。目前,有关儿童TD的病因及发病机制仍不完全清楚,多数学者认为该病可能是由多种因素,包括遗传因素、生物因素、心理和环境因素等在儿童生长发育过程中相互作用的综合结果。1遗传因素大量研究表明,TS是一种具有明显遗传倾向的神经精神性疾病[1-2]。一般认为,TS遗传方式为常染色体不完全     

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抽动障碍(tic disorders,TD)尤其是Tourette综合征(Tourette syndrome,TS)患儿存在很多行为与情绪问题,共患精神障碍的发生率很高[1]。这些共患病和行为问题及抽动症状本身均严重干扰患儿的学习和生活,恶化其社会人际关系,因此有必要对其进行全面系统评估,为治疗提供依据,并有针对性的采用心理治疗,控制抽动症状、缓解心理压力,促进患儿全面康复。1TD心理评估1.1行为评定量表和访谈问卷     

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抽动障碍(tic disorders,TD)是一种起病于儿童和青少年时期,以不随意突发、快速、重复、非节律性、刻板单一或多部位肌肉运动和(或)发声抽动为特点的一种复杂、慢性神经精神障碍。由于运动和(或)发声抽动经常使患者缺乏自尊,导致家庭生活、社会形象及学习和工作表现受损和环境适应困难。抽动症状根据抽动部位不同可分为运动抽动与发声抽动,根据复杂程度可分为简单抽动及复杂抽动。根据发病年龄、临床表现、病程长短和是否同时伴有发声抽动而分为:短暂性TD;慢性运动或发声TD;发声     

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近年来抽动障碍(tic disorders,TD)的发生有所增加,难治病例也并不少见。因此,早期诊断、早期治疗TD十分重要,必要的鉴别诊断是保证医疗安全的必备步骤。TD需与儿童期可能出现运动障碍和抽动的疾病相鉴别,为确保诊断准确无误,首先应获得准确的由家属或患儿本人提供的病史,若能观察到患儿家属提供的发作时录像则对诊断更有帮助。另外,若家属配合,进行头部磁共振成像(MRI)、视频脑电图(EEG)或24h动态EEG、必要的血清学检查对鉴别诊断有益。现将主要需要鉴别疾病列举如下。     

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儿童抽动障碍(tic disorders,TD)治疗方法很多,目前主要以药物治疗为主,如氟哌啶醇、利培酮、硫必利等已成为治疗经典用药,随着对TD研究不断深入,尤其是对于药物难治性TD儿童患者,脑电生物反馈(electroencep halogram biofeedback)、深部脑刺激(deep brain stimulation,DBS)、经颅磁刺激(transcranial magnetic stimulation,TMS)等非药物性治疗方法正日益受到国内外许多研究者关注。本文将对儿童TD脑电生物反馈及神经调控治疗进行阐述。     

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抽动障碍(tic disorder,TD)的预防包括病因学预防、对家长和照管者的健康教育,对该疾病早期发现、早期诊断。预防工作主要是预防疾病复发,减少患儿功能损害,提高生活质量。1TD的预防1.1减少外界致病因素或诱发因素TD病因不明,目前研究认为,TD与遗传、免疫、神经递质异常及心理社会因素等多种因素相关[1-3]。减少母孕期和出生时不利因素,做到     

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目的引进耶鲁抽动症整体严重度量表(YGTSS)并评估其与临床症状轻重的关系,以及以量表积分在观察者间的一致性。方法2001年7月至2002年6月成都市儿童医院全文翻译YGTSS,未予修改,观察72例抽动患儿YGTSS总积分与临床抽动症状严重度分型的关系和该量表积分进步率与治疗后症状改善程度的关系(临床效度检验),观察24例患儿该量表运动和发声抽动数量、频度、强度、复杂性、干扰性5个维度积分及总积分在观察者间一致性。结果抽动患儿该量表总积分与临床抽动症状严重度分型之间和该量表积分进步率与治疗后症状改善程度之间有较好的效度(F值分别为59·31和124·44,P均<0·01),运动和发声抽动数量、频度、强度、复杂性、干扰性5个维度积分及总积分的组内相关系数(ICC)值均大于0·7,显示较好的观察者间一致性。结论耶鲁抽动症整体严重度量表中译本具有较好的信度和效度,是衡量抽动症状严重程度的工具之一。     

Youth meeting symptom and impairment criteria for mania-like episodes lasting less than four days: an epidemiological enquiry

Background: Little is known about short‐duration episodes of mania‐like symptoms in youth. Here we determine the prevalence, morbid associations, and contribution to social impairment of a phenotype characterised by episodes during which symptom and impairment criteria for mania are met, but DSM‐IV duration criteria are not (bipolar not otherwise specified; BP‐NOS). Methods: A cross‐sectional national survey of a sample (N = 5,326) of 8–19‐year‐olds from the general population using information from parents and youth. Outcome measures were prevalence rates and morbid associations assessed by the Developmental and Well‐Being Assessment, and social impairment assessed by the impact scale of the Strengths and Difficulties Questionnaire. Results: While only seven individuals (.1%) met definite or probable DSM‐IV criteria for BPI or BPII, the prevalence of BP‐NOS was 10‐fold higher, 1.1% by parent report and 1.5% by youth report. Parent–youth agreement was very low: κ = .02, p > .05 for BP‐NOS. Prevalence and episode duration for BP‐NOS did not vary by age. BP‐NOS showed strong associations with externalising disorders. After adjusting for a dimensional measure of general psychopathology, self‐reported (but not parent‐reported) BP‐NOS remained associated with overall social impairment. Conclusions: BP meeting full DSM‐IV criteria is rare in youth. BP‐NOS, defined by episodes shorter than those required by DSM‐IV, but during which DSM‐IV symptom and impairment criteria are met, is commoner and may be associated with social impairment that is beyond what can be accounted for by other psychopathology. These findings support the importance of research into these short episodes during which manic symptoms are met in youth but they also call into question the extent to which BP‐NOS in youth is a variant of DSM‐IV BP – superficially similar symptoms may not necessarily imply deeper similarities in aetiology or treatment response.     

Three dimensions of oppositionality in youth

Background: Oppositional defiant disorder (ODD) in youth is a strong predictor of mental illness yet the wide range of associations with psychiatric disorders remains largely unexplained. The aim of this study was to investigate whether the identification of irritable, headstrong and hurtful dimensions within youth oppositionality would clarify the pattern of associations between oppositionality and a wide range of psychopathology in early and adult life. Methods: Cross‐sectional data from national mental health surveys including 18,415 subjects aged 5–16 in the United Kingdom. The main outcome measures were the associations between a priori hypothesised dimensions of oppositionality with psychiatric disorders and symptoms; parent and teacher‐derived information were used in multivariate regression analysis. Results: Our three a priori dimensions had very different associations with disorders and symptom scales. Irritability was the only predictor of emotional disorders (parent report: OR = 3.26 [CI 95% 2.79, 3.80]; teacher report: OR = 2.78 [2.39, 3.22]); the hurtful dimension was particularly strongly associated with seeming cold‐blooded or callous (parent report: β = .32 [.27, .37]; teacher report: .33 [.30, .36]); and the headstrong dimension was most strongly associated with attention deficit hyperactivity disorder (ADHD; parent report: OR = 3.21 [2.43, 4.23]; teacher report : OR = 7.18 [5.25, 9.82]). All three dimensions were associated with conduct disorder, with the headstrong dimension being the main predictor of non‐aggressive symptoms (parent report: β = .31 [.27, .34]; teacher report: .43 [.40, .45]), and with the hurtful dimension being the main predictor of aggressive symptoms (parent report: β = .35 [.32, .39]; teacher report: .40 [.39, .42]). Conclusions: The three dimensions of oppositionality have distinctive external correlates, suggesting they may also be differential predictors of aetiology, prognosis and treatment responsiveness.     

父母的子女教育心理控制对伴或不伴对立违抗障碍的注意缺陷多动障碍患儿的影响

目的 从心理控制源的角度探讨父母教育对伴或不伴对立违抗障碍(ODD)的注意缺陷多动障碍(ADHD)患儿的影响.方法 对湖南省长沙、益阳、娄底、郴州、水州、怀化6个城市5～17岁中小学生采用分层、随机、整群的抽样方法 进行抽样调查,共抽样9 495例儿童.采用二阶段流行病学调查方法 .第一阶段筛查,即由凋查儿童的父母、教师或抚养者填写儿童精神障碍调查筛查表(自编),凡父母或教师所填的症状筛查表有一条为"是"或ADHD、ODD诊断量表中任一个达到该疾病的诊断条目数者为筛查阳性;第二阶段为临床诊断,调查者对筛查阳性的中小学生用半定式诊断检查表和<美国精神疾病诊断与统计手册>4版进行临床诊断.确定单纯ADHD组247例,ADHD加ODD组138例,健康对照组217例.凡符合诊断标准的ADHD儿童和随机抽取的健康对照组儿童由父母填写一般情况调查表和子女教育心理控制源量表(PLOC).结果1.健康对照组与单纯ADHD组比较,母亲教育方式和父母教养态度比较差异均具有统计学意义(Pa＜0.01).健康对照组与ADHD加ODD组比较,父母亲教育方式和父母教养态度,差异均具有统计学意义(Pa＜0.01).2.单纯ADHD组与健康对照组比较,教育成效与子女对父母生活的控制因子评分较高,而父母对命运或机遇信念因子评分较低,差异均具有统计学意义(Pa＜0.05).3.ADHD加ODD组与健康对照组比较,教育成效因子评分与父母对子女行为的控制因子评分较高,差异均具有统计学意义(Pa＜0.01).4.单纯ADHD组与ADHD加ODD组比较,父母对子女行为的控制因子评分较低,差异具有统计学意义(P＜0.01).结论父母负性心理控制源与伴或不伴ODD的ADHI)患儿的不良行为发生、发展有一定联系,应改变父母对孩子教育认知的偏差.     

Time to redefine the diagnosis of oppositional defiant disorder

Oppositional defiant disorder (ODD) is a common and difficult problem that is regularly seen in general paediatric practice. Although classified as an independent diagnosis, ODD very commonly coexists with attention‐deficit/hyperactivity disorder (ADHD) but in contrast to the latter, there are few studies that deal specifically with ODD and there is a lack of formal management guidelines. However, if ODD was included as a subtype of ADHD, this exclusion would not be sustainable. This would make guidelines more helpful and relevant for Australian paediatricians who currently have little support beyond their own clinical experience in dealing with this often very disabling condition.     

单纯与共患对立违抗障碍的注意缺陷多动障碍儿童事件相关电位研究

目的探讨注意缺陷多动障碍(ADHD)儿童和ADHD共患对立违抗障碍(ODD)儿童与正常儿童相比对冲突的监测功能及解决能力的差异。方法对15例ADHD儿童、18例ADHD共患ODD儿童和18例正常儿童,进行事件相关电位(ERP)测试。结果 ERP显示,病例组(ADHD与ADHD共患ODD组)Go刺激的反应时高于正常对照组,正确率低于对照组,差异有统计学意义;Nogo刺激的反应时和正确率与正常对照组的差异无统计学意义。病例组Go-N2,Nogo-N2的潜伏期均大于对照组,差异有统计学意义,两病例组间无差别。病例组Nogo-P3b的波幅较正常组小,两病例组之间无差别。结论 ADHD儿童对冲突的监测能力延迟;对冲突的决策处理能力减弱,尤其是在对冲突处理的后半程。     

Sleep patterns in children with attention-deficit/hyperactivity disorder, tic disorder, and comorbidity

BACKGROUND: In children, attention-deficit/hyperactivity disorder (ADHD), tic disorder (TD), and their coexistence (ADHD + TD comorbidity) are very common and clinically important. Associated sleep patterns and their clinical role are still insufficiently investigated. This study aimed at characterizing these sleep patterns in children with ADHD, TD, and ADHD + TD comorbidity and determining whether, in ADHD + TD, the factors ADHD and TD may affect the sleep pattern in an independent (additive) or in a complex (interactive) manner. METHOD: By means of polysomnography, sleep patterns were investigated in 4 groups of unmedicated 8.0-16.4-year-old children (healthy controls, ADHD-only, TD-only, and ADHD + TD). Each group consisted of 18 subjects matched for age, gender, and intelligence. RESULTS: ADHD was primarily characterized by increase in rapid eye movement (REM) sleep, whereas TD patients displayed lower sleep efficiency and elevated arousal index in sleep. In children with ADHD + TD, both effects appeared. No interaction between the ADHD and TD factors was found for any of the sleep parameters. Significant correlations between sleep patterns and clinical symptoms were found. CONCLUSIONS: ADHD and TD are characterized by specific sleep alterations. When coexisting, the two disorders alter the sleep pattern in an additive manner, suggesting a high impact on clinical and therapeutic perspectives.     

Which better predicts conduct problems? The relationship of trajectories of conduct problems with ODD and ADHD symptoms from childhood into adolescence

BACKGROUND: To assess the co-occurrence in deviant trajectories of parent-rated symptoms of conduct disorder (CD), oppositional defiant disorder (ODD) and attention-deficit/hyperactivity disorder (ADHD) from age 4 to 18 years old in a general population sample of Dutch children. METHODS: Developmental trajectories of CD, ODD, and ADHD were estimated in a sample of 1,016 males and 1,060 females. Children's disruptive problem behaviors were rated at 5 time-points. The co-occurrence patterns between the deviant CD trajectory, and the high ODD and high ADHD trajectory were studied for males and females separately. RESULTS: Four percent of males and 2% of females followed a deviant CD trajectory. Six percent of the sample followed a high ODD trajectory, and 5% a high ADHD trajectory. Engagement in the deviant CD trajectory was predicted by ODD and ADHD in females, but only by ODD in males. CONCLUSIONS: Although ADHD co-occurs with CD, the association between ADHD and CD is largely accounted for by accompanying ODD. Gender differences should be taken into account in understanding the onset of CD.     

Biological, psychological and social processes in the conduct disorders

BACKGROUND: This paper reviews recent evidence on the causes and maintenance of aggressive and disruptive behaviours in childhood and adolescence. It considers the relative merits of several different ways of conceptualising such problems, in relation to the contribution of biological, psychological and social factors. METHOD: It focuses on conduct problems appearing in young childhood, which greatly increase the likelihood of persistent antisocial behaviours in adolescence and adult life in association with wider interpersonal and social role impairments. It considers the contribution of individual factors, including impaired verbal skills, deficits in executive functions, and an imbalance between behavioural activation and inhibition systems. These are viewed in interaction with commonly associated environmental disadvantages such as hostile or intrusive parenting. The roles of attributional biases, unrealistic self-evaluations, and insecure attachment are considered in relation to affect regulation, and effective social action. The contributions of the wider social environments of peers, neighbourhood and socio-economic conditions are evaluated. CONCLUSIONS: The paper concludes that, although considerable progress has been made over the past ten years, there is a need to further refine our conceptualisation of the behaviours to be explained, to develop a coherent theory of the causal and maintaining processes, and to carry out prospective studies with adequate numbers of high risk children.     

Prevalence of psychiatric disorders in preschoolers

Background: Many disorders in childhood and adolescence were already present in the preschool years. However, there is little empirical research on the prevalence of psychiatric disorders in young children. A true community study using structured diagnostic tools has yet to be published. Methods: All children born in 2003 or 2004 in the city of Trondheim, Norway, who attended the regular community health check‐up for 4‐year‐olds (97.2% of eligible children) whose parents consented to take part in the study (N = 2,475, 82.0%) were screened for behavioral and emotional problems with the Strengths and Difficulties Questionnaire (SDQ). A screen‐stratified subsample of 1,250 children took part in a furthermore comprehensive study including a structured diagnostic interview (the Preschool Age Psychiatric Assessment, PAPA), which 995 parents (79.6%) completed. Results: The estimated population rate for any psychiatric disorder (excluding encopresis – 6.4%) was 7.1%. The most common disorders were attention deficit hyperactivity disorder (1.9%), oppositional defiant disorder (1.8%), conduct disorder (0.7%), anxiety disorders (1.5%), and depressive disorders (2.0%). Comorbidity among disorders was common. More emotional and behavioral disorders were seen in children whose parents did not live together and in those of low socioeconomic status. Boys more often had attention‐deficit/hyperactivity disorder (ADHD) and depressive disorders than girls. Conclusions: The prevalence of disorders among preschoolers was lower than in previous studies from the USA. Comorbidity was frequent and there was a male preponderance in ADHD and depression at this early age. These results underscore the fact that the most common disorders of childhood can already be diagnosed in preschoolers. However, rates of disorder in Norway may be lower than in the USA.