1
|
Roessner V, Ehrlich S, Backhausen L, Rempel S, Uhlmann A. Heterogeneous courses of obsessive-compulsive disorders-better data on a lifetime perspective urgently needed. Eur Child Adolesc Psychiatry 2022; 31:1-3. [PMID: 35829779 PMCID: PMC9343295 DOI: 10.1007/s00787-022-02043-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Affiliation(s)
- Veit Roessner
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, University Hospital Carl Gustav Carus, TU Dresden, Fetscherstrasse 74, 01307, Dresden, Germany.
| | - Stefan Ehrlich
- grid.412282.f0000 0001 1091 2917Department of Child and Adolescent Psychiatry, Faculty of Medicine, University Hospital Carl Gustav Carus, TU Dresden, Fetscherstrasse 74, 01307 Dresden, Germany ,grid.4488.00000 0001 2111 7257Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine, TU Dresden, Fetscherstrasse 74, 01307 Dresden, Germany
| | - Lea Backhausen
- grid.412282.f0000 0001 1091 2917Department of Child and Adolescent Psychiatry, Faculty of Medicine, University Hospital Carl Gustav Carus, TU Dresden, Fetscherstrasse 74, 01307 Dresden, Germany
| | - Sarah Rempel
- grid.412282.f0000 0001 1091 2917Department of Child and Adolescent Psychiatry, Faculty of Medicine, University Hospital Carl Gustav Carus, TU Dresden, Fetscherstrasse 74, 01307 Dresden, Germany
| | - Anne Uhlmann
- grid.412282.f0000 0001 1091 2917Department of Child and Adolescent Psychiatry, Faculty of Medicine, University Hospital Carl Gustav Carus, TU Dresden, Fetscherstrasse 74, 01307 Dresden, Germany
| |
Collapse
|
2
|
Yan J, Gu Y, Wang M, Cui Y, Li Y. The Obsessive-Compulsive Symptoms in Tic Disorders and the Psychometric Properties of Children's Yale-Brown Obsessive-Compulsive Scale: An Evidence-Based Survey in a Chinese Sample. Front Pediatr 2022; 10:794188. [PMID: 35757143 PMCID: PMC9218257 DOI: 10.3389/fped.2022.794188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 04/27/2022] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Patients with tic disorders (TDs) usually also have obsessive-compulsive disorder (OCD). The severity of obsessive-compulsive symptoms (OCSs) in TD is widely evaluated using the Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS). However, there is no survey on the severity of OCSs in patients with TD based on a Chinese sample, and the reliability and validity of the CY-BOCS in patients with TD have not been well established in China. This study examined the severity of OCSs in TDs and the psychometric properties of the CY-BOCS in Chinese pediatric patients with TD. METHODS A total of 367 patients who were diagnosed with TD [152 with Tourette syndrome (TS)] were enrolled in the Department of Psychiatry at Beijing Children's Hospital in China. The mean age of the patients was 9.21 ± 2.06 years (range: 5-16 years). The Yale Global Tic Severity Scale (YGTSS) and CY-BOCS were used as screening tools. The psychometric properties of the CY-BOCS were assessed using Cronbach's alpha, test-retest reliability, and construct validity. RESULTS The OCSs in TDs were 3.93 ± 5.15 based on the CY-BOCS in the whole sample. The older adolescent group showed higher scores than the young adolescent groups (Z = -3.37, p = 0.001). However, the young adolescent group showed a higher incidence rate of OCSs than the older adolescent group (p < 0.01). Men with TDs also showed a higher incidence rate of OCSs than women (p = 0.03). The reliability and validity analyses of the CY-BOCS showed Cronbach's alpha and test-retest reliability values of 0.81 and 0.82, respectively. The CY-BOCS showed an acceptable level in the two-factor structure (obsession and compulsive) in patients with TD. The comparative fit index (CFI) was 0.84 for TD, 0.86 for Tourette, 0.94 for the younger adolescent group, and 0.74 for the older adolescent group. CONCLUSION More OCSs were identified in the TS group and the older adolescent group with TDs. The CY-BOCS showed good psychometric properties in children and adolescents with TD, especially in younger patients with TD. OCSs might be associated with age and functional impairment of TD.
Collapse
Affiliation(s)
- Junjuan Yan
- Department of Psychiatry, Beijing Children's Hospital, Capital Medical University, National Center for Children Healthy, Beijing, China
| | - Yi Gu
- Department of Psychiatry, Beijing Children's Hospital, Capital Medical University, National Center for Children Healthy, Beijing, China
| | - Mengyu Wang
- Medical Psychology Department, The First Medical Center, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Yonghua Cui
- Department of Psychiatry, Beijing Children's Hospital, Capital Medical University, National Center for Children Healthy, Beijing, China
| | - Ying Li
- Department of Psychiatry, Beijing Children's Hospital, Capital Medical University, National Center for Children Healthy, Beijing, China
| |
Collapse
|
3
|
Rothenberger A, Roessner V. Psychopharmacotherapy of Obsessive-Compulsive Symptoms within the Framework of Tourette Syndrome. Curr Neuropharmacol 2020; 17:703-709. [PMID: 30152283 PMCID: PMC7059153 DOI: 10.2174/1570159x16666180828095131] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 06/30/2018] [Accepted: 08/21/2018] [Indexed: 12/22/2022] Open
Abstract
While Behavioral Therapy (BT) should be recommended as the first step in the treatment of OCD as well as TS, medication can be added for augmentation and in certain situations (e.g. family preference, BT not available or feasible) the priority may even reverse. This narrative review is given on the complexity of drug treatment in patients comorbid with obsessive-compulsive disorder (OCD) and Tourette syndrome (TS) and other tic problems. OCD with TS is a co-occurring combination of the two generally delimitable, but in detail, also overlapping disorders which wax and wane with time but have different courses as well as necessities and options of treatment. Distinct subtypes like “tic-related OCD” are questionable. Obsessive-compulsive symptoms (OCS) and tics are frequently associated (OCS in TS up to 90%, tics in OCD up to 37%). Sensory-motor phenomena like urges and just-right feelings reflect some behavioral overlap. The main additional psychopathologies are attention-deficit hyperactivity disorder (ADHD), mood problems and anxiety. Also, hair pulling disorder and skin picking disorder are related to OCD with TS. Hence, the assessment and drug treatment of its many psychopathological problems need high clinical experience, careful planning, and ongoing evaluation/adaptation. Drugs are able to reduce clinical symptoms but cannot cure the disorders, which should be treated in parallel in their own right; i.e. for OCD serotonin reuptake inhibitors (SSRI) and for TS (tics), certain antipsychotics can be successfully prescribed. In cases of OCD with tics, when OCS responds only partially, an augmentation with antipsychotics (recommended: risperidone and aripiprazole) may improve OCS as well as tics. Also, the benzamide sulpiride, an atypical antipsychotics, may be beneficial in treating the combination of OCS, tics and anxious-depressive problems. Probably, any additional psychopathologies of OCD might attenuate the effectiveness of SSRI on OCS; on the other hand, in cases of OCD with tics, SSRI may reduce not only OCS but also stress sensitivity and emotional problems and thus leading to better selfregulatory abilities, useful to improve tic suppression. In sum, some clinical guidance can be given, but there remain many uncertainties because of a scarce database for psychopharmacotherapy in OCD with TS.
Collapse
Affiliation(s)
- Aribert Rothenberger
- Clinic for Child and Adolescent Psychiatry and Psychotherapy, University Medical Center Gottingen, Gottingen, Germany
| | - Veit Roessner
- Department of Child and Adolescent Psychiatry and Psychotherapy, TU Dresden, Germany
| |
Collapse
|
4
|
Darmahkasih AJ, Rybalsky I, Tian C, Shellenbarger KC, Horn PS, Lambert JT, Wong BL. Neurodevelopmental, behavioral, and emotional symptoms common in Duchenne muscular dystrophy. Muscle Nerve 2020; 61:466-474. [PMID: 31909820 DOI: 10.1002/mus.26803] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 12/26/2019] [Accepted: 12/31/2019] [Indexed: 11/11/2022]
Abstract
INTRODUCTION We studied neurodevelopmental and behavioral/emotional symptoms in patients with Duchenne muscular dystrophy (DMD). METHODS Retrospective case series of neurodevelopmental and behavioral/emotional symptoms obtained through review of systems of 700 DMD patients in relation to dystrophin gene mutations. RESULTS The most common symptoms encountered were emotional/behavioral dysregulation (38.7%), inattention/hyperactive features (31.4%), obsessive and compulsive features (25.0%), and language/speech delays (24.4%). Most patients (72.7%) had at least one symptom. Patients with mutations near the 3' end of the dystrophin gene were at higher risk for developing inattention/hyperactive features, language/speech delays, and global intellectual delays. Those with mutations between exon 31 and 79 had higher risk of clustering of symptoms when compared with those upstream of exon 30. DISCUSSION Neurodevelopmental, emotional, and behavioral symptoms are common comorbidities in DMD. There is higher prevalence of inattention/hyperactive features, language/speech delays, and global intellectual delays in genotypes affecting the 3' end of the dystrophin gene.
Collapse
Affiliation(s)
- Andrew J Darmahkasih
- Pediatric Residency Program, University of California, Irvine/Children's Hospital of Orange County, Orange, California
| | - Irina Rybalsky
- Neurology Division, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Cuixia Tian
- Division of Neurology, Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Karen C Shellenbarger
- Department of Pediatrics, University of Massachusetts Medical School, Worchester, Massachusetts
| | - Paul S Horn
- Division of Neurology, Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Joshua T Lambert
- Neurology Division, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Brenda L Wong
- Department of Pediatrics, University of Massachusetts Medical School, Worchester, Massachusetts
| |
Collapse
|
5
|
Buse J, Roessner V. Neural correlates of processing harmonic expectancy violations in children and adolescents with OCD. NEUROIMAGE-CLINICAL 2016; 10:267-73. [PMID: 26900566 PMCID: PMC4723992 DOI: 10.1016/j.nicl.2015.12.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Revised: 11/19/2015] [Accepted: 12/14/2015] [Indexed: 12/04/2022]
Abstract
It has been suggested that patients with obsessive–compulsive disorder (OCD) exhibit enhanced awareness of embedded stimulus patterns as well as enhanced allocation of attention towards unexpected stimuli. Our study aimed at investigating these OCD characteristics by running the harmonic expectancy violation paradigm in 21 boys with OCD and 29 healthy controls matched for age, gender and IQ during a functional magnetic resonance imaging (fMRI) scan. Each trial consisted of a chord sequence in which the first four chords induced a strong expectancy for a harmonic chord at the next position. In 70% of the trials the fifth chord fulfilled this expectancy (harmonic condition), while in 30% the expectancy was violated (disharmonic condition). Overall, the harmonic condition elicited blood-oxygen-level dependent (BOLD) activation in the auditory cortex, while during the disharmonic condition the precuneus, the auditory cortex, the medial frontal gyrus, the premotor cortex, the lingual gyrus, the inferior frontal gyrus and the superior frontal gyrus were activated. In a cluster extending from the right superior temporal gyrus to the inferior frontal gyrus, boys with OCD exhibited increased activation compared to healthy controls in the harmonic condition and decreased activation in the disharmonic condition. Our findings might indicate that patients with OCD are excessively engaged in processing the implicit structure embedded in music stimuli, but they speak against the suggestion that OCD is associated with a misallocation of attention towards the processing of unexpected stimuli. We ran the harmonic expectancy violations in boys with OCD and controls during fMRI. We examined processing of embedded stimulus pattern and unexpected stimuli. We found increased activation in superior temporal/inferior frontal gyrus in OCD. Boys with OCD excessively processed the implicit structure of music stimuli.
Collapse
Affiliation(s)
- Judith Buse
- Department of Child and Adolescent Psychiatry, Faculty of Medicine of the TU, Dresden, Germany
| | - Veit Roessner
- Department of Child and Adolescent Psychiatry, Faculty of Medicine of the TU, Dresden, Germany
| |
Collapse
|
6
|
Eapen V, Snedden C, Črnčec R, Pick A, Sachdev P. Tourette syndrome, co-morbidities and quality of life. Aust N Z J Psychiatry 2016; 50:82-93. [PMID: 26169656 DOI: 10.1177/0004867415594429] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Tourette syndrome is often associated with attention deficit hyperactivity disorder, obsessive compulsive disorder and other co-morbidities, the presence of which can reduce health-related quality of life. The relationship between the number and type of co-morbidities and tic severity upon health-related quality of life has been insufficiently examined in Tourette syndrome populations and not at all in the Australian context. We hypothesised that an increased number of co-morbid diagnoses would be inversely related to health-related quality of life and that the presence of attention deficit hyperactivity disorder and obsessive compulsive disorder in particular would negatively impact health-related quality of life. METHOD In all, 83 people with a previously established diagnosis of Tourette syndrome, who responded to a letter of invitation sent to the Tourette Syndrome Association of Australia past-member database, formed the study sample. Participants completed the Gilles de la Tourette Syndrome-Quality of Life Scale and a short form of the National Hospital Interview Schedule to assess tics and related behaviours. RESULTS Participants with pure-Tourette syndrome had significantly better health-related quality of life than those with Tourette syndrome and three or more co-morbid diagnoses. Few differences were observed between the pure-Tourette syndrome and Tourette syndrome and one or two co-morbid diagnoses groups. Analysis of the impact of individual co-morbid disorders and Tourette syndrome symptoms on health-related quality of life indicated that attention deficit hyperactivity disorder exerted a significant negative effect, as did the presence of complex tics, especially coprolalia and copropraxia. When these variables were examined in multiple regression analysis, number of co-morbidities and the presence of coprophenomena emerged as significant predictors of health-related quality of life. CONCLUSION While tics are the defining feature of Tourette syndrome, it appears to be the presence of co-morbidities, attention deficit hyperactivity disorder, in particular, and coprophenomena that have the greater impact on health-related quality of life. This has implications for symptom-targeting in the treatment of Tourette syndrome since all available treatments are symptomatic and not disease modifying.
Collapse
Affiliation(s)
- Valsamma Eapen
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia Academic Unit of Child Psychiatry, South Western Sydney Local Health District (AUCS) & Ingham Institute, Liverpool, NSW, Australia
| | - Corina Snedden
- Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Rudi Črnčec
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia Academic Unit of Child Psychiatry, South Western Sydney Local Health District (AUCS) & Ingham Institute, Liverpool, NSW, Australia
| | - Anna Pick
- Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Perminder Sachdev
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia Centre for Healthy Brain Ageing (CHeBA), University of New South Wales, Sydney, NSW, Australia Neuropsychiatric Institute, Prince of Wales Hospital, Randwick, NSW, Australia
| |
Collapse
|
7
|
Woitecki K, Döpfner M. [Changes in comorbid symptoms and subjective interference in a habit reversal therapy in children with chronic tic disorder - a pilot study]. ZEITSCHRIFT FUR KINDER-UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2012; 40:181-90. [PMID: 22532110 DOI: 10.1024/1422-4917/a000168] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE This pilot study investigates the effects of habit reversal training in a German-speaking population of children and young adults with chronic tic disorders on comorbid symptoms and subjective interference. METHODS 16 children were treated using a manualized program. Comorbid-symptoms (ADHD, anxiety and OCD, depression) were assessed using parent and self-ratings. Additionally, the correlation of tic symptoms with comorbid symptoms at the beginning of the therapy was analyzed. RESULTS We obtained positive results in reducing comorbid symptoms during a primary treatment of tic symptoms. We further found a correlation of tic symptoms and comorbid symptoms especially in parent ratings. CONCLUSIONS These first findings show that a primary treatment of tics may be indicated in patients with comorbid symptoms, because a therapy of tic symptoms has also positive effects on comorbid symptoms.
Collapse
Affiliation(s)
- Katrin Woitecki
- Institut für Klinische Kinderpsychologie der Christoph-Dornier-Stiftung an der Universität zu Köln.
| | | |
Collapse
|
8
|
Roessner V, Plessen KJ, Rothenberger A, Ludolph AG, Rizzo R, Skov L, Strand G, Stern JS, Termine C, Hoekstra PJ. European clinical guidelines for Tourette syndrome and other tic disorders. Part II: pharmacological treatment. Eur Child Adolesc Psychiatry 2011; 20:173-96. [PMID: 21445724 PMCID: PMC3065650 DOI: 10.1007/s00787-011-0163-7] [Citation(s) in RCA: 275] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
To develop a European guideline on pharmacologic treatment of Tourette syndrome (TS) the available literature was thoroughly screened and extensively discussed by a working group of the European Society for the Study of Tourette syndrome (ESSTS). Although there are many more studies on pharmacotherapy of TS than on behavioral treatment options, only a limited number of studies meets rigorous quality criteria. Therefore, we have devised a two-stage approach. First, we present the highest level of evidence by reporting the findings of existing Cochrane reviews in this field. Subsequently, we provide the first comprehensive overview of all reports on pharmacological treatment options for TS through a MEDLINE, PubMed, and EMBASE search for all studies that document the effect of pharmacological treatment of TS and other tic disorders between 1970 and November 2010. We present a summary of the current consensus on pharmacological treatment options for TS in Europe to guide the clinician in daily practice. This summary is, however, rather a status quo of a clinically helpful but merely low evidence guideline, mainly driven by expert experience and opinion, since rigorous experimental studies are scarce.
Collapse
Affiliation(s)
- Veit Roessner
- Department of Child and Adolescent Psychiatry, University of Dresden Medical School, Fetscherstrasse 74, 01307 Dresden, Germany.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
9
|
Roessner V, Hoekstra PJ, Rothenberger A. Tourette's disorder and other tic disorders in DSM-5: a comment. Eur Child Adolesc Psychiatry 2011; 20:71-4. [PMID: 21076848 PMCID: PMC3038221 DOI: 10.1007/s00787-010-0143-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2010] [Accepted: 10/23/2010] [Indexed: 11/29/2022]
Abstract
Classification of tic disorders will be revised in the forthcoming edition of the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5). We do not support the suggestion to move tic disorders to "Anxiety and Obsessive-Compulsive Disorders", if the section "Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence" is not retained. Other than that, most proposed changes of the criteria for tic disorders contain a number of welcome improvements, e.g., the more unified definition of tics including the removal of the term "stereotyped" and the better capture of the temporal pattern of tics (e.g., removal of the maximum 3 months criterion for a tic-free period in chronic tic disorders). But, unfortunately there are some inconsistencies in detail, e.g., the unification of diagnostic criteria for tic disorders had not been consistently pursued in transient tic disorder. In sum, the proposed DSM-5 criteria could be seen as an important step forward particularly in clinical routine. However, continued research is needed to justify the existing and proposed classification of tic disorders as well as to better clarify what other changes should be made in the DSM-5 and beyond.
Collapse
Affiliation(s)
- Veit Roessner
- Department of Child and Adolescent Psychiatry, University of Dresden, Goetheallee 12, 01309 Dresden, Germany.
| | - Pieter J. Hoekstra
- Department of Child and Adolescent Psychiatry, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Aribert Rothenberger
- Department of Child and Adolescent Psychiatry, University of Göttingen, Von-Siebold-Straße 5, 37075 Göttingen, Germany
| |
Collapse
|
10
|
Roessner V, Becker A, Banaschewski T, Rothenberger A. Executive functions in children with chronic tic disorders with/without ADHD: new insights. Eur Child Adolesc Psychiatry 2007; 16 Suppl 1:36-44. [PMID: 17665281 DOI: 10.1007/s00787-007-1005-5] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE In Chronic Tic Disorders (CTD) associated Attention Deficit Hyperactivity Disorder (ADHD) is very common. Hence, it is important to clarify how both conditions are related to cognitive dysfunctions in patients with CTD+ADHD comorbidity. Recent studies on neuropsychology revealed equivocal results, mostly due to methodological shortcomings like problems in sample composition. Thus better and more detailed information on this topic is needed to improve diagnostic and treatment approaches. METHOD Three tasks related to different domains of executive functions (the Matching Familiar Figures Test, the Stroop color-word interference task, and a computerized version of the Wisconsin Card Sorting Test) have been performed in two independent samples (altogether n = 138 children) both including four groups of children (CTD-only, CTD+ADHD, ADHD-only, healthy controls) matched for age and IQ. To specify the influence of either tics or ADHD-symptoms on executive functions and to answer the question of their interactive or additive relationship two-way analyses of variance (MANOVA) for the factors CTD (yes,-no) x ADHD (yes,no) were conducted. Eta squared was calculated to reveal the effect sizes for each factor. For a deeper understanding of group differences and to better enable the comparison with data in literature, additional analyses of variance (ANOVA) with posthoc testing were applied. RESULTS In summary, there was a main effect only for the factor ADHD reflected by decreased performance, while no main effect of the factor CTD could be found. Admittedly, the effects were not uniform in both samples. However, in all three tasks and both samples, uniformly no interaction between the main factors has been observed. CONCLUSIONS In cases of coexisting CTD+ADHD the factor ADHD shows the main negative impact on neuropsychological performance and this impact seems to be independent of any feature of the coexisting tics (additive model). This supports the notion to primarily treat the ADHD-symptoms in order to increase cognitive self regulatory abilities of these children. Contrarily, tics seem to have little impact on cognitive performance in most cases.
Collapse
Affiliation(s)
- Veit Roessner
- Dept. of Child and Adolescent Psychiatry/Psychotherapy, University of Goettingen, Von Siebold-Str. 5, 37075, Goettingen, Germany.
| | | | | | | |
Collapse
|
11
|
Abstract
Zusammenfassung. Erst in den letzten Jahren wird auch in der Forschung vermehrtes Augenmerk auf die Überschneidung von Tic- und Zwangsstörungen gerichtet. Während in Übersichtsarbeiten zum gemeinsamen Auftreten von Tic- und Zwangsstörungen die zahlreichen Befunde zu Phänomenologie, begleitender Psychopathologie, Epidemiologie und daraus resultierenden Therapieimplikationen breiten Raum einnehmen, sind die Untersuchungsergebnisse hinsichtlich ätiologischer und pathophysiologischer Gemeinsamkeiten in entsprechenden Arbeiten unterrepräsentiert. Daher wird mit dieser Arbeit ein Überblick über den aktuellen neurobiologischen Forschungsstand zu den Gemeinsamkeiten und Unterschieden von Tic- und Zwangsstörungen gegeben.
Collapse
Affiliation(s)
- Veit Roessner
- Universität Göttingen, Abteilung für Kinder- und Jugendpsychiatrie/Psychotherapie
| | - Aribert Rothenberger
- Universität Göttingen, Abteilung für Kinder- und Jugendpsychiatrie/Psychotherapie
| |
Collapse
|
12
|
Roessner V, Becker A, Rothenberger A. Psychopathologisches Profil bei Tic- und Zwangsstörungen. KINDHEIT UND ENTWICKLUNG 2007. [DOI: 10.1026/0942-5403.16.2.110] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Zusammenfassung. Neben der Kernsymptomatik und manch symptomatischer Überlappung von Tic- und Zwangsstörungen ist für eine therapierelevante Diagnostik auch das breitere psychopathologische Profil von Bedeutung. Daher ist es Ziel dieser Arbeit anhand des mit der Child Behavior Checklist (CBCL) erhobenen allgemeinen psychopathologischen Profils diese diagnostischen Schritte zu erleichtern und zu präzisieren. Die Diskriminanzanalyse der CBCL-Skalen von 49 Kindern und Jugendlichen mit alleiniger Zwangsstörung und 67 mit alleiniger Ticstörung (kein Gruppenunterschied in Alter und Geschlechtsverteilung) erbrachte eine hohe Güte der Unterscheidung anhand der CBCL-Skalen Schizoid/Zwanghaft, Angst/Depressivität sowie Sozialer Rückzug. Auf diesen drei CBCL-Skalen zeigten die Patienten mit einer Zwangsstörung höhere Werte als die Kinder und Jugendlichen mit einer Ticstörung. Daher sind die genannten Skalen im klinischen Alltag für die orientierende Differenzialdiagnostik von Tic- und/oder Zwangsstörungen geeignet und können ein gezieltes und ökonomisches weiteres Vorgehen leiten.
Collapse
Affiliation(s)
- Veit Roessner
- Universität Göttingen, Abteilung für Kinder- und Jugendpsychiatrie/Psychotherapie
| | - Andreas Becker
- Universität Göttingen, Abteilung für Kinder- und Jugendpsychiatrie/Psychotherapie
| | - Aribert Rothenberger
- Universität Göttingen, Abteilung für Kinder- und Jugendpsychiatrie/Psychotherapie
| |
Collapse
|
13
|
Abstract
Zusammenfassung. In diesem Übersichtsartikel werden die Gemeinsamkeiten und Unterschiede von Tic- und Zwangsstörungen auf verschiedenen Ebenen dargestellt. In der Psychopathologie unterscheiden sich beide Phänomene zunächst deutlich - Tics sind plötzlich auftretende, unwillkürliche, motorische Bewegungen oder Vokalisationen. Zwänge sind wiederholte, zweckmäßige und beabsichtigte Verhaltensweisen. Es gibt jedoch fließende Übergänge, die sich vor allem bei den Just-Right-Zwängen manifestieren, die bei Tourette-Störungen gehäuft auftreten. Die diagnostischen Strategien und die dabei hilfreichen Instrumente werden vorgestellt. In der Therapie haben sich bei beiden Störungen sowohl verhaltenstherapeutische als auch pharmakotherapeutische Verfahren bewährt. Es wird eine Übersicht über den Stand der empirischen Evidenz gegeben. Die Behandlung von kombinierten Tic- und Zwangsstörungen wird speziell erörtert.
Collapse
Affiliation(s)
- Manfred Döpfner
- Klinik und Poliklinik für Psychiatrie und Psychotherapie des Kindes- und Jugendalters am Klinikum der Universität zu Köln
| | - Aribert Rothenberger
- Universität Göttingen, Abteilung für Kinder- und Jugendpsychiatrie/Psychotherapie
| |
Collapse
|