Lifetime prevalence, age of risk, and genetic relationships of comorbid psychiatric disorders in Tourette syndrome.
Lifetime prevalence, age of risk, and genetic relationships of comorbid psychiatric disorders in Tourette syndrome.
复制标题
DOI：
10.1001/jamapsychiatry.2014.2650
复制
发表时间：
2015-04
期刊：
影响因子：
25.8
通讯作者：
Mathews, Carol A.
中科院分区：
文献类型：
--
作者：
Hirschtritt, Matthew E.;Lee, Paul C.;Pauls, David L.;Dion, Yves;Grados, Marco A.;Illmann, Cornelia;King, Robert A.;Sandor, Paul;McMahon, William M.;Lyon, Gholson J.;Cath, Danielle C.;Kurlan, Roger;Robertson, Mary M.;Osiecki, Lisa;Scharf, Jeremiah M.;Mathews, Carol A.
抽动秽语综合征（TS）的特点是精神共病的发生率高，然而，很少有研究充分描述这些共病。此外，大多数研究纳入的参与者相对较少（<200），并且没有研究过每种TS相关合并症的最高风险年龄或其与TS的病因关系。描述TS患者中精神共病的终生患病率、临床相关性、最高风险年龄和病因。1992年4月1日至2008年12月31日，对TS（n = 1374）和TS未受影响的家庭成员（n = 1142）进行了横断面结构化诊断访谈。共病DSM-IV-TR疾病的终生患病率、遗传性、最大风险年龄以及与症状严重程度、发病年龄和父母精神病史的相关性TS患者中任何精神共病的终生患病率为85.7%; 57.7%的人群患有2种或2种以上精神疾病。一生共病诊断的平均数（SD）为2.1（1.6）;排除强迫症（OCD）和注意力缺陷/多动症（ADHD）后，平均数为0.9（1.3），72.1%的个体符合强迫症或ADHD的标准。其他疾病，包括情绪，焦虑和破坏性行为，每种都发生在大约30%的参与者中。大多数共病精神障碍的最大发病风险年龄在4至10岁之间，但饮食和物质使用障碍除外，其始于青春期（四分位距，两者均为15-19岁）。图雷特综合征与焦虑风险增加有关（比值比[OR]，1.4; 95% CI，1.0-1.9; P = 0.04）和物质使用障碍风险降低（OR，0.6; 95% CI，0.3-0.9; P = 0.02）独立于共病强迫症和多动症;然而，TS患者中情绪障碍的发生率较高（29.8%），这可能与共病强迫症有关（OR，3.7; 95%CI，2.9-4.8; P <0.001）。父母有ADHD病史与非强迫症、非ADHD共病精神障碍的负担较高相关（OR，1.86; 95%CI，1.32-2.61; P < .001）。TS与情绪（RhoG，0.47）、焦虑（RhoG，0.35）和破坏性行为障碍（RhoG，0.48）之间的遗传相关性可能由ADHD解释，而对于情绪障碍，则由OCD解释。据我们所知，这项研究是同类研究中最全面的。它证实了这样的信念，即精神病合并症是常见的个人与TS，表明大多数合并症开始开始在生命的早期，并表明，某些合并症可能介导的存在共病的强迫症或多动症。此外，遗传分析表明，一些合并症可能与OCD和/或ADHD而不是TS更具生物学相关性。
Tourette syndrome (TS) is characterized by high rates of psychiatric comorbidity; however, few studies have fully characterized these comorbidities. Furthermore, most studies have included relatively few participants (<200), and none has examined the ages of highest risk for each TS-associated comorbidity or their etiologic relationship to TS. To characterize the lifetime prevalence, clinical associations, ages of highest risk, and etiology of psychiatric comorbidity among individuals with TS. Cross-sectional structured diagnostic interviews conducted between April 1, 1992, and December 31, 2008, of participants with TS (n = 1374) and TS-unaffected family members (n = 1142). Lifetime prevalence of comorbid DSM-IV-TR disorders, their heritabilities, ages of maximal risk, and associations with symptom severity, age at onset, and parental psychiatric history. The lifetime prevalence of any psychiatric comorbidity among individuals with TS was 85.7%; 57.7% of the population had 2 or more psychiatric disorders. The mean (SD) number of lifetime comorbid diagnoses was 2.1 (1.6); the mean number was 0.9 (1.3) when obsessive-compulsive disorder (OCD) and attention-deficit/hyperactivity disorder (ADHD) were excluded, and 72.1% of the individuals met the criteria for OCD or ADHD. Other disorders, including mood, anxiety, and disruptive behavior, each occurred in approximately 30% of the participants. The age of greatest risk for the onset of most comorbid psychiatric disorders was between 4 and 10 years, with the exception of eating and substance use disorders, which began in adolescence (interquartile range, 15–19 years for both). Tourette syndrome was associated with increased risk of anxiety (odds ratio [OR], 1.4; 95% CI, 1.0–1.9; P = .04) and decreased risk of substance use disorders (OR, 0.6; 95% CI, 0.3–0.9; P = .02) independent from comorbid OCD and ADHD; however, high rates of mood disorders among participants with TS (29.8%) may be accounted for by comorbid OCD (OR, 3.7; 95% CI, 2.9–4.8; P < .001). Parental history of ADHD was associated with a higher burden of non-OCD, non-ADHD comorbid psychiatric disorders (OR, 1.86; 95% CI, 1.32–2.61; P < .001). Genetic correlations between TS and mood (RhoG, 0.47), anxiety (RhoG, 0.35), and disruptive behavior disorders (RhoG, 0.48), may be accounted for by ADHD and, for mood disorders, by OCD. This study is, to our knowledge, the most comprehensive of its kind. It confirms the belief that psychiatric comorbidities are common among individuals with TS, demonstrates that most comorbidities begin early in life, and indicates that certain comorbidities may be mediated by the presence of comorbid OCD or ADHD. In addition, genetic analyses suggest that some comorbidities may be more biologically related to OCD and/or ADHD rather than to TS.
登录
查看更多内容
DOI：
10.1097/00004583-200005000-00009
发表时间：
2000-05-01
影响因子：
13.3
作者：
Coffey, BJ;Biederman, J;Kim, GS
通讯作者：
Kim, GS
影响因子：
10.6
作者：
Berthier, ML;Kulisevsky, J;Campos, VM
通讯作者：
Campos, VM
影响因子：
1.9
作者：
Coffey, BJ;Miguel, EC;Jenike, MA
通讯作者：
Jenike, MA
影响因子：
3.8
作者：
Freeman, RD;Fast, DG;Sandor, P
通讯作者：
Sandor, P
影响因子：
--
作者：
Kessler, RC;Berglund, P;Walters, EE
通讯作者：
Walters, EE