소아청소년 틱 장애(Tic disorder) 환자의 임상적 특성과 심리분석

우샛별,심영석,이건희,김성구 대한소아신경학회 2012 대한소아신경학회지 Vol.20 No.2

Purpose : Tic disorder is a neurodevelopmental disorder which begins in early childhood and continues into adolescence and adults. Tic disorder affects 1-2% of the population. In order to make a correct diagnosis and treatment of tic disorder, the clinical psychological analysis is needed because children with tic disorder tend to have higher rates of emotional and behavioral difficulties than those of the general population. The aim of this study was to evaluate the clinical and psychological characteristics of child with tic disorder. Methods : The sample consisted of 69 patients with tic disorder who visited to the pediatric neurology clinic of Kangnam sacred heart hospital from January 2007 to June 2010. Fifty patients who visited our clinic without tic disorder were included in the control group. Patients were classified as the DSM-IV, Tourette’s disorder, chronic motor or vocal tic disorder, tran- sient tic disorder and tic disorder not otherwise specified. Korean child behavior checklist (K-CBCL), K-WISC-III, ADS, K-ARS was conducted in the tic disorder patients and T score of K-CBCL was compared with the control group. Results : Male to female ratio was 2.5:1 in the study group and the mean age was 9.5±3.2 years old. The symptom period was 16.7±17.2 months at their first visit. Twelve subjects (18%) presented with Tourette syndrome, 14 subjects (20%) had multiple chronic motor or phonic tic disorder, 20 subjects (29%) had transient tic disorder and 23 subjects (33%) had tic disorder not otherwise specified. The Medications were given in 26 patients and risperidone was the primary drug for most of them. The mean T scores of K-CBCL were 55.5±6.1 for attention scale, 56.9±6.9 for anxiety-depression scale, 56.5±7.4 for withdrawn scale, 52.0±3.4 for emotional lability scale. All of them were higher than control group (P

틱 장애의 진단분류에 따른 임상특징과 질환 심각도와 연관된 변인들

정선주,정희연,황정민 대한소아청소년정신의학회 2001 소아청소년정신의학 Vol.12 No.1

연구목적 : 본 연구는 일과성 틱 장애(Transient tic disorder : TTD), 만성 틱 장애(chronic tic disoder : CTD), 뚜렛 장애(Tourette's disorder TD) 아동의 임상 양상을 비교하고, 틱 장애의 질환 심각도와 연관된 변인을 알아보기 위해 시행되었다. 방법 : DSM-IV 진단분류에 따라 틱 장애로 진단된 69명의 아동과 대조군 43명을 대상으로 인구학적 변인 및 틱과 관련된 임상적 변인을 조사하였다. 틱 증상의 심각도를 알아보기 위해 예일 틱 증상 평가 척도(Yale Global Tic Serverity Scale)을 시행하였으며 연구 대상 모두에게 동반된 정서/행동 문제를 평가하기 인해 아동 행동조사표(Child Behavior Checklist)를 시행하였다. 결과 : TTD군은 CTD및 TD군과 비교할 때 틱 증상의 지속 기간이 짧을 뿐 아니라 틱 증상의 심각도와 장해 정도도 미약하였다. TTD군의 동반된 정서/행동 문제 역시 CTD, TD군에 비해 유의하게 적었으며 공격성 소척도 점수를 제외하고는 정상대조군과 차이가 없었다. CTD군과 TD군간에는 틱 증상의 종류, 개수와 CBCL의 사회성 문제 소척도 점수외에는 통계적으로 유의한 차이를 나타내는 변인이 없었다. 틱 증상으로 인한 장해 정도를 가장 잘 예측해 주는 변인은 운동틱의 강도와 방해도, 틱 증상의 지속기간이었으며, CBCL 총 문제행동 점수와 가장 높은 연관성이 있는 변인은 주의력결핍/과잉운동장애(Attention deficit hyperactivity disorder : ADHD) 의 존재여부였다. 결론 : 본 연구의 곁과는 틱 증상의 심각도 외에 증상의 지속 기간이 틱 장애 아동들의 틱으로 인한 장해도에 큰 영향을 미치며, 동반된 ADHD의 존재가 이득의 임상상을 결정하는 데 있어 중요한 역할을 한다는 점을 시사한다. 또한 위와 같은 임상 변인들이 틱 장애의 진단적 분류보다도 틱 장애 아동의 질환 심각도를 판단하고 치료방침을 결정하는데 있어 더욱 중요함을 시사한다. 중심 단어 : 틱 장애 · 하위 진단 · 질환 심각도 · 장해. Objective : The purpose of this study was to compare the clinical features of children with three sub-diagnoses of tic disorder (transient tic disorder (TTD) , chronic tic disorder (CTD) and Tourette's disorder (TD)) and to exam the factors related with illness severity of them. Method : Subjects were 69 children who met DSM-Ⅳ criteria for tic disorder and 43 control chil-dren. All subjects were investigated demographic and clinical factors related to tic. The severity of tic was assessed with the Yale Global Tic Severity Scale (YGTSS) in tic disorder children. The Child Behavior Checklist (CBCL) was accomplished by parents of all subjects. Results : Children with TTD had not only shorter duration of tic symtoms but also milder tic severity and impairment than those with CTD and TD. They also had significantly lower scores on most CBCL subscales than children with CTD and TD, while they were similar with controls in all the CBCL subcale scores except aggressive behavior. Children with CTD and those with TD were similar to each other in clinical variables except number of tic symptom and scores on CBCL social problem subscale. The interference and intensity of motor tic symptoms and duration of tic symptoms were significant predictors of global impairment score on YGTSS, while the presence of comorbid ADHD was a pre-ictor of the total behavior problem score of CBCL. Conclusion : These findings indicate that duration of tic symptoms and the presence of comorbid ADHD as well as the severity of tic symptoms strongly associated with the illness severity of children with tic disorder. These results also suggest that those clinical factors may be more important for assessing the severity of illness and determining the treatment strategy than the sub-diagnosis itself in children with tic disorder. KEY WORDS : Tic disorder ㆍ Sub-diagnosis ㆍ Illness severity ㆍ Impairment.

만성 틱 장애 뚜렛씨 장애의 임상 특성

신성웅,임명호,현태영,성양숙,조수철 대한소아청소년정신의학회 2001 소아청소년정신의학 Vol.12 No.1

뚜렛씨 장애는 근육틱과 음성틱이 만성적으로 지속되는 질환이다. 만성 틱장애는 근육틱 혹은 음성틱 중 하나만 지속적으로 나타나는 질환이다. 본 연구에서는 1998년 4월 1일부터 1999년 4월 1일까지 서울대학교병원 소아정신과 병동에 입원한 만성 틱 장애 아동과 뚜렛씨 장애 아동의 임상적 특징을 조사하고 두 질환 사이의 관계를 비교하고자 시행되었다. 이들의 특성을 확인하기 위해 대조군으로 학습장애 환자를 선정하였다. 조사 결과는 다음과 같다. 첫째, 만성 틱장애(n=13)와 뚜렛씨 장애 환자(n=29)의 평균 발병연령은 각각7.3±2.5, 7.2±2.2.세, 입원시 연령은 평균 11.7±2.7, 11.5±2.6세, 입원기간은 5.7±5.4, 11.0±8.7주였고두 군 사이에 의미 있는 차이는 없었다. 학습장애의 경우 발병연령(4.2±1.9세)이 두 장애보다 빠르고 의료기관을 찾는 시기(9.8±3.2세)도 빨랐다. 출생 계절은 틱장애 환자들에서 6월에서 9월 사이가 가장 적었지만 의미 있는 차이는 없었다. 남녀의 성비율은 각각 10 : 3, 26 : 3, 11 : 5였고 의미 있는 차이는 보이지 않았다. 환자가 출생할 때의 아버지와 어머니 연령은 세 군 모두 차이가 없었다. 둘째, 정신과적 가족력이 있는 경우도 세 군 사이에 차이가 없었고 각각 24.1%, 46.2%, 56.3%였다. 발병전 유발 요인이 확인된 경우는 만성틱장애와 뚜렛씨 장애에서 11.1%와 35.7%로서 의리 있는 차이를 보이지는 않았지만 학습장애(56.3%)에 비해서는 적었다. 셋째, 만성 틱장애와 뚜렛씨 장애, 그리고 학습장애 환자의 지능지수는 각각 언어성 지능 92.3±10.7, 94.7±14.9, 94.3±13.8이었고, 동작성 지능은 93.0±20.5, 97.5±13.0, 95.0±16.9이었으며, 전체 지능은 91.9±20.1, 95.8±14.5, 93.9±15.1로서 세 군 사이에 의미 있는 차이가 없었다. 기질적 뇌장애 소견은 CT/MRI등에서 0%, 27.3%, 6.3%, 뇌파 이상은 8.3%, 17.2%, 12.5%에서 나타났고 차이는 발견하지 못하였다. 넷째, 항도파민 약물에 대한 반응은 만성 틱장애와 뚜렛씨 장애 환자에서 각각 84.6%, 77.0%가 부분관해를 보였고 완전 관해된 경우는 한 명도 없었으며 두 군 사이에 차이가 없었다. 다섯째, 공동 유병현황을 조사한 결과 주의력결핍 · 과잉운동장애가 학습장애에서 의리 있게 많은 것을 제외하고는 세 군 사이에 통계적으로 의미 있는 차이를 보이지 않았다. 조사 결과 입원한 환자의 경우 만성 틱장애와 뚜렛씨 장애를 가진 환자들은 임상적으로 학습장애를 가진 환자와 많은 부분에서 파이를 보였으나 만성 틱장애와 뚜렛씨 장애를 구분해야 하는 근거를 찾지 못하였다. 중심 단어 : 뚜렛씨 장애 · 틱장애 · 진단 분류 ㆍ 임상적 특성. Tourette's disorder is a disease which manifests one or more motor tics and vocal tics for more than a year. Chronic motor tic or vocal tic disorders are characterized by only one kind of tics for more than a year. We intended to investigate the clinical characteristics of the patients with chronic motor tic disorders or Tourette's disorders who had admitted from May 1, 1998 to May 1, 1999 to Seoul National University Hospital Child and Adolescent Psychiatry ward. In addition, we compared the clinical characteristics of the patients in order to elucidate the relationship between the two disorders. The patients with learning disabilities were selected as controls. There was no statistically significant difference between the onsets of the patients with chronic motor tic disorders(n=13, 7.3±2.5 years) , and Tourette's disorder(n=39, 7.2±2.2 years), but with learning disability (4.2±1.9 years). Also, the patients with chronic motor tic disorder and Tourette's disorder showed similar age at admission (11.7±2.7 versus 11.5±2.6 years), duration of admission (5.7±5.4 versus 11.0±8.7 weeks), mothers' ages at child birth(27.3±2.9 versus 28.3 ±6.7 years old), and fathers' age at child birth (32.2±3.2 versus 33.3±5.2 years old). We observed that those who had learning disabilities were alike in those aspects, except for age at visit to clinic (9.8±3.2 years old). Family history of psychiatric illnesses (24.1% versus 46.2%), recognized precipitating factors (11.1% versus 35.7%) and response to pharmacological treatments (77.8% versus 76.9%) of the patients with chronic motor tic disorders and Tourette's disorders were observed and no differences were found. Comorbid patterns of diseases were noted. Intrafamilial conflicts were more common in the patients with learning disabilities than those with chronic tic disorders or Tourette's disorders. Precipitating factors were observed more frequent in chronic tic disorder and Tourette's disorder than learning disability. Neurocognitive profiles were investigated, and verbal IQs of the patients with chronic motor tic disorder, Tourette's disorder and learning disability were 92.3±10.7, 94.7±14.9, 94.3±13.8, performance IQs 93.0±20.5, 97.5±13.0, 95.0±16.9 and full-scale IQs 91.9±20.1, 95.8±14.5, 93.9±15.1, respectively, which were found to be not significantly different. No difference was found in structural neurological abnormalities and EEG profiles. The patients with learning disabilities showed more common Bender-Gestalt test abnormalities. In conclusion, we have not found any affirmative clues for the division of chronic motor tic disorder and Tourette's disorder in clinical perspective. KEY WORDS : Tourette's disorder ㆍ Tic disorder ㆍ Classification ㆍ Clinical study.

성인기에 재발한 복합성 운동 틱 장애에서 Aripiprazole로 치료한 1예

김유진,노재성,신윤미 大韓神經精神醫學會 2007 신경정신의학 Vol.46 No.4

Tic disorder is a childhood-onset neuropsychiatric disorder that is characterized by both motor or phonic tics. Two thirds of children with tic disorder experience reduction or complete resolution of tic symptoms duhng adolescence. Doluble-blind trial have demonstrated that the typical antipsychotics are better than placebo. Recently, atypical antipsychotics have been used successfully. A 37 - year - old man, was diagnosed with chronic motor tic disorder during childhood. Over the last 27 years, his tic symptoms have improved. At the age of thirty-seven, he abruptly developed complex motor and vocal tics. The mMotor tics included shoulder shrugging, and neck and leg movement. The severity of tics was assessed at baseline using the Yale global tics everity sca1e(YGTSS) before initiating treatment. Global severity score of YGTSS at baseline was 58. He was initially prescribed with aripiprazole 5mg /day. After two days, his global severity score of YGTSS decreased to 20, and. this improvement was main-tained for eight weeks. Aripiprazole, a newer atypical antipsychotic with a unique pharmacodynamic profile, appears to be efficacious in treatment of tic disorder.

한의원에 내원한 틱장애 환자 292례 증례분석

천영호 ( Young Ho Chun ),김원일 ( Won Ill Kim ),김보경 ( Bo Kyung Kim ) 대한한방신경정신과학회 2009 동의신경정신과학회지 Vol.20 No.1

Objectives: In this study, patients with tic disorders who visited an Oriental medicine clinic were examined for their demographic characteristics, characteristics of symptoms, relation to Attention-deficit Hyperactivity Disorder(ADHD) and peculiarity according to various variables such as motor and vocal tics. Methods: After surveying 292 patients who visited an Oriental medicine clinic with tic symptoms as main complaints for 17 months, SAS 9.1, a statistical program was used for statistical analysis. Results: 1. The BMI of male tic patients was significantly higher than female ones and it was similar to or higher than the normal group. 2. Patients who are eldest children were 1.7 times higher than those who are not eldest ones. 3. The most usual case of motor tics was the eye blink and the most one of vocal tics was a dry cough. 4. There was no significant difference between male and female patients for all symptoms of motor and vocal tics, but male patients had significantly more obsessions related to tics than female ones. 5. There was no significant difference in the age of initial occurrence of Transient tic disorder(TTD), Chronic tic disoder(CTD) and Tourette`s disorder(TD). 6. For the general disorder of a tic and Conners` ADHD rating scale, there was no significance in TTD, CTD and TD. 7. 66% out of the total subjects of 197 cases were found to score more than 65 points in more than 1 items among 8 items such as the time, hearing, wrong alarm, mean response time and standard deviation in the response time, etc. of the ADHD diagnosis system(ADS). 8. The eye blink among motor tics was shown mainly by patients under 10 years old and the frown, movement of the head, shrug and movement of the arms were shown mainly by 11-19 years old patients. Conclusions: For the number, frequency, seriousness and inconvenience in life of tics, TD showed a significantly higher result than TTD and CTD.

귀비온담탕가미방(歸脾溫膽湯加味方)의 틱장애 환아 20례에 대한 치료효과

강경하,박은정,Kang, Kyung Ha,Park, Eun Jung 대한한방소아과학회 2014 대한한방소아과학회지 Vol.28 No.4

Objectives The purpose of this study is to report 20 cases of tic disorder children who were treated by Kuibiondam-tang Gami. Methods We treated the tic disorder children with herbal medicine, Kuibiondam-tang Gami. Then we evaluated tic disorder by Yale Global Tic Severity Scale (YGTSS) and observed the progress of tic disorder. Results 20 children (male 17, female 3 / transient tic disorder 6, chronic motor or vocal tic disorder 13, Tourette's disorder 1) were studied, the average age of children was $8.45{\pm}2.08$ years, the average duration of illness was $16.55{\pm}13.63$ month and the mean of treatment was $13.20{\pm}9.29$ week. After the treatment, mean of YGTSS was reduced $36.35{\pm}9.84$ to $9.35{\pm}1.03$ and total effective rate was 95%. Conclusions Kuibiondam-tang Gami is effective for reducing tic symptom and improving general conditions in children.

ADHD와 Tic 장애 아동의 공포

이영식,구영진 중앙대학교 의과대학 의과학연구소 1998 中央醫大誌 Vol.23 No.1

1996년 8월부터 1997년 3월까지 인천 중앙길병원과 중대부속 용산병원에 내원한 주의력결핍과잉행동장애 남아 45명과 틱장애 남아 20명을 대상으로 fear survey schedule for children-revised를 실시하여 정상군 자료와 비교한 결과를 요약하면 다음과 같다. 공포점수총점, 5개의 요인점수에서 ADHD와 Tic 장애 집단간 통계적으로 유의한 차이를 보이지 않았다. 정상집단과 ADHD군을 비교하였을 때, 공포점수 총점은 통계적으로 유의한 차이가 없었고, 제 2요인인 작은 동물 및 공포스러운 단순자극에 대한 공포와 제 3요인인 실패와 비난에 대한 공포가 통계적으로 유의하게 높았다. 정상집단과 Tic장애 아동군을 비교하였을 때, 통계적으로 유의하게 공포점수총점이 높았고, 공포요인구조상, 제 1요소인 위험과 죽음에 대한 공포와 제 2요인인 작은동물이나 공포스러운 단순자극에 대한 공포가 통계적으로 유의하게 높았다. 제 3요인(실패나 비난에 대한 공포)의 경우 통계적 의미는 없었으나 정상집단보다 높았다. ADHD집단의 경우 학년이 증가할수록 공포점수 총점이 통계적으로 유의하게 감소하였으며, 특히 공포요인 구조상 제 2요인(작은 동물 및 공포스러운 단순자극에 대한 공포)과 제 4요인(혼자 남겨지는 것에 대한 공포)이 통계적으로 유의하게 감소하였다. Tic 장애의 경우 저학년과 고학년간의 공포점수 총점 및 하부요인점수의 감소가 통계적으로 유의하지 않아, 성장에 따른 공포의 감소가 뚜렷지 않았고, 제 4요인(혼자 남겨지는 것에 대한 공포)이 고학년으로 갈수록 증가하였으며, 이는 ADHD군과의 비교에서 통계적으로 유의한 차이를 보였다. 두 군에서 가장 심하게 느끼는 공포항목들은 모두 제 1요인인 위험과 죽음에 대한 공표(폭발, 높은데서 떨어지기, 교통사고등)에 속하였다. 위의 결과로 미루어 보아, ADHD아동과 Tic 장애 아동들은 발달단계에 따른 공포대상 변화가 정상아동 보다 늦고, 질환과 환경과의 상호작용의 결과로 인해, ADHD군은 실패와 비난에 대한 공포가 더 많았으며, Tic 장애군은 외적 상황을 보다 더 공포스럽게 지각하는 것으로 나타났다. The content and intensity of fear are influenced by many factors including temperament, past experiences, situational stimuli, physical and cognitive development. Attention deficit hyperactivity disorder and Tic disorders are very common mental diseases in child psychiatric field. This study investigated the fear aspects in ADHD(n=45) and in Tic(n=20) disordered boys by using the fear survey schedule for children-revised C and employing the community sampled boys(n=356) as a control. Tic disordered boys scored significantly higher than ADHD boys on fears of small animals and horrible stimuli. ADHD boys scored significantly higher than community sampled boys on the fears of small animal and horrible stimuli, and on the fears of failure and criticism. Tic disordered boys scored significantly higher than community sampled boys on total fear score, fear of death and danger, fear of small animal and horrible stimuli, fear of leaving alone. Tic disordered boys did not demonstrate the age-appropriate decrease in fear found for boys of community sample. Nine of the top 10 fears reported by these ADHD and Tic disordered boys were identical to those reported by community sampled boys. From the above fear content analysis, it was suggested that mainly negative environmental stimuli influence the formation of ADHD boys' fear and global developmental delay phenomenon in Tic disordered boys.

Effects of Group Comprehensive Behavioral Intervention for Tics in Children With Tourette’s Disorder and Chronic Tic Disorder

강나리,김희정,문덕수,곽영숙 대한소아청소년 정신의학회 2022 소아청소년정신의학 Vol.33 No.4

Objectives: Comprehensive behavioral intervention for tics (CBIT) is effective in children with chronic tic disorders. This study aimed to assess the effect of group-based CBIT (group-CBIT) on tic severity and comorbid symptoms. We compared the efficacy of group CBIT with that of a control. Methods: Thirty children with chronic tic disorder or Tourette’s disorder were enrolled in this study. Eighteen were assigned to the group-CBIT for eight sessions, and 12 were assigned to the control group. Tics and comorbid symptoms were assessed pre- and postintervention using the Yale Global Tic Severity Scale (YGTSS), Premonitory Urge for Tics Scale, attention-deficit hyperactivity disorder Rating Scale-IV, Children’s Yale-Brown Obsessive-Compulsive Scale, and the Korean-Children Behavioral Checklist. We compared the pre- and post-intervention results of each group and determined the difference in the pre- and post-intervention results between intervention and the control group. Results: The YGTSS motor and vocal tic interference, global impairment, and global severity scores decreased in the intervention group only. Group CBIT was superior in reducing the motor tic interference, impairment score, and global severity score to the control group. Conclusion: The group-CBIT showed an improvement in tic symptoms, especially in reducing the level of interference and impairment of tics.

Sensitiv Imago^TM 측정에 의한 틱 장애 환아의 검사 결과 보고

김민주,김덕곤,이진용,Kim, Min Joo,Kim, Deog Gon,Lee, Jin Yong 대한한방소아과학회 2014 대한한방소아과학회지 Vol.28 No.3

Objectives The purpose of this study is to report test results in eight tic disorder children using Sensitiv $Imago^{TM}$. Methods Eight tic disorder children were tested using Sensitiv $Imago^{TM}$. Also, they were diagnosed with tic disorders by DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, $4^{th}$ edition) and we evaluated tic disorder cases by Yale Global Tic Severity Scale (YGTSS). Results In 8 cases, 1 case was transient tic disorder, 3 cases were Tourette's disorder and 4 cases were unspecified tic disorder. In the result of Sensitiv $Imago^{TM}$, 4 cases showed the lowest score at filter ${\sharp}5^*$ and 4 cases showed the lowest score at filter ${\sharp}6^*$ in [Express Monitoring] of [Review of System Disorders of Homeostasis]. Filter #5 includes urogenital organs, liver, gallbladder, kidneys, urinary bladder and ureter and Filter #6 stands for organs of immune and respiratory systems. Conclusion We report test results in eight tic disorder children using Sensitiv $Imago^{TM}$. Further studies about the principle, repeatability, reproducibility of Sensitiv $Imago^{TM}$ are needed.

Aripiprazole in ADHD with Tic Disorder and in ADHD with Tourette Disorder: Two Case Reports

임명호,Jin Kyung Kang,박태원,백기청,김현우 대한정신약물학회 2007 CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE Vol.5 No.2

We report the effect of aripiprazole in attention deficit hyperactivity disorder (ADHD) with tic disorder and in ADHD with Tourette disorder, which are very common in clinical settings, but are not supported by theory. We administered 15 mg of the dopamine partial agonist aripiprazole, which led to the obvious improvement of symptoms in ADHD patients with tic disorder or Tourette disorder. We report the effect of aripiprazole in attention deficit hyperactivity disorder (ADHD) with tic disorder and in ADHD with Tourette disorder, which are very common in clinical settings, but are not supported by theory. We administered 15 mg of the dopamine partial agonist aripiprazole, which led to the obvious improvement of symptoms in ADHD patients with tic disorder or Tourette disorder.