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Seishin Igaku Volume 31, Issue 12 （December 1989）

精神医学 31巻12号（1989年12月発行）

Japanese English

研究と報告

全般性チックと自閉症 Generalized Tics Developing in Patients with Infantile Autism 金生由紀子 ¹ , 太田昌孝 ¹ , 永井洋子 ¹ Yukiko Kano ¹ , Masataka Ohta ¹ , Yoko Nagai ¹ ¹東京大学医学部附属病院精神神経科 ¹Department of Neuropsychiatry, Faculty of Medicine, University of Tokyo キーワード： Infantile autism , Generalized tics , Tourette's disorder , Mental development , Haloperidol Keyword: Infantile autism , Generalized tics , Tourette's disorder , Mental development , Haloperidol pp.1261-1268

発行日 1989年12月15日 Published Date 1989/12/15

DOI https://doi.org/10.11477/mf.1405204813

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Abstract 文献概要
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　抄録　しばしば全身に及ぶ，複合性で重症のチックを音声チックの有無にかかわらず全般性チックと定義した。自閉症の経過中に全般性チックを発症した5例を報告した。最初に，チック症状と自閉症児に多くみられる常同運動との相違点を明確にし，チック症状の随意的抑制の基準を提案した。自閉症児ではトゥレット障害の発症が発達の指標になるという報告があるが，この5例では全般性チックの発症で発達の促進や予後の改善はなかった。全般性チックの症例は，チック症状自体が重症なうえに，自閉症児の中でも異常行動が豊富で，社会適応上も重症であった。薬物療法でチック症状はかなり改善し，社会適応も一定程度改善した。全般性チックの概念は，DSM-Ⅲ-RやICD-10のトゥレット障害（あるいは症候群）のうち重症なものとその近縁の比較的重症なチックをまとめ，チック症に薬物療法を適用する指針を与えることができ，最新の診断基準と比べて有用であることを示した。

　At the Outpatient Psychiatric Clinic of Tokyo University Hospital, five patients with infantile autism (four male and one female) were found to have "generalized tics", which we define as complex, severe tics often extending throughout the whole body, with or without vocal tics.

　With this group, we clarified the differences between motor tics and stereotyped movements, and proposed criteria for voluntary tic suppression in patients with both infantile autism and "generalized tics".

　Although Burd et al. reported that patientswith infantile autism developing Tourette's disorder manifested spurts in language and social relationships, and had good prognoses, these five patients who developed "generalized tics" have not exhibited such "spurts" in mental development nor overall improvement. On the contrary, these five patients have exhibited more severe, multiple abnormal behavior, and have greater difficulty in communication and social adaptability than autistic patients without "generalized tics".

　In the majority of such severe autistic patients with poor adaptation and "generalized tics", psychopharmacological therapy reduced tics dramatically and improved adaptation to some degree.

　Since "generalized tics" include a severe form of Tourette's disorder along with other closely related tic disorders, as defined in the criteria of DSM-III-R and ICD-10, we believe that "generalized tics" is a more useful descriptor. "Generalized tics" is a highly practical term, especially in regard to the treatment of tics, because it presents guidelines for application of psychopharmacological therapy for patients with both infantile autism and certain tic disorders.