Behavior Therapy for Adults with Tourette Syndrome

成人抽动秽语综合症的行为治疗

• 批准号: 7450817
• 负责人: ALAN L PETERSON
• 金额: $ 17.35万
• 依托单位: UNIVERSITY OF TEXAS HLTH SCIENCE CENTER
• 依托单位国家: 美国
• 财政年份: 2005
• 资助国家: 美国
• 起止时间: 2005-09-22 至 2011-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7450817
• 关键词: Academic Medical Centers; Adolescent; Adult; Adverse effects; Age; Age-Years; Anxiety; Appearance; Awareness; Basal Ganglia; Behavior Therapy; Behavioral; Behavioral Sciences; Blinded; California; Case Study; Chronic; Clinical; Clinical Trials Data Monitoring Committees; Code; Collaborations; Complex; Condition; Count; Country; Data; Discrimination; Distress; Dopamine; Dose; Educational Status; Environmental Risk Factor; Esthesia; Face; Fostering; Functional disorder; General Hospitals; Gilles de la Tourette syndrome; Group Psychotherapy; Habits; Health Sciences; Impairment; Individual; Informatics; Intervention; Investigation; Limb structure; Literature; Long-Term Effects; Los Angeles; Maintenance; Manuals; Massachusetts; Measures; Mission; Monitor; Motor; Movement; NIH Program Announcements; Neuropsychological Tests; Occupational; Outcome; Outcome Measure; Pathway interactions; Patient Self-Report; Patients; Performance; Pharmaceutical Preparations; Pharmacotherapy; Pilot Projects; Play; Procedures; Protocols documentation; Psychotherapy; Public Health; Purpose; Randomized; Randomized Controlled Clinical Trials; Range; Rate; Relative (related person); Relaxation Therapy; Research; Research Personnel; Role; Safety; Services; Severities; Shoulder; Site; Standards of Weights and Measures; Structure; Symptoms; Testing; Texas; Thalamic structure; Time; Training; Training Programs; Treatment outcome; Universities; Videotape; Vocal Tics; Waxes; Week; Wisconsin; Work; base; blind; contingency management; data management; depressive symptoms; design; eligible participant; follow-up; frontal lobe; impression; improved; interest; medical schools; member; multidisciplinary; nervous system disorder; partial response; programs; quality assurance; response; social; sound; tic-related; treatment duration

DESCRIPTION (provided by applicant): Tourette Syndrome (TS) is a neurological disorder characterized by persistent motor and vocal tics. Tics can be brief, rapid and darting movements of the face, shoulders, and extremities or more complex and purposeful in appearance. Vocal tics can be simple sounds such as sniffing or grunting or more complex sounds including repeated words and phrases. Tics wax and wane over time with peak severity between ages 10 and 12 years. However, some individuals have a more enduring course of tics into adulthood. When present in adults, the tics of TS can be associated with considerable distress, social and occupational impairment, and discrimination. A substantial body of evidence implicates dysfunction of cortical-subcortical pathways involving the thalamus, basal ganglia and the frontal cortex. Although neurologically-based, behavioral and environmental factors may also play a role in tic maintenance. Currently, the standard treatment for tic suppression is medication, particularly centrally acting dopamine-blocking drugs. However, these medications are associated with a range of adverse effects that can result in poor compliance or in premature termination of treatment. Moreover, currently available medications rarely eliminate all tics. Thus, when managing their chronic condition, adults are often faced with a partial response to medication, or they opt to avoid all medications due to unacceptable side effects. Preliminary research by the investigators listed on this application suggests that a behavioral treatment called habit reversal training (HRT) is a promising intervention for tics. HRT is a multi-component treatment approach that includes awareness training, selfmonitoring, contingency management, inconvenience review, relaxation training and competing responses. HRT is designed as a monotherapy and/or as an augmentation to pharmacotherapy. Although the initial studies evaluating the efficacy of HRT in TS have been encouraging, to date the investigations have been case studies or small randomized trials, and HRT has never been systematically investigated as an augmentation to pharmacotherapy. In response to Program Announcement PA 01-123, this application describes a multisite investigation to evaluate the efficacy of a structured HRT program for tic reduction in adults with TS. To conduct this study, the Tourette Syndrome Association (TSA) assembled the Behavioral Sciences Consortium (BSC). The BSC is a multidisciplinary group of investigators representing some of the leading TS research programs in the country including Yale, Massachusetts General Hospital (MGH)/Harvard Medical School, University of California at Los Angeles (UCLA), and Johns Hopkins. Two additional centers, Wilford Hall Medical Center/University of Texas Health Sciences Center at San Antonio (WHMC/UTHSCSA), and the University of Wisconsin-Milwaukee (UWM), have investigators with specific expertise in HRT. The mission of the BSC is to develop, test, and disseminate behavioral interventions for patients with TS. In this proposed study, 120 eligible participants will be randomly assigned to receive either HRT or Enhanced- Supportive Psychotherapy. Both treatments will consist of 10 sessions over 12 weeks followed by 2 booster sessions and 3- and 6-months follow up assessments. The primary outcome of interest will be change in tic severity assessed by an independent evaluator blind to treatment assignment. The effect of HRT as a monotherapy for tics and as augmentation to ongoing, stable tic-suppressing medication will also be evaluated. The three study recruitment sites are MGH/Harvard, WHMC/UTHSCSA, and Yale University. Investigators from UCLA and the UWM will provide specific quality assurance and assessment services via separate subcontracts, and a Data Safety and Monitoring Board (DSMB) will be assembled for data and safety monitoring purposes. The Informatics group at Yale University will provide data management services.

描述（由申请人提供）：Tourette综合征（TS）是一种神经系统疾病，其特征是持续的运动和人声。抽动可以是脸部，肩膀和四肢的短暂，快速和飞镖运动，也可以是更复杂和有目的的外观。声音抽动可以是简单的声音，例如嗅探或咕unt声或更复杂的声音，包括重复的单词和短语。随着时间的流逝，蜡和峰值在10至12岁之间的峰值严重程度。但是，有些人到成年后有更持久的抽动过程。当在成年人中存在时，TS的抽动可能与相当大的困扰，社会和职业障碍和歧视有关。大量证据表明，涉及丘脑，基底神经节和额叶皮质的皮质皮质途径的功能障碍。尽管基于神经学的行为和环境因素也可能在TIC维持中发挥作用。目前，用于抑制作用的标准治疗方法是药物，尤其是中央作用的多巴胺阻断药物。但是，这些药物与一系列不良反应有关，可能导致依从性差或过早终止治疗。此外，目前可用的药物很少消除所有抽动。因此，当管理慢性病时，成年人通常面临对药物的部分反应，或者由于无法接受的副作用而选择避免所有药物。研究人员在此应用程序上列出的研究人员的初步研究表明，一种称为习惯逆转训练（HRT）的行为治疗是对抽动的有希望的干预措施。 HRT是一种多组分治疗方法，包括宣传培训，自我监控，应急管理，不便审查，放松培训和竞争反应。 HRT被设计为单一疗法和/或药物疗法的增强。尽管评估HRT在TS中的疗效的初步研究令人鼓舞，但至今研究是案例研究或小型随机试验，并且HRT从未被系统地研究为药物疗法的增强。 为了响应计划公告PA 01-123，该应用程序描述了一项多站点调查，以评估结构化HRT计划在TS中减少TIC的功效。为了进行这项研究，图雷特综合征协会（TSA）组装了行为科学联盟（BSC）。 BSC是一个多学科的研究人员小组，代表该国一些领先的TS研究计划，包括耶鲁大学，马萨诸塞州综合医院（MGH）/哈佛医学院，加利福尼亚大学洛杉矶分校（UCLA）和约翰·霍普金斯（Johns Hopkins）。另外两个中心，圣安东尼奥市的威尔福德·霍尔医学中心/德克萨斯大学健康科学中心（WHMC/UTHSCSA）和威斯康星大学 - 米尔沃基大学（UWM）的研究人员在HRT方面具有具体专业知识。 BSC的任务是为TS患者开发，测试和传播行为干预措施。在这项拟议的研究中，将随机分配120名合格的参与者接受HRT或增强的支持性心理治疗。两种治疗方法将在12周内进行10次课程，然后进行2次助推器会议以及3个月和6个月的随访评估。感兴趣的主要结果将是由不明治疗分配的独立评估者评估的抽动严重程度的变化。还将评估HRT作为抽动的单一疗法的影响，并将评估作为持续的，稳定的TIC抑制药物的增强。三个研究招聘场所是MGH/Harvard，WHMC/UTHSCSA和耶鲁大学。来自UCLA和UWM的调查人员将通过单独的分包合同提供特定的质量保证和评估服务，并且将组装数据安全和监测委员会（DSMB）以进行数据和安全监控目的。耶鲁大学的信息小组将提供数据管理服务。

项目成果

Neurocognitive predictors of treatment response to randomized treatment in adults with tic disorders.

患有抽动障碍的成人对随机治疗的治疗反应的神经认知预测因子。

• DOI: 10.1016/j.pnpbp.2016.11.002
• 发表时间: 2017-03-06
• 期刊: Progress in neuro-psychopharmacology & biological psychiatry
• 影响因子: 5.6
• 作者: Abramovitch A;Hallion LS;Reese HE;Woods DW;Peterson A;Walkup JT;Piacentini J;Scahill L;Deckersbach T;Wilhelm S
• 通讯作者: Wilhelm S

The premonitory urge to tic: measurement, characteristics, and correlates in older adolescents and adults.

抽动的先兆冲动：老年青少年和成人的测量、特征和相关性。

• DOI: 10.1016/j.beth.2013.09.002
• 发表时间: 2014
• 期刊: Behavior therapy
• 影响因子: 3.7
• 作者: Reese,HannahE;Scahill,Lawrence;Peterson,AlanL;Crowe,Katherine;Woods,DouglasW;Piacentini,John;Walkup,JohnT;Wilhelm,Sabine
• 通讯作者: Wilhelm,Sabine

Self-esteem in adults with Tourette syndrome and chronic tic disorders: The roles of tic severity, treatment, and comorbidity.

抽动秽语综合征和慢性抽动障碍成人的自尊：抽动严重程度、治疗和合并症的作用。

• DOI: 10.1016/j.comppsych.2018.04.008
• 发表时间: 2018
• 期刊: Comprehensive psychiatry
• 影响因子: 7.3
• 作者: Weingarden,Hilary;Scahill,Lawrence;Hoeppner,Susanne;Peterson,AlanL;Woods,DouglasW;Walkup,JohnT;Piacentini,John;Wilhelm,Sabine
• 通讯作者: Wilhelm,Sabine