Correlations between attention deficit/hyperactivity disorder, obsessive-compulsive disorder and tics in children and adolescents: case report

Povezanost poremećaja nedostatka pozornosti s hiperaktivnošću (ADHD), opsesivno-kompulzivnog poremećaja (OKP) i tikova primarno se opisuje kroz genetičke, neurobiološke, neurokognitivne i neurokemijske supstrate smanjene inhibicije motoričkog odgovora. Komorbiditet ovih poremećaja u djece i adolescenata nije rijetkost. U predškolskoj dobi u našeg 14-godišnjeg pacijenta dijagnosticirani su ADHD i tikovi, a potom u desetoj godini i OKP. Poremećaji su dijagnosticirani prema kriterijima iz DSM-IV. i uporabom polustrukturiranih intervjua koji se na njemu temelje. U multimodalnom pristupu liječenju provodili smo kognitivno-bihevioralne psihoterapijske tehnike, psihoedukaciju i potporu roditelja, terapiju senzorne integracije uz potporu terapijskog psa, neurofeedback te smo primijenili medikamentoznu terapiju (metilfenidat, fluvoxamin), grupnu terapiju usmjerenu poboljšanju socijalnih vještina, izražavanju i razumijevanju emocija i individualizirani pristup u školi uz pomoć osobnog asistenta. U raspravi smo opisali složenost u liječenju kliničke slike komplicirane komorbiditetom i emocionalnim distresom te poznate i moguće poveznice ovih poremećaja. Liječenje ADHD-a zahtijeva multimodalni pristup i suradnju stručnjaka različitih profila. Između ostalog, pravodobno prepoznavanje udruženih simptoma i znakova drugih psihijatrijskih poremećaja i sagledavanje njihovih poveznica bitno je za sprječavanje razvoja složenije kliničke slike i određivanje terapijskih smjernica. Potrebna su daljnja istraživanja.The relationship between the attention deficit/hyperactivity disorder (ADHD), obsessive-compulsive disorder (OCD) and tics is primarily discussed through genetic, neurobiological, neurocognitive and neurochemical substrates of reduced impulse control. The comorbidity of these disorders in children and adolescents is not a rarity. In our 14-year-old patient, ADHD and simple motor tics were diagnosed at pre-school age and OCD at the age of 10. We diagnosed these disorders by DSM-IV criteria and semi-structured interviews based on it. In a multimodal treatment we used techniques from cognitive behavioural psychotherapy, psychoeducation and parental support, sensory integration therapy with a assistance dog, neurofeedback, medication therapy (methylphenidate, fluvoxamine), group therapy aimed at enhancing social skills and expressing emotions, individualized approach to learning in school with a personal assistant. We discuss the complexity of treatment of clinical presentation complicated by comorbidity and emotional distress, and some known and possible links between these disorders. Treatment of ADHD demands multimodal approach and cooperation of different professionals. Among other things, timely recognition of associated symptoms and other psychiatric disorders and their linkage is very important to prevent intensification of symptoms and signs of the disorder and to determine therapeutic guidelines. Further investigation is needed