Tabla I. Porcentaje de comorbilidades psiquiátricas diagnosticadas previamente a realizar los cuestionarios de cribado y tras su realización. |
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Con diagnóstico previo de comorbilidad (%) |
Comorbilidades diagnosticadas a través de cuestionario (%) |
|
TDAH |
14 (63,6%) |
9 (40,9%) |
TOC |
10 (45,5%) |
6 (27,3%) |
Ansiedad |
2 (9,1%) |
17 (72,7%) |
Depresión |
1 (4,5%) |
11 (50%) |
TDAH: trastorno por déficit de atención/hiperactividad; TOC: trastorno obsesivo-compulsivo. |
Figura 1. Puntuaciones de calidad de vida en las diferentes subescalas de los cuestionarios Pediatric Quality of Life Inventory (arriba) y escala de calidad de vida en el síndrome de Gilles de la Tourette (abajo). Los valores se muestran en medianas (línea media), rangos intercuartílicos (cajas) y valores máximos y mínimos (bigotes).
Figura 2. Modelos lineales de correlación entre la grave dad de los tics (Yale Global Tic Severity Scale) y la calidad de vida medida por el Pediatric Quality of Life Inventory (azul) y la Gilles de la Tourette Syndrome-Quality of Life Scale for Children and Adolescents (rojo). En gris se muestran los intervalos de confianza del modelo.
Tabla II. Puntuaciones medias de calidad de vida en los pacientes con y sin cada una de las comorbilidades psiquiátricas investigadas en los cuestionarios. |
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|
Calidad de vida sin comorbilidad psiquiátrica |
Calidad de vida con comorbilidad psiquiátrica |
Valor de p |
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PedsQL |
GTS-QOL |
PedsQL |
GTS-QOL |
PedsQL |
GTS-QOL |
|
Ansiedad |
64,8 (DE: 24,5) |
65,4 (DE: 23,3) |
54,9 (DE: 16,3) |
51,8 (DE: 13,7) |
0,30 |
0,12 |
Depresión |
60,1 (DE: 16,6) |
60,3 (DE: 15,4) |
52,3 (DE: 20,4) |
48,3 (DE: 16,7) |
0,33 |
0,09 |
TOC |
61,3 (DE: 17,9) |
58,4 (DE: 16,2) |
45,3 (DE: 16,3) |
48 (DE: 19) |
0,07 |
0,23 |
DE: desviación estándar; GTS-QOL: escala de calidad de vida en el síndrome de Gilles de la Tourette; PedsQL: Pediatric Quality of Life Inventory; TOC: trastorno obsesivo-compulsivo. |
Quality of life and psychiatric comorbidities in pediatric patients with Gilles de la Tourette syndrome Introduction. Tourette Syndrome (TS) is a complex neurodevelopmental disorder which is normally associated to psychiatric comorbidity such as attention deficit hyperactivity disorder, obsessive compulsive disorder, anxiety or depression. Quality of life (QoL) in these patients can be affected by tic severity and associated comorbidities. Aim. The aim of the study was to describe and analyze QoL and psychiatric comorbidities in a sample of pediatric patients, as well as to develop a Spanish version of the questionnaire C&A-GTS-QoL to measure quality of life in this population. Patients and methods. Single-center, observational, prospective study. Patients aged 6 to 16 years old with TS were included. Demographic, clinical, diagnostic and treatment data were gathered. Questionnaires regarding tic severity, psychiatric comorbidity and quality of life were used. Results. Twenty-two patients with DSM-5 diagnosis of TS were included (86.4% male, median age 11 years). Of those, 86.4% had been previously diagnosed of psychiatric comorbidities and 72.7% received psychopharmacologic treatment. The prevalence of an ICD-10 current diagnosis of anxiety was 72.7%, depression 50%, ADHD 40.9% and OCD 7.3%. Median QoL score was 59.5 (RIC: 34.8-71.3) for PedsQL, and 55.5 (RIC: 45-65) for C&A-GTS-QoL, with a correlation between scores of R2 = 0.83 (p < 0.01). Higher tic severity was associated with poorer QoL (PedsQL R2: –0.732, p <0.01, C&A-GTS-QoL R2: –0.501, p = 0.021). A higher EDAH score for ADHD was associated with poorer QoL (PedsQL R2: –0.463, p = 0.03, C&A-GTS-QoL R2-0.534, p < 0.01). Conclusion. Prevalence of psychiatric comorbidities in pediatric TS is high and frequently underdiagnosed. Tics and psychiatric comorbidities affect quality of life. Further studies are needed to validate the Spanish version of C&A-GTS-QoL scale. Key words. ADHD. Anxiety. Depression. OCD. Quality of life. Tourette Syndrome. |