広汎性発達障害

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/04/28 17:38:12」(JST)

The diagnostic category pervasive developmental disorders (PDD), as opposed to specific developmental disorders (SDD), refers to a group of five disorders characterized by delays in the development of multiple basic functions including socialization and communication. The pervasive developmental disorders are:^[1]

Pervasive developmental disorder not otherwise specified (PDD-NOS), which includes atypical autism, and is the most common;
Autism, the best-known, now understood to be part of a spectrum;
Asperger syndrome;
Rett syndrome; and
Childhood disintegrative disorder (CDD).

The first three of these disorders are commonly called the autism spectrum disorders; the last two disorders are much rarer, and are sometimes placed in the autism spectrum and sometimes not.^[2]^[3]

The onset of pervasive developmental disorders occurs during infancy, but the condition is usually not identified until the child is around 3 years old. Parents may begin to question the health of their child when developmental milestones are not met, including age appropriate motor movement and speech production.^[4]

There is a division among doctors on the use of the term PDD.^[1] Many use the term PDD as a short way of saying PDD-NOS.^[1] Others use the general category label of PDD because they are hesitant to diagnose very young children with a specific type of PDD, such as autism.^[1] Both approaches contribute to confusion about the term, because the term PDD actually refers to a category of disorders and is not a diagnostic label.^[1]

Classification

The pervasive developmental disorders are:^[1]

Pervasive developmental disorder not otherwise specified (PDD-NOS), which includes atypical autism, and is the most common (47% of diagnoses);^[5]
Autism, the best-known;
Asperger syndrome (9% of autism diagnoses);
Rett syndrome; and
Childhood disintegrative disorder (CDD).

The first three of these disorders are commonly called the autism spectrum disorders; the last two disorders are much rarer, and are sometimes placed in the autism spectrum and sometimes not.^[2]^[3]

In May 2013, the Diagnostic and Statistical Manual-Fifth Edition (DSM-5) was released, updating the classification for pervasive developmental disorders. The grouping of disorders, including PDD-NOS, Autism, Asperger Syndrome, Rett Syndrome, and CDD, has been removed and replaced with the general term of Autism Spectrum Disorders. The American Psychiatric Association has concluded that using the general diagnosis of ASD supports more accurate diagnoses. The combination of these disorders was also fueled by the standpoint that Autism is characterized by common symptoms and should therefore bear a single diagnostic term. In order to distinguish between the different disorders, the DSM-5 employs severity levels. The severity levels take into account required support, restricted interests and repetitive behaviors, and deficits in social communication.^[6]

PDD and PDD-NOS

There is a division among doctors on the use of the term PDD.^[1] Many use the term PDD as a short way of saying PDD-NOS.^[1] Others use the general category because the term PDD actually refers to a category of disorders and is not a diagnostic label.^[1]

PDD is not itself a diagnosis, while PDD-NOS is a diagnosis. To further complicate the issue, PDD-NOS can also be referred to as "atypical personality development", "atypical PDD", or "atypical Autism".

Because of the "NOS", which means "not otherwise specified", it is hard to describe what PDD-NOS is, other than its being an autism spectrum disorder (ASD). Some people diagnosed with PDD-NOS are close to having Asperger syndrome, but do not quite fit. Others have near full-fledged autism, but without some of its symptoms. The psychology field is^[when?] considering creating several subclasses within PDD-NOS.^{[citation needed]}

Symptoms

Symptoms of PDD may include behavioral and communication problems such as:

Difficulty using and understanding language
Difficulty relating to people, objects, and events; for example, lack of eye contact, pointing behavior, and lack of facial responses
Unusual play with toys and other objects
Difficulty with changes in routine or familiar surroundings
Repetitive body movements or behavior patterns, such as hand flapping, hair twirling, foot tapping, or more complex movements
Inability to cuddle or be comforted
Difficulty regulating behaviors and emotions, which may result in temper tantrums, anxiety, and aggression.

Degrees

Children with PDD vary widely in abilities, intelligence, and behaviors. Some children do not speak at all, others speak in limited phrases or conversations, and some have relatively normal language development. Repetitive play skills and limited social skills are generally evident as well. Unusual responses to sensory information – loud noises, lights – are also common.

Diagnosis

Diagnosis is usually made during early childhood. With the release of the DSM-5 in May 2013, the diagnosis for PDD has been removed and replaced with autism spectrum disorders. Distinction between the past disorders is implicated by a series of severity levels. Individuals who received diagnoses based on the DSM-IV should still maintain their diagnosis under the autism spectrum disorders. A study published in the October 2012 issue of American Journal of Psychiatry, found that 91% of children with PDD diagnoses from the DSM-IV retained their diagnosis under the autism spectrum disorders diagnosis using the new DSM-5.^[7]

Due to the recent release of the new diagnostic criteria, the shift in classification and diagnoses will be gradual. Additionally, the replacement of pervasive developmental disorders with autism spectrum disorders has faced great criticism from those with past diagnoses and their family members.

Before the release of the DSM-5, some clinicians used PDD-NOS as a "temporary" diagnosis for children under the age of five when, for whatever reason, they are reluctant to diagnose autism. There are several justifications for this. Very young children have limited social interaction and communication skills to begin with, so it can be tricky to diagnose milder cases of autism in toddlers. The unspoken assumption is that by the age of five, unusual behaviors will either resolve or develop into diagnosable autism. However, some parents view the PDD label as no more than a euphemism for autism spectrum disorders, problematic because this label makes it more difficult to receive aid for early childhood intervention.

Care

Medications are used to address certain behavioral problems; therapy for children with PDD should be specialized according to the child's specific needs. Some children with PDD benefit from specialized classrooms in which the class size is small and instruction is given on a one-to-one basis. Others function well in standard special education classes or regular classes with support. Early intervention, including appropriate and specialized educational programs and support services, play a critical role in improving the outcome of individuals with PDD.

References

This article incorporates public domain material from the National Institutes of Health document "NINDS Pervasive Developmental Disorders Information Page".

^ ^a ^b ^c ^d ^e ^f ^g ^h ⁱ National Dissemination Center for Children with Disabilities (NICHCY) (October 2003) Disability Info: Pervasive Developmental Disorders (FS20). Fact Sheet 20 (FS20)
^ ^a ^b Lord C, Cook EH, Leventhal BL, Amaral DG (2000). "Autism spectrum disorders". Neuron 28 (2): 355–63. doi:10.1016/S0896-6273(00)00115-X. PMID 11144346.
^ ^a ^b Johnson CP, Myers SM, Council on Children with Disabilities (2007). "Identification and evaluation of children with autism spectrum disorders". Pediatrics 120 (5): 1183–215. doi:10.1542/peds.2007-2361. PMID 17967920. Lay summary – AAP (2007-10-29).
^ "Pervasive Developmental Disorders (PDDs)". WebMD. Retrieved 2013-06-29. |first1= missing |last1= in Authors list (help)
^ Jon Baio, EdS, National Center on Birth Defects and Developmental Disabilities, CDC (2012). "Prevalence of Autism Spectrum Disorders — Autism and Developmental Disabilities Monitoring Network, 14 Sites, United States, 2008".
^ "DSM-V: What Changes May Mean". Retrieved 29 June 2013. |first1= missing |last1= in Authors list (help)
^ "Autism Spectrum Disorder" (PDF). American Psychiatric Association. Retrieved 2013. |first1= missing |last1= in Authors list (help)

External links

CDC's "Learn the Signs. Act Early." campaign - Information for parents on early childhood development and developmental disabilities
NINDS Pervasive Developmental Disorders Information Page
NICHCY fact sheet on Pervasive Developmental Disorder (note: not in the public domain)
Information about Pervasive Developmental Disorders Yale Developmental Disabilities Clinic
http://childstudycenter.yale.edu/autism/pddnos.html
http://www.medicinenet.com/pervasive_development_disorders/page3.htm#treated

UpToDate Contents

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1. 小児および思春期における自閉症スペクトラム障害：薬理学的介入 autism spectrum disorder in children and adolescents pharmacologic interventions
2. パーキンソン病による認知症 parkinson disease dementia
3. 小児における発話および言語障害の病因 etiology of speech and language disorders in children
4. レビー小体型認知症の臨床的特徴および診断 clinical features and diagnosis of dementia with lewy bodies
5. パーキンソン病の診断 diagnosis of parkinson disease

English Journal

Experience with 53 portal-duodenal drained solitary pancreas transplants.

Perosa M, Noujaim H, Ianhez LE, Oliveira RA, Mota LT, Branez JR, Paredes MM, Giacaglia L, Genzini T.Author information HEPATO - Hepatology and Organ Transplantation, Bandeirantes Hospital, São Paulo, Brazil.AbstractSystemic-enteric drainage is currently the most common technique for pancreas transplantation (PT). A novel alternative technique, portal-duodenal drainage (PDD), has potential physiological benefits and provides improved monitoring of the pancreatic graft. The current study describes 53 solitary PT procedures (43 pancreas after kidney and 10 pancreas transplant alone) using the PDD technique over the last three yr. This method resulted in one-yr patient survival at 96% and 83% graft survival. There were five cases (9.4%) of thrombosis, in which transplantectomy and two-layer closure of the native duodenum were performed. No fistulas were observed. Here, we demonstrate that the PDD technique in PT was as safe and effective as current techniques in clinical use.
Clinical transplantation.Clin Transplant.2014 Jan 2. doi: 10.1111/ctr.12297. [Epub ahead of print]
Systemic-enteric drainage is currently the most common technique for pancreas transplantation (PT). A novel alternative technique, portal-duodenal drainage (PDD), has potential physiological benefits and provides improved monitoring of the pancreatic graft. The current study describes 53 solitary PT
PMID 24382212

Highly multiplexed phenotypic imaging for cell proliferation studies.

Cappella P, Gasparri F.Author information 1Cell Biology Department, Oncology Business Unit, Nerviano Medical Sciences S.r.l., Nerviano, Italy.AbstractThe application of multiplexed imaging technologies in phenotypic drug discovery (PDD) enables profiling of complex cellular perturbations in response to drug treatment. High-content analysis (HCA) is among the most pursued approaches in PDD, with a proven capability to identify compounds with a given cellular mechanism of action (MOA), as well as to unveil unexpected drug cellular activities. The ability of fluorescent image-based cytometric techniques to dissect the phenotypic heterogeneity of cell populations depends on the degree of multiplexing achievable. At present, most high-content assays employ up to four cellular markers separately detected in distinct fluorescence channels. We explored the possibility to increase HCA multiplexing through analysis of multiple proliferation markers in the same fluorescence channel by taking advantage of the different timing of antigen appearance during the cell cycle, or differential intracellular localization. Simultaneous analysis of DAPI staining and five immunofluorescence markers (BrdU incorporation, active caspase-3, phospho-histone H3, phospho-S6, and Ki-67) resulted in the first six-marker high-content assay readily applicable to compound MOA studies. This approach allows detection of rare cell subpopulations, unveiling a high degree of phenotypic heterogeneity in exponentially growing cell cultures and variability in the individual cell response to antiproliferative drugs.
Journal of biomolecular screening.J Biomol Screen.2014 Jan;19(1):145-57. doi: 10.1177/1087057113495712. Epub 2013 Jul 29.
The application of multiplexed imaging technologies in phenotypic drug discovery (PDD) enables profiling of complex cellular perturbations in response to drug treatment. High-content analysis (HCA) is among the most pursued approaches in PDD, with a proven capability to identify compounds with a giv
PMID 23896684

Decreased ipsilateral [(123)I]iododexetimide binding to cortical muscarinic receptors in unilaterally 6-hydroxydopamine lesioned rats.

Knol RJ, de Bruin K, Opmeer B, Voorn P, Jonker AJ, van Eck-Smit BL, Booij J.Author information Department of Nuclear Medicine, University of Amsterdam, Academic Medical Center, Amsterdam, The Netherlands; Graduate School of Neurosciences, Amsterdam, The Netherlands; Department of Nuclear Medicine, Medical Center Alkmaar, Alkmaar, The Netherlands. Electronic address: r.j.j.knol@mca.nl.AbstractINTRODUCTION: Dysfunction of the cholinergic neurotransmitter system is present in Parkinson's disease, Parkinson's disease related dementia and dementia with Lewy bodies, and is thought to contribute to cognitive deficits in these patients. In vivo imaging of the cholinergic system in these diseases may be of value to monitor central cholinergic disturbances and to select cases in which treatment with cholinesterase inhibitors could be beneficial. The muscarinic receptor tracer [(123)I]iododexetimide, predominantly reflecting M1 receptor binding, may be an appropriate tool for imaging of the cholinergic system by means of SPECT. In this study, we used [(123)I]iododexetimide to study the effects of a 6-hydroxydopamine lesion (an animal model of Parkinson's disease) on the muscarinic receptor availability in the rat brain.
Nuclear medicine and biology.Nucl Med Biol.2014 Jan;41(1):90-5. doi: 10.1016/j.nucmedbio.2013.10.003. Epub 2013 Oct 18.
INTRODUCTION: Dysfunction of the cholinergic neurotransmitter system is present in Parkinson's disease, Parkinson's disease related dementia and dementia with Lewy bodies, and is thought to contribute to cognitive deficits in these patients. In vivo imaging of the cholinergic system in these disease
PMID 24267055

Japanese Journal

回復過程からみた病的賭博の病型分類 : 「葛藤型」と「自閉型」を鑑別することの有用性について

河本泰信
アディクションと家族 : 日本嗜癖行動学会誌 28(3), 195-205, 2012-05
NAID 40019336941

大学病院精神科外来を受診した成人期広汎性発達障害の後方視的検討 : 児童青年期症例との比較を通して

河邉憲太郎,堀内史枝,長谷川芙美 [他]
精神医学 54(5), 517-522, 2012-05
NAID 40019252453

Related Pictures

★リンクテーブル★

リンク元	「レビー小体型認知症」「深部線量百分率」
拡張検索	「PDDST」
関連記事	「PD」「P」「PDDs」

「レビー小体型認知症」

Pervasive developmental disorder
Classification and external resources
ICD-10	F84
ICD-9	299
DiseasesDB	33524
eMedicine	ped/1780
MeSH	D002659

　　[★]

英: dementia with Lewy body, DLB、Lewy body dementia
同: レヴィ小体型痴呆 , レビー小体型痴呆, Lewy小体型痴呆、レビー小体型認知症, (国試)Lewy小体型認知症
関: レビー小体。びまん性レビー小体病, diffuse Lewy body disease、レビー小体病, Lewy小体病, Lewy body disease。parkinson disease with dementia, PDD

概念

パーキンソン病と同じ疾患スペクトラム上にあると考えられている。(HBN.928)

疫学

アルツハイマー型認知症、脳血管性認知症についで多い認知症。　←　第3位

病理

病理学的にはびまん性レビー小体病、移行型レビー小体病であることが多い。
大脳、脳幹に広範にレビー小体を認め、パーキンソン病と同様に黒質、青斑核、迷走神経背側核の神経細胞脱落が認められる。(HBN.928)

症状

検査

CT, MRI：所見に乏しい
MIBG心筋交感神経シンチグラフィ：取り込み低下　→　パーキンソン病と同じ所見
脳血流SPECT：後頭葉の血流低下 (保健適応外)
PET：後頭葉の糖代謝低下 (保健適応外)

診断基準

uptodate.2 HBN.929

()内はDLBで見られる頻度

1. 必須

認知症(100%)

2. 中核項目(1つあてはまる場合は疑い例、2つ以上ならばほぼ確実)

動揺する認知機能(60-80%)
反復、具体的、かつ鮮明な幻視(50-75%)　←　Recurrent well-formed, detailed visual hallucinations
パーキンソン症候群(80-90%)　←　Spontaneous features of parkinsonism(特に誘因のない)

3. 支持項目

レム睡眠行動障害
抗精神病薬に対する著しい感受性の亢進
SPECT、PETでの大脳基底核でのドパミントランスポーターの取り込み低下

(以下略)

治療

コリンエステラーゼ阻害薬　→　認知機能に対して。　アルツハイマー病より著効する
抑肝散　→　精神症状に対して
クエチアピン　→　幻視などの精神症状

参考

1. Pathologic correlates of dementia in individuals with Lewy body disease.

Sonnen JA, Postupna N, Larson EB, Crane PK, Rose SE, Montine KS, Leverenz JB, Montine TJ.SourceDepartment of Pathology, University of Washington, Seattle, WA 98104, USA.
Brain pathology (Zurich, Switzerland).Brain Pathol.2010 May;20(3):654-9.
Cognitive impairment and dementia are more common in patients with Parkinson disease (PD) than age-matched controls and appear to become more frequent as PD progresses. However, estimates of dementia in patients with PD have varied widely, likely due in part to differences in case definition, case a
PMID 20522091

2. wiki ja

http://ja.wikipedia.org/wiki/%E3%83%AC%E3%83%93%E3%83%BC%E5%B0%8F%E4%BD%93%E5%9E%8B%E8%AA%8D%E7%9F%A5%E7%97%87

3. レビー小体型認知症研究会-DLBとは-

http://www.d-lewy.com/about.html

4. 認知症あれこれ（1）―レビー小体型認知症―

http://www.clinic-nishikawa.com/1_1.html

5. レビー小体型認知症

http://rockymuku.sakura.ne.jp/seisinnka/rebi-syoutaigataninntisyou.pdf

6. 英文診断基準

http://www.lbda.org/node/470

7. Diagnosis and management of dementia with Lewy bodies: third report of the DLB Consortium.

McKeith IG, Dickson DW, Lowe J, Emre M, O'Brien JT, Feldman H, Cummings J, Duda JE, Lippa C, Perry EK, Aarsland D, Arai H, Ballard CG, Boeve B, Burn DJ, Costa D, Del Ser T, Dubois B, Galasko D, Gauthier S, Goetz CG, Gomez-Tortosa E, Halliday G, Hansen LA, Hardy J, Iwatsubo T, Kalaria RN, Kaufer D, Kenny RA, Korczyn A, Kosaka K, Lee VM, Lees A, Litvan I, Londos E, Lopez OL, Minoshima S, Mizuno Y, Molina JA, Mukaetova-Ladinska EB, Pasquier F, Perry RH, Schulz JB, Trojanowski JQ, Yamada M; Consortium on DLB.SourceInstitute for Ageing and Health, University of Newcastle upon Tyne, UK. i.g.mckeith@ncl.ac.uk
Neurology.Neurology.2005 Dec 27;65(12):1863-72. Epub 2005 Oct 19.
The dementia with Lewy bodies (DLB) Consortium has revised criteria for the clinical and pathologic diagnosis of DLB incorporating new information about the core clinical features and suggesting improved methods to assess them. REM sleep behavior disorder, severe neuroleptic sensitivity, and reduced
PMID 16237129