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Colautti L, Magenes S, Rago S, Camerin S, Zanaboni Dina C, Antonietti A, Cancer A. Creative thinking in Tourette's syndrome: A comparative study of patients and healthy controls. J Clin Exp Neuropsychol 2023; 45:482-497. [PMID: 37667639 DOI: 10.1080/13803395.2023.2251644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 08/18/2023] [Indexed: 09/06/2023]
Abstract
INTRODUCTION Tourette's syndrome is a neurological disorder characterized by tics, that may interfere with patients' everyday life. Research suggested that creative thinking (namely, divergent and convergent thinking) could help patients cope with their symptoms, and therefore it can be a resource in non-pharmacological interventions. The present study aimed at investigating (i) possible differences in creative thinking between Tourette's syndrome patients and healthy controls and (ii) whether creative thinking can support patients in coping with their symptomatology. METHODS A group of 25 Tourette's syndrome patients and 25 matched healthy controls underwent an assessment of creative thinking, fluid intelligence, and depressive symptoms. Creative thinking was compared between patients and healthy controls after controlling for fluid intelligence and depressive symptoms. Moreover, the moderating role of divergent and convergent thinking on the subjective impact of tics was tested in a group of 30 patients. RESULTS Tourette's syndrome patients outperformed healthy controls in convergent thinking. Moreover, divergent thinking was found as a significant moderator of the relationship between tics severity and the subjective impact in Tourette's syndrome patients. CONCLUSIONS Findings highlighted the specific impact of convergent and divergent thinking on Tourette's syndrome patients. Considering the supportive role of creative thinking in Tourette's syndrome, our results confirm that higher levels of divergent thinking may reduce the tic-related discomfort. These findings suggest the potential positive implications of creative thinking in non-pharmacological interventions for Tourette's syndrome.
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Affiliation(s)
- Laura Colautti
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Sara Magenes
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
- Fraternità e Amicizia Società Cooperativa Sociale ONLUS, Milan, Italy
| | - Sabrina Rago
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Stefania Camerin
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Carlotta Zanaboni Dina
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
- Tourette Syndrome Centre, IRCCS, San Raffaele,Milan, Italy
| | | | - Alice Cancer
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
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Tygesen MLB, Maigaard K, Hagstrøm J, Skov L, Plessen KJ, Debes NMM. Fine Motor Skills in Children with Tourette Syndrome and their Unaffected First-degree Siblings. Scand J Child Adolesc Psychiatr Psychol 2023; 11:60-68. [PMID: 37359272 PMCID: PMC10286835 DOI: 10.2478/sjcapp-2023-0006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2023] Open
Abstract
Background The exact etiology of Tourette Syndrome (TS) remains unclear, making the search for impaired neuropsychological functions possibly connected to the underlying cause of TS as important as it is challenging. One neuropsychological domain of interest is fine motor skills. Method This study compared fine motor skill performance on the Purdue Pegboard Task (PPT) in 18 children with TS, 24 unaffected first-degree siblings and 20 controls. A set of screening questionnaires was administered to determine comorbid psychiatric illness. Results Children with TS, their siblings and controls did not differ significantly in fine motor skills as measured with the PPT. Performance on the PPT was not correlated with tic severity; however, we found an inverse correlation with severity of attention-deficit/hyperactivity disorder (ADHD) symptoms, as assessed by parent reported ADHD symptoms. Children with TS were found to have significantly higher parent reported ADHD symptoms compared to controls, yet only two out of the 18 participants had been diagnosed with ADHD. Conclusion This study suggests that fine motor skill impairment in children with TS may be more strongly correlated with comorbid ADHD than to TS and tics.
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Affiliation(s)
- Marie Louise Boeg Tygesen
- Child and Adolescent Mental Health Center, Mental Health Services, Gentofte, Capital Region of Denmark
| | - Katrine Maigaard
- Child and Adolescent Mental Health Center, Mental Health Services, Gentofte, Capital Region of Denmark
| | - Julie Hagstrøm
- Child and Adolescent Mental Health Center, Mental Health Services, Gentofte, Capital Region of Denmark
| | - Liselotte Skov
- Department of Pediatrics, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Kerstin Jessica Plessen
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
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European clinical guidelines for Tourette syndrome and other tic disorders-version 2.0. Part I: assessment. Eur Child Adolesc Psychiatry 2022; 31:383-402. [PMID: 34661764 PMCID: PMC8521086 DOI: 10.1007/s00787-021-01842-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 06/30/2021] [Indexed: 11/03/2022]
Abstract
In 2011 a working group of the European Society for the Study of Tourette Syndrome (ESSTS) has developed the first European assessment guidelines for Tourette syndrome (TS). Now, we present an updated version 2.0 of these European clinical guidelines for Tourette syndrome and other tic disorders, part I: assessment. Therefore, the available literature has been thoroughly screened, supplemented with national guidelines across countries and discussions among ESSTS experts. Diagnostic changes between DSM-IV and DSM-5 classifications were taken into account and new information has been added regarding differential diagnoses, with an emphasis on functional movement disorders in both children and adults. Further, recommendations regarding rating scales to evaluate tics, comorbidities, and neuropsychological status are provided. Finally, results from a recently performed survey among ESSTS members on assessment in TS are described. We acknowledge that the Yale Global Tic Severity Scale (YGTSS) is still the gold standard for assessing tics. Recommendations are provided for scales for the assessment of tics and psychiatric comorbidities in patients with TS not only in routine clinical practice, but also in the context of clinical research. Furthermore, assessments supporting the differential diagnosis process are given as well as tests to analyse cognitive abilities, emotional functions and motor skills.
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Kalsi N, Tambelli R, Altavilla D, Trentini C, Panunzi S, Stanca M, Aceto P, Cardona F, Lai C. Neurophysiological correlate of emotional regulation in cognitive and motor deficits in Tourette's syndrome. World J Biol Psychiatry 2019; 20:647-661. [PMID: 29364039 DOI: 10.1080/15622975.2018.1430375] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Objectives: The present study investigated the role of different emotions in the expression of cognitive and motor control abilities of children having Tourette's syndrome (TS) compared to healthy controls.Methods: The electroencephalography activity of 33 children (mean age in final sample: TS (n = 10) = 10.5 ± 2.3; control (n = 10) = 10.1 ± 2.9) was recorded during a visual task consisting of four emotional face cues (anger, happiness, neutral and sadness) followed by a target in congruent or incongruent position with emotional cue. The participants were asked to indicate the target location.Results: The TS patients showed a shorter latency of the P1 and N170 only for anger cues compared to controls. In addition, sLORETA results showed an increased activation in the left occipital area and a decreased activation in the left amygdala, temporal and cingulate for anger cues in TS patients. Coherently, TS patients showed a lower accuracy of response only with anger cue and severity of tics resulted correlated with the event-related potentials data and behavioural responses linked to anger cue.Conclusions: These results suggest that children with TS process emotions (in particular the anger) differently from the controls, and that its regulation seems to have an important role in the cognitive and motor deficits in TS.
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Affiliation(s)
- Navkiran Kalsi
- Department of Dynamic and Clinical Psychology, "Sapienza" University, Rome, Italy
| | - Renata Tambelli
- Department of Dynamic and Clinical Psychology, "Sapienza" University, Rome, Italy
| | - Daniela Altavilla
- Department of Dynamic and Clinical Psychology, "Sapienza" University, Rome, Italy
| | - Cristina Trentini
- Department of Dynamic and Clinical Psychology, "Sapienza" University, Rome, Italy
| | - Sara Panunzi
- Department of Paediatrics and Child Neuropsychiatry, "Sapienza" University, Rome, Italy
| | - Mariella Stanca
- Department of Paediatrics and Child Neuropsychiatry, "Sapienza" University, Rome, Italy
| | - Paola Aceto
- Department of Anaesthesiology and Intensive Care, Catholic University of Sacred Heart, Rome, Italy
| | - Francesco Cardona
- Department of Paediatrics and Child Neuropsychiatry, "Sapienza" University, Rome, Italy
| | - Carlo Lai
- Department of Dynamic and Clinical Psychology, "Sapienza" University, Rome, Italy
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Kyriazi M, Kalyva E, Vargiami E, Krikonis K, Zafeiriou D. Premonitory Urges and Their Link With Tic Severity in Children and Adolescents With Tic Disorders. Front Psychiatry 2019; 10:569. [PMID: 31474885 PMCID: PMC6702331 DOI: 10.3389/fpsyt.2019.00569] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Accepted: 07/22/2019] [Indexed: 12/15/2022] Open
Abstract
Tics wax and wane regarding their severity, while their expression is affected by non-motor sensory or cognitive elements that are mostly known as "premonitory urges." Since premonitory urges are often used in non-pharmacological interventions to decrease tic severity, it is of interest in the present study to examine whether premonitory urges can actually predict tic severity. Fifty-two children and adolescents diagnosed with tics and Tourette syndrome (29 children with provisional tic disorder, 16 children with chronic motor tic disorder, and 7 children with Tourette syndrome) were included in the study. Their age ranged between 6 and 15.7 years (mean age 9 years and 2 months). All participants completed the YGTSS (Yale Global Tic Severity Scale) in order to assess tic severity and the Premonitory Urge for Tics Scale (PUTS) to measure premonitory urges (PU). Regression analysis revealed that PU were present at a higher rate in older subjects (>12 years of age) than in younger children and with a higher level of tic severity. Although the presence of PU was associated with tic severity across the entire age range, there was a stronger association between PU and tic severity in older children. A better insight into the pathophysiology of premonitory urges could possibly lead to the identification of new therapeutic modalities targeting the sensory initiators of tics in future research.
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Affiliation(s)
- Maria Kyriazi
- 1st Department of Pediatrics, Hippokratio General Hospital, Aristotle University, Thessaloniki, Greece
| | - Efrosini Kalyva
- 1st Department of Pediatrics, Hippokratio General Hospital, Aristotle University, Thessaloniki, Greece
- Centre of Child and Adolescent Research and Development, Thessaloniki, Greece
| | - Efthymia Vargiami
- 1st Department of Pediatrics, Hippokratio General Hospital, Aristotle University, Thessaloniki, Greece
| | - Konstantinos Krikonis
- DatAnalysis, Statistical Analysis and Design of Scientific Research, Ioannina, Greece
| | - Dimitrios Zafeiriou
- 1st Department of Pediatrics, Hippokratio General Hospital, Aristotle University, Thessaloniki, Greece
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Lu YY, Wang MY, Wei IH, Lin CC, Huang CC. Tourette syndrome increases risk of bone fractures: a population-based cohort study. Eur Child Adolesc Psychiatry 2017; 26:531-539. [PMID: 27807804 DOI: 10.1007/s00787-016-0916-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 10/27/2016] [Indexed: 11/24/2022]
Abstract
This study assesses the risk of fractures among children with Tourette syndrome (TS), and identifies the effects of comorbidities and antipsychotics. We randomly sampled the claims data of 1 million enrollees in the National Health Insurance program of Taiwan, and identified 1258 children with TS diagnosed between 2000 and 2010. Additionally, 12,580 children without TS who were frequency matched for sex, age, residential area, parental occupation, and index year were identified for comparison. The children's cases were followed until December 31, 2010, or censored to ascertain incident fractures cases and associations with comorbidities of attention-deficit/hyperactivity disorder (ADHD) or obsessive-compulsive disorder (OCD) and treatments with antipsychotics, antidepressants, or clonidine. The TS cohort had a 1.27-fold higher incidence of fractures than did the comparison cohort (190.37 vs. 149.94 per 10,000 person-years), with an adjusted hazard ratio (HR) of 1.28 [95% confidence interval (CI) 1.06-1.55] based on multivariable Cox regression analysis. This increased risk of fractures was apparent for fractures of the skull, neck, and spine. Comorbid ADHD and OCD did not result in an additional risk of fractures. The children without both ADHD and OCD were also at a higher risk of fractures, indicating that TS alone increases the risk of fractures. The children taking antipsychotics had a reduced risk of fractures, and the adjusted HR decreased to 1.17 (95% CI 0.90-1.52). Children with TS have an increased risk of fractures. ADHD and OCD do not increase the risk further.
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Affiliation(s)
- Yuan-Yuan Lu
- Department of Psychiatry, China Medical University Hospital, Taichung, Taiwan.,Graduate Institute of Clinical Medical Science and Graduate Institute of BioMedical Sciences, China Medical University, Taichung, Taiwan
| | - Ming-Yu Wang
- Department of Psychiatry, China Medical University Hospital, Taichung, Taiwan.,Graduate Institute of Clinical Medical Science and Graduate Institute of BioMedical Sciences, China Medical University, Taichung, Taiwan
| | - I-Hua Wei
- Department of Anatomy, China Medical University, Taichung, Taiwan
| | - Che-Chen Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Chih-Chia Huang
- Department of Psychiatry, China Medical University Hospital, Taichung, Taiwan. .,Graduate Institute of Clinical Medical Science and Graduate Institute of BioMedical Sciences, China Medical University, Taichung, Taiwan. .,Department of Psychiatry, China Medical University, No. 2, Yuh-Der Road, Taichung, Taiwan.
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Zhang W, Wei L, Yu W, Cui X, Liu X, Wang Q, Wang S. Effect of Jian-Pi-Zhi-Dong Decoction on striatal glutamate and γ-aminobutyric acid levels detected using microdialysis in a rat model of Tourette syndrome. Neuropsychiatr Dis Treat 2016; 12:1233-42. [PMID: 27279743 PMCID: PMC4878666 DOI: 10.2147/ndt.s106330] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Jian-Pi-Zhi-Dong Decoction (JPZDD) is a dedicated treatment of Tourette syndrome (TS). The balance of neurotransmitters in the cortico-striato-pallido-thalamo-cortical network is crucial to the occurrence of TS and related to its severity. This study evaluated the effect of JPZDD on glutamate (Glu) and γ-aminobutyric acid (GABA) and their receptors in a TS rat model. MATERIALS AND METHODS Rats were divided into four groups (n=12 each). TS was induced in three of the groups by injecting them with 3,3'-iminodipropionitrile for 7 consecutive days. Two model groups were treated with tiapride (Tia) or JPZDD, while the control and the remaining model group were gavaged with saline. Behavior was assessed by stereotypic score and autonomic activity. Striatal Glu and GABA contents were detected using microdialysis. Expressions of N-methyl-D-aspartate receptor 1 and GABAA receptor (GABAAR) were observed using Western blot and real-time polymerase chain reaction. RESULTS Tia and JPZDD groups had decreased stereotypy compared with model rats; however, the JPZDD group showed a larger decrease in stereotypy than the Tia group at a 4-week time point. In a spontaneous activity test, the total distance of the JPZDD and Tia groups was significantly decreased compared with the model group. The Glu levels of the model group were higher than the control group and decreased with Tia or JPZDD treatment. The GABA level was higher in the model group than the control group. Expressions of GABAAR protein in the model group were higher than in the control group. Treatment with Tia or JPZDD reduced the expression of GABAAR protein. In the case of the mRNA expression, only Tia reduced the expression of N-methyl-D-aspartate receptor 1, compared with the model group. CONCLUSION JPZDD could alleviate impairments in behavior and dysfunctional signaling by downregulating GABAAR in the striatum. We suggest that this acts to maintain the balance of Glu and GABA.
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Affiliation(s)
- Wen Zhang
- Department of Pediatrics, The Third Affiliated Hospital, Beijing University of Chinese Medicine, Beijing, People's Republic of China
| | - Li Wei
- Department of Pediatrics, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, People's Republic of China
| | - Wenjing Yu
- Department of Pediatrics, The Third Affiliated Hospital, Beijing University of Chinese Medicine, Beijing, People's Republic of China
| | - Xia Cui
- Department of Pediatrics, The Third Affiliated Hospital, Beijing University of Chinese Medicine, Beijing, People's Republic of China
| | - Xiaofang Liu
- Department of Pediatrics, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, People's Republic of China
| | - Qian Wang
- Department of Pediatrics, The Third Affiliated Hospital, Beijing University of Chinese Medicine, Beijing, People's Republic of China
| | - Sumei Wang
- Department of Pediatrics, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, People's Republic of China
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Abstract
Gilles de la Tourette's syndrome is an uncommon illness associated with repetitive un-voluntary abnormal movements and utterance. It is often associated with other psychiatric morbidities. Management requires awareness of this uncommon illness, keen observation, relevant evaluation, and combination of pharmacology and psychotherapy for an optimal outcome. This case is brought out here for florid presentation and nuances of management.
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Affiliation(s)
- Jyoti Prakash
- Department of Psychiatry, Command Hospital Eastern Command, Kolkata, West Bengal, India
| | - Pragnya Singh
- Department of Psychiatry, INHS Asvini, Mumbai, Maharashtra, India
| | - P S Bhat
- Department of Pathology, Command Hospital Southern Command, Pune, Maharashtra, India
| | - K Srivastava
- Scientist F and Clinical Psychologist, Armed Forces Medical College, Pune, Maharashtra, India
| | - Vikash Gupta
- Psychiatrist, Air Force Hospital, Kanpur, Uttar Pradesh, India
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Nondopaminergic Neurotransmission in the Pathophysiology of Tourette Syndrome. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2013; 112:95-130. [DOI: 10.1016/b978-0-12-411546-0.00004-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Fine motor skills in adult Tourette patients are task-dependent. BMC Neurol 2012; 12:120. [PMID: 23057645 PMCID: PMC3527195 DOI: 10.1186/1471-2377-12-120] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2012] [Accepted: 10/10/2012] [Indexed: 11/21/2022] Open
Abstract
Background Tourette syndrome is a neuropsychiatric disorder characterized by motor and phonic tics. Deficient motor inhibition underlying tics is one of the main hypotheses in its pathophysiology. Therefore the question arises whether this supposed deficient motor inhibition affects also voluntary movements. Despite severe motor tics, different personalities who suffer from Tourette perform successfully as neurosurgeon, pilot or professional basketball player. Methods For the investigation of fine motor skills we conducted a motor performance test battery in an adult Tourette sample and an age matched group of healthy controls. Results The Tourette patients showed a significant lower performance in the categories steadiness of both hands and aiming of the right hand in comparison to the healthy controls. A comparison of patients’ subgroup without comorbidities or medication and healthy controls revealed a significant difference in the category steadiness of the right hand. Conclusions Our results show that steadiness and visuomotor integration of fine motor skills are altered in our adult sample but not precision and speed of movements. This alteration pattern might be the clinical vignette of complex adaptations in the excitability of the motor system on the basis of altered cortical and subcortical components. The structurally and functionally altered neuronal components could encompass orbitofrontal, ventrolateral prefrontal and parietal cortices, the anterior cingulate, amygdala, primary motor and sensorimotor areas including altered corticospinal projections, the corpus callosum and the basal ganglia.
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Neuner I, Nordt C, Schneider F, Kawohl W. Effectiveness of aripiprazole in the treatment of adult Tourette patients up to 56 months. Hum Psychopharmacol 2012; 27:364-9. [PMID: 22700477 DOI: 10.1002/hup.2235] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2011] [Revised: 03/16/2012] [Accepted: 05/02/2012] [Indexed: 01/28/2023]
Abstract
OBJECTIVE Tourette Syndrome (TS) is characterized by motor and vocal tics. Its pharmacological treatment is often a challenge because of the so-called tachyphylactic effects. Aripiprazole has been reported to be effective in small case series with short follow-up periods. METHODS In a retrospective analysis, we assessed the effect of off-label treatments with aripiprazole in 20 adult patients (mean age 27.4) divided in a group of severely [67 Yale Global Tourette Severity Scale (YGTTS)-total] and moderately (43.3 YGTTS-total) affected patients. TS patients were treated with aripiprazole (mean 11.8 mg daily) and followed for up to 56 months. RESULTS Applying a random coefficient model, we found a significant benefit resulting from treatment with aripiprazole. This effect was larger in the severely affected patient group in comparison with the moderately affected patient group. The effect was stable over a time period up to 56 months. CONCLUSION Aripiprazole, a neuroleptic drug of the third generation with a partial D(2) -agonism is effective in moderately and severely affected adult Tourette patients. We add to the current knowledge through our data extending the follow-up interval up to a maximum of 56 months. All available clinical data strongly support the initiation of a double-blind placebo or other neuroleptic substance controlled trial.
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Affiliation(s)
- Irene Neuner
- Department of Psychiatry and Psychotherapy, RWTH Aachen University, Aachen, Germany.
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Cubo E. Review of prevalence studies of tic disorders: methodological caveats. Tremor Other Hyperkinet Mov (N Y) 2012; 2:tre-02-61-349-1. [PMID: 23440028 PMCID: PMC3569952 DOI: 10.7916/d8445k68] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2011] [Accepted: 11/10/2011] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Tic disorders are neurodevelopmental disorders of childhood associated with psychiatric comorbidity and academic problems. Estimating the prevalence and understanding the epidemiology of tic disorders is more complex than was once thought. Until fairly recently, tic disorders were thought to be rare, but today tics are believed to be the most common movement disorder, with 0.2-46.3% of schoolchildren experiencing tics during their lifetime. Tentative explanations for differing prevalence estimates include the multidimensional nature of tics with a varied and heterogeneous presentation, and the use of different epidemiological methods and study designs. METHODS Literature review and analysis of methodological issues pertinent to epidemiological studies of tic disorders. RESULTS Epidemiological studies of tic disorders were reviewed, and the main elements of epidemiological studies, including sample selection, case ascertainment strategy, definition of tic disorders, and the degree of coverage of the eligible population (i.e., the response rate) were examined. DISCUSSION In order to improve the quality of epidemiological studies of tic disorders, a number of recommendations were made, including but not limited to a review of the diagnostic criteria for tic disorders, and inclusion of new tic disorder categories for those with tics of secondary etiology.
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Affiliation(s)
- Esther Cubo
- Neurology Department, Complejo Asistencial Universitario de Burgos, Spain
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Chiappedi M, de Vincenzi S, Dolci R, De Luca S, Bejor M. Gilles de la Tourette's syndrome in a patient with 47(XXX) syndrome: a case report. J Med Case Rep 2011; 5:542. [PMID: 22054059 PMCID: PMC3223519 DOI: 10.1186/1752-1947-5-542] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2011] [Accepted: 11/05/2011] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION To the best of our knowledge, this is the first report of a comorbidity between Gilles de la Tourette's syndrome and 47 (XXX) syndrome. The clinical picture of Gilles de la Tourette's Syndrome is well described, while 47 (XXX) syndrome is much more rare and has a broader spectrum of possible phenotypic presentations. CASE PRESENTATION An Italian Caucasian girl was referred at the age of 11 to our Rehabilitation Center for anxiety and learning difficulties. The girl had already been diagnosed as having 47(XXX) syndrome; she had some rather typical features of the chromosomal abnormality, but she also showed a high level of anxiety and the presence of motor and vocal tics. When an accurate history was taken, a diagnosis of Gilles de la Tourette's Syndrome emerged. CONCLUSIONS The possible interaction between peculiar features of these two syndromes in terms of neuropsychological and affective functioning is both interesting for the specific case and to hypothesize models of rehabilitation for patients with one or both syndromes. Executive functions are specifically reduced in both syndromes, therefore it might be hard to discriminate the contribution of each one to the general impairment; the same applies to anxiety. Moreover, mental retardation (with a significantly lower verbal cognitive functioning) poses relevant problems when suggesting cognitive behavioral or psychoeducational rehabilitative approaches.
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Affiliation(s)
- Matteo Chiappedi
- Don C Gnocchi Foundation, Piazzale Morandi 6, 2012 Milan, Italy.
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Cath DC, Hedderly T, Ludolph AG, Stern JS, Murphy T, Hartmann A, Czernecki V, Robertson MM, Martino D, Munchau A, Rizzo R. European clinical guidelines for Tourette syndrome and other tic disorders. Part I: assessment. Eur Child Adolesc Psychiatry 2011; 20:155-71. [PMID: 21445723 PMCID: PMC3065640 DOI: 10.1007/s00787-011-0164-6] [Citation(s) in RCA: 128] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
A working group of the European Society for the Study of Tourette Syndrome (ESSTS) has developed the first European assessment guidelines of Tourette Syndrome (TS). The available literature including national guidelines was thoroughly screened and extensively discussed in the expert group of ESSTS members. Detailed clinical assessment guidelines of tic disorders and their comorbidities in both children and adults are presented. Screening methods that might be helpful and necessary for specialists' differential diagnosis process are suggested in order to further analyse cognitive abilities, emotional functions and motor skills. Besides clinical interviews and physical examination, additional specific tools (questionnaires, checklists and neuropsychological tests) are recommended.
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Affiliation(s)
- Danielle C Cath
- Department of Clinical and Health Psychology, Utrecht University/Altrecht Academic Anxiety Outpatient Services, PO Box 80.140, 3508 TC Utrecht, The Netherlands.
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Microstructure assessment of grey matter nuclei in adult tourette patients by diffusion tensor imaging. Neurosci Lett 2011; 487:22-6. [DOI: 10.1016/j.neulet.2010.09.066] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2010] [Revised: 09/13/2010] [Accepted: 09/23/2010] [Indexed: 01/18/2023]
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Werner CJ, Stöcker T, Kellermann T, Wegener HP, Schneider F, Shah NJ, Neuner I. Altered amygdala functional connectivity in adult Tourette's syndrome. Eur Arch Psychiatry Clin Neurosci 2010; 260 Suppl 2:S95-9. [PMID: 20960002 DOI: 10.1007/s00406-010-0161-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2010] [Accepted: 09/24/2010] [Indexed: 12/15/2022]
Abstract
Tourette's syndrome (TS) is a developmental neuropsychiatric disorder characterized by motor and vocal tics as well as psychiatric comorbidities. Recently, differences in maturation of cortical networks using functional connectivity metrics have been described for this disorder. However, adult data on subcortical networks are scarce. In particular, the connectivity of the amygdala, for which a role in the pathophysiology of TS has been established, has not been examined so far. We studied 15 adult TS patients (11 male, aged 30.4 ± 9.7y) and 15 age- and sex-matched controls (11 male, aged 32.0 ± 9.3y) in a functional magnetic resonance imaging study at 1.5T using a simple motor task. We corrected for possible confounds introduced by tics, motion and brain-structural differences as well as age, sex, and medication. Task performance was monitored by simultaneous MR-compatible video-recording. Data were analyzed using an independent component approach sensitive to functional connectivity patterns. A stable component comprising both amygdalae could be identified across all subjects. Additionally, we observed a highly significant increase in coupling between/within amygdalae in the TS group when compared to controls, although behavioral data obtained during scanning did not show significant differences. These findings are expected to add to our understanding of the functional architecture of Tourette's syndrome.
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Affiliation(s)
- Cornelius J Werner
- Research Centre Juelich, Institute of Neuroscience and Medicine, INM4, Juelich, Germany
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Neuner I, Kellermann T, Stöcker T, Kircher T, Habel U, Shah JN, Schneider F. Amygdala hypersensitivity in response to emotional faces in Tourette's patients. World J Biol Psychiatry 2010; 11:858-72. [PMID: 20560820 DOI: 10.3109/15622975.2010.480984] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVES Tourette's syndrome is characterised by motor and vocal tics as well as a high level of impulsivity and emotional dysregulation. Neuroimaging studies point to structural changes of the basal ganglia, prefrontal cortex and parts of the limbic system. However, there is no link between behavioural symptoms and the structural changes in the amygdala. One aspect of daily social interaction is the perception of emotional facial expressions, closely linked to amgydala function. METHODS We therefore investigated via fMRI the implicit discrimination of six emotional facial expressions in 19 adult Tourette's patients. RESULTS In comparison to healthy control group, Tourette's patients showed significantly higher amygdala activation, especially pronounced for fearful, angry and neutral expressions. The BOLD-activity of the left amygdala correlated negatively with the personality trait extraversion. CONCLUSIONS We will discuss these findings as a result of either deficient frontal inhibition due to structural changes or a desynchronization in the interaction of the cortico-striato-thalamo-cortical network within structures of the limbic system. Our data show an altered pattern of implicit emotion discrimination and emphasize the need to consider motor and non-motor symptoms in Tourette's syndrome in the choice of both behavioural and pharmacological treatment.
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Affiliation(s)
- Irene Neuner
- Department of Psychiatry and Psychotherapy, RWTH Aachen University, Aachen, Germany.
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White-matter abnormalities in Tourette syndrome extend beyond motor pathways. Neuroimage 2010; 51:1184-93. [PMID: 20188196 DOI: 10.1016/j.neuroimage.2010.02.049] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2009] [Revised: 02/06/2010] [Accepted: 02/16/2010] [Indexed: 01/11/2023] Open
Abstract
Tourette syndrome is a neuropsychiatric disorder with the cardinal symptoms of motor and vocal tics. Often tics are accompanied by comorbidities such as obsessive-compulsive disorder, attention-deficit-hyperactivity disorder or depression. Research has mainly focused on the cortico-striato-thalamo circuit, but clinical symptoms and recent neuroimaging studies reporting altered resting network connectivity have suggested abnormalities in Tourette syndrome beyond the major motor circuits. We acquired diffusion-weighted data at 1.5T in nineteen adult patients fulfilling the DSM-IV-TR criteria for Tourette syndrome and in a healthy control group. Diffusion tensor imaging (DTI) analysis in our adult TS sample shows a decrease of FA and increase in radial diffusivity in the corticospinal tract. There are widespread changes (reduced FA and increased radial diffusivity) in the anterior and posterior limb of the internal capsule. Furthermore, it confirms prior findings of altered interhemispheric connectivity as indicated by a FA-decrease in the corpus callosum. In addition, our results indicate that TS is not restricted to motor pathways alone but affects association fibres such as the inferior fronto-occipitalis fascicle, the superior longitudinal fascicle and fascicle uncinatus as well. Tics are the hallmark of Tourette syndrome, so the involvement of the corticospinal tract fits in well with clinical symptoms. Cortical regions as well as limbic structures take part in the modulation of tics. Our findings of alterations in long association fibre tracts and the corpus callosum are a potential source for hindered interhemispheric and transhemispheric interaction. The change in radial diffusivity points toward a deficit in myelination as one pathophysiological factor in Tourette syndrome.
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Niederhofer H. Duloxetine May Improve Tourette's Syndrome: A Case Report. PRIMARY CARE COMPANION TO THE JOURNAL OF CLINICAL PSYCHIATRY 2010; 12:PCC.09l00889. [PMID: 20944778 PMCID: PMC2947533 DOI: 10.4088/pcc.09l00889blu] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Helmut Niederhofer
- Clinics of Child and Adolescence Psychiatry and Psychotherapy, Psychiatric Hospital of Rodewisch, Rodewisch, Germany
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