1
|
Tan CY, Chiu NC, Zeng YH, Huang JY, Tzang RF, Chen HJ, Lin YJ, Sun FJ, Ho CS. Psychosocial stress in children with Tourette syndrome and chronic tic disorder. Pediatr Neonatol 2024; 65:336-340. [PMID: 38000929 DOI: 10.1016/j.pedneo.2023.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 04/21/2023] [Accepted: 06/16/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND This study aimed to understand the longitudinal relationship between psychosocial stress with tic exacerbation in children with Tourette syndrome (TS) and chronic tic disorder. METHODS Consecutive ratings of tic severity as well as child and parental reports of psychosocial stress were obtained for 373 children (296 males, 77 females; mean age 9y 5mo; SD 3y 3mo) with TS and chronic tic disorder between January 2018 and December 2020. The Yale Global Tic Severity Scale (YGTSS) global severity score, total tic score, and impairment rating were calculated. The stressful events and YGTSS measurements were used and treated as time-varying variables in the analyses. Models that controlled for non-independence among the repeated observations using a random intercept and random slope model were employed. Each participant was treated as a random factor in the modelling. RESULTS Family-related stress, personal relationship stress and school-related stress were independently associated with increasing YGTSS global severity, total tic score, and impairment rating over time. An increased number of stressful events were associated with increased severity of tics. CONCLUSION Family, personal relationships, and school-related stress were consistently associated with the exacerbation of tics. Managing these stressful events is important in the treatment of TS and chronic tic disorder.
Collapse
Affiliation(s)
- Chiew Yin Tan
- Division of Pediatric Neurology, Department of Pediatrics, MacKay Children's Hospital, Taipei, Taiwan; Department of Pediatrics, Taitung Hospital, Ministry of Health and Welfare, Taiwan
| | - Nan-Chang Chiu
- Division of Pediatric Neurology, Department of Pediatrics, MacKay Children's Hospital, Taipei, Taiwan; The Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
| | - Yi-Hong Zeng
- The Department of Medicine, MacKay Medical College, New Taipei City, Taiwan; Division of Endocrinology and Metabolism, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan
| | - Jia-Yun Huang
- Division of Pediatric Neurology, Department of Pediatrics, MacKay Children's Hospital, Taipei, Taiwan
| | - Ruu-Fen Tzang
- The Department of Medicine, MacKay Medical College, New Taipei City, Taiwan; Department of Psychiatry, Mackay Memorial Hospital, Taipei, Taiwan; MacKay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan
| | - Hui-Ju Chen
- Division of Pediatric Neurology, Department of Pediatrics, MacKay Children's Hospital, Taipei, Taiwan; The Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
| | - Yi-Jie Lin
- Division of Pediatric Neurology, Department of Pediatrics, MacKay Children's Hospital, Taipei, Taiwan; The Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
| | - Fang-Ju Sun
- MacKay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan; Department of Medical Research, MacKay Memorial Hospital, Taipei, Taiwan; Institute of Biomedical Informatics, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
| | - Che-Sheng Ho
- Division of Pediatric Neurology, Department of Pediatrics, MacKay Children's Hospital, Taipei, Taiwan; The Department of Medicine, MacKay Medical College, New Taipei City, Taiwan.
| |
Collapse
|
2
|
Abbasi P, Tanhaie S, Kazeminia M. Prevalence of depression and anxiety in patients with Tourette syndrome; 1997 to 2022: a systematic review and meta-analysis. Ital J Pediatr 2023; 49:160. [PMID: 38041151 PMCID: PMC10693074 DOI: 10.1186/s13052-023-01562-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Accepted: 11/21/2023] [Indexed: 12/03/2023] Open
Abstract
Tourette Syndrome (TS) is a disorder in which the patient has a history of multiple motor and vocal tics. Depression and anxiety are common in these patients. The results of the studies show different prevalence of these disorders in patients with TS. So, the objective of the present study was to liken the prevalence of depression and anxiety in patients with TS by systematic review and meta-analysis. The present study was conducted according to PRISMA guidelines during 1997-2022. The articles were obtained from Scopus, Embase, PubMed, Web of Science (WoS) and Google Scholar databases. I2 was used to investigate heterogeneity between studies. Data were analyzed by comprehensive meta-analysis software (Version 2). Finally, 12 articles with a sample size of n = 3812 were included in the study. As a result of combining the results of the studies, the total estimate of the prevalence of depression and anxiety in patients with TS was 36.4% (95% confidence interval: 21.1-54.9%) and 53.5% (95% confidence interval: 39.9-66.6%), respectively. The results of meta-regression showed that by increasing mean age (9-31.5 years), the prevalence of depression and anxiety in patients with TS increased significantly (P<0.001). The results of the present study showed that the prevalence of depression and anxiety was high in patients with TS. Therefore, it is suggested that health officials and policy makers design measures to prevent and control these disorders.
Collapse
Affiliation(s)
- Parvin Abbasi
- Department of Nursing, School of Nursing and Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Sepideh Tanhaie
- School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mohsen Kazeminia
- Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran.
| |
Collapse
|
3
|
Iverson AM, Black KJ. Why Tic Severity Changes from Then to Now and from Here to There. J Clin Med 2022; 11:5930. [PMID: 36233797 PMCID: PMC9570874 DOI: 10.3390/jcm11195930] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 09/23/2022] [Accepted: 10/05/2022] [Indexed: 11/29/2022] Open
Abstract
Much of the research regarding Tourette's syndrome (TS) has focused on why certain individuals develop tics while others do not. However, a separate line of research focuses on the momentary influences that cause tics to increase or decrease in patients who are already known to have TS or another chronic tic disorder (CTD). Environmental and internal variables such as fatigue, anxiety, and certain types of thoughts all have been shown to worsen tic severity and may even overcome the positive effects of treatment. Other influences such as stress, distraction, and being observed have had mixed effects in the various studies that have examined them. Still, other variables such as social media exposure and dietary habits have received only minimal research attention and would benefit from additional study. Understanding the impact of these environmental and internal influences provides an opportunity to improve behavioral treatments for TS/CTD and to improve the lives of those living with these conditions. This review will examine the current literature on how these moment-to-moment influences impact tic expression in those with TS/CTD.
Collapse
Affiliation(s)
- Ann M. Iverson
- School of Medicine, Washington University in St. Louis, St. Louis, MO 63110, USA
| | - Kevin J. Black
- Departments of Psychiatry, Neurology, Radiology and Neuroscience, Washington University in St. Louis, St. Louis, MO 63110-1010, USA
| |
Collapse
|
4
|
Enhanced habit formation in Tourette patients explained by shortcut modulation in a hierarchical cortico-basal ganglia model. Brain Struct Funct 2022; 227:1031-1050. [PMID: 35113242 PMCID: PMC8930794 DOI: 10.1007/s00429-021-02446-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 12/15/2021] [Indexed: 12/28/2022]
Abstract
Devaluation protocols reveal that Tourette patients show an increased propensity to habitual behaviors as they continue to respond to devalued outcomes in a cognitive stimulus-response-outcome association task. We use a neuro-computational model of hierarchically organized cortico-basal ganglia-thalamo-cortical loops to shed more light on habit formation and its alteration in Tourette patients. In our model, habitual behavior emerges from cortico-thalamic shortcut connections, where enhanced habit formation can be linked to faster plasticity in the shortcut or to a stronger feedback from the shortcut to the basal ganglia. We explore two major hypotheses of Tourette pathophysiology-local striatal disinhibition and increased dopaminergic modulation of striatal medium spiny neurons-as causes for altered shortcut activation. Both model changes altered shortcut functioning and resulted in higher rates of responses towards devalued outcomes, similar to what is observed in Tourette patients. We recommend future experimental neuroscientific studies to locate shortcuts between cortico-basal ganglia-thalamo-cortical loops in the human brain and study their potential role in health and disease.
Collapse
|
5
|
Baltzan M, Yao C, Rizzo D, Postuma R. Dream enactment behavior: review for the clinician. J Clin Sleep Med 2020; 16:1949-1969. [PMID: 32741444 PMCID: PMC8034224 DOI: 10.5664/jcsm.8734] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 07/24/2020] [Accepted: 07/24/2020] [Indexed: 12/12/2022]
Abstract
NONE Dream enactment behavior commonly occurs on occasion in normal children and adults. Disruptive and frequent dream enactment behavior may come to the attention of the clinician either as the primary reason for consultation or as a prominent characteristic of a patient with other sleep disorders. Questioning patients with chronic neurologic and psychiatric disorders may also reveal previously unrecognized behavior. In the absence of sleep pathology, process of dream enactment likely begins with active, often emotionally charged dream content that may occasionally break through the normal REM sleep motor suppressive activity. Disrupted sleep resulting from many possible causes, such as circadian disruption, sleep apnea, or medications, may also disrupt at least temporarily the motor-suppressive activity in REM sleep, allowing dream enactment to occur. Finally, pathological neurological damage in the context of degenerative, autoimmune, and infectious neurological disorders may lead to chronic recurrent and severe dream enactment behavior. Evaluating the context, frequency, and severity of dream enactment behavior is guided first and foremost by a structured approach to the sleep history. Physical exam and selected testing support the clinical diagnosis. Understanding the context and the likely cause is essential to effective therapy.
Collapse
Affiliation(s)
- Marc Baltzan
- Faculty of Medicine, Department of Epidemiology Biostatistics and Occupational Health, McGill University, Montréal, Canada
- Centre Intégré Universitaire des Soins et Services Sociaux du Nord de L’île de Montréal, Montréal, Canada
- Mount Sinai Hospital, Centre Intégré Universitaire des Soins et Services Sociaux du Centre-ouest de L’île de Montréal, Montréal, Canada
- Institut de Médecine du Sommeil, Montréal, Canada
| | - Chun Yao
- Integrated Program in Neuroscience, McGill University, Montréal, Canada
- Research Institute of McGill University Health Centre, Montréal, Canada
| | - Dorrie Rizzo
- Faculty of Medicine, Department of Family Medicine, McGill University, Montréal, Canada
- Lady Davis Institute for Medical Research, Centre Intégré Universitaire des Soins et Services Sociaux de l’ouest de l’île, Montréal, Canada
| | - Ron Postuma
- Research Institute of McGill University Health Centre, Montréal, Canada
- Department of Neurology and Neurosurgery, McGill University, Montréal, Canada
| |
Collapse
|
6
|
Prevalence and clinical correlates of self-injurious behavior in Tourette syndrome. Neurosci Biobehav Rev 2020; 113:299-307. [DOI: 10.1016/j.neubiorev.2020.03.022] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 02/11/2020] [Accepted: 03/19/2020] [Indexed: 02/08/2023]
|
7
|
Gagné JP. The psychology of Tourette disorder: Revisiting the past and moving toward a cognitively-oriented future. Clin Psychol Rev 2018; 67:11-21. [PMID: 30292438 DOI: 10.1016/j.cpr.2018.09.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 09/15/2018] [Accepted: 09/21/2018] [Indexed: 01/04/2023]
Abstract
Tourette syndrome is a neurodevelopmental disorder characterized by chronic tics (i.e., repetitive and stereotyped movements and vocalizations) and premonitory urges (i.e., aversive sensations preceding tics that are alleviated once a tic is performed). Research supports that dysfunctional neurobiological and psychological processes interact and contribute to the development and maintenance of tics. However, psychological theories of Tourette syndrome and accompanying research have mainly focused on the emotional states (e.g., anxiety and frustration) and behavioural principles (i.e., operant conditioning) that play a role in tic exacerbation. This selective review summarizes key discoveries pertaining to the emotional and behavioural aspects of Tourette syndrome but also proposes a more comprehensive, cognitively-oriented conceptualization of the disorder. Specifically, it is proposed that maladaptive beliefs about discomfort and about one's ability to cope with discomfort underlie negative appraisals of unpleasant sensory experiences in individuals with Tourette syndrome. It is further suggested that these beliefs lead individuals to perceive premonitory urges in a catastrophic manner and thereby enhance tic frequency. Concrete research avenues to empirically examine these hypotheses are outlined and clinical implications for the field of cognitive-behaviour therapy are discussed.
Collapse
Affiliation(s)
- Jean-Philippe Gagné
- Department of Psychology, Concordia University, 7141 Sherbrooke St. West, Montreal, QC H4B 1R6, Canada.
| |
Collapse
|
8
|
Barfell KSF, Snyder RR, Isaacs-Cloes KM, Garris JF, Roeckner AR, Horn PS, Guthrie MD, Wu SW, Gilbert DL. Parent and Patient Perceptions of Functional Impairment Due to Tourette Syndrome: Development of a Shortened Version of the Child Tourette Syndrome Impairment Scale. J Child Neurol 2017; 32:725-730. [PMID: 28429606 DOI: 10.1177/0883073817702782] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The Child Tourette Syndrome Impairment Scale (CTIM) rates 37 problems in school, social, and home domains separately for tics and for comorbid diagnoses. However, a shorter version would be easier to implement in busy clinics. Using published data from 85 children with Tourette syndrome, 92 controls, and parents, factor analysis was used to generate a "mini-CTIM" composed of 12 items applied to tic and comorbid diagnoses. Child- and parent-rated mini-CTIM scores were compared and correlated across raters and accounting for clinician-rated tic severity and presence of attention-deficit hyperactivity disorder (ADHD) and obsessive-compulsive disorder (OCD). The mini-CTIM achieved domain Cronbach alphas ranging from 0.71 to 0.94 and intra-item correlation coefficients ranging from 0.84 to 0.96. The resulting scale correlated with clinician-rated tic severity and reflected the presence of ADHD and OCD. The mini-CTIM appears promising as a practical assessment tool for tic- and non-tic-related impairment in children with Tourette syndrome.
Collapse
Affiliation(s)
- Kara S Francis Barfell
- 1 Division of Neurology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, OH, USA
| | - Ryan R Snyder
- 1 Division of Neurology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, OH, USA
| | | | - Jordan F Garris
- 1 Division of Neurology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, OH, USA
| | - Alyssa R Roeckner
- 1 Division of Neurology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, OH, USA
| | - Paul S Horn
- 1 Division of Neurology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, OH, USA
| | - Michael D Guthrie
- 1 Division of Neurology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, OH, USA
| | - Steve W Wu
- 1 Division of Neurology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, OH, USA
| | - Donald L Gilbert
- 1 Division of Neurology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, OH, USA
| |
Collapse
|
9
|
Baweja R, Byler D. Tourette’s Syndrome and Comorbid Neurological Condition. CURRENT DEVELOPMENTAL DISORDERS REPORTS 2017. [DOI: 10.1007/s40474-017-0113-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
10
|
Godar SC, Bortolato M. What makes you tic? Translational approaches to study the role of stress and contextual triggers in Tourette syndrome. Neurosci Biobehav Rev 2017; 76:123-133. [PMID: 27939782 PMCID: PMC5403589 DOI: 10.1016/j.neubiorev.2016.10.003] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 09/17/2016] [Accepted: 10/05/2016] [Indexed: 01/04/2023]
Abstract
Tourette syndrome (TS) is a neurodevelopmental condition characterized by multiple, recurring motor and phonic tics. Rich empirical evidence shows that the severity of tics and associated manifestations is increased by several stressors and contextual triggers; however, the neurobiological mechanisms responsible for symptom exacerbation in TS remain poorly understood. This conceptual gap partially reflects the high phenotypic variability in tics, as well as the existing difficulties in operationalizing and standardizing stress and its effects in a clinical setting. Animal models of TS may be highly informative tools to overcome some of these limitations; these experimental preparations have already provided critical insights on key aspects of TS pathophysiology, and may prove useful to identify the neurochemical alterations induced by different stressful contingencies. In particular, emerging knowledge on the role of contextual triggers in animal models of TS may inform the development of novel pharmacological interventions to reduce tic fluctuations in this disorder.
Collapse
Affiliation(s)
- Sean C Godar
- Dept. of Pharmacology and Toxicology, College of Pharmacy, United States; University of Utah, Salt Lake City, UT, United States
| | - Marco Bortolato
- Dept. of Pharmacology and Toxicology, College of Pharmacy, United States; University of Utah, Salt Lake City, UT, United States.
| |
Collapse
|
11
|
Rizzo R, Gulisano M, Martino D, Robertson MM. Gilles de la Tourette Syndrome, Depression, Depressive Illness, and Correlates in a Child and Adolescent Population. J Child Adolesc Psychopharmacol 2017; 27:243-249. [PMID: 28099039 DOI: 10.1089/cap.2016.0120] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Gilles de la Tourette syndrome (GTS) and depression are both common disorders. It has been suggested that depression occurs in 13%-76% GTS patients. Despite this, there are few studies into the specific relationships and correlates between the two disorders. There is only some consensus as to the precise relationship between the two disorders. MATERIALS AND METHODS We undertook the study to investigate the relationship between depressive symptomatology and the core clinical features of GTS in a well-characterized clinical population of youth with this disorder. Our aim was to verify the association between depression and comorbid obsessive-compulsive disorder and explore further other potential associations highlighted in some, but not all, of the studies focused on this topic. RESULTS Our results demonstrated that (1) the GTS patients were significantly older than the controls, (2) the GTS patients were significantly more depressed than controls, (3) depression was associated with tic severity, (4) the Diagnostic Confidence Index scores were higher in GTS patients without depression, (5) anxiety, attention-deficit/hyperactivity disorder (ADHD), conduct disorder (CD), and behavioral problems were significantly associated with depression, and (6) finally, patients with GTS and depression have a positive family history of depression. However, obsessionality (CY-BOCS) did not differentiate between depressed and not depressed GTS patients. CONCLUSIONS Depression is common in patients with GTS and occurs significantly more in GTS than in controls. Depression is significantly associated with GTS factors such as tic severity, comorbidity with ADHD, and the presence of coexistent anxiety, CDs, and behavior problems. Depression is importantly significantly associated with a positive family history of depression. Intriguingly, depression in our sample was not related to obsessionality.
Collapse
Affiliation(s)
- Renata Rizzo
- 1 Section of Child and Adolescent Neuropsychiatry, Department of Experimental and Clinical Medicine, University of Catania , Catania, Italy
| | - Mariangela Gulisano
- 1 Section of Child and Adolescent Neuropsychiatry, Department of Experimental and Clinical Medicine, University of Catania , Catania, Italy
| | - Davide Martino
- 2 Department of Neurology, King's College Hospital NHS Foundation Trust , London, United Kingdom .,3 Queen Elizabeth Hospital , Woolwich, Lewisham and Greenwich NHS Trust, London, United Kingdom
| | | |
Collapse
|
12
|
Eaton CK, Jones AM, Gutierrez-Colina AM, Ivey EK, Carlson O, Melville L, Kardon P, Blount RL. The Influence of Environmental Consequences and Internalizing Symptoms on Children's Tic Severity. Child Psychiatry Hum Dev 2017; 48:327-334. [PMID: 27044052 DOI: 10.1007/s10578-016-0644-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Although there is evidence that environmental consequences for displaying tics and internalizing symptoms are related to tic severity in children with TS, less is known about the inter-relationships of these variables or how these factors jointly contribute to tic severity. This study included 45 children with Tourette syndrome. Caregivers reported on children's environmental consequences for displaying tics, internalizing symptoms, and tic severity. Results indicated that children with higher levels of internalizing symptoms experienced significantly more environmental consequences for displaying tics. Children with higher levels of separation anxiety symptoms demonstrated significantly greater tic severity. Environmental consequences for displaying tics accounted for significantly more variance in predicting tic severity than anxiety symptoms. This preliminary evidence suggests that environmental consequences for displaying tics, such as receiving accommodations or attention from others, have a greater influence on children's tic severity than emotional factors.
Collapse
Affiliation(s)
- Cyd K Eaton
- Department of Psychology, University of Georgia, 125 Baldwin Street, Athens, GA, 30602, USA.
| | - Anna M Jones
- Department of Psychology, University of Georgia, 125 Baldwin Street, Athens, GA, 30602, USA
| | - Ana M Gutierrez-Colina
- Department of Psychology, University of Georgia, 125 Baldwin Street, Athens, GA, 30602, USA
| | - Emily K Ivey
- Department of Psychology, University of Georgia, 125 Baldwin Street, Athens, GA, 30602, USA
| | - Olivia Carlson
- Department of Psychology, University of Georgia, 125 Baldwin Street, Athens, GA, 30602, USA
| | - Lauren Melville
- Department of Psychology, University of Georgia, 125 Baldwin Street, Athens, GA, 30602, USA
| | - Patricia Kardon
- Tourette Information Center and Support (TICS) of Georgia/Camp Twitch & Shout, Dunwoody, GA, USA
| | - Ronald L Blount
- Department of Psychology, University of Georgia, 125 Baldwin Street, Athens, GA, 30602, USA
| |
Collapse
|
13
|
Fowler SC, Mosher LJ, Godar SC, Bortolato M. Assessment of gait and sensorimotor deficits in the D1CT-7 mouse model of Tourette syndrome. J Neurosci Methods 2017; 292:37-44. [PMID: 28099872 DOI: 10.1016/j.jneumeth.2017.01.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 01/11/2017] [Accepted: 01/13/2017] [Indexed: 12/23/2022]
Abstract
Tourette syndrome (TS) is a neurodevelopmental disorder characterized by multiple motor and phonic tics. While TS patients have been also shown to exhibit subtle abnormalities of sensorimotor integration and gait, animal models of this disorder are seldom tested for these functions. To fill this gap, we assessed gait and sensorimotor integration in the D1CT-7 mouse, one of the best-validated animal models of TS. D1CT-7 mice exhibit spontaneous tic-like manifestations, which, in line with the clinical phenomenology of TS, are markedly exacerbated by environmental stress. Thus, to verify whether stress may affect sensorimotor integration and gait functions in D1CT-7 mice, we subjected these animals to a 20-min session of spatial confinement, an environmental stressor that was recently shown to worsen tic-like manifestations. Immediately following this manipulation (or no confinement, for controls), animals were subjected to either the sticky-tape task, to test for sensorimotor integration; or a 60-min session in an open field (42×42cm) force-plate actometer for gait analysis. Gait analyses included spatial, temporal, and dynamic (force) parameters. D1CT-7 mice displayed a longer latency to remove a sticky tape, indicating marked impairments in sensorimotor integration; furthermore, these mutants exhibited shortened stride length, increased stride rate, nearly equal early-phase velocity, and higher late-phase velocity. D1CT-7 mice also ran with greater force amplitude than wild-type (WT) littermates. None of these phenotypes was worsened by spatial confinement. These results highlight the potential importance of testing sensorimotor integration and gait functions as a phenotypic correlate of cortical connectivity deficits in animal models of TS.
Collapse
Affiliation(s)
- Stephen C Fowler
- Dept. of Pharmacology and Toxicology, School of Pharmacy, University of Kansas, Lawrence, KS, USA.
| | - Laura J Mosher
- Dept. of Pharmacology and Toxicology, School of Pharmacy, University of Kansas, Lawrence, KS, USA; Dept. of Pharmacology and Toxicology, College of Pharmacy; University of Utah, Salt Lake City UT, USA
| | - Sean C Godar
- Dept. of Pharmacology and Toxicology, College of Pharmacy; University of Utah, Salt Lake City UT, USA
| | - Marco Bortolato
- Dept. of Pharmacology and Toxicology, College of Pharmacy; University of Utah, Salt Lake City UT, USA
| |
Collapse
|
14
|
Espil FM, Elkin TD, Young J. Manualized and Modular Behavior Therapy for a Child With Tourette’s Disorder, Inattention, and Disruptive Behavior. Clin Case Stud 2016. [DOI: 10.1177/1534650116679732] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Persistent tic disorders (PTDs), including Tourette’s Disorder (TD), involve motor and/or vocal tics and often cause significant impairment and distress for affected individuals and families. Functional impairment is typically greater among individuals with PTDs and comorbid disorders. The current gold standard behavioral intervention for tic disorders, Comprehensive Behavioral Intervention for Tics (CBIT), has demonstrated efficacy in randomized clinical trials. Complications introduced by comorbidities, however, potentially facilitate less optimal long-term outcomes using this treatment approach. This case study describes the implementation of CBIT and subsequent modularized parent training for an 8-year-old boy diagnosed with TD who also exhibited comorbid symptoms of inattention, hyperactivity, and oppositional behavior. Emphasis is placed on delineating treatment decisions, including the sequencing of specific techniques, in accord with algorithms for complicated PTD presentations discussed in the literature.
Collapse
Affiliation(s)
- Flint M. Espil
- Stanford University School of Medicine, Stanford, CA, USA
| | - T. David Elkin
- University of Mississippi Medical Center, Jackson, MS, USA
| | - John Young
- University of Mississippi, University Park, MS, USA
| |
Collapse
|
15
|
Hollis C, Pennant M, Cuenca J, Glazebrook C, Kendall T, Whittington C, Stockton S, Larsson L, Bunton P, Dobson S, Groom M, Hedderly T, Heyman I, Jackson GM, Jackson S, Murphy T, Rickards H, Robertson M, Stern J. Clinical effectiveness and patient perspectives of different treatment strategies for tics in children and adolescents with Tourette syndrome: a systematic review and qualitative analysis. Health Technol Assess 2016; 20:1-450, vii-viii. [PMID: 26786936 DOI: 10.3310/hta20040] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Tourette syndrome (TS) is a neurodevelopmental condition characterised by chronic motor and vocal tics affecting up to 1% of school-age children and young people and is associated with significant distress and psychosocial impairment. OBJECTIVE To conduct a systematic review of the benefits and risks of pharmacological, behavioural and physical interventions for tics in children and young people with TS (part 1) and to explore the experience of treatment and services from the perspective of young people with TS and their parents (part 2). DATA SOURCES For the systematic reviews (parts 1 and 2), mainstream bibliographic databases, The Cochrane Library, education, social care and grey literature databases were searched using subject headings and text words for tic* and Tourette* from database inception to January 2013. REVIEW/RESEARCH METHODS For part 1, randomised controlled trials and controlled before-and-after studies of pharmacological, behavioural or physical interventions in children or young people (aged < 18 years) with TS or chronic tic disorder were included. Mixed studies and studies in adults were considered as supporting evidence. Risk of bias associated with each study was evaluated using the Cochrane tool. When there was sufficient data, random-effects meta-analysis was used to synthesize the evidence and the quality of evidence for each outcome was assessed using the Grading of Recommendations Assessment, Development and Evaluation approach. For part 2, qualitative studies and survey literature conducted in populations of children/young people with TS or their carers or in health professionals with experience of treating TS were included in the qualitative review. Results were synthesized narratively. In addition, a national parent/carer survey was conducted via the Tourettes Action website. Participants included parents of children and young people with TS aged under 18 years. Participants (young people with TS aged 10-17 years) for the in-depth interviews were recruited via a national survey and specialist Tourettes clinics in the UK. RESULTS For part 1, 70 studies were included in the quantitative systematic review. The evidence suggested that for treating tics in children and young people with TS, antipsychotic drugs [standardised mean difference (SMD) -0.74, 95% confidence interval (CI) -1.08 to -0.41; n = 75] and noradrenergic agents [clonidine (Dixarit(®), Boehringer Ingelheim) and guanfacine: SMD -0.72, 95% CI -1.03 to -0.40; n = 164] are effective in the short term. There was little difference among antipsychotics in terms of benefits, but adverse effect profiles do differ. Habit reversal training (HRT)/comprehensive behavioural intervention for tics (CBIT) was also shown to be effective (SMD -0.64, 95% CI -0.99 to -0.29; n = 133). For part 2, 295 parents/carers of children and young people with TS contributed useable survey data. Forty young people with TS participated in in-depth interviews. Four studies were in the qualitative review. Key themes were difficulties in accessing specialist care and behavioural interventions, delay in diagnosis, importance of anxiety and emotional symptoms, lack of provision of information to schools and inadequate information regarding medication and adverse effects. LIMITATIONS The number and quality of clinical trials is low and this downgrades the strength of the evidence and conclusions. CONCLUSIONS Antipsychotics, noradrenergic agents and HRT/CBIT are effective in reducing tics in children and young people with TS. The balance of benefits and harms favours the most commonly used medications: risperidone (Risperdal(®), Janssen), clonidine and aripiprazole (Abilify(®), Otsuka). Larger and better-conducted trials addressing important clinical uncertainties are required. Further research is needed into widening access to behavioural interventions through use of technology including mobile applications ('apps') and video consultation. STUDY REGISTRATION This study is registered as PROSPERO CRD42012002059. FUNDING The National Institute for Health Research Health Technology Assessment programme.
Collapse
Affiliation(s)
- Chris Hollis
- Division of Psychiatry and Applied Psychology, Institute of Mental Health, University of Nottingham Innovation Park, University of Nottingham, Nottingham, UK
| | - Mary Pennant
- National Collaborating Centre for Mental Health, Royal College of Psychiatrists, London, UK
| | - José Cuenca
- Division of Psychiatry and Applied Psychology, Institute of Mental Health, University of Nottingham Innovation Park, University of Nottingham, Nottingham, UK
| | - Cris Glazebrook
- Division of Psychiatry and Applied Psychology, Institute of Mental Health, University of Nottingham Innovation Park, University of Nottingham, Nottingham, UK
| | - Tim Kendall
- National Collaborating Centre for Mental Health, Royal College of Psychiatrists, London, UK
| | - Craig Whittington
- National Collaborating Centre for Mental Health, Royal College of Psychiatrists, London, UK
| | - Sarah Stockton
- National Collaborating Centre for Mental Health, Royal College of Psychiatrists, London, UK
| | - Linnéa Larsson
- National Collaborating Centre for Mental Health, Royal College of Psychiatrists, London, UK
| | - Penny Bunton
- School of Psychological Sciences, University of Manchester, Manchester, UK
| | - Suzanne Dobson
- Tourettes Action, The Meads Business Centre, Farnborough, Hampshire, UK
| | - Madeleine Groom
- Division of Psychiatry and Applied Psychology, Institute of Mental Health, University of Nottingham Innovation Park, University of Nottingham, Nottingham, UK
| | - Tammy Hedderly
- Paediatric Neurology Department, Kings College Hospital NHS Foundation Trust, London, UK
| | - Isobel Heyman
- Department of Child and Adolescent Mental Health, Great Ormond Street Hospital for Children, London, UK
| | - Georgina M Jackson
- Division of Psychiatry and Applied Psychology, Institute of Mental Health, University of Nottingham Innovation Park, University of Nottingham, Nottingham, UK
| | - Stephen Jackson
- School of Psychology, University of Nottingham, Nottingham, UK
| | - Tara Murphy
- Institute of Neurology, University College London, London, UK
| | | | - Mary Robertson
- Department of Neurology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Jeremy Stern
- Tourettes Action, The Meads Business Centre, Farnborough, Hampshire, UK
| |
Collapse
|
16
|
Whittington C, Pennant M, Kendall T, Glazebrook C, Trayner P, Groom M, Hedderly T, Heyman I, Jackson G, Jackson S, Murphy T, Rickards H, Robertson M, Stern J, Hollis C. Practitioner Review: Treatments for Tourette syndrome in children and young people - a systematic review. J Child Psychol Psychiatry 2016; 57:988-1004. [PMID: 27132945 DOI: 10.1111/jcpp.12556] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/22/2016] [Indexed: 12/22/2022]
Abstract
BACKGROUND Tourette syndrome (TS) and chronic tic disorder (CTD) affect 1-2% of children and young people, but the most effective treatment is unclear. To establish the current evidence base, we conducted a systematic review of interventions for children and young people. METHODS Databases were searched from inception to 1 October 2014 for placebo-controlled trials of pharmacological, behavioural, physical or alternative interventions for tics in children and young people with TS or CTD. Certainty in the evidence was assessed with the GRADE approach. RESULTS Forty trials were included [pharmacological (32), behavioural (5), physical (2), dietary (1)]. For tics/global score there was evidence favouring the intervention from four trials of α2-adrenergic receptor agonists [clonidine and guanfacine, standardised mean difference (SMD) = -0.71; 95% CI -1.03, -0.40; N = 164] and two trials of habit reversal training (HRT)/comprehensive behavioural intervention (CBIT) (SMD = -0.64; 95% CI -0.99, -0.29; N = 133). Certainty in the effect estimates was moderate. A post hoc analysis combining oral clonidine/guanfacine trials with a clonidine patch trial continued to demonstrate benefit (SMD = -0.54; 95% CI -0.92, -0.16), but statistical heterogeneity was high. Evidence from four trials suggested that antipsychotic drugs improved tic scores (SMD = -0.74; 95% CI -1.08, -0.40; N = 76), but certainty in the effect estimate was low. The evidence for other interventions was categorised as low or very low quality, or showed no conclusive benefit. CONCLUSIONS When medication is considered appropriate for the treatment of tics, the balance of clinical benefits to harm favours α2-adrenergic receptor agonists (clonidine and guanfacine) as first-line agents. Antipsychotics are likely to be useful but carry the risk of harm and so should be reserved for when α2-adrenergic receptor agonists are either ineffective or poorly tolerated. There is evidence that HRT/CBIT is effective, but there is no evidence for HRT/CBIT alone relative to combining medication and HRT/CBIT. There is currently no evidence to suggest that the physical and dietary interventions reviewed are sufficiently effective and safe to be considered as treatments.
Collapse
Affiliation(s)
- Craig Whittington
- National Collaborating Centre for Mental Health, University College London, London, UK
| | - Mary Pennant
- National Collaborating Centre for Mental Health, Royal College of Psychiatrists, London, UK
| | - Tim Kendall
- National Collaborating Centre for Mental Health, Royal College of Psychiatrists, London, UK
| | - Cristine Glazebrook
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Penny Trayner
- School of Psychological Sciences, University of Manchester, Manchester, UK
| | - Madeleine Groom
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Tammy Hedderly
- Paediatric Neurosciences, Evelina London Children's Hospital, Guys and St Thomas' Hospital, London, UK
| | - Isobel Heyman
- Department of Child and Adolescent Mental Health, Great Ormond Street Hospital for Children, London, UK
| | - Georgina Jackson
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Stephen Jackson
- School of Psychology, University of Nottingham, Nottingham, UK
| | - Tara Murphy
- Department of Child and Adolescent Mental Health, Great Ormond Street Hospital for Children, London, UK
| | - Hugh Rickards
- National Centre for Mental Health, University of Birmingham, Birmingham, UK
| | - Mary Robertson
- Department of Neurology, St Georges Hospital, London, UK
| | - Jeremy Stern
- Department of Neurology, St Georges Hospital, London, UK
| | - Chris Hollis
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK
| |
Collapse
|
17
|
Piedad JCP, Cavanna AE. Depression in Tourette syndrome: A controlled and comparison study. J Neurol Sci 2016; 364:128-32. [PMID: 27084230 DOI: 10.1016/j.jns.2016.03.030] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Revised: 03/08/2016] [Accepted: 03/18/2016] [Indexed: 01/22/2023]
Abstract
BACKGROUND Tourette syndrome (TS) is a neurodevelopmental condition characterised by multiple tics and co-morbid behavioural problems. Previous research found that up to 76% of patients with TS experience affective symptoms, with 13% fulfilling diagnostic criteria for depression. OBJECTIVES We aimed to assess the severity of depression and profile of depressive symptoms in adult patients with TS compared to patients with major depression and healthy controls. METHODS Depression ratings were collected from patients with TS (N=65) using the BDI-II and from patients with recurrent major depressive disorder (rMDD, N=696) and healthy controls (N=293) using the Beck Depression Inventory (BDI)-IA. Direct comparisons were possible for 14/21 BDI items. RESULTS Patients with TS scored significantly higher on the BDI than controls (P<0.001) and all individual symptoms were reported more frequently by patients with TS than by controls (P<0.001). Total BDI score in TS was not significantly different to that in rMDD, however irritability was significantly more frequently reported in the TS group and this remained significant after controlling for age and gender differences between the two groups (OR 5.24, 95% CI 1.97-14.00; P=0.001). CONCLUSIONS Our findings show that depression is a prominent feature in TS and may present with a more irritable phenotype than rMDD. Patients with TS should be routinely screened for depression to implement treatment as appropriate.
Collapse
Affiliation(s)
- John Carlo P Piedad
- Michael Trimble Neuropsychiatry Research Group, University of Birmingham & BSMHFT, Birmingham, UK
| | - Andrea E Cavanna
- Michael Trimble Neuropsychiatry Research Group, University of Birmingham & BSMHFT, Birmingham, UK; School of Life and Health Sciences, Aston University, Birmingham, UK; Sobell Department of Motor Neuroscience and Movement Disorders, University College London & Institute of Neurology, London, UK.
| |
Collapse
|
18
|
Hanks CE, McGuire JF, Lewin AB, Storch EA, Murphy TK. Clinical Correlates and Mediators of Self-Concept in Youth with Chronic Tic Disorders. Child Psychiatry Hum Dev 2016; 47:64-74. [PMID: 25791488 PMCID: PMC4575820 DOI: 10.1007/s10578-015-0544-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
This study investigated the clinical correlates and mediators of self-concept in youth with Chronic Tic Disorders (CTD). Ninety-seven youth aged 6-17 (M = 11.1 ± 2.89; 79.4 % male) with CTD were administered the Yale Global Tic Severity Scale, the Piers-Harris Children's Self-Concept Scale-Second Edition, and self-report and clinician-administered measures assessing behavioral and psychological difficulties and comorbid conditions. Youth with CTD had a slightly below average level of self-concept, with 20 % (n = 19) exhibiting low self-concept. Youth with CTD-only had greater self-concept relative to youth with CTD and obsessive-compulsive disorder (OCD) (p = 0.04) or CTD, OCD, and attention deficit hyperactivity disorder (ADHD) combined (p = 0.009). Medium-to-large-sized associations were observed between youth's self-concept and clinical characteristics (e.g., severity of ADHD, OCD and depressive symptoms). Youth's self-concept partially mediated the relationship between tic severity and depressive symptom severity, and the interaction between tic impairment and youth's reliance on avoidant coping strategies moderated youth's self-concept. Implications, limitations, and recommendations for future interventions are discussed.
Collapse
Affiliation(s)
- Camille E. Hanks
- Department of Pediatrics, University of South Florida, 880 6th Street South, Suite 460, Box 7523, St. Petersburg, FL 33701, USA
| | - Joseph F. McGuire
- Department of Pediatrics, University of South Florida, 880 6th Street South, Suite 460, Box 7523, St. Petersburg, FL 33701, USA,Department of Psychology, University of South Florida, St. Petersburg, FL, USA
| | - Adam B. Lewin
- Department of Pediatrics, University of South Florida, 880 6th Street South, Suite 460, Box 7523, St. Petersburg, FL 33701, USA,Department of Psychology, University of South Florida, St. Petersburg, FL, USA,Departments of Psychiatry and Behavioral Neurosciences, University of South Florida, St. Petersburg, FL, USA
| | - Eric A. Storch
- Department of Pediatrics, University of South Florida, 880 6th Street South, Suite 460, Box 7523, St. Petersburg, FL 33701, USA,Department of Psychology, University of South Florida, St. Petersburg, FL, USA,Departments of Psychiatry and Behavioral Neurosciences, University of South Florida, St. Petersburg, FL, USA,Rogers Behavioral Health – Tampa Bay, Tampa, FL, USA,All Children’s Hospital – Johns Hopkins Medicine, St. Petersburg, FL, USA,Department of Health Policy and Management, University of South Florida, Tampa, FL, USA
| | - Tanya K. Murphy
- Department of Pediatrics, University of South Florida, 880 6th Street South, Suite 460, Box 7523, St. Petersburg, FL 33701, USA,Departments of Psychiatry and Behavioral Neurosciences, University of South Florida, St. Petersburg, FL, USA,All Children’s Hospital – Johns Hopkins Medicine, St. Petersburg, FL, USA
| |
Collapse
|
19
|
Bodeck S, Lappe C, Evers S. Tic-reducing effects of music in patients with Tourette's syndrome: Self-reported and objective analysis. J Neurol Sci 2015; 352:41-7. [PMID: 25805454 DOI: 10.1016/j.jns.2015.03.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2014] [Revised: 03/09/2015] [Accepted: 03/10/2015] [Indexed: 01/02/2023]
Abstract
BACKGROUND Self-reports by musicians affected with Tourette's syndrome and other sources of anecdotal evidence suggest that tics stop when subjects are involved in musical activity. For the first time, we studied this effect systematically using a questionnaire design to investigate the subjectively assessed impact of musical activity on tic frequency (study 1) and an experimental design to confirm these results (study 2). METHODS A questionnaire was sent to 29 patients assessing whether listening to music and musical performance would lead to a tic frequency reduction or increase. Then, a within-subject repeated measures design was conducted with eight patients. Five experimental conditions were tested: baseline, musical performance, short time period after musical performance, listening to music and music imagery. Tics were counted based on videotapes. RESULTS Analysis of the self-reports (study 1) yielded in a significant tic reduction both by listening to music and musical performance. In study 2, musical performance, listening to music and mental imagery of musical performance reduced tic frequency significantly. We found the largest reduction in the condition of musical performance, when tics almost completely stopped. Furthermore, we could find a short-term tic decreasing effect after musical performance. CONCLUSIONS Self-report assessment revealed that active and passive participation in musical activity can significantly reduce tic frequency. Experimental testing confirmed patients' perception. Active and passive participation in musical activity reduces tic frequency including a short-term lasting tic decreasing effect. Fine motor control, focused attention and goal directed behavior are believed to be relevant factors for this observation.
Collapse
Affiliation(s)
- Sabine Bodeck
- Münster University Hospital, Institute for Biomagnetism and Biosignalanalysis, University of Münster, Malmedyweg 15, Münster 48149, Germany.
| | - Claudia Lappe
- Münster University Hospital, Institute for Biomagnetism and Biosignalanalysis, University of Münster, Malmedyweg 15, Münster 48149, Germany.
| | - Stefan Evers
- Department of Neurology, Krankenhaus Lindenbrunn, Lindenbrunn 1, Coppenbrügge 31863, Germany.
| |
Collapse
|
20
|
A personal 35 year perspective on Gilles de la Tourette syndrome: prevalence, phenomenology, comorbidities, and coexistent psychopathologies. Lancet Psychiatry 2015; 2:68-87. [PMID: 26359614 DOI: 10.1016/s2215-0366(14)00132-1] [Citation(s) in RCA: 107] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Accepted: 09/15/2014] [Indexed: 02/07/2023]
Abstract
This Series is a personal narrative of my experience with patients with Gilles de la Tourette syndrome and covers its definition and history since the first description in 1825. Controversy entered the prevalence debate early. Although originally considered very rare, in the 1980s, Tourette's syndrome was reported to be common. However, Tourette's syndrome has been shown to occur at a prevalence of about 0·85% to 1%. Tourette's syndrome is more common in the male population, more prominent during childhood, and usually improves, but does not disappear with age. Tourette's syndrome is considered less common in people of sub-Saharan black African, African-American, and American Hispanic ethnic origin. The phenomenology is similar worldwide, indicating a biological basis. The hallmark characteristics are multiple motor and one or more vocal/phonic tics. Other associated features include premonitory urges, a waxing and waning course, and to a much lesser degree, coprolalia. Comorbid disorders are common and are suggested to include obsessive-compulsive disorder and behaviours, attention deficit hyperactivity disorder, and autistic spectrum disorder. Coexistent psychopathologies are suggested to include depression and conduct and personality disorders. Importantly, I argue that Tourette's syndrome is not a unitary condition. Finally, I offer suggestions for future research.
Collapse
|
21
|
Ferreira BR, Pio-Abreu JL, Januário C. Tourette's syndrome and associated disorders: a systematic review. TRENDS IN PSYCHIATRY AND PSYCHOTHERAPY 2014; 36:123-33. [DOI: 10.1590/2237-6089-2014-1003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Objective: To compile data on Tourette's syndrome (TS), tics and associated disorders.Methods: A systematic review of the literature was conducted using the 5S levels of organization of healthcare research evidence (systems, summaries, synopses, syntheses, studies), based on the model described by Haynes. The search keywords were Tourette, tics and comorbidity, which were cross-referenced. Studies provided by publishers and articles being processed on July 31, 2013, were also included.Results: Of all studies retrieved during the search, 64 were selected because they analyzed the epidemiology, clinical features and etiopathogenesis of TS and its comorbidities. TS is classified as a hyperkinetic movement disorder, and at least 90% of the patients have neuropsychiatric comorbidities, of which attention deficit hyperactivity and obsessive-compulsive disorders are the most common. The syndrome is clinically heterogeneous and has been associated with a dysfunction of cortico-striatal-thalamic-cortical circuits involving various neurotransmitters. Although its genetic etiology has been widely studied, other factors may be important to understand this syndrome and its associated disorders.Conclusions: TS is a neurodevelopmental disorder that results from the impact of stress factors on a vulnerable biological substrate during the critical periods of neurodevelopment. The study of TS and its comorbidities may contribute, at different levels, to the understanding of several neuropsychiatric disorders of clinical and therapeutic relevance.
Collapse
|
22
|
Nixon E, Glazebrook C, Hollis C, Jackson GM. Reduced Tic Symptomatology in Tourette Syndrome After an Acute Bout of Exercise: An Observational Study. Behav Modif 2014; 38:235-63. [PMID: 24778432 DOI: 10.1177/0145445514532127] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In light of descriptive accounts of attenuating effects of physical activity on tics, we used an experimental design to assess the impact of an acute bout of aerobic exercise on tic expression in young people (N = 18) with Tourette Syndrome (TS). We compared video-based tic frequency estimates obtained during an exercise session with tic rates obtained during pre-exercise (baseline) and post-exercise interview-based sessions. Results showed significantly reduced tic rates during the exercise session compared with baseline, suggesting that acute exercise has an attenuating effect on tics. Tic rates also remained reduced relative to baseline during the post-exercise session, likely reflecting a sustained effect of exercise on tic reduction. Parallel to the observed tic attenuation, exercise also had a beneficial impact on self-reported anxiety and mood levels. The present findings provide novel empirical evidence for the beneficial effect of exercise on TS symptomatology bearing important research and clinical implications.
Collapse
|
23
|
Caurín B, Serrano M, Fernández-Alvarez E, Campistol J, Pérez-Dueñas B. Environmental circumstances influencing tic expression in children. Eur J Paediatr Neurol 2014; 18:157-62. [PMID: 24210363 DOI: 10.1016/j.ejpn.2013.10.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2013] [Revised: 10/01/2013] [Accepted: 10/17/2013] [Indexed: 12/19/2022]
Abstract
AIM To assess the clinical features and severity of tics and environmental factors influencing tic expression in a cohort of children with tic disorders. METHODS We performed a cross-sectional study in a cohort of children and adolescents (N = 92) with tic disorders referred to the outpatient clinic of a tertiary-level paediatric centre in Barcelona. The severity of tics was evaluated using the Yale Global Tic Severity Scale (YGTSS). A questionnaire including a list of environmental factors and common daily activities that might influence tic occurrence was completed for patients greater than 5 years old. RESULTS Children were classified as having Tourette syndrome (TS) (52 patients), chronic motor or phonic tics (22 patients) and tics of less than 12 months' duration (18 patients). Tics worsened with stressful situations, activities related to school, playing video games and watching TV. A significant proportion of children reported a reduction in tics while they were concentrating on artistic or creative activities or when playing sports and participating in outdoor activities. The YGTSS scores were higher for TS patients (P < .001) and correlated positively with the time of evolution of tics (r = .273, P = .026). Poor school performance was associated with TS (p = .043) and higher scores on the YGTSS (P = .018), as well as attention deficit/hyperactivity disorder (P = .007). CONCLUSIONS Several activities of daily living were identified as modifying tic severity in children and may be important clues for tic management. In a subgroup of children with TS, tics were associated with significant morbidity and poor academic performance. Our results emphasise the importance of developing specific school programmes and tailored recommendations in patients with TS.
Collapse
Affiliation(s)
- Belén Caurín
- Department of Child Neurology, Hospital Sant Joan de Déu, Universitat de Barcelona, Spain
| | - Mercedes Serrano
- Department of Child Neurology, Hospital Sant Joan de Déu, Universitat de Barcelona, Spain; Centre for Biomedical Research on Rare Diseases (CIBER-ER), Instituto de Salud Carlos III, Barcelona, Spain
| | | | - Jaume Campistol
- Department of Child Neurology, Hospital Sant Joan de Déu, Universitat de Barcelona, Spain; Centre for Biomedical Research on Rare Diseases (CIBER-ER), Instituto de Salud Carlos III, Barcelona, Spain
| | - Belén Pérez-Dueñas
- Department of Child Neurology, Hospital Sant Joan de Déu, Universitat de Barcelona, Spain; Centre for Biomedical Research on Rare Diseases (CIBER-ER), Instituto de Salud Carlos III, Barcelona, Spain.
| |
Collapse
|
24
|
Kobierska M, Sitek M, Gocyła K, Janik P. Coprolalia and copropraxia in patients with Gilles de la Tourette syndrome. Neurol Neurochir Pol 2014; 48:1-7. [DOI: 10.1016/j.pjnns.2013.03.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Accepted: 03/19/2013] [Indexed: 10/25/2022]
|
25
|
Evidence-based assessment of compulsive skin picking, chronic tic disorders and trichotillomania in children. Child Psychiatry Hum Dev 2012; 43:855-83. [PMID: 22488574 DOI: 10.1007/s10578-012-0300-7] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Body-focused repetitive behavior (BFRB) is an umbrella term for debilitating, repetitive behaviors that target one or more body regions. Despite regularly occurring in youth, there has been limited investigation of BFRBs in pediatric populations. One reason for this may be that there are few reliable and valid assessments available to evaluate the presence, severity and impairment of BFRBs in youth. Given the shift toward evidence-based assessment in mental health, the development and utilization of evidence-based measures of BFRBs warrants increasing attention. This paper examines the available evidence-base for assessments in youth across three BFRB-related disorders: compulsive skin picking, chronic tic disorders and trichotillomania. Based upon present empirical support in samples of youth, recommendations are made for an evidence-based assessment of each condition.
Collapse
|
26
|
Woitecki K, Döpfner M. [Changes in comorbid symptoms and subjective interference in a habit reversal therapy in children with chronic tic disorder - a pilot study]. ZEITSCHRIFT FUR KINDER-UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2012; 40:181-90. [PMID: 22532110 DOI: 10.1024/1422-4917/a000168] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE This pilot study investigates the effects of habit reversal training in a German-speaking population of children and young adults with chronic tic disorders on comorbid symptoms and subjective interference. METHODS 16 children were treated using a manualized program. Comorbid-symptoms (ADHD, anxiety and OCD, depression) were assessed using parent and self-ratings. Additionally, the correlation of tic symptoms with comorbid symptoms at the beginning of the therapy was analyzed. RESULTS We obtained positive results in reducing comorbid symptoms during a primary treatment of tic symptoms. We further found a correlation of tic symptoms and comorbid symptoms especially in parent ratings. CONCLUSIONS These first findings show that a primary treatment of tics may be indicated in patients with comorbid symptoms, because a therapy of tic symptoms has also positive effects on comorbid symptoms.
Collapse
Affiliation(s)
- Katrin Woitecki
- Institut für Klinische Kinderpsychologie der Christoph-Dornier-Stiftung an der Universität zu Köln.
| | | |
Collapse
|
27
|
Storch EA, Morgan JE, Caporino NE, Brauer L, Lewin AB, Piacentini J, Murphy TK. Psychosocial Treatment to Improve Resilience and Reduce Impairment in Youth With Tics: An Intervention Case Series of Eight Youth. J Cogn Psychother 2012. [DOI: 10.1891/0889-8391.26.1.57] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background: Many youth with tic disorders experience distress about having tics and how others may perceive them. Such symptoms are often more impairing and distressing than the tics themselves and negatively impact self-concept, psychosocial functioning, and quality of life. Objective: Although there exist pharmacological and behavioral treatments that target the frequency and severity of tics, no intervention has been developed specifically to help youth with tics cope with their condition and limit associated functional impairment and distress. With this in mind, we report an intervention case series of eight youth (ages 8–16 years) supporting the initial efficacy of a cognitive-behavioral therapy program entitled “Living with Tics” that promotes coping and resiliency among youth with tics. Method: Eight youth with a principal diagnosis of a tic disorder (i.e., Tourette syndrome [N = 6]; Chronic Tic Disorder [N = 2]) and associated psychosocial impairment participated. Assessments were conducted at screening, pretreatment, and posttreatment by trained raters. Treatment consisted of 10 weekly individual psychotherapy session focused on improving coping with having tics. Results: Six of eight youth were considered treatment responders. On average, participants exhibited meaningful reductions in tic-related impairment, anxiety, and overall tic severity as well as improvements in self-concept and quality of life. Conclusions: These data provide preliminary evidence for conducting a larger controlled trial to examine the utility of the Living with Tics psychosocial intervention for promoting adaptive functioning among youth with tics.
Collapse
|
28
|
Conelea CA, Woods DW, Brandt BC. The impact of a stress induction task on tic frequencies in youth with Tourette Syndrome. Behav Res Ther 2011; 49:492-7. [PMID: 21658680 DOI: 10.1016/j.brat.2011.05.006] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2010] [Revised: 04/02/2011] [Accepted: 05/16/2011] [Indexed: 11/17/2022]
Abstract
Tourette Syndrome (TS) is a neuropsychiatric disorder characterized by motor and vocal tics. Tic fluctuations are common and thought to be attributable in part, to contextual variables. Stress is one such variable, but its effects and mechanism of action are poorly understood. The current study measured the effects of a stress induction task on tic frequencies during periods of suppression and non-suppression of tics. Ten youth with TS between the ages of 9 and 17 were exposed to four conditions in random sequence: free-to-tic baseline (BL), reinforced tic suppression (SUP), reinforced tic suppression plus a stress induction task (SUP + STRESS), and a stress induction task alone (STRESS). Tic frequencies did not differ during STRESS and BL. Tic frequencies were greater in SUP + STRESS than SUP. Stress may impact tics through disrupting suppression efforts. Clinically, results suggest that interventions designed to improve tic inhibition in the presence of acute stressors may be beneficial.
Collapse
|
29
|
Termine C, Selvini C, Balottin U, Luoni C, Eddy CM, Cavanna AE. Self-, parent-, and teacher-reported behavioral symptoms in youngsters with Tourette syndrome: a case-control study. Eur J Paediatr Neurol 2011; 15:95-100. [PMID: 21273099 DOI: 10.1016/j.ejpn.2011.01.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2010] [Revised: 12/16/2010] [Accepted: 01/04/2011] [Indexed: 11/16/2022]
Abstract
AIMS Tourette syndrome (TS) is a neurodevelopmental disorder characterized by multiple tics and associated with co-morbid behavioral problems (TS-plus). We investigated the usefulness of self-report versus parent- and teacher-report instruments in assisting the specialist assessment of TS-plus in a child/adolescent population. METHODS Twenty-three patients diagnosed with TS (19 males; age 13.9 ± 3.7 years) and 69 matched healthy controls participated in this study. All recruited participants completed a standardized psychometric battery, including the Children's Depression Inventory (CDI), the Self Administrated Psychiatric Scales for Children and Adolescents (SAFA) and the State-Trait Anger Expression Inventory (STAXI). Parents completed the Child Behavior Checklist (CBCL) and Conners' Parent Rating Scales-Revised (CPRS-R). Participants' teachers completed the Conners' Teacher Rating Scales-Revised (CTRS-R). Results were compared with similar data obtained from controls. RESULTS Nineteen patients (82.6%) fulfilled DSM-IV-TR criteria for at least one co-morbid condition: obsessive-compulsive disorder (OCD, n = 8; 34.8%); attention deficit-hyperactivity disorder (ADHD, n = 6; 26.1%); OCD + ADHD (n = 5; 21.7%). Scores on self-report instruments failed to show any significant differences between TS and controls. Most subscores of the CPRS-R, CTRS-R, and CBCL were significantly higher for the TS group than controls. The TS + OCD subgroup scored significantly higher than the TS-OCD subgroup on the CBCL-Externalizing, Anxious/Depressed and Obsessive-Compulsive subscales. CONCLUSIONS Self-report instruments appear to have limited usefulness in assisting the assessment of the behavioral spectrum of young patients with TS. However, proxy-rated instruments differentiate TS populations from healthy subjects, and the CBCL can add relevant information to the clinical diagnosis of co-morbid OCD.
Collapse
Affiliation(s)
- Cristiano Termine
- Child Neuropsychiatry Unit, Department of Experimental Medicine, University of Insubria, Varese, Italy
| | | | | | | | | | | |
Collapse
|
30
|
Robertson MM. Gilles de la Tourette syndrome: the complexities of phenotype and treatment. Br J Hosp Med (Lond) 2011; 72:100-7. [DOI: 10.12968/hmed.2011.72.2.100] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Mary M Robertson
- Professor Mary M Robertson is Emeritus Professor of Neuropsychiatry, University College London and Visiting Professor and Honorary Consultant, Department of Neurology, St Georges Hospital and Medical School, London SW17 0QT
| |
Collapse
|
31
|
Storch EA, Merlo LJ, Lack C, Milsom VA, Geffken GR, Goodman WK, Murphy TK. Quality of Life in Youth With Tourette's Syndrome and Chronic Tic Disorder. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2010; 36:217-27. [PMID: 17484694 DOI: 10.1080/15374410701279545] [Citation(s) in RCA: 122] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
This study sought to examine quality of life (QoL) in clinic-referred children and adolescents (n = 59, M age = 11.4+/-2.6 years) with a chronic tic disorder. The QoL scores for tic patients were lower than for healthy controls but higher than for the psychiatric sample on the majority of domains. Children's self-reported QoL scores and a measure of tic severity were moderately and inversely correlated. Parent reports of their child's QoL were weakly related to tic severity. Correlations between parent and child ratings of QoL for children ages 8 to 11 years were generally higher than those for youth ages 12 to 17 years. Finally, externalizing behavior moderated the relations between tic severity and parent-rated QoL, such that tic severity was significantly associated with parent-rated QoL for children with below average externalizing symptoms but not for children 3with above average externalizing symptoms.
Collapse
Affiliation(s)
- Eric A Storch
- Department of Psychiatry and Pediatrics, University of Florida, Gainesville, FL 32610, USA.
| | | | | | | | | | | | | |
Collapse
|
32
|
Eapen V, Crncec R. Tourette syndrome in children and adolescents: special considerations. J Psychosom Res 2009; 67:525-32. [PMID: 19913657 DOI: 10.1016/j.jpsychores.2009.08.003] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2009] [Revised: 06/20/2009] [Accepted: 08/06/2009] [Indexed: 11/18/2022]
Abstract
Tourette syndrome (TS) affects people of all ages, with onset in early childhood and continuing through the different stages of the life cycle into adolescence and adults. This review focuses on barriers to diagnosis and challenges in the management of young patients with TS. Barriers to identification occur at multiple levels, including detection in the community setting (including schools), parents' help-seeking behavior, and cultural influences on such behavior, as well as diagnosis by the medical provider. Challenges to management include unfamiliarity of primary care providers, inconsistencies in the diagnosis and management plan, and failure to recognize comorbid conditions, as well as inadequate knowledge and lack of resources to effectively deal with comorbidities. In addition to the complexities posed by pharmacological interactions, there are unique psychosocial challenges experienced by young people with TS and their families. Effective communication and collaboration between families, health care providers, and school personnel, as well as supportive communities, are essential components of comprehensive management.
Collapse
|
33
|
Balottin U, Rossi M, Rossi G, Viganò L, Nanti M, Salini S, Lanzi G, Termine C. The Rorschach test and Gilles de la Tourette's syndrome: a pilot case-control study. Brain Dev 2009; 31:657-65. [PMID: 19041203 DOI: 10.1016/j.braindev.2008.10.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2008] [Revised: 09/14/2008] [Accepted: 10/19/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND To date only three studies, all lacking a control group, have investigated the personality style underlying tic disorders or Tourette's syndrome (TS), using the projective Rorschach test. Despite the recent controversy about its proper use in clinical practice and research, the Rorschach test may be useful to explore personality organization in TS. The research hypothesis under investigation in this exploratory study was that young TS patients exhibit a peculiar personality organization, with significantly increased indicators of poor emotional control, aggression, anxiety and depression, on the Rorschach test, compared to healthy controls. METHODS We analyed the Rorschach protocols of 17 newly diagnosed paediatric TS patients and 17 age- and sex-matched healthy controls. RESULTS Compared with the controls young TS patients recorded significantly lower mean percentages of F and F+ responses and a significantly higher number of FM and FC responses, thus showing reduced control of emotions and difficulty in integrating aggressivity. Furthermore, associations emerged between comorbidity with ADHD and increased emotional instability and between severity of tics and of OCD and a pattern of emotional hyper-control and application of rigid defensive mechanisms. CONCLUSIONS These results seem to confirm the existence of a peculiar personality style in young TS patients and may have important implications, both pathogenetic and therapeutic.
Collapse
Affiliation(s)
- Umberto Balottin
- Department of Child Neurology and Psychiatry, IRCCS C. Mondino Foundation, University of Pavia, Pavia, Italy
| | | | | | | | | | | | | | | |
Collapse
|
34
|
Murphy TK, Mutch PJ, Reid JM, Edge PJ, Storch EA, Bengtson M, Yang M. Open label aripiprazole in the treatment of youth with tic disorders. J Child Adolesc Psychopharmacol 2009; 19:441-7. [PMID: 19702496 DOI: 10.1089/cap.2008.0149] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Primarily safe and efficacious treatments for chronic tic disorders are needed. Also needed are such treatments that target co-morbid conditions. Aripiprazole, a dopaminergic/serotonergic agent with partial agonist properties at the D2 dopamine receptor and 5-hydrdoxytryptamine 1A (5-HT(1A)) receptor and antagonist properties at the 5-HT(2A) receptor, holds promise in both regards. OBJECTIVE This was an open-label, flexible-dose study to evaluate the safety of aripiprazole in children and adolescents with a primary diagnosis of a chronic tic disorder with/without co-morbid disorder(s). METHOD Sixteen children (15 males) aged 8-17 years participated in the 6-week trial. Ratings for tic, obsessive compulsive disorder (OCD), attention-deficit/hyperactivity disorder (ADHD), and side effects were administered weekly. Baseline and exit laboratory measures, electrocardiograms (ECGs), weight, and height were obtained. RESULTS The average daily aripiprazole dose was 3.3 mg (range 1.25-7.5 mg). Significant pre-and posttreatment differences were ascertained for the Yale Global Tic Severity Scale motor (p < or = 0.0001), phonic (p < or = 0.0001), and total tic (p < or = 0.0001) scores. Results of other rating scales suggested significant improvements in co-morbid disorders as well, including OCD, ADHD, and depressive disorders. Although aripiprazole was well tolerated, increases in weight were found. CONCLUSION In this preliminary open-label trial, aripiprazole was a well-tolerated treatment for tics and co-morbid OCD and ADHD symptoms. Improvements in co-morbid conditions may be secondary to tic reduction or to specific to aripiprazole therapy; however, further study is warranted.
Collapse
Affiliation(s)
- Tanya K Murphy
- Department of Pediatrics & Psychiatry, University of South Florida , St. Petersburg, FL 33701, USA.
| | | | | | | | | | | | | |
Collapse
|
35
|
Freeman RD, Zinner SH, Müller-Vahl KR, Fast DK, Burd LJ, Kano Y, Rothenberger A, Roessner V, Kerbeshian J, Stern JS, Jankovic J, Loughin T, Janik P, Shady G, Robertson MM, Lang AE, Budman C, Magor A, Bruun R, Berlin CM. Coprophenomena in Tourette syndrome. Dev Med Child Neurol 2009; 51:218-27. [PMID: 19183216 DOI: 10.1111/j.1469-8749.2008.03135.x] [Citation(s) in RCA: 109] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The aims of this descriptive study were to examine the prevalence and associations of coprophenomena (involuntary expression of socially unacceptable words or gestures) in individuals with Tourette syndrome. Participant data were obtained from the Tourette Syndrome International Database Consortium. A specialized data collection form was completed for each of a subset of 597 consecutive new patients with Tourette syndrome from 15 sites in seven countries. Coprolalia occurred at some point in the lifetime of 19.3% of males and 14.6% of females, and copropraxia in 5.9% of males and 4.9% of females. Coprolalia was three times as frequent as copropraxia, with a mean onset of each at about 11 years, 5 years after the onset of tics. In 11% of those with coprolalia and 12% of those with copropraxia these coprophenomena were one of the initial symptoms of Tourette syndrome. The onsets of tics, coprophenomena, smelling of non-food objects, and spitting were strongly intercorrelated. Early onset of coprophenomena was not associated with its longer persistence. The most robust associations of coprophenomena were with the number of non-tic repetitive behaviors, spitting, and inappropriate sexual behavior. Although coprophenomena are a frequently feared possibility in the course of Tourette syndrome, their emergence occurs in only about one in five referred patients. Because the course and actual impact of coprophenomena are variable, additional prospective research is needed to provide better counseling and prognostic information.
Collapse
|
36
|
Rivera-Navarro J, Cubo E, Almazán J. The diagnosis of Tourette's Syndrome: communication and impact. Clin Child Psychol Psychiatry 2009; 14:13-23. [PMID: 19103702 DOI: 10.1177/1359104508100127] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
No study to date has investigated differences in perception regarding the manner in which a diagnosis of Tourette's Syndrome (TS) is communicated and the impact that this diagnosis can have on patients, as well as their relatives and physicians. The main objective was to explore the personal experiences regarding the communication and impact of a TS diagnosis on those who receive the diagnosis, their caregivers and physicians. A qualitative research methodology was used in this study, based on the use of focus groups (FGs). All health professionals, persons with TS and their relatives said that TS was difficult to diagnose. However, each group perceived different causes for the difficulty. Physicians cited the complexity of the symptoms, while the patients themselves noted the general lack of knowledge regarding the disease. In adittion, the physicians and the relatives both noted that the symptoms of TS were often hidden behind family guilt. The communication of the diagnosis to relatives of children with TS was not adequate because of poor understanding and interpretation of the clinical terminology. The most important conclusion was that the current method for communicating the diagnosis of TS to patients and relatives should be improved to facilitate better understanding and interpretation.
Collapse
|
37
|
Porta M, Sassi M, Cavallazzi M, Fornari M, Brambilla A, Servello D. Tourette's syndrome and role of tetrabenazine: review and personal experience. Clin Drug Investig 2008; 28:443-59. [PMID: 18544005 DOI: 10.2165/00044011-200828070-00006] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Gilles de la Tourette's syndrome (Tourette's syndrome; TS) is an inherited tic disorder commonly associated with other neurobehavioural conditions such as attention-deficit hyperactivity disorder (ADHD) and obsessive-compulsive disorder (OCD). While the clinical presentation of TS and other features of this disorder have been well characterized, the genetic and neurobiological basis of the disease remains incompletely elucidated. The suggestion of a central role of dopamine in the aetiology of TS has been made on the basis of experimental studies, evidence from neuroimaging studies and the therapeutic response patients with TS have to agents that antagonize or interfere with putative dopaminergic pathways. Tetrabenazine is such an agent; it depletes presynaptic dopamine and serotonin stores and blocks postsynaptic dopamine receptors. In clinical studies, tetrabenazine has been found to be effective in a wide range of hyperkinetic movement disorders, including small numbers (<50) of patients with TS in some studies. Results of a retrospective chart review enrolling only patients with TS (n = 77; mean age approximately 15 years) showed that 2 years' treatment with tetrabenazine resulted in an improvement in functioning and TS-related symptoms in over 80% of patients, findings that suggest that treatment with tetrabenazine may have long-term benefits. The authors' experience with 120 heavily co-medicated patients with TS confirms these findings. Long-term (mean 19 months) tetrabenazine treatment resulted in a Clinical Global Impressions of Change scale rating of 'improved' in 76% of patients. Such findings are promising and suggest that tetrabenazine may be suitable as add-on therapy in patients for whom additional suppression of tics is required.
Collapse
Affiliation(s)
- Mauro Porta
- Tourette Clinic and Functional Neurosurgery, IRCCS Galaezzi Hospital, Milan, Italy.
| | | | | | | | | | | |
Collapse
|
38
|
Conelea CA, Woods DW. The influence of contextual factors on tic expression in Tourette's syndrome: a review. J Psychosom Res 2008; 65:487-96. [PMID: 18940379 DOI: 10.1016/j.jpsychores.2008.04.010] [Citation(s) in RCA: 137] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2007] [Revised: 08/28/2007] [Accepted: 02/22/2008] [Indexed: 11/17/2022]
Abstract
Symptoms of Tourette's syndrome vary in frequency and intensity. Although such variability may be the result of deficits in the underlying neurological system, tic expression can also be systematically impacted by contextual factors. This article reviews research on the impact of several contextual factors on tic expression and discusses implications for future research and treatment development.
Collapse
|
39
|
Mol Debes NMM, Hjalgrim H, Skov L. Validation of the presence of comorbidities in a Danish clinical cohort of children with Tourette syndrome. J Child Neurol 2008; 23:1017-27. [PMID: 18827268 DOI: 10.1177/0883073808316370] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Tourette syndrome (TS) is characterized by the presence of motor and vocal tics and is often accompanied by comorbid symptoms. We assessed the frequency of the comorbid symptoms obsessive-compulsive disorder obsessive-compulsive disorder, attention-deficit hyperactivity disorder (ADHD), rage attacks, sleeping disturbances, and depressive symptoms in a Danish clinical cohort of 314 children with TS using validated diagnostic instruments. For the assessment of symptoms of seasonal affective disorder and stuttering, we used a nonvalidated systematic interview. In total, only 10.2% of the children did not have any comorbid symptoms at all. If ADHD and/or obsessive-compulsive disorder were present, the rates of the comorbidities rage, symptoms of seasonal affective disorder, sleep disturbances, and depressive symptoms were significantly higher than if ADHD and/or obsessive-compulsive disorder were absent. The most severe tics were found in the group for which both ADHD and obsessive-compulsive disorder were present. Furthermore, there was a tendency toward more severe tics if other comorbid symptoms were present.
Collapse
|
40
|
Cohen E, Sade M, Benarroch F, Pollak Y, Gross-Tsur V. Locus of control, perceived parenting style, and symptoms of anxiety and depression in children with Tourette's syndrome. Eur Child Adolesc Psychiatry 2008; 17:299-305. [PMID: 18301938 DOI: 10.1007/s00787-007-0671-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/06/2007] [Indexed: 11/29/2022]
Abstract
AIM This study explored the contribution of two psychosocial factors, locus of control (LOC) and perceived parenting style, to symptoms of internalizing disorders in children with Tourette syndrome (TS). This contribution was further evaluated in relation to TS severity. METHODS Sixty-five children (53 boys, 12 girls) ages 9.0-16.9 years, of normal intelligence, completed questionnaires evaluating their depression and anxiety symptoms, LOC, and maternal parenting style. Their mothers rated TS severity, determined by tic severity, symptoms of attention-deficit hyperactivity disorder (ADHD) and obsessive compulsive symptoms (OCS). RESULTS Higher rates of symptoms of anxiety and depression were associated with a more external LOC and a more rejecting and controlling parenting style. Additionally, depression correlated significantly with tic severity, ADHD and OCS, whereas anxiety correlated only with ADHD symptoms and OCS, but not with tics. Regression analyses showed that LOC, OCS and ADHD symptoms each significantly contributed to predicting anxiety level, whereas LOC and ADHD symptoms significantly contributed to predicting depression symptoms. CONCLUSIONS Rates of symptoms of anxiety and depression in children with TS are markedly influenced by psychosocial factors, extending beyond the influence of ADHD and OCD, both common comorbid disorders in TS. An internal LOC, which is associated with an accepting and autonomy-granting parenting style, appears to be a protective factor against anxiety and depression.
Collapse
Affiliation(s)
- Esther Cohen
- School of Education, Hebrew University of Jerusalem, Mt. Scopus, Jerusalem 91905, Israel.
| | | | | | | | | |
Collapse
|
41
|
Abstract
We report the case of a child affected by Gilles de la Tourette syndrome and comorbid obsessive-compulsive disorder who claimed to have caused the September 11, 2001 terrorist attacks in the United States by failing to accomplish a stereotyped compulsive ritual. Special attention is paid to the relationship between the patient's neuropsychiatric symptoms and the belief that he personally had influenced the outcome of an internationally notorious disaster. Prognostic and treatment implications are also presented, along with a review of the literature on the clinical and psychosocial impact of terrorist attacks and natural disasters on children suffering from neuropsychiatric disorders.
Collapse
Affiliation(s)
- Mary M Robertson
- Department of Mental Health Sciences, Royal Free and University College Medical School, University College London, London, UK.
| | | |
Collapse
|
42
|
Storch EA, Merlo LJ, Lehmkuhl H, Grabill KM, Geffken GR, Goodman WK, Murphy TK. Further psychometric examination of the Tourette's Disorder Scales. Child Psychiatry Hum Dev 2007; 38:89-98. [PMID: 17136450 DOI: 10.1007/s10578-006-0043-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2006] [Accepted: 10/30/2006] [Indexed: 11/28/2022]
Abstract
The Tourette's Disorder Scales (Shytle et al., 2003) are parent- (Tourette's Disorder Scales-Parent Rated; TODS-PR) and clinician-rated (Tourette's Disorder Scales-Clinician Rated; TODS-CR) measures that assess tics, obsessions, compulsions, inattention, hyperactivity, aggression, and emotional disturbances among children with tics. Although the TODS-PR/CR are being increasingly used in clinical trials, relatively little psychometric data have been reported. Subjects were 44 children and adolescents recruited in a university tic specialty clinic. Families were administered the TODS-CR and Yale Global Tic Severity Scale. Completion of the TODS-PR and Child Behavior Checklist were counterbalanced. Results indicated adequate to excellent internal consistency for the TODS-PR/CR scores. Excellent inter-rater agreement and convergent and divergent validity was found. These results provide further psychometric support for the TODS-PR and TODS-CR.
Collapse
Affiliation(s)
- Eric A Storch
- Department of Psychiatry, University of Florida, Gainesville, FL 32610, USA.
| | | | | | | | | | | | | |
Collapse
|
43
|
Storch EA, Murphy TK, Chase RM, Keeley M, Goodman WK, Murray M, Geffken GR. Peer Victimization in Youth with Tourette’s Syndrome and Chronic Tic Disorder: Relations with Tic Severity and Internalizing Symptoms. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2007. [DOI: 10.1007/s10862-007-9050-4] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
|
44
|
Roessner V, Becker A, Banaschewski T, Freeman RD, Rothenberger A. Developmental psychopathology of children and adolescents with Tourette syndrome--impact of ADHD. Eur Child Adolesc Psychiatry 2007; 16 Suppl 1:24-35. [PMID: 17665280 DOI: 10.1007/s00787-007-1004-6] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND In Tourette syndrome (TS) as a neurodevelopmental disorder not only the tics but also the comorbid conditions change with increasing age. ADHD is highly comorbid with TS and usually impairs psychosocial functioning more than the tics. Its impact on further comorbidity during development is important for clinical practice and still a matter of debate. METHOD Aspects of developmental psychopathology considering the impact of ADHD were examined by logistic regression (year wisely) in a cross-sectional sample of children and adolescents (n = 5060) from the TIC database. RESULTS In TS+ADHD (compared to TS-ADHD) higher rates of comorbid conditions like OCD, anxiety disorders, CD/ODD and mood disorders were found in children (5-10 years). In adolescents (11-17 years) higher comorbidity rates in TS+ADHD remained only for CD/ODD and mood disorders. Accordingly, for OCD and anxiety disorders there was a steeper year wise increase of these comorbidities in TS-ADHD while it was a similar for CD/ODD and mood disorders in TS-ADHD as well as TS+ADHD. CONCLUSION Children with TS+ADHD have more comorbidities than the TS-ADHD group, whereas in both adolescent groups this did no longer hold for OCD and anxiety disorders. These findings indicate that in TS comorbid ADHD is associated with high rates of externalizing and internalizing problems, whereas TS without ADHD is associated only with internalizing problems in adolescence.
Collapse
Affiliation(s)
- Veit Roessner
- Dept. of Child and Adolescent Psychiatry/Psychotherapy, University of Goettingen, Von-Siebold-Str. 5, 37075, Göttingen, Germany.
| | | | | | | | | |
Collapse
|
45
|
Martino D, Defazio G, Church AJ, Dale RC, Giovannoni G, Robertson MM, Orth M. Antineuronal antibody status and phenotype analysis in Tourette's syndrome. Mov Disord 2007; 22:1424-1429. [PMID: 17516471 DOI: 10.1002/mds.21454] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
The Gilles de la Tourette syndrome (GTS) spectrum includes psychiatric comorbidities, mainly obsessive-compulsive disorder (OCD) and attention-deficit-hyperactivity disorder (ADHD). The role of environmental factors, e.g., antineuronal antibodies (ANeA), remains unclear. We compared the clinical features of ANeA-positive and ANeA-negative patients in 53 children and 75 adults with GTS. All diagnoses were made according to DSM-IV-TR criteria. A positive ANeA Western immunoblot showed bands for at least 1 of 3 reported striatal antigens (40, 45, and 60 kDa). Twelve children (23%) and 18 adults (25%) with GTS were ANeA-positive. Disease duration, tic phenomenology and severity, frequency of echo/pali/coprophenomena, self-injurious and aggressive behavior, or frequency of OCD comorbidity did not significantly differ between ANeA-positive and negative patients. Similar findings were obtained analyzing separately the three different antibody reactivities. A comorbid diagnosis of ADHD was significantly less frequent in GTS patients positive for the anti-60 kDa antibody only. Using a multivariate logistic regression model, adjusting for age, gender, and age at disease onset, a comorbid diagnosis of ADHD remained inversely associated with anti-60 kDa antibodies (odds ratio = 0.14; P = 0.002; 95% confidence interval 0.04-0.49). ANeA status does not differentiate a specific phenotype of GTS.
Collapse
Affiliation(s)
- Davide Martino
- Department of Neuroinflammation, Institute of Neurology, University College London, London, United Kingdom
- Department of Neurological and Psychiatric Sciences, University of Bari, Bari, Italy
| | - Giovanni Defazio
- Department of Neurological and Psychiatric Sciences, University of Bari, Bari, Italy
| | - Andrew J Church
- Department of Neuroinflammation, Institute of Neurology, University College London, London, United Kingdom
| | - Russell C Dale
- Department of Neuroinflammation, Institute of Neurology, University College London, London, United Kingdom
- Neurosciences Unit, Great Ormond Street Hospital NHS Trust and Institute of Child Health, University College London, Queen Square, London, United Kingdom
| | - Gavin Giovannoni
- Department of Neuroinflammation, Institute of Neurology, University College London, London, United Kingdom
| | - Mary M Robertson
- Department of Mental Health Sciences, University College London, Queen Square, London, United Kingdom
| | - Michael Orth
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, University College London, Queen Square, London, United Kingdom
| |
Collapse
|
46
|
Abstract
Zusammenfassung. In diesem Übersichtsartikel werden die Gemeinsamkeiten und Unterschiede von Tic- und Zwangsstörungen auf verschiedenen Ebenen dargestellt. In der Psychopathologie unterscheiden sich beide Phänomene zunächst deutlich - Tics sind plötzlich auftretende, unwillkürliche, motorische Bewegungen oder Vokalisationen. Zwänge sind wiederholte, zweckmäßige und beabsichtigte Verhaltensweisen. Es gibt jedoch fließende Übergänge, die sich vor allem bei den Just-Right-Zwängen manifestieren, die bei Tourette-Störungen gehäuft auftreten. Die diagnostischen Strategien und die dabei hilfreichen Instrumente werden vorgestellt. In der Therapie haben sich bei beiden Störungen sowohl verhaltenstherapeutische als auch pharmakotherapeutische Verfahren bewährt. Es wird eine Übersicht über den Stand der empirischen Evidenz gegeben. Die Behandlung von kombinierten Tic- und Zwangsstörungen wird speziell erörtert.
Collapse
Affiliation(s)
- Manfred Döpfner
- Klinik und Poliklinik für Psychiatrie und Psychotherapie des Kindes- und Jugendalters am Klinikum der Universität zu Köln
| | - Aribert Rothenberger
- Universität Göttingen, Abteilung für Kinder- und Jugendpsychiatrie/Psychotherapie
| |
Collapse
|
47
|
Lin H, Katsovich L, Ghebremichael M, Findley DB, Grantz H, Lombroso PJ, King RA, Zhang H, Leckman JF. Psychosocial stress predicts future symptom severities in children and adolescents with Tourette syndrome and/or obsessive-compulsive disorder. J Child Psychol Psychiatry 2007; 48:157-66. [PMID: 17300554 PMCID: PMC3073143 DOI: 10.1111/j.1469-7610.2006.01687.x] [Citation(s) in RCA: 122] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND The goals of this prospective longitudinal study were to monitor levels of psychosocial stress in children and adolescents with Tourette syndrome (TS) and/or obsessive-compulsive disorder (OCD) compared to healthy control subjects and to examine the relationship between measures of psychosocial stress and fluctuations in tic, obsessive-compulsive (OC), and depressive symptom severity. METHODS Consecutive ratings of tic, OC and depressive symptom severity were obtained for 45 cases and 41 matched healthy control subjects over a two-year period. Measures of psychosocial stress included youth self-report, parental report, and clinician ratings of long-term contextual threat. Structural equation modeling for unbalanced repeated measures was used to assess the temporal sequence of psychosocial stress with the severity of tic, OC and depressive symptoms. RESULTS Subjects with TS and OCD experienced significantly more psychosocial stress than did the controls. Estimates of psychosocial stress were predictive of future depressive symptoms. Current levels of psychosocial stress were also a significant predictor of future OC symptom severity, but not vice versa. Current OC symptom severity was a predictor of future depressive symptom severity, but not vice versa. Current levels of psychosocial stress and depression were independent predictors of future tic severity, even after controlling for the effect of advancing chronological age. CONCLUSIONS The impact of antecedent psychosocial adversity is greater on future depressive symptoms than for tic and/or OC symptoms. Worsening OC symptoms are also a predictor of future depressive symptoms. Advancing chronological age is robustly associated with reductions in tic severity.
Collapse
Affiliation(s)
- Haiqun Lin
- Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, CT 06520-7900, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
48
|
Khalifa N, VON Knorring AL. Psychopathology in a Swedish population of school children with tic disorders. J Am Acad Child Adolesc Psychiatry 2006; 45:1346-1353. [PMID: 17075357 DOI: 10.1097/01.chi.0000251210.98749.83] [Citation(s) in RCA: 118] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine patterns of psychiatric comorbid disorders and associated problems in a school population of children with tic disorders. METHOD From a total population of 4,479 children, 25 with Tourette's disorder (TD), 34 with chronic motor tics (CMT), 24 with chronic vocal tics (CVT), and 214 with transient tics (TT) during the past year were found. A three-stage procedure was used: tic screening, telephone interview, and clinical assessment. The TD group was compared with 25 children with TT and 25 controls without tics. RESULTS Psychiatric comorbid disorders were found in 92% of the children with TD. Attention-deficit/hyperactivity disorder was most common, and patterns of psychiatric comorbidity were similar in children with TD and CVT, but not with CMT and TT. Aggressive behavior was more common in children with TD than other tic disorders. CONCLUSIONS Psychiatric comorbid disorders are common even in community-based samples of children with TD and CVT. TD and CVT seem to be part of the same disease entity, with TD being a more severe form. Chronic tics may be a marker for behavioral and learning difficulties in children, and awareness of these associations is critical to the care and treatment of children with tics.
Collapse
Affiliation(s)
- Najah Khalifa
- Drs. Khalifa and Von Knorring are with the Department of Neuroscience, Uppsala University, Uppsala, Sweden
| | - Anne-Liis VON Knorring
- Drs. Khalifa and Von Knorring are with the Department of Neuroscience, Uppsala University, Uppsala, Sweden
| |
Collapse
|
49
|
Robertson MM. Mood disorders and Gilles de la Tourette's syndrome: An update on prevalence, etiology, comorbidity, clinical associations, and implications. J Psychosom Res 2006; 61:349-58. [PMID: 16938513 DOI: 10.1016/j.jpsychores.2006.07.019] [Citation(s) in RCA: 120] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2006] [Indexed: 10/24/2022]
Abstract
Gilles de la Tourette's syndrome (GTS) consists of multiple motor tics and one or more phonic tics. Psychopathology occurs in approximately 90% of GTS patients, with attention-deficit/hyperactivity disorder (ADHD) and obsessive-compulsive disorder (OCD) being common. Depression is common, with a lifetime risk of 10% and a prevalence of between 1.8% and 8.9%. Depression and depressive symptoms are found to occur in 13% and 76% of GTS patients attending specialist clinics, respectively. In controlled studies embracing over 700 GTS patients, the patients were significantly more depressed than controls in all but one instance. In community and epidemiological studies, depression in GTS individuals was evident in two of five investigations. Clinical correlates of depression in people with GTS appear to be: tic severity and duration, the presence of echophenomena and coprophenomena, premonitory sensations, sleep disturbances, obsessive-compulsive behaviors/OCD, self-injurious behaviors, aggression, conduct disorder (CD) in childhood, and, possibly, ADHD. Depression in people with GTS has been shown to result in a lower quality of life, potentially leading to hospitalization and suicide. The etiology of depression appears to be multifactorial. Bipolar affective disorder (BAD) and GTS may be related in some individuals. However, it is noted that sample sizes in most of these studies were small, and it is unclear at the present time as to why BAD may be overrepresented among GTS patients.
Collapse
Affiliation(s)
- Mary May Robertson
- Department of Mental Health Sciences, University College London, W1W 7EY London, UK.
| |
Collapse
|
50
|
Abstract
More than half of all children and adolescents with Tourette syndrome show evidence of psychiatric comorbidity, exhibiting symptoms of attention-deficit hyperactivity disorder (ADHD), obsessive-compulsive disorder, and other anxiety and mood disorders. Although the prevalence of co-occurring conditions varies depending on the clinical setting, it is crucial for clinicians to be familiar with these disorders because they are often more impairing than tics and can influence the initial treatment choice. Left untreated, these conditions can negatively affect important developmental outcomes, such as academic and social functioning. We review the most common co-occurring disorders, the relationship of these co-occurring disorders to Tourette syndrome, and treatment recommendations for co-occurring conditions when tic symptoms are present.
Collapse
Affiliation(s)
- Catherine Gaze
- Division of Child and Adolescent Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD 21287-3325, USA
| | | | | |
Collapse
|