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Che G, Ren W, McGuire JF, Li P, Zhao Z, Tian J, Zhang J, Zhang Y. Clinical evaluation of premonitory urges in children and adolescents using the Chinese version of Individualized Premonitory Urge for Tics Scale. Front Psychiatry 2023; 14:1224825. [PMID: 38034925 PMCID: PMC10687167 DOI: 10.3389/fpsyt.2023.1224825] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 10/10/2023] [Indexed: 12/02/2023] Open
Abstract
Background Premonitory urges (PUs) have been the focus of recent efforts to assess the severity and develop interventions for tic disorders (TD). We aimed to investigate the PUs in TD and its comorbidities from multiple dimensions, using the Chinese version of the Premonitory Urge for Tics Scale (C-PUTS) and the Chinese version of the Individualized Premonitory Urge for Tics Scale (C-IPUTS), in order to provide perspectives for the diagnosis and management of TD in children and adolescents. Methods A total of 123 cases were included in the study. The IPUTS was translated, back-translated, culturally adjusted, and pre-investigated to determine the items of the C-IPUTS. The reliability and validity of the C-IPUTS scale were evaluated by a questionnaire survey on children and adolescents with TD at the Developmental Pediatrics Department of the Second Hospital of Jilin University. Meanwhile, the C-PUTS, which had been evaluated and used in China, Yale Global Tic Severity Scale (YGTSS), Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), Depression Self-Rating Scale (DSRS), Screen for Childhood Anxiety-Related Disorders (SCARED), Achenbach Child Behavior Checklist (CBCL), and Swanson, Nolan and Pelham, Version IV (SNAP-IV), were used to assess the association of PUs with tics and comorbidities of TD. Results All dimensions of the C-IPUTS demonstrated good reliability and validity. Our findings suggested that PUs in children and adolescents in China occurred primarily at the head/face and neck/throat. The different dimensions of the C-IPUTS (number, frequency, and intensity) and C-PUTS were positively correlated with the YGTSS total score, while the C-PUTS was positively correlated with the Y-BOCS, SCARED, DSRS, and SNAP-IV scale total scores. The three dimensions of the C-IPUTS demonstrated correlations with anxiety severity and obsessive-compulsive symptoms. Conclusion The C-IPUTS can be used to assess PUs reliably and effectively and provide further information for the C-PUTS from various dimensions in a Chinese setting. PUs relate to obsessive-compulsive symptoms, anxiety, attention deficit hyperactivity, and behavioral problems in children and adolescents with TDs. Accordingly, PUs evaluation using the C-IPUTS combined with the PUTS might provide useful information for future therapies for TDs to achieve greater tic reduction.
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Affiliation(s)
- Guanghua Che
- Department of Developmental Pediatrics, The Second Hospital of Jilin University, Changchun, China
- Pediatrics Centre, The Second Hospital of Jilin University, Changchun, China
| | - Wenjing Ren
- Department of Developmental Pediatrics, The Second Hospital of Jilin University, Changchun, China
| | - Joseph F. McGuire
- Center for Obsessive-Compulsive Disorder (OCD), Anxiety, and Related Disorders for Children, Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Ping Li
- Department of Developmental Pediatrics, The Second Hospital of Jilin University, Changchun, China
| | - Zhiruo Zhao
- Department of Developmental Pediatrics, The Second Hospital of Jilin University, Changchun, China
| | - Jing Tian
- Department of Developmental Pediatrics, The Second Hospital of Jilin University, Changchun, China
| | - Jinyuan Zhang
- Department of Developmental Pediatrics, The Second Hospital of Jilin University, Changchun, China
| | - Yue Zhang
- Department of Developmental Pediatrics, The Second Hospital of Jilin University, Changchun, China
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Brandt V, Essing J, Jakubovski E, Müller‐Vahl K. Premonitory Urge and Tic Severity, Comorbidities, and Quality of Life in Chronic Tic Disorders. Mov Disord Clin Pract 2023; 10:922-932. [PMID: 37332633 PMCID: PMC10272904 DOI: 10.1002/mdc3.13742] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 02/06/2023] [Accepted: 03/29/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Tics are intimately associated with premonitory urges (PU) but knowledge about urges is still limited, with small sample sizes often limiting the generalizability of findings. OBJECTIVES This study addressed the following open questions: (1) is tic severity associated with urge severity, (2) how common is relief, (3) which comorbidities are associated with urges, (4) are urges, tics, and comorbidities associated with lower quality of life, and (5) can complex and simple, motor and vocal tics be differentiated based on PU? METHODS N = 291 patients who reported a confirmed diagnosis of chronic primary tic disorder (age = 18-65, 24% female) filled out an online survey assessing demographic data, comorbid conditions, location, quality and intensity of PU, as well as quality of life. Every tic was recorded, and whether the patient experienced a PU, the frequency, intensity, and quality of that urge. RESULTS PU and tic severity were significantly associated, and 85% of urge-related tics were followed by relief. A diagnosis of attention deficit/hyperactivity disorder (ADHD) or depression, female gender, and older age increased the likelihood of experiencing PU, while more obsessive compulsive (OCD) symptoms and younger age were associated with higher urge intensities. PU, complex vocal tics, ADHD, OCD, anxiety, and depression were related to lower quality of life. Motor and vocal, complex and simple tics did not differ regarding PU intensity, frequency, and quality, or relief. CONCLUSIONS The results shed light on the relationship between PU, tics, comorbidities, age, gender, and quality of life in tic disorders.
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Affiliation(s)
- Valerie Brandt
- School of Psychology, Centre for Innovation in Mental healthUniversity of SouthamptonSouthamptonUK
- Clinic of Psychiatry, Social Psychiatry and PsychotherapyHannover Medical SchoolHanoverGermany
| | - Jana Essing
- Clinic of Psychiatry, Social Psychiatry and PsychotherapyHannover Medical SchoolHanoverGermany
| | - Ewgeni Jakubovski
- Clinic of Psychiatry, Social Psychiatry and PsychotherapyHannover Medical SchoolHanoverGermany
| | - Kirsten Müller‐Vahl
- Clinic of Psychiatry, Social Psychiatry and PsychotherapyHannover Medical SchoolHanoverGermany
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Schubert L, Verrel J, Behm A, Bäumer T, Beste C, Münchau A. Inter-individual differences in urge-tic associations in Tourette syndrome. Cortex 2021; 143:80-91. [PMID: 34391084 DOI: 10.1016/j.cortex.2021.06.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 05/26/2021] [Accepted: 06/16/2021] [Indexed: 10/20/2022]
Abstract
Premonitory urges are a cardinal feature in Tourette syndrome (GTS) and are commonly viewed as a driving force of tics. However, inter-individual differences in experimentally measured urges, tics and urge-tic associations, as well as possible relations to clinical characteristics and abnormal perception-action processing recently demonstrated in these patients have not been investigated in detail. Here, we analyze the temporal associations between urges and tics in 21 adult patients with GTS including inter-individual differences and the relation of such associations with clinical measures and experimentally tested perception-action coupling. At the group level, our results confirm known positive associations between subjective urges and tics, with increased tic frequency and tic intensity during periods of elevated urge. Inter-individual differences in the associations between urges and tics were, however, substantial. While most participants (57-66 % depending on the specific measure) showed positive associations as expected, several participants did not, and two even had negative associations with tic occurrence and intensity being reduced at times of increased urges. Subjective urge levels and tic occurrence correlated with corresponding clinical scores, providing converging evidence. Measures of the strength of urge-tic associations did not correlate with clinical measures nor the strength of perception-action coupling. Taken together, urge-tic associations in GTS are complex and heterogenous, casting doubt on the notion that tics are primarily driven by urges.
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Affiliation(s)
- Lina Schubert
- Institute of Systems Motor Science, Center of Brain, Behavior and Metabolism, University of Lübeck, Germany
| | - Julius Verrel
- Institute of Systems Motor Science, Center of Brain, Behavior and Metabolism, University of Lübeck, Germany
| | - Amelie Behm
- Institute of Systems Motor Science, Center of Brain, Behavior and Metabolism, University of Lübeck, Germany
| | - Tobias Bäumer
- Institute of Systems Motor Science, Center of Brain, Behavior and Metabolism, University of Lübeck, Germany
| | - Christian Beste
- Cognitive Neurophysiology, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Dresden, Germany
| | - Alexander Münchau
- Institute of Systems Motor Science, Center of Brain, Behavior and Metabolism, University of Lübeck, Germany.
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Baumung L, Müller-Vahl K, Dyke K, Jackson G, Jackson S, Golm D, Münchau A, Brandt V. Developing the Premonitory Urges for Tic Disorders Scale-Revised (PUTS-R). J Neuropsychol 2020; 15:129-142. [PMID: 32543110 DOI: 10.1111/jnp.12216] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 04/02/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Patients with Gilles de la Tourette syndrome (GTS) or chronic tic disorders frequently experience premonitory urges prior to tics. The 'Premonitory Urges for Tic Disorders Scale' (PUTS) is commonly used in order to assess urge severity in patients with tics. Several studies suggest that the PUTS might measure more than one dimension of urges. These include the quality and severity of premonitory urges. METHODS This study aims to replicate and extend previous findings concerning the psychometric properties of the PUTS and its underlying dimensions in a large sample of 241 patients with GTS including both adults (n = 93; mean age = 34.2 ± 12.84; 73 male) and minors (n = 148; mean age = 11.8 ± 2.86; 123 male), pooled from three different recruitment sites. RESULTS Data analysis confirmed good reliability across the PUTS items for both minors and adults and acceptable item characteristics for items 2-8. A factor analysis of items 1-8 confirmed the existence of two factors in both age groups. CONCLUSIONS The results suggest that the PUTS might benefit from several further small modifications, such as rephrasing items 1 and 9 to increase convergence with the overall construct of the scale. Finally, we propose a revised version of the PUTS, consisting of two subscales: one for urge severity and another one for urge quality by including several new items.
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Affiliation(s)
- Leoni Baumung
- Department of Paediatric and Adult Movement Disorders and Neuropsychiatry, Institute of Neurogenetics, Center for Brain, Behavior and Metabolism, University of Lübeck, Germany
| | - Kirsten Müller-Vahl
- Clinic of Psychiatry, Socialpsychiatry and Psychotherapy, Hannover Medical School, Germany
| | | | - Georgina Jackson
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, UK.,Institute of Mental Health, School of Medicine, University of Nottingham, UK
| | - Stephen Jackson
- School of Psychology, University of Nottingham, UK.,Institute of Mental Health, School of Medicine, University of Nottingham, UK
| | - Dennis Golm
- Department of Psychology, Centre for Innovation in Mental Health, University of Southampton, UK
| | - Alexander Münchau
- Department of Paediatric and Adult Movement Disorders and Neuropsychiatry, Institute of Neurogenetics, Center for Brain, Behavior and Metabolism, University of Lübeck, Germany
| | - Valerie Brandt
- Department of Psychology, Centre for Innovation in Mental Health, University of Southampton, UK
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Openneer TJC, Tárnok Z, Bognar E, Benaroya-Milshtein N, Garcia-Delgar B, Morer A, Steinberg T, Hoekstra PJ, Dietrich A. The Premonitory Urge for Tics Scale in a large sample of children and adolescents: psychometric properties in a developmental context. An EMTICS study. Eur Child Adolesc Psychiatry 2020; 29:1411-1424. [PMID: 31802271 PMCID: PMC7501098 DOI: 10.1007/s00787-019-01450-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 11/22/2019] [Indexed: 12/27/2022]
Abstract
Premonitory urges are uncomfortable physical sensations preceding tics that occur in most individuals with a chronic tic disorder. The Premonitory Urge for Tics Scale (PUTS) is the most frequently used self-report measure to assess the severity of premonitory urges. We aimed to evaluate the psychometric properties of the PUTS in the largest sample size to date (n = 656), in children aged 3-16 years, from the baseline measurement of the longitudinal European Multicenter Tics in Children Study (EMTICS). Our psychometric evaluation was done in three age-groups: children aged 3-7 years (n = 103), children between 8 and 10 years (n = 253), and children aged 11-16 years (n = 300). The PUTS exhibited good internal reliability in children and adolescents, also under the age of 10, which is younger than previously thought. We observed significant but small correlations between the severity of urges and severity of tics and obsessive-compulsive symptoms, and between severity of urges and ratings of attention-deficit/hyperactivity disorder and internalizing and externalizing behaviors, however, only in children of 8-10 years. Consistent with previous results, the 10th item of the PUTS correlated less with the rest of the scale compared to the other items and, therefore, should not be used as part of the questionnaire. We found a two-factor structure of the PUTS in children of 11 years and older, distinguishing between sensory phenomena related to tics, and mental phenomena as often found in obsessive-compulsive disorder. The age-related differences observed in this study may indicate the need for the development of an age-specific questionnaire to assess premonitory urges.
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Affiliation(s)
- Thaïra J. C. Openneer
- grid.4494.d0000 0000 9558 4598Department of Child and Adolescent Psychiatry, University of Groningen, University Medical Center Groningen, Hanzeplein 1 XA10, 9713 GZ Groningen, The Netherlands
| | - Zsanett Tárnok
- Vadaskert Child and Adolescent Psychiatric Hospital, Budapest, Hungary
| | - Emese Bognar
- Vadaskert Child and Adolescent Psychiatric Hospital, Budapest, Hungary
| | - Noa Benaroya-Milshtein
- grid.12136.370000 0004 1937 0546Child and Adolescent Psychiatry Department, Affiliated to Sackler Faculty of Medicine, Schneider Children’s Medical Center of Israel, Tel Aviv University, Petah-Tikva, Israel
| | - Blanca Garcia-Delgar
- grid.410458.c0000 0000 9635 9413Department of Child and Adolescent Psychiatry and Psychology, Institute of Neurosciences, Hospital Clinic Universitari, Barcelona, Spain
| | - Astrid Morer
- grid.410458.c0000 0000 9635 9413Department of Child and Adolescent Psychiatry and Psychology, Institute of Neurosciences, Hospital Clinic Universitari, Barcelona, Spain ,grid.10403.36Institut d’Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain ,grid.413448.e0000 0000 9314 1427Centro de Investigacion en Red de Salud Mental (CIBERSAM), Instituto Carlos III, Madrid, Spain
| | - Tamar Steinberg
- grid.12136.370000 0004 1937 0546Child and Adolescent Psychiatry Department, Affiliated to Sackler Faculty of Medicine, Schneider Children’s Medical Center of Israel, Tel Aviv University, Petah-Tikva, Israel
| | - Pieter J. Hoekstra
- grid.4494.d0000 0000 9558 4598Department of Child and Adolescent Psychiatry, University of Groningen, University Medical Center Groningen, Hanzeplein 1 XA10, 9713 GZ Groningen, The Netherlands
| | - Andrea Dietrich
- grid.4494.d0000 0000 9558 4598Department of Child and Adolescent Psychiatry, University of Groningen, University Medical Center Groningen, Hanzeplein 1 XA10, 9713 GZ Groningen, The Netherlands
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Lamothe H, Baleyte JM, Mallet L, Pelissolo A. Trichotillomania is more related to Tourette disorder than to obsessive-compulsive disorder. REVISTA BRASILEIRA DE PSIQUIATRIA (SAO PAULO, BRAZIL : 1999) 2020; 42:87-104. [PMID: 31576938 PMCID: PMC6986481 DOI: 10.1590/1516-4446-2019-0471] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Accepted: 06/08/2019] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Trichotillomania (TTM) is characterized by the pulling out of one's hair. TTM was classified as an impulse control disorder in DSM-IV, but is now classified in the obsessive-compulsive related disorders section of DSM-5. Classification for TTM remains an open question, especially considering its impact on treatment of the disorder. In this review, we questioned the relation of TTM to tic disorder and obsessive-compulsive disorder (OCD). METHOD We reviewed relevant MEDLINE-indexed articles on clinical, neuropsychological, neurobiological, and therapeutic aspects of trichotillomania, OCD, and tic disorders. RESULTS Our review found a closer relationship between TTM and tic disorder from neurobiological (especially imaging) and therapeutic standpoints. CONCLUSION We sought to challenge the DSM-5 classification of TTM and to compare TTM with both OCD and tic disorder. Some discrepancies between TTM and tic disorders notwithstanding, several arguments are in favor of a closer relationship between these two disorders than between TTM and OCD, especially when considering implications for therapy. This consideration is essential for patients.
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Affiliation(s)
- Hugues Lamothe
- Centre Hospitalier Intercommunal de Créteil, Université Paris Est Créteil, Créteil, France
- Institut National de la Santé et de la Recherche Médicale (INSERM), U955, Créteil, France
- Fondation FondaMental, Créteil, France
| | - Jean-Marc Baleyte
- Centre Hospitalier Intercommunal de Créteil, Université Paris Est Créteil, Créteil, France
- Institut National de la Santé et de la Recherche Médicale (INSERM), U955, Créteil, France
- Fondation FondaMental, Créteil, France
- Université de Caen Normandie (UNICAEN), INSERM, U1077, Caen, France
| | - Luc Mallet
- Fondation FondaMental, Créteil, France
- Assistance Publique Hôspitaux de Paris (APHP), Hôpitaux Universitaires Henri Mondor Albert Chenevier, Université Paris Est Créteil, Créteil, France
- Department of Mental Health and Psychiatry, Geneva University Hospital, University of Geneva, Geneva, Switzerland
- Unité Mixte de Recherche (UMR) S1127, Centre National de la Recherche Scientifique (CNRS), UMR 7225, Institut du Cerveau et de la Moelle Epinière, Paris, France
| | - Antoine Pelissolo
- Institut National de la Santé et de la Recherche Médicale (INSERM), U955, Créteil, France
- Fondation FondaMental, Créteil, France
- Assistance Publique Hôspitaux de Paris (APHP), Hôpitaux Universitaires Henri Mondor Albert Chenevier, Université Paris Est Créteil, Créteil, France
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Sensory aspects of Tourette syndrome. Neurosci Biobehav Rev 2018; 88:170-176. [PMID: 29559228 DOI: 10.1016/j.neubiorev.2018.03.016] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 03/14/2018] [Accepted: 03/15/2018] [Indexed: 12/25/2022]
Abstract
Motor and vocal tics have long been recognised as the core features of Tourette syndrome (TS). However, patients' first-person accounts have consistently reported that these involuntary motor manifestations have specific sensory correlates. These sensory symptoms are often described as feelings of mounting inner tension ("premonitory urges") and are transiently relieved by tic expression. Multimodal hypersensitivity to external stimuli, perceived as triggers and/or exacerbating factors for specific tic symptoms, is also commonly reported by patients with TS. This article focuses on the rapidly expanding literature on the clinical and neurobiological aspects of the premonitory urge and multimodal hypersensitivity in patients with TS, with particular attention to pathophysiological mechanisms and possible treatment implications. These findings suggest that TS is a neurobehavioural condition characterised by intrinsic perceptual abnormalities involving the insula and sensorimotor areas, in addition to basal ganglia dysfunction. Further research will clarify the role of sensory symptoms in TS, as well as the effects of external sensory input on underlying motor abnormalities.
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The Current Understanding of Premonitory Urge Phenomena in Chronic Tic Disorders. Curr Behav Neurosci Rep 2016. [DOI: 10.1007/s40473-016-0099-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Bertaut S, Rondepierre F, Jalenques I. Évaluation de la douleur physique dans le syndrome de Gilles de la Tourette, étude exploratoire. ANNALES MEDICO-PSYCHOLOGIQUES 2016. [DOI: 10.1016/j.amp.2016.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
Tourette syndrome (TS) is a childhood onset neurologic disorder with manifestations including multiple motor and phonic tics, and in most cases a variety of behavioral comorbidities such as attention deficit hyperactivity disorder, obsessive compulsive disorder, and other impulse control disorders. Although it is considered a hereditary disorder, likely modified by environmental factors, genetic studies have yet to uncover relevant causative genes and there is no animal model that mimics the broad clinical phenomenology of TS. There has been a marked increase in the number of neurophysiological, neuroimaging, and other studies on TS. The findings from these studies, however, have been difficult to interpret because of small sample sizes, variability of symptoms across patients, and comorbidities. Although anti-dopaminergic drugs are the most widely used medications in the treatment of TS, there has been increasing interest in other drugs, behavioral therapies, and surgical approaches including deep brain stimulation. Herein, we review the current literature and discuss the complexities of TS and the challenges in understanding its pathophysiology and in selecting the most appropriate treatment. We also offer an expert's view of where the field of TS may be headed.
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Brandt VC, Beck C, Sajin V, Baaske MK, Bäumer T, Beste C, Anders S, Münchau A. Temporal relationship between premonitory urges and tics in Gilles de la Tourette syndrome. Cortex 2016; 77:24-37. [DOI: 10.1016/j.cortex.2016.01.008] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Revised: 12/30/2015] [Accepted: 01/08/2016] [Indexed: 10/22/2022]
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Brandt VC, Beck C, Sajin V, Anders S, Münchau A. Convergent Validity of the PUTS. Front Psychiatry 2016; 7:51. [PMID: 27092085 PMCID: PMC4823310 DOI: 10.3389/fpsyt.2016.00051] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 03/23/2016] [Indexed: 11/16/2022] Open
Abstract
Premonitory urges are a cardinal feature in Gilles de la Tourette syndrome. Severity of premonitory urges can be assessed with the "Premonitory Urge for Tic Disorders Scale" (PUTS). However, convergent validity of the measure has been difficult to assess due to the lack of other urge measures. We investigated the relationship between average real-time urge intensity assessed by an in-house developed real-time urge monitor (RUM), measuring urge intensity continuously for 5 min on a visual analog scale, and general urge intensity assessed by the PUTS in 22 adult Tourette patients (mean age 29.8 ± 10.3 SD, 19 males). Additionally, underlying factors of premonitory urges assessed by the PUTS were investigated in the adult sample using factor analysis and were replicated in 40 children and adolescents diagnosed with Tourette syndrome (mean age 12.05 ± 2.83 SD, 31 males). Cronbach's α for the PUTS 10 was acceptable (α = 0.79) in the adult sample. Convergent validity between average real-time urge intensity scores (as assessed with the RUM) and the 10-item version of the PUTS (r = 0.64) and the 9-item version of the PUTS (r = 0.66) was good. A factor analysis including the 10 items of the PUTS and average real-time urge intensity scores revealed three factors. One factor included the average real-time urge intensity score and appeared to measure urge intensity, whereas the other two factors can be assumed to reflect the (sensory) quality of urges and subjective control, respectively. The factor structure of the 10 PUTS items alone was replicated in a sample of children and adolescents. The results indicate that convergent validity between the PUTS and the real-time urge assessment monitor is good. Furthermore, the results suggest that the PUTS might assess more than one dimension of urges, and it may be worthwhile developing different subscales of the PUTS assessing premonitory urges in terms of intensity and quality, as well as subjectively experienced control over tics and premonitory urges.
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Affiliation(s)
- Valerie Cathérine Brandt
- Department of Paediatric and Adult Movement Disorders and Neuropsychiatry, Center of Brain, Behavior and Metabolism, University of Lübeck, Lübeck, Germany; Department of Neurology, University of Lübeck, Lübeck, Germany
| | - Christian Beck
- Department of Neurology, Institute of Social and Affective Neuroscience, University of Lübeck , Lübeck , Germany
| | - Valeria Sajin
- Department of Paediatric and Adult Movement Disorders and Neuropsychiatry, Center of Brain, Behavior and Metabolism, University of Lübeck, Lübeck, Germany; Department of Neurology, University of Lübeck, Lübeck, Germany
| | - Silke Anders
- Department of Neurology, Institute of Social and Affective Neuroscience, University of Lübeck , Lübeck , Germany
| | - Alexander Münchau
- Department of Paediatric and Adult Movement Disorders and Neuropsychiatry, Center of Brain, Behavior and Metabolism, University of Lübeck, Lübeck, Germany; Department of Neurology, University of Lübeck, Lübeck, Germany
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Gulisano M, Calì P, Palermo F, Robertson M, Rizzo R. Premonitory Urges in Patients with Gilles de la Tourette Syndrome: An Italian Translation and a 7-Year Follow-up. J Child Adolesc Psychopharmacol 2015; 25:810-6. [PMID: 26288345 DOI: 10.1089/cap.2014.0154] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Premonitory sensations or urges (PUs) are described as characteristic sensory phenomena preceding tics, which are often described as unpleasant. They occur in 90% of patients affected by Gilles de la Tourette Syndrome (GTS). They may be localized (around the area of tic) or generalized (covering a wide area of the body). The PUs can be measured by the Premonitory Urge for Tics Scale (PUTS). In this study we translated the PUTS scale into Italian and then assessed children and adolescents/young people (CYP) with GTS using the scale. METHODS GTS patients were assessed at the initial interview and after 7 years to evaluate the PUs, and the correlations of the PUTS scores with tic severity, severity of comorbid disorders (obsessive-compulsive disorder [OCD], attention-deficit/hyperactivity disorder [ADHD]), and a variety of coexisting psychopathologies. RESULTS A total of 95 patients were studied. We successfully translated the PUTS into Italian, and our results indicated that our translated version had good psychometric properties. Results demonstrated that the CYP had PUs at both interviews, but that older CYP were more consistent in reporting PUs than younger CYP (i.e., PUTS scores increased with age). We found no correlations between PUTS score and tic severity at either interview. We found a statistical significant correlation between PUTS score and obsessive-compulsive symptoms (OCS) at both interviews; Moreover both the PUTS and Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS) scores increased significantly, whereas the Yale Global Tic Severity Rating Scale (YGTSS) score decreased significantly. We found no relationships between PUTS scores and anxiety, depression, ADHD, and externalizing/internalizing behavioral scores. CONCLUSIONS Our results suggest the the Italian translation of the PUTS has good psychometric properties. Although both younger (<10 years of age) and older CYP (≤ 10 years of age) reported PUs, the scores at the initial interview were statistically significantly lower than at follow-up. Moreover, in CYP >10 years of age, the PUs correlated with obsessions and compulsions (CY-BOCS scores).
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Affiliation(s)
- Mariangela Gulisano
- 1 Departmento of Clinical and Experimental Medicine, Section of Child and Adolescent Neuropsychiatry, University of Catania , Catania, Italy
| | - Paola Calì
- 1 Departmento of Clinical and Experimental Medicine, Section of Child and Adolescent Neuropsychiatry, University of Catania , Catania, Italy
| | - Filippo Palermo
- 2 Department of Internal and Specialist Medicine, Section of Infectious Disease, University of Catania , Catania, Italy
| | - Mary Robertson
- 3 University College, London, England; University of Cape Town, Cape Town, South Africa; St George's Hospital & Medical School, London, England; University of Catania , Catania, Italy
| | - Renata Rizzo
- 1 Departmento of Clinical and Experimental Medicine, Section of Child and Adolescent Neuropsychiatry, University of Catania , Catania, Italy
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14
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Ganos C, Bongert J, Asmuss L, Martino D, Haggard P, Münchau A. The somatotopy of tic inhibition: Where and how much? Mov Disord 2015; 30:1184-9. [DOI: 10.1002/mds.26188] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Revised: 01/20/2015] [Accepted: 01/21/2015] [Indexed: 11/06/2022] Open
Affiliation(s)
- Christos Ganos
- Institute of Cognitive Neuroscience, University College London; UK
- Department of Neurology; University Medical Center Hamburg-Eppendorf (UKE); Hamburg Germany
| | - Jens Bongert
- Department of Neurology; University Medical Center Hamburg-Eppendorf (UKE); Hamburg Germany
| | - Luisa Asmuss
- Department of Neurology; University Medical Center Hamburg-Eppendorf (UKE); Hamburg Germany
| | - Davide Martino
- Neurology Department; King's College Hospital NHS Foundation Trust; London
- Queen Elizabeth Hospital, Lewisham & Greenwich NHS Trust; London
| | - Patrick Haggard
- Institute of Cognitive Neuroscience, University College London; UK
| | - Alexander Münchau
- Department of Paediatric and Adult Movement Disorders and Neuropsychiatry; Institute of Neurogenetics, University of Lübeck; Lübeck Germany
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15
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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.
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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.
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16
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Eapen V, Robertson MM. Are there distinct subtypes in Tourette syndrome? Pure-Tourette syndrome versus Tourette syndrome-plus, and simple versus complex tics. Neuropsychiatr Dis Treat 2015; 11:1431-6. [PMID: 26089672 PMCID: PMC4468986 DOI: 10.2147/ndt.s72284] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
This study addressed several questions relating to the core features of Tourette syndrome (TS) including in particular coprolalia (involuntary utterance of obscene words) and copropraxia (involuntary and inappropriate rude gesturing). A cohort of 400 TS patients was investigated. We observed that coprolalia occurred in 39% of the full cohort of 400 patients and copropraxia occurred in 20% of the cohort. Those with coprolalia had significantly higher Yale Global Tic Severity Scale (YGTSS) and Diagnostic Confidence Index (DCI) total scores and a significantly higher proportion also experienced copropraxia and echolalia. A subgroup of 222 TS patients with full comorbidity data available were also compared based on whether they had pure-TS (motor and vocal tics only) or associated comorbidities and co-existent psychopathologies (TS-plus). Pure-TS and TS-plus groups were compared across a number of characteristics including TS severity, associated clinical features, and family history. In this subgroup, 13.5% had pure-TS, while the remainder had comorbidities and psychopathologies consistent with TS-plus. Thirty-nine percent of the TS-plus group displayed coprolalia, compared to (0%) of the pure-TS group and the difference in proportions was statistically significant. The only other significant difference found between the two groups was that pure-TS was associated with no family history of obsessive compulsive disorder which is an interesting finding that may suggest that additional genes or environmental factors may be at play when TS is associated with comorbidities. Finally, differences between individuals with simple versus complex vocal/motor tics were evaluated. Results indicated that individuals with complex motor/vocal tics were significantly more likely to report premonitory urges/sensations than individuals with simple tics and TS. The implications of these findings for the assessment and understanding of TS are discussed.
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Affiliation(s)
- Valsamma Eapen
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia ; Academic Unit of Child Psychiatry, South Western Sydney Local Health District, Ingham Institute, Liverpool, NSW, Australia
| | - Mary M Robertson
- Neuropsychiatry, University College London, UK ; St Georges Hospital and Medical School, London, UK
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