Tic Severity and Treatment in Children: The Effect of Comorbid Attention Deficit Hyperactivity Disorder and Obsessive Compulsive Behaviors

Tic Disorder of Children Analyzed and Diagnosed by Magnetic Resonance Imaging Features under Convolutional Neural Network

This work aimed to explore the analysis and diagnosis of children with tic disorder by magnetic resonance imaging (MRI) features under convolutional neural network (CNN), to provide a certain reference basis for clinical identification. A total of 45 children diagnosed with tic disorder in hospital from January 2018 to June 2020 were selected as the research subjects. A total of 30 normal children were selected as the control group. MRI images were collected, and CNN was constructed for image processing. The results showed that the convolutional neural network could significantly improve the speed of MRI reconstruction and can improve the diagnostic accuracy. Compared with normal children, the metabolites in children with tic disorder were slightly increased, but there was no statistical significance (P > 0.05). The results of the Yale score showed that the proportion of children with moderate illness was significantly greater than that of children with mild and severe illness. In short, the pathological changes of tic disorder were effectively discovered by MRI based on CNN algorithms, which can provide a reference for clinical identification.

Refractory Gilles de la Tourette Syndrome-Many Pieces That Define the Puzzle

Gilles de la Tourette syndrome (GTS) is a childhood onset neuropsychiatric disorder characterized by the presence of motor and vocal tics. The clinical spectrum of GTS is heterogeneous and varies from mild cases that do not require any medical attention to cases that are refractory to standard treatments. One of the unresolved issues is the definition of what constitutes treatment-refractory GTS. While for some other neuropsychiatric disorders, such as obsessive-compulsive disorder (OCD), a clear definition has been established, there is still no consensus with regard to GTS. One important issue is that many individuals with GTS also meet criteria for one or more other neurodevelopmental and neuropsychiatric disorders. In many individuals, the severity of these comorbid conditions contributes to the degree to which GTS is treatment refractory. The scope of this paper is to present the current state-of-the-art regarding refractory GTS and indicate possible approaches to define it. In closing, we discuss promising approaches to the treatment of individuals with refractory GTS.

Population-Based Epidemiology of Pediatric Patients with Treated Tic Disorders from Real-World Evidence in Korea

Objectives: Although tic disorder (TD) is a common mental disorder in children and adolescents, epidemiological data based on real-world evidence (RWE) are insufficient. Using RWE, this study sought to examine the prevalence of treated TD, use of medical utilization, and use of prescription drugs among patients with TD with respect to TD type and comorbid psychiatric illness. Methods: We performed a retrospective cross-sectional study. Using the Korean Health Insurance Review and Assessment Service Pediatric Patient Sample data from 2009 to 2016, we analyzed 20,599 patients with TD (Korean Standard Classification of Diseases-6/7 code: F95.x) aged 2-19 years. Results: The annual average TD prevalence was 2.6/1000 population (95% confidence interval, 2.3-2.8/1000). Between 2009 and 2016, a slight increase in TD prevalence was observed from 1.9 to 2.9/1000 population. The TD prevalence rate in male patients was four times higher than that in female patients. Differences were observed in health care utilization and drug prescription types between patients with Tourette syndrome and chronic or transient TD. In addition, more than half of patients with TD had comorbid psychiatric disorders, and one-third of patients with TD had attention-deficit/hyperactivity disorder (ADHD). Patients with TD without comorbidities were frequently prescribed aripiprazole, while patients with TD and comorbid ADHD were frequently prescribed atomoxetine, methylphenidate, risperidone, and aripiprazole. Conclusion: This study described the epidemiological characteristics of TD based on recent RWE from Korea, and its findings can help establish future TD evidence-based clinical guidelines and related policies.

Systematic review of co-occurring OCD and TD: Evidence for a tic-related OCD subtype?

OBJECTIVE

The aim of this review is to summarize the current knowledge of associated features of co-occurring obsessive-compulsive disorder (OCD) and tic disorders (TD) and to critically evaluate hypotheses regarding the nature of their comorbidity.

METHOD

We conducted a systematic review following PRISMA guidelines. To this aim, the PubMed, PsychInfo and ISI Web of Knowledge databases were searched up to August 30, 2018. For gender and age-of-onset we additionally conducted meta-analyses.

RESULTS

One hundred eighty-nine studies met inclusion criteria. We substantiate some acknowledged features and report evidence for differential biological mechanisms and treatment response. In general, studies were of limited methodological quality.

CONCLUSIONS

Several specific features are reliable associated with co-occurring OCD + TD. The field lacks methodological sound studies. The review found evidence against and in favor for different hypotheses regarding the nature of comorbidity of OCD and TD. This could indicate the existence of a stepwise model of co-morbidity, or could be an artefact of the low methodological quality of studies.

Review of the evidence for the management of co-morbid Tic disorders in children and adolescents with attention deficit hyperactivity disorder

Attention deficit hyperactivity disorder (ADHD) is the most common neurodevelopmental disorder in children and adolescents, with prevalence ranging between 5% and 12% in the developed countries. Tic disorders (TD) are common co-morbidities in paediatric ADHD patients with or without pharmacotherapy treatment. There has been conflicting evidence of the role of psychostimulants in either precipitating or exacerbating TDs in ADHD patients. We carried out a literature review relating to the management of TDs in children and adolescents with ADHD through a comprehensive search of MEDLINE, EMBASE, CINAHL and Cochrane databases. No quantitative synthesis (meta-analysis) was deemed appropriate. Meta-analysis of controlled trials does not support an association between new onset or worsening of tics and normal doses of psychostimulant use. Supratherapeutic doses of dextroamphetamine have been shown to exacerbate TD. Most tics are mild or moderate and respond to psychoeducation and behavioural management. Level A evidence support the use of alpha adrenergic agonists, including Clonidine and Guanfacine, reuptake noradrenenaline inhibitors (Atomoxetine) and stimulants (Methylphenidate and Dexamphetamines) for the treatment of Tics and comorbid ADHD. Priority should be given to the management of co-morbid Tourette’s syndrome (TS) or severely disabling tics in children and adolescents with ADHD. Severe TDs may require antipsychotic treatment. Antipsychotics, especially Aripiprazole, are safe and effective treatment for TS or severe Tics, but they only moderately control the co-occurring ADHD symptomatology. Short vignettes of different common clinical scenarios are presented to help clinicians determine the most appropriate treatment to consider in each patient presenting with ADHD and co-morbid TDs.