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Barber KE, Pitts BX, Stiede JT, Espil FM, Woods DW, Specht MW, Bennett SM, Walkup JT, Ricketts EJ, McGuire JF, Peterson AL, Compton SN, Wilhelm S, Scahill L, Piacentini JC. Perceived Negative Effects of Tic Management Strategies in Adults With Tic Disorders. Behav Modif 2024; 48:449-470. [PMID: 38557310 PMCID: PMC11179959 DOI: 10.1177/01454455241236446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Behavior therapy is a well-established and empirically supported treatment for tic disorders (TDs). However, concerns have been expressed about the negative effects of behavioral interventions, such as tic worsening, tic substitution, and excessive effort. This study explored perceived negative effects of tic management strategies in adults with TDs and predictors of these experiences. Participants (N = 72) completed semi-structured interviews 11 years after receiving behavior therapy or supportive therapy in a randomized clinical trial. We examined responses to interview questions about managing tics and predictors of reported negative effects. Most participants did not experience tic worsening (84%) or tic substitution (75%) from tic management strategies. The majority felt they could manage tics while participating in their environment (87%) and did not report life interference from tic management (77%). About half (45%) felt less present when managing tics. Treatment non-responders in the original trial were more likely to report negative effects of tic management strategies. No differences in reported negative consequences were found between those who received behavior therapy versus supportive therapy, suggesting that behavior therapy specifically does not lead to such adverse effects. These findings could reduce misconceptions about behavior therapy for TDs and enhance its acceptability and utilization.
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Affiliation(s)
| | | | | | | | | | | | | | - John T Walkup
- Ann and Robert H. Lurie Children's Hospital, Chicago, IL, USA
| | - Emily J Ricketts
- UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA
| | | | - Alan L Peterson
- The University of Texas Health Science Center at San Antonio, San Antonio, USA
| | | | | | - Lawrence Scahill
- Emory University School of Medicine Marcus Center, Atlanta, GA, USA
| | - John C Piacentini
- UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA
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2
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Maxwell-Scott M, O'Keeffe F, Eccles FJR. Coping with Tourette's syndrome: a meta-ethnography of individual and family perspectives. Psychol Health 2024:1-23. [PMID: 38818804 DOI: 10.1080/08870446.2024.2360126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 05/22/2024] [Indexed: 06/01/2024]
Abstract
OBJECTIVE This systematic review and meta-ethnography aimed to examine how children, adults and families cope with Tourette's syndrome (TS). METHODS A systematic search of four databases was completed in October 2022. Sixteen papers met the inclusion criteria and were synthesised using Noblit and Hare's (1988) meta-ethnographic approach. RESULTS Three themes were constructed: redefining the self and social identity, controlling the visible presentation of Tourette's syndrome, and challenging the narrative. CONCLUSION Findings indicate that coping involves the need to integrate TS with identity, to exert control over tics and to challenge the misrepresentations of TS in wider society. A supportive environment provided by parents and friends enables individuals to feel proud that they can control their tics, and this allows for the positive integration of TS into identity. Raising awareness at a societal level through educational campaigns is important when aiming to improve coping with a stigmatised condition. Further research is recommended, for example, to understand how common co-occurring conditions, such as attention deficit hyperactivity disorder, impact coping.
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Affiliation(s)
| | - Fiadhnait O'Keeffe
- Department of Psychology, St Vincent's University Hospital, Dublin, Ireland
| | - Fiona J R Eccles
- Division of Health Research, Lancaster University, Lancaster, United Kingdom
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3
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Alshammery S, Patel S, Jones HF, Han VX, Gloss BS, Gold WA, Dale RC. Common targetable inflammatory pathways in brain transcriptome of autism spectrum disorders and Tourette syndrome. Front Neurosci 2022; 16:999346. [PMID: 36590292 PMCID: PMC9799059 DOI: 10.3389/fnins.2022.999346] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 11/24/2022] [Indexed: 12/23/2022] Open
Abstract
Neurodevelopmental disorders (NDDs), including autism-spectrum disorders (ASD) and Tourette syndrome (TS) are common brain conditions which often co-exist, and have no approved treatments targeting disease mechanisms. Accumulating literature implicates the immune system in NDDs, and transcriptomics of post-mortem brain tissue has revealed an inflammatory signal. We interrogated two RNA-sequencing datasets of ASD and TS and identified differentially expressed genes, to explore commonly enriched pathways through GO, KEGG, and Reactome. The DEGs [False Discovery Rate (FDR) <0.05] in the ASD dataset (n = 248) and the TS dataset (n = 156) enriched pathways involving inflammation, cytokines, signal transduction and cell signalling. Of the DEGs from the ASD and TS analyses, 23 were shared, all of which were up-regulated: interaction networks of the common protein-coding genes using STRING revealed 5 central up-regulated hub genes: CCL2, ICAM1, HMOX1, MYC, and SOCS3. Applying KEGG and Reactome analysis to the 23 common genes identified pathways involving the innate immune response such as interleukin and interferon signalling pathways. These findings bring new evidence of shared immune signalling in ASD and TS brain transcriptome, to support the overlapping symptoms that individuals with these complex disorders experience.
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Affiliation(s)
- Sarah Alshammery
- Kids Neuroscience Centre, The Children’s Hospital at Westmead, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia,The Children’s Hospital at Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Shrujna Patel
- Kids Neuroscience Centre, The Children’s Hospital at Westmead, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia,The Children’s Hospital at Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Hannah F. Jones
- Kids Neuroscience Centre, The Children’s Hospital at Westmead, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia,The Children’s Hospital at Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia,Department of Neuroservices, Starship Children’s Hospital, Auckland, New Zealand
| | - Velda X. Han
- Kids Neuroscience Centre, The Children’s Hospital at Westmead, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia,Khoo Teck Puat-National University Children’s Medical Institute, National University Health System, Singapore, Singapore
| | - Brian S. Gloss
- Westmead Research Hub, Westmead Institute for Medical Research, Westmead, NSW, Australia
| | - Wendy A. Gold
- Kids Neuroscience Centre, The Children’s Hospital at Westmead, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia,The Children’s Hospital at Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Russell C. Dale
- Kids Neuroscience Centre, The Children’s Hospital at Westmead, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia,The Children’s Hospital at Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia,The Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia,*Correspondence: Russell C. Dale,
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4
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Lin X, Lin F, Chen H, Weng Y, Wen J, Ye Q, Chen C, Cai G. Comparison of efficacy of deep brain stimulation, repeat transcranial magnetic stimulation, and behavioral therapy in Tourette syndrome: A systematic review and Bayesian Network Meta-Analysis. Heliyon 2022; 8:e10952. [PMID: 36281376 PMCID: PMC9587297 DOI: 10.1016/j.heliyon.2022.e10952] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 05/19/2022] [Accepted: 09/29/2022] [Indexed: 11/06/2022] Open
Abstract
Background Tourette syndrome (TS) is an incurable neuropsychiatric disorder. Deep brain stimulation (DBS), repeat transcranial magnetic stimulation (rTMS), and behavioral therapy (BT) are all effective treatments. However, the comparison of therapeutic effect of these three therapies is lacking. Methods A systematic literature search was conducted for randomized controlled studies (RCT). A network meta-analysis by R4.04 software according to Bayesian framework were performed. Results were meta-analyzed and network meta-analyzed to evaluate and compare the efficacy of DBS, rTMS and BT in TS patients. Results A total of 18 randomized controlled studies with 661 participants were included. The Yale Global Tic Severity Scale (YGTSS) and the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) were utilized to evaluate the symptoms of TS. All three treatments improved the tic symptoms of TS [DBS 12.11 (95%CI 7.58-16.65); rTMS 4.96 (95%CI 1.01-10.93); andBT 11.72 (95%CI 10.42-13.01)]; and obsessive-compulsive symptom [DBS 4.9 (95%CI 1.13-8.67); rTMS 5.28 (95%CI 0.21-10.77); and BT 1.61 (95%CI 0.74-2.48)]. The cumulative probability results showed that DBS had the best effect on the improvement of tic symptoms, followed by BT; and rTMS was ranked last. However, in terms of improvement of obsessional symptoms, rTMS was ranked first, DBS was ranked second, and BT was ranked last. In addition, the meta regression analysis of YGTSS in DBS, rTMS and BT has significant difference (P = 0.05). Limitation Due to the lack of quantitative indicators, we did not perform a network meta-analysis of the side effects of the three treatments. Conclusion Our study showed that DBS, rTMS, and BT are effective in TS. DBS causes the best improvement in tic symptoms, and rTMS is the most effective in improving the obsessive-compulsive symptoms.
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Affiliation(s)
- Xiaofeng Lin
- Department of Neurology, Union Hospital, Institute of Neuroscience, Institute of Clinical Neurology, Fujian Medical University, Fuzhou 350001, China,Endocrinology, Fujian Provincial Hospital, Fuzhou 350001, China
| | - Fabin Lin
- Department of Neurology, Union Hospital, Institute of Neuroscience, Institute of Clinical Neurology, Fujian Medical University, Fuzhou 350001, China,Department of Clinical Medicine, Fujian Medical University, Fuzhou 350001, China,Department of Neurosurgery, Fujian Medical University Union Hospital, Fuzhou 350001, China
| | - Huiyun Chen
- Fujian Province Key Laboratory of Environment and Health, School of Public Health, Fujian Medical University, Fujian 35008, China
| | - Yanhong Weng
- Department of Neurology, Union Hospital, Institute of Neuroscience, Institute of Clinical Neurology, Fujian Medical University, Fuzhou 350001, China
| | - Junping Wen
- Endocrinology, Fujian Provincial Hospital, Fuzhou 350001, China,Corresponding author.
| | - Qinyong Ye
- Department of Neurology, Union Hospital, Institute of Neuroscience, Institute of Clinical Neurology, Fujian Medical University, Fuzhou 350001, China
| | - Chunmei Chen
- Department of Neurosurgery, Fujian Medical University Union Hospital, Fuzhou 350001, China,Corresponding author.
| | - Guoen Cai
- Department of Neurology, Union Hospital, Institute of Neuroscience, Institute of Clinical Neurology, Fujian Medical University, Fuzhou 350001, China,Department of Clinical Medicine, Fujian Medical University, Fuzhou 350001, China,Corresponding author.
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5
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Suh HW, Yoon SI, Hong S, Lee HW, Lee M, Kim JW, Chung SY. How do children with Tourette's syndrome and their caregivers live with the disorder? A systematic review of qualitative evidence. Front Psychiatry 2022; 13:992905. [PMID: 36245875 PMCID: PMC9557735 DOI: 10.3389/fpsyt.2022.992905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 09/12/2022] [Indexed: 11/13/2022] Open
Abstract
Background Tourette's syndrome (TS) is a childhood neurodevelopmental disorder characterized by sudden, repetitive, involuntary, and irregular muscle movement and vocalization. Recently, non-pharmaceutical methods, such as behavioral therapy, psychotherapy, and deep brain stimulation, have been introduced as alternatives to pharmacological treatment for TS. This study aimed to systematically review and synthesize qualitative evidence on the experiences of children with TS and their caregivers. A meta-synthesis of qualitative evidence could help provide a comprehensive understanding of the challenges experienced by children with TS and their caregivers with the aim of providing more effective treatment and services for them. Materials and methods A systematic search was conducted using MEDLINE/PubMed, EMBASE, Cumulative Index to Nursing and Allied Health Literature, PsycARTICLES, and three Korean databases (Korean Medical Database, Research Information Sharing Service, and ScienceON) in July 2021. Studies were included if they collected and analyzed qualitative data from children with tic disorder or TS, or their caregivers. Qualitative research findings on the experiences and perspectives of children with TS and their caregivers were critically appraised and synthesized using the Joanna Briggs Institute methodology. Results Eight eligible studies were included. The findings from these studies (i.e., themes or subthemes of qualitative research) were aggregated into categories (a group of similar findings) and synthesized findings (a group of categorized findings). Ultimately, the 60 findings were aggregated into 15 categories. Finally, four synthesized findings were derived from the 15 categories: (i) continuation of challenging daily life, (ii) denying that TS causes emotional distress, (iii) accepting and understanding TS as part of oneself, and (iv) looking to the future. Conclusion Children with TS and their caregivers experience physical and psychological distress and social deprivation. Avoiding and suppressing TS causes secondary distress such as guilt. However, seeking social support and accepting the disorder reduce the distress caused by symptoms and lays the foundation for later growth. Even in the face of adversity, children with TS and their caregivers find personal value and acquire a more open and optimistic attitude toward life. This review shows that acceptance-based therapy and social support should be provided for the treatment and management of TS.
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Affiliation(s)
- Hyo-Weon Suh
- Department of Neuropsychiatry, College of Korean Medicine, Kyung Hee University, Seoul, South Korea
| | - Seok-In Yoon
- Department of Neuropsychiatry, College of Korean Medicine, Kyung Hee University, Seoul, South Korea
| | - Sunggyu Hong
- Department of Neuropsychiatry, Kyung Hee University Korean Medicine Hospital at Gangdong, Seoul, South Korea
| | - Hyun Woo Lee
- Department of Neuropsychiatry, Kyung Hee University Korean Medicine Hospital at Gangdong, Seoul, South Korea
| | - Misun Lee
- Industry-Academic Cooperation Foundation, Kyung Hee University, Seoul, South Korea
| | - Jong Woo Kim
- Department of Neuropsychiatry, College of Korean Medicine, Kyung Hee University, Seoul, South Korea
- Department of Neuropsychiatry, Kyung Hee University Korean Medicine Hospital at Gangdong, Seoul, South Korea
| | - Sun-Yong Chung
- Department of Neuropsychiatry, College of Korean Medicine, Kyung Hee University, Seoul, South Korea
- Department of Neuropsychiatry, Kyung Hee University Korean Medicine Hospital at Gangdong, Seoul, South Korea
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6
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Langelage J, Verrel J, Friedrich J, Siekmann A, Schappert R, Bluschke A, Roessner V, Paulus T, Bäumer T, Frings C, Beste C, Münchau A. Urge-tic associations in children and adolescents with Tourette syndrome. Sci Rep 2022; 12:16008. [PMID: 36163482 PMCID: PMC9512906 DOI: 10.1038/s41598-022-19685-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 09/01/2022] [Indexed: 11/24/2022] Open
Abstract
Premonitory urges preceding tics are a cardinal feature of Gilles de la Tourette syndrome (GTS), a developmental disorder usually starting during middle childhood. However, the temporal relation between urges and tics has only been investigated in adults. In 25 children and adolescents with GTS (8–18 years), we assess urge-tic associations, including inter-individual differences, correlation to clinical measures, and in comparison to a previously reported sample of adult GTS patients. Group-level analyses confirmed positive associations between urges and tics. However, at the individual level, less than half of participants showed positive associations, a similar proportion did not, and in two participants, the association was reversed. Tic expression and subjective urge levels correlated with corresponding clinical scores and participants with more severe tics during the urge monitor exhibited stronger urge-tic associations. Associations between reported urge levels and instantaneous tic intensity tended to be less pronounced in children and adolescents than in adult GTS patients. The observed heterogeneity of urge-tic associations cast doubt on the notion that tics are directly caused by urges. More severe tics may facilitate anticipation of tics and thereby lead to more pronounced urge-tic associations, consistent with a hypothesis of urges as a byproduct of tics.
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Affiliation(s)
- Jennifer Langelage
- Institute of Systems Motor Science, Center of Brain, Behavior and Metabolism, Universität zu Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Julius Verrel
- Institute of Systems Motor Science, Center of Brain, Behavior and Metabolism, Universität zu Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Julia Friedrich
- Institute of Systems Motor Science, Center of Brain, Behavior and Metabolism, Universität zu Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Alina Siekmann
- Institute of Systems Motor Science, Center of Brain, Behavior and Metabolism, Universität zu Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Ronja Schappert
- Institute of Systems Motor Science, Center of Brain, Behavior and Metabolism, Universität zu Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Annet Bluschke
- Cognitive Neurophysiology, Department of Child and Adolescent Psychiatry, Faculty of Medicine, TU Dresden, Dresden, Germany
| | - Veit Roessner
- Cognitive Neurophysiology, Department of Child and Adolescent Psychiatry, Faculty of Medicine, TU Dresden, Dresden, Germany
| | - Theresa Paulus
- Institute of Systems Motor Science, Center of Brain, Behavior and Metabolism, Universität zu Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany.,Department of Neurology, Universität zu Lübeck, Lübeck, Germany
| | - Tobias Bäumer
- Institute of Systems Motor Science, Center of Brain, Behavior and Metabolism, Universität zu Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Christian Frings
- Cognitive Psychology, Department of Psychology, University of Trier, Trier, Germany
| | - Christian Beste
- Cognitive Neurophysiology, Department of Child and Adolescent Psychiatry, Faculty of Medicine, TU Dresden, Dresden, Germany
| | - Alexander Münchau
- Institute of Systems Motor Science, Center of Brain, Behavior and Metabolism, Universität zu Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany.
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7
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Tomskiy AA, Poddubskaya AA, Gamaleya AA, Zaitsev OS. Neurosurgical management of Tourette syndrome: A literature review and analysis of a case series treated with deep brain stimulation. PROGRESS IN BRAIN RESEARCH 2022; 272:41-72. [PMID: 35667806 DOI: 10.1016/bs.pbr.2022.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Tourette syndrome (TS) is a heterogeneous disorder, which clinical presentation includes both multiple motor and vocal tics and commonly associated psychiatric conditions (obsessive-compulsive disorder, attention deficit hyperactivity disorder, depression, anxiety, etc.). Treatment options primarily consist of non-pharmacological interventions (habit reversal training, relaxation techniques, cognitive behavioral therapy, and social rehabilitation) and pharmacotherapy. In case of the intractable forms, neurosurgical treatment may be considered, primarily deep brain stimulation (DBS). DBS appear to be effective in medically intractable TS patients, although, the preferential brain target is still not defined. The majority of studies describe small number of cases and the issues of appropriate patient selection and ethics remain to be clarified. In this article, we review the main points in management of TS, discuss possible indications and contraindications for neurosurgical treatment, and analyze our experience of DBS in a case series of refractory TS patients with the focus on target selection and individual outcomes.
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Affiliation(s)
- Alexey A Tomskiy
- Department of Functional Neurosurgery, Burdenko National Medical Research Center of Neurosurgery, Moscow, Russian Federation.
| | - Anna A Poddubskaya
- Department of Functional Neurosurgery, Burdenko National Medical Research Center of Neurosurgery, Moscow, Russian Federation; Psychiatry Research Group, Burdenko National Medical Research Center of Neurosurgery, Moscow, Russian Federation
| | - Anna A Gamaleya
- Department of Functional Neurosurgery, Burdenko National Medical Research Center of Neurosurgery, Moscow, Russian Federation
| | - Oleg S Zaitsev
- Psychiatry Research Group, Burdenko National Medical Research Center of Neurosurgery, Moscow, Russian Federation
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8
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Andrén P, Jakubovski E, Murphy TL, Woitecki K, Tarnok Z, Zimmerman-Brenner S, van de Griendt J, Debes NM, Viefhaus P, Robinson S, Roessner V, Ganos C, Szejko N, Müller-Vahl KR, Cath D, Hartmann A, Verdellen C. European clinical guidelines for Tourette syndrome and other tic disorders-version 2.0. Part II: psychological interventions. Eur Child Adolesc Psychiatry 2022; 31:403-423. [PMID: 34313861 PMCID: PMC8314030 DOI: 10.1007/s00787-021-01845-z] [Citation(s) in RCA: 52] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 07/07/2021] [Indexed: 12/20/2022]
Abstract
Part II of the European clinical guidelines for Tourette syndrome and other tic disorders (ECAP journal, 2011) provides updated information and recommendations for psychological interventions for individuals with tic disorders, created by a working group of the European Society for the Study of Tourette Syndrome (ESSTS). A systematic literature search was conducted to obtain original studies of psychological interventions for tic disorders, published since the initial European clinical guidelines were issued. Relevant studies were identified using computerized searches of the MEDLINE and PsycINFO databases for the years 2011-2019 and a manual search for the years 2019-2021. Based on clinical consensus, psychoeducation is recommended as an initial intervention regardless of symptom severity. According to a systematic literature search, most evidence was found for Habit Reversal Training (HRT), primarily the expanded package Comprehensive Behavioral Intervention for Tics (CBIT). Evidence was also found for Exposure and Response Prevention (ERP), but to a lesser degree of certainty than HRT/CBIT due to fewer studies. Currently, cognitive interventions and third-wave interventions are not recommended as stand-alone treatments for tic disorders. Several novel treatment delivery formats are currently being evaluated, of which videoconference delivery of HRT/CBIT has the most evidence to date. To summarize, when psychoeducation alone is insufficient, both HRT/CBIT and ERP are recommended as first-line interventions for tic disorders. As part of the development of the clinical guidelines, a survey is reported from ESSTS members and other tic disorder experts on preference, use and availability of psychological interventions for tic disorders.
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Affiliation(s)
- Per Andrén
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, and Stockholm Health Care Services, Region Stockholm, Gävlegatan 22, 113 30, Stockholm, Sweden.
| | - Ewgeni Jakubovski
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Tara L Murphy
- Tic Disorder Clinic, Great Ormond Street Hospital NHS Foundation Trust, London, WC1 3JH, UK
| | - Katrin Woitecki
- School of Child and Adolescent Cognitive Behavior Therapy (AKiP), University Hospital, Cologne, Germany
| | - Zsanett Tarnok
- Vadaskert Child and Adolescent Psychiatry, Budapest, Hungary
| | - Sharon Zimmerman-Brenner
- Baruch Ivcher School of Psychology, The Interdisciplinary Center (IDC) Herzliya, Herzliya, Israel
| | | | - Nanette Mol Debes
- Department of Pediatrics, Herlev University Hospital, Herlev, Denmark
| | - Paula Viefhaus
- School of Child and Adolescent Cognitive Behavior Therapy (AKiP), University Hospital, Cologne, Germany
| | - Sally Robinson
- Tic and Neurodevelopmental Movement Service (TANDeM), Children's Neurosciences, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Veit Roessner
- Department of Child and Adolescent Psychiatry, TU Dresden, Dresden, Germany
| | - Christos Ganos
- Department of Neurology, Charité University Medicine Berlin, Berlin, Germany
| | - Natalia Szejko
- Department of Neurology, Medical University of Warsaw, Warsaw, Poland
- Department of Bioethics, Medical University of Warsaw, Warsaw, Poland
- Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale School of Medicine, New Haven, USA
| | - Kirsten R Müller-Vahl
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Danielle Cath
- Department of Psychiatry, University Medical Center Groningen, Rijks Universiteit Groningen, GGZ Drenthe Mental Health Institution, Assen, The Netherlands
| | - Andreas Hartmann
- Department of Neurology, Hôpital de La Pitié-Salpêtrière, 75013, Paris, France
| | - Cara Verdellen
- PsyQ Nijmegen, Outpatient Treatment Center, Parnassia Group, Den Haag, The Netherlands
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9
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Chow G, Gan JKE, Chan JKY, Wu XV, Klainin-Yobas P. Effectiveness of psychosocial interventions among older adults with mild cognitive impairment: a systematic review and meta-analysis. Aging Ment Health 2021; 25:1986-1997. [PMID: 33200623 DOI: 10.1080/13607863.2020.1839861] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVES This review aimed to examine available evidence concerning the effectiveness of psychosocial interventions in improving memory, executive function, depression and activities of daily living (ADL) in older adults with MCI. METHODS Eight electronic databases were used to conduct a comprehensive literature search for published and unpublished studies. A primary outcome was cognitive function, including memory and executive function. Secondary outcomes were depression and ADL. Two researchers independently appraised quality of included studies and extracted data. Meta-analysis, heterogeneity test, subgroup analysis and sensitivity analyses were performed. RESULTS Ten studies (out of 1,265 records) were included in this review. Psychosocial interventions contributed to a significant improvement in memory, not executive function, depression and ADL. Subgroup analyses suggested that interventions with a longer duration, more therapeutic sessions, and individual format had larger effect sizes. Strategies found to enhance memory entailed behavior modification and activation, memory training, visual imagery, storytelling, memory aids, journaling, and exercise. CONCLUSION Healthcare providers may offer psychosocial interventions to client with MCI in clinical settings. Higher quality trials should be conducted to increase solid evidence in this domain.
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Affiliation(s)
- Gigi Chow
- Khoo Teck Puat Hospital, Singapore, Singapore
| | | | | | - Xi Vivien Wu
- Alice Lee Centre for Nursing Studies, Level 2, Clinical Research Centre, National University of Singapore, Singapore, Singapore
| | - Piyanee Klainin-Yobas
- Alice Lee Centre for Nursing Studies, Level 2, Clinical Research Centre, National University of Singapore, Singapore, Singapore
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10
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Liang JH, Zhang SX, Chen YC, Tan KY, Zhang JS, Zhao Y, Kakaer A, Chen YJ. Role of psychotherapy strategy for the management of patients with Tourette syndrome - A Bayesian network meta-analysis. J Psychiatr Res 2021; 143:451-461. [PMID: 34482986 DOI: 10.1016/j.jpsychires.2021.07.051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 07/16/2021] [Accepted: 07/31/2021] [Indexed: 11/19/2022]
Abstract
Tourette's syndrome (TS) is a complex neurodevelopmental disorder characterized by high comorbidity. Treatment with psychotherapy is highly recommended, however, there exists limited available evidence on the use and the optimal psychotherapeutic outcome is debatable. We performed a systematic search on several bibliographic databases for randomized controlled trials (RCTs) reporting the use of psychotherapy treatment in TS patients, from inception to August 1st, 2020, and without language restrictions. Outcome measures were measured by the Yale global tic severity scale (YGTSS) to determine the efficacy of psychotherapy. Data were pooled as Standard mean difference (SMD) in the Bayesian analysis of the random effect model. A total of 17 RCTs with 9 treatments and 1042 participants were included from an initial 4901 records. The primary outcome including, Comprehensive behavioral intervention (CBIT) [SMD = -1.43, 95%Credible interval (CrI): -2.39, -0.44], Exposure with response prevention (ERP) [SMD = -1.37, 95%CrI: -2.62, -0.13], Habit reversal therapy (HRT) [SMD = -0.93, 95%CrI: 1.83, -0.05], and Behavior therapy (BT) [SMD = -0.85, 95%CrI: 1.51, -0.18], were found to be significantly lower in the TS group compared with the control group (including wait-list, treatment-as-usual or other named control group). Based on the Surface under the cumulative ranking curve (SUCRA), CBIT (SUCRA value = 86.97%, 95%CrI: 44%, 100%) was found to be a suitable psychotherapeutic treatment for TS patients. High-quality RCTs on psychotherapy are needed to perform for establishing the foundation of the generation of evidence-based guidelines.
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Affiliation(s)
- Jing-Hong Liang
- Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, PR China.
| | - Shu-Xin Zhang
- Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, PR China.
| | - Yi-Can Chen
- Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, PR China.
| | - Kai-Yun Tan
- Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, PR China.
| | - Jing-Shu Zhang
- Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, PR China.
| | - Yu Zhao
- Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, PR China.
| | - Aerziguli Kakaer
- Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, PR China.
| | - Ya-Jun Chen
- Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, PR China.
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Kim KM, Bae E, Lee J, Park TW, Lim MH. A Review of Cognitive and Behavioral Interventions for Tic Disorder. Soa Chongsonyon Chongsin Uihak 2021; 32:51-62. [PMID: 33828404 PMCID: PMC8018680 DOI: 10.5765/jkacap.200042] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 12/15/2020] [Accepted: 12/31/2020] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVES Tic disorder is a neurodevelopmental disorder characterized by multiple involuntary movements of muscles or vocalization. Although tic symptoms subside as the patient ages, some patients suffer from significant functional impairments related to severe tic symptoms. This manuscript aimed to review the latest scientific evidences for the effect of cognitive-behavioral interventions on tic disorder. METHODS The relevant studies were identified by searching medical research databases. We focused our search on studies published between 2000 and 2020 in order to reflect the latest scientific evidence. A total of 821 articles were identified in the initial database search and 27 articles were finally included for the review after the exclusion of duplicated and irrelevant articles. RESULTS Behavioral therapies including habit reversal training, Comprehensive Behavioral Intervention for Tics, and exposure and response prevention were the most widely studied interventions for tic disorder and are recommended as first-line treatments for tic disorders with high confidence. Cognitive psychophysiologic approaches were also reported to be effective. CONCLUSION Further studies are needed to support the future treatment of tics with low-cost and more widely available treatments, in order to ensure better treatment outcomes.
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Affiliation(s)
- Kyoung Min Kim
- Department of Psychiatry, College of Medicine, Dankook University, Cheonan, Korea
- Department of Psychiatry, Dankook University Hospital, Cheonan, Korea
| | - Eunju Bae
- Graduate School of Psychology, Dankook University, Cheonan, Korea
| | - Jiryun Lee
- Department of Psychiatry, Dankook University Hospital, Cheonan, Korea
| | - Tae-Won Park
- Department of Psychiatry, Jeonbuk National University Hospital, Jeonju, Korea
| | - Myung Ho Lim
- Department of Psychology, College of Health Science, Dankook University, Cheonan, Korea
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Yu L, Li Y, Zhang J, Yan C, Wen F, Yan J, Wang F, Liu J, Cui Y. The therapeutic effect of habit reversal training for Tourette syndrome: a meta-analysis of randomized control trials. Expert Rev Neurother 2020; 20:1189-1196. [PMID: 32948114 DOI: 10.1080/14737175.2020.1826933] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVES Comprehensive behavioral intervention for tics (CBIT) and habit reversal training (HRT) are forms of cognitive behavioral therapy that can effectively reduce tic symptoms in patients with tic disorders, but their efficacies and potential moderators were needed to be clarified. METHODS In the present study, a meta-analysis was performed to identify the efficacy of HRT and CBIT for individuals with tic disorders. The standard mean difference (SMD) was calculated to assess the effect size of the efficacy of HRT. Subgroup analysis and meta-regression analysis were performed to identify the potential heterogeneity of the SMD of HRT. RESULTS A total of 10 randomized controlled trials (RCTs) including 586 patients with tic disorders were identified. The pooled SMD was -0.43 (95% CI: -0.71, -0.16). The effect size of HRT was moderated by different 'Comparison Conditions' (it means the different behavioral therapies in the control group). CONCLUSION Overall, the authors found a small to medium effect size for the efficacy of HRT. As the most promising behavioral therapy, they conclude that HRT is effective for the treatment of patients with tic disorders. Further high-quality RCTs are needed to determine the efficacy of HRT compared with that of medications.
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Affiliation(s)
- Liping Yu
- Department of Psychiatry, Beijing Children's Hospital, Capital Medical University, National Center for Children Healthy , Beijing, China
| | - Ying Li
- Department of Psychiatry, Beijing Children's Hospital, Capital Medical University, National Center for Children Healthy , Beijing, China
| | - Jishui Zhang
- Department of Psychiatry, Beijing Children's Hospital, Capital Medical University, National Center for Children Healthy , Beijing, China
| | - Chunmei Yan
- Department of Psychiatry, Beijing Children's Hospital, Capital Medical University, National Center for Children Healthy , Beijing, China
| | - Fang Wen
- Department of Psychiatry, Beijing Children's Hospital, Capital Medical University, National Center for Children Healthy , Beijing, China
| | - Junjuan Yan
- Department of Psychiatry, Beijing Children's Hospital, Capital Medical University, National Center for Children Healthy , Beijing, China
| | - Fang Wang
- Department of Psychiatry, Beijing Children's Hospital, Capital Medical University, National Center for Children Healthy , Beijing, China
| | - Jingran Liu
- Department of Psychiatry, Beijing Children's Hospital, Capital Medical University, National Center for Children Healthy , Beijing, China
| | - Yonghua Cui
- Department of Psychiatry, Beijing Children's Hospital, Capital Medical University, National Center for Children Healthy , Beijing, China
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Gu Y, Li Y, Cui Y. Correlation between premonitory urges and tic symptoms in a Chinese population with tic disorders. Pediatr Investig 2020; 4:86-90. [PMID: 32851350 PMCID: PMC7331428 DOI: 10.1002/ped4.12189] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 05/18/2020] [Indexed: 12/27/2022] Open
Abstract
IMPORTANCE Tics usually start around 4-6 years old and affect about 1% of school-age children. Premonitory urges (PUs) are sensory phenomena that precede tics and are often described as unpleasant feelings. Recent evidence supports a relationship between PUs and tic severity, but reports are conflicting. In addition, there is no report of PUs in the Chinese population. OBJECTIVE To investigate the correlation between PUs and tic symptoms in the Chinese population with tic disorders. METHODS We recruited 252 Chinese individuals with chronic tic disorders (age 5-16 years). The Yale Global Tic Severity Scale (YGTSS) was used to assess tic symptoms, and the Premonitory Urge for Tics Scale (PUTS) was used to assess PUs. We calculated Spearman correlations between PUTS and YGTSS scores, and constructed a linear regression model to predict the tic symptom severity by PUs. RESULTS There was a significant positive correlation between PU severity (PUTS scores) and motor tic severity, total tic severity, tic-caused impairment (YGTSS scores) (P < 0.05). PU severity was a significant positive predictor of tic symptom severity (standardized beta coefficient = 0.174, t = 2.786, P = 0.006). INTERPRETATION We provide evidence for a correlation between PUs and tic symptoms. PU severity predicts tic symptom severity. Further research on PUs is needed to clarify the shared brain mechanism with tics, and their role in tic expression. A suitable tool to assess PUs in younger children is also needed.
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Affiliation(s)
- Yi Gu
- Department of PsychiatryBeijing Children’s HospitalCapital Medical UniversityNational Center for Children’s HealthBeijingChina
| | - Ying Li
- Department of PsychiatryBeijing Children’s HospitalCapital Medical UniversityNational Center for Children’s HealthBeijingChina
| | - Yonghua Cui
- Department of PsychiatryBeijing Children’s HospitalCapital Medical UniversityNational Center for Children’s HealthBeijingChina
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Singer HS, McDermott S, Ferenc L, Specht M, Mahone EM. Efficacy of Parent-Delivered, Home-Based Therapy for Tics. Pediatr Neurol 2020; 106:17-23. [PMID: 32165032 DOI: 10.1016/j.pediatrneurol.2019.12.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 12/23/2019] [Accepted: 12/27/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Although behavioral therapy is an effective approach to reduce tics in children and adults, there is an insufficient availability and accessibility of behavioral therapy in the community. OBJECTIVE The goal of the study was to test the clinical efficacy of home-based, parent-provided behavioral therapy in children with Tourette syndrome aged seven to 13 years. METHOD An instructional habit reversal training-based video and guide was developed for use by parents. Eligible families, in this 10-week study, were enrolled in either a home-based therapy (DVD) group (received disk and written instructions) or an in-person therapist group (had scheduled visits with the therapist). Outcome scales included the Yale Global Tic Severity Scale, both the total Tic Severity Score and total Global Severity Score, and the parent report of Clinical Global Impressions of Improvement. RESULTS Forty-four children (mean age = 10.21 ± 1.69 years) were enrolled into either the DVD (n = 33) or in-person therapist (n = 11) groups. Eighteen completed the study-eight in the DVD and 10 in the in-person therapist group. Outcome measures showed significant reductions in Yale Global Tic Severity Scale change ratios: mean improvement on the Tic Severity Score was DVD 32.4% (P < 0.001) and in-person therapist 26.6% (P = 0.01); and for the Global Severity Score, DVD 33.7% (P < 0.001) and in-person therapist 26.7% (P < 0.001). CONCLUSIONS Home-based, parent-administered habit reversal training behavioral therapy is efficacious for reducing tics in children. Telephone contacts early in the DVD treatment course might reduce the number of dropouts.
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Affiliation(s)
- Harvey S Singer
- Johns Hopkins University School of Medicine, Baltimore, Maryland; Kennedy Krieger Institute, Baltimore, Maryland.
| | | | - Lisa Ferenc
- Kennedy Krieger Institute, Baltimore, Maryland
| | | | - E Mark Mahone
- Johns Hopkins University School of Medicine, Baltimore, Maryland; Kennedy Krieger Institute, Baltimore, Maryland
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Abstract
PURPOSE OF REVIEW The purpose of this article is to present current information on the phenomenology, epidemiology, comorbidities, and pathophysiology of tic disorders and discuss therapy options. It is hoped that a greater understanding of each of these components will provide clinicians with the necessary information to deliver thoughtful and optimal care to affected individuals. RECENT FINDINGS Recent advances include the finding that Tourette syndrome is likely due to a combination of several different genes, both low-effect and larger-effect variants, plus environmental factors. Pathophysiologically, increasing evidence supports involvement of the cortical-basal ganglia-thalamocortical circuit; however, the primary location and neurotransmitter remain controversial. Behavioral therapy is first-line treatment, and pharmacotherapy is based on tic severity. Several newer therapeutic agents are under investigation (eg, valbenazine, deutetrabenazine, cannabinoids), and deep brain stimulation is a promising therapy. SUMMARY Tics, defined as sudden, rapid, recurrent, nonrhythmic motor movements or vocalizations, are essential components of Tourette syndrome. Although some tics may be mild, others can cause significant psychosocial, physical, and functional difficulties that affect daily activities. In addition to tics, most affected individuals have coexisting neuropsychological difficulties (attention deficit hyperactivity disorder, obsessive-compulsive disorder, anxiety, mood disorder, disruptive behaviors, schizotypal traits, suicidal behavior, personality disorder, antisocial activities, and sleep disorders) that can further impact social and academic activities or employment.
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Ignatowicz A, Atherton H, Bernstein CJ, Bryce C, Court R, Sturt J, Griffiths F. Internet videoconferencing for patient-clinician consultations in long-term conditions: A review of reviews and applications in line with guidelines and recommendations. Digit Health 2019; 5:2055207619845831. [PMID: 31069105 PMCID: PMC6495459 DOI: 10.1177/2055207619845831] [Citation(s) in RCA: 87] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 03/28/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The use of internet videoconferencing in healthcare settings is widespread, reflecting the normalisation of this mode of communication in society and current healthcare policy. As the use of internet videoconferencing is growing, increasing numbers of reviews of literature are published. METHODS The authors conducted a review of the existing reviews of literature relating to the use of internet videoconferencing for consultations between healthcare professionals and patients with long-term conditions in their own home. The review was followed with an assessment of United Kingdom National Institute for Health and Clinical Excellence guidelines for patient care in the context of common long-term illnesses to examine where videoconferencing could be implemented in line with these recommendations. RESULTS The review of reviews found no formal evidence in favour of or against the use of internet videoconferencing. Patients were satisfied with the use of videoconferencing but there was limited evidence that it led to a change in health outcomes. Evidence of healthcare professional satisfaction when using this mode of communication with patients was limited. The review of guidelines suggested a number of opportunities for adoption and expansion of internet videoconferencing. Implementing videoconferencing in line with current evidence for patient care could offer support and provide information on using a communication channel that suits individual patient needs and circumstances. The evidence base for videoconferencing is growing, but there is still a lack of data relating to cost, ethics and safety. CONCLUSIONS While the current evidence base for internet videoconferencing is equivocal, it is likely to change as more research is undertaken and evidence published. With more videoconferencing services added in more contexts, research needs to explore how internet videoconferencing can be implemented in ways that it is valued by patients and clinicians, and how it can fit within organisational and technical infrastructure of the healthcare services.
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Affiliation(s)
- Agnieszka Ignatowicz
- Institute of Applied Health Research, University of Birmingham,
Birmingham, United Kingdom
- Warwick Medical School, The University of Warwick, Coventry,
United Kingdom
| | - Helen Atherton
- Warwick Medical School, The University of Warwick, Coventry,
United Kingdom
| | | | - Carol Bryce
- Warwick Medical School, The University of Warwick, Coventry,
United Kingdom
| | - Rachel Court
- Warwick Medical School, The University of Warwick, Coventry,
United Kingdom
| | - Jackie Sturt
- Florence Nightingale Faculty of Nursing, Midwifery and
Palliative Care, King’s College London, London, United Kingdom
| | - Frances Griffiths
- Warwick Medical School, The University of Warwick, Coventry,
United Kingdom
- Centre for Health Policy, School of Public Health, University of
the Witwatersrand, Johannesburg, South Africa
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Pinares-Garcia P, Stratikopoulos M, Zagato A, Loke H, Lee J. Sex: A Significant Risk Factor for Neurodevelopmental and Neurodegenerative Disorders. Brain Sci 2018; 8:E154. [PMID: 30104506 PMCID: PMC6120011 DOI: 10.3390/brainsci8080154] [Citation(s) in RCA: 108] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 08/08/2018] [Accepted: 08/10/2018] [Indexed: 12/11/2022] Open
Abstract
Males and females sometimes significantly differ in their propensity to develop neurological disorders. Females suffer more from mood disorders such as depression and anxiety, whereas males are more susceptible to deficits in the dopamine system including Parkinson's disease (PD), attention-deficit hyperactivity disorder (ADHD) and autism. Despite this, biological sex is rarely considered when making treatment decisions in neurological disorders. A better understanding of the molecular mechanism(s) underlying sex differences in the healthy and diseased brain will help to devise diagnostic and therapeutic strategies optimal for each sex. Thus, the aim of this review is to discuss the available evidence on sex differences in neuropsychiatric and neurodegenerative disorders regarding prevalence, progression, symptoms and response to therapy. We also discuss the sex-related factors such as gonadal sex hormones and sex chromosome genes and how these might help to explain some of the clinically observed sex differences in these disorders. In particular, we highlight the emerging role of the Y-chromosome gene, SRY, in the male brain and its potential role as a male-specific risk factor for disorders such as PD, autism, and ADHD in many individuals.
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Affiliation(s)
- Paulo Pinares-Garcia
- Brain and Gender laboratory, Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Clayton, Victoria 3168, Australia.
- Department of Anatomy and Developmental Biology, Monash University, Clayton, Victoria 3168, Australia.
| | - Marielle Stratikopoulos
- Brain and Gender laboratory, Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Clayton, Victoria 3168, Australia.
- Department of Anatomy and Developmental Biology, Monash University, Clayton, Victoria 3168, Australia.
| | - Alice Zagato
- Brain and Gender laboratory, Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Clayton, Victoria 3168, Australia.
- School of Life and Environmental Sciences, Deakin University, Burwood, Victoria 3125, Australia.
| | - Hannah Loke
- Brain and Gender laboratory, Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Clayton, Victoria 3168, Australia.
| | - Joohyung Lee
- Brain and Gender laboratory, Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Clayton, Victoria 3168, Australia.
- Department of Anatomy and Developmental Biology, Monash University, Clayton, Victoria 3168, Australia.
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Abstract
Gilles de la Tourette syndrome is a chronic and complex tic disorder accompanied by specific behavioral problems in the majority of patients. With its multifaceted interplay between motion and emotion, this condition is a paradigmatic example of the science and art of clinical neuropsychiatry. This review article encompasses the clinical phenomenology of motor and vocal tics and associated sensory experiences (premonitory urges), as well as the behavioral spectrum of the most common comorbidities, including obsessive-compulsive disorder, attention-deficit and hyperactivity disorder, affective symptoms, and impulsivity. Knowledge of the contributions of both tics and behavioral problems to patients' health-related quality of life across the lifespan should assist treating clinicians in formulating a targeted management plan. Although the exact pathophysiology of Gilles de la Tourette syndrome remains elusive, research into therapeutic interventions has expanded the range of available interventions across multiple domains. A thorough understanding of the neurology and psychiatry of this condition is of key importance to meet the needs of this patient population, from the formulation of an accurate diagnosis to the implementation of effective treatment strategies.
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Hartmann A, Deniau E, Czernecki V, Negovanska V, d’Harcourt S, Depienne C, Klein-Koerkamp Y, Worbe Y. Tic e sindrome di Gilles de la Tourette. Neurologia 2018. [DOI: 10.1016/s1634-7072(18)89402-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Psychiatric Treatment and Management of Psychiatric Comorbidities of Movement Disorders. Semin Pediatr Neurol 2018; 25:123-135. [PMID: 29735110 DOI: 10.1016/j.spen.2017.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Pediatric movement disorders may present with psychiatric symptoms at many points during the course of the disease. For the relatively common pediatric movement disorder, Tourette syndrome, psychiatric comorbidities are well-described and treatment is well-studied. Managing these comorbidities may be more effective than improving the movements themselves. For more uncommon movement disorders, such as juvenile-onset Huntington disease, treatment of psychiatric comorbidities is not well-characterized, and best-practice recommendations are not available. For the least common movement disorders, such as childhood neurodegeneration with brain iron accumulation, psychiatric features may be nonspecific so that underlying diagnosis may be apparent only after recognition of other symptoms. However, psychiatric medication, psychotherapy, and psychosocial support for these disorders may prove helpful to many children and adolescents.
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Griffiths FE, Armoiry X, Atherton H, Bryce C, Buckle A, Cave JAK, Court R, Hamilton K, Dliwayo TR, Dritsaki M, Elder P, Forjaz V, Fraser J, Goodwin R, Huxley C, Ignatowicz A, Karasouli E, Kim SW, Kimani P, Madan JJ, Matharu H, May M, Musumadi L, Paul M, Raut G, Sankaranarayanan S, Slowther AM, Sujan MA, Sutcliffe PA, Svahnstrom I, Taggart F, Uddin A, Verran A, Walker L, Sturt J. The role of digital communication in patient–clinician communication for NHS providers of specialist clinical services for young people [the Long-term conditions Young people Networked Communication (LYNC) study]: a mixed-methods study. HEALTH SERVICES AND DELIVERY RESEARCH 2018. [DOI: 10.3310/hsdr06090] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BackgroundYoung people (aged 16–24 years) with long-term health conditions tend to disengage from health services, resulting in poor health outcomes. They are prolific users of digital communications. Innovative UK NHS clinicians use digital communication with these young people. The NHS plans to use digital communication with patients more widely.ObjectivesTo explore how health-care engagement can be improved using digital clinical communication (DCC); understand effects, impacts, costs and necessary safeguards; and provide critical analysis of its use, monitoring and evaluation.DesignObservational mixed-methods case studies; systematic scoping literature reviews; assessment of patient-reported outcome measures (PROMs); public and patient involvement; and consensus development through focus groups.SettingTwenty NHS specialist clinical teams from across England and Wales, providing care for 13 different long-term physical or mental health conditions.ParticipantsOne hundred and sixty-five young people aged 16–24 years living with a long-term health condition; 13 parents; 173 clinical team members; and 16 information governance specialists.InterventionsClinical teams and young people variously used mobile phone calls, text messages, e-mail and voice over internet protocol.Main outcome measuresEmpirical work – thematic and ethical analysis of qualitative data; annual direct costs; did not attend, accident and emergency attendance and hospital admission rates plus clinic-specific clinical outcomes. Scoping reviews–patient, health professional and service delivery outcomes and technical problems. PROMs: scale validity, relevance and credibility.Data sourcesObservation, interview, structured survey, routinely collected data, focus groups and peer-reviewed publications.ResultsDigital communication enables access for young people to the right clinician when it makes a difference for managing their health condition. This is valued as additional to traditional clinic appointments. This access challenges the nature and boundaries of therapeutic relationships, but can improve them, increase patient empowerment and enhance activation. Risks include increased dependence on clinicians, inadvertent disclosure of confidential information and communication failures, but clinicians and young people mitigate these risks. Workload increases and the main cost is staff time. Clinical teams had not evaluated the impact of their intervention and analysis of routinely collected data did not identify any impact. There are no currently used generic outcome measures, but the Patient Activation Measure and the Physicians’ Humanistic Behaviours Questionnaire are promising. Scoping reviews suggest DCC is acceptable to young people, but with no clear evidence of benefit except for mental health.LimitationsQualitative data were mostly from clinician enthusiasts. No interviews were achieved with young people who do not attend clinics. Clinicians struggled to estimate workload. Only eight full sets of routine data were available.ConclusionsTimely DCC is perceived as making a difference to health care and health outcomes for young people with long-term conditions, but this is not supported by evidence that measures health outcomes. Such communication is challenging and costly to provide, but valued by young people.Future workFuture development should distinguish digital communication replacing traditional clinic appointments and additional timely communication. Evaluation is needed that uses relevant generic outcomes.Study registrationTwo of the reviews in this study are registered as PROSPERO CRD42016035467 and CRD42016038792.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
| | - Xavier Armoiry
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Helen Atherton
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Carol Bryce
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Abigail Buckle
- Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Rachel Court
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Kathryn Hamilton
- Florence Nightingale Faculty of Nursing and Midwifery, King’s College London, London, UK
| | - Thandiwe R Dliwayo
- Florence Nightingale Faculty of Nursing and Midwifery, King’s College London, London, UK
| | | | - Patrick Elder
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Vera Forjaz
- Florence Nightingale Faculty of Nursing and Midwifery, King’s College London, London, UK
| | - Joe Fraser
- Patient and public involvement representative, London, UK
| | - Richard Goodwin
- Florence Nightingale Faculty of Nursing and Midwifery, King’s College London, London, UK
| | | | | | | | - Sung Wook Kim
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Peter Kimani
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Jason J Madan
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Harjit Matharu
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Mike May
- Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Moli Paul
- Coventry and Warwickshire Partnership Trust, Coventry, UK
| | - Gyanu Raut
- King’s College Hospital NHS Foundation Trust, London, UK
| | | | | | - Mark A Sujan
- Warwick Medical School, University of Warwick, Coventry, UK
| | | | | | | | - Ayesha Uddin
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Alice Verran
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Leigh Walker
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Jackie Sturt
- Florence Nightingale Faculty of Nursing and Midwifery, King’s College London, London, UK
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Quality assessment of clinical practice guidelines on tic disorders with AGREE II instrument. Psychiatry Res 2018; 259:385-391. [PMID: 29120847 DOI: 10.1016/j.psychres.2017.08.060] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Revised: 08/16/2017] [Accepted: 08/23/2017] [Indexed: 11/23/2022]
Abstract
To assess the methodological quality of existing clinical practice guidelines (CPGs) on the treatment of tic disorders (TDs) using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument and summarize the guideline recommendations. Five CPGs met our inclusion criteria. The mean percentages for the AGREE II domain scores were: scope and purpose 83.33% (95% confidence interval [CI], 77.78-94.44%), stakeholder involvement 62.22% (95% CI, 38.89-94.44%), rigor of development 47.08% (95% CI, 6.25-83.33%), clarity of presentation 87.78% (95% CI, 72.22-94.44%), applicability 56.67% (95% CI, 33.33-87.50%), and editorial independence 46.67% (95% CI, 8.33-91.67%). There were large differences among the five CPGs concerning the categorization of evidence and recommendations. The recommendations for drug therapy were similar in all five CPGs, although there was controversy in certain areas. The methodological quality of CPGs for TDs was acceptable in terms of scope and purpose, stakeholder involvement, and clarity of presentation. However, CPG developers need to pay more attention to rigorous development processes, applicability, and editorial independence. Developers of future CPGs should improve adherence to the AGREE II guidelines. In addition, high quality studies on the treatment of TDs are needed to provide more evidence for developing guidelines.
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Thienemann M, Murphy T, Leckman J, Shaw R, Williams K, Kapphahn C, Frankovich J, Geller D, Bernstein G, Chang K, Elia J, Swedo S. Clinical Management of Pediatric Acute-Onset Neuropsychiatric Syndrome: Part I-Psychiatric and Behavioral Interventions. J Child Adolesc Psychopharmacol 2017; 27:566-573. [PMID: 28722481 PMCID: PMC5610394 DOI: 10.1089/cap.2016.0145] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE This article outlines the consensus guidelines for symptomatic treatment for children with Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS) and Pediatric Autoimmune Neuropsychiatric Syndrome Associated with Streptococcal Infection (PANDAS). METHODS Extant literature on behavioral, psychotherapeutic, and psychopharmacologic treatments for PANS and PANDAS was reviewed. Members of the PANS Research Consortium pooled their clinical experiences to find agreement on treatment of PANS and PANDAS symptoms. RESULTS Current guidelines result from consensus among the Consortium members. CONCLUSION While underlying infectious and inflammatory processes in PANS and PANDAS patients are treated, psychiatric and behavioral symptoms need simultaneous treatment to decrease suffering and improve adherence to therapeutic intervention. Psychological, behavioral, and psychopharmacologic interventions tailored to each child's presentation can provide symptom improvement and improve functioning during both the acute and chronic stages of illness. In general, typical evidence-based interventions are appropriate for the varied symptoms of PANS and PANDAS. Individual differences in expected response to psychotropic medication may require marked reduction of initial treatment dose. Antimicrobials and immunomodulatory therapies may be indicated, as discussed in Parts 2 and 3 of this guideline series.
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Affiliation(s)
| | - Tanya Murphy
- University of South Florida, St. Petersburg, Florida
| | | | | | - Kyle Williams
- Massachusetts General Hospital, Boston, Massachusetts
| | | | | | | | | | - Kiki Chang
- Stanford University, Stanford, California
| | - Josephine Elia
- Nemours, Alfred I duPont Hospital for Children, Wilmington, Delaware
| | - Susan Swedo
- National Institute of Mental Health, Bethesda, Maryland
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Morand-Beaulieu S, Grot S, Lavoie J, Leclerc JB, Luck D, Lavoie ME. The puzzling question of inhibitory control in Tourette syndrome: A meta-analysis. Neurosci Biobehav Rev 2017; 80:240-262. [PMID: 28502600 DOI: 10.1016/j.neubiorev.2017.05.006] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 05/04/2017] [Accepted: 05/08/2017] [Indexed: 02/02/2023]
Abstract
Tourette syndrome (TS) is a neuropsychiatric disorder involving motor and phonic tics. Inhibitory control is a key issue in TS, and many disruptive or impulsive behaviors might arise from inhibitory deficits. However, conflicting findings regarding TS patients' inhibitory performance in neuropsychological tasks have been reported throughout the literature. Therefore, this meta-analysis aimed to evaluate inhibitory control through neuropsychological tasks, and to analyze the factors modulating inhibitory deficits. To this end, a literature search was performed through MEDLINE and PsycINFO, to retrieve studies including neuropsychological tasks that assessed inhibitory control in TS patients. Of the 4020 studies identified, 61 were included in the meta-analysis, for a total of 1717 TS patients. Our analyses revealed a small to medium effect in favor of inhibitory deficits in TS patients. This effect was larger in TS+ADHD patients, but pure TS patients also showed some inhibitory deficits. Therefore, deficits in inhibitory control seem to be an inherent component of TS, and are exacerbated when ADHD is concomitant.
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Affiliation(s)
- Simon Morand-Beaulieu
- Cognitive and Social Psychophysiology Lab, Montreal, Qc, Canada; Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Montreal, Qc, Canada; Département de neurosciences, Université de Montréal, Montreal, Qc, Canada.
| | - Stéphanie Grot
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Montreal, Qc, Canada; Département de psychiatrie, Université de Montréal, Montreal, Qc, Canada.
| | - Jacob Lavoie
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Montreal, Qc, Canada; Département de neurosciences, Université de Montréal, Montreal, Qc, Canada.
| | - Julie B Leclerc
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Montreal, Qc, Canada; Département de psychologie, Université du Québec à Montréal, Montreal, Qc, Canada.
| | - David Luck
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Montreal, Qc, Canada; Département de neurosciences, Université de Montréal, Montreal, Qc, Canada; Département de psychiatrie, Université de Montréal, Montreal, Qc, Canada.
| | - Marc E Lavoie
- Cognitive and Social Psychophysiology Lab, Montreal, Qc, Canada; Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Montreal, Qc, Canada; Département de neurosciences, Université de Montréal, Montreal, Qc, Canada; Département de psychiatrie, Université de Montréal, Montreal, Qc, Canada.
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Smith JL, Gregory S, McBride N, Murphy TK, Storch EA. Outpatient Treatment of Tic Disorders Among Children and Adults. Mov Disord Clin Pract 2017; 4:559-567. [PMID: 30363490 DOI: 10.1002/mdc3.12472] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 12/21/2016] [Accepted: 01/10/2017] [Indexed: 12/19/2022] Open
Abstract
Introduction Limited information is available regarding treatment practices in applied settings for children and adults with tic disorders (TDs). We describe, for the first time, the treatment of TDs in U.S. children and adults in the outpatient setting. Methods Data from the 2003-2010 National Ambulatory Medical Care Survey and the National Hospital Ambulatory Care Survey were used. Descriptive statistics for modality of treatment and class of pharmacological medications were reported by patient and visit characteristics. Separate multivariable logistic regression models were used to examine associations between patient and visit characteristics and classes of medications prescribed. Results One third (n = 99) of the sample did not receive any psychiatric or psychological treatment. Nearly two-thirds received a psychotropic medication. The most common class of medication was alpha-2 agonists (25%), followed by stimulants (23%), serotonin-reuptake inhibitors (SRIs) (19%), atypical antipsychotics (18%), anxiolytics (14%), anticonvulsants (11%), and typical antipsychotics (8%). Comorbid disorders and chronicity of problems were significantly associated with the receipt of certain classes of medications. Relatively few patients (18%) received psychotherapy. Conclusions If the decision is made to treat tic disorders, the choice of medication is dependent on the primary complaints, severity, chronicity, and the presence of comorbid psychiatric disorders. In general, comorbid externalizing, anxiety and mood disorders appear to influence treatment decisions in addition to TDs.
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Affiliation(s)
- Joseph L Smith
- Department of Health Policy and Management College of Public Health University of South Florida Tampa Florida USA
| | - Sean Gregory
- Department of Health Policy and Management College of Public Health University of South Florida Tampa Florida USA
| | - Nicole McBride
- Department of Psychology University of South Florida Tampa Florida USA
| | - Tanya K Murphy
- Department of Pediatrics University of South Florida Tampa Florida USA.,All Children's Hospital-Johns Hopkins Medicine Baltimore Maryland USA.,Department of Psychiatry and Behavioral Neurosciences University of South Florida Tampa Florida USA
| | - Eric A Storch
- Department of Health Policy and Management College of Public Health University of South Florida Tampa Florida USA.,Department of Psychology University of South Florida Tampa Florida USA.,Department of Pediatrics University of South Florida Tampa Florida USA.,Rogers Behavioral Health-Tampa Bay Tampa Florida USA.,All Children's Hospital-Johns Hopkins Medicine Baltimore Maryland USA.,Department of Psychiatry and Behavioral Neurosciences University of South Florida Tampa Florida USA
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26
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Ganos C, Martino D, Pringsheim T. Tics in the Pediatric Population: Pragmatic Management. Mov Disord Clin Pract 2017; 4:160-172. [PMID: 28451624 PMCID: PMC5396140 DOI: 10.1002/mdc3.12428] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 07/23/2016] [Accepted: 07/27/2016] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Primary tic disorders, notably Tourette syndrome, are very common movement disorders in childhood. However, the management of such patients still poses great therapeutic challenges to medical professionals. METHODS Based on a synthesis of the available guidelines published in Europe, Canada, and the United States, coupled with more recent therapeutic developments, the authors provide a pragmatic guide to aid clinicians in deciding when and how to treat patients who have primary tic disorders. RESULTS After a systematic assessment of tics and common neuropsychiatric comorbidities (primarily attention-deficit hyperactivity disorder [ADHD] and obsessive-compulsive disorder [OCD]), the first step in treatment is a comprehensive psychoeducation of patients and families that addresses the protean phenomenology of tics and associated behaviors, coping mechanisms, prognosis, and treatment options. When more active intervention beyond watchful monitoring is indicated, hierarchical evaluation of treatment targets (i.e., tics vs. comorbid behavioral symptoms) is crucial. Behavioral treatments for tics are restricted to older children and are not readily available to all centers, mainly due to the paucity of well-trained therapists. Pharmacological treatments, such as antipsychotics for tics, stimulants and atomoxetine for ADHD, and α2A-agonists for children with tics plus ADHD, represent widely available and effective treatment options, but safety monitoring must be provided. Combined polypharmacological and behavioral/pharmacological approaches, as well as neuromodulation strategies, remain under-investigated in this population of patients. CONCLUSIONS The treatment of children with tics and Tourette syndrome is multifaceted. Multidisciplinary teams with expertise in neurology, psychiatry, psychology, and pediatrics may be helpful to address the complex needs of these children.
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Affiliation(s)
- Christos Ganos
- Department of NeurologyUniversity Medical Center Hamburg‐EppendorfHamburgGermany
- Sobell Department of Motor Neuroscience and Movement DisordersUniversity College London Institute of NeurologyUniversity College LondonLondonUnited Kingdom
| | - Davide Martino
- International Parkinson's Centre of ExcellenceKing's College and King's College HospitalDenmark Hill CampusLondonUnited Kingdom
- Queen Elizabeth Hospital, WoolwichLewisham and Greenwich National Health Service TrustLondonUnited Kingdom
| | - Tamara Pringsheim
- Department of Clinical NeurosciencesUniversity of CalgaryCalgaryAlbertaCanada
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27
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Edwards KR, Specht M. A Review of the Literature Regarding Behavioral Therapy for Chronic Tic Disorders (CTDs): Where Do We Go from Here? CURRENT DEVELOPMENTAL DISORDERS REPORTS 2016. [DOI: 10.1007/s40474-016-0100-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Kious BM, Jimenez-Shahed J, Shprecher DR. Treatment-refractory Tourette Syndrome. Prog Neuropsychopharmacol Biol Psychiatry 2016; 70:227-36. [PMID: 26875502 DOI: 10.1016/j.pnpbp.2016.02.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 02/02/2016] [Accepted: 02/08/2016] [Indexed: 12/27/2022]
Abstract
Tourette Syndrome (TS) is a complex neurodevelopmental condition marked by tics and frequently associated with psychiatric comorbidities. While most cases are mild and improve with age, some are treatment-refractory. Here, we review strategies for the management of this population. We begin by examining the diagnosis of TS and routine management strategies. We then consider emerging treatments for refractory cases, including deep brain stimulation (DBS), electroconvulsive therapy (ECT), repetitive transcranial magnetic stimulation (rTMS), and novel pharmacological approaches such as new vesicular monoamine transporter type 2 inhibitors, cannabinoids, and anti-glutamatergic drugs.
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Affiliation(s)
- Brent M Kious
- University of Utah, Department of Psychiatry, 501 Chipeta Way, Salt Lake City, UT 84108, United States.
| | - Joohi Jimenez-Shahed
- Baylor College of Medicine, Department of Neurology, 7200 Cambridge, Suite 9a/MS: BCM 609, Houston, TX 77030, United States
| | - David R Shprecher
- University of Utah, Department of Neurology, 729 Arapeen Drive, Salt Lake City, UT 84108, United States; Banner Sun Health Research Institute, 10515 W. Santa Fe Drive, Sun City, AZ 85351, United States
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29
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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.
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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
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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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Abstract
Movement disorders comprise hyperkinetic involuntary movements (eg tremor, myoclonus, tics, dystonia and chorea) and hypokinetic (parkinsonism) disorders. Tics are cardinal features of primary tic disorders encompassing Tourette syndrome (TS), but are also found in some neurodegenerative conditions and may be induced by psychoactive substances. The first line treatment for tics is pharmacological (mainly dopamine receptor blockers or alpha-2 adrenergic agonists) and behavioural. Dystonia and chorea syndromes are considerably heterogeneous in aetiology, and age at onset, body distribution of the movement disorder, accompanying neurological motor and non-motor features, and systemic manifestations are all important to reach a correct aetiological diagnosis. While symptomatic pharmacological treatment remains the mainstay of treatment for choreas, deep brain stimulation surgery has a well-defined place in the management of medically refractory dystonia.
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Affiliation(s)
| | - Davide Martino
- National Parkinson Foundation International Centre of Excellence, King's College Hospital NHS Trust, London, UK and Queen Elizabeth Hospital Lewisham and Greenwich NHS Trust, London, UK
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32
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Interventions for tic disorders: An overview of systematic reviews and meta analyses. Neurosci Biobehav Rev 2016; 63:239-55. [PMID: 26751711 DOI: 10.1016/j.neubiorev.2015.12.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 11/24/2015] [Accepted: 12/28/2015] [Indexed: 02/05/2023]
Abstract
We conducted a comprehensive search and the overview included 22 systematic reviews (SRs) for treating tic disorders (TDs). Three SRs indicated typical antipsychotics (i.e., haloperidol, pimozide) were efficacious in the reduction of tic severity compared with placebo but with poor tolerability. Six SRs assessed the efficacy of atypical antipsychotics and indicated that atypical antipsychotics (i.e., risperidone, aripiprazole) could significantly improved tic symptoms compared with placebo or typical antipsychotics with less AEs. Four SRs indicated alpha adrenergic agonists (i.e., clonidine, guanfacine) could improve tic symptoms. Two SRs assessed the efficacy of antiepileptic drugs and indicated topiramate was a promising therapy. Six SRs evaluated the efficacy of behavior therapy and showed habit reversal therapy (HRT) and exposure and response prevention (ERP) were effective. One SR evaluated the efficacy deep brain stimulation (DBS) and indicated DBS is a promising treatment option for severe cases of TS. In conclusion, RCTs directly comparing different pharmacological treatment options are scarce. In practice, typical and atypical antipsychotics are often considered firstly while other pharmacological medications are suggested as alternatives in the case of treatment failure or contradictory outcomes. Behavioral therapies can be used either alone or in combination with medication.
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Morand-Beaulieu S, O'Connor KP, Richard M, Sauvé G, Leclerc JB, Blanchet PJ, Lavoie ME. The Impact of a Cognitive-Behavioral Therapy on Event-Related Potentials in Patients with Tic Disorders or Body-Focused Repetitive Behaviors. Front Psychiatry 2016; 7:81. [PMID: 27242551 PMCID: PMC4861894 DOI: 10.3389/fpsyt.2016.00081] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 04/25/2016] [Indexed: 12/19/2022] Open
Abstract
CONTEXT Tic disorders (TD) are characterized by the presence of non-voluntary contractions of functionally related groups of skeletal muscles in one or multiple body parts. Patients with body-focused repetitive behaviors (BFRB) present frequent and repetitive behaviors, such as nail biting or hair pulling. TD and BFRB can be treated with a cognitive-behavioral therapy (CBT) that regulates the excessive amount of sensorimotor activation and muscular tension. Our CBT, which is called the cognitive-psychophysiological (CoPs) model, targets motor execution and inhibition, and it was reported to modify brain activity in TD. However, psychophysiological effects of therapy are still poorly understood in TD and BFRB patients. Our goals were to compare the event-related potentials (ERP) of TD and BFRB patients to control participants and to investigate the effects of the CoPs therapy on the P200, N200, and P300 components during a motor and a non-motor oddball task. METHOD Event-related potential components were compared in 26 TD patients, 27 BFRB patients, and 27 control participants. ERP were obtained from 63 EEG electrodes during two oddball tasks. In the non-motor task, participants had to count rare stimuli. In the motor task, participants had to respond with a left and right button press for rare and frequent stimuli, respectively. ERP measures were recorded before and after therapy in both patient groups. RESULTS CoPs therapy improved symptoms similarly in both clinical groups. Before therapy, TD and BFRB patients had reduced P300 oddball effect during the non-motor task, in comparison with controls participants. An increase in the P300 oddball effect was observed posttherapy. This increase was distributed over the whole cortex in BFRB patients, but localized in the parietal area in TD patients. DISCUSSION These results suggest a modification of neural processes following CoPs therapy in TD and BFRB patients. CoPs therapy seems to impact patients' attentional processes and context updating capacities in working memory (i.e., P300 component). Our results are consistent with a possible role of the prefrontal cortex and corpus callosum in mediating interhemispheric interference in TD.
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Affiliation(s)
- Simon Morand-Beaulieu
- Laboratoire de psychophysiologie cognitive et sociale, Montreal, QC, Canada; Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Montreal, QC, Canada; Département de neurosciences, Faculté de médecine, Université de Montréal, Montreal, QC, Canada
| | - Kieron P O'Connor
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Montreal, QC, Canada; Département de psychiatrie, Faculté de médecine, Université de Montréal, Montreal, QC, Canada
| | - Maxime Richard
- Laboratoire de psychophysiologie cognitive et sociale, Montreal, QC, Canada; Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Montreal, QC, Canada; Département de neurosciences, Faculté de médecine, Université de Montréal, Montreal, QC, Canada
| | - Geneviève Sauvé
- Laboratoire de psychophysiologie cognitive et sociale, Montreal, QC, Canada; Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Montreal, QC, Canada
| | - Julie B Leclerc
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Montreal, QC, Canada; Département de psychologie, Faculté des sciences humaines, Université du Québec à Montréal, Montreal, QC, Canada
| | - Pierre J Blanchet
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Montreal, QC, Canada; Département de stomatologie, Faculté de médecine dentaire, Université de Montréal, Montreal, QC, Canada
| | - Marc E Lavoie
- Laboratoire de psychophysiologie cognitive et sociale, Montreal, QC, Canada; Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Montreal, QC, Canada; Département de psychiatrie, Faculté de médecine, Université de Montréal, Montreal, QC, Canada
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Jakubovski E, Reichert C, Karch A, Buddensiek N, Breuer D, Müller-Vahl K. The ONLINE-TICS Study Protocol: A Randomized Observer-Blind Clinical Trial to Demonstrate the Efficacy and Safety of Internet-Delivered Behavioral Treatment for Adults with Chronic Tic Disorders. Front Psychiatry 2016; 7:119. [PMID: 27445874 PMCID: PMC4928510 DOI: 10.3389/fpsyt.2016.00119] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 06/20/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In recent years, behavioral therapy with comprehensive behavioral intervention for tics (CBIT) has been recognized as an effective and safe treatment in patients with Gilles de la Tourette syndrome. In Germany, however, dissemination of CBIT is restricted due to a considerable lack of well-trained therapists. The aim of this study is to overcome this deficiency by creating a new and sophisticated Internet-delivered CBIT (iCBIT) program. With this study, we want to demonstrate that iCBIT is superior to Internet-delivered psychoeducation and comparable to face-to-face CBIT. METHOD AND ANALYSIS This is a multicenter, prospective, randomized, controlled, observer-blind clinical trial, which will be conducted at five sites in Germany (ONLINE-TICS). Over the course of 2 years, 160 adult patients with chronic tic disorders will be assigned to one of three treatment arms: iCBIT (n = 72), online psychoeducation (n = 72), or face-to-face CBIT (n = 16). All treatments will consist of eighty therapy sessions over a period of 10 weeks and will follow the well-established CBIT manual by Woods and colleagues. The primary outcome measure will be the change in Yale Global Tic Severity Scale (YGTSS) at 1-week posttreatment. Secondary outcome measures include YGTSS change at 3 and 6 months, video- and self-ratings of tics as well as scales for psychiatric comorbidities assessed at each visit. The primary analysis will compare iCBIT to online psychoeducation using a mixed linear model with the YGTSS change as dependent variable. Secondary analyses will look at the comparison between iCBIT and face-to-face CBIT in a non-inferiority analysis. DISCUSSION If iCBIT proves to be effective, it would be a considerable contribution to close the wide gap in treatment providers for tic disorders not only in Germany but also in several other countries, since this Internet-delivered therapy does not require the supervision of a therapist. In addition, iCBIT would be a cost-effective and readily available treatment alternative that guarantees high quality standard of CBIT. ETHICS AND DISSEMINATION All institutional review boards approve the protocol. All participants will provide informed consent. There are no conflicts of interest. After study completion, the results will be published. STUDY REGISTRATION ClinicalTrials.gov Identifier: NCT02413216.
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Affiliation(s)
- Ewgeni Jakubovski
- Department of Psychiatry, Socialpsychiatry and Psychotherapy, Hannover Medical School , Hannover , Germany
| | - Cornelia Reichert
- Department of Psychiatry, Socialpsychiatry and Psychotherapy, Hannover Medical School , Hannover , Germany
| | - Annika Karch
- Institute for Biostatistics, Hannover Medical School , Hannover , Germany
| | - Nadine Buddensiek
- Department of Psychiatry, Socialpsychiatry and Psychotherapy, Hannover Medical School , Hannover , Germany
| | - Daniel Breuer
- Clinical Trial Center, Hannover Medical School , Hannover , Germany
| | - Kirsten Müller-Vahl
- Department of Psychiatry, Socialpsychiatry and Psychotherapy, Hannover Medical School , Hannover , Germany
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35
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Abstract
Tourette Syndrome is a disorder characterized by tics. It typically begins in childhood and often improves in adult life. Tics are best described as voluntary movements made automatically so that volition is not ordinarily appreciated. There is frequently an urge, sometimes in the form of a specific sensory feeling (sensory tic), that precedes the tic. Patients say that they make the tic in order to reduce the urge, although shortly after the tic, the urge recurs. The sensory feeling may arise due to defective sensory habituation. Since tics relieve the urge, this can be considered rewarding, and repetition of this behavior may perpetuate the tic as a habit. Tourette Syndrome affects boys more than girls and is associated with attention deficit hyperactivity disorder and obsessive compulsive disorder. Although Tourette Syndrome often appears to be autosomal recessive in inheritance, it has been difficult to find any abnormal genes. There is a loss of inhibition in these patients and recent studies show abnormalities in brain GABA. Certainly there is also an abnormality in dopamine function and dopamine blocking agents are effective therapy. In severe drug-refractory patients, deep brain stimulation can be effective.
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Affiliation(s)
- Mark HALLETT
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke
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36
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Abstract
Tourette syndrome (TS) is a childhood-onset neurodevelopmental disorder characterized by multiple motor tics and at least one vocal or phonic tic, and often one or more comorbid psychiatric disorders. Premonitory sensory urges before tic execution and desire for "just-right" perception are central features. The pathophysiology involves cortico-striato-thalamo-cortical circuits and possibly dopaminergic system. TS is considered a genetic disorder but the genetics is complex and likely involves rare mutations, common variants, and environmental and epigenetic factors. Treatment is multimodal and includes education and reassurance, behavioral interventions, pharmacologic, and rarely, surgical interventions.
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Morand-Beaulieu S, O'Connor KP, Sauvé G, Blanchet PJ, Lavoie ME. Cognitive-behavioral therapy induces sensorimotor and specific electrocortical changes in chronic tic and Tourette's disorder. Neuropsychologia 2015; 79:310-21. [PMID: 26022060 DOI: 10.1016/j.neuropsychologia.2015.05.024] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Revised: 05/21/2015] [Accepted: 05/22/2015] [Indexed: 01/09/2023]
Abstract
BACKGROUND Tic disorders, such as the Gilles de la Tourette syndrome and persistent tic disorder, are neurodevelopmental movement disorders involving impaired motor control. Hence, patients show repetitive unwanted muscular contractions in one or more parts of the body. A cognitive-behavioral therapy, with a particular emphasis on the psychophysiology of tic expression and sensorimotor activation, can reduce the frequency and intensity of tics. However, its impact on motor activation and inhibition is not fully understood. METHODS To study the effects of a cognitive-behavioral therapy on electrocortical activation, we recorded the event-related potentials (ERP) and lateralized readiness potentials (LRP), before and after treatment, of 20 patients with tic disorders and 20 healthy control participants (matched on age, sex and intelligence), during a stimulus-response compatibility inhibition task. The cognitive-behavioral therapy included informational, awareness training, relaxation, muscle discrimination, cognitive restructuration and relapse prevention strategies. RESULTS Our results revealed that prior to treatment; tic patients had delayed stimulus-locked LRP onset latency, larger response-locked LRP peak amplitude, and a frontal overactivation during stimulus inhibition processing. Both stimulus-locked LRP onset latency and response-locked LRP peak amplitude normalized after the cognitive behavioral therapy completion. However, the frontal overactivation related to inhibition remained unchanged following therapy. CONCLUSIONS Our results showed that P300 and reaction times are sensitive to stimulus-response compatibility, but are not related to tic symptoms. Secondly, overactivity of the frontal LPC and impulsivity in TD patients were not affected by treatment. Finally, CBT had normalizing effects on the activation of the pre-motor and motor cortex in TD patients. These results imply specific modifications of motor processes following therapy, while inhibition processes remained unchanged. Given that LRPs are partially generated within the sensorimotor and supplementary motor area, the reported reduction in tic frequency and improvements of LRPs components suggest that CBT induced a physiological change in patients' motor area.
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Affiliation(s)
- Simon Morand-Beaulieu
- Laboratoire de Psychophysiologie Cognitive et Sociale, Canada; Centre de recherche de l'Institut universitaire en santé mentale de Montréal, 7331 rue Hochelaga, Montréal, QC, Canada H1N 3V2; Department of Psychiatry, Faculty of Medicine, University of Montreal, Canada
| | - Kieron P O'Connor
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal, 7331 rue Hochelaga, Montréal, QC, Canada H1N 3V2; Department of Psychiatry, Faculty of Medicine, University of Montreal, Canada
| | - Geneviève Sauvé
- Laboratoire de Psychophysiologie Cognitive et Sociale, Canada; Centre de recherche de l'Institut universitaire en santé mentale de Montréal, 7331 rue Hochelaga, Montréal, QC, Canada H1N 3V2; Department of Psychiatry, Faculty of Medicine, University of Montreal, Canada
| | - Pierre J Blanchet
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal, 7331 rue Hochelaga, Montréal, QC, Canada H1N 3V2; Department of Stomatology, Faculty of Dental Medicine, University of Montreal, Canada
| | - Marc E Lavoie
- Laboratoire de Psychophysiologie Cognitive et Sociale, Canada; Centre de recherche de l'Institut universitaire en santé mentale de Montréal, 7331 rue Hochelaga, Montréal, QC, Canada H1N 3V2; Department of Psychiatry, Faculty of Medicine, University of Montreal, Canada.
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Cuenca J, Glazebrook C, Kendall T, Hedderly T, Heyman I, Jackson G, Murphy T, Rickards H, Robertson M, Stern J, Trayner P, Hollis C. Perceptions of treatment for tics among young people with Tourette syndrome and their parents: a mixed methods study. BMC Psychiatry 2015; 15:46. [PMID: 25879205 PMCID: PMC4359496 DOI: 10.1186/s12888-015-0430-0] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 02/24/2015] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Tourette syndrome (TS) among young people is associated with psychosocial difficulties and parents play an important role in the management of the condition. Clinical guidelines have been developed for the treatment of TS and tics, but little is known about how young people and their parents perceive their treatment options or their desired outcomes of treatment. The aim of this study is to explore perceptions of treatments for tics among young people with TS and their parents. METHODS In-depth interviews with 42 young people with TS and a mixed-methods, online survey of 295 parents of young people with TS. Participant recruitment was conducted through Tourettes Action (TA): a non-profit UK organisation for the support of people with TS. Interview transcripts were analysed using thematic analysis and responses to survey open-ended questions were analysed using content analysis. Triangulation of qualitative and quantitative data from the parents' survey and qualitative data from the interviews with young people was used to increase the validity and depth of the findings. RESULTS A strong theme was the perception that health professionals have limited knowledge of TS and its treatment. Medication was a common treatment for tics and both young people and parents described benefits of medication. However, adverse effects were frequently described and these were a common reason for stopping medication among young people. Aripiprazole was viewed most positively. Access to behavioural interventions for tics was limited and 76% of parents wanted this treatment to be available for their child. Some young people had reservations about the effectiveness or practicality of behavioural interventions. Reduction and abolition of tics were desired outcomes of treatment, but both parents and young people also identified the importance of increasing control over tics and reducing anxiety-related symptoms. For young people, managing the urge to tic was an important outcome of treatment. CONCLUSIONS The results suggest a need for more training in the identification and management of TS and wider availability of behavioural treatments. Clinical trials could explore the effectiveness of Aripiprazole used in combination with psycho-educational interventions to reduce anxiety and promote a sense of control.
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Affiliation(s)
- José Cuenca
- Division of Psychiatry and Applied Psychology, School of Medicine, Institute of Mental Health, University of Nottingham, Jubilee Campus, Nottingham, UK.
| | - Cris Glazebrook
- Division of Psychiatry and Applied Psychology, School of Medicine, Institute of Mental Health, University of Nottingham, Jubilee Campus, Nottingham, UK.
| | - Tim Kendall
- National Collaborating Centre for Mental Health, Royal College of Psychiatrists, London, UK.
| | - Tammy Hedderly
- Department of Paediatric Neurology, King's 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 Jackson
- Division of Psychiatry and Applied Psychology, School of Medicine, Institute of Mental Health, University of Nottingham, Jubilee Campus, Nottingham, UK.
| | - Tara Murphy
- Department of Clinical Neuropsychology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.
| | - Hugh Rickards
- Department of Neuropsychiatry, University of Birmingham and Barberry National Centre for Mental Health, Birmingham, UK.
| | - Mary Robertson
- Department of Neurology, St George's Hospital and Medical School, London, UK.
| | - Jeremy Stern
- Department of Neurology, St George's Hospital and Medical School, London, UK.
| | - Penny Trayner
- Division of Clinical Psychology, University of Manchester, Manchester, UK.
| | - Chris Hollis
- Division of Psychiatry and Applied Psychology, School of Medicine, Institute of Mental Health, University of Nottingham, Jubilee Campus, Nottingham, UK.
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Smith H, Fox JRE, Trayner P. The lived experiences of individuals with Tourette syndrome or tic disorders: a meta-synthesis of qualitative studies. Br J Psychol 2015; 106:609-34. [PMID: 25721405 DOI: 10.1111/bjop.12118] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Revised: 11/09/2014] [Indexed: 11/29/2022]
Abstract
There is a growing body of qualitative literature describing the lived experiences of people with tic disorders (TDs). The aim of this paper was to conduct a systematic review of this literature, synthesizing the perspectives of individuals on their experiences. Meta-synthesis methodology was utilized to review and draw together findings from 10 articles, from which key concepts were extracted, and over-arching themes generated. Six themes were identified to encompass the experience of TDs, including (1) cultural, semantic issues of the condition; (2) negative experiences in organizations and treatment; (3) the value and negative impact on interpersonal relationships; (4) personal identity in the constant presence of TDs; (5) concerns for the future; and (6) strategies to control and manage the observable presence of tics. Adaptive coping strategies were found to encompass continuous social adaptation, strategies to manage tics and social perceptions, self-acceptance, advocacy, and support from others. The results highlighted the significant role of social and cultural issues related to understanding and stigma, which underpinned many of the lived experiences. Implications for clinical practice in supporting individuals with TDs were also highlighted.
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Affiliation(s)
- Heather Smith
- School of Psychological Sciences, Section for Clinical and Health Psychology, University of Manchester, UK
| | - John R E Fox
- School of Psychological Sciences, Section for Clinical and Health Psychology, University of Manchester, UK
| | - Penny Trayner
- School of Psychological Sciences, Section for Clinical and Health Psychology, University of Manchester, UK
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Abstract
PURPOSE OF REVIEW This update summarizes progress in understanding Tourette syndrome clinical characteristics, etiology, and treatment over the past year. RECENT FINDINGS Premonitory sensory phenomena were found to have important impacts on Tourette syndrome quality of life. A rare genetic form of Tourette syndrome due to L-histidine-decarboxylase mutation, with similar features in human and rodent, has inspired new research on functional anatomy of Tourette syndrome. In response to new data, treatment guidelines have been revised to include behavioral therapy as first-line treatment. Novel dopamine receptor antagonists aripiprazole and ecopipam have shown potential efficacy - as well as tolerability concerns. Recent work has suggested efficacy and tolerability of topiramate and fluphenazine, but more rigorous studies are needed to further understand their role in Tourette syndrome management. Recent consensus guidelines explain when deep brain stimulation can be considered for severe refractory cases under a multidisciplinary team. SUMMARY More research is needed to identify better tolerated treatments for, to understand pathophysiology or functional anatomy of, and to predict or influence longitudinal outcome of Tourette syndrome.
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Bachmann CJ, Roessner V, Glaeske G, Hoffmann F. Trends in psychopharmacologic treatment of tic disorders in children and adolescents in Germany. Eur Child Adolesc Psychiatry 2015; 24:199-207. [PMID: 24888751 DOI: 10.1007/s00787-014-0563-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Accepted: 05/15/2014] [Indexed: 10/25/2022]
Abstract
Data on medical treatment of children and adolescents with tic disorders are scarce. This study examined the administrative prevalence of psychopharmacological prescriptions in this patient group in Germany. Data of the largest German health insurance fund were analysed. In outpatients aged 0-19 years with diagnosed tic disorder, psychotropic prescriptions were evaluated for the years 2006 and 2011. In 2011, the percentage of psychotropic prescriptions was slightly higher than in 2006 (21.2 vs. 18.6%). The highest prescription prevalence was found in Tourette syndrome (51.5 and 53.0%, respectively). ADHD drugs were most frequently prescribed, followed by antipsychotics. In 2011, prescriptions of second generation antipsychotics (SGA) were higher and prescriptions of first generation antipsychotics (FGA) lower than in 2006. Concerning prescribed antipsychotic substances, in 2011 risperidone prescriptions were higher and tiapride prescriptions lower. Paediatricians issued 37.4%, and child and adolescent psychiatrists issued 37.1% of psychotropic prescriptions. The FGA/SGA ratio was highest in GPs (1.25) and lowest in child and adolescent psychiatrists (0.96). From 2006 to 2011, there was only a slight increase in psychotropic prescriptions for children and adolescents with a diagnosis of tic disorder in Germany, which stands in contrast towards the significant increase in psychotropic prescriptions in other child and adolescent psychiatric disorders (e.g. ADHD). There were marked differences in treatment patterns by tic disorder subgroups, with Tourette syndrome patients receiving most frequently psychopharmacotherapy. Risperidone prescriptions increased, probably reflecting a switch in prescribing practice towards up-to-date treatment guidelines. In primary care physicians, dissemination of current tic disorder treatment guidelines might constitute an important educational goal.
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Affiliation(s)
- Christian J Bachmann
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Philipps-University Marburg, Schützenstr. 49, 35039, Marburg, Germany,
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McGuire JF, Piacentini J, Brennan EA, Lewin AB, Murphy TK, Small BJ, Storch EA. A meta-analysis of behavior therapy for Tourette Syndrome. J Psychiatr Res 2014; 50:106-12. [PMID: 24398255 DOI: 10.1016/j.jpsychires.2013.12.009] [Citation(s) in RCA: 146] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Revised: 11/30/2013] [Accepted: 12/18/2013] [Indexed: 10/25/2022]
Abstract
Individual randomized controlled trials (RCTs) of habit reversal training and a Comprehensive Behavioral Intervention for Tics (collectively referred to as behavior therapy, BT) have demonstrated efficacy in reducing tic severity for individuals with Tourette Syndrome and Chronic Tic Disorders (collectively referred to as TS), with no examination of treatment moderators. The present meta-analysis synthesized the treatment effect sizes (ES) of BT relative to comparison conditions, and examined moderators of treatment. A comprehensive literature search identified eight RCTs that met inclusion criteria, and produced a total sample of 438 participants. A random effects meta-analysis found a medium to large ES for BT relative to comparison conditions. Participant mean age, average number of therapy sessions, and the percentage of participants with co-occurring attention deficit hyperactivity disorder (ADHD) were found to moderate treatment effects. Participants receiving BT were more likely to exhibit a treatment response compared to control interventions, and identified a number needed to treat (NNT) of three. Sensitivity analyses failed to identify publication bias. Overall, BT trials yield medium to large effects for TS that are comparable to treatment effects identified by meta-analyses of antipsychotic medication RCTs. Larger treatment effects may be observed among BT trials with older participants, more therapeutic contact, and less co-occurring ADHD.
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Affiliation(s)
- Joseph F McGuire
- Department of Psychology, University of South Florida, 4202 E. Fowler Avenue, PCD 4118G, Tampa, FL 33620, USA; Department of Pediatrics, University of South Florida Tampa, FL, USA.
| | - John Piacentini
- Semel Institute of Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, CA, USA
| | - Erin A Brennan
- Department of Pediatrics, University of South Florida Tampa, FL, USA
| | - Adam B Lewin
- Department of Psychology, University of South Florida, 4202 E. Fowler Avenue, PCD 4118G, Tampa, FL 33620, USA; Department of Pediatrics, University of South Florida Tampa, FL, USA; Departments of Psychiatry and Behavioral Neurosciences, University of South Florida Tampa, FL, USA
| | - Tanya K Murphy
- Department of Pediatrics, University of South Florida Tampa, FL, USA; Departments of Psychiatry and Behavioral Neurosciences, University of South Florida Tampa, FL, USA
| | - Brent J Small
- School of Aging Studies, University of South Florida Tampa, FL, USA
| | - Eric A Storch
- Department of Psychology, University of South Florida, 4202 E. Fowler Avenue, PCD 4118G, Tampa, FL 33620, USA; Department of Pediatrics, University of South Florida Tampa, FL, USA; Departments of Psychiatry and Behavioral Neurosciences, University of South Florida Tampa, FL, USA
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Buse J, Kirschbaum C, Leckman JF, Münchau A, Roessner V. The Modulating Role of Stress in the Onset and Course of Tourette’s Syndrome. Behav Modif 2014; 38:184-216. [DOI: 10.1177/0145445514522056] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Accumulating data indicate a common occurrence of tic exacerbations and periods of psychosocial stress. Patients with Tourette’s syndrome (TS) also exhibit aberrant markers of hypothalamic-pituitary-adrenal (HPA) axis activation. Based on these findings, a functional relationship between stress and tic disorders has been suggested, but the underlying mechanism of how stress may affect tic pathology remains to be elucidated. We suggest that dopaminergic and noradrenergic neurotransmission as well as immunology play a crucial role in mediating this relationship. Two possibilities of causal direction might be assumed: (a) psychosocial stress might lead to an exacerbation of tics via activation of HPA axis and subsequent changes in neurotransmission or immunology and (b) TS-related abnormalities in neurotransmission or immunology result in a higher vulnerability of affected patients to respond to psychosocial stress with a strong activation of the HPA axis. It may also be the case that both assumptions hold true and interact with each other.
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Affiliation(s)
- Judith Buse
- Department of Child and Adolescent Psychiatry, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Germany
| | - Clemens Kirschbaum
- Institute of Biopsychology, Department of Psychology, Technische Universität Dresden
| | - James F. Leckman
- Child Study Center and Departments of Paediatrics, Psychiatry, and Psychology, Yale University School of Medicine, New Haven, CT, USA
| | - Alexander Münchau
- Department of Pediatric and Adult Movement Disorders and Neuropsychiatry, Institute of Neurogenetics, University of Lübeck, Germany
| | - Veit Roessner
- Department of Child and Adolescent Psychiatry, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Germany
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