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Parvizi-Wayne D, Severs L. When the interoceptive and conceptual clash: The case of oppositional phenomenal self-modelling in Tourette syndrome. COGNITIVE, AFFECTIVE & BEHAVIORAL NEUROSCIENCE 2024; 24:660-680. [PMID: 38777988 PMCID: PMC11233343 DOI: 10.3758/s13415-024-01189-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/15/2024] [Indexed: 05/25/2024]
Abstract
Tourette syndrome (TS) has been associated with a rich set of symptoms that are said to be uncomfortable, unwilled, and effortful to manage. Furthermore, tics, the canonical characteristic of TS, are multifaceted, and their onset and maintenance is complex. A formal account that integrates these features of TS symptomatology within a plausible theoretical framework is currently absent from the field. In this paper, we assess the explanatory power of hierarchical generative modelling in accounting for TS symptomatology from the perspective of active inference. We propose a fourfold analysis of sensory, motor, and cognitive phenomena associated with TS. In Section 1, we characterise tics as a form of action aimed at sensory attenuation. In Section 2, we introduce the notion of epistemic ticcing and describe such behaviour as the search for evidence that there is an agent (i.e., self) at the heart of the generative hierarchy. In Section 3, we characterise both epistemic (sensation-free) and nonepistemic (sensational) tics as habitual behaviour. Finally, in Section 4, we propose that ticcing behaviour involves an inevitable conflict between distinguishable aspects of selfhood; namely, between the minimal phenomenal sense of self-which is putatively underwritten by interoceptive inference-and the explicit preferences that constitute the individual's conceptual sense of self. In sum, we aim to provide an empirically informed analysis of TS symptomatology under active inference, revealing a continuity between covert and overt features of the condition.
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Affiliation(s)
- D Parvizi-Wayne
- Department of Psychology, Royal Holloway University of London, London, UK.
| | - L Severs
- Centre for the Philosophy of Science, Faculty of Sciences, University of Lisbon, Lisbon, Portugal
- Ruhr-Universität Bochum, Institute of Philosophy II, Bochum, Germany
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2
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Shiu C, Chen W, Kim B, Ricketts E, Stiede JT, Espil FM, Specht MW, Woods DW, Piacentini J. The Roles of Lifetime Enacted Stigma in Tic Symptoms among Young Adults with Tourette Syndrome. Mov Disord Clin Pract 2023; 10:1759-1768. [PMID: 38094654 PMCID: PMC10715356 DOI: 10.1002/mdc3.13900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 08/24/2023] [Accepted: 10/04/2023] [Indexed: 02/01/2024] Open
Abstract
Background Although rarely framed as enacted stigma, adults with Tourette syndrome (ATS) have long suffered from discrimination associated with their tic symptoms. Given the high stress levels of enacted stigma that ATS experience, it is expected that their tic symptoms are profoundly impacted. However, the evidence linking enacted stigma to ATS's tic symptoms remains limited. Methods This study used a secondary data-analysis approach to reanalyze the data from the follow-up phase of a multi-centered, randomized controlled trial in which a behavioral intervention was tested for its efficacy in managing tic symptoms. This study first conducted psychometric testing on a list of 16 enacted stigma events across five life stages and identified the underlying factor structure. The Yale Global Tic Severity Scale (YGTSS) was used to assess severity and impairment of current tic symptoms, whereas the Clinical Global Impression of Severity scale (CGI) was used to obtain the gestalt of clinical judgment on tic severity. A series of multivariate linear models were then fitted to test the relationships between different types of lifetime enacted stigma and current tic symptoms. Results The analytic sample included 73 young ATS (average age of 23.2 [standard deviation = 2.5] years). The factor analysis identified three types of enacted stigmas: "traumatic events," "confrontations," and "subtle mistreatments." In multivariate models, traumatic events significantly associated with YGTSS-severity, whereas subtle mistreatments provided additional explanations for CGI. Conclusions Enacted stigma may play important roles in shaping ATS's current tics symptom severity and, therefore, should be carefully considered in future intervention development.
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Affiliation(s)
- Chengshi Shiu
- Department of Social Work and Taiwan Social Resilient Research CenterNational Taiwan UniversityTaipeiTaiwan
- School of NursingUniversity of CaliforniaLos AngelesCaliforniaUSA
| | - Wei‐Ti Chen
- School of NursingUniversity of CaliforniaLos AngelesCaliforniaUSA
| | - Boram Kim
- School of NursingUniversity of CaliforniaLos AngelesCaliforniaUSA
| | - Emily Ricketts
- Department of PsychologyMarquette UniversityMilwaukeeWisconsinUSA
| | - Jordan T. Stiede
- Department of Psychiatry and Behavioral SciencesBaylor College of MedicineHoustonTexasUSA
- Department of Psychiatry and Biobehavioral SciencesUniversity of CaliforniaLos AngelesCaliforniaUSA
| | - Flint M. Espil
- Department of Psychiatry and Behavioral SciencesStanford UniversityStanfordCaliforniaUSA
| | | | - Douglas W. Woods
- Department of Psychiatry and Behavioral SciencesBaylor College of MedicineHoustonTexasUSA
| | - John Piacentini
- Department of PsychologyMarquette UniversityMilwaukeeWisconsinUSA
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van de Griendt JMTM, van den Berg NME, Verdellen CWJ, Cath DC, Verbraak MJPM. Working Mechanisms of Exposure and Response Prevention in the Treatment of Tourette Syndrome and Tic Disorders Revisited: No Evidence for within-Session Habituation to Premonitory Urges. J Clin Med 2023; 12:7087. [PMID: 38002700 PMCID: PMC10672020 DOI: 10.3390/jcm12227087] [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: 09/30/2023] [Revised: 10/29/2023] [Accepted: 11/07/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Exposure and response prevention (ERP) has been shown to be an effective treatment for Tourette syndrome (TS) and chronic tic disorders (CTD). ERP is based on voluntary tic suppression in combination with prolonged exposure to premonitory urges preceding tics. A prevailing hypothesis of the working mechanism underlying ERP in tics is habituation to the premonitory urges as a result of prolonged exposure. However, results so far are equivocal. This study aims to further explore the relation between urges and ERP in tics, by investigating the course of premonitory urges during ERP sessions. METHODS Using a data-driven approach, within-session habituation to premonitory urge intensity was investigated. In total, 29 TS patients rated urge intensity at seven timepoints during ten 1 h ERP sessions. RESULTS/CONCLUSIONS Latent growth modeling showed an increase in urge intensity during the first 15 min of each session followed by a plateau in the remaining 45 min of the session. This does not support the idea of within-session habituation to premonitory urges as a working mechanism of ERP. Other potential underlying working mechanisms are discussed and should be tested in future research.
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Affiliation(s)
| | - Nelleke M. E. van den Berg
- Department of Psychology, Erasmus University Rotterdam, ‘s Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands;
| | - Cara W. J. Verdellen
- PsyQ Nijmegen, Parnassia Group, Sint Annastraat 263, 6525 GR Nijmegen, The Netherlands;
| | - Daniëlle C. Cath
- Department of Psychiatry, University Medical Center Groningen, Rijksuniversiteit Groningen, 9700 AD Groningen, The Netherlands;
- GGZ Drenthe, Dennenweg 9, 9404 LA Assen, The Netherlands
| | - Marc J. P. M. Verbraak
- Behavioural Science Institute, Radboud University Nijmegen, Thomas van Aquinostraat 4, 6525 GD Nijmegen, The Netherlands;
- Pro Persona, Wolfheze 2, 6874 BE Wolfheze, The Netherlands
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Gill JS. Cariprazine in an Adolescent with Tourette Syndrome with Comorbid Attention Deficit Hyperactive Disorder and Depression: A Case Report. Healthcare (Basel) 2023; 11:2531. [PMID: 37761728 PMCID: PMC10530423 DOI: 10.3390/healthcare11182531] [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: 08/10/2023] [Revised: 09/06/2023] [Accepted: 09/12/2023] [Indexed: 09/29/2023] Open
Abstract
Tourette syndrome is a complex neuropsychiatric condition that manifests in childhood and is often associated with other psychiatric comorbidities. This case report describes a young male with Tourette syndrome with major depressive disorder and attention deficit hyperactivity disorder (ADHD) who experienced troublesome side effects due to his existing medications (escitalopram, risperidone, and methylphenidate). In order to control his tics, ameliorate depressive symptoms, and eliminate side effects of stiffness and sedation, risperidone was switched to cariprazine, a third-generation antipsychotic medication with D3-D2 partial agonism. In addition, the antidepressant dose was also increased. With the new combination, the patient reported good control of his tics, together with significant improvement in depressive symptoms and no side effects. Based on this case and the reviewed literature, cariprazine might be a viable option for patients with Tourette syndrome with other comorbid illnesses who are prone to side effects of medication.
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Affiliation(s)
- Jesjeet Singh Gill
- Department of Psychological Medicine, University Malaya, Kuala Lumpur 50603, Malaysia
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Nilles C, Hartmann A, Roze E, Martino D, Pringsheim T. Tourette syndrome and other tic disorders of childhood. HANDBOOK OF CLINICAL NEUROLOGY 2023; 196:457-474. [PMID: 37620085 DOI: 10.1016/b978-0-323-98817-9.00002-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Abstract
Tics are repetitive, patterned, and nonrhythmic movements or vocalizations/audible sounds that are misplaced in context. Phenomenology and characteristics of tics (e.g., premonitory urge, suppressibility) differentiate them from compulsions, stereotypies, functional tic-like behaviors, and other types of hyperkinetic movement disorders. With a prevalence of approximately 1% in school-aged boys, Tourette syndrome (TS) is considered a common childhood-onset neurodevelopmental disorder, defined by the combination of at least two motor tics and at least one phonic tic lasting more than 1 year. TS is a highly heritable disorder, with a wide spectrum of severity. In some individuals, tics can cause pain, distress, functional impairment, or stigmatization. About 90% of individuals with TS have at least one mental health comorbidity (attention-deficit/hyperactivity disorder, obsessive-compulsive disorder, anxiety/depressive disorders). These comorbidities significantly impact patients' quality of life and must therefore be screened and managed accordingly in this population. Treatment of tics is based on behavioral therapies targeting tics (habit reversal training included in the comprehensive behavioral intervention for tics, and exposure and response prevention for tics), in association with medication if needed (e.g., alpha-2-agonists, second-generation antipsychotics). Deep brain stimulation is considered an experimental option in the most severe, treatment-resistant patients. In adulthood, less than 25% of individuals still have moderate or severe tics.
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Affiliation(s)
- Christelle Nilles
- Department of Clinical Neurosciences, Psychiatry, Pediatrics and Community Health Sciences, University of Calgary, Calgary, AB, Canada; Department of Neurology, Pitié-Salpêtrière Hospital, Paris, France
| | - Andreas Hartmann
- Department of Neurology, Pitié-Salpêtrière Hospital, Paris, France; National Reference Center for Tourette Disorder, Pitié-Salpêtrière Hospital, Paris, France
| | - Emmanuel Roze
- Department of Neurology, Pitié-Salpêtrière Hospital, Paris, France; Faculty of Medicine of Sorbonne University, Institut du Cerveau et de la Moelle épinière, Paris, France
| | - Davide Martino
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Tamara Pringsheim
- Department of Clinical Neurosciences, Psychiatry, Pediatrics and Community Health Sciences, University of Calgary, Calgary, AB, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.
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Husain W, Wasif S, Fatima I. Profanity as a Self-Defense Mechanism and an Outlet for Emotional Catharsis in Stress, Anxiety, and Depression. DEPRESSION RESEARCH AND TREATMENT 2023; 2023:8821517. [PMID: 37181488 PMCID: PMC10171984 DOI: 10.1155/2023/8821517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 04/14/2023] [Accepted: 04/18/2023] [Indexed: 05/16/2023]
Abstract
Background Swearing is an increasing trend among men and women worldwide. Earlier studies on the positive aspects of profanity mostly relate to pain management and the release of negative emotions. The uniqueness of the current study is its analysis for a possible constructive role of profanity in stress, anxiety, and depression. Method The current survey involved 253 conveniently selected participants from Pakistan. The study analyzed the role of profanity in connection to stress, anxiety, and depression. Profanity Scale and the Urdu version of Depression, Anxiety, and Stress Scale were used along with a structured interview schedule. Descriptive statistics, Pearson's correlation coefficient, and t-test were implied to obtain results. Results The study revealed that the usage of profane language had significantly inverse correlations with stress (r = -0.250; p < 0.01), anxiety (r = -0.161; p < 0.05), and depression (r = -0.182; p < 0.01). Higher profaners also revealed significantly lower levels of depression (M = 29.91, SD = 10.80 vs. M = 33.48, SD = 10.40; p = 0.009; Cohen's d = 0.338) and stress (M = 30.83, SD = 11.41 vs. M = 35.16, SD = 11.31; p = 0.003; Cohen's d = 0.381) as compared to lower profaners. Profanity had no significant correlations with age (r = 0.031; p > 0.05) and education (r = 0.016; p > 0.05). Men projected significantly higher levels of profanity as compared to women. Conclusion The current study viewed profanity similar to the self-defense mechanisms and emphasized on its cathartic role in stress, anxiety, and depression.
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Affiliation(s)
- Waqar Husain
- Department of Humanities, COMSATS University, Park Road, Islamabad, Pakistan
| | - Samia Wasif
- Department of Humanities, COMSATS University, Park Road, Islamabad, Pakistan
| | - Insha Fatima
- Department of Humanities, COMSATS University, Park Road, Islamabad, Pakistan
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Li Y, Yan JJ, Cui YH. Clinical characteristics of pediatric patients with treatment-refractory Tourette syndrome: An evidence-based survey in a Chinese population. World J Psychiatry 2022; 12:958-969. [PMID: 36051602 PMCID: PMC9331451 DOI: 10.5498/wjp.v12.i7.958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 04/06/2022] [Accepted: 06/27/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Tourette syndrome (TS) is a complex neurodevelopmental condition marked by tics, as well as a variety of psychiatric comorbidities, such as obsessive-compulsive disorders (OCDs), attention deficit hyperactivity disorder (ADHD), anxiety, and self-injurious behavior. TS might progress to treatment-refractory Tourette syndrome (TRTS) in some patients. However, there is no confirmed evidence in pediatric patients with TRTS.
AIM To investigate the clinical characteristics of TRTS in a Chinese pediatric sample.
METHODS A total of 126 pediatric patients aged 6-12 years with TS were identified, including 64 TRTS and 62 non-TRTS patients. The Yale Global Tic Severity Scale (YGTSS), Premonitory Urge for Tics Scale (PUTS), and Child Behavior Checklist (CBCL) were used to assess these two groups and compared the difference between the TRTS and non-TRTS patients.
RESULTS When compared with the non-TRTS group, we found that the age of onset for TRTS was younger (P < 0.001), and the duration of illness was longer (P < 0.001). TRTS was more often caused by psychosocial (P < 0.001) than physiological factors, and coprolalia and inappropriate parenting style were more often present in the TRTS group (P < 0.001). The TRTS group showed a higher level of premonitory urge (P < 0.001), a lower intelligence quotient (IQ) (P < 0.001), and a higher percentage of family history of TS. The TRTS patients demonstrated more problems (P < 0.01) in the “Uncommunicative”, “Obsessive-Compulsive”, “Social-Withdrawal”, “Hyperactive”, “Aggressive”, and “Delinquent” subscales in the boys group, and “Social-Withdrawal” (P = 0.02) subscale in the girls group.
CONCLUSION Pediatric TRTS might show an earlier age of onset age, longer duration of illness, lower IQ, higher premonitory urge, and higher comorbidities with ADHD-related symptoms and OCD-related symptoms. We need to pay more attention to the social communication deficits of TRTS.
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Affiliation(s)
- Ying Li
- Department of Psychiatry, Beijing Children's Hospital, Beijing 100045, China
| | - Jun-Juan Yan
- Department of Psychiatry, Beijing Children's Hospital, Beijing 100045, China
| | - Yong-Hua Cui
- Department of Psychiatry, Beijing Children's Hospital, Beijing 100045, China
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Fan F, Han F, Hao L. Mechanisms of Action of Semen Ziziphi spinosae in the Treatment of Tourette Syndrome. Degener Neurol Neuromuscul Dis 2022; 12:85-96. [PMID: 35875687 PMCID: PMC9297330 DOI: 10.2147/dnnd.s370278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 07/09/2022] [Indexed: 11/23/2022] Open
Abstract
Background Semen Ziziphi spinosae, known as Suanzaoren (SZR) in Chinese, is a Chinese herbal medicine widely used in sedatives and tranquilizers. Although SZR is important for the clinical treatment of Tourette syndrome (TS), its mechanism of action remains unclear. Therefore, we investigated the pharmacological mechanisms of SZR in TS treatment using network pharmacology and systems biology approaches. Methods The bioactive components and potential targets of SZR were screened using the TCMSP database. UniProt was used to identify targets by mapping the known genes related to SZR. The known genes related to TS were identified by GeneCards and OMIM databases. A protein-protein interaction network was constructed using information from STRING 11.0 database. Cytoscape 3.8.0 software and Bioinformatics online platform were used for plotting this network. Gene ontology and KEGG enrichment analyses were performed using Metascape. Finally, AutoDock was used to verify the molecular docking. Results We found that SZR had 10 active compounds. There were 30 overlapping target genes between TS and SZR. These genes were associated with several signaling and metabolic pathways. AChE, SLC6A4, and HTR3A were the top three hub genes. The active components in SZR had a high binding affinity for the key targets. Conclusion SZR therapy for TS could achieve network regulation through the action of various active components of Chinese medicine on different targets and generate a complex regulatory relationship via interaction with potential targets, thereby playing a therapeutic role. Thus, SZR is a potential candidate for treating TS because it regulates nervous system functions.
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Affiliation(s)
- Fei Fan
- Department of Pediatrics, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, People’s Republic of China
| | - Fei Han
- Department of Pediatrics, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, People’s Republic of China
| | - Long Hao
- Department of Paediatrics, Beijing Fangshan District Liangxiang Hospital, Beijing, People’s Republic of China
- Correspondence: Long Hao, Department of Paediatrics, Beijing Fangshan District Liangxiang Hospital, No. 45 Gongchen Street, Fangshan District, Beijing, People’s Republic of China, Tel +86 10-813560000, Email
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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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Bamigbade SE, Rogers SL, Wills W, Ludlow AK. Mothers' accounts of mealtime and feeding challenges for children with Tourette syndrome or persistent tic disorders. Front Psychiatry 2022; 13:936796. [PMID: 35978849 PMCID: PMC9377638 DOI: 10.3389/fpsyt.2022.936796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 07/05/2022] [Indexed: 12/02/2022] Open
Abstract
Parenting a young person with a tic disorder can present daily challenges to families struggling to manage their child's tics and establish routines. Research recognises that tics can be problematic to everyday activities, however no attention has been given to mealtimes, arguably an important family activity closely related to quality of life of the family. The current qualitative study aimed to investigate the mealtime experiences of families with a child with a tic disorder from the perspective of mothers, looking at mealtime challenges, their impact and how these challenges are navigated. Seventeen mothers with children diagnosed with Tourette Syndrome (TS) or a Persistent Tic Disorder (PTD) (aged 3-14) took part in semi-structured interviews. Interpretative phenomenological analysis of 17 semi-structured interviews resulted in seven subthemes which were grouped under two superordinate themes: (1) tics as a barrier to positive mealtime experiences and (2) eating behaviours and other mealtime challenges. The findings highlight tics to create functional mealtime challenges, affecting a young person's ability to eat, drink and be seated, with mothers noting the family dynamic was often intensified and compounded by additional challenges related to their child's tics and comorbidities. Tics also have the power to disrupt the conviviality of mealtimes. For example, eating out-of-home can be especially challenging, with restaurants being high-pressure environments for young people with tics and their families. The cumulative effect of dissatisfaction, stress and additional foodwork can have a diminishing effect on maternal and familial resilience and wellbeing. Mealtime-related interventions need to be considered to help increase confidence and skills in managing mealtimes.
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Affiliation(s)
- Sandra-Eve Bamigbade
- Centre for Research in Public Health and Community Care, University of Hertfordshire, Hatfield, United Kingdom.,NIHR Applied Research Collaboration, Cambridge, United Kingdom
| | - Samantha L Rogers
- Centre for Research in Public Health and Community Care, University of Hertfordshire, Hatfield, United Kingdom
| | - Wendy Wills
- Centre for Research in Public Health and Community Care, University of Hertfordshire, Hatfield, United Kingdom.,NIHR Applied Research Collaboration, Cambridge, United Kingdom
| | - Amanda K Ludlow
- Department of Psychology and Sports Sciences, University of Hertfordshire, Hatfield, United Kingdom
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Cui Y, Chu J, Li Y, Li Y. The Behavioral and Emotional Profile of Pediatric Tourette Syndrome Based on CBCL in a Chinese Sample. Front Psychiatry 2022; 13:784753. [PMID: 35280165 PMCID: PMC8907575 DOI: 10.3389/fpsyt.2022.784753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 01/31/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Tourette syndrome (TS) is a childhood-onset neuropsychiatric disorder that has a unique status of a quintessentially neuropsychiatric condition at the interface of neurology (movement disorder) and psychiatry (behavioral/emotional condition). However, the behavioral and emotional profile has seemed to be neglected in the literature thus far. This study aimed to investigate the behavioral and emotional profile of TS. METHODS A total of 124 patients aged 6-16 years with TS were included in this study, including age- and sex-matched health control, attention-deficit/hyperactivity disorder (ADHD), obsessive-compulsive disorder (OCD), and major depressive disorder (MDD) groups. The Child Behavior Checklist (CBCL) was used to screen the behavioral and emotional profile of the TS and other compared groups. The Yale Global Tic Severity Scale (YGTSS) was used to assess TS tic severity. Analysis of variance (ANOVA) was used to investigate the difference between the TS and other compared groups. RESULTS The results showed that the eight factors of the CBCL had no association with motor tics, vocal tics, or tic severity (p > 0.05). However, positive correlations were identified between functional impairments (subscales of YGTSS) and thought problems (TP) and rule-breaking behavior (RBB). Based on the eight-factor profile of the CBCL, TS showed a similar profile to MDD but different from ADHD and OCD, which showed similar profiles. CONCLUSIONS Based on the assessment of the CBCL of TS, it was found that "pure" TS might show fewer behavioral and emotional problems than OCD, ADHD, and MDD. Similar behavioral and emotional profiles were identified between TS and MDD, but not OCD and ADHD. More attention needs to be paid to the thought problems and rule break problems in the CBCL in the screening stage, which might have a potential influence on the functional impairments of TS.
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Affiliation(s)
- Yonghua Cui
- Department of Psychiatry, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Jiahui Chu
- Department of Psychiatry, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Yanlin Li
- Department of Psychiatry, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Ying Li
- Department of Psychiatry, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
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12
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Paulus T, Schappert R, Bluschke A, Alvarez-Fischer D, Naumann KER, Roessner V, Bäumer T, Beste C, Münchau A. Questioning the definition of Tourette syndrome-evidence from machine learning. Brain Commun 2021; 3:fcab282. [PMID: 34993475 PMCID: PMC8728701 DOI: 10.1093/braincomms/fcab282] [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] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 09/24/2021] [Accepted: 10/04/2021] [Indexed: 11/13/2022] Open
Abstract
Tics in Tourette syndrome are often difficult to discern from single spontaneous movements or vocalizations in healthy people. In this study, videos of patients with Tourette syndrome and healthy controls were taken and independently scored according to the Modified Rush Videotape Rating Scale. We included n = 101 patients with Tourette syndrome (71 males, 30 females, mean age 17.36 years ± 10.46 standard deviation) and n = 109 healthy controls (57 males, 52 females, mean age 17.62 years ± 8.78 standard deviation) in a machine learning-based analysis. The results showed that the severity of motor tics, but not vocal phenomena, is the best predictor to separate and classify patients with Tourette syndrome and healthy controls. This finding questions the validity of current diagnostic criteria for Tourette syndrome requiring the presence of both motor and vocal tics. In addition, the negligible importance of vocalizations has implications for medical practice, because current recommendations for Tourette syndrome probably also apply to the large group with chronic motor tic disorders.
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Affiliation(s)
- Theresa Paulus
- Institute of Systems Motor Science, University of Lübeck, 23562 Lübeck, Germany
- Department of Neurology, University of Lübeck, 23538 Lübeck, Germany
| | - Ronja Schappert
- Institute of Systems Motor Science, University of Lübeck, 23562 Lübeck, Germany
| | - Annet Bluschke
- Cognitive Neurophysiology, Department of Child and Adolescent Psychiatry, Faculty of Medicine, TU Dresden, 01069 Dresden, Germany
- Faculty of Medicine, University Neuropsychology Centre, TU Dresden, 01069 Dresden, Germany
| | | | - Kim Ezra Robin Naumann
- Cognitive Neurophysiology, Department of Child and Adolescent Psychiatry, Faculty of Medicine, TU Dresden, 01069 Dresden, Germany
- Faculty of Medicine, University Neuropsychology Centre, TU Dresden, 01069 Dresden, Germany
| | - Veit Roessner
- Cognitive Neurophysiology, Department of Child and Adolescent Psychiatry, Faculty of Medicine, TU Dresden, 01069 Dresden, Germany
| | - Tobias Bäumer
- Institute of Systems Motor Science, University of Lübeck, 23562 Lübeck, Germany
| | - Christian Beste
- Cognitive Neurophysiology, Department of Child and Adolescent Psychiatry, Faculty of Medicine, TU Dresden, 01069 Dresden, Germany
- Faculty of Medicine, University Neuropsychology Centre, TU Dresden, 01069 Dresden, Germany
- Cognitive Psychology, Faculty of Psychology, Shandong Normal University, Qianfoshan Campus, No. 88 East Wenhua Road, Lixia District, Jinan, 250014, China
| | - Alexander Münchau
- Institute of Systems Motor Science, University of Lübeck, 23562 Lübeck, Germany
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13
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Levy AM, Paschou P, Tümer Z. Candidate Genes and Pathways Associated with Gilles de la Tourette Syndrome-Where Are We? Genes (Basel) 2021; 12:1321. [PMID: 34573303 PMCID: PMC8468358 DOI: 10.3390/genes12091321] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 08/05/2021] [Accepted: 08/25/2021] [Indexed: 12/21/2022] Open
Abstract
Gilles de la Tourette syndrome (GTS) is a childhood-onset neurodevelopmental and -psychiatric tic-disorder of complex etiology which is often comorbid with obsessive-compulsive disorder (OCD) and/or attention deficit hyperactivity disorder (ADHD). Twin and family studies of GTS individuals have shown a high level of heritability suggesting, that genetic risk factors play an important role in disease etiology. However, the identification of major GTS susceptibility genes has been challenging, presumably due to the complex interplay between several genetic factors and environmental influences, low penetrance of each individual factor, genetic diversity in populations, and the presence of comorbid disorders. To understand the genetic components of GTS etiopathology, we conducted an extensive review of the literature, compiling the candidate susceptibility genes identified through various genetic approaches. Even though several strong candidate genes have hitherto been identified, none of these have turned out to be major susceptibility genes yet.
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Affiliation(s)
- Amanda M. Levy
- Kennedy Center, Department of Clinical Genetics, Copenhagen University Hospital, Rigshospitalet, 2600 Glostrup, Denmark;
| | - Peristera Paschou
- Department of Molecular Biology and Genetics, Democritus University of Thrace, 68100 Alexandroupolis, Greece;
- Department of Biological Sciences, Purdue University, West Lafayette, IN 47907, USA
| | - Zeynep Tümer
- Kennedy Center, Department of Clinical Genetics, Copenhagen University Hospital, Rigshospitalet, 2600 Glostrup, Denmark;
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
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14
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Wen F, Gu Y, Yan J, Liu J, Wang F, Yu L, Li Y, Cui Y. Revisiting the structure of the Yale Global Tic Severity Scale (YGTSS) in a sample of Chinese children with tic disorders. BMC Psychiatry 2021; 21:394. [PMID: 34372795 PMCID: PMC8351146 DOI: 10.1186/s12888-021-03399-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 07/28/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND To the best of our knowledge, although the Chinese version of the Yale Global Tic Severity Scale (YGTSS) is widely used in child psychiatry departments in China, there is very little evidence focusing on the psychometric characteristics of the Chinese version of YGTSS. In this present study, we aim to re-examine the structure of the Chinese version of YGTSS and investigate its reliability and validity. METHODS A total of 367 children and adolescents with tic disorders aged 5-16 years old participated in the study. The Cronbach's alpha, test-retest reliability and concurrent validity will be calculated. Confirmatory Factor Analysis (CFA) also will be performed to assess the structure of YGTSS. RESULTS The Cronbach's alpha of the motor tic subscale of YGTSS was 0.84, for the phonic tic subscale of YGTSS, it was 0.90, but for the whole scale, it was 0.58. The test-retest reliability of YGTSS was 0.84. For the results of CFA, the Comparative Fit Index (CFI) of YGTSS based on the Two-Factor Model and Three-Factor Model was 0.97 and 0.96 respectively. The measurement invariance analysis suggested that the Two-Factor model of YGTSS across different age and sex groups was at the accepted level (≥0.90). CONCLUSION Overall, according to the results of this research, it suggested that the Chinese version of YGTSS showed good psychometric properties. It can be used in the assessment of tic disorders in the Chinese population. In the future, more comprehensive tools for assessing tics need to be further developed, which can cover the symptoms of premonitory urge and tic related obsessive-compulsive symptoms.
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Affiliation(s)
- Fang Wen
- grid.411609.bDepartment of Psychiatry, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, 56 Nanlishi Road, Beijing, 100101 China
| | - Yi Gu
- grid.411609.bDepartment of Psychiatry, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, 56 Nanlishi Road, Beijing, 100101 China
| | - Junjuan Yan
- grid.411609.bDepartment of Psychiatry, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, 56 Nanlishi Road, Beijing, 100101 China
| | - Jingran Liu
- grid.411609.bDepartment of Psychiatry, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, 56 Nanlishi Road, Beijing, 100101 China
| | - Fang Wang
- grid.411609.bDepartment of Psychiatry, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, 56 Nanlishi Road, Beijing, 100101 China
| | - Liping Yu
- grid.411609.bDepartment of Psychiatry, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, 56 Nanlishi Road, Beijing, 100101 China
| | - Ying Li
- Department of Psychiatry, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, 56 Nanlishi Road, Beijing, 100101, China.
| | - Yonghua Cui
- Department of Psychiatry, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, 56 Nanlishi Road, Beijing, 100101, China.
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15
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Abstract
Tourette syndrome (TS) causes academic, social, emotional, physical, and functional problems. Most TS patients also have comorbid neuropsychological conditions. The purpose of this review is to provide updated information to the clinician about phenomenology, epidemiology, comorbidities, pathophysiology and management strategies for tics (a hallmark of TS) and TS. Recent findings suggest that TS is likely due to a combination of several different genes and environmental factors, with possible involvement of the cortical-basal ganglia-thalamocortical circuit and related multiple neurotransmitters. First-line management includes psychoeducation for families, patients, and school personnel, as well as behavioral therapy. Non-medicine treatment for tics is advancing to include younger children and increase access via remote service applications. Pharmacotherapy is used if appropriate and several new medicines are under investigation (e.g., Tetrabenazine, valbenazine, deutetrabenazine, ecopipam, cannabinoids). Deep brain stimulation and Mouthguard therapy can be used for children with intractable illness.
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Affiliation(s)
- Kallol K Set
- Pediatric Neurologist, Dayton Children's Hospital, Clinical Assistant Professor, Pediatrics, Boonshoft School of Medicine, Wright State University, One Children's Plaza, Dayton, Ohio, 45404-1815, USA.
| | - Jacqueline N Warner
- Pediatric Psychologist, Clinical Assistant Professor, Pediatrics. Boonshoft School of Medicine, Wright State University, Dayton Children's Hospital, One Children's Plaza, Dayton, Ohio, 45404-1815, USA.
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16
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Haas M, Jakubovski E, Fremer C, Dietrich A, Hoekstra PJ, Jäger B, Müller-Vahl KR. Yale Global Tic Severity Scale (YGTSS): Psychometric Quality of the Gold Standard for Tic Assessment Based on the Large-Scale EMTICS Study. Front Psychiatry 2021; 12:626459. [PMID: 33716826 PMCID: PMC7949908 DOI: 10.3389/fpsyt.2021.626459] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 01/19/2021] [Indexed: 11/26/2022] Open
Abstract
The Yale Global Tic Severity Scale (YGTSS) is a clinician-rated instrument considered as the gold standard for assessing tics in patients with Tourette's Syndrome and other tic disorders. Previous psychometric investigations of the YGTSS exhibit different limitations such as small sample sizes and insufficient methods. To overcome these shortcomings, we used a subsample of the large-scale "European Multicentre Tics in Children Study" (EMTICS) including 706 children and adolescents with a chronic tic disorder and investigated convergent, discriminant and factorial validity, as well as internal consistency of the YGTSS. Our results confirm acceptable convergent and good to very good discriminant validity, respectively, indicated by a sufficiently high correlation of the YGTSS total tic score with the Clinical Global Impression Scale for tics (r s = 0.65) and only low to medium correlations with clinical severity ratings of attention deficit/hyperactivity symptoms (r s = 0.24), obsessive-compulsive symptoms (r s = 27) as well as internalizing symptoms (r s = 0.27). Internal consistency was found to be acceptable (Ω = 0.58 for YGTSS total tic score). A confirmatory factor analysis supports the concept of the two factors "motor tics" and "phonic tics," but still demonstrated just a marginal model fit (root mean square error of approximation = 0.09 [0.08; 0.10], comparative fit index = 0.90, and Tucker Lewis index = 0.87). A subsequent analysis of local misspecifications revealed correlated measurement errors, suggesting opportunities for improvement regarding the item wording. In conclusion, our results indicate acceptable psychometric quality of the YGTSS. However, taking the wide use and importance of the YGTSS into account, our results suggest the need for further investigations and improvements of the YGTSS. In addition, our results show limitations of the global severity score as a sum score indicating that the separate use of the total tic score and the impairment rating is more beneficial.
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Affiliation(s)
- Martina Haas
- Clinic of Psychiatry, Social Psychiatry, and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Ewgeni Jakubovski
- Clinic of Psychiatry, Social Psychiatry, and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Carolin Fremer
- Clinic of Psychiatry, Social Psychiatry, and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Andrea Dietrich
- Department of Child and Adolescent Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Pieter J Hoekstra
- Department of Child and Adolescent Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Burkard Jäger
- Clinic of Psychosomatics and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Kirsten R Müller-Vahl
- Clinic of Psychiatry, Social Psychiatry, and Psychotherapy, Hannover Medical School, Hannover, Germany
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17
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Graziola F, Pellorca C, Di Criscio L, Vigevano F, Curatolo P, Capuano A. Impaired Motor Timing in Tourette Syndrome: Results From a Case-Control Study in Children. Front Neurol 2020; 11:552701. [PMID: 33192986 PMCID: PMC7658319 DOI: 10.3389/fneur.2020.552701] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 09/28/2020] [Indexed: 12/14/2022] Open
Abstract
Tourette syndrome (TS) is a neurodevelopmental disorder characterized by motor and vocal tics. Co-occurrence of attention-deficit/hyperactivity disorder (ADHD) or obsessive–compulsive disorder (OCD) is very frequent in the pediatric population as well as the presence of an impairment of the executive functions. The aim of our study was to investigate motor timing, that is, the temporal organization of motor behavior, in a pediatric population of Tourette patients. Thirty-seven Tourette patients (divided in 22 “pure” Tourette patients and 15 with ADHD) were compared with 22 healthy age- and gender-matched subjects. All subjects underwent a neuropsychiatric screening and were tested for their planning and decision-making abilities by using a standardized test, such as Tower of London (ToL). Two experimental paradigms were adopted: finger-tapping test (FTT), a free motor tapping task, and synchronization–continuation task. An accuracy index was calculated as measure of ability of synchronization. We found that “pure” TS as well as TS+ADHD showed lower scores in the FTT for the dominant and non-dominant hands than controls. Moreover, in the synchronization and continuation test, we observed an overall lack of accuracy in both TS groups in the continuation phase for 2,000 ms (supra-second interval), interestingly, with opposite direction of accuracy index. Thus, “pure” TS patients were classified as “behind the beat,” whereas, TS+ADHD as “ahead of the beat.” The performance in the finger tapping was inversely correlated to ToL total scores and execution time, whereas we did not find any correlation with the accuracy index of the synchronization and continuation test. In conclusion, here, we explored motor timing ability in a childhood cohort of Tourette patients, confirming that patients exhibit an impaired temporal control of motor behavior and these findings may be explained by the common underlying neurobiology of TS and motor timing.
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Affiliation(s)
- Federica Graziola
- Movement Disorders Clinic, Department of Neurosciences, Bambino Gesù Children's Hospital, Rome, Italy.,Department of Neuroscience, University of Rome Tor Vergata, Rome, Italy
| | - Chiara Pellorca
- Movement Disorders Clinic, Department of Neurosciences, Bambino Gesù Children's Hospital, Rome, Italy
| | - Lorena Di Criscio
- Movement Disorders Clinic, Department of Neurosciences, Bambino Gesù Children's Hospital, Rome, Italy.,Department of Neuroscience, University of Rome Tor Vergata, Rome, Italy
| | - Federico Vigevano
- Movement Disorders Clinic, Department of Neurosciences, Bambino Gesù Children's Hospital, Rome, Italy
| | - Paolo Curatolo
- Department of Neuroscience, University of Rome Tor Vergata, Rome, Italy
| | - Alessandro Capuano
- Movement Disorders Clinic, Department of Neurosciences, Bambino Gesù Children's Hospital, Rome, Italy
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18
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Conte G, Valente F, Fioriello F, Cardona F. Rage attacks in Tourette Syndrome and Chronic Tic Disorder: a systematic review. Neurosci Biobehav Rev 2020; 119:21-36. [PMID: 32980398 DOI: 10.1016/j.neubiorev.2020.09.019] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 09/04/2020] [Accepted: 09/16/2020] [Indexed: 01/10/2023]
Abstract
Tourette syndrome (TS) and chronic motor/vocal tic disorder (CTD) are neurodevelopmental conditions defined by the occurrence of multiple tics. Besides the well-known association with attention deficit/hyperactivity disorder (ADHD) and obsessive-compulsive disorder (OCD), rage attacks (RA) represent common and detrimental symptoms for patients. Inorder to explore prevalence of RA in tic disorders, relation to tic severity/comorbidities and available treatments, we performed a systematic literature review based on PRISMA Guidelines. 32 studies published between January 2008 - December 2019 were deemed suitable for the analysis and provided a prevalence of 20-67 %. Most findings showed a direct correlation with tic severity and a significant impact on psychosocial functioning. Although apparently related to comorbid ADHD, RA also frequently occur as independent manifestations. Association with other comorbidities, such as OCD, impulse control and mood disorders has also been reported, not yet fully established. Behavioral interventions appear to be effective, whereas there is limited evidence concerning the efficacy of medication. In TS/CTD, RA may be regarded as a major comorbidity that requires clinical investigation in order to develop personalized treatments.
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Affiliation(s)
- Giulia Conte
- Department of Human Neurosciences, Institute of Child and Adolescent Neuropsychiatry, Sapienza University of Rome - Italy, Via dei Sabelli, 108, 00185 Rome, Italy.
| | - Francesca Valente
- Department of Human Neurosciences, Institute of Child and Adolescent Neuropsychiatry, Sapienza University of Rome - Italy, Via dei Sabelli, 108, 00185 Rome, Italy.
| | - Francesca Fioriello
- Department of Human Neurosciences, Institute of Child and Adolescent Neuropsychiatry, Sapienza University of Rome - Italy, Via dei Sabelli, 108, 00185 Rome, Italy.
| | - Francesco Cardona
- Department of Human Neurosciences, Institute of Child and Adolescent Neuropsychiatry, Sapienza University of Rome - Italy, Via dei Sabelli, 108, 00185 Rome, Italy.
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19
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Cavanna AE, Ganos C, Hartmann A, Martino D, Pringsheim T, Seri S. The cognitive neuropsychiatry of Tourette syndrome. Cogn Neuropsychiatry 2020; 25:254-268. [PMID: 32372718 DOI: 10.1080/13546805.2020.1760812] [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] [Indexed: 02/08/2023]
Abstract
Introduction: Converging evidence from both clinical and experimental studies has shown that Tourette syndrome (TS) is not a unitary condition, but a cluster of multiple phenotypes, which encompass both tics and specific behavioural and cognitive symptoms (mainly attention-deficit and hyperactivity disorder and obsessive-compulsive disorder). Methods: We conducted a narrative review of the recent literature on the cognitive neuropsychiatry of TS. Results: Although clinical research has shown that TS is not associated with cognitive deficits per se, the findings of recent studies have suggested the presence of subtle alterations in specific cognitive functions. A promising line of research on imitative behaviour could provide a common background for the alterations in executive control and social cognition observed in TS. Two different (but not mutually exclusive) neurocognitive theories have recently suggested that TS could originate from altered perception-action binding and social decision-making dysfunction, respectively. Conclusions: Since the presence of behavioural comorbidities influences individualised treatment approaches, it is likely that a more precise characterisation of TS phenotypes, including cognitive aspects, will result in improved levels of care for patients with tic disorders.
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Affiliation(s)
- Andrea E Cavanna
- Department of Neuropsychiatry, BSMHFT and University of Birmingham, Birmingham, United Kingdom.,Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology and University College London, London, United Kingdom.,School of Life and Health Sciences, Aston Brain Centre, Aston University, Birmingham, United Kingdom
| | - Christos Ganos
- Department of Neurology, Charité, University Medicine Berlin, Germany
| | - Andreas Hartmann
- French Reference Centre for Gilles de la Tourette Syndrome, Groupe Hospitalier Pitié-Salpêtrière, Paris, France.,Sorbonne Universités, UPMC Université Paris 06, UMR S 1127, CNRS UMR 7225, ICM, Paris, France.,Department of Neurology, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Davide Martino
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary and Hotchkiss Brain Institute, Calgary, Canada
| | - Tamara Pringsheim
- Department of Clinical Neurosciences, Psychiatry, Pediatrics and Community Health Sciences, University of Calgary, Calgary, Canada
| | - Stefano Seri
- School of Life and Health Sciences, Aston Brain Centre, Aston University, Birmingham, United Kingdom
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20
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Yadegar M, Guo S, Ricketts EJ, Zinner SH. Assessment and Management of Tic Disorders in Pediatric Primary Care Settings. CURRENT DEVELOPMENTAL DISORDERS REPORTS 2020; 6:159-172. [PMID: 32467820 DOI: 10.1007/s40474-019-00168-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Purpose of Review Pediatricians and other primary care providers are often the first and sole healthcare clinicians of patients who present with tics. However, limited primary care pediatric training in neuropsychiatric concerns, as well as perceived lack of comfort and preparation, make it challenging for these clinicians to confidently identify and manage tic disorders. Recent Findings Current empirical findings of tic disorder management relevant to pediatric physicians, including assessment, psychoeducation, behavioral interventions, psychotropic medications, and alternative treatments are reviewed. Summary This article discusses neuropsychiatric and medical complexities of tic disorder assessment, with particular emphasis on differential and comorbid diagnoses. Tiered referral recommendations, based on symptom severity, impairment, and consideration of comorbid conditions, are provided. Future directions for tic management, including dissemination of evidence-based treatments of tic disorders and multidisciplinary teams within pediatric primary care settings, are included.
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Affiliation(s)
- Mina Yadegar
- Univeristy of California, Los Angeles.,Boston Child Study Center - Los Angeles.,Behavioral Associates Los Angeles
| | - Sisi Guo
- Univeristy of California, Los Angeles
| | | | - Samuel H Zinner
- University of Washington School of Medicine.,Seattle Children's Hospital
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21
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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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22
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Liu ZS, Cui YH, Sun D, Lu Q, Jiang YW, Jiang L, Wang JQ, Luo R, Fang F, Zhou SZ, Wang Y, Cai FC, Lin Q, Xiong L, Zheng Y, Qin J. Current Status, Diagnosis, and Treatment Recommendation for Tic Disorders in China. Front Psychiatry 2020; 11:774. [PMID: 32903695 PMCID: PMC7438753 DOI: 10.3389/fpsyt.2020.00774] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Accepted: 07/21/2020] [Indexed: 12/19/2022] Open
Abstract
Tic disorders (TD) are a group neuropsychiatric disorders with childhood onset characterized by tics, i.e. repetitive, sudden, and involuntary movements or vocalizations; and Tourette syndrome (TS) is the most severe form of TD. Their clinical manifestations are diverse; and are often associated with various psychopathological and/or behavioral comorbidities, including attention deficit hyperactivity disorder (ADHD), obsessive-compulsive disorder (OCD), anxiety, depression, and sleep disorders. Individual severity and response to treatment are highly variable, and there are some refractory cases, which are less responsive to conventional TD treatment. TD/TS are also common in the Chinese pediatric population. To help improve the understanding of TD for pediatricians and other health professionals, and to improve its diagnosis and treatment in China, the Chinese Child Neurology Society (CCNS) has developed an Expert Consensus on Diagnosis and Treatment of TD in China, which is based on our clinical experience and the availability therapeutic avenues. It is focused on clinical diagnosis and evaluation of TD and its comorbidities, psychological and educational intervention, nonpharmacological therapy, pharmacological treatment, including traditional Chinese medicine and acupuncture, as well as prognosis in children with TD in China. A summary of the current status of TD and up-to-date diagnosis and treatment recommendations for TD in China is presented here.
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Affiliation(s)
- Zhi-Sheng Liu
- Department of Neurology, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yong-Hua Cui
- Department of Neurology and Psychiatry, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Dan Sun
- Department of Neurology, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qing Lu
- Department of Neurology, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yu-Wu Jiang
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Li Jiang
- Department of Neurology, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Jia-Qin Wang
- Department of Pediatrics, Third Affiliated Hospital of Xinxiang Medical College, Xinxiang, China
| | - Rong Luo
- Department of Pediatrics, Huaxi Second Hospital of Sichuan University, Chengdu, China
| | - Fang Fang
- Department of Neurology and Psychiatry, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Shui-Zhen Zhou
- Department of Neurology, Pediatric Hospital Affiliated to Fudan University, Shanghai, China
| | - Yi Wang
- Department of Neurology, Pediatric Hospital Affiliated to Fudan University, Shanghai, China
| | - Fang-Cheng Cai
- Department of Neurology, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Qing Lin
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Lan Xiong
- Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada
| | - Yi Zheng
- Department of Pediatrics, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Jiong Qin
- Department of Pediatrics, Peking University People's Hospital, Beijing, China
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23
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Abstract
Movement disorders in women during pregnancy are uncommon. Therefore, high quality studies are limited, and guidelines are lacking for the treatment of movement disorders in pregnancy, thus posing a significant therapeutic challenge for the treating physicians. In this chapter, we discuss movement disorders that arise during pregnancy and the preexisting movement disorders during pregnancy. Common conditions encountered in pregnancy include but are not limited to restless legs syndrome, chorea gravidarum, Parkinson disease, essential tremor, and Huntington disease as well as more rare movement disorders (Wilson's disease, dystonia, etc.). This chapter summarizes the published literature on movement disorders and pharmacologic and surgical considerations for neurologists and physicians in other specialties caring for patients who are pregnant or considering pregnancy.
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Affiliation(s)
- Fang Ba
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Janis M Miyasaki
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, AB, Canada.
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24
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Pringsheim T, Holler-Managan Y, Okun MS, Jankovic J, Piacentini J, Cavanna AE, Martino D, Müller-Vahl K, Woods DW, Robinson M, Jarvie E, Roessner V, Oskoui M. Comprehensive systematic review summary: Treatment of tics in people with Tourette syndrome and chronic tic disorders. Neurology 2019; 92:907-915. [PMID: 31061209 DOI: 10.1212/wnl.0000000000007467] [Citation(s) in RCA: 101] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 11/24/2018] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To systematically evaluate the efficacy of treatments for tics and the risks associated with their use. METHODS This project followed the methodologies outlined in the 2011 edition of the American Academy of Neurology's guideline development process manual. We included systematic reviews and randomized controlled trials on the treatment of tics that included at least 20 participants (10 participants if a crossover trial), except for neurostimulation trials, for which no minimum sample size was required. To obtain additional information on drug safety, we included cohort studies or case series that specifically evaluated adverse drug effects in individuals with tics. RESULTS There was high confidence that the Comprehensive Behavioral Intervention for Tics was more likely than psychoeducation and supportive therapy to reduce tics. There was moderate confidence that haloperidol, risperidone, aripiprazole, tiapride, clonidine, onabotulinumtoxinA injections, 5-ling granule, Ningdong granule, and deep brain stimulation of the globus pallidus were probably more likely than placebo to reduce tics. There was low confidence that pimozide, ziprasidone, metoclopramide, guanfacine, topiramate, and tetrahydrocannabinol were possibly more likely than placebo to reduce tics. Evidence of harm associated with various treatments was also demonstrated, including weight gain, drug-induced movement disorders, elevated prolactin levels, sedation, and effects on heart rate, blood pressure, and ECGs. CONCLUSIONS There is evidence to support the efficacy of various medical, behavioral, and neurostimulation interventions for the treatment of tics. Both the efficacy and harms associated with interventions must be considered in making treatment recommendations.
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Affiliation(s)
- Tamara Pringsheim
- From the Department of Clinical Neurosciences, Psychiatry, Pediatrics and Community Health Sciences (T.P., D.M.), Cumming School of Medicine, University of Calgary, Alberta, Canada; Department of Pediatrics (Neurology) (Y.H.-M.), Northwestern University Feinberg School of Medicine, Chicago, IL; Departments of Neurology and Neurosurgery (M.S.O.), Fixel Center for Neurological Diseases, University of Florida, Gainesville; Department of Neurology (J.J.), Baylor College of Medicine, Houston, TX; Department of Psychiatry and Biobehavioral Sciences (J.P.), Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles; Department of Neuropsychiatry (A.E.C.), BSMHFT, University of Birmingham and Aston University, UK; Department of Psychiatry, Social Psychiatry, and Psychotherapy (K.M.-V.), Hannover Medical School, Germany; Department of Psychology (D.W.W.), Marquette University, Milwaukee, WI; Massachusetts Chapter (M.R.), Tourette Association of America, Bayside, NY; Waisman Center (E.J.), University Center for Excellence in Developmental Disabilities, University of Wisconsin, Madison; Technische Universitaet Dresden (V.R.), Germany; and Departments of Pediatric and Neurology/Neurosurgery (M.O.), McGill University, Montréal, Canada
| | - Yolanda Holler-Managan
- From the Department of Clinical Neurosciences, Psychiatry, Pediatrics and Community Health Sciences (T.P., D.M.), Cumming School of Medicine, University of Calgary, Alberta, Canada; Department of Pediatrics (Neurology) (Y.H.-M.), Northwestern University Feinberg School of Medicine, Chicago, IL; Departments of Neurology and Neurosurgery (M.S.O.), Fixel Center for Neurological Diseases, University of Florida, Gainesville; Department of Neurology (J.J.), Baylor College of Medicine, Houston, TX; Department of Psychiatry and Biobehavioral Sciences (J.P.), Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles; Department of Neuropsychiatry (A.E.C.), BSMHFT, University of Birmingham and Aston University, UK; Department of Psychiatry, Social Psychiatry, and Psychotherapy (K.M.-V.), Hannover Medical School, Germany; Department of Psychology (D.W.W.), Marquette University, Milwaukee, WI; Massachusetts Chapter (M.R.), Tourette Association of America, Bayside, NY; Waisman Center (E.J.), University Center for Excellence in Developmental Disabilities, University of Wisconsin, Madison; Technische Universitaet Dresden (V.R.), Germany; and Departments of Pediatric and Neurology/Neurosurgery (M.O.), McGill University, Montréal, Canada
| | - Michael S Okun
- From the Department of Clinical Neurosciences, Psychiatry, Pediatrics and Community Health Sciences (T.P., D.M.), Cumming School of Medicine, University of Calgary, Alberta, Canada; Department of Pediatrics (Neurology) (Y.H.-M.), Northwestern University Feinberg School of Medicine, Chicago, IL; Departments of Neurology and Neurosurgery (M.S.O.), Fixel Center for Neurological Diseases, University of Florida, Gainesville; Department of Neurology (J.J.), Baylor College of Medicine, Houston, TX; Department of Psychiatry and Biobehavioral Sciences (J.P.), Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles; Department of Neuropsychiatry (A.E.C.), BSMHFT, University of Birmingham and Aston University, UK; Department of Psychiatry, Social Psychiatry, and Psychotherapy (K.M.-V.), Hannover Medical School, Germany; Department of Psychology (D.W.W.), Marquette University, Milwaukee, WI; Massachusetts Chapter (M.R.), Tourette Association of America, Bayside, NY; Waisman Center (E.J.), University Center for Excellence in Developmental Disabilities, University of Wisconsin, Madison; Technische Universitaet Dresden (V.R.), Germany; and Departments of Pediatric and Neurology/Neurosurgery (M.O.), McGill University, Montréal, Canada
| | - Joseph Jankovic
- From the Department of Clinical Neurosciences, Psychiatry, Pediatrics and Community Health Sciences (T.P., D.M.), Cumming School of Medicine, University of Calgary, Alberta, Canada; Department of Pediatrics (Neurology) (Y.H.-M.), Northwestern University Feinberg School of Medicine, Chicago, IL; Departments of Neurology and Neurosurgery (M.S.O.), Fixel Center for Neurological Diseases, University of Florida, Gainesville; Department of Neurology (J.J.), Baylor College of Medicine, Houston, TX; Department of Psychiatry and Biobehavioral Sciences (J.P.), Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles; Department of Neuropsychiatry (A.E.C.), BSMHFT, University of Birmingham and Aston University, UK; Department of Psychiatry, Social Psychiatry, and Psychotherapy (K.M.-V.), Hannover Medical School, Germany; Department of Psychology (D.W.W.), Marquette University, Milwaukee, WI; Massachusetts Chapter (M.R.), Tourette Association of America, Bayside, NY; Waisman Center (E.J.), University Center for Excellence in Developmental Disabilities, University of Wisconsin, Madison; Technische Universitaet Dresden (V.R.), Germany; and Departments of Pediatric and Neurology/Neurosurgery (M.O.), McGill University, Montréal, Canada
| | - John Piacentini
- From the Department of Clinical Neurosciences, Psychiatry, Pediatrics and Community Health Sciences (T.P., D.M.), Cumming School of Medicine, University of Calgary, Alberta, Canada; Department of Pediatrics (Neurology) (Y.H.-M.), Northwestern University Feinberg School of Medicine, Chicago, IL; Departments of Neurology and Neurosurgery (M.S.O.), Fixel Center for Neurological Diseases, University of Florida, Gainesville; Department of Neurology (J.J.), Baylor College of Medicine, Houston, TX; Department of Psychiatry and Biobehavioral Sciences (J.P.), Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles; Department of Neuropsychiatry (A.E.C.), BSMHFT, University of Birmingham and Aston University, UK; Department of Psychiatry, Social Psychiatry, and Psychotherapy (K.M.-V.), Hannover Medical School, Germany; Department of Psychology (D.W.W.), Marquette University, Milwaukee, WI; Massachusetts Chapter (M.R.), Tourette Association of America, Bayside, NY; Waisman Center (E.J.), University Center for Excellence in Developmental Disabilities, University of Wisconsin, Madison; Technische Universitaet Dresden (V.R.), Germany; and Departments of Pediatric and Neurology/Neurosurgery (M.O.), McGill University, Montréal, Canada
| | - Andrea E Cavanna
- From the Department of Clinical Neurosciences, Psychiatry, Pediatrics and Community Health Sciences (T.P., D.M.), Cumming School of Medicine, University of Calgary, Alberta, Canada; Department of Pediatrics (Neurology) (Y.H.-M.), Northwestern University Feinberg School of Medicine, Chicago, IL; Departments of Neurology and Neurosurgery (M.S.O.), Fixel Center for Neurological Diseases, University of Florida, Gainesville; Department of Neurology (J.J.), Baylor College of Medicine, Houston, TX; Department of Psychiatry and Biobehavioral Sciences (J.P.), Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles; Department of Neuropsychiatry (A.E.C.), BSMHFT, University of Birmingham and Aston University, UK; Department of Psychiatry, Social Psychiatry, and Psychotherapy (K.M.-V.), Hannover Medical School, Germany; Department of Psychology (D.W.W.), Marquette University, Milwaukee, WI; Massachusetts Chapter (M.R.), Tourette Association of America, Bayside, NY; Waisman Center (E.J.), University Center for Excellence in Developmental Disabilities, University of Wisconsin, Madison; Technische Universitaet Dresden (V.R.), Germany; and Departments of Pediatric and Neurology/Neurosurgery (M.O.), McGill University, Montréal, Canada
| | - Davide Martino
- From the Department of Clinical Neurosciences, Psychiatry, Pediatrics and Community Health Sciences (T.P., D.M.), Cumming School of Medicine, University of Calgary, Alberta, Canada; Department of Pediatrics (Neurology) (Y.H.-M.), Northwestern University Feinberg School of Medicine, Chicago, IL; Departments of Neurology and Neurosurgery (M.S.O.), Fixel Center for Neurological Diseases, University of Florida, Gainesville; Department of Neurology (J.J.), Baylor College of Medicine, Houston, TX; Department of Psychiatry and Biobehavioral Sciences (J.P.), Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles; Department of Neuropsychiatry (A.E.C.), BSMHFT, University of Birmingham and Aston University, UK; Department of Psychiatry, Social Psychiatry, and Psychotherapy (K.M.-V.), Hannover Medical School, Germany; Department of Psychology (D.W.W.), Marquette University, Milwaukee, WI; Massachusetts Chapter (M.R.), Tourette Association of America, Bayside, NY; Waisman Center (E.J.), University Center for Excellence in Developmental Disabilities, University of Wisconsin, Madison; Technische Universitaet Dresden (V.R.), Germany; and Departments of Pediatric and Neurology/Neurosurgery (M.O.), McGill University, Montréal, Canada
| | - Kirsten Müller-Vahl
- From the Department of Clinical Neurosciences, Psychiatry, Pediatrics and Community Health Sciences (T.P., D.M.), Cumming School of Medicine, University of Calgary, Alberta, Canada; Department of Pediatrics (Neurology) (Y.H.-M.), Northwestern University Feinberg School of Medicine, Chicago, IL; Departments of Neurology and Neurosurgery (M.S.O.), Fixel Center for Neurological Diseases, University of Florida, Gainesville; Department of Neurology (J.J.), Baylor College of Medicine, Houston, TX; Department of Psychiatry and Biobehavioral Sciences (J.P.), Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles; Department of Neuropsychiatry (A.E.C.), BSMHFT, University of Birmingham and Aston University, UK; Department of Psychiatry, Social Psychiatry, and Psychotherapy (K.M.-V.), Hannover Medical School, Germany; Department of Psychology (D.W.W.), Marquette University, Milwaukee, WI; Massachusetts Chapter (M.R.), Tourette Association of America, Bayside, NY; Waisman Center (E.J.), University Center for Excellence in Developmental Disabilities, University of Wisconsin, Madison; Technische Universitaet Dresden (V.R.), Germany; and Departments of Pediatric and Neurology/Neurosurgery (M.O.), McGill University, Montréal, Canada
| | - Douglas W Woods
- From the Department of Clinical Neurosciences, Psychiatry, Pediatrics and Community Health Sciences (T.P., D.M.), Cumming School of Medicine, University of Calgary, Alberta, Canada; Department of Pediatrics (Neurology) (Y.H.-M.), Northwestern University Feinberg School of Medicine, Chicago, IL; Departments of Neurology and Neurosurgery (M.S.O.), Fixel Center for Neurological Diseases, University of Florida, Gainesville; Department of Neurology (J.J.), Baylor College of Medicine, Houston, TX; Department of Psychiatry and Biobehavioral Sciences (J.P.), Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles; Department of Neuropsychiatry (A.E.C.), BSMHFT, University of Birmingham and Aston University, UK; Department of Psychiatry, Social Psychiatry, and Psychotherapy (K.M.-V.), Hannover Medical School, Germany; Department of Psychology (D.W.W.), Marquette University, Milwaukee, WI; Massachusetts Chapter (M.R.), Tourette Association of America, Bayside, NY; Waisman Center (E.J.), University Center for Excellence in Developmental Disabilities, University of Wisconsin, Madison; Technische Universitaet Dresden (V.R.), Germany; and Departments of Pediatric and Neurology/Neurosurgery (M.O.), McGill University, Montréal, Canada
| | - Michael Robinson
- From the Department of Clinical Neurosciences, Psychiatry, Pediatrics and Community Health Sciences (T.P., D.M.), Cumming School of Medicine, University of Calgary, Alberta, Canada; Department of Pediatrics (Neurology) (Y.H.-M.), Northwestern University Feinberg School of Medicine, Chicago, IL; Departments of Neurology and Neurosurgery (M.S.O.), Fixel Center for Neurological Diseases, University of Florida, Gainesville; Department of Neurology (J.J.), Baylor College of Medicine, Houston, TX; Department of Psychiatry and Biobehavioral Sciences (J.P.), Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles; Department of Neuropsychiatry (A.E.C.), BSMHFT, University of Birmingham and Aston University, UK; Department of Psychiatry, Social Psychiatry, and Psychotherapy (K.M.-V.), Hannover Medical School, Germany; Department of Psychology (D.W.W.), Marquette University, Milwaukee, WI; Massachusetts Chapter (M.R.), Tourette Association of America, Bayside, NY; Waisman Center (E.J.), University Center for Excellence in Developmental Disabilities, University of Wisconsin, Madison; Technische Universitaet Dresden (V.R.), Germany; and Departments of Pediatric and Neurology/Neurosurgery (M.O.), McGill University, Montréal, Canada
| | - Elizabeth Jarvie
- From the Department of Clinical Neurosciences, Psychiatry, Pediatrics and Community Health Sciences (T.P., D.M.), Cumming School of Medicine, University of Calgary, Alberta, Canada; Department of Pediatrics (Neurology) (Y.H.-M.), Northwestern University Feinberg School of Medicine, Chicago, IL; Departments of Neurology and Neurosurgery (M.S.O.), Fixel Center for Neurological Diseases, University of Florida, Gainesville; Department of Neurology (J.J.), Baylor College of Medicine, Houston, TX; Department of Psychiatry and Biobehavioral Sciences (J.P.), Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles; Department of Neuropsychiatry (A.E.C.), BSMHFT, University of Birmingham and Aston University, UK; Department of Psychiatry, Social Psychiatry, and Psychotherapy (K.M.-V.), Hannover Medical School, Germany; Department of Psychology (D.W.W.), Marquette University, Milwaukee, WI; Massachusetts Chapter (M.R.), Tourette Association of America, Bayside, NY; Waisman Center (E.J.), University Center for Excellence in Developmental Disabilities, University of Wisconsin, Madison; Technische Universitaet Dresden (V.R.), Germany; and Departments of Pediatric and Neurology/Neurosurgery (M.O.), McGill University, Montréal, Canada
| | - Veit Roessner
- From the Department of Clinical Neurosciences, Psychiatry, Pediatrics and Community Health Sciences (T.P., D.M.), Cumming School of Medicine, University of Calgary, Alberta, Canada; Department of Pediatrics (Neurology) (Y.H.-M.), Northwestern University Feinberg School of Medicine, Chicago, IL; Departments of Neurology and Neurosurgery (M.S.O.), Fixel Center for Neurological Diseases, University of Florida, Gainesville; Department of Neurology (J.J.), Baylor College of Medicine, Houston, TX; Department of Psychiatry and Biobehavioral Sciences (J.P.), Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles; Department of Neuropsychiatry (A.E.C.), BSMHFT, University of Birmingham and Aston University, UK; Department of Psychiatry, Social Psychiatry, and Psychotherapy (K.M.-V.), Hannover Medical School, Germany; Department of Psychology (D.W.W.), Marquette University, Milwaukee, WI; Massachusetts Chapter (M.R.), Tourette Association of America, Bayside, NY; Waisman Center (E.J.), University Center for Excellence in Developmental Disabilities, University of Wisconsin, Madison; Technische Universitaet Dresden (V.R.), Germany; and Departments of Pediatric and Neurology/Neurosurgery (M.O.), McGill University, Montréal, Canada
| | - Maryam Oskoui
- From the Department of Clinical Neurosciences, Psychiatry, Pediatrics and Community Health Sciences (T.P., D.M.), Cumming School of Medicine, University of Calgary, Alberta, Canada; Department of Pediatrics (Neurology) (Y.H.-M.), Northwestern University Feinberg School of Medicine, Chicago, IL; Departments of Neurology and Neurosurgery (M.S.O.), Fixel Center for Neurological Diseases, University of Florida, Gainesville; Department of Neurology (J.J.), Baylor College of Medicine, Houston, TX; Department of Psychiatry and Biobehavioral Sciences (J.P.), Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles; Department of Neuropsychiatry (A.E.C.), BSMHFT, University of Birmingham and Aston University, UK; Department of Psychiatry, Social Psychiatry, and Psychotherapy (K.M.-V.), Hannover Medical School, Germany; Department of Psychology (D.W.W.), Marquette University, Milwaukee, WI; Massachusetts Chapter (M.R.), Tourette Association of America, Bayside, NY; Waisman Center (E.J.), University Center for Excellence in Developmental Disabilities, University of Wisconsin, Madison; Technische Universitaet Dresden (V.R.), Germany; and Departments of Pediatric and Neurology/Neurosurgery (M.O.), McGill University, Montréal, Canada
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Huisman‐van Dijk HM, Matthijssen SJMA, Stockmann RTS, Fritz AV, Cath DC. Effects of comorbidity on Tourette's tic severity and quality of life. Acta Neurol Scand 2019; 140:390-398. [PMID: 31418815 PMCID: PMC6899939 DOI: 10.1111/ane.13155] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 07/30/2019] [Accepted: 08/04/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The aim of this study is to gain more insight in the differential contributions of anxiety, depression and obsessive-compulsive (OC) symptom severity to quality of life (QoL) and tic severity in adults with Tourette Disorder (TD). METHODS Self-reported OC symptom, anxiety and depression severity measures were used to investigate their predictive value on QoL and Tic severity in adult TD patients (N = 187), using correlation, regression, and mediation analyses. RESULTS Tic severity has no effect on QoL. Depression severity directly reduces QoL, whereas anxiety and OC symptom severity have an indirect effect on QoL, mediated by depression severity. OC symptom severity directly affects tic severity, whereas depression and anxiety severity do not have a direct effect on tic or OC severity. Finally, anxiety severity indirectly impacts tic severity, with OC symptom severity functioning as a mediator. CONCLUSION In line with and extending previous studies, these findings indicate that OC symptom severity directly influences tic symptom severity whereas depression severity directly influences QoL in TD. Results imply that to improve QoL in TD patients, treatment should primarily focus on diminishing OC and depressive symptom severity rather than focusing on tic reduction.
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Affiliation(s)
- Hilde M. Huisman‐van Dijk
- Department of Clinical Psychology Faculty of Social Sciences Utrecht University Utrecht The Netherlands
- Altrecht Academic Anxiety Center Utrecht The Netherlands
| | - Suzy J. M. A. Matthijssen
- Department of Clinical Psychology Faculty of Social Sciences Utrecht University Utrecht The Netherlands
- Altrecht Academic Anxiety Center Utrecht The Netherlands
| | - Ruben T. S. Stockmann
- Department of Clinical Psychology Faculty of Social Sciences Utrecht University Utrecht The Netherlands
| | - Anne V. Fritz
- Department of Clinical Psychology Faculty of Social Sciences Utrecht University Utrecht The Netherlands
| | - Danielle C. Cath
- Rob Giel Onderzoekcentrum Groningen The Netherlands
- Department of Psychiatry University Medical Center Groningen and RUG Groningen The Netherlands
- GGZ Drenthe Mental Health Institution Assen The Netherlands
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26
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Krack P, Volkmann J, Tinkhauser G, Deuschl G. Deep Brain Stimulation in Movement Disorders: From Experimental Surgery to Evidence‐Based Therapy. Mov Disord 2019; 34:1795-1810. [DOI: 10.1002/mds.27860] [Citation(s) in RCA: 89] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 08/01/2019] [Accepted: 08/19/2019] [Indexed: 12/21/2022] Open
Affiliation(s)
- Paul Krack
- Department of Neurology Bern University Hospital and University of Bern Bern Switzerland
| | - Jens Volkmann
- Department of Neurology University Hospital and Julius‐Maximilian‐University Wuerzburg Germany
| | - Gerd Tinkhauser
- Department of Neurology Bern University Hospital and University of Bern Bern Switzerland
| | - Günther Deuschl
- Department of Neurology University Hospital Schleswig Holstein (UKSH), Kiel Campus; Christian‐Albrechts‐University Kiel Germany
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Callari A, Miniati M. Clinical and Therapeutic Challenges when Psychiatric Disorders Occur in Neurological Diseases: A Narrative Review. CURRENT PSYCHIATRY RESEARCH AND REVIEWS 2019. [DOI: 10.2174/1573400515666190411142109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background:Over the course of the 20th century, neurology and psychiatry diverged and became two separate disciplines. Subsequently, the continuous progress of neurosciences confused their boundaries. However, with ‘the splitting’ and ‘the lumping’ approaches, relevant difficulties remain in targeting clinical and therapeutic goals, when psychiatric signs and symptoms co-occur with neurological diseases.Objective:The study summarize current evidence on psychiatric signs and symptoms comorbid with neurological diseases, with the aim to provide information on diagnostic problems and available therapeutic options.Methods:Finding from searches of publications on ‘PsycInfo’, ‘Medline’, and ‘Science Direct’, from January 1993 to December 2018 (25 years) is summarized in a narrative manner on six main neurological areas: congenital neurological illnesses (n=16), dementias (n=15), basal ganglia diseases (n=30), epilepsy (n=22), strokes/focal brain injuries (n=29), and neurological neoplastic/paraneoplastic diseases (n=15).Results:Clinical phenotypes of psychiatric syndromes are frequently described in neurological studies. Little evidence is provided on the most adequate therapeutic approaches.Conclusion:Psychiatric syndromes in comorbidity with neurological diseases are heterogeneous and severe; evidence-based treatments are scarce. Despite a model supporting an equal approach between psychiatric and neurological syndromes, psychiatric syndromes in neurological diseases have been described, to a relevant degree, as less important, leading to a hierarchical primate of the neurological manifestations, and thus, in our opinion, limiting the systematic studies on psychopharmacological treatments in this area.
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Affiliation(s)
| | - Mario Miniati
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy
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28
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Cavanna A, Nani A. Gilles de la Tourette syndrome: An overview. ARCHIVES OF MEDICINE AND HEALTH SCIENCES 2019. [DOI: 10.4103/amhs.amhs_122_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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29
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The neuropsychiatry of Gilles de la Tourette syndrome: The état de l’art. Rev Neurol (Paris) 2018; 174:621-627. [DOI: 10.1016/j.neurol.2018.06.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 06/25/2018] [Indexed: 01/23/2023]
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30
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Poh W, Payne JM, Gulenc A, Efron D. Chronic tic disorders in children with ADHD. Arch Dis Child 2018; 103:847-852. [PMID: 29317441 DOI: 10.1136/archdischild-2017-314139] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 12/07/2017] [Accepted: 12/07/2017] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To examine in a community-based cohort: (1) the prevalence of chronic tic disorder (CTD) in children with attention-deficit/hyperactivity disorder (ADHD) compared with non-ADHD controls at ages 7 and 10; and (2) the additional psychiatric and functional burden of CTD in children with ADHD. METHODS Children aged 6-8 years with ADHD (n=179) and controls (n=212) were recruited through 43 Victorian schools using parent and teacher screening surveys (Conners 3 ADHD Index), followed by case confirmation (Diagnostic Interview Schedule for Children-IV (DISC-IV)). CTD was identified using the DISC-IV categories chronic motor tic disorder, chronic vocal tic disorder or Tourette syndrome at baseline and 36-month follow-up. Internalising and externalising disorders, social functioning, academic performance and quality of life were also measured. Tests of proportions and independent t-tests were used to compare the ADHD+CTD group with sex-matched ADHD alone children. RESULTS Compared with controls, children with ADHD were 4.1 (95% CI 1.1 to 14.1) times more likely to have CTD at age 7, and 5.9 (95% CI 1.6 to 17.9) times more likely at age 10. Children with ADHD+CTD experienced higher rates of internalising disorders and peer problems, and poorer quality of life than those with ADHD alone. CONCLUSIONS CTD prevalence is higher in children with ADHD compared with controls, and confers substantial additional psychiatric and functional burden. Clinicians need to consider CTD in both the initial assessment and ongoing management of children with ADHD, and address both the symptoms and the associated impairments.
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Affiliation(s)
- William Poh
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Jonathan M Payne
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Population Health, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Alisha Gulenc
- Population Health, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Daryl Efron
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Population Health, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,The Royal Children's Hospital, Melbourne, Victoria, 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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32
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Edemann-Callesen H, Habelt B, Wieske F, Jackson M, Khadka N, Mattei D, Bernhardt N, Heinz A, Liebetanz D, Bikson M, Padberg F, Hadar R, Nitsche MA, Winter C. Non-invasive modulation reduces repetitive behavior in a rat model through the sensorimotor cortico-striatal circuit. Transl Psychiatry 2018; 8:11. [PMID: 29317605 PMCID: PMC5802458 DOI: 10.1038/s41398-017-0059-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2017] [Revised: 09/26/2017] [Accepted: 10/01/2017] [Indexed: 01/19/2023] Open
Abstract
Involuntary movements as seen in repetitive disorders such as Tourette Syndrome (TS) results from cortical hyperexcitability that arise due to striato-thalamo-cortical circuit (STC) imbalance. Transcranial direct current stimulation (tDCS) is a stimulation procedure that changes cortical excitability, yet its relevance in repetitive disorders such as TS remains largely unexplored. Here, we employed the dopamine transporter-overexpressing (DAT-tg) rat model to investigate behavioral and neurobiological effects of frontal tDCS. The outcome of tDCS was pathology dependent, as anodal tDCS decreased repetitive behavior in the DAT-tg rats yet increased it in wild-type (wt) rats. Extensive deep brain stimulation (DBS) application and computational modeling assigned the response in DAT-tg rats to the sensorimotor pathway. Neurobiological assessment revealed cortical activity changes and increase in striatal inhibitory properties in the DAT-tg rats. Our findings show that tDCS reduces repetitive behavior in the DAT-tg rat through modulation of the sensorimotor STC circuit. This sets the stage for further investigating the usage of tDCS in repetitive disorders such as TS.
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Affiliation(s)
- Henriette Edemann-Callesen
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Berlin, Germany
- Department of Psychiatry and Psychotherapy, Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- International Graduate Program Medical Neurosciences, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Bettina Habelt
- Department of Psychiatry and Psychotherapy, Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Franziska Wieske
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Berlin, Germany
- Department of Psychiatry and Psychotherapy, Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Mark Jackson
- Department of Biomedical Engineering, The City College of The City University of New York, New York, NY, USA
| | - Niranjan Khadka
- Department of Biomedical Engineering, The City College of The City University of New York, New York, NY, USA
| | - Daniele Mattei
- Cellular Neuroscience, Max-Delbrueck-Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany
| | - Nadine Bernhardt
- Department of Psychiatry and Psychotherapy, Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Andreas Heinz
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - David Liebetanz
- Department of Clinical Neurophysiology, University Medical Center, Georg-August-University, Goettingen, Germany
| | - Marom Bikson
- Department of Biomedical Engineering, The City College of The City University of New York, New York, NY, USA
| | - Frank Padberg
- Department of Psychiatry and Psychotherapy, Ludwig Maximillian University, Munich, Germany
| | - Ravit Hadar
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Berlin, Germany
- Department of Psychiatry and Psychotherapy, Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Michael A Nitsche
- Department of Psychology and Neurosciences, Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany
- Department of Neurology, University Medical Hospital Bergmannsheil, Bochum, Germany
| | - Christine Winter
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Berlin, Germany.
- Department of Psychiatry and Psychotherapy, Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
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Ricketts EJ, McGuire JF, Chang S, Bose D, Rasch MM, Woods DW, Specht MW, Walkup JT, Scahill L, Wilhelm S, Peterson AL, Piacentini J. Benchmarking Treatment Response in Tourette's Disorder: A Psychometric Evaluation and Signal Detection Analysis of the Parent Tic Questionnaire. Behav Ther 2018; 49:46-56. [PMID: 29405921 PMCID: PMC5988429 DOI: 10.1016/j.beth.2017.05.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 04/04/2017] [Accepted: 05/15/2017] [Indexed: 11/26/2022]
Abstract
This study assessed the psychometric properties of a parent-reported tic severity measure, the Parent Tic Questionnaire (PTQ), and used the scale to establish guidelines for delineating clinically significant tic treatment response. Participants were 126 children ages 9 to 17 who participated in a randomized controlled trial of Comprehensive Behavioral Intervention for Tics (CBIT). Tic severity was assessed using the Yale Global Tic Severity Scale (YGTSS), Hopkins Motor/Vocal Tic Scale (HMVTS) and PTQ; positive treatment response was defined by a score of 1 (very much improved) or 2 (much improved) on the Clinical Global Impressions - Improvement (CGI-I) scale. Cronbach's alpha and intraclass correlations (ICC) assessed internal consistency and test-retest reliability, with correlations evaluating validity. Receiver- and Quality-Receiver Operating Characteristic analyses assessed the efficiency of percent and raw-reduction cutoffs associated with positive treatment response. The PTQ demonstrated good internal consistency (α = 0.80 to 0.86), excellent test-retest reliability (ICC = .84 to .89), good convergent validity with the YGTSS and HM/VTS, and good discriminant validity from hyperactive, obsessive-compulsive, and externalizing (i.e., aggression and rule-breaking) symptoms. A 55% reduction and 10-point decrease in PTQ Total score were optimal for defining positive treatment response. Findings help standardize tic assessment and provide clinicians with greater clarity in determining clinically meaningful tic symptom change during treatment.
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Deep Brain Stimulation in Tourette Syndrome. Neuromodulation 2018. [DOI: 10.1016/b978-0-12-805353-9.00077-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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Fründt O, Woods D, Ganos C. Behavioral therapy for Tourette syndrome and chronic tic disorders. Neurol Clin Pract 2017; 7:148-156. [PMID: 29185535 DOI: 10.1212/cpj.0000000000000348] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 02/12/2017] [Indexed: 11/15/2022]
Abstract
Purpose of review To summarize behavioral interventions for the treatment of primary tic disorders. Recent findings Although tics were attributed to a disordered weak volition, the shift towards neurobiological models of tic disorders also transformed nonpharmacologic treatment practices. Current international guidelines recommend habit reversal training, comprehensive behavioral intervention, and exposure and response prevention as first-line therapies for tics. Appropriate patient selection, including age and presence of comorbidities, are salient clinical features that merit consideration. Evidence for further behavioral interventions is also presented. Summary Currently recommended behavioral interventions view tics as habitual responses that may be further strengthened through negative reinforcement. Although availability and costs related to these interventions may limit their effect, Internet-based and telehealth approaches may facilitate wide accessibility. Novel nonpharmacologic treatments that take different approaches, such as autonomic modulation or attention-based interventions, may also hold therapeutic promise.
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Affiliation(s)
- Odette Fründt
- Department of Neurology (OF, CG), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; and Department of Psychology (DW), Marquette University, Milwaukee, WI
| | - Douglas Woods
- Department of Neurology (OF, CG), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; and Department of Psychology (DW), Marquette University, Milwaukee, WI
| | - Christos Ganos
- Department of Neurology (OF, CG), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; and Department of Psychology (DW), Marquette University, Milwaukee, WI
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Abstract
BACKGROUND Previous studies suggest that adults with Tourette syndrome (TS) can respond unconventionally on tasks involving social cognition. We therefore hypothesized that these patients would exhibit different neural responses to healthy controls in response to emotionally salient expressions of human eyes. METHOD Twenty-five adults with TS and 25 matched healthy controls were scanned using fMRI during the standard version of the Reading the Mind in the Eyes Task which requires mental state judgements, and a novel comparison version requiring judgements about age. RESULTS During prompted mental state recognition, greater activity was apparent in TS within left orbitofrontal cortex, posterior cingulate, right amygdala and right temporo-parietal junction (TPJ), while reduced activity was apparent in regions including left inferior parietal cortex. Age judgement elicited greater activity in TS within precuneus, medial prefrontal and temporal regions involved in mentalizing. The interaction between group and task revealed differential activity in areas including right inferior frontal gyrus. Task-related activity in the TPJ covaried with global ratings of the urge to tic. CONCLUSIONS While recognizing mental states, adults with TS exhibit greater activity than controls in brain areas involved in the processing of negative emotion, in addition to reduced activity in regions associated with the attribution of agency. In addition, increased recruitment of areas involved in mental state reasoning is apparent in these patients when mentalizing is not a task requirement. Our findings highlight differential neural reactivity in response to emotive social cues in TS, which may interact with tic expression.
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Affiliation(s)
- C M Eddy
- BSMHFT National Centre for Mental Health,Birmingham,UK
| | - A E Cavanna
- BSMHFT National Centre for Mental Health,Birmingham,UK
| | - P C Hansen
- Birmingham University Imaging Centre and School of Psychology,College of Life and Environmental Sciences,University of Birmingham,UK
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Feldman G, Lian H, Kosinski M, Stillwell D. Frankly, We Do Give a Damn: The Relationship Between Profanity and Honesty. SOCIAL PSYCHOLOGICAL AND PERSONALITY SCIENCE 2017; 8:816-826. [PMID: 29187959 PMCID: PMC5686790 DOI: 10.1177/1948550616681055] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
There are two conflicting perspectives regarding the relationship between profanity and dishonesty. These two forms of norm-violating behavior share common causes and are often considered to be positively related. On the other hand, however, profanity is often used to express one’s genuine feelings and could therefore be negatively related to dishonesty. In three studies, we explored the relationship between profanity and honesty. We examined profanity and honesty first with profanity behavior and lying on a scale in the lab (Study 1; N = 276), then with a linguistic analysis of real-life social interactions on Facebook (Study 2; N = 73,789), and finally with profanity and integrity indexes for the aggregate level of U.S. states (Study 3; N = 50 states). We found a consistent positive relationship between profanity and honesty; profanity was associated with less lying and deception at the individual level and with higher integrity at the society level.
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Affiliation(s)
- Gilad Feldman
- Department of Work and Social Psychology, Maastricht University, Maastricht, the Netherlands
| | - Huiwen Lian
- Department of Management, Hong Kong University of Science and Technology, Clearwater Bay, Kowloon, Hong Kong
| | - Michal Kosinski
- Graduate School of Business, Stanford University, Stanford, CA, USA
| | - David Stillwell
- Judge School of Business, University of Cambridge, Cambridge, United Kingdom
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Martino D, Pringsheim TM, Cavanna AE, Colosimo C, Hartmann A, Leckman JF, Luo S, Munchau A, Goetz CG, Stebbins GT, Martinez-Martin P. Systematic review of severity scales and screening instruments for tics: Critique and recommendations. Mov Disord 2017; 32:467-473. [PMID: 28071825 DOI: 10.1002/mds.26891] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 11/02/2016] [Accepted: 11/09/2016] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Several clinician, informant, and self-report instruments for tics and associated phenomena have been developed that differ in construct, comprehensiveness, and ease of administration. OBJECTIVE A Movement Disorders Society subcommittee aimed to rate psychometric quality of severity and screening instruments for tics and related sensory phenomena. METHODS Following the methodology adopted by previous Movement Disorders Society subcommittee papers, a review of severity and screening instruments for tics was completed, applying a classification as "recommended," "suggested," or "listed" to each instrument. RESULTS A total of 5 severity scales (Yale Global Tic Severity Scale, Tourette Syndrome Clinical Global Impression, Tourette's Disorder Scale, Shapiro Tourette syndrome Severity Scale, Premonitory Urges for Tics Scale) were "recommended," and 6 (Rush Video-Based Tic Rating Scale, Motor tic, Obsessions and compulsions, Vocal tic Evaluation Survey, Tourette Syndrome Global Scale, Global Tic Rating Scale, Parent Tic Questionnaire, Tourette Syndrome Symptom List) were "suggested." A total of 2 screening instruments (Motor tic, Obsession and compulsions, Vocal tic Evaluation Survey and Autism-Tics, Attention Deficit/Hyperactivity Disorder and Other Comorbidities Inventory) were "recommended," whereas 2 others (Apter 4-questions screening and Proxy Report Questionnaire for Parents and Teachers) were "suggested." CONCLUSIONS Our review does not support the need for developing new tic severity or screening instruments. Potential objectives of future research include developing a rating instrument targeting the full spectrum of tic-related abnormal behaviors, assessing/screening malignant forms of tic disorders, and developing patient-reported outcome measures. © 2017 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Davide Martino
- International Parkinson's Centre of Excellence, King's College and King's College Hospital, London, UK.,Queen Elizabeth Hospital, Woolwich, Lewisham & Greenwich NHS Trust, London, UK
| | - Tamara M Pringsheim
- Department of Clinical Neurosciences, Psychiatry, Pediatrics and Community Health Sciences, University of Calgary, Calgary, Canada
| | - Andrea E Cavanna
- Birmingham and Solihull Mental Health National Health Service Foundation Trust, Department of Neuropsychiatry, The Barberry National Centre for Mental Health, Birmingham, UK
| | - Carlo Colosimo
- Department of Neuroscience, University of Rome "La Sapienza,", Rome, Italy
| | - Andreas Hartmann
- Centre de Reference National Maladie Rare: "Syndrome Gilles de la Tourette," Departement de Neurologie, Pole des Maladies du Systeme Nerveux, Paris, France
| | - James F Leckman
- Child Study Center, Yale University, New Haven, Connecticut, USA
| | - Sheng Luo
- Department of Biostatistics, School of Public Health, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Alexander Munchau
- Department of Paediatric and Adult Movement Disorders and Neuropsychiatry, Institut of Neurogenetics, University of Lübeck, Lübeck, Germany
| | - Christopher G Goetz
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Ilinois, USA
| | - Glenn T Stebbins
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Ilinois, USA
| | - Pablo Martinez-Martin
- National Center of Epidemiology and Centro Investigación Biomédica en Red Enfermedades Neurodegenerativas, Carlos III Institute of Health, Madrid, Spain
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Hashemiyoon R, Kuhn J, Visser-Vandewalle V. Putting the Pieces Together in Gilles de la Tourette Syndrome: Exploring the Link Between Clinical Observations and the Biological Basis of Dysfunction. Brain Topogr 2017; 30:3-29. [PMID: 27783238 PMCID: PMC5219042 DOI: 10.1007/s10548-016-0525-z] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 09/20/2016] [Indexed: 12/21/2022]
Abstract
Gilles de la Tourette syndrome is a complex, idiopathic neuropsychiatric disorder whose pathophysiological mechanisms have yet to be elucidated. It is phenotypically heterogeneous and manifests more often than not with both motor and behavioral impairment, although tics are its clinical hallmark. Tics themselves present with a complex profile as they characteristically wax and wane and are often preceded by premonitory somatosensory sensations to which it is said a tic is the response. Highly comorbid with obsessive-compulsive disorder and attention deficit-hyperactivity disorder, it is purported to be an epigenetic, neurodevelopmental spectrum disorder with a complex genetic profile. It has a childhood onset, occurs disproportionately in males, and shows spontaneous symptomatic attenuation by adulthood in the majority of those afflicted. Although not fully understood, its neurobiological basis is linked to dysfunction in the cortico-basal ganglia-thalamo-cortical network. Treatment modalities for Tourette syndrome include behavioral, pharmacological and surgical interventions, but there is presently no cure for the disorder. For those severely affected, deep brain stimulation (DBS) has recently become a viable therapeutic option. A key factor to attaining optimal results from this surgery is target selection, a topic still under debate due to the complex clinical profile presented by GTS patients. Depending on its phenotypic expression and the most problematic aspect of the disorder for the individual, one of three brain regions is most commonly chosen for stimulation: the thalamus, globus pallidus, or nucleus accumbens. Neurophysiological analyses of intra- and post-operative human electrophysiological recordings from clinical DBS studies suggest a link between tic behavior and activity in both the thalamus and globus pallidus. In particular, chronic recordings from the thalamus have shown a correlation between symptomatology and (1) spectral activity in gamma band power and (2) theta/gamma cross frequency coherence. These results suggest gamma oscillations and theta/gamma cross correlation dynamics may serve as biomarkers for dysfunction. While acute and chronic recordings from human subjects undergoing DBS have provided better insight into tic genesis and the neuropathophysiological mechanisms underlying Tourette syndrome, these studies are still sparse and the field would greatly benefit from further investigations. This review reports data and discoveries of scientific and clinical relevance from a wide variety of methods and provides up-to-date information about our current understanding of the pathomechanisms underlying Tourette syndrome. It gives a comprehensive overview of the current state of knowledge and addresses open questions in the field.
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Affiliation(s)
- Rowshanak Hashemiyoon
- Department of Stereotactic and Functional Neurosurgery, University Hospital of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany.
| | - Jens Kuhn
- Department of Psychiatry and Psychotherapy, University Hospital of Cologne, Cologne, Germany
- Johanniter Hospital, EVKLN, Oberhausen, Germany
| | - Veerle Visser-Vandewalle
- Department of Stereotactic and Functional Neurosurgery, University Hospital of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany
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Tourette Syndrome and Chronic Tic Disorders: The Clinical Spectrum Beyond Tics. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2017; 134:1461-1490. [DOI: 10.1016/bs.irn.2017.05.006] [Citation(s) in RCA: 84] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Su MT, McFarlane F, Cavanna AE, Termine C, Murray I, Heidemeyer L, Heyman I, Murphy T. The English Version of the Gilles de la Tourette Syndrome-Quality of Life Scale for Children and Adolescents (C&A-GTS-QOL). J Child Neurol 2017; 32:76-83. [PMID: 27686095 DOI: 10.1177/0883073816670083] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Gilles de la Tourette syndrome is a chronic neuropsychiatric disorder that can have a detrimental impact on the health-related quality of life of children with the condition. To date no patient-reported health-related quality of life measures have been developed for children and adolescents in the English language. This study validated the first disease-specific scale for the quantitative assessment of health-related quality of life in 118 children and adolescents with Gilles de la Tourette syndrome (C&A-GTS-QOL) following language adaptation from Italian to English in the United Kingdom. Standard statistical methods were used to test the psychometric properties of the rating scale. Principal component factor analyses led to the identification of six health-related quality of life domains (cognitive, copro-phenomena, psychological, physical, obsessive-compulsive, and activities of daily living), explaining 66.7% of the overall variance. The C&A-GTS-QOL demonstrated satisfactory scaling assumptions and acceptability; validity was supported by interscale correlations (range 0.2-0.7), confirmatory factor analysis, and correlation patterns with other rating scales and clinical variables.
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Affiliation(s)
- Merina T Su
- 1 Developmental Neurosciences Programme, UCL Institute of Child Health, London, United Kingdom.,2 Psychological Medicine Team, Department of Child and Adolescent Mental Health, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Fiona McFarlane
- 2 Psychological Medicine Team, Department of Child and Adolescent Mental Health, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Andrea E Cavanna
- 3 Department of Neuropsychiatry, BSMHFT and University of Birmingham, Birmingham, United Kingdom.,4 School of Life and Health Sciences, Aston Brain Centre, Aston University, Birmingham, United Kingdom.,5 Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology and University College London, London, United Kingdom
| | - Cristiano Termine
- 6 Child Neuropsychiatry Unit, Department of Experimental Medicine, University of Insubria, Varese, Italy
| | - Imogen Murray
- 2 Psychological Medicine Team, Department of Child and Adolescent Mental Health, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Larissa Heidemeyer
- 2 Psychological Medicine Team, Department of Child and Adolescent Mental Health, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Isobel Heyman
- 1 Developmental Neurosciences Programme, UCL Institute of Child Health, London, United Kingdom.,2 Psychological Medicine Team, Department of Child and Adolescent Mental Health, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Tara Murphy
- 1 Developmental Neurosciences Programme, UCL Institute of Child Health, London, United Kingdom.,2 Psychological Medicine Team, Department of Child and Adolescent Mental Health, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
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Termine C, Luoni C, Fontolan S, Selvini C, Perego L, Pavone F, Rossi G, Balottin U, Cavanna AE. Impact of co-morbid attention-deficit and hyperactivity disorder on cognitive function in male children with Tourette syndrome: A controlled study. Psychiatry Res 2016; 243:263-7. [PMID: 27423633 DOI: 10.1016/j.psychres.2016.06.048] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2016] [Revised: 04/18/2016] [Accepted: 06/26/2016] [Indexed: 11/30/2022]
Abstract
Tourette syndrome (TS) and attention-deficit and hyperactivity disorder (ADHD) are co-morbid neurodevelopmental conditions affecting more commonly male patients. We set out to determine the impact of co-morbid ADHD on cognitive function in male children with TS by conducting a controlled study. Participants included four matched groups of unmedicated children (age range 6-15 years): TS (n=13), TS+ADHD (n=8), ADHD (n=39), healthy controls (n=66). Following clinical assessment, each participant completed a battery of tests from the Wechsler Intelligence Scale for Children-III, the Italian Battery for ADHD, the Tower of London test, the Corsi test, and the Digit Span test. All patient groups reported significantly lower scores than healthy controls across the neuropsychological tests involving executive functions. The TS+ADHD group was the most severely affected, followed by the ADHD group and the TS group, particularly in the tests assessing planning ability, inhibitory function, working memory and visual attention, but not auditory attention. Problems in executive functions are more common in patients with neurodevelopmental disorders than controls. Deficits in planning ability, inhibitory function, working memory and visual attention reported by children with TS appear to be more strongly related to the presence of co-morbid ADHD symptoms than core TS symptoms.
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Affiliation(s)
- Cristiano Termine
- Child Neuropsychiatry Unit, Department of Experimental Medicine, University of Insubria, Varese, Italy; Child Neuropsychiatry Unit, Ospedale di Circolo & Macchi Foundation, Varese, Italy
| | - Chiara Luoni
- Child Neuropsychiatry Unit, Department of Experimental Medicine, University of Insubria, Varese, Italy
| | - Stefania Fontolan
- Child Neuropsychiatry Unit, Department of Experimental Medicine, University of Insubria, Varese, Italy
| | - Claudia Selvini
- Child Neuropsychiatry Unit, Department of Experimental Medicine, University of Insubria, Varese, Italy
| | - Livia Perego
- Child Neuropsychiatry Unit, Department of Experimental Medicine, University of Insubria, Varese, Italy
| | - Francesca Pavone
- Child Neuropsychiatry Unit, Ospedale di Circolo & Macchi Foundation, Varese, Italy
| | - Giorgio Rossi
- Child Neuropsychiatry Unit, Ospedale di Circolo & Macchi Foundation, Varese, Italy
| | - Umberto Balottin
- Department of Child Neurology and Psychiatry, IRCCS "C. Mondino" Foundation, University of Pavia, Italy
| | - Andrea E Cavanna
- Department of Neuropsychiatry, BSMHFT and University of Birmingham, United Kingdom; School of Life and Health Sciences, Aston University, Birmingham, United Kingdom; Sobell Department of Motor Neuroscience and Movement Disorders, UCL and Institute of Neurology, London, United Kingdom.
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Wong LC, Huang HL, Weng WC, Jong YJ, Yin YJ, Chen HA, Lee WT, Ho SY. Increased risk of epilepsy in children with Tourette syndrome: A population-based case-control study. RESEARCH IN DEVELOPMENTAL DISABILITIES 2016; 51-52:181-187. [PMID: 26597416 DOI: 10.1016/j.ridd.2015.10.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Revised: 10/07/2015] [Accepted: 10/10/2015] [Indexed: 06/05/2023]
Abstract
The association between epilepsy and Tourette syndrome has rarely been investigated. In this retrospective cohort study, we analyzed a dataset of 1,000,000 randomly sampled individuals from the Taiwan National Health Insurance Research Database to determine the risk of epilepsy in children with Tourette syndrome. The study cohort consisted of 1062 patients with Tourette syndrome aged ≤ 18 years, and the control group consisted of three times the number of age- and sex-matched patients without Tourette syndrome, who were insurants, from the same database during the same period. The Tourette syndrome group had an 18.38-fold increased risk of epilepsy than the control group [hazard ratio=18.38, 95% confidence interval (CI)=8.26-40.92; P<0.001]. Even after adjusting for the comorbidities, the risk of epilepsy in the Tourette syndrome group with comorbidities remained high (hazard ratio=16.27, 95% CI=6.26-18.46; P<0.001), indicating that the increased risk was not associated with comorbidities. This population-based retrospective cohort study provides the first and strong evidence that Tourette syndrome is associated with a higher risk of epilepsy. A close follow-up of children with Tourette syndrome for the development of epilepsy is warranted.
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Affiliation(s)
- Lee Chin Wong
- Department of Pediatrics, Min-Sheng General Hospital, Taoyuan, Taiwan
| | - Hui-Ling Huang
- Institute of Bioinformatics and Systems Biology, National Chiao Tung University, Hsinchu, Taiwan; Department of Biological Science and Technology, National Chiao Tung University, Hsinchu, Taiwan
| | - Wen-Chin Weng
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | - Yuh-Jyh Jong
- Department of Biological Science and Technology, National Chiao Tung University, Hsinchu, Taiwan
| | - Yun-Ju Yin
- Institute of Bioinformatics and Systems Biology, National Chiao Tung University, Hsinchu, Taiwan
| | - Hong-An Chen
- Institute of Bioinformatics and Systems Biology, National Chiao Tung University, Hsinchu, Taiwan
| | - Wang-Tso Lee
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan; Institute of Brain and Mind Sciences, National Taiwan University, Taipei, Taiwan.
| | - Shinn-Ying Ho
- Institute of Bioinformatics and Systems Biology, National Chiao Tung University, Hsinchu, Taiwan; Department of Biological Science and Technology, National Chiao Tung University, Hsinchu, Taiwan.
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Piedad JCP, Cavanna AE. Depression in Tourette syndrome: A controlled and comparison study. J Neurol Sci 2016; 364:128-32. [PMID: 27084230 DOI: 10.1016/j.jns.2016.03.030] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Revised: 03/08/2016] [Accepted: 03/18/2016] [Indexed: 01/22/2023]
Abstract
BACKGROUND Tourette syndrome (TS) is a neurodevelopmental condition characterised by multiple tics and co-morbid behavioural problems. Previous research found that up to 76% of patients with TS experience affective symptoms, with 13% fulfilling diagnostic criteria for depression. OBJECTIVES We aimed to assess the severity of depression and profile of depressive symptoms in adult patients with TS compared to patients with major depression and healthy controls. METHODS Depression ratings were collected from patients with TS (N=65) using the BDI-II and from patients with recurrent major depressive disorder (rMDD, N=696) and healthy controls (N=293) using the Beck Depression Inventory (BDI)-IA. Direct comparisons were possible for 14/21 BDI items. RESULTS Patients with TS scored significantly higher on the BDI than controls (P<0.001) and all individual symptoms were reported more frequently by patients with TS than by controls (P<0.001). Total BDI score in TS was not significantly different to that in rMDD, however irritability was significantly more frequently reported in the TS group and this remained significant after controlling for age and gender differences between the two groups (OR 5.24, 95% CI 1.97-14.00; P=0.001). CONCLUSIONS Our findings show that depression is a prominent feature in TS and may present with a more irritable phenotype than rMDD. Patients with TS should be routinely screened for depression to implement treatment as appropriate.
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Affiliation(s)
- John Carlo P Piedad
- Michael Trimble Neuropsychiatry Research Group, University of Birmingham & BSMHFT, Birmingham, UK
| | - Andrea E Cavanna
- Michael Trimble Neuropsychiatry Research Group, University of Birmingham & BSMHFT, Birmingham, UK; School of Life and Health Sciences, Aston University, Birmingham, UK; Sobell Department of Motor Neuroscience and Movement Disorders, University College London & Institute of Neurology, London, UK.
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Balottin L, Selvini C, Luoni C, Mannarini S, Chiappedi M, Seri S, Termine C, Cavanna AE. Personality Profile of Male Adolescents With Tourette Syndrome: A Controlled Study. J Child Neurol 2016; 31:294-9. [PMID: 26078419 DOI: 10.1177/0883073815589762] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2015] [Accepted: 05/11/2015] [Indexed: 11/15/2022]
Abstract
Tourette syndrome is a neurodevelopmental disorder characterized by multiple tics and commonly associated with behavioral problems, especially obsessive-compulsive disorder and attention-deficit hyperactivity disorder (ADHD). The presence of specific personality traits has been documented in adult clinical populations with Tourette syndrome but has been underresearched in younger patients. We assessed the personality profiles of 17 male adolescents with Tourette syndrome and 51 age- and gender-matched healthy controls using the Minnesota Multiphasic Personality Inventory-Adolescent version, along with a standardized psychometric battery. All participants scored within the normal range across all Minnesota Multiphasic Personality Inventory-Adolescent version scales. Patients with Tourette syndrome scored significantly higher than healthy controls on the Obsessiveness Content Scale only (P = .046). Our findings indicate that younger male patients with Tourette syndrome do not report abnormal personality traits and have similar personality profiles to healthy peers, with the exception of obsessionality traits, which are likely to be related to the presence of comorbid obsessive compulsive symptoms rather than tics.
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Affiliation(s)
- Laura Balottin
- Department of Philosophy, Sociology, Education and Applied Psychology, Section of Applied Psychology, University of Padova, Padova, Italy
| | - Claudia Selvini
- Child Neuropsychiatry Unit, Department of Experimental Medicine, University of Insubria, Varese, Italy
| | - Chiara Luoni
- Child Neuropsychiatry Unit, Department of Experimental Medicine, University of Insubria, Varese, Italy
| | - Stefania Mannarini
- Department of Philosophy, Sociology, Education and Applied Psychology, Section of Applied Psychology, University of Padova, Padova, Italy
| | - Matteo Chiappedi
- Department of Child Neurology and Psychiatry, "C. Mondino" National Neurological Institute, Pavia, Italy
| | - Stefano Seri
- School of Life and Health Sciences, Aston University, Birmingham, United Kingdom
| | - Cristiano Termine
- Child Neuropsychiatry Unit, Department of Experimental Medicine, University of Insubria, Varese, Italy
| | - Andrea E Cavanna
- School of Life and Health Sciences, Aston University, Birmingham, United Kingdom Department of Neuropsychiatry, BSMHFT and University of Birmingham, Birmingham, United Kingdom Sobell Department of Motor Neuroscience and Movement Disorders, UCL and Institute of Neurology, London, United Kingdom
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Wolff N, Luehr I, Sender J, Ehrlich S, Schmidt-Samoa C, Dechent P, Roessner V. A DTI study on the corpus callosum of treatment-naïve boys with 'pure' Tourette syndrome. Psychiatry Res Neuroimaging 2016; 247:1-8. [PMID: 26747579 DOI: 10.1016/j.pscychresns.2015.12.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2015] [Revised: 11/19/2015] [Accepted: 12/17/2015] [Indexed: 10/22/2022]
Abstract
Disturbances in the corpus callosum (CC) indicating altered interhemispheric connectivity have been associated with Tourette syndrome (TS). The objective of the present study was to refine knowledge about interhemispheric connectivity in TS by analyzing four different diffusion tensor imaging (DTI) parameters in a very homogeneous group of treatment-naïve boys with pure TS in comparison to male healthy controls (HC). Fractional anisotropy (FA), radial diffusivity (RD), axial diffusivity (AD) and mean diffusivity (MD) of five CC-segments were assessed from DTI of 26 treatment-naïve boys with pure TS and 24 HC. We observed no group differences in both FA and RD. However, we found a significant effect for AD and a trend for MD, being both reduced in boys with TS in comparison to HC. Moreover, a negative correlation between AD and the Yale Global Tic Severity Scale total score was observed. Reduced AD of the CC in treatment-naïve boys with pure TS in comparison to HC may indicate that significant alterations in white matter microstructure of the CC contribute to tic symptomatology per se and seem not to be related to confounders such as consequences of long-term medication, tic performance or tic suppression.
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Affiliation(s)
- Nicole Wolff
- Department of Child and Adolescent Psychiatry, Faculty of Medicine Carl Gustav Carus, TU Dresden, Fetscherstrasse 74, 01307 Dresden, Germany.
| | - Ina Luehr
- Department of Child and Adolescent Psychiatry, Faculty of Medicine Carl Gustav Carus, TU Dresden, Fetscherstrasse 74, 01307 Dresden, Germany
| | - Jennifer Sender
- MR-Research in Neurology and Psychiatry, Department of Cognitive Neurology, University of Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany
| | - Stefan Ehrlich
- Department of Child and Adolescent Psychiatry, Faculty of Medicine Carl Gustav Carus, TU Dresden, Fetscherstrasse 74, 01307 Dresden, Germany
| | - Carsten Schmidt-Samoa
- MR-Research in Neurology and Psychiatry, Department of Cognitive Neurology, University of Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany
| | - Peter Dechent
- MR-Research in Neurology and Psychiatry, Department of Cognitive Neurology, University of Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany
| | - Veit Roessner
- Department of Child and Adolescent Psychiatry, Faculty of Medicine Carl Gustav Carus, TU Dresden, Fetscherstrasse 74, 01307 Dresden, Germany
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Zheng Y, Zhang ZJ, Han XM, Ding Y, Chen YY, Wang XF, Wei XW, Wang MJ, Cheng Y, Nie ZH, Zhao M, Zheng XX. A proprietary herbal medicine (5-Ling Granule) for Tourette syndrome: a randomized controlled trial. J Child Psychol Psychiatry 2016; 57:74-83. [PMID: 26072932 DOI: 10.1111/jcpp.12432] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/28/2015] [Indexed: 01/04/2023]
Abstract
BACKGROUND Tourette syndrome (TS) is a common tic disorder in children and adolescents. There is preliminary evidence that herbal medicine may possess the potential to treat tics. The purpose of this study was to formally evaluate the efficacy and safety of 5-Ling Granule (5-LGr), a proprietary polyherbal product, for the treatment of patients with TS in comparison with tiapride and placebo. METHODS In this multisite, double-blind, double-dummy, randomized, placebo-controlled trial, 603 patients with TS aged 5-18 years were randomly assigned to treatment with placebo (n = 117), tiapride (n = 123, 200-400 mg/day) or 5-LGr (n = 363, 15-22.5 g/day) for 8 weeks. The primary outcome was measured using the Yale Global Tic Severity Scale (YGTSS) and its subscales, total tic Score (TTS) and tic-related impairment. Incidence of adverse events was compared among the three groups. RESULTS While tics of all patients were reduced over time, 5-LGr and tiapride treatment produced significantly greater improvement on the YGTSS overall scale and subscale for TTS and impairment at endpoint than the placebo. Seventy-four percentage of patients in the 5-LGr arm and 68.3% in the tiapride arm had clinical response and these rates of response were significantly higher than those on placebo (44.0%, p < .001). The incidence of overall adverse events was significantly fewer for patients on placebo and 5-LGr compared to tiapride (11.2% and 13.8% vs. 26.0%, p = .002); in particular physical tiredness, dizziness and sleep disturbance. CONCLUSIONS The clinical efficacy of 5-LGr is comparable to tiapride in reducing tics. Its safety profile is better than tiapride. 5-LGr can be considered a safe and effective therapy for TS (Trial registration: www.clinicaltrials.gov: NCT01501695).
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Affiliation(s)
- Yi Zheng
- Beijing Institutes for Brain Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Zhang-Jin Zhang
- Beijing Institutes for Brain Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China.,School of Chinese Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Xin-Min Han
- Department of Pediatrics, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Ying Ding
- Department of Pediatrics, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, Henan, China
| | - Yu-Yan Chen
- Department of Pediatrics, The First Affiliated Hospital of Zhejiang University of Chinese Medicine, Hangzhou, Zhejiang, China
| | - Xue-Feng Wang
- Department of Pediatrics, The Affiliated Hospital of Liaoning University of Chinese Medicine, Shenyang, Liaoning, China
| | - Xiao-Wei Wei
- Department of Pediatrics, The First Affiliated Hospital of Tianjin University of Chinese Medicine, Tianjin, China
| | - Min-Jie Wang
- Department of Pediatrics, Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yan Cheng
- Department of Pediatrics, The Second Affiliated Hospital of Tianjin University of Chinese Medicine, Tianjin, China
| | | | - Min Zhao
- Tasly Pharmaceutical Company, Tianjin, China
| | - Xi-Xi Zheng
- Department of Internal Medicine, Peking Union Medical College (PUMC) Hospital, Chinese Academy of Medical Sciences, Beijing, China
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Hovik KT, Plessen KJ, Cavanna AE, Skogli EW, Andersen PN, Øie M. Cognition, Emotion and Behavior in Children with Tourette's Syndrome and Children with ADHD-Combined Subtype-A Two-Year Follow-Up Study. PLoS One 2015; 10:e0144874. [PMID: 26673612 PMCID: PMC4686049 DOI: 10.1371/journal.pone.0144874] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 11/24/2015] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE This two-year follow-up study investigates the course of and association among measures of cognitive control, focused attention, decision-making and symptom severity (anxiety, depression and behavior) in children and adolescents with Tourette's Syndrome (TS) or Attention-Deficit/Hyperactivity Disorder-Combined subtype (ADHD-C). METHOD 19 children with TS, 33 with ADHD-C, and 50 typically developing children (TDC) were examined with a battery of psychometric measures and rating forms at baseline and two-years later. RESULTS All three groups improved likewise in measures of cognitive control over time, whereas only the TDC improved in focused attention. The group of children with TS with comorbidities performed more similar to the children with ADHD-C in cognitive control at T1 and T2, whereas the children with TS without comorbidities performed more similar to the TDC in cognitive control at T1 and T2. In the decision-making task, the children with TS (with or without comorbidities) preferred a safer strategy in selecting advantageous choices than the children with ADHD-C and the TDC at T2. Children with TS and children with ADHD-C showed higher symptoms of anxiety and depression and more problems with emotional control compared with TDC at both time points. Finally, children with ADHD-C self-reported more depression symptoms than those with TS at both assessments. For the TS group, safer decision-making was related to better emotional control, and this relationship was stronger for the TS subgroup without comorbidities. CONCLUSION This study emphasizes the importance of addressing symptoms of anxiety and depression in children with TS or ADHD-C, identifying the effect of comorbidities in children with TS, and that children with TS or ADHD-C likely differ in their sensitivity to reinforcement contingencies.
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Affiliation(s)
- Kjell Tore Hovik
- Innlandet Hospital Trust, Division Mental Health Care, Lillehammer, Norway
- University of Oslo, Institute of Psychology, Oslo, Norway
| | - Kerstin J. Plessen
- Child and Adolescent Mental Health Centre, Capital Region Psychiatry, University of Copenhagen, Copenhagen, Denmark
- Institute for Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Andrea E. Cavanna
- Department of Neuropsychiatry, University of Birmingham and BSMHFT, Birmingham, United Kingdom
- School of Life and Health Sciences, Aston University, Birmingham, United Kingdom
- Sobell Department of Movement Disorders, Institute of Neurology, London, United Kingdom
| | | | - Per Normann Andersen
- Innlandet Hospital Trust, Division Mental Health Care, Lillehammer, Norway
- Lillehammer University College, Department of Education and Social Work, Lillehammer, Norway
| | - Merete Øie
- Innlandet Hospital Trust, Division Mental Health Care, Lillehammer, Norway
- University of Oslo, Institute of Psychology, Oslo, Norway
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Trillini MO, Müller-Vahl KR. Narcissistic vulnerability is a common cause for depression in patients with Gilles de la Tourette syndrome. Psychiatry Res 2015; 230:695-703. [PMID: 26548979 DOI: 10.1016/j.psychres.2015.10.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 10/01/2015] [Accepted: 10/28/2015] [Indexed: 12/11/2022]
Abstract
The aim of this study was to assess for the first time different dimensions of narcissistic self-regulation in a large cohort of adult patients with Gilles de la Tourette syndrome (GTS) (n=50). From preliminary studies it is suggested that narcissistic personality trait and disorder, respectively, are relatively uncommon and occur in only 6-10% of GTS patients. In this study we used the Narcissism Inventory (NI), a 163-items questionnaire that measures four different dimensions of narcissism. The main result was that the prevalence of narcissism strongly depends on the subtype of narcissism: while the vulnerable narcissism ("threatened self" and "hypochondriac self") was common, the "classic narcissistic self" (grandiose narcissism) was rare. From our data an association between comorbid depression and increased values of the "threatened self" and comorbid OCD with increased values of the "hypochondriac self" is suggested. Narcissism correlated positively with the personality domain neuroticism and had a significantly negative impact on patients' quality of life. Therefore it can be speculated that vulnerable narcissism is - among several others - one cause for depression in patients with GTS. These findings may open new psychotherapeutic perspectives in the treatment of depression in patients with GTS.
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Affiliation(s)
- Morounke O Trillini
- Clinic of Psychiatry, Socialpsychiatry and Psychotherapy Hannover Medical School, Germany
| | - Kirsten R Müller-Vahl
- Clinic of Psychiatry, Socialpsychiatry and Psychotherapy Hannover Medical School, Germany.
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