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Zhang A, Liu T, Xu J, Zhao Q, Wang X, Jiang Z, Liang S, Cui Y, Li Y. Treatment refractory Tourette syndrome in adolescents: Assessment and application of deep brain stimulation. Asian J Psychiatr 2024; 94:103948. [PMID: 38335642 DOI: 10.1016/j.ajp.2024.103948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 01/07/2024] [Accepted: 01/31/2024] [Indexed: 02/12/2024]
Affiliation(s)
- Anyi Zhang
- Department of Psychiatry, Beijing Children's Hospital, Capital Medical University, National Centre for Children's Health, Beijing, China
| | - Tinghong Liu
- Functional Neurosurgery Department, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Jinshan Xu
- Functional Neurosurgery Department, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Qing Zhao
- Department of Psychiatry, Beijing Children's Hospital, Capital Medical University, National Centre for Children's Health, Beijing, China
| | - Xianbin Wang
- Department of Psychiatry, Beijing Children's Hospital, Capital Medical University, National Centre for Children's Health, Beijing, China
| | - Zhongliang Jiang
- Department of Psychiatry, Beijing Children's Hospital, Capital Medical University, National Centre for Children's Health, Beijing, China
| | - Shuli Liang
- Functional Neurosurgery Department, Beijing Children's Hospital, Capital Medical University, Beijing, China.
| | - Yonghua Cui
- Department of Psychiatry, Beijing Children's Hospital, Capital Medical University, National Centre for Children's Health, Beijing, China.
| | - Ying Li
- Department of Psychiatry, Beijing Children's Hospital, Capital Medical University, National Centre for Children's Health, Beijing, China.
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Lee MY, Wang HS, Chen CJ. Psychosocial experiences in youth with Tourette syndrome: a systematic review and meta-synthesis. Eur Child Adolesc Psychiatry 2023:10.1007/s00787-023-02339-w. [PMID: 38129352 DOI: 10.1007/s00787-023-02339-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 11/28/2023] [Indexed: 12/23/2023]
Abstract
Suffering from Tourette syndrome (TS) disrupts the daily lives and interpersonal relationships of patients. The psychosocial experiences of young people with TS are not yet clear. The aim of the systematic review is to identify and synthesize the psychosocial experiences of young people with TS. A meta-synthesis was conducted. PubMed, EMBASE, Cumulative Index to Nursing and Allied Health Literature, Web of Science, and Chinese Electronic Periodical Services databases were searched for articles published from their inception to February 2023. This review followed the Joanna Briggs Institute's Guidelines for Systematic Reviews according to a previously developed protocol. We used the confidence of synthesized qualitative findings (ConQual) approach to evaluate the credibility and dependability of the synthesized findings. This review included 12 qualitative studies from Western and Asian countries published between 2005 and 2019, representing 190 young people with TS. We identified five synthesized findings: affliction by intractable TS, TS was negatively perceived in the social and cultural context, self-adjustment in response to social interaction, response to receiving various interventions, and positivity in promoting self-acceptance. The ConQual grade for each generated synthesized finding ranged from low to moderate. The psychosocial experiences of youths living with TS are unique and are influenced by their interpersonal relationships, social context, and cultural framework. The findings recommend that healthcare providers assist young people in developing personalized symptom management strategies and provide guidance and care that meets the needs of each individual.
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Affiliation(s)
- Mei-Yin Lee
- National Taipei University of Nursing and Health Sciences, Taipei, Taiwan.
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Vermilion JA, Bitsko RH, Danielson ML, Bonifacio KP, Dean SL, Hyman SL, Augustine EF, Mink JW, Morrison PE, Vierhile AE, Sulkes SB, van Wijngaarden E, Adams HR. Performance of a Tic Screening Tool (MOVeIT) in Comparison to Expert Clinician Assessment in a Developmental-Behavioral Pediatrics Clinic Sample. EVIDENCE-BASED PRACTICE IN CHILD AND ADOLESCENT MENTAL HEALTH 2023; 9:245-261. [PMID: 39109230 PMCID: PMC11299864 DOI: 10.1080/23794925.2023.2272948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/10/2024]
Abstract
Youth with intellectual and developmental disabilities typically have higher rates of tics and stereotypies compared to children with otherwise typical development. Differentiating between these two pediatric movement disorders can be challenging due to overlapping clinical features, but is relevant due to distinct treatment modalities. The current study evaluated sensitivity and specificity of a tic screening measure, the Motor or Vocal Inventory of Tics (MOVeIT) in a pediatric sample enriched for stereotypy and tics. Children (n=199, age 2-15 years old) receiving care in a developmental-behavioral pediatrics clinic underwent a gold-standard diagnostic assessment by a tic expert; these evaluations were compared to the MOVeIT. The MOVeIT demonstrated good sensitivity (89.8%) and relatively lower specificity (57.1%) compared to tic expert for detecting tics in the overall sample. Specificity of the MOVeIT to identify tics improved to 75% when excluding children with co-occurring stereotypy. For children with tics and co-occurring stereotypy, sensitivity remained high (91.9%) but specificity was low (39.1%). The area under the curve (AUC) value to detect tics on the MOVeIT compared to the tic expert gold standard was significantly higher for children without stereotypy (AUC=85.7%) than those with stereotypy (AUC=64.3%, p <0.01). Overall, the ability to detect tics was better in those without co-occurring stereotypy symptoms. Further work is needed to establish the utility of the MOVeIT in populations where there is a high likelihood of co-occurring tics and stereotypy and in general population settings. Accurate distinction between tics and stereotypy will guide choices for intervention and anticipatory guidance for families.
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Affiliation(s)
- Jennifer A. Vermilion
- Department of Neurology, Division of Child Neurology, University of Rochester Medical Center (URMC), Rochester, NY
| | - Rebecca H. Bitsko
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA
| | - Melissa L. Danielson
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA
| | | | - Shannon L. Dean
- Department of Neurology, Kennedy Krieger Institute, Baltimore, MD
| | - Susan L. Hyman
- Department of Pediatrics, Division of Developmental and Behavioral Pediatrics, University of Rochester Medical Center (URMC), Rochester, NY
| | - Erika F. Augustine
- Department of Neurology, Kennedy Krieger Institute, Baltimore, MD
- Clinical Trials Unit, Kennedy Krieger Institute, Baltimore, MD
| | - Jonathan W. Mink
- Department of Neurology, Division of Child Neurology, University of Rochester Medical Center (URMC), Rochester, NY
| | - Peter E. Morrison
- Department of Neurology, Movement Disorders Division, University of Rochester Medical Center (URMC), Rochester, NY
| | - Amy E. Vierhile
- Department of Neurology, Division of Child Neurology, University of Rochester Medical Center (URMC), Rochester, NY
| | - Stephen B. Sulkes
- Department of Pediatrics, Division of Developmental and Behavioral Pediatrics, University of Rochester Medical Center (URMC), Rochester, NY
| | - Edwin van Wijngaarden
- Department of Public Health Sciences, University of Rochester Medical Center (URMC), Rochester, NY
| | - Heather R. Adams
- Department of Neurology, Division of Child Neurology, University of Rochester Medical Center (URMC), Rochester, NY
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Farhat LC, Behling E, Landeros-Weisenberger A, Levine JLS, Macul Ferreira de Barros P, Wang Z, Bloch MH. Comparative efficacy, tolerability, and acceptability of pharmacological interventions for the treatment of children, adolescents, and young adults with Tourette's syndrome: a systematic review and network meta-analysis. THE LANCET. CHILD & ADOLESCENT HEALTH 2023; 7:112-126. [PMID: 36528030 DOI: 10.1016/s2352-4642(22)00316-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 10/24/2022] [Accepted: 10/25/2022] [Indexed: 12/16/2022]
Abstract
BACKGROUND In clinical practice guidelines there is no consensus about the medications that should be initially offered to children and young people with Tourette's syndrome. To provide a rigorous evidence base that could help guide decision making and guideline development, we aimed to compare the efficacy, tolerability, and acceptability of pharmacological interventions for Tourette's syndrome. METHODS For this systematic review and network meta-analysis, we searched the Cochrane Central Register of Controlled Trials, Embase, PsycINFO, PubMed, Web of Science, the WHO International Clinical Trials Registry Platform, and ClinicalTrials.gov, for published and unpublished studies from database inception to Nov 19, 2021. We included double-blind randomised controlled trials of any medication administered as a monotherapy for at least 1 week against another medication or placebo in children and adolescents (aged ≥4 years and ≤18 years), adults (>18 years), or both, diagnosed with Tourette's syndrome according to standardised criteria. We excluded studies that exclusively recruited participants with comorbid attention-deficit hyperactivity disorder or obsessive-compulsive disorder. The primary outcome was change in severity of tic symptoms (efficacy). Secondary outcomes were treatment discontinuations due to adverse events (tolerability) and for any reason (acceptability). Pharmacological interventions were examined considering medication categories and medications individually in separate analyses. Summary data were extracted and pooled with a random-effects network meta-analysis to calculate standardised mean differences for efficacy and odds ratios for tolerability and acceptability, with 95% CIs. The Confidence in Network Meta-Analysis (CINeMA) framework was used to assess the certainty of evidence. The protocol was pre-registered in PROSPERO (CRD42022296975). FINDINGS Of the 12 088 records identified through the database search, 88 records representing 39 randomised controlled trials were included in the network meta-analysis; these 39 randomised controlled trials comprised 4578 participants (mean age 11·8 [SD 4·5] years; 3676 [80·8%] male participants) and evaluated 23 individual medications distributed across six medication categories. When considering medication categories, first-generation (standardised mean difference [SMD] -0·65 [95% CI -0·79 to -0·51]; low certainty of evidence) and second-generation (-0·71 [-0·88 to -0·54]; moderate certainty of evidence) antipsychotic drugs, as well as α-2 agonists (-0·21 [-0·39 to -0·03]; moderate certainty of evidence), were more efficacious than placebo. First-generation and second-generation antipsychotic drugs did not differ from each other (SMD 0·06 [95% CI -0·14 to 0·25]; low certainty of evidence). However, both first-generation (SMD 0·44 [95% CI 0·21 to 0·66]) and second-generation (0·49 [0·25 to 0·74]) antipsychotic drugs outperformed α-2 agonists, with moderate certainty of evidence. Similar findings were observed when individual medications were considered: aripiprazole (SMD -0·60 [95% CI -0·83 to -0·38]), haloperidol (-0·51 [-0·88 to -0·14]), olanzapine (-0·83 [-1·49 to -0·18]), pimozide (-0·48 [-0·84 to -0·12]), risperidone (-0·66 [-0·98 to -0·34]), and clonidine (-0·20 [-0·37 to -0·02]) all outperformed placebo, with moderate certainty of evidence. Antipsychotic medications did not differ from each other, but there was low to very low certainty of evidence for these comparisons. However, aripiprazole (SMD -0·40 [95% CI -0·69 to -0·12]) and risperidone (-0·46 [-0·82 to -0·11]) outperformed clonidine, with moderate certainty of evidence. Heterogeneity or inconsistency only emerged for a few comparisons. In terms of tolerability and acceptability, there were no relevant findings for any of the efficacious medication categories or individual medications against each other or placebo, but there was low to very low certainty of evidence associated with these comparisons. INTERPRETATION Our analyses show that antipsychotic drugs are the most efficacious intervention for Tourette's syndrome, while α-2 agonists are also more efficacious than placebo and could be chosen by those who elect not to take antipsychotic drugs. Shared decision making about the degree of tic-related severity and distress or impairment, the trade-offs of efficacy and safety between antipsychotic drugs and α-2 agonists, and other highly relevant individual factors that could not be addressed in the present analysis, should guide the choice of medication for children and young people with Tourette's syndrome. FUNDING None.
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Affiliation(s)
- Luis C Farhat
- Child Study Center, Yale University School of Medicine, New Haven, CT, USA; Department of Psychiatry, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil; Department of Psychiatry, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Emily Behling
- Child Study Center, Yale University School of Medicine, New Haven, CT, USA
| | - Angeli Landeros-Weisenberger
- Child Study Center, Yale University School of Medicine, New Haven, CT, USA; Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Jessica L S Levine
- Child Study Center, Yale University School of Medicine, New Haven, CT, USA
| | | | - Ziyu Wang
- Child Study Center, Yale University School of Medicine, New Haven, CT, USA
| | - Michael H Bloch
- Child Study Center, Yale University School of Medicine, New Haven, CT, USA; Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.
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Peterson AL, Blount TH, Villarreal R, Raj JJ, McGuire JF. Relaxation training with and without Comprehensive Behavioral Intervention for Tics for Tourette's disorder: A multiple baseline across participants consecutive case series. J Behav Ther Exp Psychiatry 2022; 74:101692. [PMID: 34543803 DOI: 10.1016/j.jbtep.2021.101692] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 08/29/2021] [Accepted: 09/14/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND OBJECTIVES Behavioral therapies such as the Comprehensive Behavioral Intervention for Tics (CBIT) are recommended as the first-line treatment for Tourette's Disorder. This treatment approach is comprised of three central components: habit reversal training, functional assessment/intervention, and relaxation training. Despite its combined efficacy, the contribution of each therapeutic component in CBIT for reducing tic severity remains undetermined. The study evaluated the efficacy of relaxation training alone or alongside other CBIT components for reducing tic severity. METHODS In this multiple-baseline study, participants completed a baseline assessment (A), 4 weekly sessions of relaxation training followed by a posttreatment assessment (B), 8 weekly sessions of CBIT followed by a posttreatment assessment (C), and a 1 month posttreatment follow up assessment (D). Six participants (83% male) aged 10-18 with Tourette's Disorder completed study procedures. Primary outcomes of tic severity was the Yale Global Tic Severity Scale (YGTSS). RESULTS A repeated measures ANOVA revealed a significance reduction in tic severity over time (p = .010). While post-hoc tests revealed a moderate non-significant reduction in tic severity after relaxation training (d =.23), large significant reductions in tic severity were observed after the combined treatment of relaxation training and CBIT (d = 1.17) that were maintained at a 1-month follow-up visit (d = 1.53). LIMITATIONS Findings are limited by the small sample size. CONCLUSIONS While relaxation training is effective when included in conjunction with CBIT, relaxation training alone is not effective in reducing tic severity in patients with Tourette's Disorder.
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Affiliation(s)
- Alan L Peterson
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA; Research and Development Service, South Texas Veterans Health Care System, San Antonio, TX, USA; Department of Psychology, University of Texas at San Antonio, San Antonio, TX, USA.
| | - Tabatha H Blount
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Robert Villarreal
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Jeslina J Raj
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Joseph F McGuire
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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