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Miller-Fleming TW, Allos A, Gantz E, Yu D, Isaacs DA, Mathews CA, Scharf JM, Davis LK. Developing a phenotype risk score for tic disorders in a large, clinical biobank. Transl Psychiatry 2024; 14:311. [PMID: 39069519 DOI: 10.1038/s41398-024-03011-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 06/28/2024] [Accepted: 07/04/2024] [Indexed: 07/30/2024] Open
Abstract
Tics are a common feature of early-onset neurodevelopmental disorders, characterized by involuntary and repetitive movements or sounds. Despite affecting up to 2% of children and having a genetic contribution, the underlying causes remain poorly understood. In this study, we leverage dense phenotype information to identify features (i.e., symptoms and comorbid diagnoses) of tic disorders within the context of a clinical biobank. Using de-identified electronic health records (EHRs), we identified individuals with tic disorder diagnosis codes. We performed a phenome-wide association study (PheWAS) to identify the EHR features enriched in tic cases versus controls (n = 1406 and 7030; respectively) and found highly comorbid neuropsychiatric phenotypes, including: obsessive-compulsive disorder, attention-deficit/hyperactivity disorder, autism spectrum disorder, and anxiety (p < 7.396 × 10-5). These features (among others) were then used to generate a phenotype risk score (PheRS) for tic disorder, which was applied across an independent set of 90,051 individuals. A gold standard set of tic disorder cases identified by an EHR algorithm and confirmed by clinician chart review was then used to validate the tic disorder PheRS; the tic disorder PheRS was significantly higher among clinician-validated tic cases versus non-cases (p = 4.787 × 10-151; β = 1.68; SE = 0.06). Our findings provide support for the use of large-scale medical databases to better understand phenotypically complex and underdiagnosed conditions, such as tic disorders.
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Affiliation(s)
- Tyne W Miller-Fleming
- Vanderbilt Genetics Institute, Vanderbilt University Medical Center, TN, Nashville, USA.
- Division of Genetic Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Annmarie Allos
- Vanderbilt Genetics Institute, Vanderbilt University Medical Center, TN, Nashville, USA
- Department of Cognitive Science, Dartmouth College, Hanover, NH, USA
| | - Emily Gantz
- Department of Pediatric Neurology, Children's Hospital of Alabama, Birmingham, AL, USA
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Pediatrics, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA
| | - Dongmei Yu
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - David A Isaacs
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Pediatrics, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA
| | - Carol A Mathews
- Department of Psychiatry, Genetics Institute, Center for OCD, Anxiety and Related Disorders, University of Florida, Gainesville, FL, USA
| | - Jeremiah M Scharf
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Lea K Davis
- Vanderbilt Genetics Institute, Vanderbilt University Medical Center, TN, Nashville, USA.
- Division of Genetic Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
- Department of Biomedical Informatics, Vanderbilt University Medical Center, TN, Nashville, USA.
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, TN, Nashville, USA.
- Department of Molecular Physiology and Biophysics, Vanderbilt University, TN, Nashville, USA.
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Gagnon M, Singer I, Morand-Beaulieu S, O’Connor KP, Gauthier B, Woods DW, Blanchet P, Lavoie ME, Leclerc JB. Sex Differences in Youth with Chronic Tic Disorder and Tourette Syndrome: Evaluation of Tic Severity, Psychological Profiles, and Quality of Life. J Clin Med 2024; 13:2477. [PMID: 38731007 PMCID: PMC11084842 DOI: 10.3390/jcm13092477] [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: 03/20/2024] [Revised: 04/08/2024] [Accepted: 04/19/2024] [Indexed: 05/13/2024] Open
Abstract
Background: Tourette syndrome (TS) and Chronic Tic Disorder (CT) are neurodevelopmental conditions involving motor and/or phonic tics. Youth with tics may encounter feelings of isolation, diminished self-esteem and quality of life, and academic difficulties. A growing body of scientific literature suggests sex differences in youth with tics, but findings have been mixed so far. Because symptom severity peaks around puberty, understanding sex differences in tic manifestations and associated symptoms during this critical period is essential. Therefore, we aimed to assess sex differences related to tic symptoms, action planning styles, quality of life, and externalizing/internalizing symptoms in youth with tics. Methods: Our sample consisted of 66 youths with tics (19 girls) aged 7-14 (mean = 10 years). Youths were assessed with clinical interviews, as well as self- and parent-reported inventories evaluating tic symptoms, psychological profiles, and quality of life. Results: While no differences in tic symptoms were found, girls exhibited lower functional inflexibility, reduced overall functional planning effectiveness, and higher impairment in the psychological well-being subscale than boys. Additionally, girls had reduced general life satisfaction and social self-esteem. Boys reported more explosive outbursts, higher levels of hyperactivity, and more difficulties with self-concept. Conclusions: Our analyses suggested differences in several manifestations associated with tics. This introduces new perspectives that refine our understanding of sex differences. A better understanding of sex differences in tic disorders may eventually improve outcomes for all individuals living with these conditions.
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Affiliation(s)
- Méliza Gagnon
- Department of Psychology, Université du Québec à Montréal, Montreal, QC H2X 3P2, Canada; (I.S.); (S.M.-B.); (J.B.L.)
- Centre de Recherche du Centre Intégré Universitaire de Santé et de Services Sociaux (CIUSSS) du Nord-de-l’Île-de-Montréal, Montreal, QC H1E 1A4, Canada
- Centre de Recherche de l’Institut Universitaire en Santé Mentale de Montréal, Montreal, QC H1N 3V2, Canada (P.B.); (M.E.L.)
| | - Ilana Singer
- Department of Psychology, Université du Québec à Montréal, Montreal, QC H2X 3P2, Canada; (I.S.); (S.M.-B.); (J.B.L.)
- Centre de Recherche du Centre Intégré Universitaire de Santé et de Services Sociaux (CIUSSS) du Nord-de-l’Île-de-Montréal, Montreal, QC H1E 1A4, Canada
- Centre de Recherche de l’Institut Universitaire en Santé Mentale de Montréal, Montreal, QC H1N 3V2, Canada (P.B.); (M.E.L.)
| | - Simon Morand-Beaulieu
- Department of Psychology, Université du Québec à Montréal, Montreal, QC H2X 3P2, Canada; (I.S.); (S.M.-B.); (J.B.L.)
- Centre de Recherche du Centre Intégré Universitaire de Santé et de Services Sociaux (CIUSSS) du Nord-de-l’Île-de-Montréal, Montreal, QC H1E 1A4, Canada
- Centre de Recherche de l’Institut Universitaire en Santé Mentale de Montréal, Montreal, QC H1N 3V2, Canada (P.B.); (M.E.L.)
| | - Kieron P. O’Connor
- Centre de Recherche de l’Institut Universitaire en Santé Mentale de Montréal, Montreal, QC H1N 3V2, Canada (P.B.); (M.E.L.)
- Department of Psychology, Université de Montréal, Montreal, QC H2V 2S9, Canada;
| | - Bruno Gauthier
- Department of Psychology, Université de Montréal, Montreal, QC H2V 2S9, Canada;
| | - Douglas W. Woods
- Department of Psychology, Marquette University, Milwaukee, WI 53233, USA;
| | - Pierre Blanchet
- Centre de Recherche de l’Institut Universitaire en Santé Mentale de Montréal, Montreal, QC H1N 3V2, Canada (P.B.); (M.E.L.)
- Department of Stomatology, Université de Montréal, Montreal, QC H3T 1J4, Canada
| | - Marc E. Lavoie
- Centre de Recherche de l’Institut Universitaire en Santé Mentale de Montréal, Montreal, QC H1N 3V2, Canada (P.B.); (M.E.L.)
- Department of Social Sciences, Literature and Communication, Université TÉLUQ, Montreal, QC G1K 9H6, Canada
| | - Julie B. Leclerc
- Department of Psychology, Université du Québec à Montréal, Montreal, QC H2X 3P2, Canada; (I.S.); (S.M.-B.); (J.B.L.)
- Centre de Recherche du Centre Intégré Universitaire de Santé et de Services Sociaux (CIUSSS) du Nord-de-l’Île-de-Montréal, Montreal, QC H1E 1A4, Canada
- Centre de Recherche de l’Institut Universitaire en Santé Mentale de Montréal, Montreal, QC H1N 3V2, Canada (P.B.); (M.E.L.)
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Dy-Hollins ME, Chibnik LB, Tracy NA, Osiecki L, Budman CL, Cath DC, Grados MA, King RA, Gholson L, Rouleau GA, Sandor P, Singer HS, Sharma N, Mathews CA, Scharf J. Sex Differences in People with Tourette Syndrome and Persistent Motor or Vocal Tic Disorder in the Tourette Association of America International Consortium for Genetics Database. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.01.07.24300816. [PMID: 38260551 PMCID: PMC10802652 DOI: 10.1101/2024.01.07.24300816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
Background and Objective Tourette Syndrome (TS) and Persistent Motor or Vocal Tic Disorders (PMVT) are more prevalent in males (vs. females). Females with TS may have a delay in diagnosis, and more complex tic features (vs. males). With respect to comorbidities, obsessive-compulsive disorder (OCD) is more prevalent in females; attention-deficit hyperactivity disorder (ADHD) is more prevalent in males. Less is known about sex differences in PMVT. This study analyzes sex differences in outcomes among individuals with TS and PMVT in the Tourette Association of America International Consortium for Genetics dataset (TAAICG). Design/Methods Data from 2403 individuals (N=2109 TS; N=294 PMVT) from the TAAICG were analyzed to explore the relationship between sex and TS or PMVT outcomes: age at tic onset; age at diagnosis; time-to-diagnosis; tic severity; and comorbidity rates. Regression models were adjusted for age and family relationships to examine the impact of sex on outcomes. Results Females with TS (25.5% of the sample) had a later age of symptom onset (6.5±2.8 vs. 6.0±2.7; p=0.001), later age at diagnosis (13.3±11.2 vs. 10.7±8.1; p=0.0001), and a longer time-to-diagnosis [3 (1,7) vs. 2 (1,5), p=0.01] than males. The total Yale-Global Tic Severity Scale (YGTSS) was lower in females with TS (28.4±9.1 vs. 30.7±8.7); p<0.0001); OCD was slightly more prevalent in females (55% vs. 48.7%; p=0.01) although OCD severity did not differ by sex; ADHD was more prevalent in males (55.7% vs 38.9%; p<0.001). Females with TS had 0.46 lower odds of being diagnosed with TS (p<0.00001). Females with PMVT (42.9% of the sample) had an earlier age of symptom onset (7.9±3.3 vs. 8.9±3.7; p=0.05). Motor or vocal tic severity (YGTSS) was not significantly different. OCD, but not ADHD, was more prevalent in females (OCD: 41.9% vs. 22.2%; p<0.001: ADHD:16.5% vs 21.0%; p=0.4). Conclusion Females with TS are less likely to be formally diagnosed and have a later age of symptom onset, later age at diagnosis, longer time-to-diagnosis, higher prevalence of OCD, and lower prevalence of ADHD (vs. males). Females with PMVT have an earlier age of symptom onset, higher prevalence of OCD, but similar ADHD prevalence rates (vs. males). Females with TS and PMVT may be clinically different than males with TS. Future research is needed to understand differences longitudinally in TS and PMVT.
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Sapozhnikov Y, Vermilion J. Co-Occurring Anxiety in Youth with Tic Disorders: A Review. J Child Adolesc Psychopharmacol 2023; 33:402-408. [PMID: 37870770 DOI: 10.1089/cap.2022.0091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
Abstract
Objective: To review the current state of the literature regarding anxiety symptoms and anxiety disorders in chronic tic disorder (CTD). Results: We conducted a literature search on anxiety and tic disorders. Anxiety symptoms and anxiety disorders are common in youth with CTD, with ∼30%-50% of youth with CTD having at least one co-occurring anxiety disorder. Tics often improve by young adulthood but anxiety symptoms tend to persist, or worsen, over time. Anxiety and tics are closely related, but the exact nature of their relationship is poorly understood. We discuss some potential ways in which anxiety and tics are linked with an emphasis on the underlying brain circuitry involved. The relationship between anxiety and tics may be related to the premonitory urge. In addition, stress hormones may link anxiety and tics. Individuals with CTD have greater activation of their hypothalamic-pituitary-adrenal system in response to acute stress. We also review the impact of anxiety on youth with CTD and approaches to management of anxiety in youth. Conclusions: Anxiety is common in youth with CTD, is associated with more severe CTD, and can adversely affect a child's function. Thus, it is important to identify anxiety disorders in CTD and manage them appropriately.
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Affiliation(s)
- Yelizaveta Sapozhnikov
- Department of Neurology, University of Rochester Medical Center, Rochester, New York, USA
| | - Jennifer Vermilion
- Department of Neurology, University of Rochester Medical Center, Rochester, New York, USA
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Andersen K, Jensen I, Okkels KB, Skov L, Debes NM. Clarifying the Differences between Patients with Organic Tics and Functional Tic-Like Behaviors. Healthcare (Basel) 2023; 11:healthcare11101481. [PMID: 37239767 DOI: 10.3390/healthcare11101481] [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: 03/28/2023] [Revised: 05/02/2023] [Accepted: 05/17/2023] [Indexed: 05/28/2023] Open
Abstract
Due to the global increase in the number of patients with Functional Tic-Like Behaviors (FTLB), it has become increasingly important to find reliable differences between this patient group and patients with organic tics (OTs), which can be used in differential diagnosis. The purpose of this retrospective study was to critically examine both established and suggested differences between the patient groups. A total of 53 FTLB patients and 200 OT patients were included. Several findings from the current literature were replicated in this study: Compared to patients with OTs, patients with FTLB had significantly more complex tics, were older at symptom onset, were more likely to be female, and were less likely to have family members with tics. Furthermore, the study also revealed new differences between the groups: Patients with FTLB had significantly more family members with a psychiatric disorder, were more likely to have experienced an adverse psychosocial event immediately before symptom onset, and had significantly fewer simple tics. Finally, this study was unable to replicate the previously found differences in comorbidities between patients with OTs and FTLB. These findings could contribute significantly to the understanding of FTLB's etiology and to improve diagnosis, as including the presence of simple tics and comorbidities in the diagnostic criteria might be discussed in future studies.
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Affiliation(s)
- Kaja Andersen
- National Tourette Syndrome Clinic, Department of Pediatrics, Copenhagen University Hospital-Herlev and Gentofte, 2730 Herlev, Denmark
- Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Ida Jensen
- National Tourette Syndrome Clinic, Department of Pediatrics, Copenhagen University Hospital-Herlev and Gentofte, 2730 Herlev, Denmark
- Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Kirstine Birkebæk Okkels
- National Tourette Syndrome Clinic, Department of Pediatrics, Copenhagen University Hospital-Herlev and Gentofte, 2730 Herlev, Denmark
| | - Liselotte Skov
- National Tourette Syndrome Clinic, Department of Pediatrics, Copenhagen University Hospital-Herlev and Gentofte, 2730 Herlev, Denmark
| | - Nanette Mol Debes
- National Tourette Syndrome Clinic, Department of Pediatrics, Copenhagen University Hospital-Herlev and Gentofte, 2730 Herlev, Denmark
- Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark
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6
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Pringsheim T, Ganos C, Nilles C, Cavanna AE, Gilbert DL, Greenberg E, Hartmann A, Hedderly T, Heyman I, Liang H, Malaty I, Malik O, Debes NM, Vahl KM, Munchau A, Murphy T, Nagy P, Owen T, Rizzo R, Skov L, Stern J, Szejko N, Worbe Y, Martino D. European Society for the Study of Tourette Syndrome 2022 criteria for clinical diagnosis of functional tic-like behaviours: International consensus from experts in tic disorders. Eur J Neurol 2023; 30:902-910. [PMID: 36587367 DOI: 10.1111/ene.15672] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 11/23/2022] [Accepted: 12/17/2022] [Indexed: 01/02/2023]
Abstract
BACKGROUND AND PURPOSE In 2020, health professionals witnessed a dramatic increase in referrals of young people with rapid onset of severe tic-like behaviours. We assembled a working group to develop criteria for the clinical diagnosis of functional tic-like behaviours (FTLBs) to help neurologists, pediatricians, psychiatrists, and psychologists recognize and diagnose this condition. METHODS We used a formal consensus development process, using a multiround, web-based Delphi survey. The survey was based on an in-person discussion at the European Society for the Study of Tourette Syndrome (ESSTS) meeting in Lausanne in June 2022. Members of an invited group with extensive clinical experience working with patients with Tourette syndrome and FTLBs discussed potential clinical criteria for diagnosis of FTLBs. An initial set of criteria were developed based on common clinical experiences and review of the literature on FTLBs and revised through iterative discussions, resulting in the survey items for voting. RESULTS In total, 24 members of the working group were invited to participate in the Delphi process. We propose that there are three major criteria and two minor criteria to support the clinical diagnosis of FTLBs. A clinically definite diagnosis of FTLBs can be confirmed by the presence of all three major criteria. A clinically probable diagnosis of FTLBs can be confirmed by the presence of two major criteria and one minor criterion. CONCLUSIONS Distinguishing FTLBs from primary tics is important due to the distinct treatment paths required for these two conditions. A limitation of the ESSTS 2022 criteria is that they lack prospective testing of their sensitivity and specificity.
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Affiliation(s)
- Tamara Pringsheim
- Department of Clinical Neurosciences, Psychiatry, Pediatrics, and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Christos Ganos
- Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Christelle Nilles
- Department of Clinical Neurosciences, Psychiatry, Pediatrics, and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Andrea E Cavanna
- Department of Neuropsychiatry, Birmingham and Solihull Mental Health National Health Service Foundation Trust and University of Birmingham, Birmingham, UK
- School of Life and Health Sciences, Aston University, Birmingham, UK
- School of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy
| | - Donald L Gilbert
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Erica Greenberg
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Andreas Hartmann
- National Reference Centre for Tourette Syndrome, Public Assistance Hospitals of Paris, Pitié-Salpêtrière Hospital Group, Paris, France
| | - Tammy Hedderly
- Evelina London Childrens Hospital, Guys and St Thomas Trust and Kings College London, London, UK
| | - Isobel Heyman
- UCL Great Ormond Street Institute of Child Health, London, UK
| | - Holan Liang
- UCL Great Ormond Street Institute of Child Health, London, UK
| | - Irene Malaty
- Department of Neurology, Fixel Institute for Neurological Diseases, University of Florida, Gainesville, Florida, USA
| | - Osman Malik
- Department of Children's Neuroscience, Evelina London Children's Hospital, Guys and St Thomas National Health Service Trust and South London and Maudsley National Health Service Trust, London, UK
| | - Nanette Mol Debes
- Copenhagen University Hospital-Herlev and Gentofte, Herlev, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Kirsten Muller Vahl
- Department of Psychiatry, Social Psychiatry, and Psychotherapy, Hanover Medical School, Hanover, Germany
| | - Alexander Munchau
- Institute of Systems Motor Science, University of Lübeck, Lübeck, Germany
| | - Tara Murphy
- UCL Great Ormond Street Institute of Child Health, London, UK
| | - Peter Nagy
- Division of Neurodevelopmental Disorders, Bethesda Children's Hospital, Budapest, Hungary
| | - Tamsin Owen
- Evelina London Childrens Hospital, Guys and St Thomas Trust and Kings College London, London, UK
| | - Renata Rizzo
- Child and Adolescent Neurology and Psychiatry, Department of Clinical and Experimental Medicine, Catania University, Catania, Italy
| | - Liselotte Skov
- Department of Paediatrics, Copenhagen University Hospital-Herlev and Gentofte, Herlev, Denmark
| | - Jeremy Stern
- Department of Neurology, St George's, University of London, London, UK
| | - Natalia Szejko
- Department of Neurology, Department of Bioethics, Medical University of Warsaw, Warsaw, Poland
| | - Yulia Worbe
- Department of Neurophysiology, Assistance Publique-Hopitaux de Paris.6-Pitié-Salpêtrière and Saint Antoine Hospitals, Sorbonne University, Paris, France
| | - Davide Martino
- Department of Clinical Neurosciences, Psychiatry, Pediatrics, and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
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Haltigan JD, Pringsheim TM, Rajkumar G. Social media as an incubator of personality and behavioral psychopathology: Symptom and disorder authenticity or psychosomatic social contagion? Compr Psychiatry 2023; 121:152362. [PMID: 36571927 DOI: 10.1016/j.comppsych.2022.152362] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 12/08/2022] [Accepted: 12/11/2022] [Indexed: 12/14/2022] Open
Abstract
There has been an increasing recognition among both medical and psychological professionals, as well as the public media, of a concerning trend for child and adolescent users of audiovisual-based, algorithmic social media platforms (e.g., TikTok) to present with or claim functional psychiatric impairment that is inconsistent with or distinct from classic psychiatric nosology. In this short communication, we provide a detailed historical overview of this transdiagnostic phenomenon and suggest a conceptual model to organize thinking and research examining it. We then discuss the implications of our suggested model for accurate assessment, diagnosis, and medical-psychiatric treatment. We believe there is an urgent need for focused empirical research investigation into this concerning phenomenon that is related to the broader research and discourse examining social media influences on mental health.
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Affiliation(s)
- John D Haltigan
- Department of Psychiatry, University of Toronto, Canada; Child & Youth Psychiatry, the Centre for Addiction and Mental Health, Canada.
| | - Tamara M Pringsheim
- Department of Clinical Neurosciences, Psychiatry, Pediatrics and Community Health Sciences, University of Calgary, Program Lead, Tourette and Pediatric Movement Disorders, Canada
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8
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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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Ricketts EJ, Woods DW, Espil FM, McGuire JF, Stiede JT, Schild J, Yadegar M, Bennett SM, Specht MW, Chang S, Scahill L, Wilhelm S, Peterson AL, Walkup JT, Piacentini J. Childhood Predictors of Long-Term Tic Severity and Tic Impairment in Tourette's Disorder. Behav Ther 2022; 53:1250-1264. [PMID: 36229120 PMCID: PMC9872160 DOI: 10.1016/j.beth.2022.07.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 05/29/2022] [Accepted: 07/07/2022] [Indexed: 01/26/2023]
Abstract
Tics peak in late childhood and decline during adolescence. Yet, for some with Tourette's disorder, tics persist into adulthood. We evaluated childhood predictors of adult tic severity and tic impairment, and change over time. Eighty adolescents/adults were evaluated 11 years following a randomized-controlled trial of behavior therapy. An independent evaluator rated tic severity and tic impairment at baseline, posttreatment, and long-term follow-up. At baseline, parents completed demographics/medical history, and youth tic, internalizing, and externalizing symptom ratings. Youth rated premonitory urge severity and family functioning. After controlling for prior tic treatment effects, female sex and higher tic severity predicted higher tic severity in adulthood; and female sex, no stimulant medication use, higher tic severity, and poorer family functioning predicted higher tic impairment. Higher tic severity and premonitory urge severity predicted smaller reductions in tic severity, whereas higher externalizing symptoms predicted greater reduction in tic severity. Female sex predicted smaller reduction in tic impairment, and externalizing symptoms predicted greater reduction in tic impairment. Female sex and childhood tic severity are important predictors of tic severity and tic impairment in adulthood. Family functioning, premonitory urge severity, and tic severity are important modifiable targets for early or targeted intervention to improve long-term outcomes.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - John T Walkup
- Ann and Robert H. Lurie Children's Hospital of Chicago; Northwestern University Feinberg School of Medicine
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Martindale JM, Mink JW. The Rise of Functional Tic-Like Behaviors: What Do the COVID-19 Pandemic and Social Media Have to Do With It? A Narrative Review. Front Pediatr 2022; 10:863919. [PMID: 35899132 PMCID: PMC9309505 DOI: 10.3389/fped.2022.863919] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 06/24/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND There has been a rise in explosive onset of tic-like behaviors during the COVID-19 pandemic. Historically, this is an uncommon phenomenology of functional movement disorders across all ages. Both the psychological burden of the pandemic and social media usage have been implicated in the rise of these tic-like behaviors. METHODS This paper provides a narrative review of the literature on chronic tic disorders, functional tics, and mass functional illness with particular focus on the key distinguishing features, role of social media, and the role of COVID-19. RESULTS The COVID-19 pandemic has profoundly affected the mental health of many individuals, including children, adolescents, and their caregivers. Implementation of lockdowns, lifestyle disruptions, school closures, and social distancing have driven a surge in social media and digital technology use. The combination of predisposing factors, the psychological burden of the COVID-19 pandemic, and social media are implicated in the rise and spread of tic-like behaviors; which may represent a modern-day form of mass functional illness. While many of the features overlap with functional tics, there are emerging distinctive features that are important to recognize. A more encompassing term, Functional Tic-Like Behaviors, is used to better reflect multiple contributing factors. CONCLUSION Knowledge of these differences is essential to mitigate downstream health effects and poor outcomes.
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Affiliation(s)
- Jaclyn M Martindale
- Department of Neurology, Wake Forest University School of Medicine, Atrium Health Wake Forest Baptist, Winston-Salem, NC, United States
| | - Jonathan W Mink
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, United States
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