1
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Skromanis S, Padgett C, Matthewson M, Honan CA. Social disinhibition in acquired brain injury and neurological disease: a concept analysis. BRAIN IMPAIR 2023; 24:529-547. [PMID: 38167359 DOI: 10.1017/brimp.2022.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Social disinhibition is becoming increasingly recognised in the neuropsychological literature as a complex and debilitating sequalae associated with acquired frontal lobe damage. Despite this, the term has been inconsistently defined and described in both clinical and research contexts. The purpose of this paper was to explore and examine the concept of social disinhibition in the context of brain injury and other organic neurological conditions. METHOD A literature search for articles published in the English language from journal inception to June 2021 was conducted using MEDLINE, PsycInfo, Embase, CINAHL and Web of Science. A 'concept analysis' was conducted on the identified literature using Walker & Avant's (2019) framework. RESULTS The analysis suggested that while several terms are often used interchangeably with social disinhibition, including impulsivity and behavioural dysregulation, these terms may be differentiated and defined separately within the broader domain of 'behaviours of concern'. Attributes, antecedents and consequences of social disinhibition were also identified and discussed. CONCLUSIONS Clarifying the concept of social disinhibition has important implications in both clinical and research contexts, including increased understanding of the behaviours, more accurate estimates of incidence and prevalence, and the development and implementation of targeted rehabilitation programmes.
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Affiliation(s)
- Sarah Skromanis
- School of Psychological Sciences, University of Tasmania, Launceston, Australia
| | - Christine Padgett
- School of Psychological Sciences, University of Tasmania, Hobart, Australia
| | - Mandy Matthewson
- School of Psychological Sciences, University of Tasmania, Hobart, Australia
| | - Cynthia A Honan
- School of Psychological Sciences, University of Tasmania, Launceston, Australia
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2
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Claudio-Campos K, Stevens D, Koo SW, Valko A, Bienvenu OJ, Budman CB, Cath DC, Darrow S, Geller D, Goes FS, Grados MA, Greenberg BD, Greenberg E, Hirschtritt ME, Illmann C, Ivankovic F, King RA, Knowles JA, Krasnow J, Lee PC, Lyon GJ, McCracken JT, Robertson MM, Osiecki L, Riddle MA, Rouleau G, Sandor P, Nestadt G, Samuels J, Scharf JM, Mathews CA. Is Persistent Motor or Vocal Tic Disorder a Milder Form of Tourette Syndrome? Mov Disord 2021; 36:1899-1910. [PMID: 33942911 PMCID: PMC8453968 DOI: 10.1002/mds.28593] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 01/28/2021] [Accepted: 03/05/2021] [Indexed: 01/04/2023] Open
Abstract
Background Persistent motor or vocal tic disorder (PMVT) has been hypothesized to be a forme fruste of Tourette syndrome (TS). Although the primary diagnostic criterion for PMVT (presence of motor or vocal tics, but not both) is clear, less is known about its clinical presentation. Objective The goals of this study were to compare the prevalence and number of comorbid psychiatric disorders, tic severity, age at tic onset, and family history for TS and PMVT. Methods We analyzed data from two independent cohorts using generalized linear equations and confirmed our findings using meta‐analyses, incorporating data from previously published literature. Results Rates of obsessive–compulsive disorder (OCD) and attention deficit hyperactivity disorder (ADHD) were lower in PMVT than in TS in all analyses. Other psychiatric comorbidities occurred with similar frequencies in PMVT and TS in both cohorts, although meta‐analyses suggested lower rates of most psychiatric disorders in PMVT compared with TS. ADHD and OCD increased the odds of comorbid mood, anxiety, substance use, and disruptive behaviors, and accounted for observed differences between PMVT and TS. Age of tic onset was approximately 2 years later, and tic severity was lower in PMVT than in TS. First‐degree relatives had elevated rates of TS, PMVT, OCD, and ADHD compared with population prevalences, with rates of TS equal to or greater than PMVT rates. Conclusions Our findings support the hypothesis that PMVT and TS occur along a clinical spectrum in which TS is a more severe and PMVT a less severe manifestation of a continuous neurodevelopmental tic spectrum disorder. © 2021 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society
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Affiliation(s)
- Karla Claudio-Campos
- Department of Pharmacotherapy and Translational Research, University of Florida College of Pharmacy, Gainesville, Florida, USA.,Department of Psychiatry, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Daniel Stevens
- Department of Psychiatry and Behavioral Sciences Baltimore, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Sang-Wahn Koo
- Department of Psychiatry, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Alexa Valko
- Department of Psychiatry, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Oscar Joseph Bienvenu
- Department of Psychiatry and Behavioral Sciences Baltimore, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Cathy B Budman
- Department of Psychiatry, Zucker School of Medicine, Hempstead, New York, USA
| | - Danielle C Cath
- Department of Psychiatry, University of Groningen, Groningen, the Netherlands.,Department of Specialized Trainings, GGZ Drenthe Mental Health Institute, University Medical Center, Assen, the Netherlands
| | - Sabrina Darrow
- School of Medicine, University of California, San Francisco, San Francisco, California, USA.,Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, USA
| | - Daniel Geller
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Fernando S Goes
- Department of Psychiatry and Behavioral Sciences Baltimore, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Marco A Grados
- Department of Psychiatry and Behavioral Sciences Baltimore, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Benjamin D Greenberg
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Butler Hospital, and Providence VA Medical Center, Providence, Rhode Island, USA
| | - Erica Greenberg
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA.,Department of Psychiatry, Psychiatric and Neurodevelopmental Genetics Unit, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Matthew E Hirschtritt
- Department of Specialized Trainings, GGZ Drenthe Mental Health Institute, University Medical Center, Assen, the Netherlands
| | - Cornelia Illmann
- Department of Psychiatry, Psychiatric and Neurodevelopmental Genetics Unit, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Franjo Ivankovic
- Department of Psychiatry and Genetics Institute, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Robert A King
- Yale Child Study Center and Department of Genetics, Yale University School of Medicine, New Haven, Connecticut, USA
| | - James A Knowles
- Department of Cell Biology, SUNY Downstate Medical Center College of Medicine, Brooklyn, New York, USA
| | - Janice Krasnow
- Department of Psychiatry and Behavioral Sciences Baltimore, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Paul C Lee
- Department of Behavioral Health, Tripler Army Medical Center, Honolulu, Hawaii, USA
| | - Gholson J Lyon
- Division of Human Genetics, Institute for Basic Research in Developmental Disabilities (IBR), Staten Island, New York, USA.,Biology PhD Program, The Graduate Center, The City University of New York, New York, New York, USA
| | - James T McCracken
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles School of Medicine, Los Angeles, California, USA
| | - Mary M Robertson
- Department of Psychiatry, University College of London, London, United Kingdom
| | - Lisa Osiecki
- Yale Child Study Center and Department of Genetics, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Mark A Riddle
- Department of Psychiatry and Behavioral Sciences Baltimore, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Guy Rouleau
- Department of Neurology and Neurosurgery, Montreal Neurological Institute-Hospital, McGill University, Montreal, Quebec, Canada
| | - Paul Sandor
- Department of Psychiatry, University of Toronto and University Health Network, Toronto, Ontario, Canada
| | - Gerald Nestadt
- Department of Psychiatry and Behavioral Sciences Baltimore, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jack Samuels
- Department of Psychiatry and Behavioral Sciences Baltimore, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jeremiah M Scharf
- Department of Psychiatry, Psychiatric and Neurodevelopmental Genetics Unit, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Carol A Mathews
- Department of Psychiatry and Genetics Institute, University of Florida College of Medicine, Gainesville, Florida, USA
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3
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Szejko N, Lombroso A, Bloch MH, Landeros-Weisenberger A, Leckman JF. Refractory Gilles de la Tourette Syndrome-Many Pieces That Define the Puzzle. Front Neurol 2020; 11:589511. [PMID: 33391155 PMCID: PMC7775596 DOI: 10.3389/fneur.2020.589511] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 11/20/2020] [Indexed: 12/27/2022] Open
Abstract
Gilles de la Tourette syndrome (GTS) is a childhood onset neuropsychiatric disorder characterized by the presence of motor and vocal tics. The clinical spectrum of GTS is heterogeneous and varies from mild cases that do not require any medical attention to cases that are refractory to standard treatments. One of the unresolved issues is the definition of what constitutes treatment-refractory GTS. While for some other neuropsychiatric disorders, such as obsessive-compulsive disorder (OCD), a clear definition has been established, there is still no consensus with regard to GTS. One important issue is that many individuals with GTS also meet criteria for one or more other neurodevelopmental and neuropsychiatric disorders. In many individuals, the severity of these comorbid conditions contributes to the degree to which GTS is treatment refractory. The scope of this paper is to present the current state-of-the-art regarding refractory GTS and indicate possible approaches to define it. In closing, we discuss promising approaches to the treatment of individuals with refractory GTS.
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Affiliation(s)
- Natalia Szejko
- Division of Neurocritical Care & Emergency Neurology, Department of Neurology, Yale School of Medicine, New Haven, CT, United States.,Department of Neurology, Medical University of Warsaw, Warsaw, Poland.,Department of Bioethics, Medical University of Warsaw, Warsaw, Poland
| | - Adam Lombroso
- Child Study Center, Departments of Psychiatry, Pediatrics and Psychology, Yale University, New Haven, CT, United States
| | - Michael H Bloch
- Child Study Center, Departments of Psychiatry, Pediatrics and Psychology, Yale University, New Haven, CT, United States
| | - Angeli Landeros-Weisenberger
- Child Study Center, Departments of Psychiatry, Pediatrics and Psychology, Yale University, New Haven, CT, United States
| | - James F Leckman
- Child Study Center, Departments of Psychiatry, Pediatrics and Psychology, Yale University, New Haven, CT, United States
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4
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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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5
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Kurvits L, Martino D, Ganos C. Clinical Features That Evoke the Concept of Disinhibition in Tourette Syndrome. Front Psychiatry 2020; 11:21. [PMID: 32161555 PMCID: PMC7053490 DOI: 10.3389/fpsyt.2020.00021] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 01/09/2020] [Indexed: 01/14/2023] Open
Abstract
The capacity to efficiently control motor output, by either refraining from prepotent actions or disengaging from ongoing motor behaviors, is necessary for our ability to thrive in a stimulus-rich and socially complex environment. Failure to engage in successful inhibitory motor control could lead to aberrant behaviors typified by an excess of motor performance. In tic disorders and Tourette syndrome (TS) - the most common tic disorder encountered in clinics - surplus motor output is rarely the only relevant clinical sign. A range of abnormal behaviors is often encountered which are historically viewed as "disinhibition phenomena". Here, we present the different clinical features of TS from distinct categorical domains (motor, sensory, complex behavioral) that evoke the concept of disinhibition and discuss their associations. We also present evidence for their consideration as phenomena of inhibitory dysfunction and provide an overview of studies on TS pathophysiology which support this view. We then critically dissect the concept of disinhibition in TS and illuminate other salient aspects, which should be considered in a unitary pathophysiological approach. We briefly touch upon the dangers of oversimplification and emphasize the necessity of conceptual diversity in the scientific exploration of TS, from disinhibition and beyond.
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Affiliation(s)
- Lille Kurvits
- Department of Neurology, Charité University Hospital, Berlin, Germany
| | - Davide Martino
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Christos Ganos
- Department of Neurology, Charité University Hospital, Berlin, Germany
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6
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Brandt V, Kerner auch Koerner J, Palmer-Cooper E. The Association of Non-obscene Socially Inappropriate Behavior With Attention-Deficit/Hyperactivity Disorder Symptoms, Conduct Problems, and Risky Decision Making in a Large Sample of Adolescents. Front Psychiatry 2019; 10:660. [PMID: 31572240 PMCID: PMC6753840 DOI: 10.3389/fpsyt.2019.00660] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 08/15/2019] [Indexed: 11/28/2022] Open
Abstract
Non-obscene socially inappropriate behavior (NOSI) is recognized as part of the tic disorder spectrum but has received little attention from researchers to date. A study in 87 patients with Tourette syndrome showed that comorbid attention-deficit/hyperactivity disorder (ADHD) and conduct disorder were also associated with an increase in socially inappropriate behavior. This study used data from the Millennium Cohort Study to investigate the relationship between NOSI and emotional symptoms, conduct problems, and hyperactivity/inattention as assessed by the Strengths and Difficulties Questionnaire (SDQ) in 1,280 youths, aged 14 years. Furthermore, the relationship between NOSI and decision-making processes as assessed by the Cambridge Gambling Task (CGT) was investigated. Hyperactivity/inattention and conduct problems were significantly associated with NOSI; emotional problems were not. Risk taking was significantly associated with misbehaving in lessons but not with being rude or noisy in public. The results replicate and confirm the association of NOSI with ADHD and conduct problems in a large sample, although it should be stressed that the size of the association was small. The results also suggest that some inappropriate behaviors are related to risk-taking behavior, while others are not.
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Affiliation(s)
- Valerie Brandt
- Department of Psychology, Centre for Innovation in Mental Health, University of Southampton, Southampton, United Kingdom
| | - Julia Kerner auch Koerner
- Educational Psychology, Helmut-Schmidt-University, Hamburg, Germany
- Center for Individual Development and Adaptive Education of Children at Risk (IDeA), Frankfurt am Main, Germany
| | - Emma Palmer-Cooper
- Department of Psychology, Centre for Innovation in Mental Health, University of Southampton, Southampton, United Kingdom
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7
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Mufford M, Cheung J, Jahanshad N, van der Merwe C, Ding L, Groenewold N, Koen N, Chimusa ER, Dalvie S, Ramesar R, Knowles JA, Lochner C, Hibar DP, Paschou P, van den Heuvel OA, Medland SE, Scharf JM, Mathews CA, Thompson PM, Stein DJ. Concordance of genetic variation that increases risk for tourette syndrome and that influences its underlying neurocircuitry. Transl Psychiatry 2019; 9:120. [PMID: 30902966 PMCID: PMC6430767 DOI: 10.1038/s41398-019-0452-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 02/13/2019] [Accepted: 02/16/2019] [Indexed: 01/18/2023] Open
Abstract
There have been considerable recent advances in understanding the genetic architecture of Tourette syndrome (TS) as well as its underlying neurocircuitry. However, the mechanisms by which genetic variation that increases risk for TS-and its main symptom dimensions-influence relevant brain regions are poorly understood. Here we undertook a genome-wide investigation of the overlap between TS genetic risk and genetic influences on the volume of specific subcortical brain structures that have been implicated in TS. We obtained summary statistics for the most recent TS genome-wide association study (GWAS) from the TS Psychiatric Genomics Consortium Working Group (4644 cases and 8695 controls) and GWAS of subcortical volumes from the ENIGMA consortium (30,717 individuals). We also undertook analyses using GWAS summary statistics of key symptom factors in TS, namely social disinhibition and symmetry behaviour. SNP effect concordance analysis (SECA) was used to examine genetic pleiotropy-the same SNP affecting two traits-and concordance-the agreement in single nucelotide polymorphism (SNP) effect directions across these two traits. In addition, a conditional false discovery rate (FDR) analysis was performed, conditioning the TS risk variants on each of the seven subcortical and the intracranial brain volume GWAS. Linkage disequilibrium score regression (LDSR) was used as validation of the SECA method. SECA revealed significant pleiotropy between TS and putamen (p = 2 × 10-4) and caudate (p = 4 × 10-4) volumes, independent of direction of effect, and significant concordance between TS and lower thalamic volume (p = 1 × 10-3). LDSR lent additional support for the association between TS and thalamus volume (p = 5.85 × 10-2). Furthermore, SECA revealed significant evidence of concordance between the social disinhibition symptom dimension and lower thalamus volume (p = 1 × 10-3), as well as concordance between symmetry behaviour and greater putamen volume (p = 7 × 10-4). Conditional FDR analysis further revealed novel variants significantly associated with TS (p < 8 × 10-7) when conditioning on intracranial (rs2708146, q = 0.046; and rs72853320, q = 0.035) and hippocampal (rs1922786, q = 0.001) volumes, respectively. These data indicate concordance for genetic variation involved in disorder risk and subcortical brain volumes in TS. Further work with larger samples is needed to fully delineate the genetic architecture of these disorders and their underlying neurocircuitry.
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Affiliation(s)
- Mary Mufford
- 0000 0004 1937 1151grid.7836.aHuman Genetics Research Unit, Division of Human Genetics, Department of Pathology, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Josh Cheung
- 0000 0001 2156 6853grid.42505.36Imaging Genetics Center, Mark and Mary Stevens Neuroimaging & Informatics Institute, Keck School of Medicine of the University of Southern California, Los Angeles, CA USA
| | - Neda Jahanshad
- 0000 0001 2156 6853grid.42505.36Imaging Genetics Center, Mark and Mary Stevens Neuroimaging & Informatics Institute, Keck School of Medicine of the University of Southern California, Los Angeles, CA USA
| | - Celia van der Merwe
- 0000 0004 1937 1151grid.7836.aHuman Genetics Research Unit, Division of Human Genetics, Department of Pathology, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Linda Ding
- 0000 0001 2156 6853grid.42505.36Imaging Genetics Center, Mark and Mary Stevens Neuroimaging & Informatics Institute, Keck School of Medicine of the University of Southern California, Los Angeles, CA USA
| | - Nynke Groenewold
- 0000 0004 1937 1151grid.7836.aDepartment of Psychiatry and MRC Unit on Risk & Resilience, University of Cape Town, Cape Town, South Africa
| | - Nastassja Koen
- 0000 0004 1937 1151grid.7836.aDepartment of Psychiatry and MRC Unit on Risk & Resilience, University of Cape Town, Cape Town, South Africa ,0000 0004 0635 1506grid.413335.3Groote Schuur Hospital and Neuroscience Institute, Cape Town, South Africa
| | - Emile R. Chimusa
- 0000 0004 1937 1151grid.7836.aHuman Genetics Research Unit, Division of Human Genetics, Department of Pathology, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Shareefa Dalvie
- 0000 0004 1937 1151grid.7836.aDepartment of Psychiatry and MRC Unit on Risk & Resilience, University of Cape Town, Cape Town, South Africa ,0000 0004 0635 1506grid.413335.3Groote Schuur Hospital and Neuroscience Institute, Cape Town, South Africa
| | - Raj Ramesar
- 0000 0004 1937 1151grid.7836.aHuman Genetics Research Unit, Division of Human Genetics, Department of Pathology, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - James A. Knowles
- 0000 0001 2156 6853grid.42505.36Department of Psychiatry and the Behavioural Sciences, Zilkha Neurogenetic Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA USA
| | - Christine Lochner
- 0000 0001 2214 904Xgrid.11956.3aDepartment of Psychiatry, University of Stellenbosch, Stellenbosch, South Africa
| | - Derrek P. Hibar
- 0000 0001 2156 6853grid.42505.36Imaging Genetics Center, Mark and Mary Stevens Neuroimaging & Informatics Institute, Keck School of Medicine of the University of Southern California, Los Angeles, CA USA
| | - Peristera Paschou
- 0000 0004 1937 2197grid.169077.eDepartment of Biological Sciences, Purdue University, West Lafayette, IN USA
| | - Odile A. van den Heuvel
- grid.484519.5Department of Psychiatry, Department of Anatomy & Neurosciences, VU University Medical Center, Amsterdam Neuroscience, Amsterdam, Netherlands
| | - Sarah E. Medland
- 0000 0001 2294 1395grid.1049.cQIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Jeremiah M. Scharf
- 000000041936754Xgrid.38142.3cPsychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Harvard Medical School, Boston, MA USA ,0000 0004 0386 9924grid.32224.35Department of Psychiatry, Massachusetts General Hospital, Boston, MA USA ,0000 0004 0386 9924grid.32224.35Department of Neurology, Massachusetts General Hospital, Boston, MA USA
| | - Carol A. Mathews
- 0000 0004 1936 8091grid.15276.37Department of Psychiatry, Genetics Institute, University of Florida, Gainesville, FL USA
| | - Paul M. Thompson
- 0000 0001 2156 6853grid.42505.36Imaging Genetics Center, Mark and Mary Stevens Neuroimaging & Informatics Institute, Keck School of Medicine of the University of Southern California, Los Angeles, CA USA
| | - Dan J. Stein
- 0000 0004 1937 1151grid.7836.aDepartment of Psychiatry and MRC Unit on Risk & Resilience, University of Cape Town, Cape Town, South Africa ,0000 0004 0635 1506grid.413335.3Groote Schuur Hospital and Neuroscience Institute, Cape Town, South Africa
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8
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Tics and stereotypies: A comparative clinical review. Parkinsonism Relat Disord 2019; 59:117-124. [DOI: 10.1016/j.parkreldis.2019.02.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 12/28/2018] [Accepted: 02/03/2019] [Indexed: 01/07/2023]
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9
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Efron D, Dale RC. Tics and Tourette syndrome. J Paediatr Child Health 2018; 54:1148-1153. [PMID: 30294996 DOI: 10.1111/jpc.14165] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 07/04/2018] [Indexed: 12/31/2022]
Abstract
Tourette syndrome is a heterogeneous disorder. The genetic basis is complex, and both in utero and ex utero environmental factors may modify the phenotypic expression of the disorder. Inflammation related to aberrations in immune activation appears to play a pathogenic role in some cases. Multiple neurochemical pathways are involved. Rather than being a pure movement problem, tics are now understood to also have a sensory component. This has resulted in new psychological therapeutic strategies and other potential treatments. Furthermore, comorbidities are common, particularly attention-deficit hyperactivity disorder, anxiety and obsessive-compulsive disorder, and often cause more difficulties than the tics. The approach to treatment is dependent on the degree and types of impairment. For many patients, education, acceptance and understanding are all that is needed. In more severe cases, psychological and/or pharmacological interventions may be indicated. In this article, the clinical features and pathophysiology of Tourette syndrome are reviewed, and a pragmatic management approach is discussed.
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Affiliation(s)
- Daryl Efron
- Health Services, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Department of General Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Russell C Dale
- Department of Paediatric Neurology, University of Sydney, Sydney, New South Wales, Australia.,Department of Neurology, Children's Hospital at Westmead, Sydney, New South Wales, Australia
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10
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Albin RL. Tourette syndrome: a disorder of the social decision-making network. Brain 2018; 141:332-347. [PMID: 29053770 PMCID: PMC5837580 DOI: 10.1093/brain/awx204] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 06/08/2017] [Accepted: 07/21/2017] [Indexed: 12/11/2022] Open
Abstract
Tourette syndrome is a common neurodevelopmental disorder defined by characteristic involuntary movements, tics, with both motor and phonic components. Tourette syndrome is usually conceptualized as a basal ganglia disorder, with an emphasis on striatal dysfunction. While considerable evidence is consistent with these concepts, imaging data suggest diffuse functional and structural abnormalities in Tourette syndrome brain. Tourette syndrome exhibits features that are difficult to explain solely based on basal ganglia circuit dysfunctions. These features include the natural history of tic expression, with typical onset of tics around ages 5 to 7 years and exacerbation during the peri-pubertal years, marked sex disparity with higher male prevalence, and the characteristic distribution of tics. The latter are usually repetitive, somewhat stereotyped involuntary eye, facial and head movements, and phonations. A major functional role of eye, face, and head movements is social signalling. Prior work in social neuroscience identified a phylogenetically conserved network of sexually dimorphic subcortical nuclei, the Social Behaviour Network, mediating many social behaviours. Social behaviour network function is modulated developmentally by gonadal steroids and social behaviour network outputs are stereotyped sex and species specific behaviours. In 2011 O'Connell and Hofmann proposed that the social behaviour network interdigitates with the basal ganglia to form a greater network, the social decision-making network. The social decision-making network may have two functionally complementary limbs: the basal ganglia component responsible for evaluation of socially relevant stimuli and actions with the social behaviour network component responsible for the performance of social acts. Social decision-making network dysfunction can explain major features of the neurobiology of Tourette syndrome. Tourette syndrome may be a disorder of social communication resulting from developmental abnormalities at several levels of the social decision-making network. The social decision-making network dysfunction hypothesis suggests new avenues for research in Tourette syndrome and new potential therapeutic targets.
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Affiliation(s)
- Roger L Albin
- Department of Neurology, University of Michigan, Ann Arbor, MI, 48109, USA
- Neurology Service and GRECC, VAAAHS, Ann Arbor, MI, 48105, USA
- University of Michigan Morris K. Udall Parkinson’s Disease Research Center, University of Michigan, Ann Arbor, MI 48109, USA
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Hirschtritt ME, Darrow SM, Illmann C, Osiecki L, Grados M, Sandor P, Dion Y, King RA, Pauls D, Budman CL, Cath DC, Greenberg E, Lyon GJ, Yu D, McGrath LM, McMahon WM, Lee PC, Delucchi KL, Scharf JM, Mathews CA. Genetic and phenotypic overlap of specific obsessive-compulsive and attention-deficit/hyperactive subtypes with Tourette syndrome. Psychol Med 2018; 48:279-293. [PMID: 28651666 PMCID: PMC7909616 DOI: 10.1017/s0033291717001672] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND The unique phenotypic and genetic aspects of obsessive-compulsive (OCD) and attention-deficit/hyperactivity disorder (ADHD) among individuals with Tourette syndrome (TS) are not well characterized. Here, we examine symptom patterns and heritability of OCD and ADHD in TS families. METHOD OCD and ADHD symptom patterns were examined in TS patients and their family members (N = 3494) using exploratory factor analyses (EFA) for OCD and ADHD symptoms separately, followed by latent class analyses (LCA) of the resulting OCD and ADHD factor sum scores jointly; heritability and clinical relevance of the resulting factors and classes were assessed. RESULTS EFA yielded a 2-factor model for ADHD and an 8-factor model for OCD. Both ADHD factors (inattentive and hyperactive/impulsive symptoms) were genetically related to TS, ADHD, and OCD. The doubts, contamination, need for sameness, and superstitions factors were genetically related to OCD, but not ADHD or TS; symmetry/exactness and fear-of-harm were associated with TS and OCD while hoarding was associated with ADHD and OCD. In contrast, aggressive urges were genetically associated with TS, OCD, and ADHD. LCA revealed a three-class solution: few OCD/ADHD symptoms (LC1), OCD & ADHD symptoms (LC2), and symmetry/exactness, hoarding, and ADHD symptoms (LC3). LC2 had the highest psychiatric comorbidity rates (⩾50% for all disorders). CONCLUSIONS Symmetry/exactness, aggressive urges, fear-of-harm, and hoarding show complex genetic relationships with TS, OCD, and ADHD, and, rather than being specific subtypes of OCD, transcend traditional diagnostic boundaries, perhaps representing an underlying vulnerability (e.g. failure of top-down cognitive control) common to all three disorders.
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Affiliation(s)
| | - Sabrina M. Darrow
- Department of Psychiatry, University of California, San Francisco, CA, USA
| | - Cornelia Illmann
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Lisa Osiecki
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Marco Grados
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Paul Sandor
- Department of Psychiatry, University of Toronto and University Health Network, Youthdale Treatment Centers, Toronto, Ontario, Canada
| | - Yves Dion
- Department of Psychiatry, University of Montreal, Montreal, Quebec, Canada
| | - Robert A. King
- Yale Child Study Center, Yale University School of Medicine, New Haven, CT, USA
| | - David Pauls
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Cathy L. Budman
- Department of Psychiatry, North Shore University Hospital, Northwell Health System, Manhasset, NY, USA
| | - Danielle C. Cath
- Faculty of Social and Behavioural Sciences, Utrecht University and Altrecht Academic Anxiety Center, Utrecht, GGz Drenthe and department of psychiatry, University Medical Center Groningen, The Netherlands
| | - Erica Greenberg
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Gholson J. Lyon
- Stanley Institute for Cognitive Genomics, Cold Spring Harbor Laboratory, Cold Spring Harbor, NY, USA
| | - Dongmei Yu
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | | | - Paul C. Lee
- Department of Behavioral Health, Tripler Army Medical Center, Honolulu, HI, USA
| | - Kevin L. Delucchi
- Department of Psychiatry, University of California, San Francisco, CA, USA
| | - Jeremiah M. Scharf
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Division of Cognitive and Behavioral Neurology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Carol A. Mathews
- Department of Psychiatry, and University of Florida Genetics Institute, University of Florida, Gainesville, FL, USA
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Martino D, Pringsheim TM. Tourette syndrome and other chronic tic disorders: an update on clinical management. Expert Rev Neurother 2017; 18:125-137. [PMID: 29219631 DOI: 10.1080/14737175.2018.1413938] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
INTRODUCTION The management of Tourette syndrome (TS) and other chronic tic disorders occurs in multiple stages and begins with comprehensive assessment and complex psychoeducation. Behavioral and pharmacological interventions (second stage) are needed when tics cause physical or psychosocial impairment. Deep brain stimulation surgery or experimental therapies represent the third stage. Areas covered: Discussed are recent advances in assessment and therapy of chronic tic disorders, encompassing the three stages of intervention, with the addition of experimental, non-invasive brain stimulation strategies. A PubMed search was performed using as keywords: 'tic disorders', 'Tourette syndrome', 'assessment', 'rating scales', 'behavioral treatment', 'pharmacological treatment', 'deep brain stimulation', 'transcranial magnetic (or current) stimulation', and 'transcranial current stimulation'. More than 300 peer-reviewed articles were evaluated. The studies discussed have been selected on the basis of novelty and impact. Expert commentary: Comprehensive assessment of tic disorders and psychoeducation are crucial to a correct active management approach. Behavioral treatments represent first line of active interventions, with increasing potential offered by telehealth. Antipsychotics and alpha agonists remain first line pharmacological interventions for tics, although VMAT-2 inhibitors appear promising. Deep brain stimulation is a potential option for medically refractory, severely disabled patients with tics, but age and target selection require further investigation.
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Affiliation(s)
- Davide Martino
- a Department of Clinical Neurosciences , Cumming School of Medicine, University of Calgary and Hotchkiss Brain Institute , Calgary , Canada
| | - Tamara M Pringsheim
- a Department of Clinical Neurosciences , Cumming School of Medicine, University of Calgary and Hotchkiss Brain Institute , Calgary , Canada.,b Department of Pediatrics , Cumming School of Medicine, University of Calgary , Calgary , Canada.,c Department of Psychiatry , Cumming School of Medicine, University of Calgary , Calgary , Canada
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Abstract
PURPOSE OF REVIEW Describe developments in the etiological understanding of Tourette syndrome. RECENT FINDINGS Tourette syndrome is a complex heterogenous clinical syndrome, which is not a unitary entity. Pathophysiological models describe gamma-aminobutyric acid-ergic-associated disinhibition of cortico-basal ganglia motor, sensory and limbic loops. MRI studies support basal ganglia volume loss, with additional white matter and cerebellar changes. Tourette syndrome cause likely involves multiple vulnerability genes and environmental factors. Only recently have some vulnerability gene findings been replicated, including histidine decarboxylase and neurexin 1, yet these rare variants only explain a small proportion of patients. Planned large genetic studies will improve genetic understanding. The role of inflammation as a contributor to disease expression is now supported by large epidemiological studies showing an association with maternal autoimmunity and childhood infection. Investigation of blood cytokines, blood mRNA and brain mRNA expression support the role of a persistent immune activation, and there are similarities with the immune literature of autistic spectrum disorder. Current treatment is symptomatic, although there is a better appreciation of factors that influence treatment response. SUMMARY At present, therapeutics is focused on symptom-based treatments, yet with improved etiological understanding, we will move toward disease-modifying therapies in the future.
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Groth C, Debes NM, Skov L. Phenotype Development in Adolescents With Tourette Syndrome: A Large Clinical Longitudinal Study. J Child Neurol 2017; 32:1047-1057. [PMID: 29046136 DOI: 10.1177/0883073817729917] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Tourette syndrome (TS) is a neurodevelopmental disorder characterized by frequent comorbidities and a wide spectrum of phenotype presentations. This study aimed to describe the development of phenotypes in TS and tic-related impairment in a large longitudinal study of 226 children and adolescents followed up after 6 years. The participants were clinically examined to assess tic severity and impairment, obsessive compulsive disorder (OCD), and attention-deficit/hyperactivity disorder (ADHD). The development in phenotypes changed toward less comorbidity with 40% TS-only (no OCD or ADHD) (TS without OCD or ADHD) at baseline and 55% at follow-up.Tic-related impairment was expected to improve with an age-related tic decline, but surprisingly the impairment score did not reflect the tic decline. Sex, vocal and motor tics, and OCD and ADHD severity were highly significantly correlated to the impairment score. Knowledge of TS phenotype development is used in clinical settings to guide patients and for genetic, etiological, and clinical research purposes.
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Affiliation(s)
- Camilla Groth
- 1 Department of Paediatrics, Copenhagen University Hospital, Herlev, Denmark
| | - Nanette Mol Debes
- 1 Department of Paediatrics, Copenhagen University Hospital, Herlev, Denmark
| | - Liselotte Skov
- 1 Department of Paediatrics, Copenhagen University Hospital, Herlev, Denmark
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Abstract
This article presents highlights chosen from research that appeared during 2016 on Tourette syndrome and other tic disorders. Selected articles felt to represent meaningful advances in the field are briefly summarized.
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Affiliation(s)
- Kevin J. Black
- Departments of Psychiatry, Neurology, Radiology, and Neuroscience, Washington University School of Medicine, St. Louis, MO, 63110, USA
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Abstract
This article presents highlights chosen from research that appeared during 2016 on Tourette syndrome and other tic disorders. Selected articles felt to represent meaningful advances in the field are briefly summarized.
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Affiliation(s)
- Kevin J. Black
- Departments of Psychiatry, Neurology, Radiology, and Neuroscience, Washington University School of Medicine, St. Louis, MO, 63110, USA
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Jeon S, Lee J, Anthony JC, Chung H. Latent Class Analysis for Multiple Discrete Latent Variables: A Study on the Association Between Violent Behavior Drug-Using Behaviors. STRUCTURAL EQUATION MODELING : A MULTIDISCIPLINARY JOURNAL 2017; 24:911-925. [PMID: 30828241 PMCID: PMC6395048 DOI: 10.1080/10705511.2017.1340844] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
This paper proposes a new type of latent class analysis, joint latent class analysis (JLCA), which provides a set of principles for the systematic identification of the subsets of joint patterns for multiple discrete latent variables. Inferences about the parameters are obtained by a hybrid method of EM and Newton-Raphson algorithms. We apply JLCA in an investigation of adolescent violent behavior and drug-using behaviors. The data are from 4,957 male high-school students who participated in the Youth Risk Behavior Surveillance System 2015. The JLCA approach identifies the different joint patterns of four latent variables: violent behavior, alcohol consumption, tobacco cigarette smoking, and other drug use. The JLCA uncovers four common violent behaviors and three representative behavioral patterns for each of three other latent variables. In addition, the JLCA supports three common joint classes, representing the most probable simultaneous patterns for being violent and being a drug user among adolescent males.
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Affiliation(s)
- Saebom Jeon
- Department of Marketing Information Consulting, Mokwon University
| | | | - James C. Anthony
- Department of Epidemiology and Biostatistics, Michigan State University
| | - Hwan Chung
- Department of Statistics, Korea University
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Morand-Beaulieu S, Grot S, Lavoie J, Leclerc JB, Luck D, Lavoie ME. The puzzling question of inhibitory control in Tourette syndrome: A meta-analysis. Neurosci Biobehav Rev 2017; 80:240-262. [PMID: 28502600 DOI: 10.1016/j.neubiorev.2017.05.006] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 05/04/2017] [Accepted: 05/08/2017] [Indexed: 02/02/2023]
Abstract
Tourette syndrome (TS) is a neuropsychiatric disorder involving motor and phonic tics. Inhibitory control is a key issue in TS, and many disruptive or impulsive behaviors might arise from inhibitory deficits. However, conflicting findings regarding TS patients' inhibitory performance in neuropsychological tasks have been reported throughout the literature. Therefore, this meta-analysis aimed to evaluate inhibitory control through neuropsychological tasks, and to analyze the factors modulating inhibitory deficits. To this end, a literature search was performed through MEDLINE and PsycINFO, to retrieve studies including neuropsychological tasks that assessed inhibitory control in TS patients. Of the 4020 studies identified, 61 were included in the meta-analysis, for a total of 1717 TS patients. Our analyses revealed a small to medium effect in favor of inhibitory deficits in TS patients. This effect was larger in TS+ADHD patients, but pure TS patients also showed some inhibitory deficits. Therefore, deficits in inhibitory control seem to be an inherent component of TS, and are exacerbated when ADHD is concomitant.
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Affiliation(s)
- Simon Morand-Beaulieu
- Cognitive and Social Psychophysiology Lab, Montreal, Qc, Canada; Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Montreal, Qc, Canada; Département de neurosciences, Université de Montréal, Montreal, Qc, Canada.
| | - Stéphanie Grot
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Montreal, Qc, Canada; Département de psychiatrie, Université de Montréal, Montreal, Qc, Canada.
| | - Jacob Lavoie
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Montreal, Qc, Canada; Département de neurosciences, Université de Montréal, Montreal, Qc, Canada.
| | - Julie B Leclerc
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Montreal, Qc, Canada; Département de psychologie, Université du Québec à Montréal, Montreal, Qc, Canada.
| | - David Luck
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Montreal, Qc, Canada; Département de neurosciences, Université de Montréal, Montreal, Qc, Canada; Département de psychiatrie, Université de Montréal, Montreal, Qc, Canada.
| | - Marc E Lavoie
- Cognitive and Social Psychophysiology Lab, Montreal, Qc, Canada; Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Montreal, Qc, Canada; Département de neurosciences, Université de Montréal, Montreal, Qc, Canada; Département de psychiatrie, Université de Montréal, Montreal, Qc, Canada.
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Darrow SM, Hirschtritt ME, Davis LK, Illmann C, Osiecki L, Grados M, Sandor P, Dion Y, King R, Pauls D, Budman CL, Cath DC, Greenberg E, Lyon GJ, Yu D, McGrath LM, McMahon WM, Lee PC, Delucchi KL, Scharf JM, Mathews CA. Identification of Two Heritable Cross-Disorder Endophenotypes for Tourette Syndrome. Am J Psychiatry 2017; 174:387-396. [PMID: 27809572 PMCID: PMC5378637 DOI: 10.1176/appi.ajp.2016.16020240] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Phenotypic heterogeneity in Tourette syndrome is partly due to complex genetic relationships among Tourette syndrome, obsessive-compulsive disorder (OCD), and attention deficit hyperactivity disorder (ADHD). Identifying symptom-based endophenotypes across diagnoses may aid gene-finding efforts. METHOD Assessments for Tourette syndrome, OCD, and ADHD symptoms were conducted in a discovery sample of 3,494 individuals recruited for genetic studies. Symptom-level factor and latent class analyses were conducted in Tourette syndrome families and replicated in an independent sample of 882 individuals. Classes were characterized by comorbidity rates and proportion of parents included. Heritability and polygenic load associated with Tourette syndrome, OCD, and ADHD were estimated. RESULTS The authors identified two cross-disorder symptom-based phenotypes across analyses: symmetry (symmetry, evening up, checking obsessions; ordering, arranging, counting, writing-rewriting compulsions, repetitive writing tics) and disinhibition (uttering syllables/words, echolalia/palilalia, coprolalia/copropraxia, and obsessive urges to offend/mutilate/be destructive). Heritability estimates for both endophenotypes were high and statistically significant (disinhibition factor=0.35, SE=0.03; symmetry factor=0.39, SE=0.03; symmetry class=0.38, SE=0.10). Mothers of Tourette syndrome probands had high rates of symmetry (49%) but not disinhibition (5%). Polygenic risk scores derived from a Tourette syndrome genome-wide association study (GWAS) were significantly associated with symmetry, while risk scores derived from an OCD GWAS were not. OCD polygenic risk scores were significantly associated with disinhibition, while Tourette syndrome and ADHD risk scores were not. CONCLUSIONS The analyses identified two heritable endophenotypes related to Tourette syndrome that cross traditional diagnostic boundaries. The symmetry phenotype correlated with Tourette syndrome polygenic load and was present in otherwise Tourette-unaffected mothers, suggesting that this phenotype may reflect additional Tourette syndrome (rather than OCD) genetic liability that is not captured by traditional DSM-based diagnoses.
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Affiliation(s)
| | | | - Lea K. Davis
- Vanderbilt University Department of Medicine, Nashville
| | - Cornelia Illmann
- Psychiatric and Neurodevelopmental Genetics Unit, Department of Psychiatry, Massachusetts General Hospital, Boston
| | - Lisa Osiecki
- Psychiatric and Neurodevelopmental Genetics Unit, Department of Psychiatry, Massachusetts General Hospital, Boston
| | - Marco Grados
- Johns Hopkins University School of Medicine Department of Psychiatry and Behavioral Sciences, Baltimore
| | - Paul Sandor
- University of Toronto Department of Psychiatry and University Health Network, and Youthdale Treatment Centers, Ontario, Canada
| | - Yves Dion
- University of Montreal Department of Psychiatry, Quebec, Canada
| | - Robert King
- Yale Child Study Center, Yale University School of Medicine Department of Genetics, New Haven
| | - David Pauls
- Psychiatric and Neurodevelopmental Genetics Unit, Department of Psychiatry, Massachusetts General Hospital, Boston
| | - Cathy L. Budman
- North Shore/Long Island Jewish Health System, Feinstein Institute for Medical Research, Manhasset
| | - Danielle C. Cath
- Utrecht University Faculty of Social and Behavioural Sciences, Utrecht, The Netherlands
| | - Erica Greenberg
- Psychiatric and Neurodevelopmental Genetics Unit, Department of Psychiatry, Massachusetts General Hospital, Boston
| | - Gholson J. Lyon
- Stanley Institute for Cognitive Genomics, Cold Spring Harbor Laboratory, Cold Spring Harbor
| | - Dongmei Yu
- Psychiatric and Neurodevelopmental Genetics Unit, Department of Psychiatry, Massachusetts General Hospital, Boston
| | | | | | - Paul C. Lee
- Tripler Army Medical Center Department of Behavioral Health, Honolulu
| | | | - Jeremiah M. Scharf
- Psychiatric and Neurodevelopmental Genetics Unit, Department of Psychiatry, Massachusetts General Hospital, Boston,Departments of Neurology, Brigham and Women’s and Massachusetts General Hospitals, Boston
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Compulsive Social Behavior Emerges after Selective Ablation of Striatal Cholinergic Interneurons. J Neurosci 2017; 37:2849-2858. [PMID: 28193688 DOI: 10.1523/jneurosci.3460-16.2017] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 01/23/2017] [Accepted: 01/27/2017] [Indexed: 12/14/2022] Open
Abstract
The mechanisms underlying social dysfunction in neuropsychiatric conditions such as obsessive-compulsive disorder and Tourette syndrome remain uncertain. However, it is known that dysfunctions in basal ganglia, including a reduced number of striatal cholinergic interneurons (SCIN), are involved in their pathophysiology. To explore the role of SCIN in relation to perseverative behaviors, we characterized a new transgenic mouse model in which inducible ablation of SCIN is achieved with high efficiency in a cell-type- and region-specific manner. Mice were subjected to extensive behavioral testing, including assessment of social behaviors, and corticostriatal functional connectivity was evaluated in vivo Selective SCIN ablation leads to altered social interactions together with exacerbated spontaneously emitted repetitive behaviors. Lesioned mice showed normal motor coordination, balance, and general locomotion. Interestingly, only environmentally driven, but not self-directed, repetitive behaviors were exacerbated in lesioned mice. Remarkably, in mice with SCIN ablation, the normal pattern of social exploration was replayed continuously. The emerging pattern of social interactions is highly predictable and invariant across time. In vivo electrophysiological recordings indicate that SCIN ablation results in an increase of the functional connectivity between different cortical areas and the motor, but not associative, region of the striatum. Our results identify a role of SCIN in suppressing perseverative behaviors, including socially related ones. In sum, SCIN ablation in mice leads to exacerbated ritualistic-like behaviors that affect social performance, providing a link between SCIN dysfunction and the social impairments present in psychiatric disorders.SIGNIFICANCE STATEMENT We sought to uncover the impact of striatal cholinergic interneuron (SCIN) degeneration on perseverative behaviors related to obsessive-compulsive disorder (OCD) and Tourette syndrome (TS). We found that extensive SCIN ablation results in exacerbated social interactions, in which normal social contacts were replayed continuously in a highly stereotyped, ritualistic pattern. SCIN ablation also leads to an increase in other spontaneously emitted repetitive behaviors without alteration of motor coordination, balance, or locomotion. Moreover, we identify an increase of functional connectivity between frontal cortical areas and the motor region of the striatum as a putative substrate for the observed behavioral alterations. Therefore, perseveration induced by SCIN ablation extends to social performance as occurs in neuropsychiatric conditions such as OCD and TS.
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Abstract
Gilles de la Tourette syndrome (GTS) is a childhood-onset neurodevelopmental disorder that is characterized by several motor and phonic tics. Tics usually develop before 10 years of age, exhibit a waxing and waning course and typically improve with increasing age. A prevalence of approximately 1% is estimated in children and adolescents. The condition can result in considerable social stigma and poor quality of life, especially when tics are severe (for example, with coprolalia (swearing tics) and self-injurious behaviours) or when GTS is accompanied by attention-deficit/hyperactivity disorder, obsessive-compulsive disorder or another neuropsychiatric disorder. The aetiology is complex and multifactorial. GTS is considered to be polygenic, involving multiple common risk variants combined with rare, inherited or de novo mutations. These as well as non-genetic factors (such as perinatal events and immunological factors) are likely to contribute to the heterogeneity of the clinical phenotype, the structural and functional brain anomalies and the neural circuitry involvement. Management usually includes psychoeducation and reassurance, behavioural methods, pharmacotherapy and, rarely, functional neurosurgery. Future research that integrates clinical and neurobiological data, including neuroimaging and genetics, is expected to reveal the pathogenesis of GTS at the neural circuit level, which may lead to targeted interventions.
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Paschou P, Müller-Vahl K. Editorial: The Neurobiology and Genetics of Gilles de la Tourette Syndrome: New Avenues through Large-Scale Collaborative Projects. Front Psychiatry 2017; 8:197. [PMID: 29075205 PMCID: PMC5641546 DOI: 10.3389/fpsyt.2017.00197] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 09/21/2017] [Indexed: 11/17/2022] Open
Affiliation(s)
- Peristera Paschou
- Department of Biological Sciences, Purdue University, West Lafayette, IN, United States
| | - Kirsten Müller-Vahl
- Department of Psychiatry, Socialpsychiatry and Psychotherapy, Hannover Medical School, Hannover, 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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