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Graber A, Rizzo M. Tourette Syndrome: A Catalyst for Operationalizing Neurodiversity. Neurology 2024; 103:e209572. [PMID: 38870461 DOI: 10.1212/wnl.0000000000209572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2024] Open
Abstract
Our goal, taking Tourette syndrome as a case example, is to introduce neurologists to, and motivate discussion on, the neurodiversity paradigm. This philosophical construct considers some neurologic conditions in diversity, instead of simply disease. Moving from philosophical idea to empirical construct draws from patient and family perspectives on (1) quality of life and discrimination, (2) disability pride, and (3) unique profiles of different patient cohorts. Listening to patient voices, attending to family, advocacy group, and societal views on neurologic disorders can strengthen precision neurology practice. Dialogs on neurodiversity, including antitherapy sentiments, offer to enhance neurologic care, patient agency, and autonomy; encourage respectful communications with patients who challenge the idea their condition is pathologic; and to set the stage for future empirical investigations and practice guidelines.
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Affiliation(s)
- Abraham Graber
- From the Department of Biomedical Education and Anatomy (A.G.); Nisonger Center Affiliate Faculty (A.G.), The Ohio State University; and Department of Neurological Sciences (M.R.), University of Nebraska Medical Center
| | - Matthew Rizzo
- From the Department of Biomedical Education and Anatomy (A.G.); Nisonger Center Affiliate Faculty (A.G.), The Ohio State University; and Department of Neurological Sciences (M.R.), University of Nebraska Medical Center
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2
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Barber KE, Pitts BX, Stiede JT, Espil FM, Woods DW, Specht MW, Bennett SM, Walkup JT, Ricketts EJ, McGuire JF, Peterson AL, Compton SN, Wilhelm S, Scahill L, Piacentini JC. Perceived Negative Effects of Tic Management Strategies in Adults With Tic Disorders. Behav Modif 2024; 48:449-470. [PMID: 38557310 PMCID: PMC11179959 DOI: 10.1177/01454455241236446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Behavior therapy is a well-established and empirically supported treatment for tic disorders (TDs). However, concerns have been expressed about the negative effects of behavioral interventions, such as tic worsening, tic substitution, and excessive effort. This study explored perceived negative effects of tic management strategies in adults with TDs and predictors of these experiences. Participants (N = 72) completed semi-structured interviews 11 years after receiving behavior therapy or supportive therapy in a randomized clinical trial. We examined responses to interview questions about managing tics and predictors of reported negative effects. Most participants did not experience tic worsening (84%) or tic substitution (75%) from tic management strategies. The majority felt they could manage tics while participating in their environment (87%) and did not report life interference from tic management (77%). About half (45%) felt less present when managing tics. Treatment non-responders in the original trial were more likely to report negative effects of tic management strategies. No differences in reported negative consequences were found between those who received behavior therapy versus supportive therapy, suggesting that behavior therapy specifically does not lead to such adverse effects. These findings could reduce misconceptions about behavior therapy for TDs and enhance its acceptability and utilization.
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Affiliation(s)
| | | | | | | | | | | | | | - John T Walkup
- Ann and Robert H. Lurie Children's Hospital, Chicago, IL, USA
| | - Emily J Ricketts
- UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA
| | | | - Alan L Peterson
- The University of Texas Health Science Center at San Antonio, San Antonio, USA
| | | | | | - Lawrence Scahill
- Emory University School of Medicine Marcus Center, Atlanta, GA, USA
| | - John C Piacentini
- UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA
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Vilela-Filho O, Souza JT, Ragazzo PC, Silva DJ, Oliveira PM, Goulart LC, Reis MD, Piedimonte F, Ribeiro TM. Bilateral Globus Pallidus Externus Deep Brain Stimulation for the Treatment of Refractory Tourette Syndrome: An Open Clinical Trial. Neuromodulation 2024; 27:742-758. [PMID: 37294231 DOI: 10.1016/j.neurom.2023.04.473] [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] [Received: 01/27/2023] [Revised: 04/24/2023] [Accepted: 04/27/2023] [Indexed: 06/10/2023]
Abstract
OBJECTIVES We have previously proposed that Tourette syndrome (TS) is the clinical expression of the hyperactivity of globus pallidus externus (GPe) and various cortical areas. This study was designed to test this hypothesis by verifying the efficacy and safety of bilateral GPe deep brain stimulation (DBS) for treating refractory TS. MATERIALS AND METHODS In this open clinical trial, 13 patients were operated on. Target coordinates (center of GPe) were obtained by direct visualization. Physiological mapping was performed with macrostimulation and microrecording. Primary and secondary outcome measures were, respectively, responder and improvement rates of TS and comorbidities, according to pre- and postoperative scores on the following assessment instruments: Yale Global Tic Severity Scale, Yale-Brown Obsessive Compulsive Scale, Beck Depression Inventory/Hamilton Depression Rating Scale, Beck Anxiety Inventory/Hamilton Anxiety Rating Scale, and Concentrated Attention test. RESULTS Intraoperative stimulation (100 Hz/5.0V) did not produce any adverse effects or impact on tics. Microrecording revealed bursting cells discharging synchronously with tics in the central part of the dorsal half of GPe. Patients were followed up for a mean of 61.46±48.50 months. Responder rates were 76.9%, 75%, 71.4%, 71.4%, and 85.7%, respectively, for TS, obsessive-compulsive disorder (OCD), depression, anxiety, and attention deficit hyperactivity disorder. Mean improvements among responders in TS, OCD, depression, and anxiety were 77.4%, 74.7%, 89%, and 84.8%, respectively. After starting stimulation, tic improvement was usually delayed, taking up to ten days to manifest. Afterward, it increased over time, usually reaching its maximum at approximately one year postoperatively. The best stimulation parameters were 2.3V to 3.0V, 90 to 120 μsec, and 100 to 150 Hz, and the most effective contacts were the two dorsal ones. Two complications were registered: reversible impairment of previous depression and transient unilateral bradykinesia. CONCLUSIONS Bilateral GPe-DBS proved to be low risk and quite effective for treating TS and comorbidities, ratifying the pathophysiological hypothesis that led to this study. Moreover, it compared favorably with DBS of other targets currently in use.
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Affiliation(s)
- Osvaldo Vilela-Filho
- Division of Neurosurgery, Department of Surgery, Medical School, Federal University of Goiás, Goiânia, Goiás, Brazil; Nervous System Unity, Clinics Hospital, Medical School, Federal University of Goiás, Goiânia, Goiás, Brazil; Department of Stereotactic and Functional Neurosurgery, Goiânia Neurological Institute, Goiânia, Goiás, Brazil.
| | - Joaquim T Souza
- Nervous System Unity, Clinics Hospital, Medical School, Federal University of Goiás, Goiânia, Goiás, Brazil
| | - Paulo C Ragazzo
- Department of Neurology, Goiânia Neurological Institute, Goiânia, Goiás, Brazil
| | - Délson J Silva
- Nervous System Unity, Clinics Hospital, Medical School, Federal University of Goiás, Goiânia, Goiás, Brazil
| | - Paulo M Oliveira
- Department of Psychiatry, Medical School, Federal University of Goiás, Goiânia, Goiás, Brazil; Department of Psychiatry, Goiânia Neurological Institute, Goiânia, Goiás, Brazil
| | - Lissa C Goulart
- Nervous System Unity, Clinics Hospital, Medical School, Federal University of Goiás, Goiânia, Goiás, Brazil
| | - Manoel D Reis
- Department of Psychiatry, Goiânia Neurological Institute, Goiânia, Goiás, Brazil
| | - Fabian Piedimonte
- JJ Naon Institute of Morphology, Medical School, University of Buenos Aires, Buenos Aires, Argentina
| | - Telma M Ribeiro
- Department of Psychiatry, Goiânia Neurological Institute, Goiânia, Goiás, Brazil
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Parvizi-Wayne D, Severs L. When the interoceptive and conceptual clash: The case of oppositional phenomenal self-modelling in Tourette syndrome. COGNITIVE, AFFECTIVE & BEHAVIORAL NEUROSCIENCE 2024:10.3758/s13415-024-01189-6. [PMID: 38777988 DOI: 10.3758/s13415-024-01189-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/15/2024] [Indexed: 05/25/2024]
Abstract
Tourette syndrome (TS) has been associated with a rich set of symptoms that are said to be uncomfortable, unwilled, and effortful to manage. Furthermore, tics, the canonical characteristic of TS, are multifaceted, and their onset and maintenance is complex. A formal account that integrates these features of TS symptomatology within a plausible theoretical framework is currently absent from the field. In this paper, we assess the explanatory power of hierarchical generative modelling in accounting for TS symptomatology from the perspective of active inference. We propose a fourfold analysis of sensory, motor, and cognitive phenomena associated with TS. In Section 1, we characterise tics as a form of action aimed at sensory attenuation. In Section 2, we introduce the notion of epistemic ticcing and describe such behaviour as the search for evidence that there is an agent (i.e., self) at the heart of the generative hierarchy. In Section 3, we characterise both epistemic (sensation-free) and nonepistemic (sensational) tics as habitual behaviour. Finally, in Section 4, we propose that ticcing behaviour involves an inevitable conflict between distinguishable aspects of selfhood; namely, between the minimal phenomenal sense of self-which is putatively underwritten by interoceptive inference-and the explicit preferences that constitute the individual's conceptual sense of self. In sum, we aim to provide an empirically informed analysis of TS symptomatology under active inference, revealing a continuity between covert and overt features of the condition.
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Affiliation(s)
- D Parvizi-Wayne
- Department of Psychology, Royal Holloway University of London, London, UK.
| | - L Severs
- Centre for the Philosophy of Science, Faculty of Sciences, University of Lisbon, Lisbon, Portugal
- Ruhr-Universität Bochum, Institute of Philosophy II, Bochum, Germany
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Mazur-Lainé E, Soubata H, Leclerc JB, Blanchet PJ, O’Connor KP, Lavoie ME. Impacts of ADHD Symptomatology on the Response to Cognitive-Behavioural Therapy with Gilles de la Tourette Syndrome Patients. J Clin Med 2024; 13:2975. [PMID: 38792517 PMCID: PMC11122476 DOI: 10.3390/jcm13102975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 05/10/2024] [Accepted: 05/16/2024] [Indexed: 05/26/2024] Open
Abstract
(1) Background: Gilles de la Tourette Syndrome (TS) is a neurodevelopmental disorder characterized by motor and vocal tics. Attention deficit and hyperactivity disorder (ADHD) is a common comorbidity of TS that adds further impairment. Cognitive-behavioural therapy (CBT) has shown efficacy in treating tics, yet its effectiveness in individuals with TS and comorbid ADHD remains unclear. Also, it is suggested that ADHD characteristics like executive dysfunction and inattention could hinder the response to CBT. This study aims to compare the response to CBT for tics and its maintenance six months post-therapy among TS individuals with and without ADHD symptoms. (2) Methods: In this study, 55 TS participants who completed 14-week CBT for tics were split into high (TS+) or low (TS-) ADHD symptomatology groups. Outcomes were evaluated using the Yale Global Tic Severity Scale (YGTSS) regarding global tic severity and motor and vocal tic frequency post-CBT and at a 6-month follow-up. (3) Results: No significant group difference was found regarding improvements post-CBT (n = 55), nor the maintenance six months later (n = 45). (4) Conclusions: ADHD symptoms may not hinder the response to CBT or its maintenance, suggesting that TS individuals with ADHD symptoms may not require specialized CBT interventions.
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Affiliation(s)
- Emmanuelle Mazur-Lainé
- Centre de Recherche de l’Institut Universitaire en Santé Mentale de Montréal, Montréal, QC H1N 3V2, Canada; (E.M.-L.); (H.S.); (J.B.L.); (P.J.B.); (K.P.O.)
- Département de Psychologie, Université de Montréal, Montréal, QC H2V 2S9, Canada
| | - Houda Soubata
- Centre de Recherche de l’Institut Universitaire en Santé Mentale de Montréal, Montréal, QC H1N 3V2, Canada; (E.M.-L.); (H.S.); (J.B.L.); (P.J.B.); (K.P.O.)
- Département de Psychologie, Université de Montréal, Montréal, QC H2V 2S9, Canada
| | - Julie B. Leclerc
- Centre de Recherche de l’Institut Universitaire en Santé Mentale de Montréal, Montréal, QC H1N 3V2, Canada; (E.M.-L.); (H.S.); (J.B.L.); (P.J.B.); (K.P.O.)
- Département de Psychologie, Université du Québec à Montréal, Montréal, QC H2X 3P2, Canada
- Groupe d’étude sur les Troubles Tic, d’Accumulation Compulsive et Obsessionnel-Compulsif (GE-tic-tac-toc), Montréal, QC H1N 3V2, Canada
- Centre de Recherche du CIUSSS du Nord-de-l’Île-de-Montréal, Montréal, QC H4J 1C5, Canada
| | - Pierre J. Blanchet
- Centre de Recherche de l’Institut Universitaire en Santé Mentale de Montréal, Montréal, QC H1N 3V2, Canada; (E.M.-L.); (H.S.); (J.B.L.); (P.J.B.); (K.P.O.)
- Faculté de Médecine Dentaire, Département de Stomatologie, Université de Montréal, Montreal, QC H3T 1J4, Canada
| | - Kieron P. O’Connor
- Centre de Recherche de l’Institut Universitaire en Santé Mentale de Montréal, Montréal, QC H1N 3V2, Canada; (E.M.-L.); (H.S.); (J.B.L.); (P.J.B.); (K.P.O.)
- Groupe d’étude sur les Troubles Tic, d’Accumulation Compulsive et Obsessionnel-Compulsif (GE-tic-tac-toc), Montréal, QC H1N 3V2, Canada
- Département de Psychiatrie et Addictologie, Université de Montréal, Montreal, QC H3T 1J4, Canada
| | - Marc E. Lavoie
- Centre de Recherche de l’Institut Universitaire en Santé Mentale de Montréal, Montréal, QC H1N 3V2, Canada; (E.M.-L.); (H.S.); (J.B.L.); (P.J.B.); (K.P.O.)
- Groupe d’étude sur les Troubles Tic, d’Accumulation Compulsive et Obsessionnel-Compulsif (GE-tic-tac-toc), Montréal, QC H1N 3V2, Canada
- Département de Psychiatrie et Addictologie, Université de Montréal, Montreal, QC H3T 1J4, Canada
- Département de Sciences Humaines, Lettres et Communication, Université TÉLUQ, Quebec, QC G1K 9H6, Canada
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Ding Q, Woods DW, Xu W, Zhao Y, Shen S, Sun J. Exploring the psychometric properties of the premonitory urge for tics scale (PUTS) and its association with psychiatric symptoms in Chinese children with tic disorders. BMC Pediatr 2024; 24:341. [PMID: 38755560 PMCID: PMC11097492 DOI: 10.1186/s12887-024-04801-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 05/02/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND The Premonitory Urge for Tics Scale (PUTS) is a common self-report measure of premonitory urges for patients with tic disorders. This study aims to evaluate the Chinese version of the PUTS (PUTS-C) and to explore its association with psychiatric symptoms in Chinese children diagnosed with tic disorders. METHODS The psychometric evaluation involved 204 outpatients with tic disorders, aged 7-16 years, who were divided into two age groups: (7-10 years, n = 103; 11-16 years, n = 95). RESULTS The PUTS-C demonstrated good internal consistency (McDonald'sω = 0.84) and two-week test-retest reliability (0.76). We observed a statistically significant correlation between the total PUTS-C score and various Yale Global Tic Severity Scale (YGTSS) subscales and total tic severity scores. The PUTS-C score also showed significant correlations with the Children Yale-Brown Obsessive Compulsive Scale (CY-BOCS), Screening Child Anxiety-Related Emotional Disorders (SCARED), and Children's Depression Inventory (CDI). Notably, premonitory urges independently predicted tic severity, beyond the influence of comorbid symptoms. A two-factor structure of the PUTS-C was identified in the total sample through factor analysis. CONCLUSIONS The PUTS-C possesses acceptable validity and good reliability. It appears that premonitory urges in Chinese patients with tic disorders are associated with obsessive-compulsive symptoms, anxiety, and depression, but can independently predict tic severity. Specific PUTS-C factors possibly related to motor and vocal tics. Future research should continue to investigate age-related differences and the association with tics and other sensory symptoms.
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Affiliation(s)
- Qiang Ding
- Department of Psychological Medicine, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, 201102, China
| | - Douglas W Woods
- Department of Psychology, Marquette University, Milwaukee, WI, 53233, USA
| | - Wen Xu
- Department of Psychological Medicine, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, 201102, China
| | - Ying Zhao
- Department of Psychological Medicine, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, 201102, China
| | - Shuqin Shen
- Department of Psychological Medicine, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, 201102, China
| | - Jinhua Sun
- Department of Psychological Medicine, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, 201102, China.
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Cadeddu R, Braccagni G, Branca C, van Luik ER, Pittenger C, Thomsen MS, Bortolato M. Activation of M 4 muscarinic receptors in the striatum reduces tic-like behaviours in two distinct murine models of Tourette syndrome. Br J Pharmacol 2024. [PMID: 38689378 DOI: 10.1111/bph.16392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 03/15/2024] [Accepted: 03/18/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND AND PURPOSE Current pharmacotherapies for Tourette syndrome (TS) are often unsatisfactory and poorly tolerated, underscoring the need for novel treatments. Insufficient striatal acetylcholine has been suggested to contribute to tic ontogeny. Thus, we tested whether activating M1 and/or M4 receptors-the two most abundant muscarinic receptors in the striatum-reduced tic-related behaviours in mouse models of TS. EXPERIMENTAL APPROACH Studies were conducted using CIN-d and D1CT-7 mice, two TS models characterized by early-life depletion of striatal cholinergic interneurons and cortical neuropotentiation, respectively. First, we tested the effects of systemic and intrastriatal xanomeline, a selective M1/M4 receptor agonist, on tic-like and other TS-related responses. Then, we examined whether xanomeline effects were reduced by either M1 or M4 antagonists or mimicked by the M1/M3 agonist cevimeline or the M4 positive allosteric modulator (PAM) VU0467154. Finally, we measured striatal levels of M1 and M4 receptors and assessed the impact of VU0461754 on the striatal expression of the neural marker activity c-Fos. KEY RESULTS Systemic and intrastriatal xanomeline reduced TS-related behaviours in CIN-d and D1CT-7 mice. Most effects were blocked by M4, but not M1, receptor antagonists. VU0467154, but not cevimeline, elicited xanomeline-like ameliorative effects in both models. M4, but not M1, receptors were down-regulated in the striatum of CIN-d mice. Additionally, VU0467154 reduced striatal c-Fos levels in these animals. CONCLUSION AND IMPLICATIONS Activation of striatal M4, but not M1, receptors reduced tic-like manifestations in mouse models, pointing to xanomeline and M4 PAMs as novel putative therapeutic strategies for TS.
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Affiliation(s)
- Roberto Cadeddu
- Department of Pharmacology and Toxicology, College of Pharmacy, University of Utah, Salt Lake City, Utah, USA
| | - Giulia Braccagni
- Department of Pharmacology and Toxicology, College of Pharmacy, University of Utah, Salt Lake City, Utah, USA
| | - Caterina Branca
- Department of Pharmacology and Toxicology, College of Pharmacy, University of Utah, Salt Lake City, Utah, USA
| | - Easton R van Luik
- Department of Pharmacology and Toxicology, College of Pharmacy, University of Utah, Salt Lake City, Utah, USA
| | - Christopher Pittenger
- Department of Psychiatry, School of Medicine, Yale University, New Haven, Connecticut, USA
- Department of Psychology, School of Arts and Sciences, Yale University, New Haven, Connecticut, USA
- Child Study Center, School of Medicine, Yale University, New Haven, Connecticut, USA
- Center for Brain and Mind Health, School of Medicine, Yale University, New Haven, Connecticut, USA
| | | | - Marco Bortolato
- Department of Pharmacology and Toxicology, College of Pharmacy, University of Utah, Salt Lake City, Utah, USA
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Desfossés-Vallée S, Leclerc JB, Blanchet P, O’Connor KP, Lavoie ME. Comparing the 'When' and the 'Where' of Electrocortical Activity in Patients with Tourette Syndrome, Body-Focused Repetitive Behaviors, and Obsessive Compulsive Disorder. J Clin Med 2024; 13:2489. [PMID: 38731020 PMCID: PMC11084402 DOI: 10.3390/jcm13092489] [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: 03/21/2024] [Revised: 04/17/2024] [Accepted: 04/17/2024] [Indexed: 05/13/2024] Open
Abstract
Background/Objectives: Tourette Syndrome (TS), Obsessive Compulsive Disorder (OCD), and Body-Focused Repetitive Behaviors (BFRB) are three disorders that share many similarities in terms of phenomenology, neuroanatomy, and functionality. However, despite the literature pointing toward a plausible spectrum of these disorders, only a few studies have compared them. Studying the neurocognitive processes using Event-Related Potentials (ERPs) offers the advantage of assessing brain activity with excellent temporal resolution. The ERP components can then reflect specific processes known to be potentially affected by these disorders. Our first goal is to characterize 'when' in the processing stream group differences are the most prominent. The second goal is to identify 'where' in the brain the group discrepancies could be. Methods: Participants with TS (n = 24), OCD (n = 18), and BFRB (n = 16) were matched to a control group (n = 59) and were recorded with 58 EEG electrodes during a visual counting oddball task. Three ERP components were extracted (i.e., P200, N200, and P300), and generating sources were modelized with Standardized Low-Resolution Electromagnetic Tomography. Results: We showed no group differences for the P200 and N200 when controlling for anxiety and depressive symptoms, suggesting that the early cognitive processes reflected by these components are relatively intact in these populations. Our results also showed a decrease in the later anterior P300 oddball effect for the TS and OCD groups, whereas an intact oddball effect was observed for the BFRB group. Source localization analyses with sLORETA revealed activations in the lingual and middle occipital gyrus for the OCD group, distinguishing it from the other two clinical groups and the controls. Conclusions: It seems that both TS and OCD groups share deficits in anterior P300 activation but reflect distinct brain-generating source activations.
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Affiliation(s)
- Sarah Desfossés-Vallée
- Laboratoire de Psychophysiologie Cognitive et Sociale, Montréal, QC H1N 3J4, Canada;
- Centre de Recherche de l’Institut Universitaire en Santé Mentale de Montréal, Montréal, QC H1N 3J4, Canada; (J.B.L.); (P.B.); (K.P.O.)
- Département de Psychologie, Université de Montréal, Montréal, QC H3C 3J7, Canada
| | - Julie B. Leclerc
- Centre de Recherche de l’Institut Universitaire en Santé Mentale de Montréal, Montréal, QC H1N 3J4, Canada; (J.B.L.); (P.B.); (K.P.O.)
- Département de Psychologie, Université du Québec à Montréal, Montréal, QC H2X 3P2, Canada
- Centre de Recherche CIUSSS du Nord-de-l’île-de-Montréal, Montréal, QC H4J 1C5, Canada
| | - Pierre Blanchet
- Centre de Recherche de l’Institut Universitaire en Santé Mentale de Montréal, Montréal, QC H1N 3J4, Canada; (J.B.L.); (P.B.); (K.P.O.)
- Faculté de Médecine Dentaire, Département de Stomatologie, Université de Montréal, Montréal, QC H3C 3J7, Canada
| | - Kieron P. O’Connor
- Centre de Recherche de l’Institut Universitaire en Santé Mentale de Montréal, Montréal, QC H1N 3J4, Canada; (J.B.L.); (P.B.); (K.P.O.)
- Département de Psychiatrie et Addictologie, Université de Montréal, Montréal, QC H3C 3J7, Canada
| | - Marc E. Lavoie
- Laboratoire de Psychophysiologie Cognitive et Sociale, Montréal, QC H1N 3J4, Canada;
- Centre de Recherche de l’Institut Universitaire en Santé Mentale de Montréal, Montréal, QC H1N 3J4, Canada; (J.B.L.); (P.B.); (K.P.O.)
- Département de Sciences Humaines, Lettres et Communication, Université TÉLUQ, Quebec City, QC G1K 9H6, Canada
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9
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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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10
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Bai L, Wang X, Niu R, Zhao M, Zhao Z, Jia P, Sun S. Association between body mass index and tic disorders in school-age children. BMC Pediatr 2024; 24:261. [PMID: 38643075 PMCID: PMC11031855 DOI: 10.1186/s12887-024-04592-7] [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] [Received: 11/21/2023] [Accepted: 01/25/2024] [Indexed: 04/22/2024] Open
Abstract
OBJECTIVE To explore the relationship between body mass index (BMI ) and the severity of tic disorders (TDs) in children 6-14 years old. METHODS A total of 86 children diagnosed with TDs in a hospital between Jan. 2023 and Sept. 2023 were collected by convenient sampling method, and the general data and TD-specific data were collected and analyzed. RESULTS Univariate analysis showed that patients with different Yale Global Tic Severity Scale (YGTSS) grades had statistically significant differences in age, BMI, residence, snacking pattern, weekly physical exercise frequency, weekly physical exercise time, and proportion of cesarean birth. Multiple linear regression analysis showed that the YGTSS score grades were related to BMI, snacking pattern, and cesarean birth of the patients. Correlation analysis revealed a positive correlation between BMI grades and the YGTSS score grades, with a higher BMI indicating more severe TDs. Predictive value evaluation showed that BMI, snacking pattern, and cesarean birth had predictive values for TD severity, and the highest value was found in the combined prediction. CONCLUSION BMI, snacking pattern, and cesarean birth are of predictive values for the severity of TDs. In addition, BMI is positively correlated with the severity of TDs, and a higher BMI suggests more severe TDs.
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Affiliation(s)
- Lu Bai
- Hebei Medical University, Shijiazhuang, 050017, China
- Department of Pediatric Neurology, Children's Hospital of Hebei Province, Hebei Medical University, No. 133 of Jianhuanan Street, YuhuaDistrict, Shijiazhuang, 050031, China
| | - Xia Wang
- Department of Pediatric Neurology, Children's Hospital of Hebei Province, Hebei Medical University, No. 133 of Jianhuanan Street, YuhuaDistrict, Shijiazhuang, 050031, China
| | - Ruijie Niu
- Hebei Medical University, Shijiazhuang, 050017, China
- Department of Pediatric Neurology, Children's Hospital of Hebei Province, Hebei Medical University, No. 133 of Jianhuanan Street, YuhuaDistrict, Shijiazhuang, 050031, China
| | - Mengchuan Zhao
- Department of Pediatric Neurology, Children's Hospital of Hebei Province, Hebei Medical University, No. 133 of Jianhuanan Street, YuhuaDistrict, Shijiazhuang, 050031, China
| | - Ziwei Zhao
- Department of Pediatric Neurology, Children's Hospital of Hebei Province, Hebei Medical University, No. 133 of Jianhuanan Street, YuhuaDistrict, Shijiazhuang, 050031, China
| | - Pengyu Jia
- Hebei Medical University, Shijiazhuang, 050017, China
- Department of Pediatric Neurology, Children's Hospital of Hebei Province, Hebei Medical University, No. 133 of Jianhuanan Street, YuhuaDistrict, Shijiazhuang, 050031, China
| | - Suzhen Sun
- Hebei Medical University, Shijiazhuang, 050017, China.
- Department of Pediatric Neurology, Children's Hospital of Hebei Province, Hebei Medical University, No. 133 of Jianhuanan Street, YuhuaDistrict, Shijiazhuang, 050031, China.
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11
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Isaacs DA, Bonnet K, Eckland MR, Markowitz K, Pena M, Schlundt DG. Perspectives from Adults with Tourette Syndrome on Research Priorities and Registry Development: A Focus Group Study. Neuropsychiatr Dis Treat 2024; 20:257-269. [PMID: 38351925 PMCID: PMC10863457 DOI: 10.2147/ndt.s442131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 12/27/2023] [Indexed: 02/16/2024] Open
Abstract
Purpose Adults with Tourette syndrome (TS) have worse mental health, physical health, and quality of life than the general population. The factors contributing to negative outcomes across multiple health domains in adults with TS remain uncertain, in part due to a lack of longitudinal studies in this population. In attempt to address these knowledge gaps, our center has initiated development of a regional registry for adults with TS. During the goal-setting and design phase of registry development, we conducted focus groups with adults with TS to identify research issues of greatest importance to this population and to obtain feedback on design and implementation of an adult TS registry. Patients and Methods Participants were recruited from a tertiary care adult TS clinic and from institutional research registries. Focus groups were conducted online and were moderated by a qualitative research expert. Qualitative data analysis was performed using an iterative inductive/deductive approach. Results Across four focus groups, adult TS participants (n=22) expressed a variety of research priorities, including developing more effective treatments for tics, identifying risk factors for tic persistence into adulthood, clarifying the interaction between TS symptoms and women's health, clarifying the relationships between TS and other mental and physical health disorders, and addressing day-to-day living issues. Focus group participants were generally enthusiastic about creation of an adult TS registry. They indicated that adults with TS are more likely to engage with a registry that logistically accommodates participants (eg, by offering a wide range of visit times, by providing telehealth options) and that fosters bidirectional interaction (eg, by disseminating results regularly, by involving participants in registry design and implementation, by notifying participants of support resources). Conclusion Focus group input clarifies the research priorities of adults with TS and will inform the ongoing development of an adult TS registry.
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Affiliation(s)
- David A Isaacs
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Pediatrics, Division of Pediatric Neurology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA
| | - Kemberlee Bonnet
- Department of Psychology, Vanderbilt University, Nashville, TN, USA
| | - Michelle R Eckland
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Maria Pena
- College of Nursing, University of Florida, Gainesville, FL, USA
| | - David G Schlundt
- Department of Psychology, Vanderbilt University, Nashville, TN, USA
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12
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Conte G, Costanza C, Novelli M, Scarselli V, Arigliani E, Valente F, Baglioni V, Terrinoni A, Chiarotti F, Cardona F. Comorbidities and Disease Duration in Tourette Syndrome: Impact on Cognition and Quality of Life of Children. CHILDREN (BASEL, SWITZERLAND) 2024; 11:226. [PMID: 38397337 PMCID: PMC10887127 DOI: 10.3390/children11020226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 02/01/2024] [Accepted: 02/04/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND Cognitive functions represent foundational factors for mental health and quality of life (QoL). In Tourette syndrome (TS), psychiatric comorbidities are common and have been inconsistently reported to affect the cognition and QoL of patients, while the role of tic disorder duration has not been yet explored. METHODS To examine how comorbidities and TS duration may influence cognition and QoL, N = 80 children with TS (6-16 years) were evaluated using the Wechsler Intelligence Scale for Children (WISC-IV). Standardized questionnaires were used to assess the presence and severity of TS main comorbidities and QoL. Data were interpreted using linear correlations, regression, and mediation analysis. RESULTS Depression and attention-deficit/hyperactivity disorder (ADHD) symptoms accounted for poorer cognitive performance. Anxiety oppositely predicted better cognitive performance, while no significant role for obsessive compulsive disorder (OCD) was observed. Disease duration was associated with lower total IQ, verbal reasoning, and working memory abilities. Depression, anxiety, and TS duration also deeply influenced QoL measures. CONCLUSIONS TS common comorbidities have a differential impact on the cognitive abilities of children and adolescents, which translates into a complex influence on their perceived QoL. A longer clinical history of tics was related to worse cognitive outcomes, which prompts further consideration of disease duration in both clinical and research settings involving children and adolescents.
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Affiliation(s)
- Giulia Conte
- Child and Adolescent Neuropsychiatry Unit, Department of Human Neuroscience, Sapienza University of Rome, 00185 Rome, Italy; (G.C.); (M.N.); (V.S.); (E.A.); (F.V.); (V.B.); (A.T.)
| | - Carola Costanza
- Department of Sciences for Health Promotion and Mother and Child Care “G. D’Alessandro”, University of Palermo, 90128 Palermo, Italy;
| | - Maria Novelli
- Child and Adolescent Neuropsychiatry Unit, Department of Human Neuroscience, Sapienza University of Rome, 00185 Rome, Italy; (G.C.); (M.N.); (V.S.); (E.A.); (F.V.); (V.B.); (A.T.)
| | - Veronica Scarselli
- Child and Adolescent Neuropsychiatry Unit, Department of Human Neuroscience, Sapienza University of Rome, 00185 Rome, Italy; (G.C.); (M.N.); (V.S.); (E.A.); (F.V.); (V.B.); (A.T.)
| | - Elena Arigliani
- Child and Adolescent Neuropsychiatry Unit, Department of Human Neuroscience, Sapienza University of Rome, 00185 Rome, Italy; (G.C.); (M.N.); (V.S.); (E.A.); (F.V.); (V.B.); (A.T.)
| | - Francesca Valente
- Child and Adolescent Neuropsychiatry Unit, Department of Human Neuroscience, Sapienza University of Rome, 00185 Rome, Italy; (G.C.); (M.N.); (V.S.); (E.A.); (F.V.); (V.B.); (A.T.)
| | - Valentina Baglioni
- Child and Adolescent Neuropsychiatry Unit, Department of Human Neuroscience, Sapienza University of Rome, 00185 Rome, Italy; (G.C.); (M.N.); (V.S.); (E.A.); (F.V.); (V.B.); (A.T.)
| | - Arianna Terrinoni
- Child and Adolescent Neuropsychiatry Unit, Department of Human Neuroscience, Sapienza University of Rome, 00185 Rome, Italy; (G.C.); (M.N.); (V.S.); (E.A.); (F.V.); (V.B.); (A.T.)
| | - Flavia Chiarotti
- Center for Behavioral Sciences and Mental Health, Istituto Superiore di Sanità, 00161 Rome, Italy;
| | - Francesco Cardona
- Child and Adolescent Neuropsychiatry Unit, Department of Human Neuroscience, Sapienza University of Rome, 00185 Rome, Italy; (G.C.); (M.N.); (V.S.); (E.A.); (F.V.); (V.B.); (A.T.)
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13
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Watson KH, Eckland M, Schwartzman JM, Molnar A, Boon W, Hiller M, Scholer S, Mace R, Rothman A, Claassen DO, Riordan HR, Isaacs DA. The Association of Quality of Life with Psychosocial Factors in Adolescents with Tourette Syndrome. Child Psychiatry Hum Dev 2024:10.1007/s10578-023-01656-0. [PMID: 38311626 DOI: 10.1007/s10578-023-01656-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/11/2023] [Indexed: 02/06/2024]
Abstract
Individuals with Tourette syndrome (TS) have poorer quality of life (QoL) than their peers, yet factors contributing to poor QoL in this population remain unclear. Research to date has predominantly focused on the impact of tics and psychiatric symptoms on QoL in TS samples. The aim of this cross-sectional, multi-informant study was to identify psychosocial variables that may impact adolescent QoL in TS. Thirty-eight adolescents aged 13 to 17 with TS and 28 age-matched controls participated with a caregiver. No group differences were found on QoL, although the TS group reported reduced QoL compared to population normative data. In the TS group, reduced QoL was associated with lower self-esteem, poorer family functioning, higher stress, and greater depression and anxiety; QoL was unrelated to tic severity. In regression analyses, after adjusting for covariates, family functioning was the strongest predictor of QoL. These results emphasize the need to further explore the influence of psychosocial factors, particularly family functioning, on QoL in adolescents with TS.
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Affiliation(s)
- Kelly H Watson
- Department of Neurology, Vanderbilt University Medical Center, 1161 21St Avenue South, A-0118 MCN, Nashville, TN, 37232, USA.
| | - Michelle Eckland
- Department of Neurology, Vanderbilt University Medical Center, 1161 21St Avenue South, A-0118 MCN, Nashville, TN, 37232, USA
| | - Jessica M Schwartzman
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
- Division of Developmental-Behavioral Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, USA
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Andrew Molnar
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Whitney Boon
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Matthew Hiller
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Seth Scholer
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Rachel Mace
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Alice Rothman
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Daniel O Claassen
- Department of Neurology, Vanderbilt University Medical Center, 1161 21St Avenue South, A-0118 MCN, Nashville, TN, 37232, USA
| | - Heather R Riordan
- Phelps Center for Cerebral Palsy and Neurodevelopmental Medicine, Kennedy Krieger Institute, Baltimore, MD, USA
- Department of Neurology, Johns Hopkins Hospital, Baltimore, MD, USA
| | - David A Isaacs
- Department of Neurology, Vanderbilt University Medical Center, 1161 21St Avenue South, A-0118 MCN, Nashville, TN, 37232, USA
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
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14
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Hadji-Michael M, Catanzano M, McAllister E, Heyman I, Lack O, Murphy T, Gilmour J. Applying an Established Exposure Response Prevention Protocol for Young People With Tourette Syndrome in an Intensive, Group Format: A Feasibility Study. Clin Child Psychol Psychiatry 2024; 29:287-300. [PMID: 37210660 DOI: 10.1177/13591045231177365] [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: 05/22/2023]
Abstract
BACKGROUND The motor and vocal tics that characterise Tourette syndrome are stigmatizing and impact on quality of life. Behavioural interventions such as Exposure Response Prevention or Comprehensive Behavioural Interventions for Tics are first line treatment for Tourette syndrome, but availability is limited. This study is the first to explore the impact of an established manualised Exposure Response Prevention treatment protocol, developed for individual therapy, but here uniquely delivered intensively, to a group. METHODS A naturalistic study comprised of a consecutive series of children (N = 20), aged 8-16 years (M = 12, SD = 2.17) were offered Exposure Response Prevention in one of two groups, delivered in series within a specialist clinic. Young people received the equivalent of 12 sessions (matching the manualised individual protocol). RESULTS The YGTSS and Giles de la Tourette Syndrome Quality of Life Scale for Children and Adolescents (Satisfaction Scale) showed significant improvement following treatment with moderate to large effect sizes. Thirty-five percent of children demonstrated a reliable improvement on the YGTSS Global Tic Severity score. CONCLUSIONS These data suggest an established Exposure Response Prevention protocol can be delivered in an intensive, group setting with a positive clinical outcome. Replication in a randomized controlled trial is an important next step.
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Affiliation(s)
- Maria Hadji-Michael
- Tic Disorder Service, Psychological and Mental Health Service, Great Ormond Street Hospital, London, UK
- UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Matteo Catanzano
- Tic Disorder Service, Psychological and Mental Health Service, Great Ormond Street Hospital, London, UK
- UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Eve McAllister
- Tic Disorder Service, Psychological and Mental Health Service, Great Ormond Street Hospital, London, UK
- UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Isobel Heyman
- Tic Disorder Service, Psychological and Mental Health Service, Great Ormond Street Hospital, London, UK
- UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Oliver Lack
- Tic Disorder Service, Psychological and Mental Health Service, Great Ormond Street Hospital, London, UK
| | - Tara Murphy
- Tic Disorder Service, Psychological and Mental Health Service, Great Ormond Street Hospital, London, UK
- UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Jane Gilmour
- Tic Disorder Service, Psychological and Mental Health Service, Great Ormond Street Hospital, London, UK
- UCL Great Ormond Street Institute of Child Health, University College London, London, UK
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15
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Keenan L, Bramham J, Downes M. Parent-Report Sleep Disturbances and Everyday Executive Functioning Difficulties in Children with Tourette Syndrome. Dev Neuropsychol 2024; 49:39-60. [PMID: 38224316 DOI: 10.1080/87565641.2023.2300428] [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] [Received: 07/25/2023] [Accepted: 12/22/2023] [Indexed: 01/16/2024]
Abstract
There is an increasing need to identify and treat sleep disturbances in Tourette syndrome (TS), a neurodevelopmental condition characterized by tics. This study explored sleep, tics, and executive functioning in children with TS (n=136) and neurotypical controls (n=101) through parent-report scales and open-ended questions. 85% of children with TS scored in the clinical range for a sleep disorder. Higher tic severity predicted increased sleep disturbances and executive difficulties. Qualitative insights indicated a bidirectional link between sleep and tics, which warrants consideration in clinical settings. Further research is needed to explore causal links.
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Affiliation(s)
- Lisa Keenan
- School of Psychology, University College Dublin, Dublin, Ireland
| | - Jessica Bramham
- School of Psychology, University College Dublin, Dublin, Ireland
| | - Michelle Downes
- School of Psychology, University College Dublin, Dublin, Ireland
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16
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Pring K, Malli M, Hardy BW, Rapp SR, Storch EA, Mink JW, Martindale JM. Reframing stigma in Tourette syndrome: an updated scoping review. Eur Child Adolesc Psychiatry 2023:10.1007/s00787-023-02332-3. [PMID: 38159134 DOI: 10.1007/s00787-023-02332-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 11/28/2023] [Indexed: 01/03/2024]
Abstract
Persistent tic disorders (PTD) such as Tourette's syndrome (TS) are common childhood-onset neurodevelopmental disorders. Stigmatization of individuals with these disorders remains an ongoing problem. The purpose of this scoping review is to serve as an updated review of the research regarding stigmatization in youth with PTD since the publication of the original systematic review about this topic in 2016. The electronic databases Embase, Web of Science, PubMed, PsycINFO, and CINAHL were searched. Of the 4751 initial articles screened after removing duplications, 47 studies met the inclusion criteria. The studies were examined under the social-ecological stigmatization model, which helps categorize stigmatization into individual, interpersonal, community, and structural levels and serves as a broader definition of stigmatization than the previous systematic review. On the individual level, youth with PTD had lower self-esteem than peers, often leading to fear of future stigmatization, avoidant behaviors, and self-stigmatization. They also experienced higher rates of bullying and other forms of abuse than peers at the interpersonal level. At the community level, youth with PTD faced discriminatory environments in school and work and limited availability of community services and healthcare access. At the structural level, knowledge about PTD was limited in the general population, often about the limited portrayals of PTD in the media. We hope that the broader scope of this review serves to help inform future efforts to decrease the stigmatization faced by this group.
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Affiliation(s)
- Kelly Pring
- Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Melina Malli
- Institute of Population Ageing, University of Oxford, Oxford, UK
| | - Brandy W Hardy
- Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Stephen R Rapp
- Department of Psychology and Behavioral Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Eric A Storch
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | | | - Jaclyn M Martindale
- Department of Neurology, Wake Forest University School of Medicine, North Carolina, Winston-Salem, NC, USA.
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17
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Lee MY, Wang HS, Chen CJ. Psychosocial experiences in youth with Tourette syndrome: a systematic review and meta-synthesis. Eur Child Adolesc Psychiatry 2023:10.1007/s00787-023-02339-w. [PMID: 38129352 DOI: 10.1007/s00787-023-02339-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 11/28/2023] [Indexed: 12/23/2023]
Abstract
Suffering from Tourette syndrome (TS) disrupts the daily lives and interpersonal relationships of patients. The psychosocial experiences of young people with TS are not yet clear. The aim of the systematic review is to identify and synthesize the psychosocial experiences of young people with TS. A meta-synthesis was conducted. PubMed, EMBASE, Cumulative Index to Nursing and Allied Health Literature, Web of Science, and Chinese Electronic Periodical Services databases were searched for articles published from their inception to February 2023. This review followed the Joanna Briggs Institute's Guidelines for Systematic Reviews according to a previously developed protocol. We used the confidence of synthesized qualitative findings (ConQual) approach to evaluate the credibility and dependability of the synthesized findings. This review included 12 qualitative studies from Western and Asian countries published between 2005 and 2019, representing 190 young people with TS. We identified five synthesized findings: affliction by intractable TS, TS was negatively perceived in the social and cultural context, self-adjustment in response to social interaction, response to receiving various interventions, and positivity in promoting self-acceptance. The ConQual grade for each generated synthesized finding ranged from low to moderate. The psychosocial experiences of youths living with TS are unique and are influenced by their interpersonal relationships, social context, and cultural framework. The findings recommend that healthcare providers assist young people in developing personalized symptom management strategies and provide guidance and care that meets the needs of each individual.
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Affiliation(s)
- Mei-Yin Lee
- National Taipei University of Nursing and Health Sciences, Taipei, Taiwan.
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18
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Atkinson-Clement C, Duflot M, Lastennet E, Patsalides L, Wasserman E, Sartoris TM, Tarrano C, Rosso C, Burbaud P, Deniau E, Czernecki V, Roze E, Hartmann A, Worbe Y. How does Tourette syndrome impact adolescents' daily living? A text mining study. Eur Child Adolesc Psychiatry 2023; 32:2623-2635. [PMID: 36460852 PMCID: PMC10682273 DOI: 10.1007/s00787-022-02116-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 11/21/2022] [Indexed: 12/03/2022]
Abstract
Tourette syndrome is a neurodevelopmental disease in which clinical manifestations are essentially present during childhood and adolescence, corresponding to one of the critical development phases. However, its consequences on the daily lives of young patients have been insufficiently investigated. Here, we aimed to investigate this using a statistical text mining approach, allowing for the analysis of a large volume of free textual data. Sixty-two adolescents with Tourette syndrome participated in an interview in which they discussed their daily life (i) in school, (ii) at home, and (iii) with strangers, (iv) the aspect of Tourette syndrome which caused the most difficulty, and (v) their thoughts regarding their future as adults. Following data pre-processing, these corpora were analyzed separately using the IRAMUTEQ software through factorial correspondence analysis to identify the most commonly recurring topics of each corpus, and their relations with clinical features. The main difficulty corpus was directly related to comorbidities of Tourette syndrome. Daily life at home was correlated with executive functioning. Difficulties at school were related to a higher severity of tics. Thoughts regarding future daily life were worst for the youngest patients and were correlated with executive functioning and a higher depression score. Taken altogether, our results highlighted that social stigma was a pervasive topic among our corpora. From a clinical standpoint, tic severity was especially related to difficulties at school, while comorbidities had a high impact on social daily living and cost for managing both tics and symptoms of comorbidities. TRIAL REGISTRATION: clinicaltrials.gov/ct2/show/NCT04179435.
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Affiliation(s)
- Cyril Atkinson-Clement
- Sorbonne Université, Paris Brain Institute Institut du Cerveau-ICM, CNRS, Hôpital de La Pitié Salpêtrière (DMU 6), InsermParis, AP-HP, France.
- Precision Imaging Beacon, School of Medicine, University of Nottingham, Nottingham, UK.
| | - Marion Duflot
- Sorbonne Université, Paris Brain Institute Institut du Cerveau-ICM, CNRS, Hôpital de La Pitié Salpêtrière (DMU 6), InsermParis, AP-HP, France
| | - Eloise Lastennet
- Sorbonne Université, Paris Brain Institute Institut du Cerveau-ICM, CNRS, Hôpital de La Pitié Salpêtrière (DMU 6), InsermParis, AP-HP, France
| | - Leïla Patsalides
- Sorbonne Université, Paris Brain Institute Institut du Cerveau-ICM, CNRS, Hôpital de La Pitié Salpêtrière (DMU 6), InsermParis, AP-HP, France
| | - Emma Wasserman
- Sorbonne Université, Paris Brain Institute Institut du Cerveau-ICM, CNRS, Hôpital de La Pitié Salpêtrière (DMU 6), InsermParis, AP-HP, France
| | - Therese-Marie Sartoris
- Sorbonne Université, Paris Brain Institute Institut du Cerveau-ICM, CNRS, Hôpital de La Pitié Salpêtrière (DMU 6), InsermParis, AP-HP, France
| | - Clément Tarrano
- Sorbonne Université, Paris Brain Institute Institut du Cerveau-ICM, CNRS, Hôpital de La Pitié Salpêtrière (DMU 6), InsermParis, AP-HP, France
| | - Charlotte Rosso
- Sorbonne Université, Paris Brain Institute Institut du Cerveau-ICM, CNRS, Hôpital de La Pitié Salpêtrière (DMU 6), InsermParis, AP-HP, France
- Urgences Cérébro-Vasculaires, Pitié-Salpétrière Hospital, Paris, France
| | - Pierre Burbaud
- Centre Hospitalier Universitaire de Bordeaux, Institut des Maladies Neurodégénératives, CNRS, University of Bordeaux, Bordeaux, France
| | - Emmanuelle Deniau
- Sorbonne Université, Paris Brain Institute Institut du Cerveau-ICM, CNRS, Hôpital de La Pitié Salpêtrière (DMU 6), InsermParis, AP-HP, France
- National Reference Center for Tourette Syndrome, Assistance Publique des Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, 75013, Paris, France
| | - Virginie Czernecki
- Sorbonne Université, Paris Brain Institute Institut du Cerveau-ICM, CNRS, Hôpital de La Pitié Salpêtrière (DMU 6), InsermParis, AP-HP, France
- National Reference Center for Tourette Syndrome, Assistance Publique des Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, 75013, Paris, France
| | - Emmanuel Roze
- Sorbonne Université, Paris Brain Institute Institut du Cerveau-ICM, CNRS, Hôpital de La Pitié Salpêtrière (DMU 6), InsermParis, AP-HP, France
| | - Andreas Hartmann
- Sorbonne Université, Paris Brain Institute Institut du Cerveau-ICM, CNRS, Hôpital de La Pitié Salpêtrière (DMU 6), InsermParis, AP-HP, France
- National Reference Center for Tourette Syndrome, Assistance Publique des Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, 75013, Paris, France
| | - Yulia Worbe
- Sorbonne Université, Paris Brain Institute Institut du Cerveau-ICM, CNRS, Hôpital de La Pitié Salpêtrière (DMU 6), InsermParis, AP-HP, France
- National Reference Center for Tourette Syndrome, Assistance Publique des Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, 75013, Paris, France
- Department of Neurophysiology, Saint Antoine Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
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Yu J, Yao X, Zhang X, Hao J. New insights of metabolite abnormalities in the thalamus of rats with iminodiproprionitrile-induced tic disorders. Front Neurosci 2023; 17:1201294. [PMID: 37841690 PMCID: PMC10570423 DOI: 10.3389/fnins.2023.1201294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 09/15/2023] [Indexed: 10/17/2023] Open
Abstract
Introduction This study aimed to investigate pathological changes in the "Glutamate (Glu)-γ-aminobutyric acid (GABA)" loop and apply widely targeted metabolomic analysis technology to comprehensively explore metabolite abnormalities/ in the thalamus of rats with tic disorders (TD). Methods Wistar rats were randomized into control, TD, and tiapride (Tia) groups. Iminodipropionitrile (IDPN) was used to induce TD in rats. The Tia group was administered tiapride. Neurotransmitter levels in the thalamus of rats in the three groups were measured using UPLC-3Q MS. And, the protein expression levels of Glu decarboxylase (GAD65/67) and GABA transporter protein (GAD-T) were measured using western blotting. The mRNA expression levels of these genes were evaluated using real-time polymerase chain reaction. Lastly, other metabolites in the thalamus were detected by widely targeted metabolomic analysis between TD and Control group rats. Results The Glu level, Glu/GABA ratio, and Asp level in the TD group were significantly higher (all p < 0.001) than those of the Control group, whereas the GABA and Gly levels were lower (p < 0.001 and p = 0.009, respectively). The Tia group exhibited a significant reduction in the Glu level (p = 0.001) compared with the TD group. The protein expression level of GAD67 in TD group was higher (p = 0.009) and the mRNA expression levels of GAD65, GAD67, and GAT-1 were lower (p < 0.05) than those of the Control group. The Tia group did not display any differences in GAD65, GAD67, or GAT-1 expression. Widely targeted metabolomic analysis revealed that 34 substances were abnornal between the TD and Control groups (9 upregulated and 25 downregulated). Neurosteroids (progesterone, corticosterone) exhibited distinct differences. Metabolite analysis using the Kyoto encyclopedia for genes and genomes indicated that the steroid hormone biosynthesis pathway may be involved in TD pathogenesis. Conclusion This study revealed metabolic abnormalities in the thalamus of rats with TD. The interaction between neurotransmitters and neurosteroid biosynthesis represents a new direction for future studies.
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Affiliation(s)
- Jingru Yu
- School of Medicine, Shaoxing University, Shaoxing, China
| | - Xuan Yao
- School of Medicine, Shaoxing University, Shaoxing, China
| | - Xin Zhang
- Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Juanjuan Hao
- School of Medicine, Shaoxing University, Shaoxing, China
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Coleman J, Melia Y. Me, My Tics and I: An Exploration of Self-Identity and its Implications for Psychological Wellbeing in Young Women with Tourette's Syndrome. JOURNAL OF DEVELOPMENTAL AND PHYSICAL DISABILITIES 2023:1-23. [PMID: 37361460 PMCID: PMC10175913 DOI: 10.1007/s10882-023-09911-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 04/04/2023] [Indexed: 06/28/2023]
Abstract
Women with Tourette's syndrome (TS) continue to be under-researched, despite female sex being associated with increased tic-related impairment in adulthood. Existing literature indicates that individuals with TS are more likely than the general population to report self-stigma, but little is known about the subjective identities of women with TS and how this relates to psychological wellbeing. Semi-structured interviews were conducted via Zoom with a purposive sample of 11 females. All were diagnosed with TS and aged 18-28. Data was transcribed verbatim and thematic analysis applied. Five themes were established: "I'm not normal", "I just want to be me", I'm a "people pleaser", seeing oneself as an "outsider", and "it's just part of me…it's not going anywhere". Difficulties with self-acceptance and the autonomy to be one's true self were noted and appeared to be intensified by stereotypical gender roles and attempts to conceal tics. Findings also suggested that personal growth and feelings of mastery can be achieved through embracing TS as part of one's identity, or recognising it as just one aspect of the self. Psychological support focused on accepting and living with tics rather than reducing them may benefit this population and is currently difficult to access. Consideration should also be given to improving the availability of support groups where women with TS can meet others like themselves. Supplementary Information The online version contains supplementary material available at 10.1007/s10882-023-09911-x.
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Affiliation(s)
- Janine Coleman
- Department of Psychology, Staffordshire University, Stoke-on-Trent, UK
| | - Yvonne Melia
- Department of Psychology, Staffordshire University, Stoke-on-Trent, UK
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21
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Sadeh DF, Frenk ML, Simha T, Horesh D, Steinberg T, Geva N, Nahon M, Dietrich A, Hoekstra PJ, Ruhrman D, Apter A, Fennig S, Benaroya-Milshtein N. Moderating Role of Depression on the Association of Tic Severity With Functional Impairment in Children. Pediatr Neurol 2023; 144:90-96. [PMID: 37196601 DOI: 10.1016/j.pediatrneurol.2023.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 04/08/2023] [Accepted: 04/17/2023] [Indexed: 05/19/2023]
Abstract
BACKGROUND Chronic tic disorders (CTDs) commonly co-occur with other psychiatric disorders. CTDs have been linked to functional impairment and reduction in quality of life. Insufficient research is available on depressive symptoms in patients with CTD, especially children and adolescents, yielding conflicting findings. To investigate the presence of depressive symptoms in a cohort of children and young adolescents with CTD and to test whether they moderate the link between tic severity and functional impairment. METHODS The sample consisted of 85 children and adolescents (six to 18 years) with a CTD who were treated in a large referral center. Participants were evaluated using gold-standard self- and clinician-reporting instruments to measure tic symptom severity and tic-related functional impairment (Yale Global Tic Severity Scale), depression (Child Depression Inventory), and obsessive-compulsive symptoms (Children Yale Brown Obsessive Compulsive Scale). RESULTS Depressive symptoms (mild to severe) were exhibited by 21% of our sample. Study participants with CTD and comorbid obsessive-compulsive disorder (OCD) and/or attention-deficit/hyperactivity disorder had higher rates of depressive symptoms compared with those without comorbidities. Significant correlations were found within and among all tic-related and OCD-related measures, yet depressive symptoms only correlated to tic-related functional impairment. Depression significantly and positively moderated the correlation between tic severity and tic-related functional impairment. CONCLUSIONS Findings suggest that depression plays an important part as a moderator in the link between tic severity and functional impairment in children and adolescents. Our study highlights the importance of screening for and treating depression in patients with CTD.
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Affiliation(s)
- Dana Feldman Sadeh
- Matta and Harry Freund Neuropsychiatric Clinic for Tourette Syndrome and Tic Disorders, The E. Richard Feinberg Department of Child and Adolescent Psychiatry, SCMCI, Petah Tiqwa, Israel
| | - Mira Levis Frenk
- Matta and Harry Freund Neuropsychiatric Clinic for Tourette Syndrome and Tic Disorders, The E. Richard Feinberg Department of Child and Adolescent Psychiatry, SCMCI, Petah Tiqwa, Israel
| | - Tomer Simha
- Matta and Harry Freund Neuropsychiatric Clinic for Tourette Syndrome and Tic Disorders, The E. Richard Feinberg Department of Child and Adolescent Psychiatry, SCMCI, Petah Tiqwa, Israel
| | - Danny Horesh
- Department of Psychology, Faculty of Social Science, Bar-Ilan University, Ramat Gan, Israel; Department of Psychiatry, New York University School of Medicine, New York, New York
| | - Tamar Steinberg
- Matta and Harry Freund Neuropsychiatric Clinic for Tourette Syndrome and Tic Disorders, The E. Richard Feinberg Department of Child and Adolescent Psychiatry, SCMCI, Petah Tiqwa, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nofar Geva
- Matta and Harry Freund Neuropsychiatric Clinic for Tourette Syndrome and Tic Disorders, The E. Richard Feinberg Department of Child and Adolescent Psychiatry, SCMCI, Petah Tiqwa, Israel
| | - Matan Nahon
- Department of Psychology, Faculty of Social Science, Bar-Ilan University, Ramat Gan, Israel
| | - Andrea Dietrich
- Department of Child and Adolescent Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Pieter J Hoekstra
- Department of Child and Adolescent Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Daphna Ruhrman
- Matta and Harry Freund Neuropsychiatric Clinic for Tourette Syndrome and Tic Disorders, The E. Richard Feinberg Department of Child and Adolescent Psychiatry, SCMCI, Petah Tiqwa, Israel; Baruch Ivcher School of Psychology, Interdisciplinary Center, Herzliya, Israel
| | - Alan Apter
- Matta and Harry Freund Neuropsychiatric Clinic for Tourette Syndrome and Tic Disorders, The E. Richard Feinberg Department of Child and Adolescent Psychiatry, SCMCI, Petah Tiqwa, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Silvana Fennig
- Matta and Harry Freund Neuropsychiatric Clinic for Tourette Syndrome and Tic Disorders, The E. Richard Feinberg Department of Child and Adolescent Psychiatry, SCMCI, Petah Tiqwa, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Noa Benaroya-Milshtein
- Matta and Harry Freund Neuropsychiatric Clinic for Tourette Syndrome and Tic Disorders, The E. Richard Feinberg Department of Child and Adolescent Psychiatry, SCMCI, Petah Tiqwa, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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22
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Xu RH, Dai Y, Ng SSM, Zhang S, Dong D. Health-related quality of life in children and adolescents with Duchenne muscular dystrophy and comorbid attention-deficit hyperactivity disorder using propensity-score matching. J Affect Disord 2023; 333:147-153. [PMID: 37084967 DOI: 10.1016/j.jad.2023.04.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 03/26/2023] [Accepted: 04/14/2023] [Indexed: 04/23/2023]
Abstract
OBJECTIVE This study aimed to assess and compare the health-related quality of life (HRQoL) in a group of paediatric patients with Duchenne muscular dystrophy (DMD) with and without comorbid attention-deficit hyperactivity disorder (ADHD) diagnosis using a propensity-scoring method (PSM). METHOD Data used in this study obtained from a cross-sectional and web-based survey to investigate the HRQoL for paediatric DMD patients. Data about those who diagnosed with ADHD was elicited for analysis. PSM was used to ensure generation of 1:5 matched pairs with no differences in several background characteristics between DMD patients with and without ADHD. Wilcoxon rank sum test and Multiple logistic regression models were used to measure the differences in HRQoL between matched DMD patients with and without ADHD. RESULTS After PSM, 630 DMD patients were assigned to the 'No ADHD' group, and successfully matched with another 126 DMD patients in the ADHD comparison group. Compared to DMD patients without ADHD, those with ADHD were more likely to report having symptoms and side-effects. Additionally, paediatric DMD patients with ADHD reported a significantly lower HRQoL on the subscales of emotional, social, and school functioning as compared to those without ADHD. CONCLUSION This study demonstrated a higher burden of clinical symptoms, health service utilization, and psychosocial factors on HRQoL in DMD patients with ADHD compared to those without ADHD. Future studies using global data may provide meaningful comparisons with our results, and the efficacy of ADHD programs in DMD patients can be compared based on their HRQoL.
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Affiliation(s)
- Richard Huan Xu
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region
| | - Yi Dai
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Shamay S M Ng
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region
| | - Shuyang Zhang
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Dong Dong
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region.
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Smith JN, Owens JS, Evans SW, Bitsko RH, Holbrook JR. A Population-Based Study of the Utility of Screening for Tics and the Relative Contribution of Tics and Psychiatric Comorbidity to Academic and Social Impairment in Adolescents. EVIDENCE-BASED PRACTICE IN CHILD AND ADOLESCENT MENTAL HEALTH 2023; 9:192-204. [PMID: 38883230 PMCID: PMC11177595 DOI: 10.1080/23794925.2023.2263856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2024]
Abstract
This study examined the performance of a brief screening tool for tics in adolescents. Academic and social impairment in students by tic screen status and emotional/behavioral problem status were examined. Data were collected as part of an epidemiologic study, the Project to Learn about Youth - Mental Health. Participants were 2,312 secondary school students at the Ohio site (47.4% female; 94.4% non-Hispanic white) and their teachers. Students completed 6 items from the Motor tic, Obsessions and compulsions, Vocal tic Evaluation Survey (MOVES-6) and the Strengths and Difficulties Questionnaire (SDQ). Teachers completed the Proxy Report Questionnaire for tics and SDQ. Based on responses to the MOVES-6, 11.1% of students screened positive for tics. Internal consistency was adequate (α = 0.76); inter-rater consistency between teachers and students was low (0.03). Based on student self-report, those who screened positive for tics self-reported more academic and social impairment than students who screened negative for tics; teacher-report of impairment was similar between those with a positive or negative tic screen. Students who screened positive for tics and reported internalizing difficulties reported more academic and social impairment than students with only a positive tic screen. Teachers perceived those screening positive for tics and externalizing difficulties as the most socially impaired. In conclusion, a positive self-reported tic screen was associated with self-reported academic and social impairment. Findings reveal the independent contribution of tics to impairment, even when internalizing and externalizing problems are present, and the potential utility of a school-based screening for tics in adolescents.
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Affiliation(s)
| | | | - Steven W. Evans
- Department of Psychology, Ohio University, Athens, Ohio, USA
| | - Rebecca H. Bitsko
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - Joseph R. Holbrook
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
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24
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P3b Amplitude and Latency in Tic Disorders: A Meta-Analysis. Brain Sci 2022; 12:brainsci12121712. [PMID: 36552171 PMCID: PMC9775302 DOI: 10.3390/brainsci12121712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 11/14/2022] [Accepted: 12/09/2022] [Indexed: 12/15/2022] Open
Abstract
P3b is an event-related potential (ERP) that may be abnormal in patients with tic disorders (TD), but evidence has been inconsistent. Given the possible association between P3b and TD and the need for biomarkers for TD, the primary objective of this meta-analysis was to characterize P3b in patients with TD in comparison to healthy controls (HCs). METHODS By searching PubMed, Embase, Web of Science, SCOPUS, Medline, and Google Scholar, we identified studies that compared P3b between TD patients and HCs. The amplitude and latency of P3b were then analyzed. Subgroup analyses were conducted to investigate the influence of different experimental factors on P3b indices. RESULT Overall, 19 articles involving 388 cases and 414 controls were evaluated. There were no significant abnormalities in P3b amplitude and latency in TD patients. The P3b amplitude of the TD patients was significantly decreased during the oddball task, and the P3b amplitude of the adult TD patients was also significantly decreased. CONCLUSION TD patients may have an abnormal P3b compared to HCs under specified conditions.
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Frey J, Black KJ, Malaty IA. TikTok Tourette's: Are We Witnessing a Rise in Functional Tic-Like Behavior Driven by Adolescent Social Media Use? Psychol Res Behav Manag 2022; 15:3575-3585. [PMID: 36505669 PMCID: PMC9733629 DOI: 10.2147/prbm.s359977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 11/19/2022] [Indexed: 12/12/2022] Open
Abstract
Perceptions of Tourette syndrome (TS) and tic disorders are often driven by social media. During the COVID-19 pandemic, social media consumption greatly increased, particularly in the adolescent population. In parallel with increased social media consumption, there has also been an increase in tic severity and functional tic-like behavior (FTLB). Given that many of the tic videos posted on social media are misleading, perpetuate false beliefs about TS, or reinforce tic-like behaviors, there is increasing concern that these videos are driving the rapid increase in FTLBs. Several studies have reviewed newly presenting cases of FTLB and have found shared characteristics, including that a higher proportion of affected individuals are female, there is a low proportion with a history of childhood or family tics, and symptom onset is typically acute and develops in the teenage years. In addition, the quality of the tics seen in association with FTLB mirrors many of the tics seen on popular social media channels, with higher rates of coprophenomena, tic attacks, and involvement of the trunk and extremities than is seen with typical tics. FTLBs are likely a specific subgroup of functional tics largely influenced by the portrayal of and growing popularity of functional tics posted on social media during the COVID-19 pandemic. However, several factors, including increased anxiety, social isolation, and social media use in general during the pandemic are likely also contributing factors to the surge of FTLBs seen recently. In this era of increased social media consumption, it will become increasingly important for clinicians to educate patients about where and how medical information is spread, to ensure the best possible diagnosis, treatment, and outcomes for patients.
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Affiliation(s)
- Jessica Frey
- Department of Neurology, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, USA,Correspondence: Jessica Frey, Department of Neurology, Rockefeller Neuroscience Institute, West Virginia University, 1 Medical Center Drive, Morgantown, WV, 26505, USA, Tel +1 304-298-6127, Fax +1 304 598 6442, Email
| | - Kevin J Black
- Departments of Psychiatry, Neurology, Radiology, and Neuroscience, Washington University in St. Louis, St. Louis, MO, USA
| | - Irene A Malaty
- Department of Neurology, Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
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26
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Adaptation of Behavioral Treatment for Youth with Tourette’s Syndrome and Complex Comorbidity. CURRENT DEVELOPMENTAL DISORDERS REPORTS 2022. [DOI: 10.1007/s40474-022-00266-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Yang C, Zhang J, Zhao Q, Zhang J, Zhou J, Wang L. Trends of Tourette Syndrome in children from 2011 to 2021: A bibliometric analysis. Front Behav Neurosci 2022; 16:991805. [DOI: 10.3389/fnbeh.2022.991805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 10/27/2022] [Indexed: 11/18/2022] Open
Abstract
ObjectiveAnalyze the research status of Tourette Syndrome (TS) in children by CiteSpace and determine the current research hotspots and frontiers.Materials and methodsWe chose publications indexed in the Web of Science Core Collection (WoSCC) database for studies related to TS in children from 2011 to 2021. We built online cooperation maps of countries/regions, institutions, authors, journals, references, and keywords by CiteSpace, and identified hotspots and frontiers of study for children’s TS.ResultsA total of 1,232 publications about TS in children were downloaded from the WoSCC. The USA (414) was the country with the highest rate of production, and University College London (87) was the institution that had the highest publication rate. Andrea Eugenio Cavanna was the most prolific author (39 papers). There was inactive cooperation between institutions, countries/regions, and authors. The Journal of European Child & Adolescent Psychiatry was the most active journal. Hot topics focused on epidemiology, comorbidities, deep brain stimulation, behavioral therapy, basal ganglia, pharmacological treatment, and risk factors of TS in children.ConclusionAccording to the CiteSpace results, this study found that authors, countries/regions, and institutions were not actively working together. Current research hotspots mainly consist of epidemiology, comorbidities, deep brain stimulation, behavior therapy, and basal ganglia. The main research trends include comorbidities, pharmacological treatment, and risk factors. Therefore, international cooperation should be strengthened in the future, and it should be mindful of the psychiatric comorbidities of TS, the choice of intervention measures, and early warning of risk factors.
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Kang NR, Kim HJ, Moon DS, Kwack YS. Effects of Group Comprehensive Behavioral Intervention for Tics in Children With Tourette’s Disorder and Chronic Tic Disorder. Soa Chongsonyon Chongsin Uihak 2022; 33:91-98. [PMID: 36203883 PMCID: PMC9513408 DOI: 10.5765/jkacap.220013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 07/12/2022] [Accepted: 07/21/2022] [Indexed: 11/05/2022] Open
Abstract
Objectives Comprehensive behavioral intervention for tics (CBIT) is effective in children with chronic tic disorders. This study aimed to assess the effect of group-based CBIT (group-CBIT) on tic severity and comorbid symptoms. We compared the efficacy of group CBIT with that of a control. Methods Thirty children with chronic tic disorder or Tourette’s disorder were enrolled in this study. Eighteen were assigned to the group-CBIT for eight sessions, and 12 were assigned to the control group. Tics and comorbid symptoms were assessed pre- and post-intervention using the Yale Global Tic Severity Scale (YGTSS), Premonitory Urge for Tics Scale, attention-deficit hyperactivity disorder Rating Scale-IV, Children’s Yale-Brown Obsessive-Compulsive Scale, and the Korean-Children Behavioral Checklist. We compared the pre- and post-intervention results of each group and determined the difference in the pre- and post-intervention results between intervention and the control group. Results The YGTSS motor and vocal tic interference, global impairment, and global severity scores decreased in the intervention group only. Group CBIT was superior in reducing the motor tic interference, impairment score, and global severity score to the control group. Conclusion The group-CBIT showed an improvement in tic symptoms, especially in reducing the level of interference and impairment of tics.
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Affiliation(s)
- Na Ri Kang
- Department of Psychiatry, Jeju National University Hospital, Jeju, Korea
- Department of Psychiatry, Jeju National University School of Medicine, Jeju, Korea
| | - Hui-Jeong Kim
- Department of Psychiatry, Jeju National University Hospital, Jeju, Korea
| | - Duk Soo Moon
- Department of Psychiatry, Jeju National University Hospital, Jeju, Korea
- Department of Psychiatry, Jeju National University School of Medicine, Jeju, Korea
| | - Young Sook Kwack
- Department of Psychiatry, Seoul Metropolitan Eunpyeong Hospital, Seoul, Korea
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29
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Fan F, Bian Z, Zhang X, Wu H, Wang S, Zhang S, Wang Q, Han F. Big data analytics frameworks for the influence of gut microbiota on the development of tic disorder. Front Comput Neurosci 2022; 16:986591. [PMID: 36093417 PMCID: PMC9452719 DOI: 10.3389/fncom.2022.986591] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 07/29/2022] [Indexed: 11/13/2022] Open
Abstract
The association between gut microbiota and psychiatric disorders has received increasing research attention. Meanwhile, big data analysis has been utilized in many filed including business, human healthcare analysis, etc. The primary objective of this article was to provide insights into Big Data Analytics (BDA) to clarify the association between gut microbiota and TD (Tic disorder). Specifically, we investigated the recent studies related to gut microbiota composition differences in patients with TD compared to health people. We searched on PubMed and Embase (Ovid) databases for relevant published articles until June 15, 2021. A total of 78 TD and 62 health control stool samples were examined. Case-control design was applied in all the studies. No consensus was evident in α-diversity and β-diversity. The abundance of phyla Bacteroidetes and Firmicutes was predominant at the taxa level. Gut microbiota taxonomic differences were found between TD cases and controls, though inconsistently across studies. Further studies are needed to reveal the underlying pathophysiology of TD and correlation between TD and gut microbiota composition.
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Affiliation(s)
- Fei Fan
- Department of Pediatrics, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- *Correspondence: Fei Fan,
| | - Zhaoxiang Bian
- Chinese EQUATOR Centre, Hong Kong Chinese Medicine Clinical Study Centre, Chinese Clinical Trial Registry (Hong Kong), School of Chinese Medicine, Hong Kong Baptist University, Kowloon, Hong Kong SAR, China
| | - Xuan Zhang
- Chinese EQUATOR Centre, Hong Kong Chinese Medicine Clinical Study Centre, Chinese Clinical Trial Registry (Hong Kong), School of Chinese Medicine, Hong Kong Baptist University, Kowloon, Hong Kong SAR, China
| | - Hongwei Wu
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing, China
| | - Simeng Wang
- Department of Pediatrics, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Si Zhang
- Department of Pediatrics, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Qiong Wang
- Clinical Medical School, Beijing University of Chinese Medicine, Beijing, China
| | - Fei Han
- Department of Pediatrics, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Fei Han,
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Li Y, Yan JJ, Cui YH. Clinical characteristics of pediatric patients with treatment-refractory Tourette syndrome: An evidence-based survey in a Chinese population. World J Psychiatry 2022; 12:958-969. [PMID: 36051602 PMCID: PMC9331451 DOI: 10.5498/wjp.v12.i7.958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 04/06/2022] [Accepted: 06/27/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Tourette syndrome (TS) is a complex neurodevelopmental condition marked by tics, as well as a variety of psychiatric comorbidities, such as obsessive-compulsive disorders (OCDs), attention deficit hyperactivity disorder (ADHD), anxiety, and self-injurious behavior. TS might progress to treatment-refractory Tourette syndrome (TRTS) in some patients. However, there is no confirmed evidence in pediatric patients with TRTS.
AIM To investigate the clinical characteristics of TRTS in a Chinese pediatric sample.
METHODS A total of 126 pediatric patients aged 6-12 years with TS were identified, including 64 TRTS and 62 non-TRTS patients. The Yale Global Tic Severity Scale (YGTSS), Premonitory Urge for Tics Scale (PUTS), and Child Behavior Checklist (CBCL) were used to assess these two groups and compared the difference between the TRTS and non-TRTS patients.
RESULTS When compared with the non-TRTS group, we found that the age of onset for TRTS was younger (P < 0.001), and the duration of illness was longer (P < 0.001). TRTS was more often caused by psychosocial (P < 0.001) than physiological factors, and coprolalia and inappropriate parenting style were more often present in the TRTS group (P < 0.001). The TRTS group showed a higher level of premonitory urge (P < 0.001), a lower intelligence quotient (IQ) (P < 0.001), and a higher percentage of family history of TS. The TRTS patients demonstrated more problems (P < 0.01) in the “Uncommunicative”, “Obsessive-Compulsive”, “Social-Withdrawal”, “Hyperactive”, “Aggressive”, and “Delinquent” subscales in the boys group, and “Social-Withdrawal” (P = 0.02) subscale in the girls group.
CONCLUSION Pediatric TRTS might show an earlier age of onset age, longer duration of illness, lower IQ, higher premonitory urge, and higher comorbidities with ADHD-related symptoms and OCD-related symptoms. We need to pay more attention to the social communication deficits of TRTS.
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Affiliation(s)
- Ying Li
- Department of Psychiatry, Beijing Children's Hospital, Beijing 100045, China
| | - Jun-Juan Yan
- Department of Psychiatry, Beijing Children's Hospital, Beijing 100045, China
| | - Yong-Hua Cui
- Department of Psychiatry, Beijing Children's Hospital, Beijing 100045, China
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Eapen V, Usherwood T. Assessing tics in children. BMJ 2022; 376:e069346. [PMID: 35241477 DOI: 10.1136/bmj-2021-069346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Valsamma Eapen
- University of New South Wales, Sydney, Australia
- South Western Sydney Local Health District, Liverpool, Australia
- Ingham Institute of Applied Medical Research, Liverpool, Australia
| | - Tim Usherwood
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- The George Institute for Global Health, Sydney, Australia
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The Assessment of Knowledge about Tourette’s Syndrome among Medical Students and Primary Physicians in Riyadh, Saudi Arabia: A Cross-Sectional Study. Neurol Res Int 2022; 2022:3018305. [PMID: 35265374 PMCID: PMC8901345 DOI: 10.1155/2022/3018305] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 01/24/2022] [Indexed: 11/17/2022] Open
Abstract
Background. Tourette’s syndrome (TS), a chronic, often disabling neuropsychiatric disorder characterized by motor and vocal tics, is frequently misdiagnosed, or patients are delayed in diagnosis. There is severe deficiency of research about Tourette’s syndrome (TS) in the Middle East region. Objectives. To evaluate the knowledge and attitude of medical students and primary care physicians (PCPs) about TS and tic disorders. Methods. IRB approved, cross-sectional study. A total of 316 medical students of King Saud bin Abdulaziz University and 59 primary care physicians of Riyadh participated. Convenient, cluster sampling was used. A validated, self-administered questionnaire was used. Sum of all knowledge questions was calculated. Data were analyzed using SPSS software. Results. Survey was completed by 375 students and physicians, of whom 253 (67.5%) were men. Mean general knowledge score was 61.5 (±12.04) out of 100. Majority (66.1%) knew the diagnostic criteria for TS; only 46.1% considered antipsychotics as effective treatment. Only 25.1% had ever heard of habit reversal; 70% wanted to learn more. Only 10% of physicians had treated a patient with TS. There was no difference in knowledge between men and women (
). Board-certified physicians had a higher knowledge score (
). Family physicians demonstrated higher level of knowledge compared to other physicians (
). There was no difference between knowledge of students of different years (
) or between students and physicians (
). Conclusion. There was alarming lack of knowledge about Tourette syndrome at various level of medical training and practice including students and physicians. Those who achieved board certification and practiced as family physicians fared better in knowledge about Tourette’s syndrome.
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Bortolato M, Coffey BJ, Gabbay V, Scheggi S. Allopregnanolone: The missing link to explain the effects of stress on tic exacerbation? J Neuroendocrinol 2022; 34:e13022. [PMID: 34423500 PMCID: PMC8800948 DOI: 10.1111/jne.13022] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 07/19/2021] [Accepted: 07/26/2021] [Indexed: 12/13/2022]
Abstract
The neurosteroid allopregnanolone (3α-hydroxy-5α-pregnan-20-one; AP) elicits pleiotropic effects in the central nervous system, ranging from neuroprotective and anti-inflammatory functions to the regulation of mood and emotional responses. Several lines of research show that the brain rapidly produces AP in response to acute stress to reduce the allostatic load and enhance coping. These effects not only are likely mediated by GABAA receptor activation but also result from the contributions of other mechanisms, such as the stimulation of membrane progesterone receptors. In keeping with this evidence, AP has been shown to exert rapid, potent antidepressant properties and has been recently approved for the therapy of moderate-to-severe postpartum depression. In addition to depression, emerging evidence points to the potential of AP as a therapy for other neuropsychiatric disorders, including anxiety, seizures, post-traumatic stress disorder and cognitive problems. Although this evidence has spurred interest in further therapeutic applications of AP, some investigations suggest that this neurosteroid may also be associated with adverse events in specific disorders. For example, our group has recently documented that AP increases tic-like manifestations in several animal models of tic disorders; furthermore, our results indicate that inhibiting AP synthesis and signalling reduces the exacerbation of tic severity associated with acute stress. Although the specific mechanisms of these effects remain partially elusive, our findings point to the possibility that the GABAergic activation by AP may also lead to disinhibitory effects, which could interfere with the ability of patients to suppress their tics. Future studies will be necessary to verify whether these mechanisms may apply to other externalising manifestations, such as impulse-control problems and manic symptoms.
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Affiliation(s)
- Marco Bortolato
- Department of Pharmacology and ToxicologyCollege of PharmacyUniversity of UtahSalt Lake CityUTUSA
- Research Consortium on NeuroEndocrine Causes of Tics (ReConNECT)
| | - Barbara J. Coffey
- Research Consortium on NeuroEndocrine Causes of Tics (ReConNECT)
- Department of Psychiatry and Behavioral ScienceMiller School of MedicineUniversity of MiamiMiamiFLUSA
| | - Vilma Gabbay
- Research Consortium on NeuroEndocrine Causes of Tics (ReConNECT)
- Department of Psychiatry and Behavioral SciencesAlbert Einstein College of MedicineBronxNYUSA
| | - Simona Scheggi
- Department of Molecular and Developmental MedicineSchool of MedicineUniversity of SienaSienaItaly
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Inggas MAM, Dianata DAI, Situmeang RFV, Wahjoepramono EJ, Kaido T. Long-term Outcome of Deep Brain Stimulation in Intralaminar Thalamus for Refractory Tourette Syndrome: A Case Report. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.8250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Tourette syndrome (TS) is a neurobehavioral disease that has onset at an early age around 5–7 years old. This disease affects 0.3–0.8% of young age population. With criteria diagnosis at least one vocal and two motor tics beginning before 18 years old. The symptoms of tics remain unusual from a social point of view, thus making it difficult for patients to evolve their professional life and education level. We present a case report of a young male patient with refractory TS with a Yale Global Tic Severity Scale (YGTSS) score of 88 out of 100; he has experienced remarkable improvement after undergoing a deep brain stimulation (DBS) procedure.
CASE REPORT: A 23-year-old male came to our neurosurgery outpatient clinic who had had a history of TS since 8 years ago. He had facial and jumping-type tics. Lately, his jumping movements cannot be controlled, with increasing frequency and intensity. The maximum tic-free interval is only 30 min. On 1st-time evaluation in the neurosurgery outpatient clinic, he scored 88 out 0f 100 on the YGTSS even after medication treatment, repetitive transcranial magnetic stimulation, and behavioral therapies. The DBS procedure was carried out in November 2018 with targets on the bilateral intralaminar nuclei of thalamus (centromedian nucleus). The result is convincing, with decrease of YGTSS score until 14 after 3 years evaluation postsurgery.
CONCLUSION: After performing DBS targeting the bilateral thalamus (central thalamus nucleus), the severity of tic was dramatically reduced. The result is pleasing to the patient as they can resume activity in public and return to college. Case reports regarding the treatment of refractory TS with DBS are still rare in Indonesia. To the best of our knowledge, this is the first such report with long-term follow-up in South East Asia.
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Khan K, Hollis C, Murphy T, Hall CL. Digital and remote behavioral therapies for treating tic disorders: Recent advances and next steps. Front Psychiatry 2022; 13:928487. [PMID: 35911244 PMCID: PMC9334700 DOI: 10.3389/fpsyt.2022.928487] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 06/24/2022] [Indexed: 11/13/2022] Open
Abstract
The rapid expansion of access to and engagement with digital technology over the past 15 years has transformed the potential for remote delivery of evidence-based digital health interventions (DHIs). Digital and remote behavioral interventions have the potential to address current gaps in the provision of evidence-based therapies in healthcare services. As the lack of access to behavioral treatments for people with tic disorders is a pressing issue across the world, there is great potential for DHIs to close this treatment gap. Here, we present a critical synthesis of the recent key advances in the field of digitally delivered, remote therapy for tics, outlining the research evidence for the clinical and cost-effectiveness and acceptability of digital or remotely delivered therapy. We found five trials aimed at reducing tic severity in children and young people and one trial for adults. The evidence supports the clinical utility of DHIs to deliver tic therapies, which shows promise in being clinically efficacious compared to an active control. Furthermore, DHIs in trials show good adherence and engagement and are acceptable to patients. The role of human support (including therapists and parents for young people) is likely to be important to encourage adherence. DHIs, where the main therapeutic content is delivered via web-based chapters, are likely to reduce clinical time, and maintain intervention fidelity, but further research is required to understand cost-effectiveness. Despite utilizing randomized controlled trials, only two trials were sufficiently powered to address efficacy and only one trial explored contextual factors that may influence engagement. Moreover, only one trial followed patients for >12 months, thus further long-term follow-ups are required. Specifically, we note that despite an emerging evidence base, DHIs for tics are yet to be routinely implemented in healthcare provision in any country. Drawing on the existing evidence, we conclude by proposing a stepped care model, in which digital therapy is implemented as a widely accessible first-line treatment using a purely online or therapist-supported approach.
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Affiliation(s)
- Kareem Khan
- NIHR MindTech MedTech Co-operative, Institute of Mental Health, School of Medicine, Mental Health and Clinical Neurosciences, University of Nottingham, Nottingham, United Kingdom
- NIHR Nottingham Biomedical Research Centre, Institute of Mental Health, Mental Health and Clinical Neurosciences, University of Nottingham, Nottingham, United Kingdom
- Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- *Correspondence: Kareem Khan
| | - Chris Hollis
- NIHR MindTech MedTech Co-operative, Institute of Mental Health, School of Medicine, Mental Health and Clinical Neurosciences, University of Nottingham, Nottingham, United Kingdom
- NIHR Nottingham Biomedical Research Centre, Institute of Mental Health, Mental Health and Clinical Neurosciences, University of Nottingham, Nottingham, United Kingdom
- Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Tara Murphy
- UCL Great Ormond Street Institute of Child Health (ICH), London, United Kingdom
- Psychological and Mental Health Services, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Charlotte L. Hall
- NIHR MindTech MedTech Co-operative, Institute of Mental Health, School of Medicine, Mental Health and Clinical Neurosciences, University of Nottingham, Nottingham, United Kingdom
- NIHR Nottingham Biomedical Research Centre, Institute of Mental Health, Mental Health and Clinical Neurosciences, University of Nottingham, Nottingham, United Kingdom
- Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, United Kingdom
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Xu W, Ding Q, Zhao Y, Jiang W, Han J, Sun J. A preliminary study of comprehensive behavioral intervention for tics in Chinese children with chronic tic disorder or Tourette syndrome. Front Psychiatry 2022; 13:997174. [PMID: 36440399 PMCID: PMC9691679 DOI: 10.3389/fpsyt.2022.997174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 10/14/2022] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To investigate the adaptability of Comprehensive Behavioral Intervention for Tics (CBIT) for a Chinese population, and evaluate the efficacy of combined CBIT and pharmacotherapy (CBIT + PT) compared to CBIT or pharmacotherapy (PT) alone for reducing tics and for improving the quality of life (QoL) in a sample of Chinese children with chronic tic disorders (CTD) and Tourette syndrome (TS). MATERIALS AND METHODS In this 10-week randomized controlled pilot trial, 37 outpatients aged between 6 and 16 years affected by TS and CTD were randomly assigned to receive CBIT (n = 22) or PT alone (n = 15). Considering the feasibility, the patients allocated to the CBIT treatment group could further choose whether to simultaneously take medicine voluntarily, resulting in a CBIT alone group (n = 12) and a CBIT + PT group (n = 10). RESULTS At baseline, no significant difference was found between the three groups in the demographic and clinical characteristics (p > 0.05). All three groups showed a significant reduction in tic severity after treatment assessed by the Yale Global Tic Severity Scale (YGTSS) severity score [F (2,33) = 35.05, p < 0.001, η p 2 = 0.51], the score of the Clinical Global Impression scale for Improvement (CGI-I) [F (1,34) = 13.87, p = 0.001, η p 2 = 0.29], and YGTSS impairment score [F (2,33) = 31.71, p < 0.001, η p 2 = 0.48]. Significant interactions were found between the time-point and group in emotional functioning [F (2,29) = 4.39, p = 0.02, η p 2 = 0.23], psychosocial functioning [F (2,29) = 5.93, p = 0.007, η p 2 = 0.29], and total QoL score [F (1,34) = 3.72, p = 0.04, η p 2 = 0.20] of Pediatric Quality of Life Inventory (PedsQL 4.0) for children suggesting a significantly larger improvement in emotional functioning, psychosocial functioning, and total QoL score of the life quality in the CBIT group for children self-report. PedsQL for proxy report only showed a significant main effect of time-point in physical functioning [F (1,33) = 8.35, p = 0.01, η p 2 = 0.2], emotional functioning [F (1,33) = 10.75, p = 0.002, η p 2 = 0.25], psychosocial functioning [F (1,34) = 11.38, p = 0.002, η p 2 = 0.26], and total Qol score [F (1,34) = 13.21, p = 0.001, η p 2 = 0.29]. CONCLUSION CBIT is probably effective in reducing tic severity in Chinese children with tic disorders. CBIT + PT may not be superior to CBIT alone in reducing tic severity and improving quality of life. CBIT alone showed advantages in improving quality of life over CBIT + PT and PT alone. CBIT might be an appropriate treatment option for patients with tic disorder in Chinese mainland.
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Affiliation(s)
- Wen Xu
- Department of Psychological Medicine, Children's Hospital of Fudan University, Shanghai, China.,Shanghai Mental Health Center, Shanghai Jiao Tong University, Shanghai, China
| | - Qiang Ding
- Department of Psychological Medicine, Children's Hospital of Fudan University, Shanghai, China
| | - Ying Zhao
- Department of Psychological Medicine, Children's Hospital of Fudan University, Shanghai, China
| | - Wenqing Jiang
- Shanghai Mental Health Center, Shanghai Jiao Tong University, Shanghai, China
| | - Jingjing Han
- School of Medicine, Tongji University, Shanghai, China
| | - Jinhua Sun
- Department of Psychological Medicine, Children's Hospital of Fudan University, Shanghai, China.,Shanghai Mental Health Center, Shanghai Jiao Tong University, Shanghai, China
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Charania SN, Danielson ML, Claussen AH, Lebrun-Harris LA, Kaminski JW, Bitsko RH. Bullying Victimization and Perpetration Among US Children with and Without Tourette Syndrome. J Dev Behav Pediatr 2022; 43:23-31. [PMID: 34050089 PMCID: PMC9100862 DOI: 10.1097/dbp.0000000000000975] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 03/01/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Tourette syndrome (TS) and co-occurring mental, behavioral, and developmental disorders (MBDDs) have been shown to affect peer relationships. This study provides nationally representative estimates of diagnosed TS prevalence and the prevalence of parent-reported bullying victimization and perpetration among US children with and without TS. METHODS This study included 2016-2017 National Survey of Children's Health data on children aged 6 to 17 years (N = 51,001) with parent-reported responses about TS diagnosis and their child's experiences with bullying victimization and perpetration. We calculated weighted prevalence estimates of diagnosed TS and of bullying indicators among children ever diagnosed with TS compared with peers without TS. We conducted a logistic regression analysis to estimate adjusted prevalence ratios of bullying involvement by TS status, controlling for age, sex, and co-occurring MBDDs. RESULTS By parent report, 0.3% of US children had ever received a diagnosis of TS; most children with a TS diagnosis (83.2%) had a co-occurring MBDD. Among children with TS, 56.1% experienced bullying victimization, 20.7% experienced bullying perpetration, and 15.9% experienced both, compared with 21.6%, 6.0%, and 4.1% for children without TS, respectively. After adjusting for age, sex, and co-occurring MBDDs, only the association between TS and bullying victimization remained statistically significant. CONCLUSION Compared with children without TS, children with TS overall experience more bullying victimization and perpetration. Health care professionals treating children with TS could assess challenges with peer relationships and co-occurring disorders to provide targeted support and referral.
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Affiliation(s)
- Sana N. Charania
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA
- Oak Ridge Institute for Science and Education, Oak Ridge, TN
| | - Melissa L. Danielson
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA
| | - Angelika H. Claussen
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA
| | - Lydie A. Lebrun-Harris
- Office of Epidemiology and Research, Maternal and Child Health Bureau, Health Resources and Services Administration, Rockville, MD
| | - Jennifer W. Kaminski
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA
| | - Rebecca H. Bitsko
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA
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Lee MY, Wang HS, Lee TY. Psychosocial stress, self-esteem, and social adjustment: A moderated mediation analysis in Taiwanese adolescents with Tourette syndrome. J Pediatr Nurs 2022; 62:e84-e90. [PMID: 34330565 DOI: 10.1016/j.pedn.2021.07.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 07/13/2021] [Accepted: 07/13/2021] [Indexed: 12/27/2022]
Abstract
PURPOSE Recent studies have shown that tics and related comorbidities can cause poorer social adjustment, lower self-esteem, and higher psychosocial stress among adolescents with Tourette syndrome. This study explored the role of self-esteem in mediating the relationship between psychosocial stress and social adjustment among adolescents with Tourette syndrome, and the role of comorbidities in moderating the relationship between self-esteem and social adjustment. DESIGN AND METHODS In this descriptive cross-sectional study, 118 Taiwanese adolescents with Tourette syndrome aged between 12 and 20 years old were recruited via convenience sampling. Their demographic information, Yale Global Tic Severity Scale, stress index for children and adolescents with Tourette syndrome, social adjustment scale for adolescents with Tourette syndrome, and Self-Esteem Scale results were collected. Moderated mediation analysis of the study data was performed with the Hayes's PROCESS macro. RESULTS Our results revealed that the self-esteem of adolescents with Tourette syndrome fully mediates the relationship between their psychosocial stress and social adjustment (B = -0.0703, 95% CI, [-0.0176, -0.001]), while comorbidities moderates the relationship between their self-esteem and social adjustment (B = -0.8416, 95% CI, [-1.4529, -0.2302]). The relationship between self-esteem and social adjustment was more pronounced in adolescents without comorbidities than those with comorbidities. CONCLUSIONS Psychosocial stress correlates negatively with social adjustment and self-esteem, and indirectly influences social adjustment through self-esteem, while comorbidities (particularly their absence) moderates the relationship between self-esteem and social adjustment. PRACTICE IMPLICATIONS Different self-esteem strengthening programs to enhance social adjustment for adolescents with Tourette syndrome may be developed in future studies.
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Affiliation(s)
- Mei-Yin Lee
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taiwan.
| | - Huei-Shyong Wang
- College of Medicine, Chang Gung University, Division of Pediatric Neurology, Chang Gung Children's Hospital, Taoyuan, Taiwan.
| | - Tzu-Ying Lee
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taiwan.
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Cui Y, Chu J, Li Y, Li Y. The Behavioral and Emotional Profile of Pediatric Tourette Syndrome Based on CBCL in a Chinese Sample. Front Psychiatry 2022; 13:784753. [PMID: 35280165 PMCID: PMC8907575 DOI: 10.3389/fpsyt.2022.784753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 01/31/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Tourette syndrome (TS) is a childhood-onset neuropsychiatric disorder that has a unique status of a quintessentially neuropsychiatric condition at the interface of neurology (movement disorder) and psychiatry (behavioral/emotional condition). However, the behavioral and emotional profile has seemed to be neglected in the literature thus far. This study aimed to investigate the behavioral and emotional profile of TS. METHODS A total of 124 patients aged 6-16 years with TS were included in this study, including age- and sex-matched health control, attention-deficit/hyperactivity disorder (ADHD), obsessive-compulsive disorder (OCD), and major depressive disorder (MDD) groups. The Child Behavior Checklist (CBCL) was used to screen the behavioral and emotional profile of the TS and other compared groups. The Yale Global Tic Severity Scale (YGTSS) was used to assess TS tic severity. Analysis of variance (ANOVA) was used to investigate the difference between the TS and other compared groups. RESULTS The results showed that the eight factors of the CBCL had no association with motor tics, vocal tics, or tic severity (p > 0.05). However, positive correlations were identified between functional impairments (subscales of YGTSS) and thought problems (TP) and rule-breaking behavior (RBB). Based on the eight-factor profile of the CBCL, TS showed a similar profile to MDD but different from ADHD and OCD, which showed similar profiles. CONCLUSIONS Based on the assessment of the CBCL of TS, it was found that "pure" TS might show fewer behavioral and emotional problems than OCD, ADHD, and MDD. Similar behavioral and emotional profiles were identified between TS and MDD, but not OCD and ADHD. More attention needs to be paid to the thought problems and rule break problems in the CBCL in the screening stage, which might have a potential influence on the functional impairments of TS.
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Affiliation(s)
- Yonghua Cui
- Department of Psychiatry, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Jiahui Chu
- Department of Psychiatry, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Yanlin Li
- Department of Psychiatry, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Ying Li
- Department of Psychiatry, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
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40
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Soós MJ, Coulson NS, Davies EB. Exploring Social Support in an Online Support Community for Tourette Syndrome and Tic Disorders: An Analysis of Postings (Preprint). J Med Internet Res 2021; 24:e34403. [PMID: 36194454 PMCID: PMC9579925 DOI: 10.2196/34403] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 02/15/2022] [Accepted: 03/13/2022] [Indexed: 12/03/2022] Open
Abstract
Background Online support communities have become an accessible way of gaining social, emotional, and informational support from peers and may be particularly useful for individuals with chronic conditions. To date, there have been few studies exploring the online support available for tic disorders, such as Tourette syndrome. An exploratory study looking at users’ experiences with using online support communities for tic disorders suggested that members used such communities to share experiences, information, and strategies for tic management. Objective To build on these preliminary findings, this study examined the provision of social support in an online community for Tourette syndrome. Methods Data were collected from one publicly available online support community for Tourette syndrome and tics, from its inception to December 2019, by randomly selecting 10% of posts and their corresponding comments from each year for analysis. This resulted in 510 unique posts and 3802 comments posted from 1270 unique usernames. The data were analyzed using inductive thematic analysis. Results The findings of this study suggest that users utilized the online community as a multifaceted virtual place where they could share and ask for information about tics, unload and share their feelings arising from living with Tourette syndrome, find people facing similar situations and experiences, and freely share the realities of living with Tourette syndrome. Conclusions The results complement the findings from a preliminary study and suggest that online support communities have a potentially valuable role as a mechanism for sharing and gaining information on illness experiences from similar peers experiencing tics and can promote self-management of tics. Limitations and recommendations for future research are discussed.
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Affiliation(s)
- Mercédesz Judit Soós
- Population and Lifespan Sciences, School of Medicine, University of Nottingham, Queen's Medical Centre, Nottingham, United Kingdom
| | - Neil S Coulson
- Population and Lifespan Sciences, School of Medicine, University of Nottingham, Queen's Medical Centre, Nottingham, United Kingdom
| | - E Bethan Davies
- National Institute for Health and Care Research MindTech MedTech Co-operative, Institute of Mental Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- Clinical Neurosciences and Mental Health, Institute of Mental Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom
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41
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Lee MY. Living with tics: Nursing Care of Pediatric Tourette Syndrome. Biomed J 2021; 45:280-285. [PMID: 34710638 PMCID: PMC9250087 DOI: 10.1016/j.bj.2021.10.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 10/15/2021] [Accepted: 10/19/2021] [Indexed: 11/17/2022] Open
Abstract
Tourette syndrome (TS) is a neurodevelopmental movement characterized by abrupt, rapid, repetitive, and non-rhythmic tics. While TS is not life-threatening, such tics and comorbidities affect a children's physical and mental health and social interactions. Treatment is necessary when the children experience physical discomfort, functional dysfunction, and poor interpersonal interaction and mental health. Common management strategies for TS include psychological interventions and pharmacological treatment. Additionally, it is important to consider the individual needs of youths with TS and reassess the treatment outcomes and the need to receive continuous treatment regularly. This review summarizes the symptom management and nursing care measures for youths with TS. Understanding and listening to the healthcare problems of youths with TS can help providers develop healthcare interventions tailored to the youths' needs. Providing the youths with strategies to reduce the tics' interference with their learning outcomes and helping them develop strategies to cope with diverse interpersonal interactions at school are also important. Further, enhancing acceptance given by parents, teachers, and peers, as well as improving the general public's understanding of TS are important measures that promote the youths' social adjustment as well as their ability to coexist with TS.
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Affiliation(s)
- Mei-Yin Lee
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taiwan.
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Wehmeyer L, Schüller T, Kiess J, Heiden P, Visser-Vandewalle V, Baldermann JC, Andrade P. Target-Specific Effects of Deep Brain Stimulation for Tourette Syndrome: A Systematic Review and Meta-Analysis. Front Neurol 2021; 12:769275. [PMID: 34744993 PMCID: PMC8563609 DOI: 10.3389/fneur.2021.769275] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 09/21/2021] [Indexed: 01/09/2023] Open
Abstract
Background: Extended research has pointed to the efficacy of deep brain stimulation (DBS) in treatment of patients with treatment-refractory Tourette syndrome (TS). The four most commonly used DBS targets for TS include the centromedian nucleus-nucleus ventrooralis internus (CM-Voi) and the centromedian nucleus-parafascicular (CM-Pf) complexes of the thalamus, and the posteroventrolateral (pvIGPi) and the anteromedial portion of the globus pallidus internus (amGPi). Differences and commonalities between those targets need to be compared systematically. Objective: Therefore, we evaluated whether DBS is effective in reducing TS symptoms and target-specific differences. Methods: A PubMed literature search was conducted according to the PRISMA guidelines. Eligible literature was used to conduct a systematic review and meta-analysis. Results: In total, 65 studies with 376 patients were included. Overall, Yale Global Tic Severity Scale (YGTSS) scores were reduced by more than 50 in 69% of the patients. DBS also resulted in significant reductions of secondary outcome measures, including the total YGTSS, modified Rush Video-Based Tic Rating Scale (mRVRS), Yale-Brown Obsessive Compulsive Scale (YBOCS), and Becks Depression Inventory (BDI). All targets resulted in significant reductions of YGTSS scores and, with the exception of the CM-Pf, also in reduced YBOCS scores. Interestingly, DBS of pallidal targets showed increased YGTSS and YBOCS reductions compared to thalamic targets. Also, the meta-analysis including six randomized controlled and double-blinded trials demonstrated clinical efficacy of DBS for TS, that remained significant for GPi but not thalamic stimulation in two separate meta-analyses. Conclusion: We conclude that DBS is a clinically effective treatment option for patients with treatment-refractory TS, with all targets showing comparable improvement rates. Future research might focus on personalized and symptom-specific target selection.
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Affiliation(s)
- Laura Wehmeyer
- Faculty of Medicine and University Hospital Cologne, Department of Stereotactic and Functional Neurosurgery, University of Cologne, Cologne, Germany,*Correspondence: Laura Wehmeyer
| | - Thomas Schüller
- Faculty of Medicine and University Hospital Cologne, Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany
| | - Jana Kiess
- Faculty of Medicine and University Hospital Cologne, Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany
| | - Petra Heiden
- Faculty of Medicine and University Hospital Cologne, Department of Stereotactic and Functional Neurosurgery, University of Cologne, Cologne, Germany
| | - Veerle Visser-Vandewalle
- Faculty of Medicine and University Hospital Cologne, Department of Stereotactic and Functional Neurosurgery, University of Cologne, Cologne, Germany
| | - Juan Carlos Baldermann
- Faculty of Medicine and University Hospital Cologne, Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany,Faculty of Medicine and University Hospital Cologne, Department of Neurology, University of Cologne, Cologne, Germany
| | - Pablo Andrade
- Faculty of Medicine and University Hospital Cologne, Department of Stereotactic and Functional Neurosurgery, University of Cologne, Cologne, Germany
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Coffey B, Jankovic J, Claassen DO, Jimenez-Shahed J, Gertz BJ, Garofalo EA, Stamler DA, Wieman M, Savola JM, Gordon MF, Alexander JK, Barkay H, Harary E. Efficacy and Safety of Fixed-Dose Deutetrabenazine in Children and Adolescents for Tics Associated With Tourette Syndrome: A Randomized Clinical Trial. JAMA Netw Open 2021; 4:e2129397. [PMID: 34661664 PMCID: PMC8524312 DOI: 10.1001/jamanetworkopen.2021.29397] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
IMPORTANCE Tourette syndrome is a neurodevelopmental disorder characterized by childhood onset of motor and phonic tics, often accompanied by behavioral and psychiatric comorbidities. Deutetrabenazine is a vesicular monoamine transporter 2 inhibitor approved in the US for the treatment of chorea associated with Huntington disease and tardive dyskinesia. OBJECTIVE To report results of the ARTISTS 2 (Alternatives for Reducing Tics in Tourette Syndrome 2) study examining deutetrabenazine for treatment of Tourette syndrome. DESIGN, SETTING, AND PARTICIPANTS This phase 3, randomized, double-blind, placebo-controlled, parallel-group, fixed-dose study was conducted over 8 weeks with a 1-week follow-up (June 21, 2018, to December 9, 2019). Children and adolescents aged 6 to 16 years with a diagnosis of Tourette syndrome and active tics causing distress or impairment were enrolled in the study. Children were recruited from 52 sites in 10 countries. Data were analyzed from February 4 to April 22, 2020. INTERVENTIONS Participants were randomized (1:1:1) to low-dose deutetrabenazine (up to 36 mg/d), high-dose deutetrabenazine (up to 48 mg/d), or a matching placebo, which were titrated over 4 weeks to the target dose followed by a 4-week maintenance period. MAIN OUTCOMES AND MEASURES The primary efficacy end point was change from baseline to week 8 in the Yale Global Tic Severity Scale-Total Tic Score (YGTSS-TTS) for high-dose deutetrabenazine. Key secondary end points included changes in YGTSS-TTS for low-dose deutetrabenazine, Tourette Syndrome Clinical Global Impression score, Tourette Syndrome Patient Global Impression of Impact score, and Child and Adolescent Gilles de la Tourette Syndrome-Quality of Life Activities of Daily Living subscale score. Safety assessments included incidence of treatment-emergent adverse events, laboratory parameters, vital signs, and questionnaires. RESULTS The study included 158 children and adolescents (mean [SD] age, 11.7 [2.6] years). A total of 119 participants (75%) were boys; 7 (4%), Asian; 1 (1%), Black; 32 (20%), Hispanic; 4 (3%), Native American; 135 (85%), White; 2 (1%), multiracial; 9 (6%), other race; and 1 (0.6%), of unknown ethnic origin. Fifty-two participants were randomized to the high-dose deutetrabenazine group, 54 to the low-dose deutetrabenazine group, and 52 to the placebo group. Baseline characteristics for participants were similar between groups. Of the total 158 participants, 64 (41%) were aged 6 to 11 years, and 94 (59%) were aged 12 to 16 years at baseline. Mean time since Tourette syndrome diagnosis was 3.3 (2.8) years, and mean baseline YGTSS-TTS was 33.8 (6.6) points. At week 8, the difference in YGTSS-TTS was not significant between the high-dose deutetrabenazine and placebo groups (least-squares mean difference, -0.8 points; 95% CI, -3.9 to 2.3 points; P = .60; Cohen d, -0.11). There were no nominally significant differences between groups for key secondary end points. Treatment-emergent adverse events were reported for 34 participants (65%) treated with high-dose deutetrabenazine, 24 (44%) treated with low-dose deutetrabenazine, and 25 (49%) treated with placebo and were generally mild or moderate. CONCLUSIONS AND RELEVANCE In this fixed-dose randomized clinical trial of deutetrabenazine in children and adolescents with Tourette syndrome, the primary efficacy end point was not met. No new safety signals were identified. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03571256.
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Affiliation(s)
- Barbara Coffey
- University of Miami Miller School of Medicine, Miami, Florida
| | | | | | | | | | | | | | - Maria Wieman
- Teva Pharmaceuticals, West Chester, Pennsylvania
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Isung J, Isomura K, Larsson H, Sidorchuk A, Fernández de la Cruz L, Mataix-Cols D. Association of Tourette Syndrome and Chronic Tic Disorder With Cervical Spine Disorders and Related Neurological Complications. JAMA Neurol 2021; 78:1205-1211. [PMID: 34424277 DOI: 10.1001/jamaneurol.2021.2798] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Importance Severe forms of Tourette syndrome or chronic tic disorder (TS/CTD) may involve repeated head jerking. Isolated case reports have described a spectrum of severe neck disorders in individuals with TS/CTD. However, the nature and prevalence of cervical spine disorders in TS/CTD are unknown. Objective To establish if TS/CTD are associated with an increased risk of cervical spine disorders and related neurological complications compared with individuals from the general population. Design, Setting, and Participants All individuals born from 1973 to 2013 and living in Sweden between 1997 and 2013 were identified. Individuals with a record of TS/CTD diagnosed in specialist settings were matched on age, sex, and county of birth with 10 unexposed individuals randomly selected from the general population. Cox proportional hazards regression models were used to estimate the risk of vascular and nonvascular cervical spine disorders among exposed individuals, compared with unexposed individuals. Models were adjusted for other known causes of cervical spine injury. Data were analyzed from March 19 to May 16, 2021. Exposures International Statistical Classification of Diseases and Related Health Problems, Tenth Revision diagnoses of TS/CTD in the Swedish National Patient Register. Main Outcomes and Measures Records of cervical vascular disorders (ie, aneurysm, cerebral infarction, transitory cerebral ischemia) and cervical nonvascular disorders (ie, spondylosis, cervical disc disorders, fractures of the cervical spine, cervicalgia) and cervical surgeries. Covariates included rheumatic disorders, traffic injuries, fall- or sport-related injuries, and attention-deficit/hyperactivity disorder comorbidity. Results A total of 6791 individuals with TS/CTD were identified (5238 [77.1%] were male; median [interquartile] age at first diagnosis, 15.6 [11.4-23.7] years) and matched to 67 910 unexposed individuals. Exposed individuals had a 39% increased risk of any cervical spine disorder (adjusted hazard ratio, 1.39; 95% CI, 1.22-1.59). Adjusted hazard ratios for cervical vascular and nonvascular disorders were 1.57 (95% CI, 1.16-2.13) and 1.38 (95% CI, 1.19-1.60), respectively. Risks were similar among men and women. Conclusions and Relevance Individuals with severe TS/CTD are at increased risk of cervical spine disorders. These outcomes are relatively rare but may lead to persistent disability in some individuals and thus require close monitoring to facilitate early interventions.
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Affiliation(s)
- Josef Isung
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Kayoko Isomura
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Anna Sidorchuk
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Lorena Fernández de la Cruz
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - David Mataix-Cols
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
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Andrén P, de la Cruz LF, Isomura K, Lenhard F, Hall CL, Davies EB, Murphy T, Hollis C, Sampaio F, Feldman I, Bottai M, Serlachius E, Andersson E, Mataix-Cols D. Efficacy and cost-effectiveness of therapist-guided internet-delivered behaviour therapy for children and adolescents with Tourette syndrome: study protocol for a single-blind randomised controlled trial. Trials 2021; 22:669. [PMID: 34593015 PMCID: PMC8481317 DOI: 10.1186/s13063-021-05592-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 09/01/2021] [Indexed: 11/21/2022] Open
Abstract
Background Treatment guidelines recommend behaviour therapy (BT) for patients with Tourette syndrome (TS) and chronic tic disorder (CTD). However, BT is rarely accessible due to limited availability of trained therapists and long travel distances to specialist clinics. Internet-delivered BT has the potential of overcoming these barriers through remote delivery of treatment with minimal therapist support. In the current protocol, we outline the design and methods of a randomised controlled trial (RCT) evaluating an internet-delivered BT programme referred to as BIP TIC. The trial’s primary objective is to determine the clinical efficacy of BIP TIC for reducing tic severity in young people with TS/CTD, compared with an active control intervention. Secondary objectives are to investigate the 12-month durability of the treatment effects and to perform a health economic evaluation of the intervention. Methods In this single-blind superiority RCT, 220 participants (9–17 years) with TS/CTD throughout Sweden will be randomised to 10–12 weeks of either therapist-supported internet-delivered BT based on exposure with response prevention (BIP TIC) or therapist-supported internet-delivered education. Data will be collected at baseline, 3 and 5 weeks into the treatment, at post-treatment, and 3, 6, and 12 months post-treatment. The primary endpoint is the 3-month follow-up. The primary outcome is tic severity as measured by the Yale Global Tic Severity Scale – Total Tic Severity Score. Treatment response is operationalised as scores of “Very much improved” or “Much improved” on the Clinical Global Impression – Improvement scale, administered at the primary endpoint. Outcome assessors will be blind to treatment condition at all assessment points. A health economic evaluation of BIP TIC will be performed, both in the short term (primary endpoint) and the long term (12-month follow-up). There are no planned interim analyses. Discussion Participant recruitment started on 26 April 2019 and finished on 9 April 2021. The total number of included participants was 221. The final participant is expected to reach the primary endpoint in September 2021 and the 12-month follow-up in June 2022. Data analysis for the primary objective will commence after the last participant reaches the primary endpoint. Trial registration ClinicalTrials.gov NCT03916055. Registered on 16 April 2019. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05592-z.
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Affiliation(s)
- Per Andrén
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Gävlegatan 22, 113 30, Stockholm, Sweden. .,Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden.
| | - Lorena Fernández de la Cruz
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Gävlegatan 22, 113 30, Stockholm, Sweden.,Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Kayoko Isomura
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Gävlegatan 22, 113 30, Stockholm, Sweden.,Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Fabian Lenhard
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Gävlegatan 22, 113 30, Stockholm, Sweden.,Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Charlotte L Hall
- Institute of Mental Health, Mental Health & Clinical Neurosciences, University of Nottingham, Nottingham, UK.,NIHR MindTech MedTech Co-operative, Institute of Mental Health, School of Medicine, Mental Health & Clinical Neurosciences, University of Nottingham, Innovation Park, Triumph Road, Nottingham, UK
| | - E Bethan Davies
- Institute of Mental Health, Mental Health & Clinical Neurosciences, University of Nottingham, Nottingham, UK.,NIHR MindTech MedTech Co-operative, Institute of Mental Health, School of Medicine, Mental Health & Clinical Neurosciences, University of Nottingham, Innovation Park, Triumph Road, Nottingham, UK
| | - Tara Murphy
- UCL Great Ormond Street Institute of Child Health (ICH), 30 Guilford Street, London, WC1N 1EH, UK.,Psychological and Mental Health Services, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, UK
| | - Chris Hollis
- Institute of Mental Health, Mental Health & Clinical Neurosciences, University of Nottingham, Nottingham, UK.,NIHR MindTech MedTech Co-operative, Institute of Mental Health, School of Medicine, Mental Health & Clinical Neurosciences, University of Nottingham, Innovation Park, Triumph Road, Nottingham, UK.,NIHR Nottingham Biomedical Research Centre, Institute of Mental Health, Division of Psychiatry and Applied Psychology, University of Nottingham, Innovation Park, Triumph Road, Nottingham, UK
| | - Filipa Sampaio
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Inna Feldman
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Matteo Bottai
- Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Eva Serlachius
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Gävlegatan 22, 113 30, Stockholm, Sweden.,Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Erik Andersson
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Gävlegatan 22, 113 30, Stockholm, Sweden.,Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - David Mataix-Cols
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Gävlegatan 22, 113 30, Stockholm, Sweden.,Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
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Zinna S, Luxton R, Papachristou E, Dima D, Kyriakopoulos M. Comorbid chronic tic disorder and tourette syndrome in children requiring inpatient mental health treatment. Clin Child Psychol Psychiatry 2021; 26:894-905. [PMID: 33860687 DOI: 10.1177/13591045211007918] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Children needing admission to an inpatient mental health unit often present with severe neuropsychiatric disorders characterised by complex psychopathology. We aimed to examine all admitted children with comorbid chronic tic disorder (CTD) and Tourette syndrome (TS) over a 10-year period and determine the clinical significance of these diagnoses. METHOD A retrospective, naturalistic study was conducted, comparing children with and without CTD/TS in terms of co-morbid diagnoses, medication use, access to education, aggression contributing to the admission, duration of admission, functional outcomes and satisfaction with treatment. Data were analysed using Chi-square/Fisher's exact test and t-test for categorical and continuous variables, respectively, and subsequently with unadjusted and adjusted linear and logistic regression analyses. RESULTS A relatively high proportion of children had co-morbid CTD/TS (19.7%). There was a significant association with co-morbid obsessive-compulsive disorder, intellectual disability and autism spectrum disorder but not attention deficit hyperactivity disorder. CTD/TS were associated with longer admissions even after adjustments for confounding but did not seem to be independently associated with other examined clinical characteristics. CONCLUSIONS The prevalence of CTD/TS in children needing inpatient treatment is significant. In our sample, comorbid CTD/TS seem to represent a marker of overall symptom severity as evidenced by longer admissions.
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Affiliation(s)
- Shaheen Zinna
- National and Specialist Acorn Lodge Inpatient Children's Unit, Child and Adolescent Mental Health Services, South London and the Maudsley NHS Foundation Trust, London, UK
| | - Rebecca Luxton
- National and Specialist Acorn Lodge Inpatient Children's Unit, Child and Adolescent Mental Health Services, South London and the Maudsley NHS Foundation Trust, London, UK
| | - Efstathios Papachristou
- Department of Psychology & Human Development, UCL Institute of Education, University College London, London, UK
| | - Danai Dima
- Department of Psychology, School of Arts and Social Sciences, City, University of London, London, UK.,Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Marinos Kyriakopoulos
- National and Specialist Acorn Lodge Inpatient Children's Unit, Child and Adolescent Mental Health Services, South London and the Maudsley NHS Foundation Trust, London, UK.,Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Li YH, Zhao K, Wang MQ, Wang J, Gao BL. Effects of stereotactic radiofrequency thermocoagulation in the globus pallidus internus on refractory tic disorders. Int J Hyperthermia 2021; 37:1404-1411. [PMID: 33342326 DOI: 10.1080/02656736.2020.1859145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVE To investigate the effect of stereotactic radiofrequency thermocoagulation in the globus pallidus internus on refractory tic disorders. MATERIALS AND METHODS Forty patients with refractory tic disorders were enrolled between January 2015 and July 2017 to experience stereotactic radiofrequency thermocoagulation in the globus pallidus internus. All clinical data, Yale Global Tic Severity Scale (YGTSS) scores, serum dopamine (SDA), and 5-hydroxytryptamine (5-HT) were analyzed. RESULTS Radiofrequency thermocoagulation was successfully performed in all patients. Periprocedural complications occurred in two patients (5.0%), one with fever (2.5%) and one with a urination disorder (2.5%); both returned to normal after treatment. After 12 months of follow-ups, excellent improvement was exhibited in 18 patients (45.0%), marked improvement in 10 (25.0%), good improvement in 9 (22.5%), and invalid in 3 (7.5%), with a total efficacy rate of 92.5% (37/40). Twenty-eight patients (70%) showed excellent or marked improvement without additional treatment after surgery. YGTSS scores were significantly (p < 0.05) decreased after compared with before thermocoagulation. SDA was significantly (p < 0.05) decreased 6 months (80.78 ± 18.82 ng/ml) and 12 months (75.65 ± 15.23 ng/ml) after compared with before (125.63 ± 35.26 ng/ml) surgery, whereas 5-HT was significantly (p < 0.05) increased 6 months (58.93 ± 16.88 ng/ml) and 12 months (62.63 ± 15.21 ng/ml) after compared with before (35.62 ± 3.41 ng/ml) surgery. CONCLUSION Stereotactic radiofrequency thermocoagulation can be safely applied in the globus pallidus internus to treat refractory tic disorders, resulting in significant tic symptom relief and a decrease in SDA but increase in 5-HT.
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Affiliation(s)
- Yu-Hui Li
- Department of Neurosurgery, Shijiazhuang People's Hospital, Shijiazhuang, China
| | - Kai Zhao
- Department of Neurosurgery, Shijiazhuang People's Hospital, Shijiazhuang, China
| | - Mei-Qing Wang
- Department of Neurosurgery, Shijiazhuang People's Hospital, Shijiazhuang, China
| | - Jing Wang
- Department of Neurology, Shijiazhuang People's Hospital, Shijiazhuang, China
| | - Bu-Lang Gao
- Department of Medical Research, Shijiazhuang People's Hospital, Shijiazhuang, China
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Ueda K, Black KJ. A Comprehensive Review of Tic Disorders in Children. J Clin Med 2021; 10:2479. [PMID: 34204991 PMCID: PMC8199885 DOI: 10.3390/jcm10112479] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 05/28/2021] [Accepted: 05/31/2021] [Indexed: 01/13/2023] Open
Abstract
Tics are characterized by sudden, rapid, recurrent, nonrhythmic movement or vocalization, and are the most common movement disorders in children. Their onset is usually in childhood and tics often will diminish within one year. However, some of the tics can persist and cause various problems such as social embarrassment, physical discomfort, or emotional impairments, which could interfere with daily activities and school performance. Furthermore, tic disorders are frequently associated with comorbid neuropsychiatric symptoms, which can become more problematic than tic symptoms. Unfortunately, misunderstanding and misconceptions of tic disorders still exist among the general population. Understanding tic disorders and their comorbidities is important to deliver appropriate care to patients with tics. Several studies have been conducted to elucidate the clinical course, epidemiology, and pathophysiology of tics, but they are still not well understood. This article aims to provide an overview about tics and tic disorders, and recent findings on tic disorders including history, definition, diagnosis, epidemiology, etiology, diagnostic approach, comorbidities, treatment and management, and differential diagnosis.
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Affiliation(s)
- Keisuke Ueda
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110, USA;
| | - Kevin J. Black
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110, USA;
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110, USA
- Department of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA
- Department of Neuroscience, Washington University School of Medicine, St. Louis, MO 63110, USA
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Ashurova M, Budman C, Coffey BJ. Ticked Off: Anger Outbursts and Aggressive Symptoms in Tourette Disorder. Child Adolesc Psychiatr Clin N Am 2021; 30:361-373. [PMID: 33743944 DOI: 10.1016/j.chc.2020.10.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Tourette disorder is a complex neuropsychiatric syndrome of childhood onset characterized by multiple motor and phonic tics and is associated with high rates of psychiatric comorbidity. Symptoms of impulsive aggression (explosive outbursts or "rage") are commonly encountered in the clinical setting, cause significant morbidity, and pose diagnostic and treatment challenges. These symptoms may be multifactorial in etiology and result from a complex interplay of illness severity and psychosocial factors. Treatment strategies require careful differential diagnostic evaluation and include both behavioral and pharmacologic interventions.
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Affiliation(s)
- Marianna Ashurova
- Zucker Hillside Hospital, ACP Building Basement, 75-59 263rd Street, Glen Oaks, NY 11004, USA; Child & Adolescent Psychiatry Consultation Liaison Service, Cohens Children's Medical Center, 268-01 76th Avenue, New Hyde Park, NY 11040, USA.
| | - Cathy Budman
- Long Island Center for Tourette, 1615 Northern Boulevard, Suite #306, Manhasset, NY 11030, USA; Zucker School of Medicine, 500 Hofstra Boulevard, Hempstead, NY 11549, USA
| | - Barbara J Coffey
- Department of Psychiatry and Behavioral Sciences, Child and Adolescent Psychiatry, Tourette Association Center of Excellence, University of Miami Miller School of Medicine, 1120 Northwest Fourteenth Street, Suite 1442, Miami, FL 33136, USA
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Reese HE, Brown WA, Summers BJ, Shin J, Wheeler G, Wilhelm S. Feasibility and acceptability of an online mindfulness-based group intervention for adults with tic disorders. Pilot Feasibility Stud 2021; 7:82. [PMID: 33757602 PMCID: PMC7988915 DOI: 10.1186/s40814-021-00818-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 03/09/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Preliminary research suggests that a mindfulness-based treatment approach may be beneficial for adults with tic disorders. In the present study, we report on the feasibility, acceptability, safety, and symptomatic effect of a novel online mindfulness-based group intervention for adults with Tourette syndrome or persistent tic disorder. Data from this study will directly inform the conduct of a funded randomized controlled trial comparing the efficacy of this intervention to another active psychological intervention. METHODS One cohort of adults with Tourette syndrome participated in an 8-week online mindfulness-based group intervention. Measures of feasibility, acceptability, and safety were administered throughout and at posttreatment. Self-reported measures of mindfulness and clinician-rated measures of tic severity and impairment were administered at baseline and posttreatment. RESULTS Data on refusal, dropout rate, attendance, participant satisfaction, and safety suggest that this is a feasible and acceptable intervention. However, participant adherence to home practice was lower than anticipated. Mindfulness, tic severity, and tic-related impairment only modestly improved from baseline to posttreatment. Qualitative analysis of participant feedback revealed aspects of the intervention that were most helpful and also areas for improvement. CONCLUSIONS Data suggest that although this is a feasible and acceptable intervention, it should be modified to enhance participant adherence, more successfully engage the target mechanism, and optimize outcomes. TRIAL REGISTRATION Clinicaltrials.gov registration # NCT03525626 . Registered on 24 April 2018.
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Affiliation(s)
- Hannah E Reese
- Department of Psychology, Bowdoin College, 6900 College Station, Brunswick, ME, 04011, USA.
| | - W Alan Brown
- Learning to Thrive, LLC, 300 2nd St., #7, Jersey City, NJ, 07302, USA
| | - Berta J Summers
- Center for OCD and Related Disorders, Massachusetts General Hospital, 185 Cambridge St., Suite 2000, Boston, MA, 02114, USA
- Department of Psychology, University of North Carolina Wilmington, 601 South College Road, Wilmington, NC, 28403-5612, USA
| | - Jin Shin
- Center for OCD and Related Disorders, Massachusetts General Hospital, 185 Cambridge St., Suite 2000, Boston, MA, 02114, USA
| | - Grace Wheeler
- Department of Psychology, Bowdoin College, 6900 College Station, Brunswick, ME, 04011, USA
| | - Sabine Wilhelm
- Center for OCD and Related Disorders, Massachusetts General Hospital, 185 Cambridge St., Suite 2000, Boston, MA, 02114, USA
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