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Bootes KR, Himle MB, Stiede JT, Wellen BCM, Mouton-Odum S, Woods DW. Predictors of Impairment and Self-Concept in Children and Adolescents with Persistent Tic Disorder. Child Psychiatry Hum Dev 2024:10.1007/s10578-024-01696-0. [PMID: 38619754 DOI: 10.1007/s10578-024-01696-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/11/2024] [Indexed: 04/16/2024]
Abstract
This study examined predictors of, and associations between, self-concept, demographic variables, and clinical measures in fifty-eight children and adolescents with Persistent Tic Disorder (PTD; 44 males, Mage = 11.9 years, SD = 2.74). Participants completed measures that assessed self-concept, tic severity, tic-related impairment, and comorbid psychological symptoms. Results showed that generalized anxiety disorder, major depressive disorder, persistent depressive disorder, total tic severity, number and complexity of tics, and total and social tic-related impairment were associated with self-concept. Tic-related social impairment mediated the relationship between tic severity and self-concept. Exploratory analyses found that total tic severity, motor tic severity, and vocal tic severity, as well as the number, intensity, and interference of tics predicted social tic-related impairment. Results suggest that treatments to reduce the number and complexity of tics, with additional focus on navigating social interactions, may serve to decrease tic severity and impairment, and in turn, improve self-concept.
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Affiliation(s)
- Kirsten R Bootes
- Department of Psychology, the University of Utah, 380 S. 1530 E. Room 1316, Salt Lake City, UT, 84112, USA.
| | - Michael B Himle
- Department of Psychology, the University of Utah, 380 S. 1530 E. Room 1316, Salt Lake City, UT, 84112, USA
| | - Jordan T Stiede
- Department of Psychology, Marquette University, Milwaukee, WI, USA
| | - Brianna C M Wellen
- Department of Psychology, the University of Utah, 380 S. 1530 E. Room 1316, Salt Lake City, UT, 84112, USA
| | | | - Douglas W Woods
- Department of Psychology, Marquette University, Milwaukee, WI, USA
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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 2024:1454455241236446. [PMID: 38557310 DOI: 10.1177/01454455241236446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [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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3
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Barber KE, Woods DW, Ely LJ, Saunders SM, Compton SN, Neal-Barnett A, Franklin ME, Capriotti MR, Conelea CA, Twohig MP. Long-term follow-up of acceptance-enhanced behavior therapy for trichotillomania. Psychiatry Res 2024; 333:115767. [PMID: 38330639 PMCID: PMC10911454 DOI: 10.1016/j.psychres.2024.115767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 01/26/2024] [Accepted: 01/28/2024] [Indexed: 02/10/2024]
Abstract
Acceptance-enhanced behavior therapy for trichotillomania (AEBT-TTM) is effective in reducing trichotillomania (TTM) symptoms, but the durability of treatment effects remains in question. This study analyzed 6-month follow-up data from a large randomized clinical trial comparing AEBT-TTM to an active psychoeducation and supportive therapy control (PST). Adults with TTM (N=85; 92% women) received 10 sessions of AEBT-TTM or PST across 12 weeks. Independent evaluators assessed participants at baseline, post-treatment, and 6 months follow-up. For both AEBT-TTM and PST, self-reported and evaluator-rated TTM symptom severity decreased from baseline to follow-up. TTM symptoms did not worsen from post-treatment to follow-up. At follow-up, AEBT-TTM and PST did not differ in rates of treatment response, TTM diagnosis, or symptom severity. High baseline TTM symptom severity was a stronger predictor of high follow-up severity for PST than for AEBT-TTM, suggesting AEBT-TTM may be a better option for more severe TTM. Results support the efficacy of AEBT-TTM and show that treatment gains were maintained over time. Although AEBT-TTM yielded lower symptoms at post-treatment, 6-month follow-up outcomes suggest AEBT-TTM and PST may lead to similar symptom levels in the longer term. Future research should examine mechanisms that contribute to long-term gain maintenance.
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Affiliation(s)
- Kathryn E Barber
- Department of Psychology, Marquette University, 317 Cramer Hall, 604 North 16th St., Milwaukee, WI 53233, USA
| | - Douglas W Woods
- Department of Psychology, Marquette University, 317 Cramer Hall, 604 North 16th St., Milwaukee, WI 53233, USA.
| | - Laura J Ely
- Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Stephen M Saunders
- Department of Psychology, Marquette University, 317 Cramer Hall, 604 North 16th St., Milwaukee, WI 53233, USA
| | - Scott N Compton
- Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | | | | | | | - Christine A Conelea
- Department of Psychiatry & Behavioral Sciences, University of Minnesota, Minneapolis, MN, USA
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4
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Shiu C, Chen W, Kim B, Ricketts E, Stiede JT, Espil FM, Specht MW, Woods DW, Piacentini J. The Roles of Lifetime Enacted Stigma in Tic Symptoms among Young Adults with Tourette Syndrome. Mov Disord Clin Pract 2023; 10:1759-1768. [PMID: 38094654 PMCID: PMC10715356 DOI: 10.1002/mdc3.13900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 08/24/2023] [Accepted: 10/04/2023] [Indexed: 02/01/2024] Open
Abstract
Background Although rarely framed as enacted stigma, adults with Tourette syndrome (ATS) have long suffered from discrimination associated with their tic symptoms. Given the high stress levels of enacted stigma that ATS experience, it is expected that their tic symptoms are profoundly impacted. However, the evidence linking enacted stigma to ATS's tic symptoms remains limited. Methods This study used a secondary data-analysis approach to reanalyze the data from the follow-up phase of a multi-centered, randomized controlled trial in which a behavioral intervention was tested for its efficacy in managing tic symptoms. This study first conducted psychometric testing on a list of 16 enacted stigma events across five life stages and identified the underlying factor structure. The Yale Global Tic Severity Scale (YGTSS) was used to assess severity and impairment of current tic symptoms, whereas the Clinical Global Impression of Severity scale (CGI) was used to obtain the gestalt of clinical judgment on tic severity. A series of multivariate linear models were then fitted to test the relationships between different types of lifetime enacted stigma and current tic symptoms. Results The analytic sample included 73 young ATS (average age of 23.2 [standard deviation = 2.5] years). The factor analysis identified three types of enacted stigmas: "traumatic events," "confrontations," and "subtle mistreatments." In multivariate models, traumatic events significantly associated with YGTSS-severity, whereas subtle mistreatments provided additional explanations for CGI. Conclusions Enacted stigma may play important roles in shaping ATS's current tics symptom severity and, therefore, should be carefully considered in future intervention development.
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Affiliation(s)
- Chengshi Shiu
- Department of Social Work and Taiwan Social Resilient Research CenterNational Taiwan UniversityTaipeiTaiwan
- School of NursingUniversity of CaliforniaLos AngelesCaliforniaUSA
| | - Wei‐Ti Chen
- School of NursingUniversity of CaliforniaLos AngelesCaliforniaUSA
| | - Boram Kim
- School of NursingUniversity of CaliforniaLos AngelesCaliforniaUSA
| | - Emily Ricketts
- Department of PsychologyMarquette UniversityMilwaukeeWisconsinUSA
| | - Jordan T. Stiede
- Department of Psychiatry and Behavioral SciencesBaylor College of MedicineHoustonTexasUSA
- Department of Psychiatry and Biobehavioral SciencesUniversity of CaliforniaLos AngelesCaliforniaUSA
| | - Flint M. Espil
- Department of Psychiatry and Behavioral SciencesStanford UniversityStanfordCaliforniaUSA
| | | | - Douglas W. Woods
- Department of Psychiatry and Behavioral SciencesBaylor College of MedicineHoustonTexasUSA
| | - John Piacentini
- Department of PsychologyMarquette UniversityMilwaukeeWisconsinUSA
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Wellen BCM, Bootes KR, Braley EI, Conelea CA, Woods DW, Himle MB. Caregiver Perspectives on the Health Care System for Tic Disorders: Utilization and Barriers. J Dev Behav Pediatr 2023; 44:e581-e589. [PMID: 37820348 DOI: 10.1097/dbp.0000000000001221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 08/07/2023] [Indexed: 10/13/2023]
Abstract
OBJECTIVE This study aimed to understand health care experiences among a sample of caregivers of children with TDs to inform future directions for improving the health care system. METHODS We conducted a survey of caregivers of youth with TDs and used descriptive statistics and quantitative analyses to characterize the health care utilization practices of the sample. RESULTS The majority (70%) of families first consulted their pediatrician/primary care provider, and caregivers reported receiving care in line with current best practice guidelines. However, caregivers in the current sample perceived a lack of knowledgeability on the part of their first providers, which significantly predicted more providers seen and also reported difficulty finding specialty providers (63% of the sample reported difficulty finding a treatment provider who understood tics). CONCLUSION Results suggest that improving caregiver satisfaction with early health care experiences for their child's TD may help to relieve the burden on families and the health care system more broadly, along with continued efforts to increase the number of specialty providers available.
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Affiliation(s)
- Brianna C M Wellen
- University of Utah, Salt Lake City, UT
- University of Minnesota Medical School, Minneapolis, MN
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6
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Woods DW, Himle MB, Stiede JT, Pitts BX. Behavioral Interventions for Children and Adults with Tic Disorder. Annu Rev Clin Psychol 2023; 19:233-260. [PMID: 37159286 DOI: 10.1146/annurev-clinpsy-080921-074307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Over the past decade, behavioral interventions have become increasingly recognized and recommended as effective first-line therapies for treating individuals with tic disorders. In this article, we describe a basic theoretical and conceptual framework through which the reader can understand the application of these interventions for treating tics. The three primary behavioral interventions for tics with the strongest empirical support (habit reversal, Comprehensive Behavioral Intervention for Tics, and exposure and response prevention) are described. Research on the efficacy and effectiveness of these treatments is summarized along with a discussion of the research evaluating the delivery of these treatments in different formats and modalities. The article closes with a review of the possible mechanisms of change underlying behavioral interventions for tics and areas for future research.
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Affiliation(s)
- Douglas W Woods
- Department of Psychology, Marquette University, Milwaukee, Wisconsin, USA;
| | - Michael B Himle
- Department of Psychology, University of Utah, Salt Lake City, Utah, USA
| | - Jordan T Stiede
- Department of Psychiatry & Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA
| | - Brandon X Pitts
- Department of Psychology, Marquette University, Milwaukee, Wisconsin, USA;
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Ong CW, Woods DW, Franklin ME, Saunders SM, Neal-Barnett AM, Compton SN, Twohig MP. The role of psychological flexibility in acceptance-enhanced behavior therapy for trichotillomania: Moderation and mediation findings. Behav Res Ther 2023; 164:104302. [PMID: 37030243 PMCID: PMC10115155 DOI: 10.1016/j.brat.2023.104302] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 03/16/2023] [Accepted: 03/18/2023] [Indexed: 04/07/2023]
Abstract
Trichotillomania is characterized by recurrent pulling out of one's hair, leading to significant hair loss and accompanied by clinically significant distress and/or functional impairment. The current study used data from a randomized controlled trial comparing the effectiveness of acceptance-enhanced behavior therapy (AEBT) to psychoeducation plus supportive therapy (PST; active control) for trichotillomania in an adult sample. The objectives were to examine the moderating and mediating influence of trichotillomania-specific psychological flexibility in treatment for trichotillomania. Participants with lower baseline flexibility performed better in AEBT than PST in terms of greater symptom reduction and quality of life. Lower baseline flexibility also predicted higher likelihood of disorder recovery in AEBT relative to PST. In addition, relative to PST, symptom reduction in AEBT was mediated by psychological flexibility, controlling for anxiety and depression. These findings suggest that psychological flexibility is a relevant process of change in the treatment of trichotillomania. Clinical implications and directions for future research are discussed.
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Affiliation(s)
- Clarissa W Ong
- Department of Psychology, University of Toledo, Toledo, OH, USA.
| | - Douglas W Woods
- Department of Psychology, Marquette University, Milwaukee, WI, USA
| | | | | | | | - Scott N Compton
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
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8
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Ricketts EJ, Wolicki SB, Holbrook JR, Rozenman M, McGuire JF, Charania SN, Piacentini J, Mink JW, Walkup JT, Woods DW, Claussen AH. Clinical Characteristics of Children With Tourette Syndrome With and Without Sleep Disorder. Pediatr Neurol 2023; 141:18-24. [PMID: 36736236 PMCID: PMC10590926 DOI: 10.1016/j.pediatrneurol.2022.12.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 11/22/2022] [Accepted: 12/22/2022] [Indexed: 12/25/2022]
Abstract
BACKGROUND Sleep problems are common in children with Tourette Syndrome (TS). However, research regarding their demographic and clinical profile is limited. METHODS We examined characteristics of 114 children aged five to 17 years with a lifetime diagnosis of TS and compared children with sleep disorder (n = 32) and without sleep disorder (n = 82). Parent report from the 2014 National Survey of the Diagnosis and Treatment of ADHD and Tourette Syndrome provided demographics and clinical information, other diagnosed disorders, medication use, TS severity, and impairment. RESULTS More children with TS with sleep disorder were from households with lower parental education (P < 0.01) and poverty (P = 0.04); had other diagnoses (P = 0.03), including obsessive-compulsive disorder (P < 0.01), oppositional defiant disorder or conduct disorder (P < 0.01), attention-deficit/hyperactivity disorder (ADHD) (P = 0.02), and autism (P = 0.03); and had ever used TS medication (P = 0.01) than children with TS without sleep disorder. More children with TS with sleep disorder had severe TS symptoms (P <0.01), tic-related impairment (P<0.01), and severe ADHD symptoms (P < 0.01) compared with children with TS without sleep disorder. CONCLUSIONS Findings suggest greater parent-reported impact and tic-related interference in children with TS with sleep disorder compared with TS without sleep disorder. Results underscore the importance of monitoring and intervention for TS exacerbations, other diagnosed disorders, and medication use, and consideration of socioeconomic context in sleep disorder management and prevention in children with TS.
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Affiliation(s)
- Emily J Ricketts
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California.
| | - Sara Beth Wolicki
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Joseph R Holbrook
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Joseph F McGuire
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sana N Charania
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - John Piacentini
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California
| | - Jonathan W Mink
- Department of Neurology, University of Rochester Medical Center, Rochester, New York
| | - John T Walkup
- Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Douglas W Woods
- Department of Psychology, Marquette University, Milwaukee, Wisconsin
| | - Angelika H Claussen
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Ricketts EJ, Woods DW, Espil FM, McGuire JF, Stiede JT, Schild J, Yadegar M, Bennett SM, Specht MW, Chang S, Scahill L, Wilhelm S, Peterson AL, Walkup JT, Piacentini J. Childhood Predictors of Long-Term Tic Severity and Tic Impairment in Tourette's Disorder. Behav Ther 2022; 53:1250-1264. [PMID: 36229120 PMCID: PMC9872160 DOI: 10.1016/j.beth.2022.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 05/29/2022] [Accepted: 07/07/2022] [Indexed: 01/26/2023]
Abstract
Tics peak in late childhood and decline during adolescence. Yet, for some with Tourette's disorder, tics persist into adulthood. We evaluated childhood predictors of adult tic severity and tic impairment, and change over time. Eighty adolescents/adults were evaluated 11 years following a randomized-controlled trial of behavior therapy. An independent evaluator rated tic severity and tic impairment at baseline, posttreatment, and long-term follow-up. At baseline, parents completed demographics/medical history, and youth tic, internalizing, and externalizing symptom ratings. Youth rated premonitory urge severity and family functioning. After controlling for prior tic treatment effects, female sex and higher tic severity predicted higher tic severity in adulthood; and female sex, no stimulant medication use, higher tic severity, and poorer family functioning predicted higher tic impairment. Higher tic severity and premonitory urge severity predicted smaller reductions in tic severity, whereas higher externalizing symptoms predicted greater reduction in tic severity. Female sex predicted smaller reduction in tic impairment, and externalizing symptoms predicted greater reduction in tic impairment. Female sex and childhood tic severity are important predictors of tic severity and tic impairment in adulthood. Family functioning, premonitory urge severity, and tic severity are important modifiable targets for early or targeted intervention to improve long-term outcomes.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - John T Walkup
- Ann and Robert H. Lurie Children's Hospital of Chicago; Northwestern University Feinberg School of Medicine
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10
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Woods DW, Ely LJ, Bauer CC, Twohig MP, Saunders SM, Compton SN, Espil FM, Neal-Barnett A, Alexander JR, Walther MR, Cahill SP, Deckersbach T, Franklin ME. Acceptance-enhanced behavior therapy for trichotillomania in adults: A randomized clinical trial. Behav Res Ther 2022; 158:104187. [PMID: 36099688 PMCID: PMC9561035 DOI: 10.1016/j.brat.2022.104187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 08/12/2022] [Accepted: 09/01/2022] [Indexed: 11/21/2022]
Abstract
Given the limited treatment options for trichotillomania (TTM), or Hair Pulling Disorder, this large randomized clinical trial evaluated the efficacy of acceptance-enhanced behavior therapy for TTM (AEBT-TTM) in reducing TTM severity relative to psychoeducation and supportive therapy (PST). Eighty-five adults (78 women) with TTM received 10 sessions (over 12 weeks) of either AEBT-TTM or PST. Independent evaluators masked to treatment assignment assessed participants at baseline (week 0), midpoint (week 6), and endpoint (week 12). Consistent with a priori hypotheses, 64% of the adults treated with AEBT-TTM were classified as clinical responders at post-treatment relative to 38% treated with PST. Clinical responders were identified by a score of 1 or 2 on the Clinical Global Impressions-Improvement (CGI-I) scale. Relative to the PST group, the AEBT-TTM group demonstrated significantly greater pre-to post-treatment reductions on the self-report Massachusetts General Hospital-Hairpulling Scale (MGH-HS) and the evaluator-rated National Institute of Mental Health Trichotillomania Severity Scale (NIMH-TSS). There were no significant post-treatment group differences on the Clinical Global Impressions-Severity (CGI-S) scale, or rate of TTM diagnoses. Results suggest AEBT-TTM provides greater treatment benefit than PST. Future research should continue to investigate AEBT-TTM along with mediators and moderators of its efficacy.
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Affiliation(s)
- Douglas W Woods
- Marquette University, Department of Psychology, Cramer Hall, Room 317, 604 N. 16th St., Milwaukee, WI, 53233, USA; University of Wisconsin-Milwaukee, Department of Psychology, Garland Hall, Room 224, 2441 E. Hartford Ave., Milwaukee, WI, 53211, USA.
| | - Laura J Ely
- University of Wisconsin-Milwaukee, Department of Psychology, Garland Hall, Room 224, 2441 E. Hartford Ave., Milwaukee, WI, 53211, USA.
| | - Christopher C Bauer
- Marquette University, Department of Psychology, Cramer Hall, Room 317, 604 N. 16th St., Milwaukee, WI, 53233, USA; University of Wisconsin-Milwaukee, Department of Psychology, Garland Hall, Room 224, 2441 E. Hartford Ave., Milwaukee, WI, 53211, USA.
| | - Michael P Twohig
- State University, Department of Psychology, 2810 Old Main Hill, Logan, UT, 84322, USA.
| | - Stephen M Saunders
- Marquette University, Department of Psychology, Cramer Hall, Room 317, 604 N. 16th St., Milwaukee, WI, 53233, USA.
| | - Scott N Compton
- Duke University School of Medicine, Department of Psychiatry & Behavioral Sciences, 2608 Erwin Rd, Suite 300, Durham, NC, 27705, USA.
| | - Flint M Espil
- University of Wisconsin-Milwaukee, Department of Psychology, Garland Hall, Room 224, 2441 E. Hartford Ave., Milwaukee, WI, 53211, USA.
| | - Angela Neal-Barnett
- Kent State University, Department of Psychology, 144 Kent Hall, Kent State University, Kent, OH, 44242-0001, USA.
| | - Jennifer R Alexander
- Marquette University, Department of Psychology, Cramer Hall, Room 317, 604 N. 16th St., Milwaukee, WI, 53233, USA.
| | - Michael R Walther
- University of Wisconsin-Milwaukee, Department of Psychology, Garland Hall, Room 224, 2441 E. Hartford Ave., Milwaukee, WI, 53211, USA.
| | - Shawn P Cahill
- University of Wisconsin-Milwaukee, Department of Psychology, Garland Hall, Room 224, 2441 E. Hartford Ave., Milwaukee, WI, 53211, USA.
| | | | - Martin E Franklin
- Rogers Behavioral Health, 1 Winding Drive, Suite 106, Philadelphia, PA, 19131, USA.
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Ricketts EJ, Peris TS, Grant JE, Valle S, Cavic E, Lerner JE, Lochner C, Stein DJ, Dougherty DD, O'Neill J, Woods DW, Keuthen NJ, Piacentini J. Clinical Characteristics of Youth with Trichotillomania (Hair-Pulling Disorder) and Excoriation (Skin-Picking) Disorder. Child Psychiatry Hum Dev 2022:10.1007/s10578-022-01458-w. [PMID: 36315372 DOI: 10.1007/s10578-022-01458-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 10/02/2022] [Accepted: 10/08/2022] [Indexed: 11/24/2022]
Abstract
Body-focused repetitive disorders (BFRBDs) are understudied in youth and understanding of their underlying mechanisms is limited. This study evaluated BFRBD clinical characteristics, and two factors commonly implicated in their maintenance - emotion regulation and impulsivity - in 53 youth aged 11 to 17 years: 33 with BFRBDs and 20 controls. Evaluators administered psychiatric diagnostic interviews. Participants rated BFRBD severity, negative affect, quality of life, family functioning, emotion regulation, distress tolerance, and impulsivity. Youth with BFRBDs showed poorer distress tolerance and quality of life, and higher impulsivity and negative affect than controls, with no differences in family impairment. BFRBD distress/impairment, but not BFRBD severity, correlated with anxiety and depression, and poorer distress tolerance. Findings suggest youth with BFRBDs show clinical patterns aligning with prior research; highlight the role of distress tolerance in child BFRBDs; and suggest the utility of acceptance and mindfulness-based therapies for unpleasant emotions in BFRBDs. Continued research should evaluate factors underlying BFRBDs in youth.
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Affiliation(s)
- Emily J Ricketts
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA.
| | - Tara S Peris
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA
| | - Jon E Grant
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, IL, USA
| | - Stephanie Valle
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, IL, USA
| | - Elizabeth Cavic
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, IL, USA
| | - Juliette E Lerner
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA
| | - Christine Lochner
- SA MRC Unit on Risk & Resilience in Mental Disorders, Department of Psychiatry, University of Stellenbosch, Stellenbosch, South Africa
| | - Dan J Stein
- SA MRC Unit on Risk & Resilience in Mental Disorders, Department of Psychiatry and Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Darin D Dougherty
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Joseph O'Neill
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA
| | - Douglas W Woods
- Department of Psychology, Marquette University, Milwaukee, WI, USA
| | - Nancy J Keuthen
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - John Piacentini
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA
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12
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Espil FM, Woods DW, Specht MW, Bennett SM, Walkup JT, Ricketts EJ, McGuire JF, Stiede JT, Schild JS, Chang SW, Peterson AL, Scahill L, Wilhelm S, Piacentini JC. Long-term Outcomes of Behavior Therapy for Youth With Tourette Disorder. J Am Acad Child Adolesc Psychiatry 2022; 61:764-771. [PMID: 34508805 DOI: 10.1016/j.jaac.2021.08.022] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 08/06/2021] [Accepted: 09/01/2021] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To determine the long-term durability of behavior therapy for tics among youth with Tourette disorder and persistent (chronic) motor or vocal tic disorders. METHOD Of the 126 youth who participated in a randomized controlled trial of behavior therapy 11 years prior, 80 were recruited for this longitudinal follow-up. Consenting participants were interviewed in person or remotely (Web-based video) by trained evaluators to determine the course of tics, current tic severity, and tic-related impairment. Recruitment and data collection occurred between 2014 and 2019, with an average follow-up duration of 11.2 years. RESULTS Treatment responders to both conditions in the original trial achieved partial, but not full, tic remission. Tic severity also decreased significantly across the sample, with 40% reporting partial remission. Behavior therapy responders (n = 21) in the original trial were more likely (67%) to achieve remission at follow-up (Total Tic Score = 12.52, SD = 10.75) compared to psychoeducation/supportive therapy responders (n = 6, 0%) at follow-up (Total Tic Score = 20.67, SD = 6.92) on the Yale Global Tic Severity Scale. Tic-related impairment decreased across the sample, with no significant differences between treatment groups or responders. CONCLUSION Despite limitations of unmeasured variables and veracity of self-report at follow-up, this study supports guidelines recommending behavior therapy as the first-line intervention for tics. Further investigation of behavior therapy as an early preventive intervention also merits attention.
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Affiliation(s)
| | | | | | | | - John T Walkup
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Emily J Ricketts
- UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, California
| | - Joseph F McGuire
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | | | - Susanna W Chang
- UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, California
| | - Alan L Peterson
- University of Texas Health Sciences Center at San Antonio, Texas
| | | | - Sabine Wilhelm
- Massachusetts General Hospital and Harvard School of Medicine, Boston, Massachusetts
| | - John C Piacentini
- UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, California
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13
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Stiede JT, Woods DW, Idnani AK, Pritchard J, Klobe K, Kumar S. Pilot trial of a technology assisted treatment for trichotillomania. J Obsessive Compuls Relat Disord 2022; 33:100726. [PMID: 37305101 PMCID: PMC10256116 DOI: 10.1016/j.jocrd.2022.100726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The present study examined the usability, acceptability, feasibility, and preliminary efficacy of a prototype wrist-worn motion detection device and accompanying mobile app, developed by HabitAware®, as a system for delivering self-administered Habit Reversal Training (HRT). As an exploratory aim, the effect of the device and HRT app combination was compared to a reminder bracelet. The pilot trial included 15 adults with trichotillomania who interacted with the device and app system (n = 10) or reminder bracelet (n = 5) for 4 weeks. Participants in the device and app condition reported high usability, acceptability, and perceived efficacy of the system. The device and HRT app combination reduced hair pulling severity. Individuals in the reminder bracelet condition also showed a significant improvement in hair pulling. A future efficacy study with a larger sample size, longer timeframe, and improved gesture detection algorithm is warranted.
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14
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Lochner C, Roos J, Kidd M, Hendricks G, Peris TS, Ricketts EJ, Dougherty DD, Woods DW, Keuthen NJ, Stein DJ, Grant JE, Piacentini J. Pain perception and physiological correlates in body-focused repetitive behavior disorders. CNS Spectr 2022; 28:1-8. [PMID: 35314011 DOI: 10.1017/s1092852922000062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Behaviors typical of body-focused repetitive behavior disorders such as trichotillomania (TTM) and skin-picking disorder (SPD) are often associated with pleasure or relief, and with little or no physical pain, suggesting aberrant pain perception. Conclusive evidence about pain perception and correlates in these conditions is, however, lacking. METHODS A multisite international study examined pain perception and its physiological correlates in adults with TTM (n = 31), SPD (n = 24), and healthy controls (HCs; n = 26). The cold pressor test was administered, and measurements of pain perception and cardiovascular parameters were taken every 15 seconds. Pain perception, latency to pain tolerance, cardiovascular parameters and associations with illness severity, and comorbid depression, as well as interaction effects (group × time interval), were investigated across groups. RESULTS There were no group differences in pain ratings over time (P = .8) or latency to pain tolerance (P = .8). Illness severity was not associated with pain ratings (all P > .05). In terms of diastolic blood pressure (DBP), the main effect of group was statistically significant (P = .01), with post hoc analyses indicating higher mean DBP in TTM (95% confidence intervals [CI], 84.0-93.5) compared to SPD (95% CI, 73.5-84.2; P = .01), and HCs (95% CI, 75.6-86.0; P = .03). Pain perception did not differ between those with and those without depression (TTM: P = .2, SPD: P = .4). CONCLUSION The study findings were mostly negative suggesting that general pain perception aberration is not involved in TTM and SPD. Other underlying drivers of hair-pulling and skin-picking behavior (eg, abnormal reward processing) should be investigated.
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Affiliation(s)
- Christine Lochner
- SAMRC Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry, University of Stellenbosch, Stellenbosch, South Africa
| | - Janine Roos
- Mental Health Information Centre of Southern Africa, Stellenbosch University, Stellenbosch, South Africa
| | - Martin Kidd
- Department of Statistics and Actuarial Sciences, Centre for Statistical Consultation, University of Stellenbosch, Stellenbosch, South Africa
| | - Gaironeesa Hendricks
- SAMRC Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry, University of Stellenbosch, Stellenbosch, South Africa
| | - Tara S Peris
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, California, USA
| | - Emily J Ricketts
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, California, USA
| | - Darin D Dougherty
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts, USA
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Human Genetics Research, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts, USA
| | - Douglas W Woods
- Department of Psychology, Marquette University, Milwaukee, Wisconsin, USA
| | - Nancy J Keuthen
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts, USA
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Human Genetics Research, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts, USA
| | - Dan J Stein
- SAMRC Unit on Risk & Resilience in Mental Disorders, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
- Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Jon E Grant
- Department of Psychiatry and Behavioral Neuroscience, Pritzker School of Medicine, University of Chicago, Chicago, Illinois, USA
| | - John Piacentini
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, California, USA
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15
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McGuire JF, Strum A, Ricketts EJ, Montalbano GE, Chang S, Loo SK, Woods DW, McCracken J, Piacentini J. Cognitive control processes in behavior therapy for youth with Tourette's disorder. J Child Psychol Psychiatry 2022; 63:296-304. [PMID: 34155637 PMCID: PMC10696898 DOI: 10.1111/jcpp.13470] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/20/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Cognitive control processes are implicated in the behavioral treatment of Tourette's disorder (TD). However, the influence of these processes on treatment outcomes has received minimal attention. This study examined whether cognitive control processes and/or tic suppression predicted reductions in tic severity and treatment response to behavior therapy. METHOD Fifty-three youth with TD or a pervasive tic disorder participated in a randomized wait list-controlled trial of behavior therapy. Following a baseline assessment to evaluate psychiatric diagnoses, tic severity, and cognitive control processes (e.g., response selection, inhibition, and suppression), youth were randomly assigned to receive eight sessions of behavior therapy (n = 23) or a wait list of equal duration (n = 28). Youth receiving immediate treatment completed a post-treatment assessment to determine improvement in tic severity. Meanwhile, youth in the wait list condition completed another assessment to re-evaluate tic severity and cognitive control processes, and subsequently received 8 sessions of behavior therapy followed by a post-treatment assessment to determine improvement. RESULTS A multiple linear regression model found that pretreatment inhibition/switching on the Delis-Kaplan Executive Function System Color-Word Interference Test predicted reductions in tic severity after behavior therapy (β = -.36, t = -2.35, p = .025, ƞ2 = .15). However, other cognitive control processes and tic suppression did not predict treatment response and/or reductions in tic severity. Small nonsignificant effects were observed in cognitive control processes after behavior therapy. CONCLUSION Cognitive control processes may influence tic severity reductions in behavior therapy. Notably, even when other cognitive control processes are impaired and youth are initially unable to voluntarily suppress their tics, youth with TD can still benefit from behavior therapy. Findings offer implications for clinical practice and research for TD.
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Affiliation(s)
- Joseph F. McGuire
- Department of Psychiatry and Behavioral Science, Johns Hopkins University School of Medicine
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles
| | - Alexandra Strum
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles
- Department of Psychology, Loyola Marymount University
| | - Emily J. Ricketts
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles
| | | | - Susanna Chang
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles
| | - Sandra K. Loo
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles
| | | | - James McCracken
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles
| | - John Piacentini
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles
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16
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Ricketts EJ, Wolicki SB, Danielson ML, Rozenman M, McGuire JF, Piacentini J, Mink JW, Walkup JT, Woods DW, Bitsko RH. Academic, Interpersonal, Recreational, and Family Impairment in Children with Tourette Syndrome and Attention-Deficit/Hyperactivity Disorder. Child Psychiatry Hum Dev 2022; 53:3-15. [PMID: 33385257 PMCID: PMC8245573 DOI: 10.1007/s10578-020-01111-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/09/2020] [Indexed: 02/03/2023]
Abstract
This study describes impairment in academic, interpersonal, recreational, and family financial or occupational domains across children in three mutually exclusive diagnostic groups: ever diagnosed with Tourette syndrome (TS), attention-deficit/hyperactivity disorder (ADHD), and both disorders. In 2014, parents reported on impairment and diagnostic status of children aged 4-17 years (n = 3014). Weighted analysis and pairwise t-tests showed more children with ADHD (with or without TS) experienced impairment in overall school performance, writing, and mathematics, relative to children with TS but not ADHD. More children with TS and ADHD had problematic handwriting relative to children with ADHD but not TS. More children with TS and ADHD had problematic interpersonal relationships relative to those with ADHD but not TS. Children with TS and ADHD had higher mean impairment across domains than children with either TS or ADHD. Findings suggest assessing disorder-specific contributions to impairment could inform targeted interventions for TS and ADHD.
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Affiliation(s)
- Emily J. Ricketts
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA
| | - Sara Beth Wolicki
- Oak Ridge Institute for Science and Education, Centers for Disease Control and Prevention Research Participation Programs, Atlanta GA,Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA
| | - Melissa L. Danielson
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA
| | | | - Joseph F. McGuire
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - John Piacentini
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA
| | | | - John T. Walkup
- Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL,Feinberg School of Medicine, Northwestern University, Chicago, IL
| | | | - 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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17
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Inoue T, Togashi K, Iwanami J, Woods DW, Sakuta R. Open-case series of a remote administration and group setting comprehensive behavioral intervention for tics (RG-CBIT): A pilot trial. Front Psychiatry 2022; 13:890866. [PMID: 35958631 PMCID: PMC9360335 DOI: 10.3389/fpsyt.2022.890866] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 06/30/2022] [Indexed: 12/04/2022] Open
Abstract
PURPOSE The comprehensive behavioral intervention for tics (CBIT) is the first-line psychotherapeutic treatment for individuals with tic disorders. However, most patients with tic disorders do not have access to CBIT due to different factors including lack of trained therapists, treatment cost, and travel distance. Such barriers are more prominent in non-English speaking countries. Therefore, the current study assessed the preliminary efficacy, feasibility, and acceptability of remotely administered group CBIT (RG-CBIT) in Japan. METHODS This was an open-case series that adopted the AB design. Three Japanese children aged between 6 and 13 years who were diagnosed with TS were recruited. RG-CBIT was developed based on the published CBIT manual. Videoconference application, slide presentation software, and cloud learning platform were used as appropriate. RESULTS The Yale Global Tic Severity Scale scores of all participants decreased from baseline to post-treatment. That is, the score reduced by an average of 7.0. Regarding feasibility and acceptability, the attendance rate of participants was 100%, and the process measurement items had favorable scores. CONCLUSIONS RG-CBIT had satisfactory efficacy, feasibility, and acceptability. Hence, it could mitigate the barriers for treatment access.
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Affiliation(s)
- Takeshi Inoue
- Dokkyo Medical University Saitama Medical Center, Saitama, Japan
| | - Kohei Togashi
- Dokkyo Medical University Saitama Medical Center, Saitama, Japan
| | - Jumpei Iwanami
- Dokkyo Medical University Saitama Medical Center, Saitama, Japan
| | - Douglas W Woods
- Department of Psychology, Marquette University, Milwaukee, WI, United States
| | - Ryoichi Sakuta
- Dokkyo Medical University Saitama Medical Center, Saitama, Japan
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18
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Ramsey KA, De Nadai AS, Espil FM, Ricketts E, Stiede JT, Schild J, Specht MW, Woods DW, Bennet S, Walkup JT, Chang S, Piacentini J, McGuire JF. Urge intolerance predicts tic severity and impairment among adults with Tourette syndrome and chronic tic disorders. Front Psychiatry 2022; 13:929413. [PMID: 36032236 PMCID: PMC9399515 DOI: 10.3389/fpsyt.2022.929413] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 07/11/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Individuals with Tourette Syndrome and Persistent Tic Disorders (collectively TS) often experience premonitory urges-aversive physical sensations that precede tics and are temporarily relieved by tic expression. The relationship between tics and premonitory urges plays a key role in the neurobehavioral treatment model of TS, which underlies first-line treatments such as the Comprehensive Behavioral Intervention for Tics (CBIT). Despite the efficacy of CBIT and related behavioral therapies, less than 40% of adults with TS respond to these treatments. Further examination of the relationship between premonitory urges, tic severity, and tic impairment can provide new insights into therapeutic targets to optimize behavioral treatment outcomes. This study examined whether urge intolerance-difficulty tolerating premonitory urges-predicted tic severity and tic-related impairment among adults with TS. METHODS Participants were 80 adults with TS. Assessments characterized premonitory urge, distress tolerance, tic severity, and tic impairment. We used structural equation modeling (SEM) to examine the construct of urge intolerance-comprised of premonitory urge ratings and distress tolerance ratings. We first evaluated a measurement model of urge intolerance through bifactor modeling, including tests of the incremental value of subfactors that reflect premonitory urge severity and distress tolerance within the model. We then evaluated a structural model where we predicted clinician-rated tic severity and tic impairment by the latent variable of urge intolerance established in our measurement model. RESULTS Analyses supported a bifactor measurement model of urge intolerance among adults with TS. Consistent with theoretical models, higher levels of urge intolerance predicted greater levels of clinician-rated tic severity and tic impairment. CONCLUSION This investigation supports the construct of urge intolerance among adults with TS and distinguishes it from subcomponents of urge severity and distress tolerance. Given its predictive relationship with tic severity and tic impairment, urge intolerance represents a promising treatment target to improve therapeutic outcomes in adults with TS.
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Affiliation(s)
- Kesley A Ramsey
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Center for OCD, Anxiety, and Related Disorders for Children (COACH), Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | | | - Flint M Espil
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States
| | - Emily Ricketts
- Division of Child and Adolescent Psychiatry, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, United States
| | - Jordan T Stiede
- Department of Psychology, Behavior Therapy and Research Lab, Marquette University, Milwaukee, WI, United States
| | - Jennifer Schild
- Department of Psychology, Choices Youth Psychopathology Lab, Suffolk University, Boston, MA, United States
| | - Matthew W Specht
- Department of Psychiatry, Weill-Cornell Medicine, New York, NY, United States
| | - Douglas W Woods
- Department of Psychology, Behavior Therapy and Research Lab, Marquette University, Milwaukee, WI, United States
| | - Shannon Bennet
- Department of Psychiatry, Weill-Cornell Medicine, New York, NY, United States
| | - John T Walkup
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Susanna Chang
- Division of Child and Adolescent Psychiatry, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, United States
| | - John Piacentini
- Division of Child and Adolescent Psychiatry, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, United States
| | - Joseph F McGuire
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Center for OCD, Anxiety, and Related Disorders for Children (COACH), Johns Hopkins University School of Medicine, Baltimore, MD, United States
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19
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McGuire JF, Bennett SM, Conelea CA, Himle MB, Anderson S, Ricketts EJ, Capriotti MR, Lewin AB, McNulty DC, Thompson LG, Espil FM, Nadeau SE, McConnell M, Woods DW, Walkup JT, Piacentini J. Distinguishing and Managing Acute-Onset Complex Tic-like Behaviors in Adolescence. J Am Acad Child Adolesc Psychiatry 2021; 60:1445-1447. [PMID: 34391859 PMCID: PMC10895863 DOI: 10.1016/j.jaac.2021.07.823] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 07/20/2021] [Accepted: 08/05/2021] [Indexed: 11/27/2022]
Abstract
Consistent with international reports,1 this group of Tourette syndrome (TS) experts has noticed a recent increase in adolescents presenting with tic-like symptoms that show a markedly atypical onset and course. These sudden-onset motor movements and vocalizations are often associated with significant impairment and disability, resulting in emergency department visits and hospitalizations for some affected youths.
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Affiliation(s)
- Joseph F McGuire
- Johns Hopkins University School of Medicine, Baltimore, Maryland.
| | | | | | | | | | | | | | - Adam B Lewin
- University of South Florida, Hillsborough County
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20
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Li Y, Woods DW, Gu Y, Yu L, Yan J, Wen F, Wang F, Liu J, Cui Y. Psychometric Properties of the Chinese Version of the Premonitory Urge for Tics Scale: A Preliminary Report. Front Psychol 2021; 12:573803. [PMID: 34646181 PMCID: PMC8503313 DOI: 10.3389/fpsyg.2021.573803] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 08/26/2021] [Indexed: 12/27/2022] Open
Abstract
Premonitory urges (PUs) are sensory phenomena that immediately precede tics. The Premonitory Urge for Tics Scale (PUTS) is widely used to assess the severity of PUs, but the psychometric properties of PUTS and clinical features of PU in Chinese patients with tic disorders are still unclear. In this study, we examined the psychometric properties of the Chinese version of the PUTS in a large sample (including 367 Chinese pediatric patients with tic disorders). We found no difference in PU in different age groups. The exploratory factor analysis (EFA) of PUTS showed the emergence of four primary factors. The results of reliability and validity analyses indicated that the Chinese version showed good psychometric properties. It seemed that PU was associated with the severity of obsession symptoms in patients with tic disorders. Network analysis showed that Item 7 is a critical node for the PU, in addition to Items 1 and 4. Overall, the Chinese version of PUTS can be used in Chinese child and adolescent patients with tic disorders, particularly for patients with Tourette syndrome.
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Affiliation(s)
- Ying Li
- Department of Psychiatry, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Douglas W Woods
- Department of Psychology, Marquette University, Milwaukee, WI, United States
| | - Yi Gu
- Department of Psychiatry, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Liping Yu
- Department of Psychiatry, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Junjuan Yan
- Department of Psychiatry, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Fang Wen
- Department of Psychiatry, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Fang Wang
- Department of Psychiatry, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Jingran Liu
- Department of Psychiatry, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Yonghua Cui
- Department of Psychiatry, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
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21
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Sturm A, Ricketts EJ, McGuire JF, Lerner J, Lee S, Loo SK, McGough JJ, Chang S, Woods DW, McCracken J, Piacentini J. Inhibitory control in youth with Tourette's Disorder, attention-deficit/hyperactivity disorder and their combination and predictors of objective tic suppressibility. Psychiatry Res 2021; 304:114163. [PMID: 34411767 PMCID: PMC8809367 DOI: 10.1016/j.psychres.2021.114163] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 06/25/2021] [Accepted: 08/03/2021] [Indexed: 10/20/2022]
Abstract
The present study investigated inhibitory control deficits in Tourette's Disorder (TD)-only, Attention Deficit/Hyperactivity Disorder (ADHD)-only, and TD+ADHD and explored the degree to which measures of inhibitory control, and tic and ADHD severity predicted objective tic suppressibility. Participants were youth ages 9 to 14 (M = 11.15) with TD-only (n = 24), TD+ADHD (n = 19), ADHD-only (n = 139), and typically-developing controls (n = 59) drawn from a larger study. Groups were compared on computer-based and paper and pencil neurocognitive inhibitory control tasks. Among youth with TD, neurocognitive measures of inhibitory control, subjective tic-suppressibility (Premonitory Urge for Tics Scale, item 10), and ADHD symptom severity were evaluated as predictors of objective tic suppressibility (i.e., laboratory-based tic suppression task), controlling for total tic severity. There were significant group differences on Color-Word inhibition/switching performance, though post-hoc comparisons yielded no significant pairwise group contrasts. Subjective tic suppressibility was the only significant predictor of objective tic suppressibility. The evident intact neurocognitive inhibitory control among youth with TD suggests that individuals with TD may use compensatory neural mechanisms to support typical speed and accuracy of response. The role of cognitive flexibility in mechanisms of tic suppression should also be further explored.
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Affiliation(s)
- Alexandra Sturm
- Psychology Department, Loyola Marymount University, One LMU Drive, Suite 4700, Los Angeles, CA 90045, United States.
| | - Emily J. Ricketts
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, 90095
| | - Joseph F. McGuire
- Department of Psychiatry and Behavioral Science, Johns Hopkins University School of Medicine, Baltimore, MD, 21205
| | - Juliette Lerner
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, 90095
| | - SoJeong Lee
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, 90095
| | - Sandra K. Loo
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, 90095
| | - James J. McGough
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, 90095
| | - Susanna Chang
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, 90095
| | - Douglas W. Woods
- Department of Psychology, Marquette University, Milwaukee, WI, 53233
| | - James McCracken
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, 90095
| | - John Piacentini
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, 90095
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22
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Grant JE, Peris TS, Ricketts EJ, Lochner C, Stein DJ, Stochl J, Chamberlain SR, Scharf JM, Dougherty DD, Woods DW, Piacentini J, Keuthen NJ. Identifying subtypes of trichotillomania (hair pulling disorder) and excoriation (skin picking) disorder using mixture modeling in a multicenter sample. J Psychiatr Res 2021; 137:603-612. [PMID: 33172654 PMCID: PMC7610704 DOI: 10.1016/j.jpsychires.2020.11.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 10/25/2020] [Accepted: 11/02/2020] [Indexed: 01/28/2023]
Abstract
Body-focused repetitive behavior disorders (BFRBs) include Trichotillomania (TTM; Hair pulling disorder) and Excoriation (Skin Picking) Disorder (SPD). These conditions are prevalent, highly heterogeneous, under-researched, and under-treated. In order for progress to be made in optimally classifying and treating these conditions, it is necessary to identify meaningful subtypes. 279 adults (100 with TTM, 81 with SPD, 40 with both TTM and SPD, and 58 controls) were recruited for an international, multi-center between-group comparison using mixture modeling, with stringent correction for multiple comparisons. The main outcome measure was to examine distinct subtypes (aka latent classes) across all study participants using item-level data from gold-standard instruments assessing detailed clinical measures. Mixture models identified 3 subtypes of TTM (entropy 0.98) and 2 subtypes of SPD (entropy 0.99) independent of the control group. Significant differences between these classes were identified on measures of disability, automatic and focused symptoms, perfectionism, trait impulsiveness, and inattention and hyperactivity. These data indicate the existence of three separate subtypes of TTM, and two separate subtypes of SPD, which are distinct from controls. The identified clinical differences between these latent classes may be useful to tailor future treatments by focusing on particular traits. Future work should examine whether these latent subtypes relate to treatment outcomes, or particular psychobiological findings using neuroimaging techniques.
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Affiliation(s)
- Jon E. Grant
- Department of Psychiatry & Behavioral Neuroscience University of Chicago, Chicago, IL, USA,Corresponding author.Department of Psychiatry & Behavioral Neuroscience, University of Chicago, 5841 S. Maryland Avenue, MC 3077, Chicago, IL, 60637, USA.
| | - Tara S. Peris
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - Emily J. Ricketts
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | | | - Dan J. Stein
- SA MRC Unit on Risk & Resilience in Mental Disorders, Dept of Psychiatry & Neuroscience Institute, University of Cape Town, South Africa
| | - Jan Stochl
- Department of Psychiatry, University of Cambridge, Cambridge, UK,Department of Kinanthropology, Charles University, Prague, Czech Republic
| | | | - Jeremiah M. Scharf
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, USA
| | - Darin D. Dougherty
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, USA
| | - Douglas W. Woods
- Department of Psychology, Marquette University, Milwaukee, WI, USA
| | - John Piacentini
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - Nancy J. Keuthen
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, USA
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23
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Essoe JKY, Ricketts EJ, Ramsey KA, Piacentini J, Woods DW, Peterson AL, Scahill L, Wilhelm S, Walkup JT, McGuire JF. Homework adherence predicts therapeutic improvement from behavior therapy in Tourette's disorder. Behav Res Ther 2021; 140:103844. [PMID: 33770556 DOI: 10.1016/j.brat.2021.103844] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 12/11/2020] [Accepted: 03/08/2021] [Indexed: 12/28/2022]
Abstract
Behavior therapy is a first-line intervention for Tourette's Disorder (TD), and a key component is the practice of therapeutic skills between treatment visits (i.e., homework). This study examined the relationship between homework adherence during behavior therapy for TD and therapeutic outcomes, and explored baseline predictors of homework adherence during treatment. Participants included 119 individuals with TD (70 youth, 49 adults) who received behavior therapy in a clinical trial. After a baseline assessment of tic severity and clinical characteristics, participants received 8 sessions of behavior therapy. Therapists recorded homework adherence at each therapy session. After treatment, tic severity was re-assessed by independent evaluators masked to treatment condition. Greater overall homework adherence predicted tic severity reductions and treatment response across participants. Early homework adherence predicted therapeutic improvement in youth, whereas late adherence predicted improvement in adults. Baseline predictors of greater homework adherence in youth included lower hyperactivity/impulsivity and caregiver strain. Meanwhile in adults, baseline predictors of increased homework adherence included younger age, lower hyperactivity/impulsivity, obsessive-compulsive severity, anger, and greater work-related disability. Homework adherence is an integral component of behavior therapy and linked to therapeutic improvement. Strategies that improve homework adherence may optimize the efficacy of behavioral treatments and improve treatment outcomes.
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Affiliation(s)
- Joey K-Y Essoe
- Division of Child and Adolescent Psychiatry, Department of Psychiatry & Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Emily J Ricketts
- Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, CA, USA
| | - Kesley A Ramsey
- Division of Child and Adolescent Psychiatry, Department of Psychiatry & Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - John Piacentini
- Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, CA, USA
| | - Douglas W Woods
- Department of Psychology, Marquette University, Milwaukee, WI, USA
| | - Alan L Peterson
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, Texas, USA; Department of Psychology, University of Texas at San Antonio, San Antonio, TX, USA; South Texas Veterans Health Care System, San Antonio, TX, USA
| | - Lawrence Scahill
- Marcus Autism Center, Emory University School of Medicine, Atlanta, GA, USA
| | - Sabine Wilhelm
- Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - John T Walkup
- Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Joseph F McGuire
- Division of Child and Adolescent Psychiatry, Department of Psychiatry & Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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24
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First MB, Gaebel W, Maj M, Stein DJ, Kogan CS, Saunders JB, Poznyak VB, Gureje O, Lewis-Fernández R, Maercker A, Brewin CR, Cloitre M, Claudino A, Pike KM, Baird G, Skuse D, Krueger RB, Briken P, Burke JD, Lochman JE, Evans SC, Woods DW, Reed GM. An organization- and category-level comparison of diagnostic requirements for mental disorders in ICD-11 and DSM-5. World Psychiatry 2021; 20:34-51. [PMID: 33432742 PMCID: PMC7801846 DOI: 10.1002/wps.20825] [Citation(s) in RCA: 64] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
In 2013, the American Psychiatric Association (APA) published the 5th edition of its Diagnostic and Statistical Manual of Mental Disorders (DSM-5). In 2019, the World Health Assembly approved the 11th revision of the International Classification of Diseases (ICD-11). It has often been suggested that the field would benefit from a single, unified classification of mental disorders, although the priorities and constituencies of the two sponsoring organizations are quite different. During the development of the ICD-11 and DSM-5, the World Health Organization (WHO) and the APA made efforts toward harmonizing the two systems, including the appointment of an ICD-DSM Harmonization Group. This paper evaluates the success of these harmonization efforts and provides a guide for practitioners, researchers and policy makers describing the differences between the two systems at both the organizational and the disorder level. The organization of the two classifications of mental disorders is substantially similar. There are nineteen ICD-11 disorder categories that do not appear in DSM-5, and seven DSM-5 disorder categories that do not appear in the ICD-11. We compared the Essential Features section of the ICD-11 Clinical Descriptions and Diagnostic Guidelines (CDDG) with the DSM-5 criteria sets for 103 diagnostic entities that appear in both systems. We rated 20 disorders (19.4%) as having major differences, 42 disorders (40.8%) as having minor definitional differences, 10 disorders (9.7%) as having minor differences due to greater degree of specification in DSM-5, and 31 disorders (30.1%) as essentially identical. Detailed descriptions of the major differences and some of the most important minor differences, with their rationale and related evidence, are provided. The ICD and DSM are now closer than at any time since the ICD-8 and DSM-II. Differences are largely based on the differing priorities and uses of the two diagnostic systems and on differing interpretations of the evidence. Substantively divergent approaches allow for empirical comparisons of validity and utility and can contribute to advances in the field.
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Affiliation(s)
- Michael B First
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - Wolfgang Gaebel
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Mario Maj
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
| | - Dan J Stein
- Department of Psychiatry, University of Cape Town and South African Medical Research Council Unit on Risk and Resilience in Mental Disorders, Cape Town, South Africa
| | - Cary S Kogan
- School of Psychology, University of Ottawa, Ottawa, ON, Canada
| | - John B Saunders
- Centre for Youth Substance Abuse Research, University of Queensland, Brisbane, QLD, Australia
| | - Vladimir B Poznyak
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Oye Gureje
- Department of Psychiatry, University of Ibadan, Ibadan, Nigeria
| | - Roberto Lewis-Fernández
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - Andreas Maercker
- Department of Psychology, University of Zurich, Zurich, Switzerland
| | - Chris R Brewin
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Marylene Cloitre
- National Center for PTSD Dissemination and Training Division, VA Palo Alto Health Care System, Palo Alto, CA, USA
- Department of Psychiatry and Behavioural Sciences, Stanford University, Stanford, CA, USA
| | - Angelica Claudino
- Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Kathleen M Pike
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Gillian Baird
- Newcomen Centre, Evelina Children's Hospital, Guys & St. Thomas NHS Foundation Trust, London, UK
| | - David Skuse
- Brain and Behaviour Science Unit, Institute of Child Health, University College London, London, UK
| | - Richard B Krueger
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - Peer Briken
- Institute for Sex Research, Sexual Medicine and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jeffrey D Burke
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, USA
| | - John E Lochman
- Department of Psychology, University of Alabama, Tuscaloosa, AL, USA
| | | | - Douglas W Woods
- Offiice of the Provost and Department of Psychology, Marquette University, Milwaukee, WI, USA
| | - Geoffrey M Reed
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, USA
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
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25
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Tsetsos F, Yu D, Sul JH, Huang AY, Illmann C, Osiecki L, Darrow SM, Hirschtritt ME, Greenberg E, Muller-Vahl KR, Stuhrmann M, Dion Y, Rouleau GA, Aschauer H, Stamenkovic M, Schlögelhofer M, Sandor P, Barr CL, Grados MA, Singer HS, Nöthen MM, Hebebrand J, Hinney A, King RA, Fernandez TV, Barta C, Tarnok Z, Nagy P, Depienne C, Worbe Y, Hartmann A, Budman CL, Rizzo R, Lyon GJ, McMahon WM, Batterson JR, Cath DC, Malaty IA, Okun MS, Berlin C, Woods DW, Lee PC, Jankovic J, Robertson MM, Gilbert DL, Brown LW, Coffey BJ, Dietrich A, Hoekstra PJ, Kuperman S, Zinner SH, Wagner M, Knowles JA, Jeremy Willsey A, Tischfield JA, Heiman GA, Cox NJ, Freimer NB, Neale BM, Davis LK, Coppola G, Mathews CA, Scharf JM, Paschou P, Barr CL, Batterson JR, Berlin C, Budman CL, Cath DC, Coppola G, Cox NJ, Darrow S, Davis LK, Dion Y, Freimer NB, Grados MA, Greenberg E, Hirschtritt ME, Huang AY, Illmann C, King RA, Kurlan R, Leckman JF, Lyon GJ, Malaty IA, Mathews CA, McMahon WM, Neale BM, Okun MS, Osiecki L, Robertson MM, Rouleau GA, Sandor P, Scharf JM, Singer HS, Smit JH, Sul JH, Yu D, Aschauer HAH, Barta C, Budman CL, Cath DC, Depienne C, Hartmann A, Hebebrand J, Konstantinidis A, Mathews CA, Müller-Vahl K, Nagy P, Nöthen MM, Paschou P, Rizzo R, Rouleau GA, Sandor P, Scharf JM, Schlögelhofer M, Stamenkovic M, Stuhrmann M, Tsetsos F, Tarnok Z, Wolanczyk T, Worbe Y, Brown L, Cheon KA, Coffey BJ, Dietrich A, Fernandez TV, Garcia-Delgar B, Gilbert D, Grice DE, Hagstrøm J, Hedderly T, Heiman GA, Heyman I, Hoekstra PJ, Huyser C, Kim YK, Kim YS, King RA, Koh YJ, Kook S, Kuperman S, Leventhal BL, Madruga-Garrido M, Mir P, Morer A, Münchau A, Plessen KJ, Roessner V, Shin EY, Song DH, Song J, Tischfield JA, Willsey AJ, Zinner S, Aschauer H, Barr CL, Barta C, Batterson JR, Berlin C, Brown L, Budman CL, Cath DC, Coffey BJ, Coppola G, Cox NJ, Darrow S, Davis LK, Depienne C, Dietrich A, Dion Y, Fernandez T, Freimer NB, Gilbert D, Grados MA, Greenberg E, Hartmann A, Hebebrand J, Heiman G, Hirschtritt ME, Hoekstra P, Huang AY, Illmann C, Jankovic J, King RA, Kuperman S, Lee PC, Lyon GJ, Malaty IA, Mathews CA, McMahon WM, Müller-Vahl K, Nagy P, Neale BM, Nöthen MM, Okun MS, Osiecki L, Paschou P, Rizzo R, Robertson MM, Rouleau GA, Sandor P, Scharf JM, Schlögelhofer M, Singer HS, Stamenkovic M, Stuhrmann M, Sul JH, Tarnok Z, Tischfield J, Tsetsos F, Willsey AJ, Woods D, Worbe Y, Yu D, Zinner S. Synaptic processes and immune-related pathways implicated in Tourette syndrome. Transl Psychiatry 2021; 11:56. [PMID: 33462189 PMCID: PMC7814139 DOI: 10.1038/s41398-020-01082-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 09/18/2020] [Accepted: 10/21/2020] [Indexed: 12/23/2022] Open
Abstract
Tourette syndrome (TS) is a neuropsychiatric disorder of complex genetic architecture involving multiple interacting genes. Here, we sought to elucidate the pathways that underlie the neurobiology of the disorder through genome-wide analysis. We analyzed genome-wide genotypic data of 3581 individuals with TS and 7682 ancestry-matched controls and investigated associations of TS with sets of genes that are expressed in particular cell types and operate in specific neuronal and glial functions. We employed a self-contained, set-based association method (SBA) as well as a competitive gene set method (MAGMA) using individual-level genotype data to perform a comprehensive investigation of the biological background of TS. Our SBA analysis identified three significant gene sets after Bonferroni correction, implicating ligand-gated ion channel signaling, lymphocytic, and cell adhesion and transsynaptic signaling processes. MAGMA analysis further supported the involvement of the cell adhesion and trans-synaptic signaling gene set. The lymphocytic gene set was driven by variants in FLT3, raising an intriguing hypothesis for the involvement of a neuroinflammatory element in TS pathogenesis. The indications of involvement of ligand-gated ion channel signaling reinforce the role of GABA in TS, while the association of cell adhesion and trans-synaptic signaling gene set provides additional support for the role of adhesion molecules in neuropsychiatric disorders. This study reinforces previous findings but also provides new insights into the neurobiology of TS.
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Grants
- R01 NS102371 NINDS NIH HHS
- R01 NS096207 NINDS NIH HHS
- R01 NS096008 NINDS NIH HHS
- R01 NS105746 NINDS NIH HHS
- R01 MH115958 NIMH NIH HHS
- K08 MH099424 NIMH NIH HHS
- K02 NS085048 NINDS NIH HHS
- R01 MH115963 NIMH NIH HHS
- U01 HG009086 NHGRI NIH HHS
- R56 MH120736 NIMH NIH HHS
- U54 MD010722 NIMHD NIH HHS
- UL1 TR001863 NCATS NIH HHS
- R01 DC016977 NIDCD NIH HHS
- DP2 HD098859 NICHD NIH HHS
- R01 MH115961 NIMH NIH HHS
- U24 MH068457 NIMH NIH HHS
- R25 NS108939 NINDS NIH HHS
- R01 MH114927 NIMH NIH HHS
- R01 NR014852 NINR NIH HHS
- R21 HG010652 NHGRI NIH HHS
- R01 MH113362 NIMH NIH HHS
- RM1 HG009034 NHGRI NIH HHS
- FT is co-financed by Greece and the European Union (European Social Fund- ESF) through the Operational Programme «Human Resources Development, Education and Lifelong Learning» in the context of the project “Reinforcement of Postdoctoral Researchers - 2nd Cycle” (MIS-5033021), implemented by the State Scholarships Foundation (IKY)
- KMV has received financial or material research support from the EU (FP7-HEALTH-2011 No. 278367, FP7-PEOPLE-2012-ITN No. 316978), the German Research Foundation (DFG: GZ MU 1527/3-1), the German Ministry of Education and Research (BMBF: 01KG1421), the National Institute of Mental Health (NIMH), the Tourette Gesellschaft Deutschland e.V., the Else-Kroner-Fresenius-Stiftung, and GW, Almirall, Abide Therapeutics, and Therapix Biosiences and has received consultant’s honoraria from Abide Therapeutics, Tilray, Resalo Vertrieb GmbH, and Wayland Group, speaker’s fees from Tilray and Cogitando GmbH, and royalties from Medizinisch Wissenschaftliche Verlagsgesellschaft Berlin, Elsevier, and Kohlhammer; and is a consultant for Nuvelution TS Pharma Inc., Zynerba Pharmaceuticals, Resalo Vertrieb GmbH, CannaXan GmbH, Therapix Biosiences, Syqe, Nomovo Pharma, and Columbia Care.
- MMN has received fees for memberships in Scientific Advisory Boards from the Lundbeck Foundation and the Robert-Bosch-Stiftung, and for membership in the Medical-Scientific Editorial Office of the Deutsches Ärzteblatt. MMN was reimbursed travel expenses for a conference participation by Shire Deutschland GmbH. MMN receives salary payments from Life & Brain GmbH and holds shares in Life & Brain GmbH. All this concerned activities outside the submitted work.
- IM has participated in research funded by the Parkinson Foundation, Tourette Association, Dystonia Coalition, AbbVie, Biogen, Boston Scientific, Eli Lilly, Impax, Neuroderm, Prilenia, Revance, Teva but has no owner interest in any pharmaceutical company. She has received travel compensation or honoraria from the Tourette Association of America, Parkinson Foundation, International Association of Parkinsonism and Related Disorders, Medscape, and Cleveland Clinic, and royalties for writing a book with Robert rose publishers.
- MSO serves as a consultant for the Parkinson’s Foundation, and has received research grants from NIH, Parkinson’s Foundation, the Michael J. Fox Foundation, the Parkinson Alliance, Smallwood Foundation, the Bachmann-Strauss Foundation, the Tourette Syndrome Association, and the UF Foundation. MSO’s DBS research is supported by: NIH R01 NR014852 and R01NS096008. MSO is PI of the NIH R25NS108939 Training Grant. MSO has received royalties for publications with Demos, Manson, Amazon, Smashwords, Books4Patients, Perseus, Robert Rose, Oxford and Cambridge (movement disorders books). MSO is an associate editor for New England Journal of Medicine Journal Watch Neurology. MSO has participated in CME and educational activities on movement disorders sponsored by the Academy for Healthcare Learning, PeerView, Prime, QuantiaMD, WebMD/Medscape, Medicus, MedNet, Einstein, MedNet, Henry Stewart, American Academy of Neurology, Movement Disorders Society and by Vanderbilt University. The institution and not MSO receives grants from Medtronic, Abbvie, Boston Scientific, Abbott and Allergan and the PI has no financial interest in these grants. MSO has participated as a site PI and/or co-I for several NIH, foundation, and industry sponsored trials over the years but has not received honoraria. Research projects at the University of Florida receive device and drug donations.
- DW receives royalties for books on Tourette Syndrome with Guilford Press, Oxford University Press, and Springer Press.
- BMN is a member of the scientific advisory board at Deep Genomics and consultant for Camp4 Therapeutics, Takeda Pharmaceutical and Biogen.
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Affiliation(s)
- Fotis Tsetsos
- Department of Molecular Biology and Genetics, Democritus University of Thrace, Alexandroupolis, Greece
| | - Dongmei Yu
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Jae Hoon Sul
- Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - Alden Y Huang
- Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
- Bioinformatics Interdepartmental Program, University of California, Los Angeles, CA, USA
| | - Cornelia Illmann
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Lisa Osiecki
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Sabrina M Darrow
- Department of Psychiatry, UCSF Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
| | - Matthew E Hirschtritt
- Department of Psychiatry, UCSF Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
| | - Erica Greenberg
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Kirsten R Muller-Vahl
- Clinic of Psychiatry, Social Psychiatry, and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Manfred Stuhrmann
- Institute of Human Genetics, Hannover Medical School, Hannover, Germany
| | - Yves Dion
- McGill University Health Center, University of Montreal, McGill University Health Centre, Montreal, Canada
| | - Guy A Rouleau
- Montreal Neurological Institute, Department of Neurology and Neurosurgery, McGill University, Montreal, Canada
| | - Harald Aschauer
- Department of Psychiatry and Psychotherapy, Medical University Vienna, Vienna, Austria
- Biopsychosocial Corporation, Vienna, Austria
| | - Mara Stamenkovic
- Department of Psychiatry and Psychotherapy, Medical University Vienna, Vienna, Austria
| | | | - Paul Sandor
- University Health Network, Youthdale Treatment Centres, and University of Toronto, Toronto, Canada
| | - Cathy L Barr
- Krembil Research Institute, University Health Network, Hospital for Sick Children, and University of Toronto, Toronto, Canada
| | - Marco A Grados
- Johns Hopkins University School of Medicine and the Kennedy Krieger Institute, Baltimore, MD, USA
| | - Harvey S Singer
- Johns Hopkins University School of Medicine and the Kennedy Krieger Institute, Baltimore, MD, USA
| | - Markus M Nöthen
- Institute of Human Genetics, University Hospital Bonn, University of Bonn Medical School, Bonn, Germany
| | - Johannes Hebebrand
- Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Anke Hinney
- Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Robert A King
- Yale Child Study Center and the Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Thomas V Fernandez
- Yale Child Study Center and the Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Csaba Barta
- Institute of Medical Chemistry, Molecular Biology, and Pathobiochemistry, Semmelweis University, Budapest, Hungary
| | - Zsanett Tarnok
- Vadaskert Child and Adolescent Psychiatric Hospital, Budapest, Hungary
| | - Peter Nagy
- Vadaskert Child and Adolescent Psychiatric Hospital, Budapest, Hungary
| | - Christel Depienne
- Institute of Human Genetics, University Hospital Essen, University Duisburg-Essen, Essen, Germany
- Sorbonne Universités, UPMC Université Paris 06, UMR S 1127, CNRS UMR 7225, ICM, Paris, France
| | - Yulia Worbe
- Sorbonne Universités, UPMC Université Paris 06, UMR S 1127, CNRS UMR 7225, ICM, Paris, France
- French Reference Centre for Gilles de la Tourette Syndrome, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
- Assistance Publique-Hôpitaux de Paris, Department of Neurology, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
- Assistance Publique Hôpitaux de Paris, Hopital Saint Antoine, Paris, France
| | - Andreas Hartmann
- Sorbonne Universités, UPMC Université Paris 06, UMR S 1127, CNRS UMR 7225, ICM, Paris, France
- French Reference Centre for Gilles de la Tourette Syndrome, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
- Assistance Publique-Hôpitaux de Paris, Department of Neurology, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Cathy L Budman
- Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Renata Rizzo
- Child Neuropsychiatry, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Gholson J Lyon
- Jervis Clinic, NYS Institute for Basic Research in Developmental Disabilities (IBR), Staten Island, NY, USA
| | - William M McMahon
- Department of Psychiatry, University of Utah, Salt Lake City, UT, USA
| | | | - Danielle C Cath
- Department of Psychiatry, University Medical Center Groningen and Rijksuniversity Groningen, and Drenthe Mental Health Center, Groningen, the Netherlands
| | - Irene A Malaty
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida Health, Gainesville, FL, USA
| | - Michael S Okun
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida Health, Gainesville, FL, USA
| | - Cheston Berlin
- Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Douglas W Woods
- Marquette University and University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Paul C Lee
- Tripler Army Medical Center and University of Hawaii John A. Burns School of Medicine, Honolulu, HI, USA
| | - Joseph Jankovic
- Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, TX, USA
| | - Mary M Robertson
- Division of Psychiatry, Department of Neuropsychiatry, University College London, London, UK
| | - Donald L Gilbert
- Division of Pediatric Neurology, Cincinnati Children's Hospital Medical Center; Department of Pediatrics, University of Cincinnati, Cincinnati, USA
| | | | - Barbara J Coffey
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Andrea Dietrich
- Department of Child and Adolescent Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Pieter J Hoekstra
- Department of Child and Adolescent Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Samuel Kuperman
- University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Samuel H Zinner
- Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - Michael Wagner
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | | | - A Jeremy Willsey
- Institute for Neurodegenerative Diseases, UCSF Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, USA
| | - Jay A Tischfield
- Department of Genetics and the Human Genetics Institute of New Jersey, Rutgers, the State University of New Jersey, Piscataway, NJ, USA
| | - Gary A Heiman
- Department of Genetics and the Human Genetics Institute of New Jersey, Rutgers, the State University of New Jersey, Piscataway, NJ, USA
| | - Nancy J Cox
- Division of Genetic Medicine, Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Nelson B Freimer
- Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - Benjamin M Neale
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Analytic and Translational Genetics Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Lea K Davis
- Division of Genetic Medicine, Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Giovanni Coppola
- Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - Carol A Mathews
- Department of Psychiatry, Genetics Institute, University of Florida, Gainesville, FL, USA
| | - Jeremiah M Scharf
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Department of Neurology, Brigham and Women's Hospital, and the Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Peristera Paschou
- Department of Biological Sciences, Purdue University, West Lafayette, IN, USA.
| | - Cathy L Barr
- Krembil Research Institute, University Health Network, Hospital for Sick Children, and University of Toronto, Toronto, Canada
| | | | - Cheston Berlin
- Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Cathy L Budman
- Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Danielle C Cath
- Department of Psychiatry, University Medical Center Groningen and Rijksuniversity Groningen, and Drenthe Mental Health Center, Groningen, the Netherlands
| | - Giovanni Coppola
- Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - Nancy J Cox
- Division of Genetic Medicine, Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sabrina Darrow
- Department of Psychiatry, UCSF Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
| | - Lea K Davis
- Division of Genetic Medicine, Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Yves Dion
- McGill University Health Center, University of Montreal, McGill University Health Centre, Montreal, Canada
| | - Nelson B Freimer
- Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - Marco A Grados
- Johns Hopkins University School of Medicine and the Kennedy Krieger Institute, Baltimore, MD, USA
| | - Erica Greenberg
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Matthew E Hirschtritt
- Department of Psychiatry, UCSF Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
| | - Alden Y Huang
- Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
- Bioinformatics Interdepartmental Program, University of California, Los Angeles, CA, USA
| | - Cornelia Illmann
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Robert A King
- Yale Child Study Center and the Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Roger Kurlan
- Atlantic Neuroscience Institute, Overlook Hospital, Summit, NJ, USA
| | - James F Leckman
- Yale Child Study Center, Yale University School of Medicine, New Haven, CT, USA
| | - Gholson J Lyon
- Jervis Clinic, NYS Institute for Basic Research in Developmental Disabilities (IBR), Staten Island, NY, USA
| | - Irene A Malaty
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida Health, Gainesville, FL, USA
| | - Carol A Mathews
- Department of Psychiatry, Genetics Institute, University of Florida, Gainesville, FL, USA
| | - William M McMahon
- Department of Psychiatry, University of Utah, Salt Lake City, UT, USA
| | - Benjamin M Neale
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Analytic and Translational Genetics Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Michael S Okun
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida Health, Gainesville, FL, USA
| | - Lisa Osiecki
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Mary M Robertson
- Division of Psychiatry, Department of Neuropsychiatry, University College London, London, UK
| | - Guy A Rouleau
- Montreal Neurological Institute, Department of Neurology and Neurosurgery, McGill University, Montreal, Canada
| | - Paul Sandor
- University Health Network, Youthdale Treatment Centres, and University of Toronto, Toronto, Canada
| | - Jeremiah M Scharf
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Department of Neurology, Brigham and Women's Hospital, and the Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Harvey S Singer
- Johns Hopkins University School of Medicine and the Kennedy Krieger Institute, Baltimore, MD, USA
| | - Jan H Smit
- Department of Psychiatry, VU UniversityMedical Center, Amsterdam, The Netherlands
| | - Jae Hoon Sul
- Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - Dongmei Yu
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Harald Aschauer Harald Aschauer
- Department of Psychiatry and Psychotherapy, Medical University Vienna, Vienna, Austria
- Biopsychosocial Corporation, Vienna, Austria
| | - Csaba Barta
- Institute of Medical Chemistry, Molecular Biology, and Pathobiochemistry, Semmelweis University, Budapest, Hungary
| | - Cathy L Budman
- Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Danielle C Cath
- Department of Psychiatry, University Medical Center Groningen and Rijksuniversity Groningen, and Drenthe Mental Health Center, Groningen, the Netherlands
| | - Christel Depienne
- Institute of Human Genetics, University Hospital Essen, University Duisburg-Essen, Essen, Germany
- Sorbonne Universités, UPMC Université Paris 06, UMR S 1127, CNRS UMR 7225, ICM, Paris, France
| | - Andreas Hartmann
- Sorbonne Universités, UPMC Université Paris 06, UMR S 1127, CNRS UMR 7225, ICM, Paris, France
- French Reference Centre for Gilles de la Tourette Syndrome, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
- Assistance Publique-Hôpitaux de Paris, Department of Neurology, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Johannes Hebebrand
- Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Anastasios Konstantinidis
- Department of Psychiatry and Psychotherapy, Medical University Vienna, Vienna, Austria
- Center for Mental Health Muldenstrasse, BBRZMed, Linz, Austria
| | - Carol A Mathews
- Department of Psychiatry, Genetics Institute, University of Florida, Gainesville, FL, USA
| | - Kirsten Müller-Vahl
- Clinic of Psychiatry, Social Psychiatry, and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Peter Nagy
- Vadaskert Child and Adolescent Psychiatric Hospital, Budapest, Hungary
| | - Markus M Nöthen
- Institute of Human Genetics, University Hospital Bonn, University of Bonn Medical School, Bonn, Germany
| | - Peristera Paschou
- Department of Biological Sciences, Purdue University, West Lafayette, IN, USA
| | - Renata Rizzo
- Child Neuropsychiatry, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Guy A Rouleau
- Montreal Neurological Institute, Department of Neurology and Neurosurgery, McGill University, Montreal, Canada
| | - Paul Sandor
- University Health Network, Youthdale Treatment Centres, and University of Toronto, Toronto, Canada
| | - Jeremiah M Scharf
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Department of Neurology, Brigham and Women's Hospital, and the Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | | | - Mara Stamenkovic
- Department of Psychiatry and Psychotherapy, Medical University Vienna, Vienna, Austria
| | - Manfred Stuhrmann
- Institute of Human Genetics, Hannover Medical School, Hannover, Germany
| | - Fotis Tsetsos
- Department of Molecular Biology and Genetics, Democritus University of Thrace, Alexandroupolis, Greece
| | - Zsanett Tarnok
- Vadaskert Child and Adolescent Psychiatric Hospital, Budapest, Hungary
| | - Tomasz Wolanczyk
- Department of Child Psychiatry, Medical University of Warsaw, 00-001, Warsaw, Poland
| | - Yulia Worbe
- Sorbonne Universités, UPMC Université Paris 06, UMR S 1127, CNRS UMR 7225, ICM, Paris, France
- French Reference Centre for Gilles de la Tourette Syndrome, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
- Assistance Publique-Hôpitaux de Paris, Department of Neurology, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
- Assistance Publique Hôpitaux de Paris, Hopital Saint Antoine, Paris, France
| | - Lawrence Brown
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Keun-Ah Cheon
- Yonsei University College of Medicine, Yonsei Yoo & Kim Mental Health Clinic, Seoul, South Korea
| | - Barbara J Coffey
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Andrea Dietrich
- Department of Child and Adolescent Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Thomas V Fernandez
- Yale Child Study Center and the Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Blanca Garcia-Delgar
- Department of Child and Adolescent Psychiatry and Psychology, Institute of Neurosciences, Hospital Clinic Universitari, Barcelona, Spain
| | - Donald Gilbert
- Division of Pediatric Neurology, Cincinnati Children's Hospital Medical Center; Department of Pediatrics, University of Cincinnati, Cincinnati, USA
| | - Dorothy E Grice
- Department of Psychiatry, Friedman Brain Institute, Mindich Child Health and Development Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Julie Hagstrøm
- Child and Adolescent Mental Health Center, Mental Health Services, Capital Region of Denmark and University of Copenhagen, Copenhagen, Denmark
| | - Tammy Hedderly
- Tic and Neurodevelopmental Movements Service (TANDeM), Evelina Children's Hospital, Guys and St Thomas' NHS Foundation Trust, London, UK
- Paediatric Neurosciences, Kings College London, London, UK
| | - Gary A Heiman
- Department of Genetics and the Human Genetics Institute of New Jersey, Rutgers, the State University of New Jersey, Piscataway, NJ, USA
| | - Isobel Heyman
- UCL Great Ormond Street Institute of Child Health, University College London, London, UK
- Psychological and Mental Health Services, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Pieter J Hoekstra
- Department of Child and Adolescent Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Chaim Huyser
- De Bascule, Academic Centre for Child and Adolescent Psychiatry, Amsterdam, The Netherlands
| | | | - Young-Shin Kim
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA, USA
| | - Robert A King
- Yale Child Study Center and the Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Yun-Joo Koh
- The Korea Institute for Children's Social Development, Rudolph Child Research Center, Seoul, South Korea
| | - Sodahm Kook
- Kangbuk Samsung Hospital, Seoul, South Korea
| | - Samuel Kuperman
- University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Bennett L Leventhal
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA, USA
| | - Marcos Madruga-Garrido
- Sección de Neuropediatría, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain
| | - Pablo Mir
- Hospital Universitario Virgen del Rocío, Sevilla, Spain
- Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - Astrid Morer
- Department of Child and Adolescent Psychiatry and Psychology, Institute of Neurosciences, Hospital Clínic Universitari, Barcelona, Spain
- Department of Medicine, University of Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en red de Salud Mental (CIBERSAM), Barcelona, Spain
| | - Alexander Münchau
- Institute of Systems Motor Science, University of Lübeck, Lübeck, Germany
| | - Kerstin J Plessen
- Child and Adolescent Mental Health Centre, Mental Health Services, Capital Region of Denmark, Copenhagen, Denmark
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus, Denmark
- Service of Child and Adolescent Psychiatry, Department of Psychiatry, University Medical Center, University of Lausanne, Lausanne, Switzerland
| | - Veit Roessner
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, University Hospital Carl Gustav CarusTU Dresden, Dresden, Germany
| | - Eun-Young Shin
- Yonsei University College of Medicine, Yonsei Yoo & Kim Mental Health Clinic, Seoul, South Korea
| | - Dong-Ho Song
- Yonsei University College of Medicine, Yonsei Yoo & Kim Mental Health Clinic, Seoul, South Korea
| | - Jungeun Song
- National Health Insurance Service Ilsan Hospital, Goyang-Si, South Korea
| | - Jay A Tischfield
- Department of Genetics and the Human Genetics Institute of New Jersey, Rutgers, the State University of New Jersey, Piscataway, NJ, USA
| | - A Jeremy Willsey
- Institute for Neurodegenerative Diseases, UCSF Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, USA
| | - Samuel Zinner
- Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - Harald Aschauer
- Department of Psychiatry and Psychotherapy, Medical University Vienna, Vienna, Austria
- Biopsychosocial Corporation, Vienna, Austria
| | - Cathy L Barr
- Krembil Research Institute, University Health Network, Hospital for Sick Children, and University of Toronto, Toronto, Canada
| | - Csaba Barta
- Institute of Medical Chemistry, Molecular Biology, and Pathobiochemistry, Semmelweis University, Budapest, Hungary
| | | | - Cheston Berlin
- Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Lawrence Brown
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Cathy L Budman
- Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Danielle C Cath
- Department of Psychiatry, University Medical Center Groningen and Rijksuniversity Groningen, and Drenthe Mental Health Center, Groningen, the Netherlands
| | - Barbara J Coffey
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Giovanni Coppola
- Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - Nancy J Cox
- Division of Genetic Medicine, Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sabrina Darrow
- Department of Psychiatry, UCSF Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
| | - Lea K Davis
- Division of Genetic Medicine, Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Christel Depienne
- Institute of Human Genetics, University Hospital Essen, University Duisburg-Essen, Essen, Germany
- Sorbonne Universités, UPMC Université Paris 06, UMR S 1127, CNRS UMR 7225, ICM, Paris, France
| | - Andrea Dietrich
- Department of Child and Adolescent Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Yves Dion
- McGill University Health Center, University of Montreal, McGill University Health Centre, Montreal, Canada
| | - Thomas Fernandez
- Yale Child Study Center and the Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Nelson B Freimer
- Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - Donald Gilbert
- Division of Pediatric Neurology, Cincinnati Children's Hospital Medical Center; Department of Pediatrics, University of Cincinnati, Cincinnati, USA
| | - Marco A Grados
- Johns Hopkins University School of Medicine and the Kennedy Krieger Institute, Baltimore, MD, USA
| | - Erica Greenberg
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Andreas Hartmann
- Sorbonne Universités, UPMC Université Paris 06, UMR S 1127, CNRS UMR 7225, ICM, Paris, France
- French Reference Centre for Gilles de la Tourette Syndrome, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
- Assistance Publique-Hôpitaux de Paris, Department of Neurology, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Johannes Hebebrand
- Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Gary Heiman
- Department of Genetics and the Human Genetics Institute of New Jersey, Rutgers, the State University of New Jersey, Piscataway, NJ, USA
| | - Matthew E Hirschtritt
- Department of Psychiatry, UCSF Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
| | - Pieter Hoekstra
- Department of Child and Adolescent Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Alden Y Huang
- Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
- Bioinformatics Interdepartmental Program, University of California, Los Angeles, CA, USA
| | - Cornelia Illmann
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Joseph Jankovic
- Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, TX, USA
| | - Robert A King
- Yale Child Study Center and the Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Samuel Kuperman
- University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Paul C Lee
- Tripler Army Medical Center and University of Hawaii John A. Burns School of Medicine, Honolulu, HI, USA
| | - Gholson J Lyon
- Jervis Clinic, NYS Institute for Basic Research in Developmental Disabilities (IBR), Staten Island, NY, USA
| | - Irene A Malaty
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida Health, Gainesville, FL, USA
| | - Carol A Mathews
- Department of Psychiatry, Genetics Institute, University of Florida, Gainesville, FL, USA
| | - William M McMahon
- Department of Psychiatry, University of Utah, Salt Lake City, UT, USA
| | - Kirsten Müller-Vahl
- Clinic of Psychiatry, Social Psychiatry, and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Peter Nagy
- Vadaskert Child and Adolescent Psychiatric Hospital, Budapest, Hungary
| | - Benjamin M Neale
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Analytic and Translational Genetics Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Markus M Nöthen
- Institute of Human Genetics, University Hospital Bonn, University of Bonn Medical School, Bonn, Germany
| | - Michael S Okun
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida Health, Gainesville, FL, USA
| | - Lisa Osiecki
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Peristera Paschou
- Department of Biological Sciences, Purdue University, West Lafayette, IN, USA
| | - Renata Rizzo
- Child Neuropsychiatry, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Mary M Robertson
- Division of Psychiatry, Department of Neuropsychiatry, University College London, London, UK
| | - Guy A Rouleau
- Montreal Neurological Institute, Department of Neurology and Neurosurgery, McGill University, Montreal, Canada
| | - Paul Sandor
- University Health Network, Youthdale Treatment Centres, and University of Toronto, Toronto, Canada
| | - Jeremiah M Scharf
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Department of Neurology, Brigham and Women's Hospital, and the Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | | | - Harvey S Singer
- Johns Hopkins University School of Medicine and the Kennedy Krieger Institute, Baltimore, MD, USA
| | - Mara Stamenkovic
- Department of Psychiatry and Psychotherapy, Medical University Vienna, Vienna, Austria
| | - Manfred Stuhrmann
- Institute of Human Genetics, Hannover Medical School, Hannover, Germany
| | - Jae Hoon Sul
- Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - Zsanett Tarnok
- Vadaskert Child and Adolescent Psychiatric Hospital, Budapest, Hungary
| | - Jay Tischfield
- Department of Genetics and the Human Genetics Institute of New Jersey, Rutgers, the State University of New Jersey, Piscataway, NJ, USA
| | - Fotis Tsetsos
- Department of Molecular Biology and Genetics, Democritus University of Thrace, Alexandroupolis, Greece
| | - A Jeremy Willsey
- Institute for Neurodegenerative Diseases, UCSF Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, USA
| | - Douglas Woods
- Marquette University and University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Yulia Worbe
- Sorbonne Universités, UPMC Université Paris 06, UMR S 1127, CNRS UMR 7225, ICM, Paris, France
- French Reference Centre for Gilles de la Tourette Syndrome, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
- Assistance Publique-Hôpitaux de Paris, Department of Neurology, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
- Assistance Publique Hôpitaux de Paris, Hopital Saint Antoine, Paris, France
| | - Dongmei Yu
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Samuel Zinner
- Department of Pediatrics, University of Washington, Seattle, WA, USA
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Ricketts EJ, Snorrason Í, Mathew AS, Sigurvinsdottir E, Ólafsson RP, Woods DW, Lee HJ. Heightened Sense of Incompleteness in Excoriation (Skin-Picking) Disorder. Cogn Ther Res 2021. [DOI: 10.1007/s10608-020-10201-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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McGuire JF, Piacentini J, Storch EA, Ricketts EJ, Woods DW, Peterson AL, Walkup JT, Wilhelm S, Ramsey K, Essoe JKY, Himle MB, Lewin AB, Chang S, Murphy TK, McCracken JT, Scahill L. Defining tic severity and tic impairment in Tourette Disorder. J Psychiatr Res 2021; 133:93-100. [PMID: 33338735 PMCID: PMC7867408 DOI: 10.1016/j.jpsychires.2020.12.040] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 12/07/2020] [Accepted: 12/10/2020] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Treatment guidelines for Tourette's Disorder (TD) are based on patients' degree of tic severity and impairment. However, clear benchmarks for determining tic severity and impairment have not been established. This study examined benchmarks of tic severity and tic impairment using the Yale Global Tic Severity Scale (YGTSS) and the Clinical Global Impression of Severity (CGI-S). METHOD Individuals with TD or another Tic Disorder (N = 519) recruited across nine sites were administered a diagnostic interview, the YGTSS, and the CGI-S. Correlations and trend analyses contrasted YGTSS scores across CGI-S ratings. A logistic regression model examined predictive benchmarks for tic severity, tic impairment, and global severity. Model classifications were compared against CGI-S ratings, and agreement was examined using kappa. RESULTS Spearman correlations between the CGI-S and YGTSS scores ranged from 0.54 to 0.63 (p < 0.001). Greater CGI-S ratings were associated with a linear stepwise increase in YGTSS Total Tic scores, Impairment scores, and Global Severity scores. Despite moderate-to-strong associations (ρ = 0.45-0.56, p < 0.001) between the CGI-S and predictive logistical regression models, only fair agreement was achieved when applying classification benchmarks (κ = 0.21-0.32, p < 0.001). CONCLUSIONS CGI-S ratings are useful to characterize benchmarks for tic severity, tic impairment, and global severity on the YGTSS. Logistic regression model benchmarks had only fair agreement with the CGI-S and underscore the heterogeneity of TD symptoms. Collectively, findings offer guidance on the delineation of tic severity categorizations to apply evidence-based treatment recommendations.
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Affiliation(s)
- Joseph F McGuire
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, USA; Semel Institute of Neuroscience and Human Behavior, University of California Los Angeles, USA.
| | - John Piacentini
- Semel Institute of Neuroscience and Human Behavior, University of California Los Angeles, USA
| | - Eric A Storch
- Department of Psychiatry, Baylor College of Medicine, USA
| | - Emily J Ricketts
- Semel Institute of Neuroscience and Human Behavior, University of California Los Angeles, USA
| | | | - Alan L Peterson
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, USA; Research and Development Service, South Texas Veterans Health Care System, USA; Department of Psychology, University of Texas at San Antonio, USA
| | - John T Walkup
- Ann and Robert H. Lurie Children's Hospital of Chicago, USA
| | - Sabine Wilhelm
- Massachusetts General Hospital and Harvard Medical School, USA
| | - Kesley Ramsey
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, USA
| | - Joey K-Y Essoe
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, USA
| | | | - Adam B Lewin
- Departments of Pediatrics, Psychiatry and Behavioral Neuroscience, University of South Florida, USA
| | - Susanna Chang
- Semel Institute of Neuroscience and Human Behavior, University of California Los Angeles, USA
| | - Tanya K Murphy
- Departments of Pediatrics, Psychiatry and Behavioral Neuroscience, University of South Florida, USA; All Children's Hospital, Johns Hopkins Medicine, USA
| | - James T McCracken
- Semel Institute of Neuroscience and Human Behavior, University of California Los Angeles, USA
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Rehm IC, Keuthen NJ, Mansueto CS, Woods DW. A clinician's quick guide of evidence‐based approaches: Body‐focused repetitive behaviour disorders. CLIN PSYCHOL-UK 2020. [DOI: 10.1111/cp.12155] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Imogen C. Rehm
- School of Health and Biomedical Sciences, RMIT University, Melbourne, Victoria, Australia,
| | - Nancy J. Keuthen
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts, USA,
| | - Charles S. Mansueto
- Behavior Therapy Center of Greater Washington, Silver Spring, Maryland, USA,
| | - Douglas W. Woods
- Department of Psychology, Marquette University, Milwaukee, Wisconsin, USA,
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McGuire JF, Ricketts EJ, Scahill L, Wilhelm S, Woods DW, Piacentini J, Walkup JT, Peterson AL. Effect of behavior therapy for Tourette's disorder on psychiatric symptoms and functioning in adults. Psychol Med 2020; 50:2046-2056. [PMID: 31451122 PMCID: PMC7190082 DOI: 10.1017/s0033291719002150] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Although behavior therapy reduces tic severity, it is unknown whether it improves co-occurring psychiatric symptoms and functional outcomes for adults with Tourette's disorder (TD). This information is essential for effective treatment planning. This study examined the effects of behavior therapy on psychiatric symptoms and functional outcomes in older adolescents and adults with TD. METHOD A total of 122 individuals with TD or a chronic tic disorder participated in a clinical trial comparing behavior therapy to psychoeducation and supportive therapy. At baseline, posttreatment, and follow-up visits, participants completed assessments of tic severity, co-occurring symptoms (inattention, impulsiveness, hyperactivity, anger, anxiety, depression, obsessions, and compulsions), and psychosocial functioning. We compared changes in tic severity, psychiatric symptoms, and functional outcomes using repeated measure and one-way analysis of variance. RESULTS At posttreatment, participants receiving behavior therapy reported greater reductions in obsessions compared to participants in supportive therapy ($\eta _p^2 $ = 0.04, p = 0.04). Across treatments, a positive treatment response on the Clinical Global Impression of Improvement scale was associated with a reduced disruption in family life ($\eta _p^2 $ = 0.05, p = 0.02) and improved functioning in a parental role ($\eta _p^2 $ = 0.37, p = 0.02). Participants who responded positively to eight sessions of behavior therapy had an improvement in tic severity ($\eta _p^2 $ = 0.75, p < 0.001), inattention ($\eta _p^2 $ = 0.48, p < 0.02), and functioning ($\eta _p^2 $ = 0.39-0.42, p < 0.03-0.04) at the 6-month follow-up. CONCLUSION Behavior therapy has a therapeutic benefit for co-occurring obsessive symptoms in the short-term, and reduces tic severity and disability in adults with TD over time. Additional treatments may be necessary to address co-occurring symptoms and improve functional outcomes.
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Affiliation(s)
- Joseph F. McGuire
- Division of Child and Adolescent Psychiatry, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Emily J. Ricketts
- Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry, University of California Los Angeles, Los Angeles, California
| | - Lawrence Scahill
- Marcus Autism Center, Emory University School of Medicine, Atlanta, Georgia
| | - Sabine Wilhelm
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Douglas W. Woods
- Department of Psychology, Marquette University, Milwaukee, Wisconsin
| | - John Piacentini
- Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry, University of California Los Angeles, Los Angeles, California
| | | | - Alan L. Peterson
- Department of Psychiatry, University of Texas Health Science at Center, San Antonio, Texas
- Department of Psychology, University of Texas at San Antonio, San Antonio, Texas
- South Texas Veterans Health Care System, San Antonio, Texas
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Heinicke MR, Stiede JT, Miltenberger RG, Woods DW. Reducing risky behavior with habit reversal: A review of behavioral strategies to reduce habitual hand-to-head behavior. J Appl Behav Anal 2020; 53:1225-1236. [PMID: 32686131 PMCID: PMC7404378 DOI: 10.1002/jaba.745] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 06/17/2020] [Accepted: 06/17/2020] [Indexed: 12/03/2022]
Abstract
Habit reversal training (HRT) has been a mainstay of behavior analysts' repertoire for nearly the last 50 years. HRT has been effective in treating a host of repetitive behavior problems. In the face of the current coronavirus pandemic, HRT has practical public health importance as a possible intervention for reducing hand‐to‐head behaviors that increase the risk of viral infection. The current paper provides a brief review of HRT for hand‐to‐head habits that is designed for a broad audience and concludes with practical suggestions, based on HRT, for reducing face‐touching behaviors.
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Fontenelle LF, Oldenhof E, Eduarda Moreira-de-Oliveira M, Abramowitz JS, Antony MM, Cath D, Carter A, Dougherty D, Ferrão YA, Figee M, Harrison BJ, Hoexter M, Soo Kwon J, Küelz A, Lazaro L, Lochner C, Marazziti D, Mataix-Cols D, McKay D, Miguel EC, Morein-Zamir S, Moritz S, Nestadt G, O'Connor K, Pallanti S, Purdon C, Rauch S, Richter P, Rotge JY, Shavitt RG, Soriano-Mas C, Starcevic V, Stein DJ, Steketee G, Storch EA, Taylor S, van den Heuvel OA, Veale D, Woods DW, Verdejo-Garcia A, Yücel M. A transdiagnostic perspective of constructs underlying obsessive-compulsive and related disorders: An international Delphi consensus study. Aust N Z J Psychiatry 2020; 54:719-731. [PMID: 32364439 DOI: 10.1177/0004867420912327] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND The Research Domain Criteria seeks to bridge knowledge from neuroscience with clinical practice by promoting research into valid neurocognitive phenotypes and dimensions, irrespective of symptoms and diagnoses as currently conceptualized. While the Research Domain Criteria offers a vision of future research and practice, its 39 functional constructs need refinement to better target new phenotyping efforts. This study aimed to determine which Research Domain Criteria constructs are most relevant to understanding obsessive-compulsive and related disorders, based on a consensus between experts in the field of obsessive-compulsive and related disorders. METHODS Based on a modified Delphi method, 46 experts were recruited from Australia, Africa, Asia, Europe and the Americas. Over three rounds, experts had the opportunity to review their opinion in light of feedback from the previous round, which included how their response compared to other experts and a summary of comments given. RESULTS Thirty-four experts completed round one, of whom 28 (82%) completed round two and 24 (71%) completed round three. At the final round, four constructs were endorsed by ⩾75% of experts as 'primary constructs' and therefore central to understanding obsessive-compulsive and related disorders. Of these constructs, one came from the Positive Valence System (Habit), two from the Cognitive Control System (Response Selection/Inhibition and Performance Monitoring) and the final construct was an additional item suggested by experts (Compulsivity). CONCLUSION This study identified four Research Domain Criteria constructs that, according to experts, cut across different obsessive-compulsive and related disorders. These constructs represent key areas for future investigation, and may have potential implications for clinical practice in terms of diagnostic processes and therapeutic management of obsessive-compulsive and related disorders.
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Affiliation(s)
- Leonardo F Fontenelle
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, VIC, Australia.,D'Or Institute for Research and Education, D'Or São Luiz Network, Rio de Janeiro, Brazil.,Obsessive, Compulsive, and Anxiety Spectrum Research Program, Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Erin Oldenhof
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, VIC, Australia
| | - Maria Eduarda Moreira-de-Oliveira
- D'Or Institute for Research and Education, D'Or São Luiz Network, Rio de Janeiro, Brazil.,Obsessive, Compulsive, and Anxiety Spectrum Research Program, Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Jonathan S Abramowitz
- Department of Psychology and Neuroscience, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Martin M Antony
- Department of Psychology, Ryerson University, Toronto, ON, Canada
| | - Danielle Cath
- RGOc and Department of Psychiatry, Rijksuniversity Groningen, UMC Groningen, Groningen, The Netherlands.,Department of Specialized Trainings, Mental Health Services Drenthe, Assen, The Netherlands
| | - Adrian Carter
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, VIC, Australia
| | - Darin Dougherty
- Division of Neurotherapeutics, Massachusetts General Hospital, Boston, MA, USA.,Obsessive-Compulsive Disorder Institute, McLean Hospital, Belmont, MA, USA.,Obsessive-Compulsive and Related Disorders Program, Massachusetts General Hospital, Boston, MA, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Ygor A Ferrão
- Department of Psychiatry, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre, Brazil
| | - Martijn Figee
- Department of Psychiatry, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands.,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Ben J Harrison
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne, Melbourne, VIC, Australia
| | - Marcelo Hoexter
- Department of Psychiatry, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Jun Soo Kwon
- Department of Psychiatry, College of Medicine, Seoul National University, Seoul, Korea
| | - Anne Küelz
- Department of Psychiatry and Psychotherapy, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Luísa Lazaro
- Department of Child and Adolescent Psychiatry and Psychology, Hospital Clinic of Barcelona, IDIBAPS, CIBERSAM, University of Barcelona, Barcelona, Spain
| | - Christine Lochner
- SU/UCT MRC Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry, Stellenbosch University, Stellenbosch, South Africa
| | - Donatella Marazziti
- Dipartimento di Medicina Clinica e Sperimentale, Section of Psychiatry, University of Pisa, Pisa, Italy
| | - David Mataix-Cols
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Dean McKay
- Department of Psychology, Fordham University, Bronx, NY, USA
| | - Euripedes C Miguel
- Department of Psychiatry, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Sharon Morein-Zamir
- School of Psychology and Sports Science, Anglia Ruskin University, Cambridge, UK
| | - Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gerald Nestadt
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Kieron O'Connor
- Research Center of the Montreal University Institute of Mental Health, University of Montreal, Montreal, QC, Canada
| | - Stefano Pallanti
- Department of Psychiatry and Behavioral Sciences, Stanford University Medical Center, Stanford, CA, USA.,Institute of Neuroscience, University of Florence, Florence, Italy
| | - Christine Purdon
- Department of Psychology, University of Waterloo, Waterloo, ON, Canada
| | - Scott Rauch
- Obsessive-Compulsive Disorder Institute, McLean Hospital, Belmont, MA, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Peggy Richter
- Anxiety Disorders Centre, Sunnybrook Health Care Sciences, Toronto, Canada and Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Jean-Yves Rotge
- Inserm U 1127, CNRS UMR 7225, Department of Psychiatry, Institut du Cerveau et de la Moelle, ICM-A-IHU, Sorbonne Université, AP-HP, Paris, France
| | - Roseli G Shavitt
- Department of Psychiatry, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Carles Soriano-Mas
- Department of Psychiatry and Department of Psychobiology and Methodology of Health Sciences, Bellvitge Biomedical Research Institute-IDIBELL, Mental Health Networking Biomedical Research Centre (CIBERSAM) and Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Vladan Starcevic
- Department of Psychiatry, Nepean Hospital, Faculty of Medicine and Health, Sydney Medical School, Nepean Clinical School, The University of Sydney, Sydney, NSW, Australia
| | - Dan J Stein
- Department of Psychiatry and MRC Unit on Risk & Resilience in Mental Disorders, University of Cape Town, Cape Town, South Africa
| | - Gail Steketee
- School of Social Work, Boston University, Boston, USA
| | - Eric A Storch
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TC, USA
| | - Steven Taylor
- Department of Psychiatry, The University of British Columbia, Vancouver, BC, Canada
| | - Odile A van den Heuvel
- Department of Psychiatry and Department of Anatomy & Neurosciences, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands.,Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway
| | - David Veale
- South London and Maudsley NHS Foundation Trust, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Douglas W Woods
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, TX, USA.,Department of Psychology, Marquette University, Milwaukee, WI, USA
| | - Antonio Verdejo-Garcia
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, VIC, Australia
| | - Murat Yücel
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, VIC, Australia
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Abstract
It is not clear whether the development of tics can be prevented. Contextual variables can impact tic expression; therefore, shifting attention to behaviors that reduce tics is an important part of decreasing tic severity. Several medications are effective in reducing tic severity, but side effects restrict their use. Behavioral treatment is the gold standard psychotherapy intervention for tic disorders, with Comprehensive Behavioral Intervention for Tics being the most well-supported nonpharmacological treatment. Although children may be unable to prevent the development of tics, they can still use several strategies to reduce tic severity and impairment.
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Affiliation(s)
- Jordan T Stiede
- Psychology Department, Marquette University, Cramer Hall, 307, PO Box 1881, Milwaukee, WI 53201-1881, USA
| | - Douglas W Woods
- Marquette University, Holthusen Hall, 305, PO Box 1881, Milwaukee, WI 5320-1881, USA.
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Mathew AS, Davine TP, Snorrason I, Houghton DC, Woods DW, Lee HJ. Body-focused repetitive behaviors and non-suicidal self-injury: A comparison of clinical characteristics and symptom features. J Psychiatr Res 2020; 124:115-122. [PMID: 32135390 DOI: 10.1016/j.jpsychires.2020.02.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 02/20/2020] [Accepted: 02/22/2020] [Indexed: 10/24/2022]
Abstract
Body-focused repetitive behaviors (BFRBs) and non-suicidal self-injury (NSSI) are recognized as distinct categories in the DSM-5. However, definitions and assessment of NSSI sometimes encompasses behaviors similar to BFRBs, and little data exist about their clinical differences. The current study examined clinical characteristics and symptom features associated with NSSI vs. BFRBs. The current sample included 1523 individuals who endorsed moderate to severe NSSI (n = 165) or BFRBs: hair pulling group (n = 102), skin picking group (n = 216), nail picking group (n = 253), nail biting group (n = 487), and cheek biting group (n = 300). Responders were asked to complete questionnaires on clinical features relevant for BFRBs and NSSI. NSSI and BFRBs had significant differences on several clinical features. Individuals in the NSSI group were more likely than individuals with BFRBs to report engaging in the behavior for social-affective reasons (i.e., to get out of doing something, or receive attention from others). Individuals in the NSSI group were also more likely to engage in the behavior to regulate tension and feelings of emptiness, and to experience relief during the act. In contrast, individuals in the BFRB groups were more likely to engage in the behavior automatically without reflective awareness, to reduce boredom, or to fix appearance. The NSSI group obtained significantly higher scores on questionnaires assessing stress, anxiety, depression, and harm avoidance. Overall, the results showed several notable differences between NSSI and BFRBs that are consistent with clinical literature and definitions of these problems in the DSM-5.
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Affiliation(s)
- Abel S Mathew
- Department of Psychology, University of Wisconsin-Milwaukee, USA
| | - Taylor P Davine
- Department of Psychology, University of Wisconsin-Milwaukee, USA
| | | | - David C Houghton
- Department of Psychiatry & Behavioral Sciences, University of Texas Medical Branch, USA
| | | | - Han-Joo Lee
- Department of Psychology, University of Wisconsin-Milwaukee, USA.
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Abstract
In this study, 285 adults who met criteria for trichotillomania (TTM) via self-report completed an online, cross-sectional survey examining antecedent phenomenological experiences pertaining to hair pulling along with measures of TTM severity and experiential avoidance (i.e., avoidance of or escape from unwanted thoughts or feelings). Results showed a heterogeneous depiction of antecedent experiences. Subsequent analyses revealed that certain antecedents were not significantly related to TTM severity but were significantly correlated with higher levels of experiential avoidance. In particular, four of five classes of antecedents (i.e., bodily sensations, physical symptoms, mental anxiety, and general uncomfortableness) were significantly related to greater experiential avoidance. The authors conclude that treatments may need to be designed to address specific private antecedents, and that this may be done through targeting experiential avoidance.
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Affiliation(s)
| | - R. Sonia Singh
- Postdoctoral Psychology Fellow at the South Central Mental Illness Research, Education and Clinical Center (MIRECC), Central Arkansas Veterans Healthcare System, North Little Rock, Arkansas, and Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock
| | - Douglas W. Woods
- Department of Psychology at Marquette University, Milwaukee, Wisconsin
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Pringsheim T, Holler-Managan Y, Okun MS, Jankovic J, Piacentini J, Cavanna AE, Martino D, Müller-Vahl K, Woods DW, Robinson M, Jarvie E, Roessner V, Oskoui M. Comprehensive systematic review summary: Treatment of tics in people with Tourette syndrome and chronic tic disorders. Neurology 2019; 92:907-915. [PMID: 31061209 DOI: 10.1212/wnl.0000000000007467] [Citation(s) in RCA: 98] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 11/24/2018] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To systematically evaluate the efficacy of treatments for tics and the risks associated with their use. METHODS This project followed the methodologies outlined in the 2011 edition of the American Academy of Neurology's guideline development process manual. We included systematic reviews and randomized controlled trials on the treatment of tics that included at least 20 participants (10 participants if a crossover trial), except for neurostimulation trials, for which no minimum sample size was required. To obtain additional information on drug safety, we included cohort studies or case series that specifically evaluated adverse drug effects in individuals with tics. RESULTS There was high confidence that the Comprehensive Behavioral Intervention for Tics was more likely than psychoeducation and supportive therapy to reduce tics. There was moderate confidence that haloperidol, risperidone, aripiprazole, tiapride, clonidine, onabotulinumtoxinA injections, 5-ling granule, Ningdong granule, and deep brain stimulation of the globus pallidus were probably more likely than placebo to reduce tics. There was low confidence that pimozide, ziprasidone, metoclopramide, guanfacine, topiramate, and tetrahydrocannabinol were possibly more likely than placebo to reduce tics. Evidence of harm associated with various treatments was also demonstrated, including weight gain, drug-induced movement disorders, elevated prolactin levels, sedation, and effects on heart rate, blood pressure, and ECGs. CONCLUSIONS There is evidence to support the efficacy of various medical, behavioral, and neurostimulation interventions for the treatment of tics. Both the efficacy and harms associated with interventions must be considered in making treatment recommendations.
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Affiliation(s)
- Tamara Pringsheim
- From the Department of Clinical Neurosciences, Psychiatry, Pediatrics and Community Health Sciences (T.P., D.M.), Cumming School of Medicine, University of Calgary, Alberta, Canada; Department of Pediatrics (Neurology) (Y.H.-M.), Northwestern University Feinberg School of Medicine, Chicago, IL; Departments of Neurology and Neurosurgery (M.S.O.), Fixel Center for Neurological Diseases, University of Florida, Gainesville; Department of Neurology (J.J.), Baylor College of Medicine, Houston, TX; Department of Psychiatry and Biobehavioral Sciences (J.P.), Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles; Department of Neuropsychiatry (A.E.C.), BSMHFT, University of Birmingham and Aston University, UK; Department of Psychiatry, Social Psychiatry, and Psychotherapy (K.M.-V.), Hannover Medical School, Germany; Department of Psychology (D.W.W.), Marquette University, Milwaukee, WI; Massachusetts Chapter (M.R.), Tourette Association of America, Bayside, NY; Waisman Center (E.J.), University Center for Excellence in Developmental Disabilities, University of Wisconsin, Madison; Technische Universitaet Dresden (V.R.), Germany; and Departments of Pediatric and Neurology/Neurosurgery (M.O.), McGill University, Montréal, Canada
| | - Yolanda Holler-Managan
- From the Department of Clinical Neurosciences, Psychiatry, Pediatrics and Community Health Sciences (T.P., D.M.), Cumming School of Medicine, University of Calgary, Alberta, Canada; Department of Pediatrics (Neurology) (Y.H.-M.), Northwestern University Feinberg School of Medicine, Chicago, IL; Departments of Neurology and Neurosurgery (M.S.O.), Fixel Center for Neurological Diseases, University of Florida, Gainesville; Department of Neurology (J.J.), Baylor College of Medicine, Houston, TX; Department of Psychiatry and Biobehavioral Sciences (J.P.), Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles; Department of Neuropsychiatry (A.E.C.), BSMHFT, University of Birmingham and Aston University, UK; Department of Psychiatry, Social Psychiatry, and Psychotherapy (K.M.-V.), Hannover Medical School, Germany; Department of Psychology (D.W.W.), Marquette University, Milwaukee, WI; Massachusetts Chapter (M.R.), Tourette Association of America, Bayside, NY; Waisman Center (E.J.), University Center for Excellence in Developmental Disabilities, University of Wisconsin, Madison; Technische Universitaet Dresden (V.R.), Germany; and Departments of Pediatric and Neurology/Neurosurgery (M.O.), McGill University, Montréal, Canada
| | - Michael S Okun
- From the Department of Clinical Neurosciences, Psychiatry, Pediatrics and Community Health Sciences (T.P., D.M.), Cumming School of Medicine, University of Calgary, Alberta, Canada; Department of Pediatrics (Neurology) (Y.H.-M.), Northwestern University Feinberg School of Medicine, Chicago, IL; Departments of Neurology and Neurosurgery (M.S.O.), Fixel Center for Neurological Diseases, University of Florida, Gainesville; Department of Neurology (J.J.), Baylor College of Medicine, Houston, TX; Department of Psychiatry and Biobehavioral Sciences (J.P.), Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles; Department of Neuropsychiatry (A.E.C.), BSMHFT, University of Birmingham and Aston University, UK; Department of Psychiatry, Social Psychiatry, and Psychotherapy (K.M.-V.), Hannover Medical School, Germany; Department of Psychology (D.W.W.), Marquette University, Milwaukee, WI; Massachusetts Chapter (M.R.), Tourette Association of America, Bayside, NY; Waisman Center (E.J.), University Center for Excellence in Developmental Disabilities, University of Wisconsin, Madison; Technische Universitaet Dresden (V.R.), Germany; and Departments of Pediatric and Neurology/Neurosurgery (M.O.), McGill University, Montréal, Canada
| | - Joseph Jankovic
- From the Department of Clinical Neurosciences, Psychiatry, Pediatrics and Community Health Sciences (T.P., D.M.), Cumming School of Medicine, University of Calgary, Alberta, Canada; Department of Pediatrics (Neurology) (Y.H.-M.), Northwestern University Feinberg School of Medicine, Chicago, IL; Departments of Neurology and Neurosurgery (M.S.O.), Fixel Center for Neurological Diseases, University of Florida, Gainesville; Department of Neurology (J.J.), Baylor College of Medicine, Houston, TX; Department of Psychiatry and Biobehavioral Sciences (J.P.), Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles; Department of Neuropsychiatry (A.E.C.), BSMHFT, University of Birmingham and Aston University, UK; Department of Psychiatry, Social Psychiatry, and Psychotherapy (K.M.-V.), Hannover Medical School, Germany; Department of Psychology (D.W.W.), Marquette University, Milwaukee, WI; Massachusetts Chapter (M.R.), Tourette Association of America, Bayside, NY; Waisman Center (E.J.), University Center for Excellence in Developmental Disabilities, University of Wisconsin, Madison; Technische Universitaet Dresden (V.R.), Germany; and Departments of Pediatric and Neurology/Neurosurgery (M.O.), McGill University, Montréal, Canada
| | - John Piacentini
- From the Department of Clinical Neurosciences, Psychiatry, Pediatrics and Community Health Sciences (T.P., D.M.), Cumming School of Medicine, University of Calgary, Alberta, Canada; Department of Pediatrics (Neurology) (Y.H.-M.), Northwestern University Feinberg School of Medicine, Chicago, IL; Departments of Neurology and Neurosurgery (M.S.O.), Fixel Center for Neurological Diseases, University of Florida, Gainesville; Department of Neurology (J.J.), Baylor College of Medicine, Houston, TX; Department of Psychiatry and Biobehavioral Sciences (J.P.), Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles; Department of Neuropsychiatry (A.E.C.), BSMHFT, University of Birmingham and Aston University, UK; Department of Psychiatry, Social Psychiatry, and Psychotherapy (K.M.-V.), Hannover Medical School, Germany; Department of Psychology (D.W.W.), Marquette University, Milwaukee, WI; Massachusetts Chapter (M.R.), Tourette Association of America, Bayside, NY; Waisman Center (E.J.), University Center for Excellence in Developmental Disabilities, University of Wisconsin, Madison; Technische Universitaet Dresden (V.R.), Germany; and Departments of Pediatric and Neurology/Neurosurgery (M.O.), McGill University, Montréal, Canada
| | - Andrea E Cavanna
- From the Department of Clinical Neurosciences, Psychiatry, Pediatrics and Community Health Sciences (T.P., D.M.), Cumming School of Medicine, University of Calgary, Alberta, Canada; Department of Pediatrics (Neurology) (Y.H.-M.), Northwestern University Feinberg School of Medicine, Chicago, IL; Departments of Neurology and Neurosurgery (M.S.O.), Fixel Center for Neurological Diseases, University of Florida, Gainesville; Department of Neurology (J.J.), Baylor College of Medicine, Houston, TX; Department of Psychiatry and Biobehavioral Sciences (J.P.), Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles; Department of Neuropsychiatry (A.E.C.), BSMHFT, University of Birmingham and Aston University, UK; Department of Psychiatry, Social Psychiatry, and Psychotherapy (K.M.-V.), Hannover Medical School, Germany; Department of Psychology (D.W.W.), Marquette University, Milwaukee, WI; Massachusetts Chapter (M.R.), Tourette Association of America, Bayside, NY; Waisman Center (E.J.), University Center for Excellence in Developmental Disabilities, University of Wisconsin, Madison; Technische Universitaet Dresden (V.R.), Germany; and Departments of Pediatric and Neurology/Neurosurgery (M.O.), McGill University, Montréal, Canada
| | - Davide Martino
- From the Department of Clinical Neurosciences, Psychiatry, Pediatrics and Community Health Sciences (T.P., D.M.), Cumming School of Medicine, University of Calgary, Alberta, Canada; Department of Pediatrics (Neurology) (Y.H.-M.), Northwestern University Feinberg School of Medicine, Chicago, IL; Departments of Neurology and Neurosurgery (M.S.O.), Fixel Center for Neurological Diseases, University of Florida, Gainesville; Department of Neurology (J.J.), Baylor College of Medicine, Houston, TX; Department of Psychiatry and Biobehavioral Sciences (J.P.), Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles; Department of Neuropsychiatry (A.E.C.), BSMHFT, University of Birmingham and Aston University, UK; Department of Psychiatry, Social Psychiatry, and Psychotherapy (K.M.-V.), Hannover Medical School, Germany; Department of Psychology (D.W.W.), Marquette University, Milwaukee, WI; Massachusetts Chapter (M.R.), Tourette Association of America, Bayside, NY; Waisman Center (E.J.), University Center for Excellence in Developmental Disabilities, University of Wisconsin, Madison; Technische Universitaet Dresden (V.R.), Germany; and Departments of Pediatric and Neurology/Neurosurgery (M.O.), McGill University, Montréal, Canada
| | - Kirsten Müller-Vahl
- From the Department of Clinical Neurosciences, Psychiatry, Pediatrics and Community Health Sciences (T.P., D.M.), Cumming School of Medicine, University of Calgary, Alberta, Canada; Department of Pediatrics (Neurology) (Y.H.-M.), Northwestern University Feinberg School of Medicine, Chicago, IL; Departments of Neurology and Neurosurgery (M.S.O.), Fixel Center for Neurological Diseases, University of Florida, Gainesville; Department of Neurology (J.J.), Baylor College of Medicine, Houston, TX; Department of Psychiatry and Biobehavioral Sciences (J.P.), Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles; Department of Neuropsychiatry (A.E.C.), BSMHFT, University of Birmingham and Aston University, UK; Department of Psychiatry, Social Psychiatry, and Psychotherapy (K.M.-V.), Hannover Medical School, Germany; Department of Psychology (D.W.W.), Marquette University, Milwaukee, WI; Massachusetts Chapter (M.R.), Tourette Association of America, Bayside, NY; Waisman Center (E.J.), University Center for Excellence in Developmental Disabilities, University of Wisconsin, Madison; Technische Universitaet Dresden (V.R.), Germany; and Departments of Pediatric and Neurology/Neurosurgery (M.O.), McGill University, Montréal, Canada
| | - Douglas W Woods
- From the Department of Clinical Neurosciences, Psychiatry, Pediatrics and Community Health Sciences (T.P., D.M.), Cumming School of Medicine, University of Calgary, Alberta, Canada; Department of Pediatrics (Neurology) (Y.H.-M.), Northwestern University Feinberg School of Medicine, Chicago, IL; Departments of Neurology and Neurosurgery (M.S.O.), Fixel Center for Neurological Diseases, University of Florida, Gainesville; Department of Neurology (J.J.), Baylor College of Medicine, Houston, TX; Department of Psychiatry and Biobehavioral Sciences (J.P.), Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles; Department of Neuropsychiatry (A.E.C.), BSMHFT, University of Birmingham and Aston University, UK; Department of Psychiatry, Social Psychiatry, and Psychotherapy (K.M.-V.), Hannover Medical School, Germany; Department of Psychology (D.W.W.), Marquette University, Milwaukee, WI; Massachusetts Chapter (M.R.), Tourette Association of America, Bayside, NY; Waisman Center (E.J.), University Center for Excellence in Developmental Disabilities, University of Wisconsin, Madison; Technische Universitaet Dresden (V.R.), Germany; and Departments of Pediatric and Neurology/Neurosurgery (M.O.), McGill University, Montréal, Canada
| | - Michael Robinson
- From the Department of Clinical Neurosciences, Psychiatry, Pediatrics and Community Health Sciences (T.P., D.M.), Cumming School of Medicine, University of Calgary, Alberta, Canada; Department of Pediatrics (Neurology) (Y.H.-M.), Northwestern University Feinberg School of Medicine, Chicago, IL; Departments of Neurology and Neurosurgery (M.S.O.), Fixel Center for Neurological Diseases, University of Florida, Gainesville; Department of Neurology (J.J.), Baylor College of Medicine, Houston, TX; Department of Psychiatry and Biobehavioral Sciences (J.P.), Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles; Department of Neuropsychiatry (A.E.C.), BSMHFT, University of Birmingham and Aston University, UK; Department of Psychiatry, Social Psychiatry, and Psychotherapy (K.M.-V.), Hannover Medical School, Germany; Department of Psychology (D.W.W.), Marquette University, Milwaukee, WI; Massachusetts Chapter (M.R.), Tourette Association of America, Bayside, NY; Waisman Center (E.J.), University Center for Excellence in Developmental Disabilities, University of Wisconsin, Madison; Technische Universitaet Dresden (V.R.), Germany; and Departments of Pediatric and Neurology/Neurosurgery (M.O.), McGill University, Montréal, Canada
| | - Elizabeth Jarvie
- From the Department of Clinical Neurosciences, Psychiatry, Pediatrics and Community Health Sciences (T.P., D.M.), Cumming School of Medicine, University of Calgary, Alberta, Canada; Department of Pediatrics (Neurology) (Y.H.-M.), Northwestern University Feinberg School of Medicine, Chicago, IL; Departments of Neurology and Neurosurgery (M.S.O.), Fixel Center for Neurological Diseases, University of Florida, Gainesville; Department of Neurology (J.J.), Baylor College of Medicine, Houston, TX; Department of Psychiatry and Biobehavioral Sciences (J.P.), Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles; Department of Neuropsychiatry (A.E.C.), BSMHFT, University of Birmingham and Aston University, UK; Department of Psychiatry, Social Psychiatry, and Psychotherapy (K.M.-V.), Hannover Medical School, Germany; Department of Psychology (D.W.W.), Marquette University, Milwaukee, WI; Massachusetts Chapter (M.R.), Tourette Association of America, Bayside, NY; Waisman Center (E.J.), University Center for Excellence in Developmental Disabilities, University of Wisconsin, Madison; Technische Universitaet Dresden (V.R.), Germany; and Departments of Pediatric and Neurology/Neurosurgery (M.O.), McGill University, Montréal, Canada
| | - Veit Roessner
- From the Department of Clinical Neurosciences, Psychiatry, Pediatrics and Community Health Sciences (T.P., D.M.), Cumming School of Medicine, University of Calgary, Alberta, Canada; Department of Pediatrics (Neurology) (Y.H.-M.), Northwestern University Feinberg School of Medicine, Chicago, IL; Departments of Neurology and Neurosurgery (M.S.O.), Fixel Center for Neurological Diseases, University of Florida, Gainesville; Department of Neurology (J.J.), Baylor College of Medicine, Houston, TX; Department of Psychiatry and Biobehavioral Sciences (J.P.), Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles; Department of Neuropsychiatry (A.E.C.), BSMHFT, University of Birmingham and Aston University, UK; Department of Psychiatry, Social Psychiatry, and Psychotherapy (K.M.-V.), Hannover Medical School, Germany; Department of Psychology (D.W.W.), Marquette University, Milwaukee, WI; Massachusetts Chapter (M.R.), Tourette Association of America, Bayside, NY; Waisman Center (E.J.), University Center for Excellence in Developmental Disabilities, University of Wisconsin, Madison; Technische Universitaet Dresden (V.R.), Germany; and Departments of Pediatric and Neurology/Neurosurgery (M.O.), McGill University, Montréal, Canada
| | - Maryam Oskoui
- From the Department of Clinical Neurosciences, Psychiatry, Pediatrics and Community Health Sciences (T.P., D.M.), Cumming School of Medicine, University of Calgary, Alberta, Canada; Department of Pediatrics (Neurology) (Y.H.-M.), Northwestern University Feinberg School of Medicine, Chicago, IL; Departments of Neurology and Neurosurgery (M.S.O.), Fixel Center for Neurological Diseases, University of Florida, Gainesville; Department of Neurology (J.J.), Baylor College of Medicine, Houston, TX; Department of Psychiatry and Biobehavioral Sciences (J.P.), Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles; Department of Neuropsychiatry (A.E.C.), BSMHFT, University of Birmingham and Aston University, UK; Department of Psychiatry, Social Psychiatry, and Psychotherapy (K.M.-V.), Hannover Medical School, Germany; Department of Psychology (D.W.W.), Marquette University, Milwaukee, WI; Massachusetts Chapter (M.R.), Tourette Association of America, Bayside, NY; Waisman Center (E.J.), University Center for Excellence in Developmental Disabilities, University of Wisconsin, Madison; Technische Universitaet Dresden (V.R.), Germany; and Departments of Pediatric and Neurology/Neurosurgery (M.O.), McGill University, Montréal, Canada
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Pringsheim T, Okun MS, Müller-Vahl K, Martino D, Jankovic J, Cavanna AE, Woods DW, Robinson M, Jarvie E, Roessner V, Oskoui M, Holler-Managan Y, Piacentini J. Practice guideline recommendations summary: Treatment of tics in people with Tourette syndrome and chronic tic disorders. Neurology 2019; 92:896-906. [PMID: 31061208 DOI: 10.1212/wnl.0000000000007466] [Citation(s) in RCA: 185] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 11/21/2018] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE To make recommendations on the assessment and management of tics in people with Tourette syndrome and chronic tic disorders. METHODS A multidisciplinary panel consisting of 9 physicians, 2 psychologists, and 2 patient representatives developed practice recommendations, integrating findings from a systematic review and following an Institute of Medicine-compliant process to ensure transparency and patient engagement. Recommendations were supported by structured rationales, integrating evidence from the systematic review, related evidence, principles of care, and inferences from evidence. RESULTS Forty-six recommendations were made regarding the assessment and management of tics in individuals with Tourette syndrome and chronic tic disorders. These include counseling recommendations on the natural history of tic disorders, psychoeducation for teachers and peers, assessment for comorbid disorders, and periodic reassessment of the need for ongoing therapy. Treatment options should be individualized, and the choice should be the result of a collaborative decision among patient, caregiver, and clinician, during which the benefits and harms of individual treatments as well as the presence of comorbid disorders are considered. Treatment options include watchful waiting, the Comprehensive Behavioral Intervention for Tics, and medication; recommendations are provided on how to offer and monitor these therapies. Recommendations on the assessment for and use of deep brain stimulation in adults with severe, treatment-refractory tics are provided as well as suggestions for future research.
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Affiliation(s)
- Tamara Pringsheim
- From the Department of Clinical Neurosciences, Psychiatry, Pediatrics and Community Health Sciences (T.P., D.M.), Cumming School of Medicine, University of Calgary, Alberta, Canada; Departments of Neurology and Neurosurgery (M.S.O.), Fixel Center for Neurological Diseases, University of Florida, Gainesville; Department of Psychiatry, Social Psychiatry, and Psychotherapy (K.M.-V.), Hannover Medical School, Germany; Department of Neurology (J.J.), Baylor College of Medicine, Houston, TX; Department of Neuropsychiatry (A.E.C.), BSMHFT, University of Birmingham and Aston University, UK; Department of Psychology (D.W.W.), Marquette University, Milwaukee, WI; Massachusetts Chapter (M.R.), Tourette Association of America, Bayside, NY; Waisman Center (E.J.), University Center for Excellence in Developmental Disabilities, University of Wisconsin, Madison; Technische Universitaet Dresden (V.R.), Germany; Departments of Pediatric and Neurology/Neurosurgery (M.O.), McGill University, Montréal, Canada; Department of Pediatrics (Neurology) (Y.H.-M.), Northwestern University Feinberg School of Medicine, Chicago, IL; and Department of Psychiatry and Biobehavioral Sciences (J.P.), Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles
| | - Michael S Okun
- From the Department of Clinical Neurosciences, Psychiatry, Pediatrics and Community Health Sciences (T.P., D.M.), Cumming School of Medicine, University of Calgary, Alberta, Canada; Departments of Neurology and Neurosurgery (M.S.O.), Fixel Center for Neurological Diseases, University of Florida, Gainesville; Department of Psychiatry, Social Psychiatry, and Psychotherapy (K.M.-V.), Hannover Medical School, Germany; Department of Neurology (J.J.), Baylor College of Medicine, Houston, TX; Department of Neuropsychiatry (A.E.C.), BSMHFT, University of Birmingham and Aston University, UK; Department of Psychology (D.W.W.), Marquette University, Milwaukee, WI; Massachusetts Chapter (M.R.), Tourette Association of America, Bayside, NY; Waisman Center (E.J.), University Center for Excellence in Developmental Disabilities, University of Wisconsin, Madison; Technische Universitaet Dresden (V.R.), Germany; Departments of Pediatric and Neurology/Neurosurgery (M.O.), McGill University, Montréal, Canada; Department of Pediatrics (Neurology) (Y.H.-M.), Northwestern University Feinberg School of Medicine, Chicago, IL; and Department of Psychiatry and Biobehavioral Sciences (J.P.), Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles
| | - Kirsten Müller-Vahl
- From the Department of Clinical Neurosciences, Psychiatry, Pediatrics and Community Health Sciences (T.P., D.M.), Cumming School of Medicine, University of Calgary, Alberta, Canada; Departments of Neurology and Neurosurgery (M.S.O.), Fixel Center for Neurological Diseases, University of Florida, Gainesville; Department of Psychiatry, Social Psychiatry, and Psychotherapy (K.M.-V.), Hannover Medical School, Germany; Department of Neurology (J.J.), Baylor College of Medicine, Houston, TX; Department of Neuropsychiatry (A.E.C.), BSMHFT, University of Birmingham and Aston University, UK; Department of Psychology (D.W.W.), Marquette University, Milwaukee, WI; Massachusetts Chapter (M.R.), Tourette Association of America, Bayside, NY; Waisman Center (E.J.), University Center for Excellence in Developmental Disabilities, University of Wisconsin, Madison; Technische Universitaet Dresden (V.R.), Germany; Departments of Pediatric and Neurology/Neurosurgery (M.O.), McGill University, Montréal, Canada; Department of Pediatrics (Neurology) (Y.H.-M.), Northwestern University Feinberg School of Medicine, Chicago, IL; and Department of Psychiatry and Biobehavioral Sciences (J.P.), Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles
| | - Davide Martino
- From the Department of Clinical Neurosciences, Psychiatry, Pediatrics and Community Health Sciences (T.P., D.M.), Cumming School of Medicine, University of Calgary, Alberta, Canada; Departments of Neurology and Neurosurgery (M.S.O.), Fixel Center for Neurological Diseases, University of Florida, Gainesville; Department of Psychiatry, Social Psychiatry, and Psychotherapy (K.M.-V.), Hannover Medical School, Germany; Department of Neurology (J.J.), Baylor College of Medicine, Houston, TX; Department of Neuropsychiatry (A.E.C.), BSMHFT, University of Birmingham and Aston University, UK; Department of Psychology (D.W.W.), Marquette University, Milwaukee, WI; Massachusetts Chapter (M.R.), Tourette Association of America, Bayside, NY; Waisman Center (E.J.), University Center for Excellence in Developmental Disabilities, University of Wisconsin, Madison; Technische Universitaet Dresden (V.R.), Germany; Departments of Pediatric and Neurology/Neurosurgery (M.O.), McGill University, Montréal, Canada; Department of Pediatrics (Neurology) (Y.H.-M.), Northwestern University Feinberg School of Medicine, Chicago, IL; and Department of Psychiatry and Biobehavioral Sciences (J.P.), Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles
| | - Joseph Jankovic
- From the Department of Clinical Neurosciences, Psychiatry, Pediatrics and Community Health Sciences (T.P., D.M.), Cumming School of Medicine, University of Calgary, Alberta, Canada; Departments of Neurology and Neurosurgery (M.S.O.), Fixel Center for Neurological Diseases, University of Florida, Gainesville; Department of Psychiatry, Social Psychiatry, and Psychotherapy (K.M.-V.), Hannover Medical School, Germany; Department of Neurology (J.J.), Baylor College of Medicine, Houston, TX; Department of Neuropsychiatry (A.E.C.), BSMHFT, University of Birmingham and Aston University, UK; Department of Psychology (D.W.W.), Marquette University, Milwaukee, WI; Massachusetts Chapter (M.R.), Tourette Association of America, Bayside, NY; Waisman Center (E.J.), University Center for Excellence in Developmental Disabilities, University of Wisconsin, Madison; Technische Universitaet Dresden (V.R.), Germany; Departments of Pediatric and Neurology/Neurosurgery (M.O.), McGill University, Montréal, Canada; Department of Pediatrics (Neurology) (Y.H.-M.), Northwestern University Feinberg School of Medicine, Chicago, IL; and Department of Psychiatry and Biobehavioral Sciences (J.P.), Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles
| | - Andrea E Cavanna
- From the Department of Clinical Neurosciences, Psychiatry, Pediatrics and Community Health Sciences (T.P., D.M.), Cumming School of Medicine, University of Calgary, Alberta, Canada; Departments of Neurology and Neurosurgery (M.S.O.), Fixel Center for Neurological Diseases, University of Florida, Gainesville; Department of Psychiatry, Social Psychiatry, and Psychotherapy (K.M.-V.), Hannover Medical School, Germany; Department of Neurology (J.J.), Baylor College of Medicine, Houston, TX; Department of Neuropsychiatry (A.E.C.), BSMHFT, University of Birmingham and Aston University, UK; Department of Psychology (D.W.W.), Marquette University, Milwaukee, WI; Massachusetts Chapter (M.R.), Tourette Association of America, Bayside, NY; Waisman Center (E.J.), University Center for Excellence in Developmental Disabilities, University of Wisconsin, Madison; Technische Universitaet Dresden (V.R.), Germany; Departments of Pediatric and Neurology/Neurosurgery (M.O.), McGill University, Montréal, Canada; Department of Pediatrics (Neurology) (Y.H.-M.), Northwestern University Feinberg School of Medicine, Chicago, IL; and Department of Psychiatry and Biobehavioral Sciences (J.P.), Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles
| | - Douglas W Woods
- From the Department of Clinical Neurosciences, Psychiatry, Pediatrics and Community Health Sciences (T.P., D.M.), Cumming School of Medicine, University of Calgary, Alberta, Canada; Departments of Neurology and Neurosurgery (M.S.O.), Fixel Center for Neurological Diseases, University of Florida, Gainesville; Department of Psychiatry, Social Psychiatry, and Psychotherapy (K.M.-V.), Hannover Medical School, Germany; Department of Neurology (J.J.), Baylor College of Medicine, Houston, TX; Department of Neuropsychiatry (A.E.C.), BSMHFT, University of Birmingham and Aston University, UK; Department of Psychology (D.W.W.), Marquette University, Milwaukee, WI; Massachusetts Chapter (M.R.), Tourette Association of America, Bayside, NY; Waisman Center (E.J.), University Center for Excellence in Developmental Disabilities, University of Wisconsin, Madison; Technische Universitaet Dresden (V.R.), Germany; Departments of Pediatric and Neurology/Neurosurgery (M.O.), McGill University, Montréal, Canada; Department of Pediatrics (Neurology) (Y.H.-M.), Northwestern University Feinberg School of Medicine, Chicago, IL; and Department of Psychiatry and Biobehavioral Sciences (J.P.), Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles
| | - Michael Robinson
- From the Department of Clinical Neurosciences, Psychiatry, Pediatrics and Community Health Sciences (T.P., D.M.), Cumming School of Medicine, University of Calgary, Alberta, Canada; Departments of Neurology and Neurosurgery (M.S.O.), Fixel Center for Neurological Diseases, University of Florida, Gainesville; Department of Psychiatry, Social Psychiatry, and Psychotherapy (K.M.-V.), Hannover Medical School, Germany; Department of Neurology (J.J.), Baylor College of Medicine, Houston, TX; Department of Neuropsychiatry (A.E.C.), BSMHFT, University of Birmingham and Aston University, UK; Department of Psychology (D.W.W.), Marquette University, Milwaukee, WI; Massachusetts Chapter (M.R.), Tourette Association of America, Bayside, NY; Waisman Center (E.J.), University Center for Excellence in Developmental Disabilities, University of Wisconsin, Madison; Technische Universitaet Dresden (V.R.), Germany; Departments of Pediatric and Neurology/Neurosurgery (M.O.), McGill University, Montréal, Canada; Department of Pediatrics (Neurology) (Y.H.-M.), Northwestern University Feinberg School of Medicine, Chicago, IL; and Department of Psychiatry and Biobehavioral Sciences (J.P.), Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles
| | - Elizabeth Jarvie
- From the Department of Clinical Neurosciences, Psychiatry, Pediatrics and Community Health Sciences (T.P., D.M.), Cumming School of Medicine, University of Calgary, Alberta, Canada; Departments of Neurology and Neurosurgery (M.S.O.), Fixel Center for Neurological Diseases, University of Florida, Gainesville; Department of Psychiatry, Social Psychiatry, and Psychotherapy (K.M.-V.), Hannover Medical School, Germany; Department of Neurology (J.J.), Baylor College of Medicine, Houston, TX; Department of Neuropsychiatry (A.E.C.), BSMHFT, University of Birmingham and Aston University, UK; Department of Psychology (D.W.W.), Marquette University, Milwaukee, WI; Massachusetts Chapter (M.R.), Tourette Association of America, Bayside, NY; Waisman Center (E.J.), University Center for Excellence in Developmental Disabilities, University of Wisconsin, Madison; Technische Universitaet Dresden (V.R.), Germany; Departments of Pediatric and Neurology/Neurosurgery (M.O.), McGill University, Montréal, Canada; Department of Pediatrics (Neurology) (Y.H.-M.), Northwestern University Feinberg School of Medicine, Chicago, IL; and Department of Psychiatry and Biobehavioral Sciences (J.P.), Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles
| | - Veit Roessner
- From the Department of Clinical Neurosciences, Psychiatry, Pediatrics and Community Health Sciences (T.P., D.M.), Cumming School of Medicine, University of Calgary, Alberta, Canada; Departments of Neurology and Neurosurgery (M.S.O.), Fixel Center for Neurological Diseases, University of Florida, Gainesville; Department of Psychiatry, Social Psychiatry, and Psychotherapy (K.M.-V.), Hannover Medical School, Germany; Department of Neurology (J.J.), Baylor College of Medicine, Houston, TX; Department of Neuropsychiatry (A.E.C.), BSMHFT, University of Birmingham and Aston University, UK; Department of Psychology (D.W.W.), Marquette University, Milwaukee, WI; Massachusetts Chapter (M.R.), Tourette Association of America, Bayside, NY; Waisman Center (E.J.), University Center for Excellence in Developmental Disabilities, University of Wisconsin, Madison; Technische Universitaet Dresden (V.R.), Germany; Departments of Pediatric and Neurology/Neurosurgery (M.O.), McGill University, Montréal, Canada; Department of Pediatrics (Neurology) (Y.H.-M.), Northwestern University Feinberg School of Medicine, Chicago, IL; and Department of Psychiatry and Biobehavioral Sciences (J.P.), Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles
| | - Maryam Oskoui
- From the Department of Clinical Neurosciences, Psychiatry, Pediatrics and Community Health Sciences (T.P., D.M.), Cumming School of Medicine, University of Calgary, Alberta, Canada; Departments of Neurology and Neurosurgery (M.S.O.), Fixel Center for Neurological Diseases, University of Florida, Gainesville; Department of Psychiatry, Social Psychiatry, and Psychotherapy (K.M.-V.), Hannover Medical School, Germany; Department of Neurology (J.J.), Baylor College of Medicine, Houston, TX; Department of Neuropsychiatry (A.E.C.), BSMHFT, University of Birmingham and Aston University, UK; Department of Psychology (D.W.W.), Marquette University, Milwaukee, WI; Massachusetts Chapter (M.R.), Tourette Association of America, Bayside, NY; Waisman Center (E.J.), University Center for Excellence in Developmental Disabilities, University of Wisconsin, Madison; Technische Universitaet Dresden (V.R.), Germany; Departments of Pediatric and Neurology/Neurosurgery (M.O.), McGill University, Montréal, Canada; Department of Pediatrics (Neurology) (Y.H.-M.), Northwestern University Feinberg School of Medicine, Chicago, IL; and Department of Psychiatry and Biobehavioral Sciences (J.P.), Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles
| | - Yolanda Holler-Managan
- From the Department of Clinical Neurosciences, Psychiatry, Pediatrics and Community Health Sciences (T.P., D.M.), Cumming School of Medicine, University of Calgary, Alberta, Canada; Departments of Neurology and Neurosurgery (M.S.O.), Fixel Center for Neurological Diseases, University of Florida, Gainesville; Department of Psychiatry, Social Psychiatry, and Psychotherapy (K.M.-V.), Hannover Medical School, Germany; Department of Neurology (J.J.), Baylor College of Medicine, Houston, TX; Department of Neuropsychiatry (A.E.C.), BSMHFT, University of Birmingham and Aston University, UK; Department of Psychology (D.W.W.), Marquette University, Milwaukee, WI; Massachusetts Chapter (M.R.), Tourette Association of America, Bayside, NY; Waisman Center (E.J.), University Center for Excellence in Developmental Disabilities, University of Wisconsin, Madison; Technische Universitaet Dresden (V.R.), Germany; Departments of Pediatric and Neurology/Neurosurgery (M.O.), McGill University, Montréal, Canada; Department of Pediatrics (Neurology) (Y.H.-M.), Northwestern University Feinberg School of Medicine, Chicago, IL; and Department of Psychiatry and Biobehavioral Sciences (J.P.), Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles
| | - John Piacentini
- From the Department of Clinical Neurosciences, Psychiatry, Pediatrics and Community Health Sciences (T.P., D.M.), Cumming School of Medicine, University of Calgary, Alberta, Canada; Departments of Neurology and Neurosurgery (M.S.O.), Fixel Center for Neurological Diseases, University of Florida, Gainesville; Department of Psychiatry, Social Psychiatry, and Psychotherapy (K.M.-V.), Hannover Medical School, Germany; Department of Neurology (J.J.), Baylor College of Medicine, Houston, TX; Department of Neuropsychiatry (A.E.C.), BSMHFT, University of Birmingham and Aston University, UK; Department of Psychology (D.W.W.), Marquette University, Milwaukee, WI; Massachusetts Chapter (M.R.), Tourette Association of America, Bayside, NY; Waisman Center (E.J.), University Center for Excellence in Developmental Disabilities, University of Wisconsin, Madison; Technische Universitaet Dresden (V.R.), Germany; Departments of Pediatric and Neurology/Neurosurgery (M.O.), McGill University, Montréal, Canada; Department of Pediatrics (Neurology) (Y.H.-M.), Northwestern University Feinberg School of Medicine, Chicago, IL; and Department of Psychiatry and Biobehavioral Sciences (J.P.), Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles
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Lochner C, Keuthen NJ, Curley EE, Tung ES, Redden SA, Ricketts EJ, Bauer CC, Woods DW, Grant JE, Stein DJ. Comorbidity in trichotillomania (hair-pulling disorder): A cluster analytical approach. Brain Behav 2019; 9:e01456. [PMID: 31692297 PMCID: PMC6908854 DOI: 10.1002/brb3.1456] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 08/08/2019] [Accepted: 09/23/2019] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND A promising approach to reducing the phenotypic heterogeneity of psychiatric disorders involves the identification of homogeneous subtypes. Careful study of comorbidity in obsessive-compulsive disorder (OCD) contributed to the identification of the DSM-5 subtype of OCD with tics. Here we investigated one of the largest available cohorts of clinically diagnosed trichotillomania (TTM) to determine whether subtyping TTM based on comorbidity would help delineate clinically meaningful subgroups. METHODS As part of an ongoing international collaboration, lifetime comorbidity data were collated from 304 adults with pathological hair-pulling who fulfilled criteria for DSM-IV-TR or DSM-5 TTM. Cluster analysis (Ward's method) based on comorbidities was undertaken. RESULTS Three clusters were identified, namely Cluster 1: cases without any comorbidities (n = 63, 20.7%) labeled "simple TTM," Cluster 2: cases with comorbid major depressive disorder only (N = 49, 16.12%) labeled "depressive TTM," and Cluster 3: cases presenting with combinations of the investigated comorbidities (N = 192, 63.16%) labeled "complex TTM." The clusters differed in terms of hair-pulling severity (F = 3.75, p = .02; Kruskal-Wallis [KW] p < .01) and depression symptom severity (F = 5.07, p = <.01; KW p < .01), with cases with any comorbidity presenting with increased severity. Analysis of the temporal nature of these conditions in a subset suggested that TTM onset generally preceded major depressive disorder in (subsets of) Clusters 2 and 3. CONCLUSIONS The findings here are useful in emphasizing that while many TTM patients present without comorbidity, depression is present in a substantial proportion of cases. In clinical practice, it is crucial to assess comorbidity, given the links demonstrated here between comorbidity and symptom severity. Additional research is needed to replicate these findings and to determine whether cluster membership based on comorbidity predicts response to treatment.
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Affiliation(s)
- Christine Lochner
- SA MRC Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
| | - Nancy J Keuthen
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Erin E Curley
- Department of Psychology, Temple University, Philadelphia, PA, USA
| | - Esther S Tung
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.,Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - Sarah A Redden
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, IL, USA.,Department of Psychology, Florida State University, Tallahassee, FL, USA
| | - Emily J Ricketts
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | | | - Douglas W Woods
- Department of Psychology, Marquette University, Milwaukee, WI, USA
| | - Jon E Grant
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, IL, USA
| | - Dan J Stein
- SA MRC Unit on Risk & Resilience in Mental Disorders, Department of Psychiatry and Neuroscience Institute, University of Cape Town, Cape Town, South Africa
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Houghton DC, Tommerdahl M, Woods DW. Increased tactile sensitivity and deficient feed-forward inhibition in pathological hair pulling and skin picking. Behav Res Ther 2019; 120:103433. [DOI: 10.1016/j.brat.2019.103433] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 03/14/2019] [Accepted: 06/21/2019] [Indexed: 12/12/2022]
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Neal-Barnett A, Woods DW, Espil FM, Davis M, Alexander JR, Compton SN, Walther MR, Twohig MP, Saunders SM, Cahill SP, Franklin ME. Acceptance-enhanced behavior therapy for trichotillomania: Randomized controlled trial rationale, method, and strategies for recruiting minority participants. Bull Menninger Clin 2019; 83:399-431. [PMID: 31380699 DOI: 10.1521/bumc_2019_83_04] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Trichotillomania (TTM) involves the chronic pulling out of hair to the point of hair loss or thinning, which continues despite repeated attempts to stop. Behavior therapy is a promising treatment for the condition, but studies have been limited by the lack of a credible control condition, small sample sizes, follow-up periods of short duration, and low participation by underrepresented populations. In the current article, the authors describe the theoretical rationale for an acceptance-enhanced form of behavior therapy for TTM in adults and describe the methodology used to test the efficacy of this intervention against a psychoeducation and supportive control condition. In addition, the authors discuss the importance of and difficulties encountered with enrolling minority participants into TTM research, as well as strategies used to enhance minority recruitment. Finally, the authors discuss the instruments, procedures, and related outcomes of the fidelity measures used in the randomized controlled trial.
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Affiliation(s)
| | - Douglas W Woods
- Texas A&M University, College Station, Texas
- Marquette University, Milwaukee, Wisconsin
| | - Flint M Espil
- Stanford University School of Medicine, Stanford, California
| | | | - Jennifer R Alexander
- Texas A&M University, College Station, Texas
- Marquette University, Milwaukee, Wisconsin
| | | | | | | | | | | | - Martin E Franklin
- University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
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Ricketts EJ, Snorrason I, Kircanski K, Alexander JR, Stiede JT, Thamrin H, Flessner CA, Franklin ME, Keuthen NJ, Walther MR, Piacentini J, Stein DJ, Woods DW. A latent profile analysis of age of onset in trichotillomania. Ann Clin Psychiatry 2019; 31:169-178. [PMID: 31369656 PMCID: PMC9528732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
BACKGROUND Trichotillomania (TTM) onset may occur across the lifespan; however, adolescent onset is most frequently reported. Several studies have explored clinical differences between TTM age-of-onset groups with mixed results. We investigated empirically defined age-of-onset groups in adults with TTM, and clinical differences between groups. METHODS Participants included 1,604 adult respondents to an internet survey who endorsed DSM-IV-TR TTM criteria. Latent profile analysis was performed to identify TTM age-of-onset subgroups, which were then compared on demographic and clinical features. RESULTS The most optimal model was a 2-class solution comprised of a large group with average TTM onset during adolescence (n = 1,539; 95.9% of the sample; mean age of onset = 12.4) and a small group with average onset in middle adulthood (n = 65; 4.1% of the sample; mean age of onset = 35.6). The late-onset group differed from the early-onset group on several clinical variables (eg, less likely to report co-occurring bodyfocused repetitive behaviors). CONCLUSIONS Findings suggest the presence of at least 2 distinct TTM age-of-onset subgroups: an early-onset group with onset during adolescence, and a late-onset group with onset in middle adulthood. Future research is needed to further validate these subgroups and explore their clinical utility.
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Affiliation(s)
- Emily J Ricketts
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA 90024-5055 USA. E-MAIL:
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Yu D, Sul JH, Tsetsos F, Nawaz MS, Huang AY, Zelaya I, Illmann C, Osiecki L, Darrow SM, Hirschtritt ME, Greenberg E, Muller-Vahl KR, Stuhrmann M, Dion Y, Rouleau G, Aschauer H, Stamenkovic M, Schlögelhofer M, Sandor P, Barr CL, Grados M, Singer HS, Nöthen MM, Hebebrand J, Hinney A, King RA, Fernandez TV, Barta C, Tarnok Z, Nagy P, Depienne C, Worbe Y, Hartmann A, Budman CL, Rizzo R, Lyon GJ, McMahon WM, Batterson JR, Cath DC, Malaty IA, Okun MS, Berlin C, Woods DW, Lee PC, Jankovic J, Robertson MM, Gilbert DL, Brown LW, Coffey BJ, Dietrich A, Hoekstra PJ, Kuperman S, Zinner SH, Luðvigsson P, Sæmundsen E, Thorarensen Ó, Atzmon G, Barzilai N, Wagner M, Moessner R, Ophoff R, Pato CN, Pato MT, Knowles JA, Roffman JL, Smoller JW, Buckner RL, Willsey JA, Tischfield JA, Heiman GA, Stefansson H, Stefansson K, Posthuma D, Cox NJ, Pauls DL, Freimer NB, Neale BM, Davis LK, Paschou P, Coppola G, Mathews CA, Scharf JM. Interrogating the Genetic Determinants of Tourette's Syndrome and Other Tic Disorders Through Genome-Wide Association Studies. Am J Psychiatry 2019; 176:217-227. [PMID: 30818990 PMCID: PMC6677250 DOI: 10.1176/appi.ajp.2018.18070857] [Citation(s) in RCA: 170] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Tourette's syndrome is polygenic and highly heritable. Genome-wide association study (GWAS) approaches are useful for interrogating the genetic architecture and determinants of Tourette's syndrome and other tic disorders. The authors conducted a GWAS meta-analysis and probed aggregated Tourette's syndrome polygenic risk to test whether Tourette's and related tic disorders have an underlying shared genetic etiology and whether Tourette's polygenic risk scores correlate with worst-ever tic severity and may represent a potential predictor of disease severity. METHODS GWAS meta-analysis, gene-based association, and genetic enrichment analyses were conducted in 4,819 Tourette's syndrome case subjects and 9,488 control subjects. Replication of top loci was conducted in an independent population-based sample (706 case subjects, 6,068 control subjects). Relationships between Tourette's polygenic risk scores (PRSs), other tic disorders, ascertainment, and tic severity were examined. RESULTS GWAS and gene-based analyses identified one genome-wide significant locus within FLT3 on chromosome 13, rs2504235, although this association was not replicated in the population-based sample. Genetic variants spanning evolutionarily conserved regions significantly explained 92.4% of Tourette's syndrome heritability. Tourette's-associated genes were significantly preferentially expressed in dorsolateral prefrontal cortex. Tourette's PRS significantly predicted both Tourette's syndrome and tic spectrum disorders status in the population-based sample. Tourette's PRS also significantly correlated with worst-ever tic severity and was higher in case subjects with a family history of tics than in simplex case subjects. CONCLUSIONS Modulation of gene expression through noncoding variants, particularly within cortico-striatal circuits, is implicated as a fundamental mechanism in Tourette's syndrome pathogenesis. At a genetic level, tic disorders represent a continuous spectrum of disease, supporting the unification of Tourette's syndrome and other tic disorders in future diagnostic schemata. Tourette's PRSs derived from sufficiently large samples may be useful in the future for predicting conversion of transient tics to chronic tic disorders, as well as tic persistence and lifetime tic severity.
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Affiliation(s)
- Dongmei Yu
- Psychiatric and Neurodevelopmental Genetics Unit, Center
for Genomic Medicine, Department of Psychiatry, Massachusetts General Hospital,
Boston, Massachusetts, USA
- Stanley Center for Psychiatric Research, Broad Institute of
MIT and Harvard, Cambridge, Massachusetts, USA
| | - Jae Hoon Sul
- Semel Institute for Neuroscience and Human Behavior, David
Geffen School of Medicine, University of California Los Angeles, Los Angeles,
California, USA
- Department of Psychiatry and Biobehavioral Sciences,
University of California, Los Angeles, California, USA
| | - Fotis Tsetsos
- Department of Molecular Biology and Genetics, Democritus
University of Thrace, Xanthi, Greece
- Department of Biological Sciences, Purdue University, West
Lafayette, Indiana, USA
| | | | - Alden Y. Huang
- Semel Institute for Neuroscience and Human Behavior, David
Geffen School of Medicine, University of California Los Angeles, Los Angeles,
California, USA
- Department of Psychiatry and Biobehavioral Sciences,
University of California, Los Angeles, California, USA
- Bioinformatics Interdepartmental Program, University of
California, Los Angeles, Los Angeles, California, USA
| | - Ivette Zelaya
- Semel Institute for Neuroscience and Human Behavior, David
Geffen School of Medicine, University of California Los Angeles, Los Angeles,
California, USA
- Department of Psychiatry and Biobehavioral Sciences,
University of California, Los Angeles, California, USA
- Bioinformatics Interdepartmental Program, University of
California, Los Angeles, Los Angeles, California, USA
| | - Cornelia Illmann
- Psychiatric and Neurodevelopmental Genetics Unit, Center
for Genomic Medicine, Department of Psychiatry, Massachusetts General Hospital,
Boston, Massachusetts, USA
| | - Lisa Osiecki
- Psychiatric and Neurodevelopmental Genetics Unit, Center
for Genomic Medicine, Department of Psychiatry, Massachusetts General Hospital,
Boston, Massachusetts, USA
| | - Sabrina M. Darrow
- Department of Psychiatry, University of California, San
Francisco, San Francisco, California, USA
| | - Matthew E. Hirschtritt
- Department of Psychiatry, UCSF Weill Institute for
Neurosciences, University of California, San Francisco, San Francisco, California,
USA
| | - Erica Greenberg
- Department of Psychiatry, Massachusetts General Hospital,
Boston, Massachusetts, USA
| | - Kirsten R. Muller-Vahl
- Clinic of Psychiatry, Social Psychiatry and
Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Manfred Stuhrmann
- Institute of Human Genetics, Hannover Medical School,
Hannover, Germany
| | - Yves Dion
- McGill University Health Center (MUHC), University of
Montréal, Centre Universitaire de Santé de Montréal (CHUM),
Montreal, Quebec, Canada
| | - Guy Rouleau
- Montreal Neurological Institute, Department of Neurology
and Neurosurgery, McGill University, Montreal, Quebec, Canada
| | - Harald Aschauer
- Department of Psychiatry and Psychotherapy, Medical
University Vienna, Vienna, Austria
- Biopsychosocial Corporation, Vienna, Austria
| | - Mara Stamenkovic
- Department of Psychiatry and Psychotherapy, Medical
University Vienna, Vienna, Austria
| | | | - Paul Sandor
- University Health Network and Youthdale Treatment Centres
University of Toronto, Toronto, Ontario, Canada
| | - Cathy L. Barr
- Krembil Research Institute, University Health Network,
Hospital for Sick Children, and The University of Toronto, Toronto, Ontario,
Canada
| | - Marco Grados
- Johns Hopkins University School of Medicine, Baltimore,
Maryland, USA
| | - Harvey S. Singer
- Johns Hopkins University School of Medicine, Baltimore,
Maryland, USA
| | - Markus M. Nöthen
- Institute of Human Genetics, University Hospital Bonn,
University of Bonn Medical School, Bonn, Germany
| | - Johannes Hebebrand
- Department of Child and Adolescent Psychiatry,
Psychosomatics and Psychotherapy, University Hospital Essen, University of
Duisburg-Essen, Essen, Germany
| | - Anke Hinney
- Department of Child and Adolescent Psychiatry,
Psychosomatics and Psychotherapy, University Hospital Essen, University of
Duisburg-Essen, Essen, Germany
| | - Robert A. King
- Yale Child Study Center, Yale University School of
Medicine, New Haven, Connecticut, USA
- Department of Psychiatry, Yale University School of
Medicine, New Haven, Connecticut, USA
| | - Thomas V. Fernandez
- Yale Child Study Center, Yale University School of
Medicine, New Haven, Connecticut, USA
- Department of Psychiatry, Yale University School of
Medicine, New Haven, Connecticut, USA
| | - Csaba Barta
- Institute of Medical Chemistry, Molecular Biology and
Pathobiochemistry, Semmelweis University, Budapest, Hungary
| | - Zsanett Tarnok
- Vadaskert Child and Adolescent Psychiatric Hospital,
Budapest, Hungary
| | - Peter Nagy
- Vadaskert Child and Adolescent Psychiatric Hospital,
Budapest, Hungary
| | - Christel Depienne
- Institute of Human Genetics, University Hospital Essen,
University Duisburg-Essen, Essen, Germany
- Sorbonne Universités, UPMC Université Paris
06, UMR S 1127, CNRS UMR 7225, ICM, Paris, France
| | - Yulia Worbe
- Sorbonne Universités, UPMC Université Paris
06, UMR S 1127, CNRS UMR 7225, ICM, Paris, France
- French Reference Centre for Gilles de la Tourette
Syndrome, Groupe Hospitalier Pitié-Salpêtrière, Paris,
France
- Assistance Publique-Hôpitaux de Paris, Department
of Neurology, Groupe Hospitalier Pitié-Salpêtrière, Paris,
France
| | - Andreas Hartmann
- Sorbonne Universités, UPMC Université Paris
06, UMR S 1127, CNRS UMR 7225, ICM, Paris, France
- French Reference Centre for Gilles de la Tourette
Syndrome, Groupe Hospitalier Pitié-Salpêtrière, Paris,
France
- Assistance Publique-Hôpitaux de Paris, Department
of Neurology, Groupe Hospitalier Pitié-Salpêtrière, Paris,
France
| | - Cathy L. Budman
- Zucker School of Medicine at Hofstra/Northwell,
Hempstead, New York, USA
| | - Renata Rizzo
- Neuropsichiatria Infantile. Dipartimento di Medicina
Clinica e Sperimentale, Università di Catania, Catania, Italy
| | - Gholson J. Lyon
- Stanley Institute for Cognitive Genomics, Cold Spring
Harbor Laboratory, Cold Spring Harbor, New York, USA
| | | | | | - Danielle C. Cath
- Department of Psychiatry, University Medical Center
Groningen & Rijksuniversity Groningen, Groningen, the Netherlands
- Drenthe Mental Health Center, Groningen, the
Netherlands
| | - Irene A. Malaty
- Department of Neurology, Fixel Center for Neurological
Diseases, McKnight Brain Institute, University of Florida, Gainesville, Florida,
USA
| | - Michael S. Okun
- Department of Neurology, Fixel Center for Neurological
Diseases, McKnight Brain Institute, University of Florida, Gainesville, Florida,
USA
| | - Cheston Berlin
- Pennsylvania State University College of Medicine,
Hershey, Pennsylvania, USA
| | - Douglas W. Woods
- Marquette University, Milwaukee, Wisconsin, USA
- University of Wisconsin-Milwaukee, Milwaukee, Wisconsin,
USA
| | - Paul C. Lee
- Tripler Army Medical Center, University of Hawai’i
John A. Burns School of Medicine, Honolulu, Hawaii, USA
| | - Joseph Jankovic
- Parkinson’s Disease Center and Movement Disorders
Clinic, Department of Neurology, Baylor College of Medicine, Houston, Texas,
USA
| | - Mary M. Robertson
- Division of Psychiatry, Department of Neuropsychiatry,
University College London, London, UK
| | - Donald L. Gilbert
- Department of Pediatrics, Cincinnati Children’s
Hospital Medical Center, Cincinnati, Ohio, USA
| | - Lawrence W. Brown
- Children’s Hospital of Philadelphia, Philadelphia,
Pennsylvania, USA
| | - Barbara J. Coffey
- Department of Psychiatry and Behavioral Sciences,
University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Andrea Dietrich
- University of Groningen, University Medical Center
Groningen, Department of Child and Adolescent Psychiatry, Groningen, The
Netherlands
| | - Pieter J. Hoekstra
- University of Groningen, University Medical Center
Groningen, Department of Child and Adolescent Psychiatry, Groningen, The
Netherlands
| | - Samuel Kuperman
- University of Iowa Carver College of Medicine, Iowa City,
Iowa, USA
| | - Samuel H Zinner
- Department of Pediatrics, University of Washington,
Seattle, Washington, USA
| | - Pétur Luðvigsson
- Department of Pediatrics, Landspitalinn University
Hospital, Reykjavik, Iceland
| | - Evald Sæmundsen
- Faculty of Medicine, University of Iceland,
Reykjavík, Iceland
- The State Diagnostic and Counselling Centre,
Kópavogur, Iceland
| | - Ólafur Thorarensen
- Department of Pediatrics, Landspitalinn University
Hospital, Reykjavik, Iceland
| | - Gil Atzmon
- Department of Genetics, Albert Einstein College of
Medicine, Bronx, New York, USA
- Department of Medicine, Albert Einstein College of
Medicine, Bronx, New York, USA
- Department of Human Biology, Haifa University, Haifa,
Israel
| | - Nir Barzilai
- Department of Genetics, Albert Einstein College of
Medicine, Bronx, New York, USA
- Department of Medicine, Albert Einstein College of
Medicine, Bronx, New York, USA
| | - Michael Wagner
- Department of Psychiatry and Psychotherapy, University of
Bonn, Bonn, Germany
| | - Rainald Moessner
- Department of Psychiatry and Psychotherapy, University of
Tuebingen, Tuebingen, Germany
| | - Roel Ophoff
- Semel Institute for Neuroscience and Human Behavior, David
Geffen School of Medicine, University of California Los Angeles, Los Angeles,
California, USA
| | | | | | | | - Joshua L. Roffman
- Department of Psychiatry, Massachusetts General Hospital,
Boston, Massachusetts, USA
- Athinoula A. Martinos Center for Biomedical Research,
Department of Radiology, Massachusetts General Hospital, Charlestown, Massachusetts,
USA
| | - Jordan W. Smoller
- Psychiatric and Neurodevelopmental Genetics Unit, Center
for Genomic Medicine, Department of Psychiatry, Massachusetts General Hospital,
Boston, Massachusetts, USA
- Department of Epidemiology, Harvard T. H. Chan School of
Public Health, Boston, Massachusetts, USA
| | - Randy L. Buckner
- Department of Psychiatry, Massachusetts General Hospital,
Boston, Massachusetts, USA
- Athinoula A. Martinos Center for Biomedical Research,
Department of Radiology, Massachusetts General Hospital, Charlestown, Massachusetts,
USA
- Center for Brain Science, Harvard University, Cambridge,
Massachusetts, USA
- Department of Psychology, Harvard University, Cambridge,
Massachusetts, USA
| | - Jeremy A. Willsey
- Department of Psychiatry, UCSF Weill Institute for
Neurosciences, University of California, San Francisco, San Francisco, California,
USA
- Institute for Neurodegenerative Diseases, UCSF Weill
Institute for Neurosciences, University of California San Francisco, San Francisco,
California, USA
| | - Jay A. Tischfield
- Department of Genetics and the Human Genetics Institute
of New Jersey, Rutgers, the State University of New Jersey, Piscataway, New Jersey,
USA
| | - Gary A. Heiman
- Department of Genetics and the Human Genetics Institute
of New Jersey, Rutgers, the State University of New Jersey, Piscataway, New Jersey,
USA
| | | | - Kári Stefansson
- deCODE Genetics/Amgen, Reykjavik, Iceland
- Faculty of Medicine, University of Iceland,
Reykjavík, Iceland
| | - Danielle Posthuma
- Department of Complex Trait Genetics Center for
Neurogenomics and Cognitive Research, VU University Amsterdam, Amsterdam, the
Netherlands
| | - Nancy J. Cox
- Division of Genetic Medicine, Vanderbilt Genetics
Institute, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - David L. Pauls
- Psychiatric and Neurodevelopmental Genetics Unit, Center
for Genomic Medicine, Department of Psychiatry, Massachusetts General Hospital,
Boston, Massachusetts, USA
| | - Nelson B. Freimer
- Semel Institute for Neuroscience and Human Behavior, David
Geffen School of Medicine, University of California Los Angeles, Los Angeles,
California, USA
- Department of Psychiatry and Biobehavioral Sciences,
University of California, Los Angeles, California, USA
| | - Benjamin M. Neale
- Psychiatric and Neurodevelopmental Genetics Unit, Center
for Genomic Medicine, Department of Psychiatry, Massachusetts General Hospital,
Boston, Massachusetts, USA
- Stanley Center for Psychiatric Research, Broad Institute of
MIT and Harvard, Cambridge, Massachusetts, USA
- Analytic and Translational Genetics Unit, Department of
Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Lea K. Davis
- Division of Genetic Medicine, Vanderbilt Genetics
Institute, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Peristera Paschou
- Department of Biological Sciences, Purdue University, West
Lafayette, Indiana, USA
| | - Giovanni Coppola
- Semel Institute for Neuroscience and Human Behavior, David
Geffen School of Medicine, University of California Los Angeles, Los Angeles,
California, USA
- Department of Psychiatry and Biobehavioral Sciences,
University of California, Los Angeles, California, USA
| | - Carol A. Mathews
- Department of Psychiatry, Genetics Institute, University
of Florida, Gainesville, Florida, USA
| | - Jeremiah M. Scharf
- Psychiatric and Neurodevelopmental Genetics Unit, Center
for Genomic Medicine, Department of Psychiatry, Massachusetts General Hospital,
Boston, Massachusetts, USA
- Stanley Center for Psychiatric Research, Broad Institute of
MIT and Harvard, Cambridge, Massachusetts, USA
- Department of Neurology, Brigham and Women’s
Hospital, Boston, Massachusetts, USA
- Department of Neurology, Massachusetts General Hospital,
Boston, Massachusetts, USA
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Houghton DC, Alexander JR, Bauer CC, Woods DW. Body-focused repetitive behaviors: More prevalent than once thought? Psychiatry Res 2018; 270:389-393. [PMID: 30300869 DOI: 10.1016/j.psychres.2018.10.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 09/27/2018] [Accepted: 10/01/2018] [Indexed: 10/28/2022]
Abstract
Body-focused repetitive behaviors (BFRBs), such as hair pulling, skin picking, and nail biting are common habits, but their pathological manifestations have been considered rare. Growing evidence suggests pathological forms of these behaviors can be conceptualized as a class of related disorders. However, few previous studies have examined the collective prevalence of related pathological BFRBs. The current study examined the self-reported prevalence of current (past month) subclinical and pathological BFRBs in a large (n = 4335) sample of college students. The study also examined the chronicity and impact of these behaviors. Results showed that 59.55% of the sample reported occasionally engaging in subclinical BFRBs, and 12.27% met criteria for a pathological BFRB, suggesting these conditions may be quite common. Of the various BFRB topographies, cheek biting was the most common. Both subclinical and pathological BFRBs tended to be chronic (i.e., occurring for longer than 1 year). Although persons with pathological BFRBs were distressed about their behavior, few experienced functional impairment or sought help for the behavior. Implications of these findings for the conceptualization and treatment of body-focused repetitive behaviors are discussed.
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Affiliation(s)
- David C Houghton
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, TX, USA; Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President St., Charleston, SC 29425, USA.
| | - Jennifer R Alexander
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, TX, USA; Department of Psychology, Marquette University, Milwaukee, WI, USA
| | - Christopher C Bauer
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, TX, USA; Department of Psychology, Marquette University, Milwaukee, WI, USA
| | - Douglas W Woods
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, TX, USA; Department of Psychology, Marquette University, Milwaukee, WI, USA
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Ricketts EJ, Snorrason I, Kircanski K, Alexander JR, Thamrin H, Flessner CA, Franklin ME, Piacentini J, Woods DW. A latent profile analysis of age of onset in pathological skin picking. Compr Psychiatry 2018; 87:46-52. [PMID: 30199665 PMCID: PMC6261272 DOI: 10.1016/j.comppsych.2018.08.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 08/02/2018] [Accepted: 08/13/2018] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Pathological Skin Picking (PSP) may begin at any age, but the most common age of onset is during adolescence. Age of onset is a potentially useful clinical marker to delineate subtypes of psychiatric disorders. The present study sought to examine empirically defined age of onset groups in adults with PSP and assess whether groups differed on clinical characteristics. METHOD Participants were 701 adult respondents to an internet survey, who endorsed recurrent skin picking with tissue damage and impairment. Latent profile analysis (LPA) was conducted to identify subtypes of PSP based on age of onset. Then subgroups were compared on demographic and clinical characteristics. RESULTS The best fitting LPA model was a two-class solution comprised of a large group with average age of onset in adolescence (n = 650; 92.9% of the sample; Mean age of onset = 13.6 years) and a small group with average onset in middle adulthood (n = 50; 7.1% of the sample; Mean age of onset = 42.8 years). Relative to the early onset group, the late onset group reported significantly less focused picking, less skin picking-related impairment, lower rates of co-occurring body-focused repetitive behaviors, and trends towards reduced family history of PSP. Individuals in the late onset group also reported increased rates of comorbid depression, anxiety and posttraumatic stress disorder, and were more likely to report that initial picking onset seemed related to or followed depression/anxiety and physical illness. CONCLUSION Findings suggest the presence of two distinct PSP age of onset groups: (1) an early onset group with average onset in adolescence, clinical characteristics suggestive of greater picking-related burden and familiality, and a profile more representative of the general PSP population; and (2) a late onset group with average onset in middle adulthood, increased co-occurring affective and trauma conditions, and initial onset associated with or following other mental health and physical problems. Future replication is needed to assess the validity and clinical utility of these subgroups.
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Affiliation(s)
- Emily J. Ricketts
- Division of Child and Adolescent Psychiatry, University of California, Los Angeles, Los Angeles, CA
| | - Ivar Snorrason
- Division of Clinical Therapeutics, New York State Psychiatric Institute, New York, NY,Department of Psychiatry, Columbia University Medical Center, New York, NY
| | - Katharina Kircanski
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD
| | | | - Hardian Thamrin
- Division of Child and Adolescent Psychiatry, University of California, Los Angeles, Los Angeles, CA
| | | | - Martin E. Franklin
- Children’s Hospital of Philadelphia, University of Pennsylvania,,Department of Child and Adolescent Psychiatry and Behavioral Sciences, Philadelphia, PA
| | - John Piacentini
- Division of Child and Adolescent Psychiatry, University of California, Los Angeles, Los Angeles, CA
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Stiede JT, Alexander JR, Wellen B, Bauer CC, Himle MB, Mouton-Odum S, Woods DW. Differentiating tic-related from non-tic-related impairment in children with persistent tic disorders. Compr Psychiatry 2018; 87:38-45. [PMID: 30195099 PMCID: PMC6240497 DOI: 10.1016/j.comppsych.2018.07.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 07/23/2018] [Accepted: 07/24/2018] [Indexed: 11/20/2022] Open
Abstract
Children with persistent (chronic) tic disorders (PTDs) experience impairment across multiple domains of functioning, but given high rates of other non-tic-related conditions, it is often difficult to differentiate the extent to which such impairment is related to tics or to other problems. The current study used the Child Tourette's Syndrome Impairment Scale - Parent Report (CTIM-P) to examine parents' attributions of their child's impairment in home, school, and social domains in a sample of 58 children with PTD. Each domain was rated on the extent to which the parents perceived that impairment was related to tics versus non-tic-related concerns. In addition, the Yale Global Tic Severity Scale (YGTSS) was used to explore the relationship between tic-related impairment and tic severity. Results showed impairment in school and social activities was not differentially attributed to tics versus non-tic-related impairment, but impairment in home activities was attributed more to non-tic-related concerns than tics themselves. Moreover, tic severity was significantly correlated with tic-related impairment in home, school, and social activities, and when the dimensions of tic severity were explored, impairment correlated most strongly with motor tic complexity. Results suggest that differentiating tic-related from non-tic-related impairment may be clinically beneficial and could lead to treatments that more effectively target problems experienced by children with PTDs.
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Affiliation(s)
- Jordan T Stiede
- Marquette University, 604 N. 16th St., Milwaukee, WI 53233, United States of America
| | - Jennifer R Alexander
- Marquette University, 604 N. 16th St., Milwaukee, WI 53233, United States of America
| | - Brianna Wellen
- University of Utah, 201 Presidents Cir., Salt Lake City, UT 84112, United States of America
| | - Christopher C Bauer
- Marquette University, 604 N. 16th St., Milwaukee, WI 53233, United States of America
| | - Michael B Himle
- University of Utah, 201 Presidents Cir., Salt Lake City, UT 84112, United States of America
| | - Suzanne Mouton-Odum
- Psychology Houston, PC, 7660 Woodway, Suite 599, Houston, TX 77063, United States of America
| | - Douglas W Woods
- Marquette University, 604 N. 16th St., Milwaukee, WI 53233, United States of America.
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Ong CW, Pierce BG, Woods DW, Twohig MP, Levin ME. The Acceptance and Action Questionnaire – II: an Item Response Theory Analysis. J Psychopathol Behav Assess 2018. [DOI: 10.1007/s10862-018-9694-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Weingarden H, Scahill L, Hoeppner S, Peterson AL, Woods DW, Walkup JT, Piacentini J, Wilhelm S. Self-esteem in adults with Tourette syndrome and chronic tic disorders: The roles of tic severity, treatment, and comorbidity. Compr Psychiatry 2018; 84:95-100. [PMID: 29729555 PMCID: PMC6002935 DOI: 10.1016/j.comppsych.2018.04.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 03/27/2018] [Accepted: 04/20/2018] [Indexed: 10/17/2022] Open
Abstract
BACKGROUND Tourette syndrome (TS) and chronic tic disorders (CTD) are stigmatizing disorders that may significantly impact self-esteem. Alternatively, comorbid psychiatric illnesses may affect self-esteem more than tics themselves. Extant research on self-esteem in TS/CTD is limited, has inconsistently examined the effect of comorbidities on self-esteem, and yields mixed findings. METHOD This study aimed to clarify the roles of tics versus comorbid diagnoses on self-esteem in a large, carefully diagnosed sample of adults with TS/CTD (N = 122) receiving 10 weeks of Comprehensive Behavioral Intervention for Tics (CBIT) or Psychoeducation and Supportive Therapy (PST). RESULTS Baseline self-esteem did not differ between adults with TS/CTD only and normative means, whereas self-esteem was significantly lower among adults with TS/CTD with a comorbid psychiatric illness. In a multiple regression testing the baseline association between tic severity, presence of comorbid psychiatric illness, and depression severity with self-esteem, comorbidity and depression severity were significantly associated with self-esteem, whereas tic severity was not. Finally, using a generalized linear model, we tested the effects of treatment assignment, comorbidity, and their interaction on changes in self-esteem across treatment, controlling for baseline depression severity. Results showed that for those with a comorbid illness, self-esteem improved significantly more with CBIT than with PST. CONCLUSIONS Comorbid illnesses appear to affect self-esteem more so than tics among adults with TS/CTD. Therapeutic attention should be paid to treating comorbid diagnoses alongside tics when treating TS/CTD.
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Affiliation(s)
- Hilary Weingarden
- Department of Psychiatry, Massachusetts General Hospital & Harvard Medical School, 185 Cambridge Street, Suite 2000, Boston, MA 02114, USA.
| | - Lawrence Scahill
- Department of Pediatrics, Emory University School of Medicine, Marcus Autism Center, 1920 Briarcliff Road, Atlanta, GA 30329, USA.
| | - Susanne Hoeppner
- Department of Psychiatry, Massachusetts General Hospital & Harvard Medical School, 185 Cambridge Street, Suite 2000, Boston, MA 02114, USA.
| | - Alan L Peterson
- Department of Psychiatry, The University of Texas Health Science Center at San Antonio, 7550 IH-10 West, Suite 1325, San Antonio, TX 78229, USA; Research and Development Service, South Texas Veterans Health Care System, 7400 Merton Minter Blvd., San Antonio, TX 78229, USA.
| | - Douglas W Woods
- Department of Psychology, Cramer Hall 317, Marquette University, Milwaukee, WI 53233, USA.
| | - John T Walkup
- Department of Psychiatry, Anne and Robert H. Lurie Children's Hospital, 225 E. Chicago Ave., Chicago, IL 60611, USA; Department of Psychiatry, Northwestern University Feinberg School of Medicine, 420 E Superior St, Chicago, IL 60611, USA.
| | - John Piacentini
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angles, 760 Westwood Plaza, Los Angeles, CA 90095-1759, USA.
| | - Sabine Wilhelm
- Department of Psychiatry, Massachusetts General Hospital & Harvard Medical School, 185 Cambridge Street, Suite 2000, Boston, MA 02114, USA.
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McGuire JF, Piacentini J, Storch EA, Murphy TK, Ricketts EJ, Woods DW, Walkup JW, Peterson AL, Wilhelm S, Lewin AB, McCracken JT, Leckman JF, Scahill L. A multicenter examination and strategic revisions of the Yale Global Tic Severity Scale. Neurology 2018; 90:e1711-e1719. [PMID: 29653992 DOI: 10.1212/wnl.0000000000005474] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 02/16/2018] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To examine the internal consistency and distribution of the Yale Global Tic Severity Scale (YGTSS) scores to inform modification of the measure. METHODS This cross-sectional study included 617 participants with a tic disorder (516 children and 101 adults), who completed an age-appropriate diagnostic interview and the YGTSS to evaluate tic symptom severity. The distributions of scores on YGTSS dimensions were evaluated for normality and skewness. For dimensions that were skewed across motor and phonic tics, a modified Delphi consensus process was used to revise selected anchor points. RESULTS Children and adults had similar clinical characteristics, including tic symptom severity. All participants were examined together. Strong internal consistency was identified for the YGTSS Motor Tic score (α = 0.80), YGTSS Phonic Tic score (α = 0.87), and YGTSS Total Tic score (α = 0.82). The YGTSS Total Tic and Impairment scores exhibited relatively normal distributions. Several subscales and individual item scales departed from a normal distribution. Higher scores were more often used on the Motor Tic Number, Frequency, and Intensity dimensions and the Phonic Tic Frequency dimension. By contrast, lower scores were more often used on Motor Tic Complexity and Interference, and Phonic Tic Number, Intensity, Complexity, and Interference. CONCLUSIONS The YGTSS exhibits good internal consistency across children and adults. The parallel findings across Motor and Phonic Frequency, Complexity, and Interference dimensions prompted minor revisions to the anchor point description to promote use of the full range of scores in each dimension. Specific minor revisions to the YGTSS Phonic Tic Symptom Checklist were also proposed.
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Affiliation(s)
- Joseph F McGuire
- From the Department of Psychiatry and Behavioral Sciences (J.F.M.), Johns Hopkins University School of Medicine, Baltimore, MD; Semel Institute of Neuroscience and Human Behavior (J.F.M., J.P., E.R., J.T.M.), University of California Los Angeles; Baylor College of Medicine (E.A.S.), Houston, TX; Departments of Pediatrics, Psychiatry and Behavioral Neuroscience (T.K.M., A.B.L.), University of South Florida, Tampa; All Children's Hospital (T.K.M.), Johns Hopkins Medicine, Baltimore, MD; Marquette University (D.W.W.), Milwaukee, WI; Weill Cornell Medical College (J.W.W.), Cornell University, New York, NY; Department of Psychiatry (A.L.P.), University of Texas Health Science Center at San Antonio; South Texas Veterans Health Care System (A.L.P.), San Antonio; Massachusetts General Hospital and Harvard Medical School (S.W.), Boston; Yale Child Study Center (J.F.L.), New Haven, CT; and Marcus Autism Center (L.S.), Emory University School of Medicine, Atlanta, GA.
| | - John Piacentini
- From the Department of Psychiatry and Behavioral Sciences (J.F.M.), Johns Hopkins University School of Medicine, Baltimore, MD; Semel Institute of Neuroscience and Human Behavior (J.F.M., J.P., E.R., J.T.M.), University of California Los Angeles; Baylor College of Medicine (E.A.S.), Houston, TX; Departments of Pediatrics, Psychiatry and Behavioral Neuroscience (T.K.M., A.B.L.), University of South Florida, Tampa; All Children's Hospital (T.K.M.), Johns Hopkins Medicine, Baltimore, MD; Marquette University (D.W.W.), Milwaukee, WI; Weill Cornell Medical College (J.W.W.), Cornell University, New York, NY; Department of Psychiatry (A.L.P.), University of Texas Health Science Center at San Antonio; South Texas Veterans Health Care System (A.L.P.), San Antonio; Massachusetts General Hospital and Harvard Medical School (S.W.), Boston; Yale Child Study Center (J.F.L.), New Haven, CT; and Marcus Autism Center (L.S.), Emory University School of Medicine, Atlanta, GA
| | - Eric A Storch
- From the Department of Psychiatry and Behavioral Sciences (J.F.M.), Johns Hopkins University School of Medicine, Baltimore, MD; Semel Institute of Neuroscience and Human Behavior (J.F.M., J.P., E.R., J.T.M.), University of California Los Angeles; Baylor College of Medicine (E.A.S.), Houston, TX; Departments of Pediatrics, Psychiatry and Behavioral Neuroscience (T.K.M., A.B.L.), University of South Florida, Tampa; All Children's Hospital (T.K.M.), Johns Hopkins Medicine, Baltimore, MD; Marquette University (D.W.W.), Milwaukee, WI; Weill Cornell Medical College (J.W.W.), Cornell University, New York, NY; Department of Psychiatry (A.L.P.), University of Texas Health Science Center at San Antonio; South Texas Veterans Health Care System (A.L.P.), San Antonio; Massachusetts General Hospital and Harvard Medical School (S.W.), Boston; Yale Child Study Center (J.F.L.), New Haven, CT; and Marcus Autism Center (L.S.), Emory University School of Medicine, Atlanta, GA
| | - Tanya K Murphy
- From the Department of Psychiatry and Behavioral Sciences (J.F.M.), Johns Hopkins University School of Medicine, Baltimore, MD; Semel Institute of Neuroscience and Human Behavior (J.F.M., J.P., E.R., J.T.M.), University of California Los Angeles; Baylor College of Medicine (E.A.S.), Houston, TX; Departments of Pediatrics, Psychiatry and Behavioral Neuroscience (T.K.M., A.B.L.), University of South Florida, Tampa; All Children's Hospital (T.K.M.), Johns Hopkins Medicine, Baltimore, MD; Marquette University (D.W.W.), Milwaukee, WI; Weill Cornell Medical College (J.W.W.), Cornell University, New York, NY; Department of Psychiatry (A.L.P.), University of Texas Health Science Center at San Antonio; South Texas Veterans Health Care System (A.L.P.), San Antonio; Massachusetts General Hospital and Harvard Medical School (S.W.), Boston; Yale Child Study Center (J.F.L.), New Haven, CT; and Marcus Autism Center (L.S.), Emory University School of Medicine, Atlanta, GA
| | - Emily J Ricketts
- From the Department of Psychiatry and Behavioral Sciences (J.F.M.), Johns Hopkins University School of Medicine, Baltimore, MD; Semel Institute of Neuroscience and Human Behavior (J.F.M., J.P., E.R., J.T.M.), University of California Los Angeles; Baylor College of Medicine (E.A.S.), Houston, TX; Departments of Pediatrics, Psychiatry and Behavioral Neuroscience (T.K.M., A.B.L.), University of South Florida, Tampa; All Children's Hospital (T.K.M.), Johns Hopkins Medicine, Baltimore, MD; Marquette University (D.W.W.), Milwaukee, WI; Weill Cornell Medical College (J.W.W.), Cornell University, New York, NY; Department of Psychiatry (A.L.P.), University of Texas Health Science Center at San Antonio; South Texas Veterans Health Care System (A.L.P.), San Antonio; Massachusetts General Hospital and Harvard Medical School (S.W.), Boston; Yale Child Study Center (J.F.L.), New Haven, CT; and Marcus Autism Center (L.S.), Emory University School of Medicine, Atlanta, GA
| | - Douglas W Woods
- From the Department of Psychiatry and Behavioral Sciences (J.F.M.), Johns Hopkins University School of Medicine, Baltimore, MD; Semel Institute of Neuroscience and Human Behavior (J.F.M., J.P., E.R., J.T.M.), University of California Los Angeles; Baylor College of Medicine (E.A.S.), Houston, TX; Departments of Pediatrics, Psychiatry and Behavioral Neuroscience (T.K.M., A.B.L.), University of South Florida, Tampa; All Children's Hospital (T.K.M.), Johns Hopkins Medicine, Baltimore, MD; Marquette University (D.W.W.), Milwaukee, WI; Weill Cornell Medical College (J.W.W.), Cornell University, New York, NY; Department of Psychiatry (A.L.P.), University of Texas Health Science Center at San Antonio; South Texas Veterans Health Care System (A.L.P.), San Antonio; Massachusetts General Hospital and Harvard Medical School (S.W.), Boston; Yale Child Study Center (J.F.L.), New Haven, CT; and Marcus Autism Center (L.S.), Emory University School of Medicine, Atlanta, GA
| | - John W Walkup
- From the Department of Psychiatry and Behavioral Sciences (J.F.M.), Johns Hopkins University School of Medicine, Baltimore, MD; Semel Institute of Neuroscience and Human Behavior (J.F.M., J.P., E.R., J.T.M.), University of California Los Angeles; Baylor College of Medicine (E.A.S.), Houston, TX; Departments of Pediatrics, Psychiatry and Behavioral Neuroscience (T.K.M., A.B.L.), University of South Florida, Tampa; All Children's Hospital (T.K.M.), Johns Hopkins Medicine, Baltimore, MD; Marquette University (D.W.W.), Milwaukee, WI; Weill Cornell Medical College (J.W.W.), Cornell University, New York, NY; Department of Psychiatry (A.L.P.), University of Texas Health Science Center at San Antonio; South Texas Veterans Health Care System (A.L.P.), San Antonio; Massachusetts General Hospital and Harvard Medical School (S.W.), Boston; Yale Child Study Center (J.F.L.), New Haven, CT; and Marcus Autism Center (L.S.), Emory University School of Medicine, Atlanta, GA
| | - Alan L Peterson
- From the Department of Psychiatry and Behavioral Sciences (J.F.M.), Johns Hopkins University School of Medicine, Baltimore, MD; Semel Institute of Neuroscience and Human Behavior (J.F.M., J.P., E.R., J.T.M.), University of California Los Angeles; Baylor College of Medicine (E.A.S.), Houston, TX; Departments of Pediatrics, Psychiatry and Behavioral Neuroscience (T.K.M., A.B.L.), University of South Florida, Tampa; All Children's Hospital (T.K.M.), Johns Hopkins Medicine, Baltimore, MD; Marquette University (D.W.W.), Milwaukee, WI; Weill Cornell Medical College (J.W.W.), Cornell University, New York, NY; Department of Psychiatry (A.L.P.), University of Texas Health Science Center at San Antonio; South Texas Veterans Health Care System (A.L.P.), San Antonio; Massachusetts General Hospital and Harvard Medical School (S.W.), Boston; Yale Child Study Center (J.F.L.), New Haven, CT; and Marcus Autism Center (L.S.), Emory University School of Medicine, Atlanta, GA
| | - Sabine Wilhelm
- From the Department of Psychiatry and Behavioral Sciences (J.F.M.), Johns Hopkins University School of Medicine, Baltimore, MD; Semel Institute of Neuroscience and Human Behavior (J.F.M., J.P., E.R., J.T.M.), University of California Los Angeles; Baylor College of Medicine (E.A.S.), Houston, TX; Departments of Pediatrics, Psychiatry and Behavioral Neuroscience (T.K.M., A.B.L.), University of South Florida, Tampa; All Children's Hospital (T.K.M.), Johns Hopkins Medicine, Baltimore, MD; Marquette University (D.W.W.), Milwaukee, WI; Weill Cornell Medical College (J.W.W.), Cornell University, New York, NY; Department of Psychiatry (A.L.P.), University of Texas Health Science Center at San Antonio; South Texas Veterans Health Care System (A.L.P.), San Antonio; Massachusetts General Hospital and Harvard Medical School (S.W.), Boston; Yale Child Study Center (J.F.L.), New Haven, CT; and Marcus Autism Center (L.S.), Emory University School of Medicine, Atlanta, GA
| | - Adam B Lewin
- From the Department of Psychiatry and Behavioral Sciences (J.F.M.), Johns Hopkins University School of Medicine, Baltimore, MD; Semel Institute of Neuroscience and Human Behavior (J.F.M., J.P., E.R., J.T.M.), University of California Los Angeles; Baylor College of Medicine (E.A.S.), Houston, TX; Departments of Pediatrics, Psychiatry and Behavioral Neuroscience (T.K.M., A.B.L.), University of South Florida, Tampa; All Children's Hospital (T.K.M.), Johns Hopkins Medicine, Baltimore, MD; Marquette University (D.W.W.), Milwaukee, WI; Weill Cornell Medical College (J.W.W.), Cornell University, New York, NY; Department of Psychiatry (A.L.P.), University of Texas Health Science Center at San Antonio; South Texas Veterans Health Care System (A.L.P.), San Antonio; Massachusetts General Hospital and Harvard Medical School (S.W.), Boston; Yale Child Study Center (J.F.L.), New Haven, CT; and Marcus Autism Center (L.S.), Emory University School of Medicine, Atlanta, GA
| | - James T McCracken
- From the Department of Psychiatry and Behavioral Sciences (J.F.M.), Johns Hopkins University School of Medicine, Baltimore, MD; Semel Institute of Neuroscience and Human Behavior (J.F.M., J.P., E.R., J.T.M.), University of California Los Angeles; Baylor College of Medicine (E.A.S.), Houston, TX; Departments of Pediatrics, Psychiatry and Behavioral Neuroscience (T.K.M., A.B.L.), University of South Florida, Tampa; All Children's Hospital (T.K.M.), Johns Hopkins Medicine, Baltimore, MD; Marquette University (D.W.W.), Milwaukee, WI; Weill Cornell Medical College (J.W.W.), Cornell University, New York, NY; Department of Psychiatry (A.L.P.), University of Texas Health Science Center at San Antonio; South Texas Veterans Health Care System (A.L.P.), San Antonio; Massachusetts General Hospital and Harvard Medical School (S.W.), Boston; Yale Child Study Center (J.F.L.), New Haven, CT; and Marcus Autism Center (L.S.), Emory University School of Medicine, Atlanta, GA
| | - James F Leckman
- From the Department of Psychiatry and Behavioral Sciences (J.F.M.), Johns Hopkins University School of Medicine, Baltimore, MD; Semel Institute of Neuroscience and Human Behavior (J.F.M., J.P., E.R., J.T.M.), University of California Los Angeles; Baylor College of Medicine (E.A.S.), Houston, TX; Departments of Pediatrics, Psychiatry and Behavioral Neuroscience (T.K.M., A.B.L.), University of South Florida, Tampa; All Children's Hospital (T.K.M.), Johns Hopkins Medicine, Baltimore, MD; Marquette University (D.W.W.), Milwaukee, WI; Weill Cornell Medical College (J.W.W.), Cornell University, New York, NY; Department of Psychiatry (A.L.P.), University of Texas Health Science Center at San Antonio; South Texas Veterans Health Care System (A.L.P.), San Antonio; Massachusetts General Hospital and Harvard Medical School (S.W.), Boston; Yale Child Study Center (J.F.L.), New Haven, CT; and Marcus Autism Center (L.S.), Emory University School of Medicine, Atlanta, GA
| | - Lawrence Scahill
- From the Department of Psychiatry and Behavioral Sciences (J.F.M.), Johns Hopkins University School of Medicine, Baltimore, MD; Semel Institute of Neuroscience and Human Behavior (J.F.M., J.P., E.R., J.T.M.), University of California Los Angeles; Baylor College of Medicine (E.A.S.), Houston, TX; Departments of Pediatrics, Psychiatry and Behavioral Neuroscience (T.K.M., A.B.L.), University of South Florida, Tampa; All Children's Hospital (T.K.M.), Johns Hopkins Medicine, Baltimore, MD; Marquette University (D.W.W.), Milwaukee, WI; Weill Cornell Medical College (J.W.W.), Cornell University, New York, NY; Department of Psychiatry (A.L.P.), University of Texas Health Science Center at San Antonio; South Texas Veterans Health Care System (A.L.P.), San Antonio; Massachusetts General Hospital and Harvard Medical School (S.W.), Boston; Yale Child Study Center (J.F.L.), New Haven, CT; and Marcus Autism Center (L.S.), Emory University School of Medicine, Atlanta, GA
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Houghton DC, Alexander JR, Bauer CC, Woods DW. Abnormal perceptual sensitivity in body-focused repetitive behaviors. Compr Psychiatry 2018; 82:45-52. [PMID: 29407358 DOI: 10.1016/j.comppsych.2017.12.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 12/19/2017] [Accepted: 12/20/2017] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE Several compulsive grooming habits such as hair pulling, skin picking, and nail biting are collectively known as body-focused repetitive behaviors (BFRBs). Although subclinical BFRBs are common and benign, more severe and damaging manifestations exist that are difficult to manage. Researchers have suggested that BFRBs are maintained by various cognitive, affective, and sensory contingencies. Although the involvement of cognitive and affective processes in BFRBs has been studied, there is a paucity of research on sensory processes. METHODS The current study tested whether adults with subclinical or clinical BFRBs would report abnormal patterns of sensory processing as compared to a healthy control sample. RESULTS Adults with clinical BFRBs (n = 26) reported increased sensory sensitivity as compared to persons with subclinical BFRBs (n = 48) and healthy individuals (n = 33). Elevations in sensation avoidance differentiated persons with clinical versus subclinical BFRBs. Sensation seeking patterns were not different between groups. Unexpectedly, BFRB severity was associated with lower registration of sensory stimuli, but this finding may be due to high psychiatric comorbidity rates in the BFRB groups. CONCLUSIONS These findings suggest that several sensory abnormalities may underlie BFRBs. Implications for the etiology and treatment of BFRBs are discussed.
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Affiliation(s)
- David C Houghton
- Department of Psychology, Texas A&M University, 4235 TAMU, College Station, TX 77843-4235, United States.
| | - Jennifer R Alexander
- Department of Psychology, Texas A&M University, 4235 TAMU, College Station, TX 77843-4235, United States; Department of Psychology, Marquette University, P.O. Box 1881, Milwaukee, WI 53201-0327, United States.
| | - Christopher C Bauer
- Department of Psychology, Texas A&M University, 4235 TAMU, College Station, TX 77843-4235, United States; Department of Psychology, Marquette University, P.O. Box 1881, Milwaukee, WI 53201-0327, United States.
| | - Douglas W Woods
- Department of Psychology, Texas A&M University, 4235 TAMU, College Station, TX 77843-4235, United States; Department of Psychology, Marquette University, P.O. Box 1881, Milwaukee, WI 53201-0327, United States.
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Lee HJ, Espil FM, Bauer CC, Siwiec SG, Woods DW. Computerized response inhibition training for children with trichotillomania. Psychiatry Res 2018; 262:20-27. [PMID: 29407564 DOI: 10.1016/j.psychres.2017.12.070] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 09/29/2017] [Accepted: 12/30/2017] [Indexed: 12/14/2022]
Abstract
Evidence suggests that trichotillomania is characterized by impairment in response inhibition, which is the ability to suppress pre-potent/dominant but inappropriate responses. This study sought to test the feasibility of computerized response inhibition training for children with trichotillomania. Twenty-two children were randomized to the 8-session response inhibition training (RIT; n = 12) or a waitlisted control (WLT; n = 10). Primary outcomes were assessed by an independent evaluator, using the Clinical Global Impression-Improvement (CGI-I), and the NIMH Trichotillomania Severity (NIMH-TSS) and Impairment scales (NIMH-TIS) at pre, post-training/waiting, and 1-month follow-up. Relative to the WLT group, the RIT group showed a higher response rate (55% vs. 11%) on the CGI-I and a lower level of impairment on the NIMH-TIS, at post-training. Overall symptom reductions rates on the NIMH-TSS were 34% (RIT) vs. 21% (WLT) at post-training. The RIT's therapeutic gains were maintained at 1-month follow-up, as indicated by the CGI-I responder status (= 66%), and a continuing reduction in symptom on the NIMH-TSS. This pattern of findings was also replicated by the 6 waitlisted children who received the same RIT intervention after post-waiting assessment. Results suggest that computerized RIT may be a potentially useful intervention for trichotillomania.
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Affiliation(s)
- Han-Joo Lee
- Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, WI, USA.
| | - Flint M Espil
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | | | - Stephan G Siwiec
- Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Douglas W Woods
- Department of Psychology, Marquette University, Milwaukee, WI, USA
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Chang SW, McGuire JF, Walkup JT, Woods DW, Scahill L, Wilhelm S, Peterson AL, Dziura J, Piacentini J. Neurocognitive correlates of treatment response in children with Tourette's Disorder. Psychiatry Res 2018; 261:464-472. [PMID: 29407718 PMCID: PMC5809184 DOI: 10.1016/j.psychres.2017.12.066] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 12/15/2017] [Accepted: 12/30/2017] [Indexed: 01/24/2023]
Abstract
This paper examined neurocognitive functioning and its relationship to behavior treatment response among youth with Tourette's Disorder (TD) in a large randomized controlled trial. Participants diagnosed with TD completed a brief neurocognitive battery assessing inhibitory functions, working memory, and habit learning pre- and post-treatment with behavior therapy (CBIT, Comprehensive Behavioral Intervention for Tics) or psychoeducation plus supportive therapy (PST). At baseline, youth with tics and Attention Deficit Hyperactivity Disorder (ADHD) exhibited some evidence of impaired working memory and simple motor inhibition relative to youth with tics without ADHD. Additionally, a small negative association was found between antipsychotic medications and youth's performance speed. Across treatment groups, greater baseline working memory and aspects of inhibitory functioning were associated with a positive treatment response; no between-group differences in neurocognitive functioning at post-treatment were identified. Within the behavior therapy group, pre-treatment neurocognitive status did not predict outcome, nor was behavior therapy associated significant change in neurocognitive functioning post-treatment. Findings suggest that co-occurring ADHD is associated with some impairments in neurocognitive functioning in youth with Tourette's Disorder. While neurocognitive predictors of behavior therapy were not found, participants who received behavior therapy exhibited significantly reduced tic severity without diminished cognitive functioning.
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Affiliation(s)
- Susanna W. Chang
- Department of Psychiatry, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA,Corresponding author: Susanna Chang, Ph.D.; UCLA Semel Institute, 760 Westwood Plaza, rm 67-463, Los Angeles, CA 90024; ; telephone: 310.206.1040; fax: 310.267.4925
| | - Joseph F. McGuire
- Department of Psychiatry, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA,Division of Child and Adolescent Psychiatry, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - John T. Walkup
- Department of Psychiatry, Weill Cornell Medical College, Cornell University, Ithaca, New York, USA
| | - Douglas W. Woods
- Department of Psychology, Marquette University, Milwaukee, WI, USA
| | - Lawrence Scahill
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Sabine Wilhelm
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Cambridge, MA, USA
| | - Alan L. Peterson
- Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | | | - John Piacentini
- Department of Psychiatry, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA
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