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Vogel AC, Black KJ. Brain Imaging in Routine Psychiatric Practice. Mo Med 2024; 121:37-43. [PMID: 38404436 PMCID: PMC10887461] [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] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
Technologies in the 21st century provide increasingly detailed and accurate maps of brain structure and function. So why don't psychiatrists order brain imaging on all our patients? Here we briefly review major neuroimaging methods and some of their findings in psychiatry. As clinicians and neuroimaging researchers, we are eager to bring brain imaging into daily clinical practice. However, to be clinically useful, any test in medicine must demonstrate adequate test statistics, and show proven benefits that outweigh its risks and costs. In 2024, beyond certain limited circumstances, we have no imaging tests that can meet those standards to provide diagnosis or guide treatment. This cold fact explains why for most psychiatric patients, neuroimaging is not currently recommended by professional organizations or the National Institute of Mental Health.
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Affiliation(s)
- Alecia C Vogel
- Assistant Professor of Psychiatry (Child), Washington University School of Medicine in St. Louis, Missouri
| | - Kevin J Black
- Professor of Psychiatry, Neurology, Radiology, and Neuroscience at Washington University School of Medicine in St. Louis, Missouri
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2
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Hartmann A, Andrén P, Atkinson-Clément C, Czernecki V, Delorme C, Monique Debes NM, Müller-Vahl K, Paschou P, Szejko N, Topaloudi A, Ueda K, Black KJ. Tourette syndrome research highlights from 2022. F1000Res 2023; 12:826. [PMID: 37691732 PMCID: PMC10483181 DOI: 10.12688/f1000research.135702.1] [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] [Accepted: 10/18/2023] [Indexed: 09/12/2023] Open
Abstract
This is the ninth yearly article in the Tourette Syndrome Research Highlights series, summarizing selected research reports from 2022 relevant to Tourette syndrome. The authors briefly summarize reports they consider most important or interesting.
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Affiliation(s)
- Andreas Hartmann
- Department of Neurology, Pitié-Salpêtrière Hospital, Assistance Publique - Hopitaux de Paris, Paris, Île-de-France, 75013, France
| | - Per Andrén
- Department of Psychology, University of Lund, Lund, Sweden, Sweden
| | | | - Virginie Czernecki
- Department of Neurology, Pitié-Salpêtrière Hospital, Assistance Publique - Hopitaux de Paris, Paris, Île-de-France, 75013, France
| | - Cécile Delorme
- Department of Neurology, Pitié-Salpêtrière Hospital, Assistance Publique - Hopitaux de Paris, Paris, Île-de-France, 75013, France
| | | | | | | | - Natalia Szejko
- Department of Neurology, University of Calgary, Calgary, Alberta, Canada
| | | | - Keisuke Ueda
- Department of Psychiatry, Washington University School of Medicine, Saint Louis, Missouri, 63110-1010, USA
| | - Kevin J. Black
- Department of Psychiatry, Washington University School of Medicine, Saint Louis, Missouri, 63110-1010, USA
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3
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Mataix-Cols D, Isomura K, Brander G, Brikell I, Lichtenstein P, Chang Z, Larsson H, Kuja-Halkola R, Black KJ, Sidorchuk A, Fernández de la Cruz L. Early-Life and Family Risk Factors for Tic Disorder Persistence into Adulthood. Mov Disord 2023; 38:1419-1427. [PMID: 37246931 DOI: 10.1002/mds.29454] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 04/18/2023] [Accepted: 05/01/2023] [Indexed: 05/30/2023] Open
Abstract
BACKGROUND Many children with tic disorders outgrow their tics, but little is known about the proportion of individuals who will continue to require specialist services in adulthood and which variables are associated with tic persistence. OBJECTIVES The aims were to estimate the proportion of individuals first diagnosed with tic disorders in childhood who continued to receive tic disorder diagnoses after age 18 years and to identify risk factors for persistence. METHODS In this Swedish nationwide cohort study including 3761 individuals diagnosed with tic disorders in childhood, we calculated the proportion of individuals whose diagnoses persisted into adulthood. Minimally adjusted logistic regression models examined the associations between sociodemographic, clinical, and family variables and tic disorder persistence. A multivariable model was then fitted, including only variables that were statistically significant in the minimally adjusted models. RESULTS Seven hundred and fifty-four (20%) children with tic disorders received a diagnosis of a chronic tic disorder in adulthood. Psychiatric comorbidity in childhood (particularly attention-deficit hyperactivity disorder, obsessive-compulsive disorder, pervasive developmental disorders, and anxiety disorders) and psychiatric disorders in first-degree relatives (particularly tic and anxiety disorders) were the strongest risk factors for persistence. We did not observe statistically significant associations with socioeconomic variables, perinatal complications, comorbid autoimmune diseases, or family history of autoimmune diseases. All statistically significant variables combined explained approximately 10% of the variance in tic disorder persistence (P < 0.0001). CONCLUSIONS Childhood psychiatric comorbidities and family history of psychiatric disorders were the strongest risk factors associated with tic disorder persistence into adulthood. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- David Mataix-Cols
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Kayoko Isomura
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Gustaf Brander
- Science for Life Laboratory, Department of Medical Biochemistry and Microbiology, Uppsala University, Uppsala, Sweden
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
| | - Isabell Brikell
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Zheng Chang
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Ralf Kuja-Halkola
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Kevin J Black
- Departments of Psychiatry, Neurology, Radiology, and Neuroscience, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Anna Sidorchuk
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Lorena Fernández de la Cruz
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
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Arbuckle AL, Bihun EC, Schlaggar BL, Black KJ. Functional tic-like presentations differ strikingly from Provisional Tic Disorder. F1000Res 2023; 11:1566. [PMID: 37224324 PMCID: PMC10186060 DOI: 10.12688/f1000research.129252.2] [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] [Accepted: 04/11/2023] [Indexed: 05/26/2023] Open
Abstract
Background: Recent years have seen a dramatic increase in new "tic" cases in teens and young adults. These individuals often present with fulminant onset of symptoms not commonly seen in Tourette syndrome (TS) and are often diagnosed with Functional Neurological Symptom Disorder (FND-tic). However, some authors have questioned whether this illness truly differs from typical Provisional Tic Disorder (PTD) and TS. Previous studies have compared FND-tic, usually a few months after symptom onset, to patients with TS, usually years after symptom onset. We sought to test whether the presenting symptoms of FND-tic differ substantially from those in patients at a similar duration of symptoms who are later diagnosed with TS. Methods: This comparative study examines clinical features summarized from published reports of FND-tic with novel data from a longitudinal study of PTD. This study came from a referral center for TS and tic disorders and included 89 children with tics whose first tic occurred a median of 3.6 months earlier, nearly all of whom were diagnosed with a chronic tic disorder at follow-up. Specifically, we examine clinical features identified in a recent literature review as supporting a diagnosis of FND-tic, including symptom characteristics, course, severity and comorbidity. Results: Several clinical features dramatically distinguish the patients diagnosed with FND-tic from those diagnosed with typical PTD. For example, coprophenomena are reported at or shortly after symptom onset in over half of FND-tic patients, whereas even several months after onset, coprophenomena had occurred in only 1 of 89 children with PTD. Six clinical features each have a positive predictive value over 90% for FND-tic diagnosis if prior probability is 50%. Conclusions: These new data provide strong evidence supporting the diagnostic validity of FND-tic as distinct from TS.
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Affiliation(s)
- Amanda L. Arbuckle
- Department of Psychiatry, Washington University in St. Louis, School of Medicine, St. Louis, Missouri, 63110, USA
| | - Emily C. Bihun
- Department of Psychiatry, Washington University in St. Louis, School of Medicine, St. Louis, Missouri, 63110, USA
| | - Bradley L. Schlaggar
- Department of Pediatrics, Johns Hopkins Medicine, Baltimore, MD, 21287, USA
- Department of Neurology, Johns Hopkins Medicine, Baltimore, Maryland, 21287, USA
- Kennedy Krieger Institute, Baltimore, Maryland, 21205, USA
| | - Kevin J. Black
- Department of Psychiatry, Washington University in St. Louis, School of Medicine, St. Louis, Missouri, 63110, USA
- Department of Neurology, Washington University in St. Louis, School of Medicine, St. Louis, Missouri, 63110, USA
- Department of Neuroscience, Washington University in St. Louis, School of Medicine, St. Louis, Missouri, 63110, USA
- Department of Radiology, Washington University in St. Louis, School of Medicine, St. Louis, Missouri, 63110, USA
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Iverson AM, Arbuckle AL, Song DY, Bihun EC, Black KJ. Median Nerve Stimulation for Treatment of Tics: A 4-Week Open Trial with Ecological Momentary Assessment. J Clin Med 2023; 12:jcm12072545. [PMID: 37048629 PMCID: PMC10095435 DOI: 10.3390/jcm12072545] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 03/21/2023] [Accepted: 03/25/2023] [Indexed: 03/30/2023] Open
Abstract
Median nerve stimulation (MNS) at 10–12 Hz was recently proposed as a treatment for Tourette syndrome and other chronic tic disorders (TS/CTD). We report on 31 participants ages 15–64 with TS/CTD in an open-label, comparative (within-group, several time points) study of MNS (ClinicalTrials.gov registration number NCT05016765). Participants were recruited from completers of a randomized controlled trial (RCT) of MNS and were given a transcutaneous electrical nerve stimulation (TENS) unit to use as desired for 12 Hz MNS for 4 weeks. Participants were instructed to complete surveys regarding tic symptoms and stimulation discomfort before and after stimulation, as well as twice daily when randomly prompted by text message. Participants also completed an extensive final survey. Twenty-seven participants completed the study. Median device use was 1.5 days per week and 50 min per day used. Tic frequency improved during MNS (mean improvement: 1.0 on a 0–5 scale, p < 0.001), as did tic intensity (mean improvement: 0.9, p < 0.001). Mean discomfort was mild (1.2 on a 3-point scale). In total, 21 participants (78%) planned to continue using the device. Participants’ results in this study did not correlate significantly with their results in the blinded RCT. We found MNS to improve tic frequency and intensity with minimal side effects.
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Affiliation(s)
- Ann M. Iverson
- Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO 63110, USA
| | - Amanda L. Arbuckle
- Department of Psychiatry, Washington University in St. Louis, St. Louis, MO 63110, USA
| | - David Y. Song
- University of Rochester School of Medicine and Dentistry, Rochester, NY 14642, USA
| | - Emily C. Bihun
- Department of Psychiatry, Washington University in St. Louis, St. Louis, MO 63110, USA
| | - Kevin J. Black
- Departments of Psychiatry, Neurology, Radiology and Neuroscience, Washington University in St. Louis, St. Louis, MO 63110, USA
- Correspondence:
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Iverson AM, Arbuckle AL, Ueda K, Song DY, Bihun EC, Koller JM, Wallendorf M, Black KJ. Median Nerve Stimulation for Treatment of Tics: Randomized, Controlled, Crossover Trial. J Clin Med 2023; 12:2514. [PMID: 37048598 PMCID: PMC10095326 DOI: 10.3390/jcm12072514] [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: 02/22/2023] [Revised: 03/09/2023] [Accepted: 03/13/2023] [Indexed: 03/29/2023] Open
Abstract
A prior study showed that rhythmic, but not arrhythmic, 12 Hz stimulation of the median nerve (MNS) entrained the sensorimotor cortex EEG signal and found that 10 Hz MNS improved tics in Tourette syndrome (TS). However, no control condition was tested, and stimulation blocks lasted only 1 min. We set out to replicate the TS results and to test whether tic improvement occurs by the proposed cortical entrainment mechanism. Preregistration was completed at ClinicalTrials.gov, under number NCT04731714. Thirty-two people with TS, age 15-64, completed two study visits with repeated MNS on and off blocks in random order, one visit for rhythmic and one for arrhythmic MNS. Subjects and staff were blind to order; a video rater was additionally blind to stimulation and to the order of visits and blocks. Rhythmic MNS at 10 Hz improved tics. Both rhythmic and arrhythmic 12 Hz MNS improved tic frequency, intensity, and urges, but the two treatments did not differ significantly. Participant masking was effective, and there was no carryover effect. Several participants described a dramatic benefit. Discomfort was minimal. There was no evidence that the MNS benefit persisted after stimulation ended. These results replicate the tic benefit from MNS but show that the EEG entrainment hypothesis cannot explain that benefit. Another electrophysiological mechanism may explain the benefit; alternatively, these data do not exclude a placebo effect.
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Affiliation(s)
- Ann M. Iverson
- Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO 63110, USA
| | - Amanda L. Arbuckle
- Department of Psychiatry, Washington University in St. Louis, St. Louis, MO 63110, USA
| | - Keisuke Ueda
- Department of Neurology, Washington University in St. Louis, St. Louis, MO 63110, USA
| | - David Y. Song
- University of Rochester School of Medicine and Dentistry, Rochester, NY 14642, USA
| | - Emily C. Bihun
- Department of Psychiatry, Washington University in St. Louis, St. Louis, MO 63110, USA
| | - Jonathan M. Koller
- Department of Psychiatry, Washington University in St. Louis, St. Louis, MO 63110, USA
| | - Michael Wallendorf
- Division of Biostatistics, Institute for Informatics, Washington University in St. Louis, St. Louis, MO 63110, USA
| | - Kevin J. Black
- Departments of Psychiatry, Neurology, Radiology, and Neuroscience, Washington University in St. Louis, St. Louis, MO 63110, USA
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7
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Iverson AM, Arbuckle AL, Ueda K, Song DY, Bihun EC, Koller JM, Wallendorf M, Black KJ. Peripheral nerve induction of inhibitory brain circuits to treat Tourette syndrome: A randomized crossover trial. medRxiv 2023:2023.02.01.23285304. [PMID: 36778375 PMCID: PMC9915823 DOI: 10.1101/2023.02.01.23285304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
A prior study showed that rhythmic, but not arrhythmic, 12 Hz stimulation of the median nerve (MNS) entrained sensorimotor cortex EEG signal, and found that 10 Hz MNS improved tics in Tourette syndrome (TS). However, no control condition was tested and stimulation blocks lasted only 1 minute. We set out to replicate the TS results and to test whether tic improvement occurs by the proposed cortical entrainment mechanism. Thirty-two people with TS, age 15-64, completed two study visits with repeated MNS on and off blocks in random order, one visit for rhythmic and one for arrhythmic MNS. Subjects and staff were blind to order; a video rater was additionally blind to stimulation and to order of visits and blocks. Rhythmic MNS at 10 Hz improved tics. Both rhythmic and arrhythmic 12 Hz MNS improved tic frequency, intensity and urges without significant difference. Participant masking was effective and there was no carryover effect. Several participants described dramatic benefit. Discomfort was minimal. MNS benefit did not persist after the end of stimulation. These results replicate the tic benefit from MNS, but show that the EEG entrainment hypothesis cannot explain that benefit. Another electrophysiological mechanism may explain benefit; alternatively, these data do not exclude a placebo effect. Registration ClinicalTrials.gov , NCT04731714 .
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8
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Ludlow AK, Anderson S, Hedderly T, Black KJ, Conelea CA. Editorial: Recent advances in understanding Tourette syndrome, tic disorders and functional tics. Front Psychiatry 2023; 14:1185489. [PMID: 37065882 PMCID: PMC10098342 DOI: 10.3389/fpsyt.2023.1185489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 03/20/2023] [Indexed: 04/18/2023] Open
Affiliation(s)
- Amanda K. Ludlow
- Department of Psychology and Sports Sciences, University of Hertfordshire, Hatfield, United Kingdom
- *Correspondence: Amanda K. Ludlow
| | | | - Tammy Hedderly
- Tic and Neurodevelopmental Movements Service (TANDeM), Guy's King's and Saint Thomas' School of Medicine, London, United Kingdom
| | - Kevin J. Black
- Departments of Psychiatry, Neurology, Radiology and Neuroscience, Washington University in St. Louis, St. Louis, MO, United States
| | - Christine A. Conelea
- Department of Psychiatry and Behavioral Sciences, Masonic Institute for the Developing Brain, University of Minnesota, Minneapolis, MN, United States
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Frey J, Black KJ, Malaty IA. TikTok Tourette's: Are We Witnessing a Rise in Functional Tic-Like Behavior Driven by Adolescent Social Media Use? Psychol Res Behav Manag 2022; 15:3575-3585. [PMID: 36505669 PMCID: PMC9733629 DOI: 10.2147/prbm.s359977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 11/19/2022] [Indexed: 12/12/2022] Open
Abstract
Perceptions of Tourette syndrome (TS) and tic disorders are often driven by social media. During the COVID-19 pandemic, social media consumption greatly increased, particularly in the adolescent population. In parallel with increased social media consumption, there has also been an increase in tic severity and functional tic-like behavior (FTLB). Given that many of the tic videos posted on social media are misleading, perpetuate false beliefs about TS, or reinforce tic-like behaviors, there is increasing concern that these videos are driving the rapid increase in FTLBs. Several studies have reviewed newly presenting cases of FTLB and have found shared characteristics, including that a higher proportion of affected individuals are female, there is a low proportion with a history of childhood or family tics, and symptom onset is typically acute and develops in the teenage years. In addition, the quality of the tics seen in association with FTLB mirrors many of the tics seen on popular social media channels, with higher rates of coprophenomena, tic attacks, and involvement of the trunk and extremities than is seen with typical tics. FTLBs are likely a specific subgroup of functional tics largely influenced by the portrayal of and growing popularity of functional tics posted on social media during the COVID-19 pandemic. However, several factors, including increased anxiety, social isolation, and social media use in general during the pandemic are likely also contributing factors to the surge of FTLBs seen recently. In this era of increased social media consumption, it will become increasingly important for clinicians to educate patients about where and how medical information is spread, to ensure the best possible diagnosis, treatment, and outcomes for patients.
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Affiliation(s)
- Jessica Frey
- Department of Neurology, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, USA,Correspondence: Jessica Frey, Department of Neurology, Rockefeller Neuroscience Institute, West Virginia University, 1 Medical Center Drive, Morgantown, WV, 26505, USA, Tel +1 304-298-6127, Fax +1 304 598 6442, Email
| | - Kevin J Black
- Departments of Psychiatry, Neurology, Radiology, and Neuroscience, Washington University in St. Louis, St. Louis, MO, USA
| | - Irene A Malaty
- Department of Neurology, Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
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10
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Malaty IA, Anderson S, Bennett SM, Budman CL, Coffey BJ, Coffman KA, Greenberg E, McGuire JF, Müller-Vahl KR, Okun MS, Quezada J, Robichaux-Viehoever A, Black KJ. Diagnosis and Management of Functional Tic-Like Phenomena. J Clin Med 2022; 11:6470. [PMID: 36362696 PMCID: PMC9656241 DOI: 10.3390/jcm11216470] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [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: 09/09/2022] [Revised: 10/25/2022] [Accepted: 10/26/2022] [Indexed: 08/31/2023] Open
Abstract
Over the past 3 years, a global phenomenon has emerged characterized by the sudden onset and frequently rapid escalation of tics and tic-like movements and phonations. These symptoms have occurred not only in youth known to have tics or Tourette syndrome (TS), but also, and more notably, in youth with no prior history of tics. The Tourette Association of America (TAA) convened an international, multidisciplinary working group to better understand this apparent presentation of functional neurological disorder (FND) and its relationship to TS. Here, we review and summarize the literature relevant to distinguish the two, with recommendations to clinicians for diagnosis and management. Finally, we highlight areas for future emphasis and research.
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Affiliation(s)
- Irene A. Malaty
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida College of Medicine, Gainesville, FL 32608, USA
| | | | - Shannon M. Bennett
- Department of Psychiatry, Weill Cornell Medicine/NewYork-Presbyterian, New York, NY 10065, USA
| | - Cathy L. Budman
- Department of Psychiatry, Northwell Health, Zucker School of Medicine, Hofstra/Northwell, Uniondale, NY 11549, USA
| | - Barbara J. Coffey
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Keith A. Coffman
- Children’s Mercy Hospital, University of Missouri-Kansas City School of Medicine, Kansas City, MO 64108, USA
| | - Erica Greenberg
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02129, USA
| | - Joseph F. McGuire
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Kirsten R. Müller-Vahl
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School (MHH), 30625 Hannover, Germany
| | - Michael S. Okun
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida College of Medicine, Gainesville, FL 32608, USA
| | - Julio Quezada
- Children’s Mercy Hospital, University of Missouri-Kansas City School of Medicine, Kansas City, MO 64108, USA
| | | | - Kevin J. Black
- Departments of Psychiatry, Neurology, Radiology and Neuroscience, Washington University in St. Louis, 660 S. Euclid Ave., St. Louis, MO 63110, USA
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11
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Beeler P, Jensen NO, Kim S, Robichaux-Viehoever A, Schlaggar BL, Greene DJ, Black KJ, Chakrabarty RK. Fractality of tics as a quantitative assessment tool for Tourette syndrome. J R Soc Interface 2022; 19:20210742. [PMID: 35193387 PMCID: PMC8864347 DOI: 10.1098/rsif.2021.0742] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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] [Indexed: 11/25/2022] Open
Abstract
Tics manifest as brief, purposeless and unintentional movements or noises that, for many individuals, can be suppressed temporarily with effort. Previous work has hypothesized that the chaotic temporal nature of tics could possess an inherent fractality, that is, have neighbour-to-neighbour correlation at all levels of timescale. However, demonstrating this phenomenon has eluded researchers for more than two decades, primarily because of the challenges associated with estimating the scale-invariant, power law exponent—called the fractal dimension Df—from fractional Brownian noise. Here, we confirm this hypothesis and establish the fractality of tics by examining two tic time series datasets collected 6–12 months apart in children with tics, using random walk models and directional statistics. We find that Df is correlated with tic severity as measured by the YGTTS total tic score, and that Df is a sensitive parameter in examining the effect of several tic suppression conditions on the tic time series. Our findings pave the way for using the fractal nature of tics as a robust quantitative tool for estimating tic severity and treatment effectiveness, as well as a possible marker for differentiating typical from functional tics.
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Affiliation(s)
- Payton Beeler
- Center for Aerosol Science and Engineering, Department of Energy, Environmental and Chemical Engineering, Washington University in St Louis, St Louis, MO 63110, USA
| | - Nicholas O Jensen
- Computational and Systems Biology Program, Division of Biology and Biomedical Sciences, Washington University in St Louis, St Louis, MO 63110, USA
| | - Soyoung Kim
- Department of Psychiatry, Washington University School of Medicine, St Louis, MO 63130, USA
| | | | - Bradley L Schlaggar
- Kennedy Krieger Institute, Baltimore, MD 21205, USA.,Departments of Neurology and Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Deanna J Greene
- Department of Cognitive Science, University of California San Diego, La Jolla, CA 92093, USA
| | - Kevin J Black
- Department of Psychiatry, Washington University School of Medicine, St Louis, MO 63130, USA.,Department of Neurology, Washington University School of Medicine, St Louis, MO 63130, USA.,Department of Radiology, Washington University School of Medicine, St Louis, MO 63130, USA.,Department of Neuroscience, Washington University School of Medicine, St Louis, MO 63130, USA
| | - Rajan K Chakrabarty
- Center for Aerosol Science and Engineering, Department of Energy, Environmental and Chemical Engineering, Washington University in St Louis, St Louis, MO 63110, USA.,Institute for Public Health, Washington University in St Louis, St Louis, MO 63110, USA
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12
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Paschou P, Jin Y, Müller-Vahl K, Möller HE, Rizzo R, Hoekstra PJ, Roessner V, Mol Debes N, Worbe Y, Hartmann A, Mir P, Cath D, Neuner I, Eichele H, Zhang C, Lewandowska K, Munchau A, Verrel J, Musil R, Silk TJ, Hanlon CA, Bihun ED, Brandt V, Dietrich A, Forde N, Ganos C, Greene DJ, Chu C, Grothe MJ, Hershey T, Janik P, Koller JM, Martin-Rodriguez JF, Müller K, Palmucci S, Prato A, Ramkiran S, Saia F, Szejko N, Torrecuso R, Tumer Z, Uhlmann A, Veselinovic T, Wolańczyk T, Zouki JJ, Jain P, Topaloudi A, Kaka M, Yang Z, Drineas P, Thomopoulos SI, White T, Veltman DJ, Schmaal L, Stein DJ, Buitelaar J, Franke B, van den Heuvel O, Jahanshad N, Thompson PM, Black KJ. Enhancing neuroimaging genetics through meta-analysis for Tourette syndrome (ENIGMA-TS): A worldwide platform for collaboration. Front Psychiatry 2022; 13:958688. [PMID: 36072455 PMCID: PMC9443935 DOI: 10.3389/fpsyt.2022.958688] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 07/18/2022] [Indexed: 11/13/2022] Open
Abstract
Tourette syndrome (TS) is characterized by multiple motor and vocal tics, and high-comorbidity rates with other neuropsychiatric disorders. Obsessive compulsive disorder (OCD), attention deficit hyperactivity disorder (ADHD), autism spectrum disorders (ASDs), major depressive disorder (MDD), and anxiety disorders (AXDs) are among the most prevalent TS comorbidities. To date, studies on TS brain structure and function have been limited in size with efforts mostly fragmented. This leads to low-statistical power, discordant results due to differences in approaches, and hinders the ability to stratify patients according to clinical parameters and investigate comorbidity patterns. Here, we present the scientific premise, perspectives, and key goals that have motivated the establishment of the Enhancing Neuroimaging Genetics through Meta-Analysis for TS (ENIGMA-TS) working group. The ENIGMA-TS working group is an international collaborative effort bringing together a large network of investigators who aim to understand brain structure and function in TS and dissect the underlying neurobiology that leads to observed comorbidity patterns and clinical heterogeneity. Previously collected TS neuroimaging data will be analyzed jointly and integrated with TS genomic data, as well as equivalently large and already existing studies of highly comorbid OCD, ADHD, ASD, MDD, and AXD. Our work highlights the power of collaborative efforts and transdiagnostic approaches, and points to the existence of different TS subtypes. ENIGMA-TS will offer large-scale, high-powered studies that will lead to important insights toward understanding brain structure and function and genetic effects in TS and related disorders, and the identification of biomarkers that could help inform improved clinical practice.
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Affiliation(s)
- Peristera Paschou
- Department of Biological Sciences, Purdue University, West Lafayette, IN, United States
| | - Yin Jin
- Department of Biological Sciences, Purdue University, West Lafayette, IN, United States
| | - Kirsten Müller-Vahl
- Department of Psychiatry, Hannover University Medical School, Hannover, Germany
| | - Harald E Möller
- Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Renata Rizzo
- Radiology Unit 1, Department of Medical Surgical Sciences and Advanced Technologies, University of Catania, Catania, Italy
| | - Pieter J Hoekstra
- University Medical Center Groningen, Department of Psychiatry, University of Groningen, Groningen, Netherlands
| | - Veit Roessner
- Department of Child and Adolescent Psychiatry, Technische Universität (TU) Dresden, Dresden, Germany
| | - Nanette Mol Debes
- Department of Pediatrics, Herlev University Hospital, Herlev, Denmark
| | - Yulia Worbe
- Department of Neurophysiology, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
| | | | - Pablo Mir
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/CSIC/University of Seville, Seville, Spain.,Centro de Investigación Biomédica en Red Sobre Enfermedades Neurodegenerativas (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain
| | - Danielle Cath
- University Medical Center Groningen, Department of Psychiatry, University of Groningen, Groningen, Netherlands
| | - Irene Neuner
- Department of Psychiatry, Psychotherapy and Psychosomatic, RWTH Aachen University, Aachen, Germany.,Institute of Neuroscience and Medicine 4, Forschungszentrum Jülich GmbH, Jülich, Germany.,JARA BRAIN-Translational Medicine, Aachen, Germany
| | - Heike Eichele
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
| | - Chencheng Zhang
- Shanghai Research Center for Brain Science and Brain-Inspired Intelligence, Shanghai, China
| | | | - Alexander Munchau
- Institute of Systems Motor Science, University of Lübeck, Lübeck, Germany
| | - Julius Verrel
- Institute of Systems Motor Science, University of Lübeck, Lübeck, Germany
| | - Richard Musil
- Department of Psychiatry and Psychotherapy, Ludwig Maximilians University of Munich, Munich, Germany
| | - Tim J Silk
- Deakin University, Geelong, VIC, Australia
| | - Colleen A Hanlon
- Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Emily D Bihun
- Department of Psychiatry, Washington University in St. Louis, St. Louis, MO, United States
| | - Valerie Brandt
- Centre for Innovation in Mental Health, School of Psychology, University of Southampton, Southampton, United Kingdom
| | - Andrea Dietrich
- University Medical Center Groningen, Department of Psychiatry, University of Groningen, Groningen, Netherlands
| | - Natalie Forde
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, Netherlands
| | - Christos Ganos
- Department of Neurology, Charité-University Medicine Berlin, Berlin, Germany
| | - Deanna J Greene
- Department of Cognitive Science, University of California, San Diego, La Jolla, CA, United States
| | - Chunguang Chu
- Shanghai Research Center for Brain Science and Brain-Inspired Intelligence, Shanghai, China
| | - Michel J Grothe
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/CSIC/University of Seville, Seville, Spain.,Centro de Investigación Biomédica en Red Sobre Enfermedades Neurodegenerativas (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain
| | - Tamara Hershey
- Department of Psychiatry, Washington University in St. Louis, St. Louis, MO, United States
| | - Piotr Janik
- Department of Neurology, Medical University of Warsaw, Warsaw, Poland
| | - Jonathan M Koller
- Department of Psychiatry, Washington University in St. Louis, St. Louis, MO, United States
| | - Juan Francisco Martin-Rodriguez
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/CSIC/University of Seville, Seville, Spain.,Centro de Investigación Biomédica en Red Sobre Enfermedades Neurodegenerativas (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain
| | - Karsten Müller
- Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Stefano Palmucci
- Radiology Unit 1, Department of Medical Surgical Sciences and Advanced Technologies, University of Catania, Catania, Italy
| | - Adriana Prato
- Child and Adolescent Neurology and Psychiatric Section, Department of Clinical and Experimental Medicine, Catania University, Catania, Italy
| | - Shukti Ramkiran
- Department of Psychiatry, Psychotherapy and Psychosomatic, RWTH Aachen University, Aachen, Germany.,Institute of Neuroscience and Medicine 4, Forschungszentrum Jülich GmbH, Jülich, Germany.,JARA BRAIN-Translational Medicine, Aachen, Germany
| | - Federica Saia
- Child Neuropsychiatry Unit, Department of Clinical and Experimental Medicine, School of Medicine, University of Catania, Catania, Italy
| | - Natalia Szejko
- Department of Neurology, Medical University of Warsaw, Warsaw, Poland
| | - Renzo Torrecuso
- Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Zeynep Tumer
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Department of Clinical Genetics, Kennedy Center, Copenhagen University Hospital Rigshospitalet, Glostrup, Denmark
| | - Anne Uhlmann
- Department of Child and Adolescent Psychiatry, Technische Universität (TU) Dresden, Dresden, Germany
| | - Tanja Veselinovic
- Department of Psychiatry, Psychotherapy and Psychosomatic, RWTH Aachen University, Aachen, Germany
| | - Tomasz Wolańczyk
- Department of Child Psychiatry, Medical University of Warsaw, Warsaw, Poland
| | | | - Pritesh Jain
- Department of Biological Sciences, Purdue University, West Lafayette, IN, United States
| | - Apostolia Topaloudi
- Department of Biological Sciences, Purdue University, West Lafayette, IN, United States
| | - Mary Kaka
- Department of Biological Sciences, Purdue University, West Lafayette, IN, United States
| | - Zhiyu Yang
- Department of Biological Sciences, Purdue University, West Lafayette, IN, United States
| | - Petros Drineas
- Department of Computer Science, Purdue University, West Lafayette, IN, United States
| | - Sophia I Thomopoulos
- Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Tonya White
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Dick J Veltman
- Department of Psychiatry, Amsterdam Neuroscience, Amsterdam UMC, Amsterdam, Netherlands
| | - Lianne Schmaal
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Dan J Stein
- South African Medical Research Council (SAMRC) Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry and Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Jan Buitelaar
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, Netherlands
| | - Barbara Franke
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, Netherlands
| | - Odile van den Heuvel
- Department Psychiatry, Department Anatomy and Neuroscience, Amsterdam University Medical Center (UMC), Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam, Netherlands
| | - Neda Jahanshad
- Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Paul M Thompson
- Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Kevin J Black
- Department of Psychiatry, Washington University in St. Louis, St. Louis, MO, United States
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13
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Lee HH, Blumberger DM, Lenze EJ, Anderson SJ, Barch DM, Black KJ, Cristancho P, Daskalakis ZJ, Eisenstein SA, Huang Y, Li S, Lissemore J, McConathy J, Mulsant BH, Rajji TK, Reynolds CF, Su Y, Tu Z, Voineskos D, Karp JF. Low-Dose Augmentation With Buprenorphine for Treatment-Resistant Depression: A Multisite Randomized Controlled Trial With Multimodal Assessment of Target Engagement. Biol Psychiatry Glob Open Sci 2021; 2:127-135. [PMID: 36325158 PMCID: PMC9616305 DOI: 10.1016/j.bpsgos.2021.09.003] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 09/14/2021] [Accepted: 09/15/2021] [Indexed: 01/31/2023] Open
Abstract
Background The experimental therapeutics approach that combines a placebo-controlled clinical trial with translational neuroscience methods can provide a better understanding of both the clinical and physiological effects of pharmacotherapy. We aimed to test the efficacy and tolerability of low-dose augmentation with buprenorphine (BPN) for treatment-resistant depression, combined with multimodal assessment of target engagement. Methods In this multisite randomized clinical trial, 85 participants ≥50 years of age with a major depressive episode that had not responded to venlafaxine extended release were randomized to augmentation with BPN or placebo for 8 weeks. The primary outcome measure was the Montgomery-Åsberg Depression Rating Scale. In addition, three linked experiments were conducted to test target engagement: 1) functional magnetic resonance imaging using the monetary incentive delay task, 2) brain positron emission tomography of healthy participants using a novel kappa opioid receptor antagonist tracer [11C]LY2795050, and 3) transcranial magnetic stimulation measure of cortical transmission after daily BPN administration. Results The mean ± SD dosage of BPN was 0.59 ± 0.33 mg/day. There were no significant differences between the BPN and placebo groups in Montgomery-Åsberg Depression Rating Scale changes over time or adverse effects. BPN administration had minimal effects on functional magnetic resonance imaging blood oxygen level-dependent responses in regions involved in reward anticipation and response, no significant displacement of kappa opioid receptor radioligand in positron emission tomography imaging, and no significant changes in transcranial magnetic stimulation measures of inhibitory and excitatory cortical transmission. Conclusions Our findings suggest a lack of clinical effect of low-dose BPN augmentation and lack of target engagement with this dosage and physiological probes.
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Affiliation(s)
- Hyewon H. Lee
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada,Address correspondence to Hyewon H. Lee, M.D.
| | - Daniel M. Blumberger
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada,Temerty Centre for Therapeutic Brain Intervention and Campbell Family Research Institute at the Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Eric J. Lenze
- Department of Psychiatry, Washington University in St. Louis, St. Louis, Missouri
| | - Stewart J. Anderson
- Department of Biostatistics, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Deanna M. Barch
- Departments of Psychological & Brain Sciences, Psychiatry, and Radiology, Washington University in St. Louis, St. Louis, Missouri
| | - Kevin J. Black
- Departments of Psychiatry, Neurology, Radiology, and Neuroscience, Washington University in St. Louis, St. Louis, Missouri
| | - Pilar Cristancho
- Department of Psychiatry, Washington University in St. Louis, St. Louis, Missouri
| | - Zafiris J. Daskalakis
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada,Temerty Centre for Therapeutic Brain Intervention and Campbell Family Research Institute at the Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Sarah A. Eisenstein
- Department of Psychiatry, Washington University in St. Louis, St. Louis, Missouri
| | - Yiyun Huang
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Connecticut
| | - Songye Li
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Connecticut
| | - Jennifer Lissemore
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada,Temerty Centre for Therapeutic Brain Intervention and Campbell Family Research Institute at the Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Jonathan McConathy
- Molecular Imaging and Therapeutics, Department of Radiology, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Benoit H. Mulsant
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada,Temerty Centre for Therapeutic Brain Intervention and Campbell Family Research Institute at the Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Tarek K. Rajji
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada,Temerty Centre for Therapeutic Brain Intervention and Campbell Family Research Institute at the Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Charles F. Reynolds
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Yi Su
- Banner Alzheimer’s Institute and Arizona Alzheimer’s Consortium, Phoenix, Arizona
| | - Zhude Tu
- Department of Radiology, Washington University in St. Louis, St. Louis, Missouri
| | - Daphne Voineskos
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada,Temerty Centre for Therapeutic Brain Intervention and Campbell Family Research Institute at the Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Jordan F. Karp
- Department of Psychiatry, University of Arizona College of Medicine, Tucson, Arizona
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14
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Abstract
Tic disorders and Tourette syndrome are the most common movement disorders in children and are characterized by movements or vocalizations. Clinically, Tourette syndrome is frequently associated with comorbid psychiatric symptoms. Although dysfunction of cortical–striatal–thalamic–cortical circuits with aberrant neurotransmitter function has been considered the proximate cause of tics, the mechanism underlying this association is unclear. Recently, many studies have been conducted to elucidate the epidemiology, clinical course, comorbid symptoms, and pathophysiology of tic disorders by using laboratory studies, neuroimaging, electrophysiological testing, environmental exposure, and genetic testing. In addition, many researchers have focused on treatment for tics, including behavioral therapy, pharmacological treatment, and surgical treatment. Here, we provide an overview of recent progress on Tourette syndrome.
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Affiliation(s)
- Keisuke Ueda
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Kevin J Black
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
- Department of Psychiatry, Washington University School of Medicine, St Louis, MO, USA
- Department of Radiology, Washington University School of Medicine, St Louis, MO, USA
- Department of Neuroscience, Washington University School of Medicine, St Louis, MO, USA
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15
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Abstract
OBJECTIVE Recent introduction of a commercial electronic medical record (EMR) system at the authors' institution raised a number of questions about documenting visits for presymptomatic testing for Huntington's disease (HD). Specifically, adoption of the EMR potentially compromised patient confidentiality and the personal delivery of test results, both of which are strongly recommended by professional consensus and lay organizations. METHODS The authors surveyed peer institutions about their experience with EMR systems in the setting of presymptomatic testing for HD. RESULTS Answers from 10 well-known HD specialty centers demonstrated a wide variety of approaches to managing these concerns. The responses did not clarify how to resolve the collision between the virtues of a shared medical record and the goal of patient control of sensitive medical information. CONCLUSIONS These results demonstrate that important issues remain unresolved. The authors propose that medical record systems must adapt to and respect the patient's desires for confidentiality and allow people undergoing presymptomatic testing to restrict access to this sensitive information.
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Affiliation(s)
- Kevin J Black
- Departments of Psychiatry (Black), Neurology (Black, Barton, Perlmutter), Radiology (Black, Perlmutter), and Neuroscience (Black, Perlmutter), and Programs in Physical Therapy and Occupational Therapy (Perlmutter), Washington University School of Medicine, St. Louis
| | - Stacey K Barton
- Departments of Psychiatry (Black), Neurology (Black, Barton, Perlmutter), Radiology (Black, Perlmutter), and Neuroscience (Black, Perlmutter), and Programs in Physical Therapy and Occupational Therapy (Perlmutter), Washington University School of Medicine, St. Louis
| | - Joel S Perlmutter
- Departments of Psychiatry (Black), Neurology (Black, Barton, Perlmutter), Radiology (Black, Perlmutter), and Neuroscience (Black, Perlmutter), and Programs in Physical Therapy and Occupational Therapy (Perlmutter), Washington University School of Medicine, St. Louis
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16
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Abstract
Tics are characterized by sudden, rapid, recurrent, nonrhythmic movement or vocalization, and are the most common movement disorders in children. Their onset is usually in childhood and tics often will diminish within one year. However, some of the tics can persist and cause various problems such as social embarrassment, physical discomfort, or emotional impairments, which could interfere with daily activities and school performance. Furthermore, tic disorders are frequently associated with comorbid neuropsychiatric symptoms, which can become more problematic than tic symptoms. Unfortunately, misunderstanding and misconceptions of tic disorders still exist among the general population. Understanding tic disorders and their comorbidities is important to deliver appropriate care to patients with tics. Several studies have been conducted to elucidate the clinical course, epidemiology, and pathophysiology of tics, but they are still not well understood. This article aims to provide an overview about tics and tic disorders, and recent findings on tic disorders including history, definition, diagnosis, epidemiology, etiology, diagnostic approach, comorbidities, treatment and management, and differential diagnosis.
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Affiliation(s)
- Keisuke Ueda
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110, USA;
| | - Kevin J. Black
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110, USA;
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110, USA
- Department of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA
- Department of Neuroscience, Washington University School of Medicine, St. Louis, MO 63110, USA
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17
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Abstract
PURPOSE OF REVIEW To summarize and update information on the course of tic disorders from childhood through later life. RECENT FINDINGS Tics tend to improve substantially over the first year after they appear. However, contrary to widespread opinion, tics usually last longer than one year, though usually at minimal severity. Tics often wane to clinical insignificance over the teen years, possibly resurging occasionally over the lifespan. However, in an important minority of patients, tics remain clinically relevant throughout life. Tics rarely first come to clinical attention later in adulthood, but new reports describe additional such cases. SUMMARY Recent publications have shown tics to persist past a few months more often than previously thought, though often at minimal severity, and recurrence after an asymptomatic period is common. The safety and efficacy of behavior therapy for tics, together with prospective indicators of early prognosis, make feasible the possibility of bettering the lifetime course of tic disorders with early intervention.
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Affiliation(s)
- Kevin J. Black
- Department of Psychiatry, Washington University in St. Louis School of Medicine, St. Louis, Missouri, 63110
- Department of Neurology, Washington University in St. Louis School of Medicine, St. Louis, Missouri, 63110
- Department of Radiology Washington University in St. Louis School of Medicine, St. Louis, Missouri, 63110
- Department of Neurosdence Washington University in St. Louis School of Medicine, St. Louis, Missouri, 63110
| | - Soyoung Kim
- Department of Psychiatry, Washington University in St. Louis School of Medicine, St. Louis, Missouri, 63110
| | - Nancy Y. Yang
- Department of Psychiatry, Washington University in St. Louis School of Medicine, St. Louis, Missouri, 63110
| | - Deanna J. Greene
- Department of Cognitive Science, University of California, San Diego, La Jolla, California, 92093
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18
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Abstract
Purpose of review Tic disorders are common in the pediatric population and are differentiated from other movement disorders by tic suppressibility. Understanding the mechanism of tic suppression may provide new insights to the pathophysiology of tic disorders. This article highlights clinical phenomenology and neuronal correlates of tic suppressibility. Recent findings Recent studies suggest that tic suppressibility exists in children shortly after onset of their tics. Moreover, those who are better able to suppress their tics have better tic outcomes. Interoceptive awareness and automatic action inhibition may be involved in tic suppression. Summary We illustrate a possible underlying mechanism of tic suppressibility and its clinical correlations and implications. New concepts such as interoceptive awareness and action inhibition may help explain tic disorders. Further study will be useful to fill remaining knowledge gaps.
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Affiliation(s)
- Keisuke Ueda
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Soyoung Kim
- Department of Psychiatry, Washington University School of Medicine, St Louis, MO, USA
| | - Deanna J Greene
- Department of Cognitive Science, University of California San Diego, La Jolla, CA, USA
| | - Kevin J Black
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA.,Department of Psychiatry, Washington University School of Medicine, St Louis, MO, USA.,Department of Radiology, Washington University School of Medicine, St Louis, MO, USA.,Department of Neuroscience, Washington University School of Medicine, St Louis, MO, USA
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19
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Abstract
This is the sixth yearly article in the Tourette Syndrome Research Highlights series, summarizing research from 2019 relevant to Tourette syndrome and other tic disorders. The highlights from 2020 is being drafted on the Authorea online authoring platform; readers are encouraged to add references or give feedback on our selections comments feature on this page. After the calendar year ends, this article is submitted as the annual update for the Tics collection F1000Research.
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Affiliation(s)
- Andreas Hartmann
- Department of Neurology, APHP, Paris, Île-de-France, 75013, France,
| | - Yulia Worbe
- Department of Neurology, APHP, Paris, Île-de-France, 75013, France
| | - Kevin J. Black
- Department of Psychiatry, Neurology, and Radiology,, Washington University School of Medicine, Saint Louis, MO, 63110, USA
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20
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Abstract
Woods and Himle developed a standardized tic suppression paradigm (TSP) for the experimental setting, to quantify the effects of intentional tic suppression in Tourette syndrome. We previously provided a computer program to facilitate recording tic occurrence and to automate reward delivery during the several experimental conditions of the TSP. The present article describes a web-based program that performs the same functions. Implementing this program on the web allows research sessions to be performed remotely, in tandem with a video calling program. Relevant data for each session, such as the timing of tics and dispensed rewards, are stored in plain text files for later analysis. Expected applications include research on Tourette syndrome and related disorders.
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Affiliation(s)
- Jonathan K Black
- Department of Mechanical Engineering, Brigham Young University, Provo, Utah, 84602, USA
| | - Jonathan M Koller
- Department of Psychiatry, Washington University in St. Louis, St. Louis, Missouri, 63110, USA
- Department of Radiology, Washington University in St. Louis, St. Louis, Missouri, 63110, USA
| | - Kevin J Black
- Department of Psychiatry, Washington University in St. Louis, St. Louis, Missouri, 63110, USA
- Department of Radiology, Washington University in St. Louis, St. Louis, Missouri, 63110, USA
- Department of Neurology, Washington University in St. Louis, St. Louis, Missouri, 63110, USA
- Department of Neuroscience, Washington University in St. Louis, St. Louis, Missouri, 63110, USA
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21
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Black JK, Koller JM, Black KJ. TicTimer Web: software for measuring tic suppression remotely. F1000Res 2020; 9:1264. [PMID: 33824720 PMCID: PMC7993402 DOI: 10.12688/f1000research.26347.1] [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] [Accepted: 10/09/2020] [Indexed: 04/01/2024] Open
Abstract
Woods and Himle developed a standardized tic suppression paradigm (TSP) for the experimental setting, to quantify the effects of intentional tic suppression in Tourette syndrome. We previously provided a computer program to facilitate recording tic occurrence and to automate reward delivery during the several experimental conditions of the TSP. The present article describes a web-based program that performs the same functions. Implementing this program on the web allows research sessions to be performed remotely, in tandem with a video calling program. Relevant data for each session, such as the timing of tics and dispensed rewards, are stored in plain text files for later analysis. Expected applications include research on Tourette syndrome and related disorders.
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Affiliation(s)
- Jonathan K. Black
- Department of Mechanical Engineering, Brigham Young University, Provo, Utah, 84602, USA
| | - Jonathan M. Koller
- Department of Psychiatry, Washington University in St. Louis, St. Louis, Missouri, 63110, USA
- Department of Radiology, Washington University in St. Louis, St. Louis, Missouri, 63110, USA
| | - Kevin J. Black
- Department of Psychiatry, Washington University in St. Louis, St. Louis, Missouri, 63110, USA
- Department of Radiology, Washington University in St. Louis, St. Louis, Missouri, 63110, USA
- Department of Neurology, Washington University in St. Louis, St. Louis, Missouri, 63110, USA
- Department of Neuroscience, Washington University in St. Louis, St. Louis, Missouri, 63110, USA
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22
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Abstract
A boy with multiple phonic tics, one lifetime motor tic, and no impairment or marked distress does not meet criteria for any DSM-5 tic disorder diagnosis. The next version of the Diagnostic and Statistical Manual should adjust the criteria for Tourette's Disorder and/or for "other specified tic disorder" and "unspecified tic disorder."
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Affiliation(s)
- Kevin J. Black
- Departments of Psychiatry, Neurology, Radiology and Neuroscience, Washington University in St. Louis School of Medicine, St. Louis, MO, 63110-1093, USA
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23
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Abstract
We report on the ongoing project "The New Tics Study: A Novel Approach to Pathophysiology and Cause of Tic Disorders," describing the work completed to date, ongoing studies and long-term goals. The overall goals of this research are to study the pathophysiology of Provisional Tic Disorder, and to study tic remission (or improvement) in a prospective fashion. Preliminary data collection for the project began almost 10 years ago. The current study is nearing completion of its third year, and has already reported several novel and important results. First, surprisingly, at least 90% of children who had experienced tics for only a mean of 3 months still had tics at the 12-month anniversary of their first tic, though in some cases tics were seen only with remote video observation of the child sitting alone. Thus almost all of them now had a DSM-5 diagnosis of Tourette's Disorder or Persistent (Chronic) Tic Disorder. Baseline clinical features that predicted 12-month outcome included tic severity, subsyndromal autism spectrum symptoms, an anxiety disorder, and a history of 3 or more phonic tics. Second, we found that poorer tic suppression ability when immediately rewarded for suppression predicted greater tic severity at follow-up. Third, striatal volumes did not predict outcome as hypothesized, but a larger hippocampus at baseline predicted worse severity at follow-up. Enrollment and data collection continue, including functional connectivity MRI (fcMRI) imaging, and additional analyses are planned once the full sample is enrolled.
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Affiliation(s)
- Kevin J. Black
- Departments of Psychiatry, Neurology, Radiology and Neuroscience, Washington University in St. Louis School of Medicine, St. Louis, MO 63110, USA
| | - Soyoung Kim
- Departments of Psychiatry and Radiology, Washington University in St. Louis School of Medicine, St. Louis, MO 63110, USA
| | - Bradley L. Schlaggar
- Kennedy Krieger Institute, Baltimore, MD 21205; and Departments of Neurology and Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Deanna J. Greene
- Departments of Psychiatry and Radiology, Washington University in St. Louis School of Medicine, St. Louis, MO 63110, USA
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Abstract
The atypical antipsychotic ziprasidone has been considered inappropriate for use in patients with Parkinson’s disease (PD), as most atypical antipsychotics worsen parkinsonism. However, the current evidence for safety and efficacy of ziprasidone in PDP has not been evaluated in a systematic fashion. We review published experience with ziprasidone for treating psychosis in PD via systematic search of MEDLINE, Embase, Cochrane CENTRAL, and Clinicaltrials.gov with terms related to “ziprasidone” and “Parkinson’s disease”, inclusive of case reports and prospective studies. We also add seven cases of ziprasidone exposure in patients in our center with idiopathic PD or Lewy body dementia (DLB), selected by retrospective query of all clinical data since 1996. In our review, two prospective trials and 11 case reports or series were found, with ziprasidone found to be generally effective for treatment of psychosis and with few adverse events reported. Our case series did not support efficacy of ziprasidone; it was generally safe in PD, but two patients with DLB had adverse motor events. We conclude that, although ziprasidone occasionally can produce substantial worsening of motor signs, it usually is well tolerated, and may provide in some cases a useful alternative to quetiapine, clozapine and pimavanserin, particularly in the acute care setting. Further randomized controlled studies are needed.
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Affiliation(s)
- John R Younce
- Department of Neurology, Washington University in St. Louis, St. Louis, MO, USA
| | - Albert A Davis
- Department of Neurology, Washington University in St. Louis, St. Louis, MO, USA
| | - Kevin J Black
- Department of Neurology, Washington University in St. Louis, St. Louis, MO, USA.,Departments of Psychiatry, Radiology, and Neuroscience, Washington University in St. Louis, St. Louis, MO, USA
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25
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Black KJ, Acevedo HK, Koller JM. Dopamine Buffering Capacity Imaging: A Pharmacodynamic fMRI Method for Staging Parkinson Disease. Front Neurol 2020; 11:370. [PMID: 32477245 PMCID: PMC7232584 DOI: 10.3389/fneur.2020.00370] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 04/14/2020] [Indexed: 11/13/2022] Open
Abstract
We propose a novel pharmacological fMRI (phMRI) method for objectively quantifying disease severity in Parkinson disease (PD). It is based on the clinical observation that the benefit from a dose of levodopa wears off more quickly as PD progresses. Biologically this has been thought to represent decreased buffering capacity for dopamine as nigrostriatal cells die. Buffering capacity has been modeled based on clinical effects, but clinical measurements are influenced by confounding factors. The new method proposes to measure the effect objectively based on the timing of the known response of several brain regions to exogenous levodopa. Such responses are robust and can be quantified using perfusion MRI. Here we present simulation studies based on published clinical dose-response data and an intravenous levodopa infusion. Standard pharmacokinetic-pharmacodynamic methods were used to model the response. Then the effect site rate constant k e was estimated from simulated response data plus Gaussian noise. Predicted time - effect curves sampled at times consistent with phMRI differ substantially based on clinical severity. Estimated k e from noisy input data was recovered with good accuracy. These simulation results support the feasibility of levodopa phMRI hysteresis mapping to measure the severity of dopamine denervation objectively and simultaneously in all brain regions with a robust imaging response to exogenous levodopa.
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Affiliation(s)
- Kevin J. Black
- Department of Psychiatry, Washington University in St. Louis, St. Louis, MO, United States
- Departments of Neurology, Radiology and Neuroscience, Washington University in St. Louis, St. Louis, MO, United States
| | - Haley K. Acevedo
- Department of Psychiatry, Washington University in St. Louis, St. Louis, MO, United States
| | - Jonathan M. Koller
- Department of Psychiatry, Washington University in St. Louis, St. Louis, MO, United States
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26
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Eisenstein SA, Black KJ, Samara A, Koller JM, Dunn JP, Hershey T, Klein S, Smith GI. Striatal Dopamine Responses to Feeding are Altered in People with Obesity. Obesity (Silver Spring) 2020; 28:765-771. [PMID: 32086877 PMCID: PMC7093218 DOI: 10.1002/oby.22753] [Citation(s) in RCA: 2] [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: 09/09/2019] [Accepted: 01/03/2020] [Indexed: 01/05/2023]
Abstract
OBJECTIVE This study determined whether striatal dopamine (DA) release is affected by food ingestion and whether the DA response to high-calorie food images is greater in the fasted than in the fed state in people with obesity. METHODS Striatal DA release was evaluated in 10 people with obesity and prediabetes after consuming a meal to satiation and after fasting overnight as well as in response to viewing images of high-calorie compared with low-calorie foods after consuming a meal to satiation or fasting overnight by using positron emission tomography with [11 C]raclopride injection. RESULTS Striatal DA D2/D3 receptor availability was not different during fasted and fed conditions. Viewing images of high-calorie foods induced striatal DA release relative to viewing images of low-calorie foods (P < 0.05), but there was no difference in the magnitude of the response between fasting and fed conditions. CONCLUSIONS People with obesity and prediabetes do not increase striatal DA release after eating a meal to satiation compared with fasting overnight and fail to inhibit DA release in response to high-calorie food stimuli after eating a meal to satiation. These data suggest that impaired DA signaling contributes to greater energy intake during meals in this population.
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Affiliation(s)
- Sarah A. Eisenstein
- Departments of Psychiatry, Washington University School of Medicine, St. Louis, MO, 63110
- Departments of Radiology, Washington University School of Medicine, St. Louis, MO, 63110
| | - Kevin J. Black
- Departments of Psychiatry, Washington University School of Medicine, St. Louis, MO, 63110
- Departments of Radiology, Washington University School of Medicine, St. Louis, MO, 63110
- Departments of Neurology, Washington University School of Medicine, St. Louis, MO, 63110
- Departments of Neuroscience, Washington University School of Medicine, St. Louis, MO, 63110
| | - Amjad Samara
- Departments of Psychiatry, Washington University School of Medicine, St. Louis, MO, 63110
| | - Jonathan M. Koller
- Departments of Psychiatry, Washington University School of Medicine, St. Louis, MO, 63110
| | - Julia P. Dunn
- Departments of Center for Human Nutrition Washington University School of Medicine, St. Louis, MO, 63110
| | - Tamara Hershey
- Departments of Psychiatry, Washington University School of Medicine, St. Louis, MO, 63110
- Departments of Radiology, Washington University School of Medicine, St. Louis, MO, 63110
- Departments of Neurology, Washington University School of Medicine, St. Louis, MO, 63110
| | - Samuel Klein
- Departments of Center for Human Nutrition Washington University School of Medicine, St. Louis, MO, 63110
| | - Gordon I. Smith
- Departments of Center for Human Nutrition Washington University School of Medicine, St. Louis, MO, 63110
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27
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Nielsen AN, Gratton C, Church JA, Dosenbach NU, Black KJ, Petersen SE, Schlaggar BL, Greene DJ. Atypical Functional Connectivity in Tourette Syndrome Differs Between Children and Adults. Biol Psychiatry 2020; 87:164-173. [PMID: 31472979 PMCID: PMC6925331 DOI: 10.1016/j.biopsych.2019.06.021] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [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: 10/23/2018] [Revised: 06/14/2019] [Accepted: 06/17/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Tourette syndrome (TS) is a neuropsychiatric disorder with symptomatology that typically changes over development. Whether and how brain function in TS also differs across development has been largely understudied. Here, we used functional connectivity magnetic resonance imaging to examine whole-brain functional networks in children and adults with TS. METHODS Multivariate classification methods were used to find patterns among functional connections that distinguish individuals with TS from control subjects separately for children and adults (N = 202). We tested whether the patterns of connections that classify diagnosis in one age group (e.g., children) could classify diagnosis in another age group (e.g., adults). We also tested whether the developmental trajectory of these connections was altered in TS. RESULTS Diagnostic classification was successful in children and adults separately but expressly did not generalize across age groups, suggesting that the patterns of functional connections that best distinguished individuals with TS from control subjects were age specific. Developmental patterns among these functional connections used for diagnostic classification deviated from typical development. Brain networks in childhood TS appeared "older" and brain networks in adulthood TS appeared "younger" in comparison with typically developing individuals. CONCLUSIONS Our results demonstrate that brain networks are differentially altered in children and adults with TS. The observed developmental trajectory of affected connections is consistent with theories of accelerated and/or delayed maturation, but may also involve anomalous developmental pathways. These findings further our understanding of neurodevelopmental trajectories in TS and carry implications for future applications aimed at predicting the clinical course of TS in individuals over development.
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Affiliation(s)
- Ashley N. Nielsen
- Department of Neurology, Washington University School of Medicine, St. Louis, MO
| | - Caterina Gratton
- Department of Psychology, Northwestern University, Evanston, IL,Department of Neuroscience, Northwestern University, Evanston, IL
| | - Jessica A. Church
- Department of Psychology, The University of Texas at Austin, Austin, TX
| | - Nico U.F. Dosenbach
- Department of Neurology, Washington University School of Medicine, St. Louis, MO,Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO,Department of Pediatrics, Washington University School of Medicine, St. Louis, MO,Department of Occupational Therapy, Washington University School of Medicine, St. Louis, MO,Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO
| | - Kevin J. Black
- Department of Neurology, Washington University School of Medicine, St. Louis, MO,Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO,Department of Psychiatry, Washington University School of Medicine, St. Louis, MO,Department of Neuroscience, Washington University School of Medicine, St. Louis, MO
| | - Steven E. Petersen
- Department of Neurology, Washington University School of Medicine, St. Louis, MO,Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO,Department of Neuroscience, Washington University School of Medicine, St. Louis, MO
| | - Bradley L. Schlaggar
- Kennedy Krieger Institute, Baltimore, MD,Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD,Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Deanna J. Greene
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO,Department of Psychiatry, Washington University School of Medicine, St. Louis, MO
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28
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Kim S, Greene DJ, Robichaux-Viehoever A, Bihun EC, Koller JM, Acevedo H, Schlaggar BL, Black KJ. Tic Suppression in Children With Recent-Onset Tics Predicts 1-Year Tic Outcome. J Child Neurol 2019; 34:757-764. [PMID: 31241402 PMCID: PMC6733613 DOI: 10.1177/0883073819855531] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [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: 11/16/2022]
Abstract
Successful voluntary tic suppression is a key component of the behavioral interventions that are used to treat tic disorders. This study aimed to examine tic suppression in children with recent-onset tics and determine whether the capacity to suppress tics predicts future tic severity. We tested 45 children (30 male, mean age 7.74 years) with recent-onset tics (mean 3.47 months prior to the first study visit; baseline) and re-examined each child at the 12-month anniversary of the first recognized tic (follow-up). At the baseline visit, children performed a tic suppression task with several conditions: tic freely, inhibit tics given a verbal request, and inhibit tics in the presence of a reward. At the baseline visit, children with tics for only a few months could suppress their tics, and tic suppression was especially successful when they received an immediate and contingent reward. Additionally, the ability to suppress tics in the presence of a reward predicted tic severity at follow-up. These findings suggest that better inhibitory control of tics within months of tic onset may be an important predictor of future tic symptom outcome.
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Affiliation(s)
- Soyoung Kim
- Department of Psychiatry, Washington University School of Medicine, United States
| | - Deanna J. Greene
- Department of Psychiatry, Washington University School of Medicine, United States
- Department of Radiology, Washington University School of Medicine, United States
| | | | - Emily C. Bihun
- Department of Psychiatry, Washington University School of Medicine, United States
| | - Jonathan M. Koller
- Department of Psychiatry, Washington University School of Medicine, United States
| | - Haley Acevedo
- Department of Psychiatry, Washington University School of Medicine, United States
| | - Bradley L. Schlaggar
- Kennedy Krieger Institute, Baltimore, MD, United States
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Kevin J. Black
- Department of Psychiatry, Washington University School of Medicine, United States
- Department of Radiology, Washington University School of Medicine, United States
- Department of Neurology, Washington University School of Medicine, United States
- Department of Neuroscience, Washington University School of Medicine, United States
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29
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Gilliam FG, Black KJ, Carter J, Freedland KE, Sheline YI, Tsai WY, Lustman PJ. A Trial of Sertraline or Cognitive Behavior Therapy for Depression in Epilepsy. Ann Neurol 2019; 86:552-560. [PMID: 31359460 DOI: 10.1002/ana.25561] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 07/23/2019] [Accepted: 07/24/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Limited evidence is available to guide treatment of depression for persons with epilepsy. We evaluated the comparative effectiveness of sertraline and cognitive behavior therapy (CBT) for depression, quality of life, seizures, and adverse treatment effects. METHODS We randomly assigned 140 adult outpatients with epilepsy and current major depressive disorder to sertraline or weekly CBT for 16 weeks. The primary outcome was remission from depression based on the Mini International Neuropsychiatric Interview (MINI). Secondary outcomes included the Quality of Life in Epilepsy Inventory-89 (QOLIE-89) seizure rates, the Adverse Events Profile (AEP), the Beck Depression Inventory, and MINI Suicide Risk Module. RESULTS In the intention-to-treat analysis, 38 (52.8%; 95% confidence interval [CI] = ±12) of the 72 subjects assigned to sertraline and 41 (60.3%; 95% CI = ±11.6) of the 68 subjects in the CBT group achieved remission; the lower bound of efficacy for both groups was greater than our historical placebo control group upper bound of 33.7%. Difference in time to remission between groups was 2.8 days (95% CI = ±0.43; p = 0.79). The percent improvement of mean QOLIE-89 scores was significant for both the CBT (25.7%; p < 0.001) and sertraline (28.3%; p < 0.001) groups. The difference in occurrence of generalized tonic-clonic seizures between groups was 0.3% (95% CI = ±8.6; p = 0.95). Suicide risk at final assessment was associated with persistent depression (p < 0.0001) but not seizures or sertraline. INTERPRETATION Depression remitted in just over one-half of subjects following sertraline or CBT. Despite the complex psychosocial disability associated with epilepsy, improving depression benefits quality of life. Serotonin reuptake inhibition does not appear to increase seizures or suicidality in persons with epilepsy. ANN NEUROL 2019;86:552-560.
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Affiliation(s)
- Frank G Gilliam
- Department of Neuroscience, University of Kentucky, Lexington, KY.,Epilepsy Research Center, University of Kentucky, Lexington, KY
| | - Kevin J Black
- Department of Psychiatry, Washington University, St Louis, MO
| | - Jewell Carter
- Department of Psychiatry, Washington University, St Louis, MO
| | | | - Yvette I Sheline
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA
| | - Wei-Yann Tsai
- Department of Biostatistics, Columbia University, New York, NY
| | - Patrick J Lustman
- Department of Psychiatry, Washington University, St Louis, MO.,Veterans Affairs St Louis Health Center, St Louis, MO
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30
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Abstract
This is the fifth yearly article in the Tourette Syndrome Research Highlights series, summarizing research from 2018 relevant to Tourette syndrome and other tic disorders. The authors briefly summarize reports they consider most important or interesting. The highlights from 2019 article is being drafted on the Authorea online authoring platform, and readers are encouraged to add references or give feedback on our selections using the comments feature on that page. After the calendar year ends, the article is submitted as the annual update for the Tics collection on F1000Research.
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Affiliation(s)
- Olivia Rose
- Department of Neuroscience, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Andreas Hartmann
- Sorbonne University, National Reference Centre for Tourette Disorder, Pitié-Salpêtrière Hospital, Paris, France
| | - Yulia Worbe
- Sorbonne University, National Reference Centre for Tourette Disorder, Pitié-Salpêtrière Hospital, Paris, France
| | - Jeremiah M. Scharf
- Psychiatric and Neurodevelopmental Genetics Unit, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kevin J. Black
- Department of Neuroscience, Washington University School of Medicine, St. Louis, MO, 63110, USA
- Psychiatry, Neurology, and Radiology, Washington University School of Medicine, St. Louis, MO, 63110, USA
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31
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Gilbert DL, Murphy TK, Jankovic J, Budman CL, Black KJ, Kurlan RM, Coffman KA, McCracken JT, Juncos J, Grant JE, Chipkin RE. Ecopipam, a D1 receptor antagonist, for treatment of tourette syndrome in children: A randomized, placebo-controlled crossover study. Mov Disord 2018; 33:1272-1280. [DOI: 10.1002/mds.27457] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 05/09/2018] [Accepted: 05/15/2018] [Indexed: 01/12/2023] Open
Affiliation(s)
- Donald L. Gilbert
- Cincinnati Children's Hospital Medical Center; Department of Pediatrics; Cincinnati Ohio USA
| | - Tanya K. Murphy
- University of South Florida; Departments of Pediatrics and Psychiatry; Tampa Florida USA
| | - Joseph Jankovic
- Baylor College of Medicine; Department of Neurology; Houston Texas USA
| | - Cathy L. Budman
- Zucker School of Medicine, Hofstra/Northwell Department of Psychiatry, Northwell Health; Hempstead New York USA
| | - Kevin J. Black
- Washington University School of Medicine; Departments of Psychiatry, Neurology, Radiology, and Neuroscience; St. Louis Missouri USA
| | - Roger M. Kurlan
- Center for Neurological and Neurodevelopmental Health; Voorhees New Jersey USA
| | | | | | - Jorge Juncos
- Emory University School of Medicine; Department of Neurology & Brain Health Center; Atlanta Georgia USA
| | - Jon E. Grant
- University of Chicago; Department of Psychiatry & Behavioral Neuroscience; Chicago Illinois USA
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32
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Abstract
This is the fourth yearly article in the Tourette Syndrome Research Highlights series, summarizing research from 2017 relevant to Tourette syndrome and other tic disorders. The authors briefly summarize reports they consider most important or interesting. The highlights from 2018 article is being drafted on the Authorea online authoring platform, and readers are encouraged to add references or give feedback on our selections using the comments feature on that page. After the calendar year ends, the article is submitted as the annual update for the Tics collection on F1000Research.
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Affiliation(s)
- Andreas Hartmann
- Sorbonne University, National Reference Centre for Tourette Disorder, Pitié-Salpêtrière Hospital, Paris, France
| | - Yulia Worbe
- Sorbonne University, National Reference Centre for Tourette Disorder, Pitié-Salpêtrière Hospital, Paris, France
- Department of Physiology, Saint-Antoine Hospital, Paris, France
| | - Kevin J. Black
- Psychiatry, Neurology, Radiology, and Neuroscience, Washington University School of Medicine, St. Louis, MO, 63110-1093, USA
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33
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Gourisankar A, Eisenstein SA, Trapp NT, Koller JM, Campbell MC, Ushe M, Perlmutter JS, Hershey T, Black KJ. Mapping movement, mood, motivation and mentation in the subthalamic nucleus. R Soc Open Sci 2018; 5:171177. [PMID: 30109035 PMCID: PMC6083651 DOI: 10.1098/rsos.171177] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 06/14/2018] [Indexed: 05/26/2023]
Abstract
The anatomical connections of the subthalamic nucleus (STN) have driven hypotheses about its functional anatomy, including the hypothesis that the precise anatomical location of STN deep brain stimulation (DBS) contributes to the variability of motor and non-motor responses across patients with Parkinson's disease (PD). We previously tested the hypothesis using a three-dimensional (3D) statistical method to interpret the acute effects of unilateral DBS at each patient's clinically optimized DBS settings and active contact. Here, we report a similar analysis from a new study in which DBS parameters were standardized and DBS locations were chosen blind to clinical response. In 74 individuals with PD and STN DBS, STN contacts were selected near the dorsal and ventral borders of the STN contralateral to the more affected side of the body. Participants were tested off PD medications in each of three unilateral DBS conditions (ventral STN DBS, dorsal STN DBS and DBS off) for acute effects on mood, apathy, working memory, response inhibition and motor function. Voltage, frequency and pulse width were standardized, and participants and raters were blind to condition. In a categorical analysis, both dorsal and ventral STN DBS improved mean motor function without affecting cognitive measures. Ventral STN DBS induced greater improvement in rigidity and anxiety than dorsal STN DBS. In the 3D analysis, contact location was significant for body hypokinesia, rigidity and resting tremor, with the greatest improvement occurring with DBS in dorsal STN and zona incerta. The 3D results provide new, direct functional evidence for the anatomically derived model of STN, in which motor function is best represented in dorsal STN. However, our data suggest that functional segregation between motor and non-motor areas of the STN is limited, because locations that induced improvements in motor function and mood overlapped substantially.
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Affiliation(s)
- Amritha Gourisankar
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO 63130, USA
| | - Sarah A. Eisenstein
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110, USA
- Department of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Nicholas T. Trapp
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Jonathan M. Koller
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Meghan C. Campbell
- Department of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Mwiza Ushe
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Joel S. Perlmutter
- Department of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110, USA
- Department of Neuroscience, Washington University School of Medicine, St. Louis, MO 63110, USA
- Department of Occupational Therapy, Washington University School of Medicine, St. Louis, MO 63110, USA
- Department of Physical Therapy, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Tamara Hershey
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110, USA
- Department of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Kevin J. Black
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110, USA
- Department of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110, USA
- Department of Neuroscience, Washington University School of Medicine, St. Louis, MO 63110, USA
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34
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Conelea CA, Wellen B, Woods DW, Greene DJ, Black KJ, Specht M, Himle MB, Lee HJ, Capriotti M. Patterns and Predictors of Tic Suppressibility in Youth With Tic Disorders. Front Psychiatry 2018; 9:188. [PMID: 29875706 PMCID: PMC5974106 DOI: 10.3389/fpsyt.2018.00188] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [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: 03/02/2018] [Accepted: 04/23/2018] [Indexed: 12/02/2022] Open
Abstract
Tic suppression is the primary target of tic disorder treatment, but factors that influence voluntary tic inhibition are not well understood. Several studies using the Tic Suppression Task have demonstrated significant inter-individual variability in tic suppressibility but have individually been underpowered to address correlates of tic suppression. The present study explored patterns and clinical correlates of reward-enhanced tic suppression in youth with tic disorders using a large, pooled dataset. Individual-level data from nine studies using the Tic Suppression Task were pooled, yielding a sample of 99 youth with tic disorders. Analyses examined patterns of tic suppressibility and the relationship between tic suppressibility and demographic and clinical characteristics. A large majority of youth demonstrated a high degree of tic suppression, but heterogeneous patterns of tic suppressibility were also observed. Better tic suppressibility was related to older age and more frequent tics but unrelated to other clinical variables, including presence of psychiatric comorbidity, psychotropic medication status, tic and premonitory urge severity, and self-rated tic suppressibility. The mechanisms underlying the observed heterogeneity in reward-enhanced tic suppressibility warrant further investigation. The Tic Suppression Task is a promising method for testing mechanistic hypotheses related to tic suppression.
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Affiliation(s)
- Christine A Conelea
- Department of Psychiatry, University of Minnesota, Minneapolis, MN, United States
| | - Brianna Wellen
- Department of Psychology, University of Utah, Salt Lake City, UT, United States
| | - Douglas W Woods
- Department of Psychology, Marquette University, Milwaukee, WI, United States
| | - Deanna J Greene
- Departments of Psychiatry and Radiology, Washington University School of Medicine, St. Louis, MO, United States
| | - Kevin J Black
- Departments of Psychiatry, Neurology, Radiology, and Neuroscience, Washington University School of Medicine, St. Louis, MO, United States
| | - Matthew Specht
- Weill Cornell Medical College, New York-Presbyterian Hospital-Westchester, New York, NY, United States
| | - Michael B Himle
- Department of Psychology, University of Utah, Salt Lake City, UT, United States
| | - Han-Joo Lee
- Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, WI, United States
| | - Matthew Capriotti
- Department of Psychology, San Jose State University, San Jose, CA, United States.,Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
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35
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Abstract
Exposure and response prevention (ERP) is a first-line behavior therapy for obsessive-compulsive disorder, and has also been tested in Tourette syndrome (TS). However, ERP for tic disorders requires intentional tic suppression, which for some patients is difficult even for brief periods. Additionally, practical access to behavior therapy is difficult for many patients, especially those in rural areas. The authors present a simple, working web platform (TicTrainer) that implements a strategy called reward-enhanced exposure and response prevention (RE-ERP). This strategy sacrifices most expert therapist components of ERP, focusing only on increasing the duration of time for which the user can suppress tics through automated differential reinforcement of tic-free periods (DRO). RE-ERP requires an external tic monitor, such as a parent, during training sessions. The user sees increasing digital rewards for longer and longer periods of successful tic suppression, similar to a video game score. TicTrainer is designed with security in mind, storing no personally identifiable health information, and has features to facilitate research, including optional masked comparison of tics during DRO vs. noncontingent reward conditions. A working instance of TicTrainer is available from https://tictrainer.com/.
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Affiliation(s)
- Jonathan K. Black
- Ira A. Fulton College of Engineering and Technology, Brigham Young University, Provo, UT, 84602, USA
| | - Kevin J. Black
- Washington University School of Medicine, St. Louis, MO, 63110, USA
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36
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Abstract
Exposure and response prevention (ERP) is a first-line behavior therapy for obsessive-compulsive disorder and Tourette syndrome (TS). However, ERP for tic disorders requires intentional tic suppression, which for some patients is difficult even for brief periods. Additionally, practical access to behavior therapy is difficult for many patients, especially those in rural areas. The authors present a simple, working web platform (TicTrainer) that implements a strategy called reward-enhanced exposure and response prevention (RE-ERP). This strategy sacrifices most expert therapist components of ERP, focusing only on increasing the duration of time for which the user can suppress tics through automated differential reinforcement of tic-free periods (DRO). RE-ERP requires an external tic monitor, such as a parent, during training sessions. The user sees increasing digital rewards for longer and longer periods of successful tic suppression, similar to a video game score. TicTrainer is designed with security in mind, storing no personally identifiable health information, and has features to facilitate research, including optional masked comparison of tics during DRO vs. noncontingent reward conditions. A working instance of TicTrainer is available from https://tictrainer.com/.
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Affiliation(s)
- Jonathan K. Black
- Ira A. Fulton College of Engineering and Technology, Brigham Young University, Provo, UT, 84602, USA
| | - Kevin J. Black
- Washington University School of Medicine, St. Louis, MO, 63110, USA
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37
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Black KJ. Treatment of Parkinson's disease psychosis. Med Int Rev 2017; 27:266-271. [PMID: 30140115 PMCID: PMC6103448] [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] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Early in the course of Parkinson disease (PD), treatment usually goes well. However, after five to ten years, things start to change as treatment requires higher doses of medications and side effects become more problematic. One of the most difficult problems is the development of hallucinations or delusions. Throughout the 20th century, treatment options were unproven and unsatisfactory, but the past 20 years have brought important changes. Two medications that are well tolerated in PD have now proved efficacious in randomized, controlled trials, and others are in development. Here I summarize this history briefly and provide a general plan for treating the patient with PD complicated by psychotic symptoms.
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38
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Abstract
Woods and Himle developed a standardized tic suppression paradigm (TSP) for the experimental setting, to quantify the effects of intentional tic suppression in Tourette syndrome. The present article describes a Java program that automates record keeping and reward dispensing during the several experimental conditions of the TSP. The software can optionally be connected to a commercial reward token dispenser to further automate reward delivery to the participant. The timing of all tics, 10-second tic-free intervals, and dispensed rewards is recorded in plain text files for later analysis. Expected applications include research on Tourette syndrome and related disorders.
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Affiliation(s)
- Jonathan K. Black
- Ira A. Fulton College of Engineering and Technology, Brigham Young University, Provo, Utah, 84602, USA
| | - Jonathan M. Koller
- Department of Psychiatry, Washington University School of Medicine , St. Louis , Missouri, 63110, USA
- Department of Radiology, Washington University School of Medicine, St. Louis, Missouri, 63110, USA
| | - Kevin J. Black
- Department of Psychiatry, Washington University School of Medicine , St. Louis , Missouri, 63110, USA
- Department of Radiology, Washington University School of Medicine, St. Louis, Missouri, 63110, USA
- Department of Neurology, Washington University School of Medicine, St. Louis, Missouri, 63110, USA
- Department of Neuroscience, Washington University School of Medicine, St. Louis, Missouri, 63110, USA
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39
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Abstract
Woods and Himle developed a standardized tic suppression paradigm (TSP) for the experimental setting, to quantify the effects of intentional tic suppression in Tourette syndrome. The present article describes a Java program that automates record keeping and reward dispensing during the several experimental conditions of the TSP. The software can optionally be connected to a commercial reward token dispenser to further automate reward delivery to the participant. The timing of all tics, 10-second tic-free intervals, and dispensed rewards is recorded in plain text files for later analysis. Expected applications include research on Tourette syndrome and related disorders.
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Affiliation(s)
- Jonathan K Black
- Ira A. Fulton College of Engineering and Technology, Brigham Young University, Provo, Utah, 84602, USA
| | - Jonathan M Koller
- Department of Psychiatry, Washington University School of Medicine , St. Louis , Missouri, 63110, USA.,Department of Radiology, Washington University School of Medicine, St. Louis, Missouri, 63110, USA
| | - Kevin J Black
- Department of Psychiatry, Washington University School of Medicine , St. Louis , Missouri, 63110, USA.,Department of Radiology, Washington University School of Medicine, St. Louis, Missouri, 63110, USA.,Department of Neurology, Washington University School of Medicine, St. Louis, Missouri, 63110, USA.,Department of Neuroscience, Washington University School of Medicine, St. Louis, Missouri, 63110, USA
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40
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Abstract
This article presents highlights chosen from research that appeared during 2016 on Tourette syndrome and other tic disorders. Selected articles felt to represent meaningful advances in the field are briefly summarized.
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Affiliation(s)
- Kevin J. Black
- Departments of Psychiatry, Neurology, Radiology, and Neuroscience, Washington University School of Medicine, St. Louis, MO, 63110, USA
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41
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Abstract
This article presents highlights chosen from research that appeared during 2016 on Tourette syndrome and other tic disorders. Selected articles felt to represent meaningful advances in the field are briefly summarized.
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Affiliation(s)
- Kevin J. Black
- Departments of Psychiatry, Neurology, Radiology, and Neuroscience, Washington University School of Medicine, St. Louis, MO, 63110, USA
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42
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Abstract
Previous studies of brain structure in Tourette syndrome (TS) have produced mixed results, and most had modest sample sizes. In the present multicenter study, we used structural magnetic resonance imaging (MRI) to compare 103 children and adolescents with TS to a well-matched group of 103 children without tics. We applied voxel-based morphometry methods to test gray matter (GM) and white matter (WM) volume differences between diagnostic groups, accounting for MRI scanner and sequence, age, sex and total GM+WM volume. The TS group demonstrated lower WM volume bilaterally in orbital and medial prefrontal cortex, and greater GM volume in posterior thalamus, hypothalamus and midbrain. These results demonstrate evidence for abnormal brain structure in children and youth with TS, consistent with and extending previous findings, and they point to new target regions and avenues of study in TS. For example, as orbital cortex is reciprocally connected with hypothalamus, structural abnormalities in these regions may relate to abnormal decision making, reinforcement learning or somatic processing in TS.
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Affiliation(s)
- D J Greene
- Department of Psychiatry, Washington University School of Medicine, St Louis, MO USA
- Department of Radiology, Washington University School of Medicine, St Louis, MO USA
| | | | - J M Koller
- Department of Psychiatry, Washington University School of Medicine, St Louis, MO USA
| | - B L Schlaggar
- Department of Psychiatry, Washington University School of Medicine, St Louis, MO USA
- Department of Radiology, Washington University School of Medicine, St Louis, MO USA
- Department of Neurology, Washington University School of Medicine, St Louis, MO USA
- Department of Neuroscience, Washington University School of Medicine, St Louis, MO USA
- Department of Pediatrics, Washington University School of Medicine, St Louis, MO USA
| | - K J Black
- Department of Psychiatry, Washington University School of Medicine, St Louis, MO USA
- Department of Radiology, Washington University School of Medicine, St Louis, MO USA
- Department of Neurology, Washington University School of Medicine, St Louis, MO USA
- Department of Neuroscience, Washington University School of Medicine, St Louis, MO USA
| | - and The Tourette Association of America Neuroimaging Consortium
- Department of Psychiatry, Washington University School of Medicine, St Louis, MO USA
- Department of Radiology, Washington University School of Medicine, St Louis, MO USA
- Washington University School of Medicine, St Louis, MO USA
- Department of Neurology, Washington University School of Medicine, St Louis, MO USA
- Department of Neuroscience, Washington University School of Medicine, St Louis, MO USA
- Department of Pediatrics, Washington University School of Medicine, St Louis, MO USA
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43
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Nemanich ST, McNeely ME, Earhart GM, Norris SA, Black KJ. A Case of Apparent Upper-Body Freezing in Parkinsonism while Using a Wheelchair. Front Neurol 2017; 8:205. [PMID: 28555128 PMCID: PMC5431276 DOI: 10.3389/fneur.2017.00205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 04/27/2017] [Indexed: 11/30/2022] Open
Abstract
Freezing of gait (FOG) is a common, disabling gait disturbance in Parkinson’s disease (PD) and other Parkinsonian syndromes. Freezing also occurs during non-gait movements involving the upper limbs. The mechanisms underlying freezing are complex, likely involving motor, cognitive, and sensory systems that contribute to the episodes. Here, we reported a 60-year-old female with a 24-year history of parkinsonism who experienced significant FOG when ambulatory. Disease progression resulted in her permanent use of a powered wheelchair. While using the power chair, the patient experiences apparent paroxysmal freezing in the hand and arm used to steer and propel the chair. These episodes, some lasting up to several minutes, occur only in circumstances (e.g., entering and leaving an elevator) that are similar to environments known to elicit and exacerbate FOG. Episodes are transient and can be volitionally interrupted by the patient but sometimes require external assistance. Therapeutic intervention for this type of potential freezing has yet to be determined. This case may provide insight into the complex nature of freezing behavior and suggests a need for new approaches to treating non-traditional freezing behavior.
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Affiliation(s)
- Samuel T Nemanich
- Program in Physical Therapy, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Marie E McNeely
- Program in Physical Therapy, Washington University School of Medicine in St. Louis, St. Louis, MO, USA.,Department of Neurology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Gammon M Earhart
- Program in Physical Therapy, Washington University School of Medicine in St. Louis, St. Louis, MO, USA.,Department of Neurology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA.,Department of Neuroscience, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Scott A Norris
- Department of Neurology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Kevin J Black
- Department of Neurology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA.,Department of Neuroscience, Washington University School of Medicine in St. Louis, St. Louis, MO, USA.,Department of Radiology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA.,Department of Psychiatry, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
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44
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Eisenstein SA, Bogdan R, Chen L, Moerlein SM, Black KJ, Perlmutter JS, Hershey T, Barch DM. Preliminary evidence that negative symptom severity relates to multilocus genetic profile for dopamine signaling capacity and D2 receptor binding in healthy controls and in schizophrenia. J Psychiatr Res 2017; 86:9-17. [PMID: 27886638 PMCID: PMC5272837 DOI: 10.1016/j.jpsychires.2016.11.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [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: 07/19/2016] [Revised: 10/07/2016] [Accepted: 11/15/2016] [Indexed: 12/31/2022]
Abstract
Deficits in central, subcortical dopamine (DA) signaling may underlie negative symptom severity, particularly anhedonia, in healthy individuals and in schizophrenia. To investigate these relationships, we assessed negative symptoms with the Schedule for the Assessment of Negative Symptoms and the Brief Negative Symptom Scale (BNSS) and self-reported anhedonia with the Scales for Physical and Social Anhedonia (SPSA), Temporal Experience of Pleasure Scale, and Snaith-Hamilton Pleasure Scale in 36 healthy controls (HC), 27 siblings (SIB) of individuals with schizophrenia, and 66 individuals with schizophrenia or schizoaffective disorder (SCZ). A subset of participants (N = 124) were genotyped for DA-related polymorphisms in genes for DRD4, DRD2/ANKK1, DAT1, and COMT, which were used to construct biologically-informed multi-locus genetic profile (MGP) scores reflective of subcortical dopaminergic signaling. DA receptor type 2 (D2R) binding was assessed among a second subset of participants (N = 23) using PET scans with the D2R-selective, non-displaceable radioligand (N-[11C]methyl)benperidol. Higher MGP scores, reflecting elevated subcortical dopaminergic signaling capacity, were associated with less negative symptom severity, as measured by the BNSS, across all participants. In addition, higher striatal D2R binding was associated with less physical and social anhedonia, as measured by the SPSA, across HC, SIB, and SCZ. The current preliminary findings support the hypothesis that subcortical DA function may contribute to negative symptom severity and self-reported anhedonia, independent of diagnostic status.
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Affiliation(s)
- Sarah A. Eisenstein
- Psychiatry Department, Washington University School of Medicine, St. Louis, MO, USA,Radiology Department, Washington University School of Medicine, St. Louis, MO, USA,Corresponding author, Sarah A. Eisenstein, Psychiatry Department, Campus Box 8225, Washington University School of Medicine, St. Louis, MO 63110, Phone: (314) 362-7107, Fax: (314) 362-0168,
| | - Ryan Bogdan
- Psychological & Brain Sciences Department, Washington University in St. Louis, St. Louis, MO, USA.
| | - Ling Chen
- Division of Biostatistics, Washington University School of Medicine, St. Louis, MO, USA.
| | - Stephen M. Moerlein
- Radiology Department, Washington University School of Medicine, St. Louis, MO, USA,Biochemistry Department, Washington University School of Medicine, St. Louis, MO, USA
| | - Kevin J. Black
- Psychiatry Department, Washington University School of Medicine, St. Louis, MO, USA,Radiology Department, Washington University School of Medicine, St. Louis, MO, USA,Neurology Department, Washington University School of Medicine, St. Louis, MO, USA,Neuroscience Department, Washington University School of Medicine, MO, USA
| | - Joel S. Perlmutter
- Radiology Department, Washington University School of Medicine, St. Louis, MO, USA,Biochemistry Department, Washington University School of Medicine, St. Louis, MO, USA,Programs in Physical Therapy and Occupational Therapy, Washington University School of Medicine, St. Louis, MO, USA
| | - Tamara Hershey
- Psychiatry Department, Washington University School of Medicine, St. Louis, MO, USA; Radiology Department, Washington University School of Medicine, St. Louis, MO, USA; Psychological & Brain Sciences Department, Washington University in St. Louis, St. Louis, MO, USA; Neurology Department, Washington University School of Medicine, St. Louis, MO, USA.
| | - Deanna M. Barch
- Psychiatry Department, Washington University School of Medicine, St. Louis, MO, USA,Radiology Department, Washington University School of Medicine, St. Louis, MO, USA,Psychological & Brain Sciences Department, Washington University in St. Louis, St. Louis, MO, USA
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45
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Abstract
Motor and vocal tics are relatively common motor manifestations identified as the core features of Tourette's syndrome (TS). Although traditional descriptions have focused on objective phenomenological observations, such as anatomical location, number and frequency of tics, patients' first-person accounts have consistently reported characteristic subjective correlates. These sensory phenomena are often described as a feeling of mounting inner tension or urge to move ("premonitory urge"), which is transiently relieved by tic expression. This article reviews the existing literature on the clinical and neurobiological aspects of the premonitory urge in patients with TS, with focus on its pathophysiology and possible treatment implications.
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Affiliation(s)
- Andrea E. Cavanna
- Department of Neuropsychiatry Research Group, BSMHFT and University of Birmingham, Birmingham, UK,School of Life and Health Sciences, Aston University, Birmingham, UK,University College London and Institute of Neurology, London, UK,Corresponding author: Andrea E. Cavanna, MD PhD FRCP, Department of Neuropsychiatry, The Barberry National Centre for Mental Health, 25 Vincent Drive, Birmingham B152FG, United Kingdom, , Tel: +44 121 3012280
| | - Kevin J Black
- Departments of Psychiatry, Neurology, Radiology, and Anatomy & Neuroscience, Washington University School of Medicine, St. Louis, MO, USA
| | - Mark Hallett
- Human Motor Control Section, Medical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Valerie Voon
- Department of Psychiatry, University of Cambridge, Cambridge, UK,Behavioural and Clinical Neurosciences Institute, Cambridge, UK,Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
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46
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Pepino MY, Eisenstein SA, Bischoff AN, Klein S, Moerlein SM, Perlmutter JS, Black KJ, Hershey T. Sweet Dopamine: Sucrose Preferences Relate Differentially to Striatal D2 Receptor Binding and Age in Obesity. Diabetes 2016; 65:2618-23. [PMID: 27307220 PMCID: PMC5001180 DOI: 10.2337/db16-0407] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Accepted: 05/31/2016] [Indexed: 11/13/2022]
Abstract
Alterations in dopaminergic circuitry play a critical role in food reward and may contribute to susceptibility to obesity. Ingestion of sweets releases dopamine in striatum, and both sweet preferences and striatal D2 receptors (D2R) decline with age and may be altered in obesity. Understanding the relationships between these variables and the impact of obesity on these relationships may reveal insight into the neurobiological basis of sweet preferences. We evaluated sucrose preferences, perception of sweetness intensity, and striatal D2R binding potential (D2R BPND) using positron emission tomography with a D2R-selective radioligand insensitive to endogenous dopamine, (N-[(11)C] methyl)benperidol, in 20 subjects without obesity (BMI 22.5 ± 2.4 kg/m(2); age 28.3 ± 5.4 years) and 24 subjects with obesity (BMI 40.3 ± 5.0 kg/m(2); age 31.2 ± 6.3 years). The groups had similar sucrose preferences, sweetness intensity perception, striatal D2R BPND, and age-related D2R BPND declines. However, both striatal D2R BPND and age correlated with sucrose preferences in subjects without obesity, explaining 52% of their variance in sucrose preference. In contrast, these associations were absent in the obese group. In conclusion, the age-related decline in D2R was not linked to the age-related decline in sweetness preferences, suggesting that other, as-yet-unknown mechanisms play a role and that these mechanisms are disrupted in obesity.
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Affiliation(s)
- Marta Y Pepino
- Atkins Center of Excellence in Obesity Medicine, Center for Human Nutrition, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Sarah A Eisenstein
- Department of Psychiatry, Washington University School of Medicine in St. Louis, St. Louis, MO Department of Radiology, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Allison N Bischoff
- Department of Psychiatry, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Samuel Klein
- Atkins Center of Excellence in Obesity Medicine, Center for Human Nutrition, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Stephen M Moerlein
- Department of Radiology, Washington University School of Medicine in St. Louis, St. Louis, MO Department of Biochemistry and Molecular Biophysics, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Joel S Perlmutter
- Department of Radiology, Washington University School of Medicine in St. Louis, St. Louis, MO Department of Neurology, Washington University School of Medicine in St. Louis, St. Louis, MO Department of Neuroscience, Washington University School of Medicine in St. Louis, St. Louis, MO Department of Occupational Therapy, Washington University School of Medicine in St. Louis, St. Louis, MO Department of Physical Therapy, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Kevin J Black
- Department of Psychiatry, Washington University School of Medicine in St. Louis, St. Louis, MO Department of Radiology, Washington University School of Medicine in St. Louis, St. Louis, MO Department of Neurology, Washington University School of Medicine in St. Louis, St. Louis, MO Department of Neuroscience, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Tamara Hershey
- Department of Psychiatry, Washington University School of Medicine in St. Louis, St. Louis, MO Department of Radiology, Washington University School of Medicine in St. Louis, St. Louis, MO Department of Neurology, Washington University School of Medicine in St. Louis, St. Louis, MO
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47
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Abstract
Population-based assessment of Tourette syndrome (TS) and other tic disorders produces a paradox. On one hand, ideally diagnosis of tic disorders requires expert observation. In fact, diagnostic criteria for TS explicitly require expert assessment of tics for a definite diagnosis. On the other hand, large-scale population surveys with expert assessment of every subject are impracticable. True, several published studies have successfully used expert assessment to find tic prevalence in a representative population (e.g. all students in a school district). However, extending these studies to larger populations is daunting. We created a multimedia tool to demonstrate tics to a lay audience, discuss their defining and common attributes, and address features that differentiate tics from other movements and vocalizations. A first version was modified to improve clarity and to include a more diverse group in terms of age and ethnicity. The result is a tool intended for epidemiological research. It may also provide additional benefits, such as more representative minority recruitment for other TS studies and increased community awareness of TS.
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Affiliation(s)
- M Jonathan Vachon
- College of Arts and Sciences, Washington University in St. Louis, University City, USA
| | - Catherine W Striley
- Department of Epidemiology, Colleges of Medicine and Public Health & Health Professions, University of Florida, Gainesville, USA
| | - Mollie R Gordon
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, USA
| | | | - Emily C Bihun
- Department of Psychiatry, Washington University School of Medicine, St. Louis, USA
| | - Jonathan M Koller
- Department of Psychiatry, Washington University School of Medicine, St. Louis, USA
| | - Kevin J Black
- Departments of Psychiatry, Neurology, Radiology, and Neuroscience, Washington University School of Medicine, St. Louis, USA
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48
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Abstract
We present selected highlights from research that appeared during 2015 on Tourette syndrome and other tic disorders. Topics include phenomenology, comorbidities, developmental course, genetics, animal models, neuroimaging, electrophysiology, pharmacology, and treatment. We briefly summarize articles whose results we believe may lead to new treatments, additional research or modifications in current models of TS.
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Affiliation(s)
- Cheryl A Richards
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA; Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Kevin J Black
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA; Department of Neurology, Washington University School of Medicine, St. Louis, Missouri, USA; Department of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA; Department of Neuroscience, Washington University School of Medicine, St. Louis, Missouri, USA
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49
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Eisenstein SA, Bogdan R, Love-Gregory L, Corral-Frías NS, Koller JM, Black KJ, Moerlein SM, Perlmutter JS, Barch DM, Hershey T. Prediction of striatal D2 receptor binding by DRD2/ANKK1 TaqIA allele status. Synapse 2016; 70:418-31. [PMID: 27241797 DOI: 10.1002/syn.21916] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [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: 04/15/2016] [Revised: 05/26/2016] [Accepted: 05/27/2016] [Indexed: 01/04/2023]
Abstract
In humans, the A1 (T) allele of the dopamine (DA) D2 receptor/ankyrin repeat and kinase domain containing 1 (DRD2/ANKK1) TaqIA (rs1800497) single nucleotide polymorphism has been associated with reduced striatal DA D2/D3 receptor (D2/D3R) availability. However, radioligands used to estimate D2/D3R are displaceable by endogenous DA and are nonselective for D2R, leaving the relationship between TaqIA genotype and D2R specific binding uncertain. Using the positron emission tomography (PET) radioligand, (N-[(11) C]methyl)benperidol ([(11) C]NMB), which is highly selective for D2R over D3R and is not displaceable by endogenous DA, the current study examined whether DRD2/ANKK1 TaqIA genotype predicts D2R specific binding in two independent samples. Sample 1 (n = 39) was composed of obese and nonobese adults; sample 2 (n = 18) was composed of healthy controls, unmedicated individuals with schizophrenia, and siblings of individuals with schizophrenia. Across both samples, A1 allele carriers (A1+) had 5 to 12% less striatal D2R specific binding relative to individuals homozygous for the A2 allele (A1-), regardless of body mass index or diagnostic group. This reduction is comparable to previous PET studies of D2/D3R availability (10-14%). The pooled effect size for the difference in total striatal D2R binding between A1+ and A1- was large (0.84). In summary, in line with studies using displaceable D2/D3R radioligands, our results indicate that DRD2/ANKK1 TaqIA allele status predicts striatal D2R specific binding as measured by D2R-selective [(11) C]NMB. These findings support the hypothesis that DRD2/ANKK1 TaqIA allele status may modify D2R, perhaps conferring risk for certain disease states.
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Affiliation(s)
- Sarah A Eisenstein
- Department of Psychiatry, Washington University in St. Louis, St. Louis, MO, 63110.,Department of Radiology, Washington University in St. Louis, St. Louis, MO, 63110
| | - Ryan Bogdan
- Department of Psychological & Brain Sciences, Washington University in St. Louis, St. Louis, MO, 63130
| | - Latisha Love-Gregory
- Department of Medicine, Washington University in St. Louis, St. Louis, MO, 63110
| | - Nadia S Corral-Frías
- Department of Psychiatry, Washington University in St. Louis, St. Louis, MO, 63110
| | - Jonathan M Koller
- Department of Psychiatry, Washington University in St. Louis, St. Louis, MO, 63110
| | - Kevin J Black
- Department of Psychiatry, Washington University in St. Louis, St. Louis, MO, 63110.,Department of Radiology, Washington University in St. Louis, St. Louis, MO, 63110.,Department of Neurology, Washington University in St. Louis, St. Louis, MO, 63110.,Department of Neuroscience, Washington University in St. Louis, St. Louis, MO, 63110
| | - Stephen M Moerlein
- Department of Radiology, Washington University in St. Louis, St. Louis, MO, 63110.,Department of Biochemistry, Washington University in St. Louis, St. Louis, MO, 63110
| | - Joel S Perlmutter
- Department of Radiology, Washington University in St. Louis, St. Louis, MO, 63110.,Department of Neurology, Washington University in St. Louis, St. Louis, MO, 63110.,Programs in Physical Therapy and Occupational Therapy, Washington University in St. Louis, St. Louis, MO, 63110
| | - Deanna M Barch
- Department of Psychiatry, Washington University in St. Louis, St. Louis, MO, 63110.,Department of Radiology, Washington University in St. Louis, St. Louis, MO, 63110.,Department of Psychological & Brain Sciences, Washington University in St. Louis, St. Louis, MO, 63130
| | - Tamara Hershey
- Department of Psychiatry, Washington University in St. Louis, St. Louis, MO, 63110.,Department of Radiology, Washington University in St. Louis, St. Louis, MO, 63110.,Department of Psychological & Brain Sciences, Washington University in St. Louis, St. Louis, MO, 63130.,Department of Neurology, Washington University in St. Louis, St. Louis, MO, 63110
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50
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Abstract
The child with recent onset of tics is a common patient in a pediatrics or child neurology practice. If the child’s first tic was less than a year in the past, the diagnosis is usually Provisional Tic Disorder (PTD). Published reviews by experts reveal substantial consensus on prognosis in this situation: the tics will almost always disappear in a few months, having remained mild while they lasted. Surprisingly, however, the sparse existing data may not support these opinions. PTD may have just as much importance for science as for clinical care. It provides an opportunity to prospectively observe the spontaneous remission of tics. Such prospective studies may aid identification of genes or biomarkers specifically associated with remission rather than onset of tics. A better understanding of tic remission may also suggest novel treatment strategies for Tourette syndrome, or may lead to secondary prevention of tic disorders. This review summarizes the limited existing data on the epidemiology, phenomenology, and outcome of PTD, highlights areas in which prospective study is sorely needed, and proposes that tic disorders may completely remit much less often than is generally believed.
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Affiliation(s)
- Kevin J Black
- Departments of Psychiatry, Washington University School of Medicine, St. Louis, USA; Departments of Neurology, Washington University School of Medicine, St. Louis, USA; Departments of Radiology, Washington University School of Medicine, St. Louis, USA; Departments of Neuroscience, Washington University School of Medicine, St. Louis, USA
| | | | - Deanna J Greene
- Departments of Psychiatry, Washington University School of Medicine, St. Louis, USA; Departments of Radiology, Washington University School of Medicine, St. Louis, USA
| | - Bradley L Schlaggar
- Departments of Psychiatry, Washington University School of Medicine, St. Louis, USA; Departments of Neurology, Washington University School of Medicine, St. Louis, USA; Departments of Radiology, Washington University School of Medicine, St. Louis, USA; Departments of Neuroscience, Washington University School of Medicine, St. Louis, USA; Departments of Pediatrics, Washington University School of Medicine, St. Louis, USA
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