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Tourette syndrome or Tourette's syndrome is a common neurodevelopmental disorder that begins in childhood or adolescence. It is characterized by multiple movement (motor) tics and at least one vocal (phonic) tic. Common tics are blinking, coughing, throat clearing, sniffing, and facial movements. These are typically preceded by an unwanted urge or sensation in the affected muscles known as a premonitory urge, can sometimes be suppressed temporarily, and characteristically change in location, strength, and frequency. Tourette's is at the more severe end of a spectrum of tic disorders. The tics often go unnoticed by casual observers.
A tic is a sudden, repetitive, nonrhythmic motor movement or vocalization involving discrete muscle groups. Tics can be invisible to the observer, such as abdominal tensing or toe crunching. Common motor and phonic tics are, respectively, eye blinking and throat clearing.
Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) is a hypothetical diagnosis whereby a subset of children with rapid onset of obsessive-compulsive disorder (OCD) or tic disorders symptoms are supposedly caused by group A beta-hemolytic streptococcal (GABHS) infections. The proposed link between infection and these disorders is that an initial autoimmune reaction to a GABHS infection produces antibodies that interfere with basal ganglia function, causing symptom exacerbations. It has been proposed that this autoimmune response can result in a broad range of neuropsychiatric symptoms. The PANDAS hypothesis was based on observations in clinical case studies at the US National Institutes of Health and in subsequent clinical trials where children appeared to have dramatic and sudden OCD exacerbations and tic disorders following infections.
Tic disorders are defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM) based on type and duration of tics. Tic disorders are defined similarly by the World Health Organization.
An intrusive thought is an unwelcome, involuntary thought, image, or unpleasant idea that may become an obsession, is upsetting or distressing, and can feel difficult to manage or eliminate. When such thoughts are associated with obsessive-compulsive disorder (OCD), depression, body dysmorphic disorder (BDD), and sometimes attention-deficit hyperactivity disorder (ADHD), the thoughts may become paralyzing, anxiety-provoking, or persistent. Intrusive thoughts may also be associated with episodic memory, unwanted worries or memories from OCD, post-traumatic stress disorder, other anxiety disorders, eating disorders, or psychosis. Intrusive thoughts, urges, and images are of inappropriate things at inappropriate times, and generally have aggressive, sexual, or blasphemous themes.
Tourette syndrome is an inherited neurodevelopmental disorder that begins in childhood or adolescence, characterized by the presence of motor and phonic tics. The management of Tourette syndrome has the goal of managing symptoms to achieve optimum functioning, rather than eliminating symptoms; not all persons with Tourette's require treatment, and there is no cure or universally effective medication. Explanation and reassurance alone are often sufficient treatment; education is an important part of any treatment plan.
Arthur K. Shapiro, M.D., was a psychiatrist and expert on Tourette syndrome. His "contributions to the understanding of Tourette syndrome completely changed the prevailing view of this disorder"; he has been described as "the father of modern tic disorder research" and is "revered by his colleagues as the first dean of modern Tourette syndrome researchers".
The obsessive–compulsive spectrum is a model of medical classification where various psychiatric, neurological and/or medical conditions are described as existing on a spectrum of conditions related to obsessive–compulsive disorder (OCD). "The disorders are thought to lie on a spectrum from impulsive to compulsive where impulsivity is said to persist due to deficits in the ability to inhibit repetitive behavior with known negative consequences, while compulsivity persists as a consequence of deficits in recognizing completion of tasks." OCD is a mental disorder characterized by obsessions and/or compulsions. An obsession is defined as "a recurring thought, image, or urge that the individual cannot control". Compulsion can be described as a "ritualistic behavior that the person feels compelled to perform". The model suggests that many conditions overlap with OCD in symptomatic profile, demographics, family history, neurobiology, comorbidity, clinical course and response to various pharmacotherapies. Conditions described as being on the spectrum are sometimes referred to as obsessive–compulsive spectrum disorders.
Tourette syndrome is an inherited neurological disorder that begins in childhood or adolescence, characterized by the presence of multiple physical (motor) tics and at least one vocal (phonic) tic.
Obsessive–compulsive disorder (OCD) is a mental and behavioral disorder in which a person has intrusive thoughts and/or feels the need to perform certain routines repeatedly to an extent where it induces distress or impairs one's general functioning.
The biology of obsessive–compulsive disorder (OCD) refers biologically based theories about the mechanism of OCD. Cognitive models generally fall into the category of executive dysfunction or modulatory control. Neuroanatomically, functional and structural neuroimaging studies implicate the prefrontal cortex (PFC), basal ganglia (BG), insula, and posterior cingulate cortex (PCC). Genetic and neurochemical studies implicate glutamate and monoamine neurotransmitters, especially serotonin and dopamine.
James Frederick Leckman, M.D., is a child psychiatrist and psychoanalyst and the Neison Harris Professor of Child Psychiatry, Psychiatry, Psychology and Pediatrics at the Yale School of Medicine, recognized for his research in Tourette syndrome (TS) and obsessive–compulsive disorder (OCD).
The Yale Global Tic Severity Scale (YGTSS) is a psychological measure designed to assess the severity and frequency of symptoms of disorders such as tic disorder, Tourette syndrome, and obsessive-compulsive disorder, in children and adolescents between ages 6 to 17.
The Dimensional Obsessive-Compulsive Scale (DOCS) is a 20-item self-report instrument that assesses the severity of Obsessive-Compulsive Disorder (OCD) symptoms along four empirically supported theme-based dimensions: (a) contamination, (b) responsibility for harm and mistakes, (c) incompleteness/symmetry, and (d) unacceptable (taboo) thoughts. The scale was developed in 2010 by a team of experts on OCD led by Jonathan Abramowitz, PhD to improve upon existing OCD measures and advance the assessment and understanding of OCD. The DOCS contains four subscales that have been shown to have good reliability, validity, diagnostic sensitivity, and sensitivity to treatment effects in a variety of settings cross-culturally and in different languages. As such, the DOCS meets the needs of clinicians and researchers who wish to measure current OCD symptoms or assess changes in symptoms over time.
Inference-based therapy (IBT) originated as a form of cognitive therapy developed for treating obsessive-compulsive disorder. IBT followed the observation that people with OCD often inferred danger on the basis of inverse inference. Later the model was extended to inferential confusion, where inverse inference leads to distrust of the senses and investment in remote possibility. In this model, individuals with obsessive-compulsive disorder are hypothesized to put a greater emphasis on an imagined possibility than on what can be perceived with the senses, and to confuse the imagined possibility with reality. According to inference-based therapy, obsessional thinking occurs when the person replaces reality and real probabilities with imagined possibilities; the obsession is hypothesize to concern a doubt about a possible state of affairs.
The Tourette Syndrome Clinical Global Impression (TS-CGI) is a psychological measure used to briefly assess severity of tics.
The Shapiro TS Severity Scale (STSS) is a psychological measure used to briefly assess severity of tics.
The Tourette's Disorder Scale (TODS) is a psychological measure used to assess tics and co-occurring conditions in tic disorders.
The Premonitory Urge for Tics Scale (PUTS) is a psychological measure used to assess premonitory urges preceding tics in tic disorders. It is not recommended for children ten and under.
The Autism – Tics, AD/HD, and other Comorbidities (A–TAC) is a psychological measure used to screen for other conditions occurring with tics. Along with tic disorders, it screens for autism spectrum disorders, attention deficit/hyperactivity disorder (ADHD) and other conditions with onset in childhood. The A-TAC has been reported as valid and reliable for detecting most disorders in children. One telephone survey found it was not validated for eating disorders.
References
- ↑ Martino D, Pringsheim TM, Cavanna AE, et al. (March 2017). "Systematic review of severity scales and screening instruments for tics: Critique and recommendations". Mov. Disord. (Review). 32 (3): 467–473. doi:10.1002/mds.26891. PMC 5482361 . PMID 28071825.
- ↑ Sukhodolsky DG, Gladstone TR, Kaushal SA, Piasecka JB, Leckman JF (2017). "Tics and Tourette Syndrome". In Matson JL (ed.). Handbook of Childhood Psychopathology and Developmental Disabilities Treatment. Autism and Child Psychopathology Series. p. 248.
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