46 Tic Disorders

TIC DISORDERS
Kaplan & Sadocks Synopsis of Psychiatry

Behavioral Sciences/ Clinical Psychiatry
Betita, Durell S.
Oliveros, Vanessa D.
TICS
defined as rapid and repetitive muscle
contractions resulting in movements or
vocalizations that are experienced as
involuntary
abnormal movements or vocalizations that most
commonly affect the muscles of the face & neck
eye-blinking, head-jerking, mouth-grimacing, head-shaking
Vocal Tics: throat-clearing, grunting, snorting, and
coughing
Children and adolescents

occur after a stimulus or in response to an
internal urge
with a stable or fluctuating course in
childhood and generally wane by
adolescence
Gilles de la Tourette syndrome (aka
Tourettes disorder) as most widely known &
most severe tic disorder: exhibit reduction or
complete remission of tic symptoms during
adolescence by half or two-thirds
Exacerbated by STRESS and ANXIETY
Obsessive-Compulsive Symptoms (OCD) coexist

in one third to two thirds of children with
Tourettes
1/3 of adults with Tourettes with persisting OCD
Tourettes + OCD:
Ordering
Symmetry
Counting
Repetitive Touching
OCD without Tourettes:

Fears of contamination
Fears of harming others
Children with Tourettes with higher IQ

(above 120), have higher risk of
developing OCD in early adulthood,
compared to those with average IQ of 100.
Tics suppressed for minutes or hours
Tics attenuated by sleep (may disappear
but not always), relaxation, absorption in
an activity
Diagnostic & Statistical Manual of

Mental Disorders (DSM-IV-TR)
Chronic Motor/ Vocal Tic Disorder
Transient Tic Disorder
Tic Disorder Not Otherwise Specified
MOTOR TICS
Simple Motor Tics repetitive, rapid contractions
of functionally similar muscle groups (eye-blinking,
neck-jerking, shoulder shrugging, facial-grimacing)
Complex Motor Tics purposeful, ritualistic than
simple tics (grooming behaviors, smelling of
objects, jumping, touching behaviors, echopraxia
or imitation of observed behavior, copropraxia or
display of obscene gestures
VOCAL TICS
Simple Vocal Tics coughing, throatclearing, grunting, sniffing, snorting, barking
Complex Vocal Tics repeating of words
or phrases out of context, coprolalia or use
of obscene words or phrases, palilalia or
repeating own words, echolalia or repetition
of last-heard words of others
Tourettes Disorder
Multiple Motor & one or more Vocal Tics
Causes distress or significant impairment in important

areas of functioning
Onset before 18 years old
Not caused by a substance or by general medical
condition
Georges Gilles de la Tourette (1875-1904) first described a
patient with this disorder and noted syndrome that
included multiple motor tics, coprolalia & echolalia
EPIDEMIOLOGY
4-5 per 10,000
More in children than adults
Onset of motor component occurs at 7
years old; vocal tics emerge at 11 years
old
More often in boys than girls
ETIOLOGY
Genetic Factors more in monozygotic twins than
dizogytic, transmission in autosomal dominant fashion,
relation to ADHD (half of all Tourettes patients)
Neurochemical & Neuroanatomical Factors dopamine
system involvement
Immunological Factors & Postinfection autoimmune
process secondary to Streptococcal infections as
potential mechanism , also associated in OCD
development
DSM-IV-TR Diagnostic Criteria for Tourette's

Disorder
Both multiple motor and one or more vocal tics have
been present at some time during the illness, although
not necessarily concurrently. (A tic is a sudden, rapid,
recurrent, nonrhythmic, stereotyped motor movement or
vocalization.)
The tics occur many times a day (usually in bouts) nearly
every day or intermittently throughout a period of more
than 1 year, and during this period there was never a ticfree period of more than 3 consecutive months.
DSM-IV-TR Diagnostic Criteria for Tourette's

Disorder
The onset is before age 18 years.
The disturbance is not due to the direct
physiological effects of a substance (e.g.,
stimulants) or a general medical condition (e.g.,
Huntington's disease or postviral encephalitis).
(From American Psychiatric Association.
Diagnostic and Statistical Manual of Mental Disorders. 4th ed.)
PATHOLOGY & LAB

EXAM
No specific lab diagnostic test

Nonspecific abnormal EEG
CT/ MRI revealed no specific
structural lesions
10% of patients with nonspecific
abnormality on CT scans
DIFFERENTIALS
Disordered Movements
(Dystonic, Choreiform, Athetoid,
Myoclonic, Hemiballismic)
Tremors, mannerisms,
stereotypic movement disorder
(head-banging, body rocking)
COURSE & PROGNOSIS

Childhood-onset neuropsychiatric
disorder
Motor & Vocal Tics
May decrease, persist, or increase, &
old symptoms replaced by new ones
May have serious emotional problems
(depression), academic, occupational
Coexistence of OCD and/or ADHD
CHRONIC MOTOR OR VOCAL TIC

DISORDER
Defined as presence of either Motor Tics or
Vocal Tics but not both
Other features same as Tourettes
Cannot be diagnosed if criteria for Tourettes
have ever been met
EPIDEMIOLOGY
100 1,000 X greater than Tourettes
School boys at higest risk, unknown
incidence
Rare, 1-2% of population
ETIOLOGY
High concordance in
monozygotic twins
DX & CLINICAL FEATURES

Early childhood
Chronic Vocal tics considerably
rarer than Chronic Motor tics
DIFFERENTIAL
DIAGNOSIS
Motor movements
Involuntary Vocal Utterances
(Huntingtons, Parkinsons)
COURSE & PROGNOSIS

Starts between 6 & 8 years old
Symptoms last for 4-6 years,
stops in early adolescence
Tics involving limbs or trunks
do less well than those with
only facial tics
TREATMENT
Psychotherapy
Reversal Treatments
Anxiolytic Agents
TRANSIENT TIC DISORDER

Presence of single tic or multiple motor or vocal
tics or both
Occur many times a day for at least 4 weeks, no
longer than 12 months
Common in children (5-24% of all school-age
children), unknown prevalence
Probably has organic origins, with some ticscombining psychogenic contributions
Occur many times a day nearly every day for

at least 4 weeks, no longer than 12 months
No Hx of Tourettes or Chronic Motor/ Vocal
Tics
Frequent among young children, not
associated with severe impairment
Doesnt necessarily progress to Chronic
Motor/ Vocal Tics, even Tourettes
Psychopharmacology is recommended only in
debilitating symptoms
Habit Reversal Treatment seen effective in
Transient Tics
DSM-IV-TR Diagnostic Criteria for Tic

Disorder
Not Otherwise Specified
This category is for disorders characterized by

tics that do not meet criteria for a specific tic
disorder. Examples include tics lasting less
than 4 weeks or tics with an onset after age
18 years.

46 Tic Disorders

Uploaded by

Copyright:

Available Formats

46 Tic Disorders

Uploaded by

Document Information

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

46 Tic Disorders

Uploaded by

Copyright:

Available Formats

TIC DISORDERS

Kaplan & Sadocks Synopsis of Psychiatry

Children and adolescents

Obsessive-Compulsive Symptoms (OCD) coexist

OCD without Tourettes:

Children with Tourettes with higher IQ

Diagnostic & Statistical Manual of

Causes distress or significant impairment in important

DSM-IV-TR Diagnostic Criteria for Tourette's

DSM-IV-TR Diagnostic Criteria for Tourette's

PATHOLOGY & LAB

No specific lab diagnostic test

COURSE & PROGNOSIS

CHRONIC MOTOR OR VOCAL TIC

DX & CLINICAL FEATURES

COURSE & PROGNOSIS

TRANSIENT TIC DISORDER

Occur many times a day nearly every day for

DSM-IV-TR Diagnostic Criteria for Tic

This category is for disorders characterized by

You might also like