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    Tic Disorders: by Rawan Chakas

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    Rawan Chakas
    Tic disorders include Tourette's disorder, persistent motor or vocal tic disorder, and provisional tic disorder. Tics are involuntary movements or vocalizations that can be exacerbated by stress or fatigue. Tourette's is characterized by multiple motor and at least one vocal tic present for over a year before age 18. It has a genetic basis and may involve abnormalities in the basal ganglia and prefrontal cortex. Treatment includes behavior therapy and medication like alpha-2 agonists or antipsychotics. Tics typically improve in adolescence but can persist into adulthood.

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    Tic Disorders: by Rawan Chakas

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    Rawan Chakas
    145 views17 pages
    Tic disorders include Tourette's disorder, persistent motor or vocal tic disorder, and provisional tic disorder. Tics are involuntary movements or vocalizations that can be exacerbated by stress or fatigue. Tourette's is characterized by multiple motor and at least one vocal tic present for over a year before age 18. It has a genetic basis and may involve abnormalities in the basal ganglia and prefrontal cortex. Treatment includes behavior therapy and medication like alpha-2 agonists or antipsychotics. Tics typically improve in adolescence but can persist into adulthood.

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    Tic disorders include Tourette's disorder, persistent motor or vocal tic disorder, and provisional tic disorder. Tics are involuntary movements or vocalizations that can be exacerbated by stress or fatigue. Tourette's is characterized by multiple motor and at least one vocal tic present for over a year before age 18. It has a genetic basis and may involve abnormalities in the basal ganglia and prefrontal cortex. Treatment includes behavior therapy and medication like alpha-2 agonists or antipsychotics. Tics typically improve in adolescence but can persist into adulthood.

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    145 views17 pages

    Tic Disorders: by Rawan Chakas

    Uploaded by

    Rawan Chakas
    Tic disorders include Tourette's disorder, persistent motor or vocal tic disorder, and provisional tic disorder. Tics are involuntary movements or vocalizations that can be exacerbated by stress or fatigue. Tourette's is characterized by multiple motor and at least one vocal tic present for over a year before age 18. It has a genetic basis and may involve abnormalities in the basal ganglia and prefrontal cortex. Treatment includes behavior therapy and medication like alpha-2 agonists or antipsychotics. Tics typically improve in adolescence but can persist into adulthood.

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    Tic Disorders

    BY RAWAN CHAKAS
    Outline Epidemiology

    Definition & Diagnostic criteria

    Etiology

    Treatment

    Course & Prognosis

    Tourette’s disorder, Persistent motor or vocal


    tic disorder and Provisional tic disorder
    What are tics?

     Tics are sudden, rapid, repetitive, stereotyped movements or vocalizations


     Tics may be simple or complex
     Although experienced as involuntary, patients can learn to temporarily
    suppress tics.
     Prior to the tic, patients may feel a premonitory urge (somatic sensation), with
    subsequent tension release after the tic.
     Anxiety, excitement, and fatigue can be aggravating factors for tics.
    Epidemiology
     Transient tic behaviors: common in children.

     Tourette’s disorder: 3 / 1000 school-age child.

     Prevalence: boys > girls.


    Motor Tics
    Vocal tics

     Barking

     Coprolalia - utterance of obscene, taboo words as


    an abrupt, sharp bark or grunt.

     Echolalia - repeating others’ words.


    Tourette’s Disorder
     Multiple motor and at least 1 vocal tics (not
    DSM-V required to occur concurrently)

    Criteria  Symptoms should be present for more than 1 year


    since onset of first tic.
     Onset prior to age 18 years.
     Not caused by a substance (e.g., cocaine) or another
    medical condition (e.g. Huntington disease).

     One of the few psychiatric disorders in which


    diagnostic criteria do not require symptoms to cause
    significant distress
     Tourette’s disorder is the most severe of the tic disorders

     Vocal tics may appear many years after the motor tics, and they may wax and
    wane in frequency.

     The most common motor tics involve the face and head, such as eye blinking
    and throat clearing.
    Etiology

     Genetic factors: >55% concordance rate in monozygotic twins.

     Prenatal/perinatal factors: Older paternal age, obstetrical complications, maternal


    smoking, and low birth weight.

     Psychological factors: Symptom exacerbations with stressful life events.


    Etiology

     TS seems to be an inherited developmental disorder of synaptic


    neurotransmission. Further studies are needed to elucidate the physiologic and
    cellular mechanisms underlying tics and TS.

     The basal ganglia, particularly the caudate nucleus and the inferior prefrontal
    cortex, are implicated in the pathogenesis of TS.

     Volumetric magnetic resonance imaging studies have shown that children with
    TS have larger dorsolateral prefrontal regions as well as increased cortical
    white matter in the right frontal lobe.
    Treatment

     Psychoeducation.
     Behavioral interventions - habit reversal therapy.
     Medications - use only if tics become severely impairing or also treating
    comorbidities. Due to the fluctuating course of the disorder, it can be difficult to
    determine medication efficacy.
     Alpha-2 agonists: guanfacine (first choice), clonidine (more sedating).
     In severe cases, can consider treatment with atypical (e.g. risperidone) or
    typical antipsychotics (e.g. pimozide).
    Course & Prognosis

     Onset typically occurs between 4 and 6 years, with the peak severity between ages
    10 and 12.
     Tics wax and wane and change in type.
     Symptoms tend to decrease in adolescence and significantly diminish in
    adulthood.
     Two thirds of children with TS can expect a significant amelioration of or
    almost complete remission. Lifelong remissions are rare, however.
     High comorbidity with OCD, ADHD, learning disability, and autism spectrum
    disorder.
    References

     DSM-V
     MedScape - https://emedicine.medscape.com/article/289457-overview
    Thank you

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