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Brandt V, Essing J, Jakubovski E, Müller‐Vahl K. Premonitory Urge and Tic Severity, Comorbidities, and Quality of Life in Chronic Tic Disorders. Mov Disord Clin Pract 2023; 10:922-932. [PMID: 37332633 PMCID: PMC10272904 DOI: 10.1002/mdc3.13742] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 02/06/2023] [Accepted: 03/29/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Tics are intimately associated with premonitory urges (PU) but knowledge about urges is still limited, with small sample sizes often limiting the generalizability of findings. OBJECTIVES This study addressed the following open questions: (1) is tic severity associated with urge severity, (2) how common is relief, (3) which comorbidities are associated with urges, (4) are urges, tics, and comorbidities associated with lower quality of life, and (5) can complex and simple, motor and vocal tics be differentiated based on PU? METHODS N = 291 patients who reported a confirmed diagnosis of chronic primary tic disorder (age = 18-65, 24% female) filled out an online survey assessing demographic data, comorbid conditions, location, quality and intensity of PU, as well as quality of life. Every tic was recorded, and whether the patient experienced a PU, the frequency, intensity, and quality of that urge. RESULTS PU and tic severity were significantly associated, and 85% of urge-related tics were followed by relief. A diagnosis of attention deficit/hyperactivity disorder (ADHD) or depression, female gender, and older age increased the likelihood of experiencing PU, while more obsessive compulsive (OCD) symptoms and younger age were associated with higher urge intensities. PU, complex vocal tics, ADHD, OCD, anxiety, and depression were related to lower quality of life. Motor and vocal, complex and simple tics did not differ regarding PU intensity, frequency, and quality, or relief. CONCLUSIONS The results shed light on the relationship between PU, tics, comorbidities, age, gender, and quality of life in tic disorders.
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Affiliation(s)
- Valerie Brandt
- School of Psychology, Centre for Innovation in Mental healthUniversity of SouthamptonSouthamptonUK
- Clinic of Psychiatry, Social Psychiatry and PsychotherapyHannover Medical SchoolHanoverGermany
| | - Jana Essing
- Clinic of Psychiatry, Social Psychiatry and PsychotherapyHannover Medical SchoolHanoverGermany
| | - Ewgeni Jakubovski
- Clinic of Psychiatry, Social Psychiatry and PsychotherapyHannover Medical SchoolHanoverGermany
| | - Kirsten Müller‐Vahl
- Clinic of Psychiatry, Social Psychiatry and PsychotherapyHannover Medical SchoolHanoverGermany
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Isaacs DA, Narapareddy A, Eckland MR, Riordan HR. Dimensional Assessment of Depression and Anxiety in a Clinical Sample of Adults With Chronic Tic Disorder. J Neuropsychiatry Clin Neurosci 2023; 35:352-360. [PMID: 37089074 PMCID: PMC10726996 DOI: 10.1176/appi.neuropsych.20220197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
OBJECTIVE Among adults with Tourette syndrome, depression and anxiety symptoms are widely prevalent and consistently associated with poor quality of life. Important knowledge gaps remain regarding mood and anxiety dimensions of the adult Tourette syndrome phenotype. Taking a dimensional approach, this study sought to determine the prevalence, severity, and clinical correlates of depression and anxiety symptoms in a clinical sample of adults with Tourette syndrome and other chronic tic disorders. METHODS A retrospective chart review was conducted of all adults with a chronic tic disorder presenting to a tertiary care Tourette syndrome clinic between December 2020 and July 2022. Information extracted during chart review included data from scales administered as part of routine care: Quality of Life in Neurological Disorders (Neuro-QoL) Depression Short Form, Neuro-QoL Anxiety Short Form, Adult Attention-Deficit/Hyperactivity Disorder Self-Report Screening Scale, Dimensional Obsessive-Compulsive Scale, and Yale Global Tic Severity Scale. Relationships between variables were examined by conducting between-group, correlation, and multivariable regression analyses. RESULTS Data from 120 adult patients with a chronic tic disorder (77 men and 43 women) were analyzed. Neuro-QoL Anxiety scores were elevated in 66% of the cohort; Neuro-QoL Depression scores were elevated in 26%. Neuro-QoL Anxiety scores were significantly higher than general population norms, whereas Neuro-QoL Depression scores were not. After adjustment for covariates, depressive and anxiety symptom severity scores were significantly associated with each other and with obsessive-compulsive disorder symptom severity but not with tic severity. Sex-based differences emerged in the analyses. CONCLUSIONS Among adults with chronic tic disorder, anxiety symptoms were more prevalent and severe than depressive symptoms, co-occurring psychiatric symptoms were more tightly linked with each other than with tic severity, and sex-based differences were evident.
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Affiliation(s)
- David A. Isaacs
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, United States
- Department of Pediatrics, Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, TN, United States
| | | | - Michelle R. Eckland
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Heather R. Riordan
- Phelps Center for Cerebral Palsy and Developmental Medicine at Kennedy Krieger Institute, Baltimore, MD, United States
- Department of Pediatric Neurology, Johns Hopkins Children’s Center, Baltimore, MD, United States
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Sadeh DF, Frenk ML, Simha T, Horesh D, Steinberg T, Geva N, Nahon M, Dietrich A, Hoekstra PJ, Ruhrman D, Apter A, Fennig S, Benaroya-Milshtein N. Moderating Role of Depression on the Association of Tic Severity With Functional Impairment in Children. Pediatr Neurol 2023; 144:90-96. [PMID: 37196601 DOI: 10.1016/j.pediatrneurol.2023.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 04/08/2023] [Accepted: 04/17/2023] [Indexed: 05/19/2023]
Abstract
BACKGROUND Chronic tic disorders (CTDs) commonly co-occur with other psychiatric disorders. CTDs have been linked to functional impairment and reduction in quality of life. Insufficient research is available on depressive symptoms in patients with CTD, especially children and adolescents, yielding conflicting findings. To investigate the presence of depressive symptoms in a cohort of children and young adolescents with CTD and to test whether they moderate the link between tic severity and functional impairment. METHODS The sample consisted of 85 children and adolescents (six to 18 years) with a CTD who were treated in a large referral center. Participants were evaluated using gold-standard self- and clinician-reporting instruments to measure tic symptom severity and tic-related functional impairment (Yale Global Tic Severity Scale), depression (Child Depression Inventory), and obsessive-compulsive symptoms (Children Yale Brown Obsessive Compulsive Scale). RESULTS Depressive symptoms (mild to severe) were exhibited by 21% of our sample. Study participants with CTD and comorbid obsessive-compulsive disorder (OCD) and/or attention-deficit/hyperactivity disorder had higher rates of depressive symptoms compared with those without comorbidities. Significant correlations were found within and among all tic-related and OCD-related measures, yet depressive symptoms only correlated to tic-related functional impairment. Depression significantly and positively moderated the correlation between tic severity and tic-related functional impairment. CONCLUSIONS Findings suggest that depression plays an important part as a moderator in the link between tic severity and functional impairment in children and adolescents. Our study highlights the importance of screening for and treating depression in patients with CTD.
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Affiliation(s)
- Dana Feldman Sadeh
- Matta and Harry Freund Neuropsychiatric Clinic for Tourette Syndrome and Tic Disorders, The E. Richard Feinberg Department of Child and Adolescent Psychiatry, SCMCI, Petah Tiqwa, Israel
| | - Mira Levis Frenk
- Matta and Harry Freund Neuropsychiatric Clinic for Tourette Syndrome and Tic Disorders, The E. Richard Feinberg Department of Child and Adolescent Psychiatry, SCMCI, Petah Tiqwa, Israel
| | - Tomer Simha
- Matta and Harry Freund Neuropsychiatric Clinic for Tourette Syndrome and Tic Disorders, The E. Richard Feinberg Department of Child and Adolescent Psychiatry, SCMCI, Petah Tiqwa, Israel
| | - Danny Horesh
- Department of Psychology, Faculty of Social Science, Bar-Ilan University, Ramat Gan, Israel; Department of Psychiatry, New York University School of Medicine, New York, New York
| | - Tamar Steinberg
- Matta and Harry Freund Neuropsychiatric Clinic for Tourette Syndrome and Tic Disorders, The E. Richard Feinberg Department of Child and Adolescent Psychiatry, SCMCI, Petah Tiqwa, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nofar Geva
- Matta and Harry Freund Neuropsychiatric Clinic for Tourette Syndrome and Tic Disorders, The E. Richard Feinberg Department of Child and Adolescent Psychiatry, SCMCI, Petah Tiqwa, Israel
| | - Matan Nahon
- Department of Psychology, Faculty of Social Science, Bar-Ilan University, Ramat Gan, Israel
| | - Andrea Dietrich
- Department of Child and Adolescent Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Pieter J Hoekstra
- Department of Child and Adolescent Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Daphna Ruhrman
- Matta and Harry Freund Neuropsychiatric Clinic for Tourette Syndrome and Tic Disorders, The E. Richard Feinberg Department of Child and Adolescent Psychiatry, SCMCI, Petah Tiqwa, Israel; Baruch Ivcher School of Psychology, Interdisciplinary Center, Herzliya, Israel
| | - Alan Apter
- Matta and Harry Freund Neuropsychiatric Clinic for Tourette Syndrome and Tic Disorders, The E. Richard Feinberg Department of Child and Adolescent Psychiatry, SCMCI, Petah Tiqwa, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Silvana Fennig
- Matta and Harry Freund Neuropsychiatric Clinic for Tourette Syndrome and Tic Disorders, The E. Richard Feinberg Department of Child and Adolescent Psychiatry, SCMCI, Petah Tiqwa, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Noa Benaroya-Milshtein
- Matta and Harry Freund Neuropsychiatric Clinic for Tourette Syndrome and Tic Disorders, The E. Richard Feinberg Department of Child and Adolescent Psychiatry, SCMCI, Petah Tiqwa, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Nilles C, Hartmann A, Roze E, Martino D, Pringsheim T. Tourette syndrome and other tic disorders of childhood. HANDBOOK OF CLINICAL NEUROLOGY 2023; 196:457-474. [PMID: 37620085 DOI: 10.1016/b978-0-323-98817-9.00002-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Abstract
Tics are repetitive, patterned, and nonrhythmic movements or vocalizations/audible sounds that are misplaced in context. Phenomenology and characteristics of tics (e.g., premonitory urge, suppressibility) differentiate them from compulsions, stereotypies, functional tic-like behaviors, and other types of hyperkinetic movement disorders. With a prevalence of approximately 1% in school-aged boys, Tourette syndrome (TS) is considered a common childhood-onset neurodevelopmental disorder, defined by the combination of at least two motor tics and at least one phonic tic lasting more than 1 year. TS is a highly heritable disorder, with a wide spectrum of severity. In some individuals, tics can cause pain, distress, functional impairment, or stigmatization. About 90% of individuals with TS have at least one mental health comorbidity (attention-deficit/hyperactivity disorder, obsessive-compulsive disorder, anxiety/depressive disorders). These comorbidities significantly impact patients' quality of life and must therefore be screened and managed accordingly in this population. Treatment of tics is based on behavioral therapies targeting tics (habit reversal training included in the comprehensive behavioral intervention for tics, and exposure and response prevention for tics), in association with medication if needed (e.g., alpha-2-agonists, second-generation antipsychotics). Deep brain stimulation is considered an experimental option in the most severe, treatment-resistant patients. In adulthood, less than 25% of individuals still have moderate or severe tics.
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Affiliation(s)
- Christelle Nilles
- Department of Clinical Neurosciences, Psychiatry, Pediatrics and Community Health Sciences, University of Calgary, Calgary, AB, Canada; Department of Neurology, Pitié-Salpêtrière Hospital, Paris, France
| | - Andreas Hartmann
- Department of Neurology, Pitié-Salpêtrière Hospital, Paris, France; National Reference Center for Tourette Disorder, Pitié-Salpêtrière Hospital, Paris, France
| | - Emmanuel Roze
- Department of Neurology, Pitié-Salpêtrière Hospital, Paris, France; Faculty of Medicine of Sorbonne University, Institut du Cerveau et de la Moelle épinière, Paris, France
| | - Davide Martino
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Tamara Pringsheim
- Department of Clinical Neurosciences, Psychiatry, Pediatrics and Community Health Sciences, University of Calgary, Calgary, AB, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.
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Jalenques I, Guiguet-Auclair C, Cyrille D, Debosque C, Derost P, Hartmann A, Lauron S, Jameux C, Tauveron—Jalenques U, Rondepierre F. The French version of the Gilles de la Tourette Syndrome Quality of Life Scale for adolescents (GTS-QOL-French-Ado): Adaptation and psychometric evaluation. PLoS One 2022; 17:e0278383. [PMID: 36449509 PMCID: PMC9710837 DOI: 10.1371/journal.pone.0278383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 11/15/2022] [Indexed: 12/05/2022] Open
Abstract
INTRODUCTION The aim of this study was to create a new version of the French GTS-QOL adapted to adolescents with GTS aged 12-16 years (GTS-QOL-French-Ado) and to evaluate its psychometric properties. METHODS We assessed the psychometric properties of the GTS-QOL-French-Ado in 84 adolescents (mean age 13.6 years, standard deviation 1.2) in terms of factor structure, internal consistency, reliability and convergent validity with the Child Depression Inventory (CDI), the Multidimensional Anxiety Scale for Children (MASC), the Motor tic, Obsessions and compulsions, Vocal tic Evaluation Survey (MOVES) and the French "Vécu et Santé Perçue de l'Adolescent" (VSP-A), a generic self-administered measure of health-related quality of life (HRQoL) in adolescents. RESULTS Exploratory factor analysis of the GTS-QOL-French-Ado resulted in a 5-factor solution. The GTS-QOL-French-Ado demonstrated good acceptability with missing values per subscale ranging from 0% to 1.2%, good internal consistency for four of the five subscales with Cronbach's alpha ranging from 0.56 to 0.87 and good test-retest reliability with intraclass correlation coefficients ranging from 0.74 (95% CI: 0.52-0.86) to 0.82 (95% CI: 0.66-0.91). Convergent validity was supported by correlations with CDI, MASC, MOVES, VSP-A and clinical variables. DISCUSSION The GTS-QOL-French-Ado is the first disease-specific HRQoL tool for French-speaking adolescents with GTS aged 12-16 years, and shows good psychometric properties. Further psychometric testing on responsiveness to change would be of great interest.
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Affiliation(s)
- Isabelle Jalenques
- Service de Psychiatrie de l’Adulte A et Psychologie Médicale, Centre de Compétence Gilles de la Tourette, CNRS, Institut Pascal, CHU Clermont-Ferrand, Université Clermont Auvergne, Clermont-Ferrand, France
- * E-mail:
| | - Candy Guiguet-Auclair
- CNRS, Institut Pascal, CHU Clermont-Ferrand, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Diane Cyrille
- Service de Psychiatrie de l’Adulte A et Psychologie Médicale, CNRS, Institut Pascal, CHU Clermont-Ferrand, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Clement Debosque
- Service de Psychiatrie de l’Adulte A et Psychologie Médicale, CNRS, Institut Pascal, CHU Clermont-Ferrand, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Philippe Derost
- Service de Neurologie, CHU Clermont-Ferrand, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Andreas Hartmann
- Department of Neurology, National Reference Center for Tourette Syndrome, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Sophie Lauron
- Service de Psychiatrie de l’Adulte A et Psychologie Médicale, CNRS, Institut Pascal, CHU Clermont-Ferrand, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Clara Jameux
- Service de Psychiatrie de l’Adulte A et Psychologie Médicale, CNRS, Institut Pascal, CHU Clermont-Ferrand, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Urbain Tauveron—Jalenques
- Service de Psychiatrie de l’Adulte A et Psychologie Médicale, CNRS, Institut Pascal, CHU Clermont-Ferrand, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Fabien Rondepierre
- Service de Psychiatrie de l’Adulte A et Psychologie Médicale, Centre de Compétence Gilles de la Tourette, CNRS, Institut Pascal, CHU Clermont-Ferrand, Université Clermont Auvergne, Clermont-Ferrand, France
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Ricketts EJ, Montalbano GE, Burgess HJ, McMakin DL, Coles ME, Piacentini J, Colwell CS. Sleep and chronotype in adults with persistent tic disorders. J Clin Psychol 2022; 78:1516-1539. [PMID: 35150595 DOI: 10.1002/jclp.23323] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 12/22/2021] [Accepted: 01/14/2022] [Indexed: 01/01/2023]
Abstract
OBJECTIVE This study examined sleep disorders and sleep medication use rates, nighttime tics, and sleep and chronotype in relation to tic and co-occurring symptoms in adults with persistent tic disorders (PTDs), including Tourette's disorder (TD). METHODS One hundred twenty-five adult internet survey respondents rated sleep history, sleep, chronotype, tic severity, impairment, attention deficit hyperactivity disorder, obsessive-compulsive symptoms, anxiety, depression, and emotional and behavioral dyscontrol. RESULTS Bruxism, insomnia, tic-related difficulty falling asleep, and melatonin use were commonly endorsed. Sleep disturbance correlated with impairment, obsessive-compulsive symptoms, and emotional and behavioral dyscontrol. Eveningness correlated with vocal and total tic severity only in TD. Controlling for age and sex, age, impairment, and obsessive-compulsive symptoms predicted sleep disturbance, and age and tic severity predicted chronotype. CONCLUSIONS Impairment and obsessive-compulsive symptoms play a role in sleep disturbance in adults with PTDs, and may be intervention targets. Eveningness relates to tic severity, which may suggest the utility of interventions to advance chronotype.
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Affiliation(s)
- Emily J Ricketts
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, California, USA
| | - Gabrielle E Montalbano
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, California, USA
| | - Helen J Burgess
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Dana L McMakin
- Department of Psychology, Florida International University, Miami, Florida, USA.,Department of Neurology, Nicklaus Children's Hospital, Miami, Florida, USA
| | - Meredith E Coles
- Department of Psychology, State University of New York-Binghamton, Binghamton, New York, USA
| | - John Piacentini
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, California, USA
| | - Christopher S Colwell
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, California, USA
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Bond M, Moll N, Rosello A, Bond R, Schnell J, Burger B, Hoekstra PJ, Dietrich A, Schrag A, Kocovska E, Martino D, Mueller N, Schwarz M, Meier UC. Vitamin D levels in children and adolescents with chronic tic disorders: a multicentre study. Eur Child Adolesc Psychiatry 2022; 31:1-12. [PMID: 33851280 PMCID: PMC9343310 DOI: 10.1007/s00787-021-01757-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 03/08/2021] [Indexed: 11/24/2022]
Abstract
This study investigated whether vitamin D is associated with the presence or severity of chronic tic disorders and their psychiatric comorbidities. This cross-sectional study compared serum 25-hydroxyvitamin D [25(OH)D] (ng/ml) levels among three groups: children and adolescents (3-16 years) with CTD (n = 327); first-degree relatives (3-10 years) of individuals with CTD who were assessed for a period of up to 7 years for possible onset of tics and developed tics within this period (n = 31); and first-degree relatives who did not develop tics and were ≥ 10 years old at their last assessment (n = 93). The relationship between 25(OH)D and the presence and severity of tics, as well as comorbid obsessive-compulsive disorder (OCD) and attention-deficit/hyperactivity disorder (ADHD), were analysed controlling for age, sex, season, centre, latitude, family relatedness, and comorbidities. When comparing the CTD cohort to the unaffected cohort, the observed result was contrary to the one expected: a 10 ng/ml increase in 25(OH)D was associated with higher odds of having CTD (OR 2.08, 95% CI 1.27-3.42, p < 0.01). There was no association between 25(OH)D and tic severity. However, a 10 ng/ml increase in 25(OH)D was associated with lower odds of having comorbid ADHD within the CTD cohort (OR 0.55, 95% CI 0.36-0.84, p = 0.01) and was inversely associated with ADHD symptom severity (β = - 2.52, 95% CI - 4.16-0.88, p < 0.01). In conclusion, lower vitamin D levels were not associated with a higher presence or severity of tics but were associated with the presence and severity of comorbid ADHD in children and adolescents with CTD.
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Affiliation(s)
- Molly Bond
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, 4 Newark Street, London, E1 2AT, UK.
| | - Natalie Moll
- Institute of Laboratory Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Alicia Rosello
- Statistics, Modelling and Economic Department, National Infection Service, PHE, London, UK ,Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Rod Bond
- University of Sussex, Brighton, UK
| | - Jaana Schnell
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Bianka Burger
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Pieter J. Hoekstra
- Department of Child and Adolescent Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Andrea Dietrich
- Department of Child and Adolescent Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Anette Schrag
- Department of Clinical Neuroscience, UCL Institute of Neurology, University College London, London, UK
| | - Eva Kocovska
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, 4 Newark Street, London, E1 2AT UK
| | - Davide Martino
- Department of Clinical Neurosciences, Cumming School of Medicine and Hotchkiss Brain Institute, University of Calgary, Calgary, AB Canada
| | - Norbert Mueller
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Markus Schwarz
- Institute of Laboratory Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Ute-Christiane Meier
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK ,Ludwig-Maximilians-University Munich, Munich, Germany
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Kisten R, van Coller R, Cassimjee N, Lubbe E, Vaidyanathan J, Slabbert P, Enslin N, Schutte C. Efficacy of deep brain stimulation of the anterior-medial globus pallidus internus in tic and non-tic related symptomatology in refractory Tourette syndrome. Clin Park Relat Disord 2022; 7:100159. [PMID: 35990793 PMCID: PMC9385676 DOI: 10.1016/j.prdoa.2022.100159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 07/05/2022] [Accepted: 08/01/2022] [Indexed: 11/24/2022] Open
Abstract
Report of clinical outcomes of 5 patients with Tourette syndrome treated with anteromedial globus pallidus deep brain stimulation. All patients showed improvement in tics over a median follow up period of 37.4 months. Improvement in psychiatric outcome measures are specifically noted with a reduction in medication burden from the time of surgery to the last follow up.
Introduction Although refractory Tourette Syndrome (TS) is rare, it poses great challenges in clinical practice. Co-morbid psychiatric symptoms often occur, negatively impacting quality of life. Deep brain stimulation (DBS) targeting different brain structures seems effective for tics, but specific literature regarding response of psychiatric symptoms is more limited. This study aimed to assess the outcome of tics and non-tic related symptomatology in refractory TS treated with antero-medial globus pallidus interna (amGPi) DBS. Methods We included all patients with refractory TS (January 2013–August 2020) from the Brain Nerve Centre and Steve Biko Academic Hospital, Pretoria, South Africa, treated with bilateral amGPi DBS; retrospective baseline, early (up to 3 months) post-DBS follow-up assessment data, as well as prospective data from the latest follow-up (mean 37.4 months) were collected using standardised scoring tools and scales. Results Five patients were identified. Tics decreased by 63,9% (p = 0,002); quality of life improved by 39,8% (p = 0,015); self-injurious behaviour ceased; obsessive–compulsive symptoms resolved in all but one. The number of different chronic medications used more than halved. Transient stimulation-related adverse events occurred in four patients. Conclusion This study contributes to the data of the efficacy of amGPi-targeted DBS in refractory TS, showing improvement in quality of life and both tic- and non-tic-related symptomatology..
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Szejko N, Worbe Y, Hartmann A, Visser-Vandewalle V, Ackermans L, Ganos C, Porta M, Leentjens AFG, Mehrkens JH, Huys D, Baldermann JC, Kuhn J, Karachi C, Delorme C, Foltynie T, Cavanna AE, Cath D, Müller-Vahl K. European clinical guidelines for Tourette syndrome and other tic disorders-version 2.0. Part IV: deep brain stimulation. Eur Child Adolesc Psychiatry 2022; 31:443-461. [PMID: 34605960 PMCID: PMC8940783 DOI: 10.1007/s00787-021-01881-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 09/15/2021] [Indexed: 12/13/2022]
Abstract
In 2011 the European Society for the Study of Tourette Syndrome (ESSTS) published its first European clinical guidelines for the treatment of Tourette Syndrome (TS) with part IV on deep brain stimulation (DBS). Here, we present a revised version of these guidelines with updated recommendations based on the current literature covering the last decade as well as a survey among ESSTS experts. Currently, data from the International Tourette DBS Registry and Database, two meta-analyses, and eight randomized controlled trials (RCTs) are available. Interpretation of outcomes is limited by small sample sizes and short follow-up periods. Compared to open uncontrolled case studies, RCTs report less favorable outcomes with conflicting results. This could be related to several different aspects including methodological issues, but also substantial placebo effects. These guidelines, therefore, not only present currently available data from open and controlled studies, but also include expert knowledge. Although the overall database has increased in size since 2011, definite conclusions regarding the efficacy and tolerability of DBS in TS are still open to debate. Therefore, we continue to consider DBS for TS as an experimental treatment that should be used only in carefully selected, severely affected and otherwise treatment-resistant patients.
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Affiliation(s)
- Natalia Szejko
- Department of Neurology, Medical University of Warsaw, Banacha 1a, 02-091, Warsaw, Poland.
- Department of Bioethics, Medical University of Warsaw, Banacha 1a, 02-091, Warsaw, Poland.
- Department of Neurology, Yale School of Medicine, Yale University, New Haven, USA.
| | - Yulia Worbe
- Department on Neurophysiology, Saint Antoine Hospital, Sorbonne Université, Paris, France
- National Reference Center for Tourette Disorder, Pitié Salpetiere Hospital, Paris, France
| | - Andreas Hartmann
- Department of Neurosurgery, Pitié-Salpetriere Hospital, Sorbonne Université, Paris, France
| | - Veerle Visser-Vandewalle
- Department of Stereotactic and Functional Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Linda Ackermans
- Department of Neurosurgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Christos Ganos
- Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Mauro Porta
- Department of Neurosurgery and Neurology, IRCCS Instituto Ortopedico Galeazzi, Milan, Italy
| | - Albert F G Leentjens
- Department of Psychiatry, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Jan-Hinnerk Mehrkens
- Department of Neurosurgery, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Daniel Huys
- Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany
| | | | - Jens Kuhn
- Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany
- Department of Psychiatry, Psychotherapy, and Psychosomatics, Johanniter Hospital Oberhausen, Oberhausen, Germany
| | - Carine Karachi
- National Reference Center for Tourette Disorder, Pitié Salpetiere Hospital, Paris, France
- Department of Neurosurgery, Pitié-Salpetriere Hospital, Sorbonne Université, Paris, France
- Department of Neurology, Pitié-Salpetriere Hospital, Sorbonne Université, Paris, France
| | - Cécile Delorme
- Department of Neurosurgery, Pitié-Salpetriere Hospital, Sorbonne Université, Paris, France
| | - Thomas Foltynie
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, UK
| | - Andrea E Cavanna
- Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Danielle Cath
- Department of Specialist Trainings, GGZ Drenthe Mental Health Institution, Assen, The Netherlands
- Department of Psychiatry, University Medical Center Groningen, Rijks University Groningen, Groningen, The Netherlands
| | - Kirsten Müller-Vahl
- Clinic of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
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Eriguchi Y, Aoki N, Kano Y, Kasai K. Rotational plane-wise analysis of angular movement of neck motor tics in Tourette's syndrome. Prog Neuropsychopharmacol Biol Psychiatry 2021; 108:110092. [PMID: 32890695 DOI: 10.1016/j.pnpbp.2020.110092] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 08/25/2020] [Accepted: 08/30/2020] [Indexed: 11/26/2022]
Abstract
Motor tics are sudden, rapid, recurrent, non-rhythmic movements. There is a lack of quantitative assessment methods for the motor tics despite severe neck complications. We aimed to provide an improved quantitative method for neck tic assessment in motor tic disorders. We recorded neck motor tics in patients with motor tic disorders and voluntary neck movements in healthy controls. The maximum peak angular velocities and angular accelerations were calculated. Motor tics were assessed in three orthogonal planes (yaw, pitch, and roll) separately, and compared between the patients with motor tic disorders and controls. Correlations between the maximum angular velocities/accelerations and tic counts were also assessed. In the pitch plane, motor tics of the patients showed higher angular velocities/accelerations than voluntary movements of the controls. Angular acceleration in the yaw, and roll planes showed positive correlations with tic count. Some of the observed tics were comparable to the movements experienced in contact sports. Our findings may aid in the identification of populations at a high risk for severe neck complications among motor tic disorder patients.
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Affiliation(s)
- Yosuke Eriguchi
- Department of Child Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Department of Neuropsychiatry, Sakura Hospital, Aomori, Japan.
| | - Naoto Aoki
- Department of Neuropsychiatry, Sakura Hospital, Aomori, Japan
| | - Yukiko Kano
- Department of Child Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kiyoto Kasai
- Department of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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11
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Wang N, Qin DD, Xie YH, Wu XC, Wang DY, Hang-Yang, Li XX, Xiong L, Liang JH. Traditional Chinese Medicine Strategy for Patients with Tourette Syndrome Based on Clinical Efficacy and Safety: A Meta-Analysis of 47 Randomized Controlled Trials. BIOMED RESEARCH INTERNATIONAL 2021; 2021:6630598. [PMID: 33778073 PMCID: PMC7977981 DOI: 10.1155/2021/6630598] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 01/23/2021] [Accepted: 02/08/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Although increasing evidence reveals the efficacy of traditional Chinese medicine (TCM) and its safety on Tourette Syndrome (TS) patients, whether TCM is indeed improving TS remains unclear. The purpose of the current study is to perform a meta-analysis to evaluate the efficacy and safety of TCM on treating TS patients. METHOD An elaborate search strategy was conducted based on several databases including Medline, Embase, Cochrane, Web of Science, CINAHL, CBM, VIP, CNKI, and Wanfang Data in order to identify the relevant randomized controlled trials (RCTs) from their inception to as late as May 1st, 2020. General information and data needing analysis were extracted simultaneously for the necessity of various analyses such as descriptive analysis and metaquantitative analysis. RESULTS Forty-seven trials with 5437 TS patients in total were eventually included according to our criteria. All trials were conducted in China, and the publication years ranged from 2004 to 2017. In terms of clinical efficacy, clinical symptoms of patients with TCM were more likely to be improved compared with the control group (odds ratio, OR = -1.29, 95% confidence interval, CI: -2.54 to -0.06, I 2 = 0.00%). As to the outcome of recurrence rate, the pooled results revealed that the TCM group was more inclined to stabilize the recurrence (OR = 0.44, 95% CI: 0.24 to 0.78, I 2 = 0.00%). Similar results were observed in adverse reaction (OR = 0.32, 95% CI: 0.24 to 0.43, I 2 = 32.90%). CONCLUSION The results of our study recommend applying TCM to treat TS patients for better efficacy and safety. Results need to be interpreted cautiously due to certain limitations in our study.
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Affiliation(s)
- Na Wang
- School of Basic Medical Science, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
| | - Dong-dong Qin
- School of Basic Medical Science, Yunnan University of Chinese Medicine, Yunnan Kunming 650500, China
| | - Yu-huan Xie
- School of Basic Medical Science, Yunnan University of Chinese Medicine, Yunnan Kunming 650500, China
| | - Xin-chen Wu
- First Affiliated Hospital, Yunnan University of Chinese Medicine, Yunnan Kunming 650500, China
| | - Ding-yue Wang
- First Affiliated Hospital, Yunnan University of Chinese Medicine, Yunnan Kunming 650500, China
| | - Hang-Yang
- First Affiliated Hospital, Yunnan University of Chinese Medicine, Yunnan Kunming 650500, China
| | - Xiao-xuan Li
- First Affiliated Hospital, Yunnan University of Chinese Medicine, Yunnan Kunming 650500, China
| | - Lei Xiong
- School of Basic Medical Science, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
- School of Basic Medical Science, Yunnan University of Chinese Medicine, Yunnan Kunming 650500, China
| | - Jing-hong Liang
- Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
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12
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Isaacs DA, Riordan HR, Claassen DO. Clinical Correlates of Health-Related Quality of Life in Adults With Chronic Tic Disorder. Front Psychiatry 2021; 12:619854. [PMID: 33776814 PMCID: PMC7987653 DOI: 10.3389/fpsyt.2021.619854] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 02/15/2021] [Indexed: 11/30/2022] Open
Abstract
Tics are the hallmark feature of Tourette syndrome (TS), but psychiatric and sensory symptoms are widely prevalent and increasingly recognized as core manifestations of the disorder. Accumulating evidence suggests that these psychiatric and sensory symptoms exert greater influence on quality of life (QOL) than tics themselves. However, much remains uncertain about determinants of QOL in TS due to the complexity of the clinical presentation. Here, we sought to clarify the association between health-related QOL (HRQOL) and common psychiatric and sensory symptoms in adults with TS and other chronic tic disorders. To do so, we prospectively recruited 52 patients from a tertiary care clinic to complete self-report measures assessing HRQOL (Gilles de la Tourette-Quality of Life Scale, GTS-QOL), depression (Patient Health Questionnaire-9, PHQ-9), anxiety (Generalized Anxiety Disorder Scale-7, GAD-7), obsessive-compulsive symptoms (Dimensional Obsessive-Compulsive Scale, DOCS), attention deficit hyperactivity disorder symptoms (Adult ADHD Self-Report Screening Scale for DSM-5, ASRS-V), and premonitory urge (Premonitory Urge to Tic Scale, PUTS). All participants were also administered the Yale Global Tic Severity Scale (YGTSS) to quantify tic severity. Using correlational analysis and multivariable linear regression modeling, we found that GTS-QOL score was significantly associated with scores from all other rating scales, with the exception of the PUTS. GTS-QOL was most strongly associated with PHQ-9, followed by ASRS-V, GAD-7, DOCS, and YGTSS total tic score. The regression model including these five independent variables, as well as sex, explained 79% of GTS-QOL score variance [F (6,40) = 29.6, p < 0.001]. Specific psychiatric symptoms differentially impacted physical, psychological, and cognitive HRQOL. Systematic assessment of psychiatric comorbidities is imperative for clinical care and clinical research efforts directed at improving QOL in adults with chronic tic disorders.
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Affiliation(s)
- David A Isaacs
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, United States.,Department of Pediatrics, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, United States
| | - Heather R Riordan
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, United States.,Department of Pediatrics, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, United States
| | - Daniel O Claassen
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, United States
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13
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Jalenques I, Cyrille D, Derost P, Hartmann A, Lauron S, Jameux C, Tauveron-Jalenques U, Guiguet-Auclair C, Rondepierre F. Cross-cultural adaptation and psychometric evaluation of the French version of the Gilles de la Tourette Syndrome Quality of Life Scale (GTS-QOL). PLoS One 2020; 15:e0243912. [PMID: 33351837 PMCID: PMC7755204 DOI: 10.1371/journal.pone.0243912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 12/01/2020] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION The Gilles de la Tourette Syndrome-Quality of Life Scale (GTS-QOL) is a self-rated disease-specific questionnaire to assess health-related quality of life of subjects with GTS. Our aim was to perform the cross-cultural adaptation of the GTS-QOL into French and to assess its psychometric properties. METHODS The GTS-QOL was cross-culturally adapted by conducting forward and backward translations, following international guidelines. The psychometric properties of the GTS-QOL-French were assessed in 109 participants aged 16 years and above with regard to factor structure, internal consistency, reliability and convergent validity with the MOVES (Motor tic, Obsessions and compulsions, Vocal tic Evaluation Survey) and the WHOQOL-BREF (World Health Organization Quality of Life Brief). RESULTS Exploratory factor analysis of the GTS-QOL-French resulted in a 6-factor solution and did not replicate the original structure in four subscales. The results showed good acceptability (missing values per subscale ranging from 0% to 0.9%), good internal consistency (Cronbach's alpha ranging from 0.68 to 0.94) and good test-retest reliability (intraclass correlation coefficients ranging from 0.70 to 0.81). Convergent validity with the MOVES and WHOQOL-BREF scales showed high correlations. DISCUSSION Our study provides evidence of the good psychometric properties of the GTS-QOL-French. The cross-cultural adaptation and validation of this specific instrument will make it possible to assess health-related quality of life in French-speaking subjects with GTS. The GTS-QOL-French could be recommended for use in future research.
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Affiliation(s)
- Isabelle Jalenques
- Centre de Compétence Gilles de la Tourette, Service de Psychiatrie de l’Adulte A et Psychologie Médicale, CHU Clermont-Ferrand, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Diane Cyrille
- Centre de Compétence Gilles de la Tourette, Service de Psychiatrie de l’Adulte A et Psychologie Médicale, CHU Clermont-Ferrand, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Philippe Derost
- Service de Neurologie, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Andreas Hartmann
- Assistance Publique-Hôpitaux de Paris (AP-HP), Pitié-Salpêtrière Hospital, National Reference Center for Tourette Syndrome, Paris, France
| | - Sophie Lauron
- Centre de Compétence Gilles de la Tourette, Service de Psychiatrie de l’Adulte A et Psychologie Médicale, CHU Clermont-Ferrand, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Clara Jameux
- Centre de Compétence Gilles de la Tourette, Service de Psychiatrie de l’Adulte A et Psychologie Médicale, CHU Clermont-Ferrand, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Urbain Tauveron-Jalenques
- Centre de Compétence Gilles de la Tourette, Service de Psychiatrie de l’Adulte A et Psychologie Médicale, CHU Clermont-Ferrand, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Candy Guiguet-Auclair
- Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, Institut Pascal, Clermont-Ferrand, France
| | - Fabien Rondepierre
- Centre de Compétence Gilles de la Tourette, Service de Psychiatrie de l’Adulte A et Psychologie Médicale, CHU Clermont-Ferrand, Université Clermont Auvergne, Clermont-Ferrand, France
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14
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McGuire JF, Ricketts EJ, Scahill L, Wilhelm S, Woods DW, Piacentini J, Walkup JT, Peterson AL. Effect of behavior therapy for Tourette's disorder on psychiatric symptoms and functioning in adults. Psychol Med 2020; 50:2046-2056. [PMID: 31451122 PMCID: PMC7190082 DOI: 10.1017/s0033291719002150] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Although behavior therapy reduces tic severity, it is unknown whether it improves co-occurring psychiatric symptoms and functional outcomes for adults with Tourette's disorder (TD). This information is essential for effective treatment planning. This study examined the effects of behavior therapy on psychiatric symptoms and functional outcomes in older adolescents and adults with TD. METHOD A total of 122 individuals with TD or a chronic tic disorder participated in a clinical trial comparing behavior therapy to psychoeducation and supportive therapy. At baseline, posttreatment, and follow-up visits, participants completed assessments of tic severity, co-occurring symptoms (inattention, impulsiveness, hyperactivity, anger, anxiety, depression, obsessions, and compulsions), and psychosocial functioning. We compared changes in tic severity, psychiatric symptoms, and functional outcomes using repeated measure and one-way analysis of variance. RESULTS At posttreatment, participants receiving behavior therapy reported greater reductions in obsessions compared to participants in supportive therapy ($\eta _p^2 $ = 0.04, p = 0.04). Across treatments, a positive treatment response on the Clinical Global Impression of Improvement scale was associated with a reduced disruption in family life ($\eta _p^2 $ = 0.05, p = 0.02) and improved functioning in a parental role ($\eta _p^2 $ = 0.37, p = 0.02). Participants who responded positively to eight sessions of behavior therapy had an improvement in tic severity ($\eta _p^2 $ = 0.75, p < 0.001), inattention ($\eta _p^2 $ = 0.48, p < 0.02), and functioning ($\eta _p^2 $ = 0.39-0.42, p < 0.03-0.04) at the 6-month follow-up. CONCLUSION Behavior therapy has a therapeutic benefit for co-occurring obsessive symptoms in the short-term, and reduces tic severity and disability in adults with TD over time. Additional treatments may be necessary to address co-occurring symptoms and improve functional outcomes.
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Affiliation(s)
- Joseph F. McGuire
- Division of Child and Adolescent Psychiatry, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Emily J. Ricketts
- Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry, University of California Los Angeles, Los Angeles, California
| | - Lawrence Scahill
- Marcus Autism Center, Emory University School of Medicine, Atlanta, Georgia
| | - Sabine Wilhelm
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Douglas W. Woods
- Department of Psychology, Marquette University, Milwaukee, Wisconsin
| | - John Piacentini
- Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry, University of California Los Angeles, Los Angeles, California
| | | | - Alan L. Peterson
- Department of Psychiatry, University of Texas Health Science at Center, San Antonio, Texas
- Department of Psychology, University of Texas at San Antonio, San Antonio, Texas
- South Texas Veterans Health Care System, San Antonio, Texas
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15
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Interventions for tic disorders: An updated overview of systematic reviews and meta analyses. Psychiatry Res 2020; 287:112905. [PMID: 32163785 DOI: 10.1016/j.psychres.2020.112905] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 02/29/2020] [Accepted: 02/29/2020] [Indexed: 01/01/2023]
Abstract
To conduct an updated overview of systematic reviews (SRs) summarizing the efficacy and safety of various strategies used to treat tic disorders (TDs) in children. We searched the Cochrane Library, PubMed, EMBASE, and relevant reference lists for articles published between the search deadline from our last overview and April 2019 and included 16 SRs. The results presented that antipsychotics, a2-adrenergic receptor agonists, and HRT/CBIT still appeared to be the most robust evidence-based options for the treatment of TDs. Compared with our last overview, more robust evidence showed that aripiprazole and acupuncture was effective treatment in treating children TDs, and DBS for medication-refractory and severely affected patients. In addition, physical activity or exercise may be promising treatments, and the clonidine adhesive patch is an effective, safe, and convenient treatment option for TDs. Moreover, methylphenidate, guanfacine, and desipramine appeared to reduce ADHD symptoms in children with tics. However, no research studies have examined HRT/CBIT alone compared with HRT/CBIT in combination with medication. More high-quality clinical trials comparing different interventions for TDs including economic evaluations should be encouraged.
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16
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Lichter D, Finnegan S. Influence of Gender on Tourette Syndrome Beyond Adolescence. Eur Psychiatry 2020; 30:334-40. [DOI: 10.1016/j.eurpsy.2014.07.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Revised: 07/02/2014] [Accepted: 07/09/2014] [Indexed: 12/17/2022] Open
Abstract
AbstractAlthough boys are disproportionately affected by tics in Tourette syndrome (TS), this gender bias is attenuated in adulthood and a recent study has suggested that women may experience greater functional interference from tics than men. The authors assessed the gender distribution of adults in a tertiary University-based TS clinic population and the relative influence of gender and other variables on adult tic severity (YGTSS score) and psychosocial functioning (GAF score). We also determined retrospectively the influence of gender on change in global tic severity and overall TS impairment (YGTSS) since adolescence. Females were over-represented in relation to previously published epidemiologic surveys of both TS children and adults. Female gender was associated with a greater likelihood of tic worsening as opposed to tic improvement in adulthood; a greater likelihood of expansion as opposed to contraction of motor tic distribution; and with increased current motor tic severity and tic-related impairment. However, gender explained only a small percentage of the variance of the YGTSS global severity score and none of the variance of the GAF scale score. Psychosocial functioning was influenced most strongly by tic severity but also by a variety of comorbid neuropsychiatric disorders.
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17
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Huisman‐van Dijk HM, Matthijssen SJMA, Stockmann RTS, Fritz AV, Cath DC. Effects of comorbidity on Tourette's tic severity and quality of life. Acta Neurol Scand 2019; 140:390-398. [PMID: 31418815 PMCID: PMC6899939 DOI: 10.1111/ane.13155] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 07/30/2019] [Accepted: 08/04/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The aim of this study is to gain more insight in the differential contributions of anxiety, depression and obsessive-compulsive (OC) symptom severity to quality of life (QoL) and tic severity in adults with Tourette Disorder (TD). METHODS Self-reported OC symptom, anxiety and depression severity measures were used to investigate their predictive value on QoL and Tic severity in adult TD patients (N = 187), using correlation, regression, and mediation analyses. RESULTS Tic severity has no effect on QoL. Depression severity directly reduces QoL, whereas anxiety and OC symptom severity have an indirect effect on QoL, mediated by depression severity. OC symptom severity directly affects tic severity, whereas depression and anxiety severity do not have a direct effect on tic or OC severity. Finally, anxiety severity indirectly impacts tic severity, with OC symptom severity functioning as a mediator. CONCLUSION In line with and extending previous studies, these findings indicate that OC symptom severity directly influences tic symptom severity whereas depression severity directly influences QoL in TD. Results imply that to improve QoL in TD patients, treatment should primarily focus on diminishing OC and depressive symptom severity rather than focusing on tic reduction.
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Affiliation(s)
- Hilde M. Huisman‐van Dijk
- Department of Clinical Psychology Faculty of Social Sciences Utrecht University Utrecht The Netherlands
- Altrecht Academic Anxiety Center Utrecht The Netherlands
| | - Suzy J. M. A. Matthijssen
- Department of Clinical Psychology Faculty of Social Sciences Utrecht University Utrecht The Netherlands
- Altrecht Academic Anxiety Center Utrecht The Netherlands
| | - Ruben T. S. Stockmann
- Department of Clinical Psychology Faculty of Social Sciences Utrecht University Utrecht The Netherlands
| | - Anne V. Fritz
- Department of Clinical Psychology Faculty of Social Sciences Utrecht University Utrecht The Netherlands
| | - Danielle C. Cath
- Rob Giel Onderzoekcentrum Groningen The Netherlands
- Department of Psychiatry University Medical Center Groningen and RUG Groningen The Netherlands
- GGZ Drenthe Mental Health Institution Assen The Netherlands
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18
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Müller-Vahl KR, Kayser L, Pisarenko A, Haas M, Psathakis N, Palm L, Jakubovski E. The Rage Attack Questionnaire-Revised (RAQ-R): Assessing Rage Attacks in Adults With Tourette Syndrome. Front Psychiatry 2019; 10:956. [PMID: 32063867 PMCID: PMC6997809 DOI: 10.3389/fpsyt.2019.00956] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 12/03/2019] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Although defined by the presence of tics, most patients with Gilles de la Tourette syndrome (TS) also suffer from different psychiatric disorders. While much is known about clinical characteristics of comorbidities such as attention deficit/hyperactivity disorder (ADHD), obsessive compulsive disorder (OCD), depression, and anxiety disorders, only very little is known about rage attacks. Most of this data is based on small studies in children. Until today no larger studies have been performed in adults with TS-most likely because of the lack of validated instruments. The aim of this study was to develop a new assessment and investigate rage attacks in a large sample of adults with TS and healthy individuals. MATERIALS AND METHODS Based on a parent questionnaire for children with TS, we generated 27 items for a revised version of a rage attack questionnaire (RAQ-R) and tested factor structure, internal consistency, as well as convergent and discriminant validity. We used an online survey and included 127 patients with TS and 645 control subjects. In addition to the RAQ-R, we used several other self-assessments to measure tic severity, quality of life, as well as several psychiatric symptoms including ADHD, OCD, depression, anxiety, and impulsivity. RESULTS Based on expert option and statistical analyses [including item-total correlation, skewness, inter-item correlation, and principal component analysis (PCA)], we performed an item reduction resulting in a final, 22-items version of the RAQ-R (range, 0-66). Investigating internal consistency, discriminant validity, test reliability, and factor structure, the RAQ-R demonstrated good to excellent quality criteria. As assessed by RAQ-R, rage attacks were significantly more common in patients with TS compared to controls (p < 0.001). Rage attacks could be clearly differentiated from the phenomenon of impulsivity. Although rage attacks occurred more often in individuals with ADHD, they were also found in patients with "TS only", independently from comorbid ADHD, impulsivity, and OCD. Rage attacks were found to significantly influence patients' quality of life. CONCLUSIONS Thus, from our data based on a large sample it is suggested that rage attacks represent a discrete comorbidity in adults with TS.
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Affiliation(s)
- Kirsten R Müller-Vahl
- Clinic of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Lena Kayser
- Clinic of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Anna Pisarenko
- Clinic of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Martina Haas
- Clinic of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Nikolas Psathakis
- Clinic of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Lisa Palm
- Clinic of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Ewgeni Jakubovski
- Clinic of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
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Schrag A, Martino D, Apter A, Ball J, Bartolini E, Benaroya-Milshtein N, Buttiglione M, Cardona F, Creti R, Efstratiou A, Gariup M, Georgitsi M, Hedderly T, Heyman I, Margarit I, Mir P, Moll N, Morer A, Müller N, Müller-Vahl K, Münchau A, Orefici G, Plessen KJ, Porcelli C, Paschou P, Rizzo R, Roessner V, Schwarz MJ, Steinberg T, Tagwerker Gloor F, Tarnok Z, Walitza S, Dietrich A, Hoekstra PJ. European Multicentre Tics in Children Studies (EMTICS): protocol for two cohort studies to assess risk factors for tic onset and exacerbation in children and adolescents. Eur Child Adolesc Psychiatry 2019; 28:91-109. [PMID: 29982875 PMCID: PMC6349795 DOI: 10.1007/s00787-018-1190-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Accepted: 06/28/2018] [Indexed: 12/22/2022]
Abstract
Genetic predisposition, autoimmunity and environmental factors [e.g. pre- and perinatal difficulties, Group A Streptococcal (GAS) and other infections, stress-inducing events] might interact to create a neurobiological vulnerability to the development of tics and associated behaviours. However, the existing evidence for this relies primarily on small prospective or larger retrospective population-based studies, and is therefore still inconclusive. This article describes the design and methodology of the EMTICS study, a longitudinal observational European multicentre study involving 16 clinical centres, with the following objectives: (1) to investigate the association of environmental factors (GAS exposure and psychosocial stress, primarily) with the onset and course of tics and/or obsessive-compulsive symptoms through the prospective observation of at-risk individuals (ONSET cohort: 260 children aged 3-10 years who are tic-free at study entry and have a first-degree relative with a chronic tic disorder) and affected individuals (COURSE cohort: 715 youth aged 3-16 years with a tic disorder); (2) to characterise the immune response to microbial antigens and the host's immune response regulation in association with onset and exacerbations of tics; (3) to increase knowledge of the human gene pathways influencing the pathogenesis of tic disorders; and (4) to develop prediction models for the risk of onset and exacerbations of tic disorders. The EMTICS study is, to our knowledge, the largest prospective cohort assessment of the contribution of different genetic and environmental factors to the risk of developing tics in putatively predisposed individuals and to the risk of exacerbating tics in young individuals with chronic tic disorders.
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Affiliation(s)
- Anette Schrag
- 0000000121901201grid.83440.3bDepartment of Clinical Neurosciences, UCL Institute of Neurology, University College London, London, UK
| | - Davide Martino
- 0000 0004 1936 7697grid.22072.35Department of Clinical Neurosciences, University of Calgary, Calgary, Canada
| | - Alan Apter
- 0000 0004 1937 0546grid.12136.37Child and Adolescent Psychiatry Department, Schneider Children’s Medical Center of Israel, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Petah-Tikva, Israel
| | - Juliane Ball
- 0000 0004 1937 0650grid.7400.3Clinic of Child and Adolescent Psychiatry and Psychotherapy, University of Zurich, Zurich, Switzerland
| | | | - Noa Benaroya-Milshtein
- 0000 0004 1937 0546grid.12136.37Child and Adolescent Psychiatry Department, Schneider Children’s Medical Center of Israel, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Petah-Tikva, Israel
| | - Maura Buttiglione
- 0000 0001 0120 3326grid.7644.1Department of Biological Sciences and Human Oncology, Medical School, University of Bari “Aldo Moro”, Bari, Italy
| | - Francesco Cardona
- grid.7841.aDepartment of Human Neurosciences, University La Sapienza of Rome, Rome, Italy
| | - Roberta Creti
- 0000 0000 9120 6856grid.416651.1Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Androulla Efstratiou
- 0000 0004 5909 016Xgrid.271308.fWHO Global Collaborating Centre for Reference and Research on Diphtheria and Streptococcal Infections, Reference Microbiology, Directorate National Infection Service, Public Health England, London, UK
| | - Maria Gariup
- 0000 0004 1937 0247grid.5841.8University of Barcelona, Barcelona, Spain ,Intensive Inpatient Unit, Copenhagen Psychiatric Center, Copenhagen, Denmark
| | - Marianthi Georgitsi
- 0000 0001 2170 8022grid.12284.3dDepartment of Molecular Biology and Genetics, Democritus University of Thrace, Alexandroupoli, Greece ,0000000109457005grid.4793.9Department of Medicine, Aristotle University of Thessaloniki, Thessaloníki, Greece
| | - Tammy Hedderly
- 0000 0004 5345 7223grid.483570.dEvelina London Children’s Hospital GSTT, Kings Health Partners AHSC, London, UK
| | - Isobel Heyman
- 0000000121901201grid.83440.3bGreat Ormond Street Hospital for Children, UCL Institute of Child Health, London, UK
| | | | - Pablo Mir
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clinica, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocio/CSIC/Universidad de Sevilla, Seville, Spain
| | - Natalie Moll
- 0000 0004 1936 973Xgrid.5252.0Institute of Laboratory Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Astrid Morer
- 0000 0000 9635 9413grid.410458.cDepartment of Child and Adolescent Psychiatry and Psychology, Institute of Neurosciences, Hospital Clinic Universitari, Barcelona, Spain ,grid.10403.36Institut d’Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain ,0000 0000 9314 1427grid.413448.eCentro de Investigacion en Red de Salud Mental (CIBERSAM), Instituto Carlos III, Madrid, Spain
| | - Norbert Müller
- 0000 0004 1936 973Xgrid.5252.0Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany ,Marion von Tessin Memory-Zentrum gGmbH, Munich, Germany
| | - Kirsten Müller-Vahl
- 0000 0000 9529 9877grid.10423.34Clinic of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Alexander Münchau
- 0000 0001 0057 2672grid.4562.5Institute of Neurogenetics, University of Lübeck, Lübeck, Germany
| | - Graziella Orefici
- 0000 0000 9120 6856grid.416651.1Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Kerstin J. Plessen
- Child and Adolescent Mental Health Center, Mental Health Services, Capital Region of Denmark and University of Copenhagen, Copenhagen, Denmark ,0000 0001 2165 4204grid.9851.5Service of Child and Adolescent Psychiatry, Department of Psychiatry, University Medical Center, University of Lausanne, Lausanne, Switzerland
| | - Cesare Porcelli
- Azienda Sanitaria Locale di Bari, Mental Health Department, Child and Adolescent Neuropsychiatry Service of Bari Metropolitan Area, Bari, Italy
| | - Peristera Paschou
- 0000 0004 1937 2197grid.169077.eDepartment of Biological Sciences, Purdue University, West Lafayette, USA
| | - Renata Rizzo
- 0000 0004 1757 1969grid.8158.4Child Neuropsychiatry Section, Department of Clinical and Experimental Medicine, School of Medicine, Catania University, Catania, Italy
| | - Veit Roessner
- 0000 0001 2111 7257grid.4488.0Department of Child and Adolescent Psychiatry, Faculty of Medicine, TU Dresden, Dresden, Germany
| | - Markus J. Schwarz
- 0000 0004 1936 973Xgrid.5252.0Institute of Laboratory Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Tamar Steinberg
- 0000 0004 1937 0546grid.12136.37Child and Adolescent Psychiatry Department, Schneider Children’s Medical Center of Israel, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Petah-Tikva, Israel
| | - Friederike Tagwerker Gloor
- 0000 0004 1937 0650grid.7400.3Clinic of Child and Adolescent Psychiatry and Psychotherapy, University of Zurich, Zurich, Switzerland
| | - Zsanett Tarnok
- Vadaskert Child and Adolescent Psychiatric Hospital, Budapest, Hungary
| | - Susanne Walitza
- 0000 0004 1937 0650grid.7400.3Clinic of Child and Adolescent Psychiatry and Psychotherapy, University of Zurich, Zurich, Switzerland
| | - Andrea Dietrich
- 0000 0004 0407 1981grid.4830.fDepartment of Child and Adolescent Psychiatry, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Pieter J. Hoekstra
- 0000 0004 0407 1981grid.4830.fDepartment of Child and Adolescent Psychiatry, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
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Jalenques I, Guiguet-Auclair C, Derost P, Joubert P, Foures L, Hartmann A, Muellner J, Rondepierre F. The MOVES (Motor tic, Obsessions and compulsions, Vocal tic Evaluation Survey): cross-cultural evaluation of the French version and additional psychometric assessment. J Neurol 2018; 265:678-687. [DOI: 10.1007/s00415-018-8769-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 01/22/2018] [Accepted: 01/23/2018] [Indexed: 11/25/2022]
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Gong J, Xiao W, Gao H, Wei W, Zhang W, Lv J, Xiao L, Duan L, Zhang Y, Liu H, Huang Y. How to Best Convey Information About Intensive/Comfort Care to the Family Members of Premature Infants to Enable Unbiased Perinatal Decisions. Front Pediatr 2018; 6:348. [PMID: 30519551 PMCID: PMC6251209 DOI: 10.3389/fped.2018.00348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 10/26/2018] [Indexed: 11/13/2022] Open
Abstract
Background: As the infant's best interests are determined through the perinatal decisions of family members and physicians, it is important to understand the factors that affect such decisions. This paper investigated the separate and combined effects of various factors related to perinatal decision making and sought to determine the best way to convey information in an unbiased manner to family members. Methods: In total, 613 participants were consecutively recruited. Each participant completed a series of surveys. All responses to four items were examined via a latent class analysis (LCA) to identify subgroups of participants with similar preferences for intensive care (IC) and comfort care (CC) regarding their potentially premature infant. Multiple logistic regression analyses were applied to identify the sociodemographic predictors for the classification of participants into different subgroups. Results: χ2-tests indicated that perinatal decision making for Item 2 was influenced by framing information, whereas decision making wasn't affected by presentation modes. Furthermore, the endorsement rates of IC significantly decreased with the information increased from brief to detailed, regardless of framing or presentation mode. The LCA indicated that a 3-subgroup model, which included the IC, CC, and variation subgroups, was optimal. Logistic regression analyses demonstrated that, compared with the IC subgroup, negative framing, higher education, parenthood, and poor numeracy predicted participants' preferences for CC. Meanwhile, worrying about physical or mental disabilities predicted preferences for CC and sensitivity to the amount of information provided regarding treatment options (variation subgroup). Conclusions: Perinatal decision making is affected by many factors, suggesting that more detailed information, improved understandability of numerical data, and a neutral tone of voice regarding therapeutic outcomes would be helpful for the families of premature infants to make unbiased decisions. Our findings should be replicated in future research.
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Affiliation(s)
- Jingjing Gong
- Department of Neurology, PLA Army General Hospital, Beijing, China
| | - Wei Xiao
- Department of Medical Psychology, Air Force Medical University, Xi'an, China
| | - Hongyan Gao
- Department of Medical Administration, PLA Army General Hospital, Beijing, China
| | - Wei Wei
- Department of Neurology, PLA Army General Hospital, Beijing, China
| | - Weiwei Zhang
- Department of Neurology, PLA Army General Hospital, Beijing, China
| | - Jing Lv
- Department of Psychology, PLA General Hospital, Beijing, China
| | - Lijun Xiao
- Department of Paediatrics, PLA Army General Hospital, Beijing, China
| | - Lida Duan
- Department of Medical Administration, PLA Zhurihe Base Hospital, Zhurihe, China
| | - Yan Zhang
- Center of Psychology, Air Force Aviation Medicine Research Institute, Beijing, China
| | - Hongyun Liu
- School of Psychology, Beijing Normal University, Beijing, China
| | - Yonghua Huang
- Department of Neurology, PLA Army General Hospital, Beijing, China
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Marwitz L, Pringsheim T. Clinical Utility of Screening for Anxiety and Depression in Children with Tourette Syndrome. JOURNAL OF THE CANADIAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY = JOURNAL DE L'ACADEMIE CANADIENNE DE PSYCHIATRIE DE L'ENFANT ET DE L'ADOLESCENT 2018; 27:15-21. [PMID: 29375629 PMCID: PMC5777687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 07/27/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Tourette syndrome (TS) is often co-morbid with attention deficit hyperactivity disorder (ADHD) and obsessive compulsive disorder (OCD). Studies of TS, anxiety and depression have found variable results depending on study methodology and sample characteristics. Our aim was to examine the clinical utility of routine screening for anxiety and depression in children with TS. METHODS Using a clinic-based sample, we evaluated the proportion of children with TS meeting diagnostic criteria for ADHD, OCD, generalized anxiety disorder (GAD), separation anxiety disorder (SAD), and major depressive disorder (MDD); the frequency of above average anxiety and depressive symptoms using the Multidimensional Anxiety Scale for Children (MASC) and the Children's Depression Inventory (CDI); and the association between diagnoses and symptom severity. RESULTS One hundred twenty six children were included (mean age 10.7 years). The most common comorbid disorder was ADHD (37%), followed by GAD (21%), OCD (10%), MDD (2%) and SAD (2%). On the MASC, the separation anxiety/panic subscale score was higher than all other subscale scores (p<0.0001). Clinically significant anxiety symptoms were present in 20% of the sample based on the MASC Anxiety Disorders Index, while 6% were identified as potentially clinically depressed based on the CDI Total Score. Yale Global Tic Severity Scale scores were positively correlated with total scores on the MASC (r=0.22, p=0.03) and CDI (r=0.37, p=0.0002). CONCLUSIONS Routine screening children with TS for anxiety is warranted given the rate of comorbidity. Screening for depression in TS will have a higher yield in adolescents, adults, and children with more severe tics.
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Affiliation(s)
- Leonie Marwitz
- Department of Clinical Neurosciences, Psychiatry, Pediatrics and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta
| | - Tamara Pringsheim
- Department of Clinical Neurosciences, Psychiatry, Pediatrics and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta
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Gong J, Zhang Y, Gao H, Wei W, Lv J, Liu H, Huang Y. Choices Regarding Thrombolysis Are Modified by the Way to Transfer the Messages. Front Neurol 2017; 8:589. [PMID: 29167657 PMCID: PMC5683066 DOI: 10.3389/fneur.2017.00589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 10/20/2017] [Indexed: 12/04/2022] Open
Abstract
Although thrombolysis is the most effective medical treatment for acute ischemic stroke, many stroke patients eligible for thrombolysis miss this treatment as a result of delay or refusal by the patients and/or their proxies. To explore the influences of prognostic information for different intervals from stroke onset to the start of thrombolytic treatment (OTT) and other factors on the preferences of patients/proxies regarding thrombolytic therapy, a cross-sectional, discrete-choice experiment was performed between August 2013 and September 2014. A total of 613 Chinese inpatients or their immediate family members were consecutively recruited at the Department of Neurology. After random assignment to a negative-framing group or a positive-framing group, the subjects completed a series of surveys, including nine items about thrombolysis. Latent class analysis (LCA) was used to examine participants’ preference paradigms for thrombolysis and to categorize the participants into different subgroups. Subsequently, regression analyses were conducted to explore predictors of categorization of the participants into each subgroup and to construct a thrombolytic decision-making model. LCA revealed an optimal 3-subgroup model including a consent to thrombolysis subgroup and objection to thrombolysis subgroups 1 and 2. Multiple regression analysis demonstrated that compared with assignment to the consent to thrombolysis subgroup, assignment to objection to thrombolysis subgroup 1 or 2 could be predicted by different factors. χ2 tests indicated effects of framing and other factors on participants’ choices regarding thrombolysis. Choices regarding thrombolysis were modified by not only prognostic information for different OTT intervals but also message framing, presentation format, and sociodemographic characteristics. To facilitate consent to thrombolysis, physicians should convey prognostic information to patients/proxies on the basis of patient OTT interval and should order the presentation of therapies according to the classification of patients/proxies. Individualized decision-making (IDM) might be an optimal strategy to increase the selection of thrombolysis, which providing important reference points for IDM in other clinical domains.
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Affiliation(s)
- Jingjing Gong
- Department of Neurology, PLA Army General Hospital, Beijing, China
| | - Yan Zhang
- Center of Psychology, Air Force Aviation Medicine Research Institute, Beijing, China
| | - Hongyan Gao
- Department of Medical Administration, PLA Army General Hospital, Beijing, China
| | - Wei Wei
- Department of Neurology, PLA Army General Hospital, Beijing, China
| | - Jing Lv
- Department of Psychology, PLA General Hospital, Beijing, China
| | - Hongyun Liu
- School of Psychology, Beijing Normal University, Beijing, China
| | - Yonghua Huang
- Department of Neurology, PLA Army General Hospital, Beijing, China
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Eriguchi Y, Kuwabara H, Inai A, Kawakubo Y, Nishimura F, Kakiuchi C, Tochigi M, Ohashi J, Aoki N, Kato K, Ishiura H, Mitsui J, Tsuji S, Doi K, Yoshimura J, Morishita S, Shimada T, Furukawa M, Umekage T, Sasaki T, Kasai K, KanoMD PhD Y. Identification of candidate genes involved in the etiology of sporadic Tourette syndrome by exome sequencing. Am J Med Genet B Neuropsychiatr Genet 2017; 174:712-723. [PMID: 28608572 DOI: 10.1002/ajmg.b.32559] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 05/15/2017] [Indexed: 01/01/2023]
Abstract
Tourette Syndrome (TS) is a neurodevelopmental disorder characterized by chronic motor and vocal tics. Although there is a large genetic contribution, the genetic architecture of TS remains unclear. Exome sequencing has successfully revealed the contribution of de novo mutations in sporadic cases with neuropsychiatric disorders such as autism and schizophrenia. Here, using exome sequencing, we investigated de novo mutations in individuals with sporadic TS to identify novel risk loci and elucidate the genetic background of TS. Exome analysis was conducted for sporadic TS cases: nine trio families and one quartet family with concordant twins were investigated. Missense mutations were evaluated using functional prediction algorithms, and their population frequencies were calculated based on three public databases. Gene expression patterns in the brain were analyzed using the BrainSpan Developmental Transcriptome. Thirty de novo mutations, including four synonymous and four missense mutations, were identified. Among the missense mutations, one in the rapamycin-insensitive companion of mammalian target of rapamycin (RICTOR)-coding gene (rs140964083: G > A, found in one proband) was predicted to be hazardous. In the three public databases analyzed, variants in the same SNP locus were absent, and variants in the same gene were either absent or present at an extremely low frequency (3/5,008), indicating the rarity of hazardous RICTOR mutations in the general population. The de novo variant of RICTOR may be implicated in the development of sporadic TS, and RICTOR is a novel candidate factor for TS etiology.
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Affiliation(s)
- Yosuke Eriguchi
- Department of Child Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Department of Neuropsychiatry, Sakura Hospital, Aomori, Japan
| | - Hitoshi Kuwabara
- Department of Child Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Disability Services Office, The University of Tokyo, Tokyo, Japan
| | - Aya Inai
- Department of Child Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yuki Kawakubo
- Department of Child Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Fumichika Nishimura
- Department of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Chihiro Kakiuchi
- Department of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Mamoru Tochigi
- Department of Neuropsychiatry, Teikyo University School of Medicine, Tokyo, Japan
| | - Jun Ohashi
- Department of Biological Sciences, Graduate School of Science, The University of Tokyo, Tokyo, Japan
| | - Naoto Aoki
- Department of Neuropsychiatry, Sakura Hospital, Aomori, Japan
| | - Kayoko Kato
- Department of Physical and Health Education, Graduate School of Education, The University of Tokyo, Tokyo, Japan
| | - Hiroyuki Ishiura
- Department of Neurology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Jun Mitsui
- Department of Neurology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Shoji Tsuji
- Department of Neurology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Medical Genome Center, The University of Tokyo Hospital, The University of Tokyo, Tokyo, Japan
| | - Koichiro Doi
- Department of Computational Biology and Medical Sciences, Graduate School of Frontier Sciences, The University of Tokyo, Chiba, Japan
| | - Jun Yoshimura
- Department of Computational Biology and Medical Sciences, Graduate School of Frontier Sciences, The University of Tokyo, Chiba, Japan
| | - Shinichi Morishita
- Department of Computational Biology and Medical Sciences, Graduate School of Frontier Sciences, The University of Tokyo, Chiba, Japan
| | - Takafumi Shimada
- Division for Counseling and Support, The University of Tokyo, Tokyo, Japan
| | - Masaomi Furukawa
- Department of Child Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Tadashi Umekage
- Department of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Tsukasa Sasaki
- Department of Physical and Health Education, Graduate School of Education, The University of Tokyo, Tokyo, Japan
| | - Kiyoto Kasai
- Department of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yukiko KanoMD PhD
- Department of Child Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Health-related quality of life, anxiety and depression in parents of adolescents with Gilles de la Tourette syndrome: a controlled study. Eur Child Adolesc Psychiatry 2017; 26:603-617. [PMID: 27942998 DOI: 10.1007/s00787-016-0923-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 11/21/2016] [Indexed: 01/12/2023]
Abstract
Our objectives were to assess health-related quality of life (HRQoL), anxiety, depression of Gilles de la Tourette syndrome (GTS) adolescents' parents compared to controls; to assess GTS adolescents' HRQoL compared to controls; to investigate which parental and adolescent variables are associated with poorer parental HRQoL. The controlled study involved GTS outpatients and their parents, adolescent healthy controls matched for gender and age and their parents. Parents' HRQoL was assessed using SF-36 and WHOQOL-BREF; anxiety, depression using HADS. Adolescents' HRQoL was assessed by adolescents using VSP-A instrument and by their parents using VSP-P. A total of 75 GTS adolescents, 75 mothers, 63 fathers were compared to 75 control adolescents, 75 mothers, 62 fathers. GTS mothers had worse HRQoL than controls on 5 of the 8 SF-36 dimensions and 1 of the 4 WHOQOL-BREF dimensions, while GTS fathers had worse HRQoL on 2 of the WHOQOL-BREF dimensions. GTS mothers had poorer HRQoL than fathers. GTS mothers had more depression than control mothers and GTS fathers had more anxiety than control fathers. GTS adolescents had worse HRQoL than controls on 5 of the 9 VSP-A dimensions. Factors significantly related to parental HRQoL were anxiety, depression, GTS adolescents' HRQoL and, concerning mothers, behavioural and emotional adolescents' problems; concerning fathers, severity of vocal tics, duration since first symptoms. This study provides a better understanding of poorer HRQoL and psychiatric morbidity of GTS adolescents' parents. Clinicians should pay attention to their emotional well-being and HRQoL and be aware that mothers and fathers are differently affected.
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Rizzo R, Gulisano M, Martino D, Robertson MM. Gilles de la Tourette Syndrome, Depression, Depressive Illness, and Correlates in a Child and Adolescent Population. J Child Adolesc Psychopharmacol 2017; 27:243-249. [PMID: 28099039 DOI: 10.1089/cap.2016.0120] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Gilles de la Tourette syndrome (GTS) and depression are both common disorders. It has been suggested that depression occurs in 13%-76% GTS patients. Despite this, there are few studies into the specific relationships and correlates between the two disorders. There is only some consensus as to the precise relationship between the two disorders. MATERIALS AND METHODS We undertook the study to investigate the relationship between depressive symptomatology and the core clinical features of GTS in a well-characterized clinical population of youth with this disorder. Our aim was to verify the association between depression and comorbid obsessive-compulsive disorder and explore further other potential associations highlighted in some, but not all, of the studies focused on this topic. RESULTS Our results demonstrated that (1) the GTS patients were significantly older than the controls, (2) the GTS patients were significantly more depressed than controls, (3) depression was associated with tic severity, (4) the Diagnostic Confidence Index scores were higher in GTS patients without depression, (5) anxiety, attention-deficit/hyperactivity disorder (ADHD), conduct disorder (CD), and behavioral problems were significantly associated with depression, and (6) finally, patients with GTS and depression have a positive family history of depression. However, obsessionality (CY-BOCS) did not differentiate between depressed and not depressed GTS patients. CONCLUSIONS Depression is common in patients with GTS and occurs significantly more in GTS than in controls. Depression is significantly associated with GTS factors such as tic severity, comorbidity with ADHD, and the presence of coexistent anxiety, CDs, and behavior problems. Depression is importantly significantly associated with a positive family history of depression. Intriguingly, depression in our sample was not related to obsessionality.
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Affiliation(s)
- Renata Rizzo
- 1 Section of Child and Adolescent Neuropsychiatry, Department of Experimental and Clinical Medicine, University of Catania , Catania, Italy
| | - Mariangela Gulisano
- 1 Section of Child and Adolescent Neuropsychiatry, Department of Experimental and Clinical Medicine, University of Catania , Catania, Italy
| | - Davide Martino
- 2 Department of Neurology, King's College Hospital NHS Foundation Trust , London, United Kingdom .,3 Queen Elizabeth Hospital , Woolwich, Lewisham and Greenwich NHS Trust, London, United Kingdom
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Robertson MM, Eapen V. The Psychosocial Aspects of the Gilles de la Tourette Syndrome: Empirical Evidence from the Literature. Curr Behav Neurosci Rep 2017. [DOI: 10.1007/s40473-017-0107-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Tourette Syndrome and Chronic Tic Disorders: The Clinical Spectrum Beyond Tics. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2017; 134:1461-1490. [DOI: 10.1016/bs.irn.2017.05.006] [Citation(s) in RCA: 84] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Bertaut S, Rondepierre F, Jalenques I. Évaluation de la douleur physique dans le syndrome de Gilles de la Tourette, étude exploratoire. ANNALES MEDICO-PSYCHOLOGIQUES 2016. [DOI: 10.1016/j.amp.2016.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Bloch Y, Arad S, Levkovitz Y. Deep TMS add-on treatment for intractable Tourette syndrome: A feasibility study. World J Biol Psychiatry 2016; 17:557-61. [PMID: 25342253 DOI: 10.3109/15622975.2014.964767] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVES In a considerable minority of patients who suffer from Tourette syndrome (TS) the disorder persists into adulthood and is associated with severe symptoms and limited therapeutic options. Repetitive transcranial magnetic stimulation (rTMS) to the supplementary motor area (SMA) has shown promising therapeutic results. Deep rTMS is a novel technology that enables deeper non-invasive cortical stimulation. This open-label pilot study is the first to examine the possible role of deep rTMS as add-on treatment for intractable TS. METHODS Twelve patients were recruited in order to examine bilateral SMA inhibition via deep TMS using the HBDL coil, as a possible treatment for adult TS treatment-resistant patients. Two patients did not complete the 20-day study protocol. RESULTS There were no significant side effects. While tics did not improve among the group as a whole, the subgroup of six patients with combined TS and OCD (obsessive compulsive syndrome) showed significant improvement in tic severity (P = 0.037). CONCLUSIONS These findings support the safety of deep rTMS for treating TS. The results also highlight the importance of studying the different TS syndromes separately (e.g., with or without OCD comorbidity) when evaluating deep rTMS protocols for TS patients.
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Affiliation(s)
- Yuval Bloch
- a The Emotion-Cognition Research Center, Shalvata Mental Health Care Center , Hod-Hasharon , Israel.,b Child and Adolescent Outpatient Clinic, Shalvata Mental Health Care Center , Hod-Hasharon , Israel.,c Sackler Faculty of Medicine, Tel-Aviv University , Tel-Aviv , Israel
| | - Shira Arad
- a The Emotion-Cognition Research Center, Shalvata Mental Health Care Center , Hod-Hasharon , Israel.,c Sackler Faculty of Medicine, Tel-Aviv University , Tel-Aviv , Israel
| | - Yechiel Levkovitz
- a The Emotion-Cognition Research Center, Shalvata Mental Health Care Center , Hod-Hasharon , Israel.,c Sackler Faculty of Medicine, Tel-Aviv University , Tel-Aviv , Israel
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Sambrani T, Jakubovski E, Müller-Vahl KR. New Insights into Clinical Characteristics of Gilles de la Tourette Syndrome: Findings in 1032 Patients from a Single German Center. Front Neurosci 2016; 10:415. [PMID: 27672357 PMCID: PMC5018493 DOI: 10.3389/fnins.2016.00415] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 08/26/2016] [Indexed: 01/23/2023] Open
Abstract
Background: Gilles de la Tourette syndrome (TS) is a complex neuropsychiatric disorder defined by the presence of motor and phonic tics, but often associated with psychiatric comorbidities. The main objective of this study was to explore the clinical presentation and comorbidities of TS. Method: We analyzed clinical data obtained from a large sample (n = 1032; 529 children and 503 adults) of patients with tic disorders from one single German TS center assessed by one investigator. Data was collected with the help of an expert-reviewed semi-structured interview, designed to assess tic severity and certain comorbidities. Group comparisons were carried out via independent sample t-tests and chi-square tests. Results: The main findings of the study are: (1) tic severity is associated with the presence of premonitory urges (PU), copro-, echo-, and paliphenomena and the number of comorbidities, but not age at tic onset; it is higher in patients with comorbid obsessive-compulsive disorder (OCD) than in patients with comorbid attention deficit/hyperactivity disorder (ADHD). (2) PU were found to be highly associated with “not just right experiences” and to emerge much earlier than previously thought alongside with the ability to suppress tics (PU in >60% and suppressibility in >75% at age 8–10 years). (3) Self-injurious behavior (SIB) is highly associated with complex motor tics and coprophenomena, but not with OCD/obsessive-compulsive behavior (OCB). While comorbid ADHD is associated with a lower ability to suppress tics, comorbid depression is associated with sleeping problems. Discussion: Our results demonstrate that tic severity is not influenced by age at onset. From our data, it is suggested that PU represent a specific type of “not just right experience” that is not a prerequisite for tic suppression. Comorbid ADHD reduces patients' ability of successful tic suppression. Our data suggest that SIB belongs to the coprophenomena spectrum and hence should be conceptualized as a complex tic rather than a compulsion. Finally, this study strongly supports the hypothesis that TS+OCD is a more severe form of TS and that comorbid OCD/OCB, depression, and anxiety belong to the TS spectrum, while ADHD should be better conceptualized as a separate problem.
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Affiliation(s)
- Tanvi Sambrani
- Department of Education, Monash UniversityMelbourne, VIC, Australia; Clinic of Psychiatry, Social Psychiatry, and Psychotherapy, Hannover Medical SchoolHannover, Germany
| | - Ewgeni Jakubovski
- Clinic of Psychiatry, Social Psychiatry, and Psychotherapy, Hannover Medical School Hannover, Germany
| | - Kirsten R Müller-Vahl
- Clinic of Psychiatry, Social Psychiatry, and Psychotherapy, Hannover Medical School Hannover, Germany
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Gerasch S, Kanaan AS, Jakubovski E, Müller-Vahl KR. Aripiprazole Improves Associated Comorbid Conditions in Addition to Tics in Adult Patients with Gilles de la Tourette Syndrome. Front Neurosci 2016; 10:416. [PMID: 27672358 PMCID: PMC5018494 DOI: 10.3389/fnins.2016.00416] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 08/26/2016] [Indexed: 12/13/2022] Open
Abstract
Gilles de la Tourette Syndrome (GTS) is characterized by motor and vocal tics, as well as associated comorbid conditions including obsessive-compulsive disorder (OCD), attention deficit/hyperactivity disorder (ADHD), depression, and anxiety which are present in a substantial number of patients. Although randomized controlled trials including a large number of patients are still missing, aripiprazole is currently considered as a first choice drug for the treatment of tics. The aim of this study was to further investigate efficacy and safety of aripiprazole in a group of drug-free, adult patients. Specifically, we investigated the influence of aripiprazole on tic severity, comorbidities, premonitory urge (PU), and quality of life (QoL). Moreover, we were interested in the factors that influence a patient's decision in electing for-or against- pharmacological treatment. In this prospective uncontrolled open-label study, we included 44 patients and used a number of rating scales to assess tic severity, PU, comorbidities, and QoL at baseline and during treatment with aripiprazole. Eighteen out of fortyfour patients decided for undergoing treatment for their tics with aripiprazole and completed follow-up assessments after 4–6 weeks. Our major findings were (1) aripiprazole resulted in significant reduction of tics, but did not affect PU; (2) aripiprazole significantly improved OCD and showed a trend toward improvement of other comorbidities including depression, anxiety, and ADHD; (3) neither severity of tics, nor PU or QoL influenced patients' decisions for or against treatment of tics with aripiprazole; instead patients with comorbid OCD tended to decide in favor of, while patients with comorbid ADHD tended to decide against tic treatment; (4) most frequently reported adverse effects were sleeping problems; (5) patients' QoL was mostly impaired by comorbid depression. Our results suggest that aripiprazole may improve associated comorbid conditions in addition to tics in patients with GTS. It can be hypothesized that these beneficial effects are related to aripiprazole's adaptive pharmacological profile, which exhibits an influence on the dopaminergic as well as a number of other neurotransmitter systems. For the first time, our data provide evidence that patients' decision making process for or against medical treatment is influenced by other factors than tic severity and QoL.
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Affiliation(s)
- Sarah Gerasch
- Clinic of Psychiatry, Socialpsychiatry and Psychotherapy, Hannover Medical School Hannover, Germany
| | - Ahmad Seif Kanaan
- Clinic of Psychiatry, Socialpsychiatry and Psychotherapy, Hannover Medical SchoolHannover, Germany; Max Planck Institute for Human Cognitive and Brain SciencesLeipzig, Germany
| | - Ewgeni Jakubovski
- Clinic of Psychiatry, Socialpsychiatry and Psychotherapy, Hannover Medical School Hannover, Germany
| | - Kirsten R Müller-Vahl
- Clinic of Psychiatry, Socialpsychiatry and Psychotherapy, Hannover Medical School Hannover, Germany
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O'Hare D, Helmes E, Eapen V, Grove R, McBain K, Reece J. The Impact of Tic Severity, Comorbidity and Peer Attachment on Quality of Life Outcomes and Functioning in Tourette's Syndrome: Parental Perspectives. Child Psychiatry Hum Dev 2016; 47:563-73. [PMID: 26440978 DOI: 10.1007/s10578-015-0590-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The aim of this controlled, community-based study based on data from parents of youth (aged 7-16 years) with Tourette's syndrome (TS; n = 86) and parents of age and gender matched peers (n = 108) was to test several hypotheses involving a range of variables salient to the TS population, including peer attachment, quality of life, severity of tics, comorbidity, and psychological, behavioural and social dysfunction. Multivariate between-group analyses confirmed that TS group youth experienced lower quality of life, increased emotional, behavioural and social difficulties, and elevated rates of insecure peer attachment relative to controls, as reported by their primary caregiver. Results also confirmed the main hypothesis that security of peer attachment would be associated with individual variability in outcomes for youth with TS. As predicted, multivariate within-TS group analyses determined strong relationships among adverse quality of life outcomes and insecure attachment to peers, increased tic severity, and the presence of comorbid disorder. Findings suggest that youth with TS are at increased risk for insecure peer attachment and that this might be an important variable impacting the quality of life outcomes for those diagnosed.
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Affiliation(s)
- Deirdre O'Hare
- School of Arts and Social Sciences, James Cook University, Townsville, QLD, Australia
| | - Edward Helmes
- School of Arts and Social Sciences, James Cook University, Townsville, QLD, Australia
| | - Valsamma Eapen
- School of Psychiatry, University of New South Wales & Ingham Institute, Sydney, NSW, Australia. .,Academic Unit of Child Psychiatry, South Western Sydney Local Health District (AUCS), Liverpool Hospital, Mental Health Centre (Level 1: ICAMHS), Locked Bag 7103, Liverpool, Sydney, NSW, 2170, Australia.
| | - Rachel Grove
- School of Psychiatry, University of New South Wales & Ingham Institute, Sydney, NSW, Australia
| | - Kerry McBain
- School of Arts and Social Sciences, James Cook University, Townsville, QLD, Australia
| | - John Reece
- School of Psychological Sciences, Australian College of Applied Psychology, Melbourne, Australia
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Eapen V, Cavanna AE, Robertson MM. Comorbidities, Social Impact, and Quality of Life in Tourette Syndrome. Front Psychiatry 2016; 7:97. [PMID: 27375503 PMCID: PMC4893483 DOI: 10.3389/fpsyt.2016.00097] [Citation(s) in RCA: 101] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 05/23/2016] [Indexed: 12/15/2022] Open
Abstract
Tourette syndrome (TS) is more than having motor and vocal tics, and this review will examine the varied comorbidities as well as the social impact and quality of life (QoL) in individuals with TS. The relationship between any individual and his/her environment is complex, and this is further exaggerated in the case of a person with TS. For example, tics may play a significant role in shaping the person's experiences, perceptions, and interactions with the environment. Furthermore, associated clinical features, comorbidities, and coexisting psychopathologies may compound or alter this relationship. In this regard, the common comorbidities include attention-deficit hyperactivity disorder and disruptive behaviors, obsessive compulsive disorder, and autism spectrum disorder, and coexistent problems include anxiety, depression, and low self-esteem, which can all lead to poorer psychosocial functioning and QoL. Thus, the symptoms of TS and the associated comorbid conditions may interact to result in a vicious cycle or a downward spiraling of negative experiences and poor QoL. The stigma and social maladjustment in TS and the social exclusion, bullying, and discrimination are considered to be caused in large part by misperceptions of the disorder by teachers, peers, and the wider community. Improved community and professional awareness about TS and related comorbidities and other psychopathologies as well as the provision of multidisciplinary services to meet the complex needs of this clinical population are critical. Future research to inform the risk and resilience factors for successful long-term outcomes is also warranted.
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Affiliation(s)
- Valsamma Eapen
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
- Academic Unit of Child Psychiatry, Ingham Institute, Sydney South Western Local Health District, Sydney, NSW, Australia
| | - Andrea E. Cavanna
- Department of Neuropsychiatry, Birmingham and Solihull Mental Health NHS Foundation Trust, Birmingham, UK
- Aston Brain Centre, School of Life and Health Sciences, Aston University, Birmingham, UK
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, University College London (UCL), London, UK
| | - Mary M. Robertson
- Neuropsychiatry, University College London (UCL), London, UK
- St Georges Hospital and Medical School, London, UK
- Department of Psychiatry, University of Cape Town, Cape Town, South Africa
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Piedad JCP, Cavanna AE. Depression in Tourette syndrome: A controlled and comparison study. J Neurol Sci 2016; 364:128-32. [PMID: 27084230 DOI: 10.1016/j.jns.2016.03.030] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Revised: 03/08/2016] [Accepted: 03/18/2016] [Indexed: 01/22/2023]
Abstract
BACKGROUND Tourette syndrome (TS) is a neurodevelopmental condition characterised by multiple tics and co-morbid behavioural problems. Previous research found that up to 76% of patients with TS experience affective symptoms, with 13% fulfilling diagnostic criteria for depression. OBJECTIVES We aimed to assess the severity of depression and profile of depressive symptoms in adult patients with TS compared to patients with major depression and healthy controls. METHODS Depression ratings were collected from patients with TS (N=65) using the BDI-II and from patients with recurrent major depressive disorder (rMDD, N=696) and healthy controls (N=293) using the Beck Depression Inventory (BDI)-IA. Direct comparisons were possible for 14/21 BDI items. RESULTS Patients with TS scored significantly higher on the BDI than controls (P<0.001) and all individual symptoms were reported more frequently by patients with TS than by controls (P<0.001). Total BDI score in TS was not significantly different to that in rMDD, however irritability was significantly more frequently reported in the TS group and this remained significant after controlling for age and gender differences between the two groups (OR 5.24, 95% CI 1.97-14.00; P=0.001). CONCLUSIONS Our findings show that depression is a prominent feature in TS and may present with a more irritable phenotype than rMDD. Patients with TS should be routinely screened for depression to implement treatment as appropriate.
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Affiliation(s)
- John Carlo P Piedad
- Michael Trimble Neuropsychiatry Research Group, University of Birmingham & BSMHFT, Birmingham, UK
| | - Andrea E Cavanna
- Michael Trimble Neuropsychiatry Research Group, University of Birmingham & BSMHFT, Birmingham, UK; School of Life and Health Sciences, Aston University, Birmingham, UK; Sobell Department of Motor Neuroscience and Movement Disorders, University College London & Institute of Neurology, London, UK.
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Motor Improvement and Emotional Stabilization in Patients With Tourette Syndrome After Deep Brain Stimulation of the Ventral Anterior and Ventrolateral Motor Part of the Thalamus. Biol Psychiatry 2016; 79:392-401. [PMID: 25034948 DOI: 10.1016/j.biopsych.2014.05.014] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Revised: 04/24/2014] [Accepted: 05/14/2014] [Indexed: 11/21/2022]
Abstract
BACKGROUND Since its first application in 1999, the potential benefit of deep brain stimulation (DBS) in reducing symptoms of otherwise treatment-refractory Tourette syndrome (TS) has been documented in several publications. However, uncertainty regarding the ideal neural targets remains, and the eventuality of so far undocumented but possible negative long-term effects on personality fuels the debate about the ethical implications of DBS. METHODS In this prospective open-label trial, eight patients (three female, five male) 19-56 years old with severe and medically intractable TS were treated with high-frequency DBS of the ventral anterior and ventrolateral motor part of the thalamus. To assess the course of TS, its clinical comorbidities, personality parameters, and self-perceived quality of life, patients underwent repeated psychiatric assessments at baseline and 6 and 12 months after DBS onset. RESULTS Analysis indicated a strongly significant and beneficial effect of DBS on TS symptoms, trait anxiety, quality of life, and global functioning with an apparently low side-effect profile. In addition, presurgical compulsivity, anxiety, emotional dysregulation, and inhibition appeared to be significant predictors of surgery outcome. CONCLUSIONS Trading off motor effects and desirable side effects against surgery-related risks and negative implications, stimulation of the ventral anterior and ventrolateral motor part of the thalamus seems to be a valuable option when considering DBS for TS.
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Gong J, Zhang Y, Feng J, Zhang W, Yin W, Wu X, Hou Y, Huang Y, Liu H, Miao D. How best to obtain consent to thrombolysis: Individualized decision-making. Neurology 2016; 86:1045-52. [PMID: 26888989 DOI: 10.1212/wnl.0000000000002434] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 10/07/2015] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To investigate the factors that influence the preferences of patients and their proxies concerning thrombolytic therapy and to determine how best to convey information. METHODS A total of 613 participants were randomly assigned to a positively or negatively framed group. Each participant completed a series of surveys. We applied latent class analysis (LCA) to explore participants' patterns of choices of thrombolysis and to classify the participants into different subgroups. Then we performed regression analyses to investigate predictors of classification of the participants into each subgroup and to establish a thrombolytic decision-making model. RESULTS LCA indicated an optimal 3-subgroup model comprising intermediate, favorable to thrombolysis, and aversion to thrombolysis subgroups. Multiple regression analysis revealed that 10 factors predicted assignment to the intermediate subgroup and 4 factors predicted assignment to the aversion to thrombolysis subgroup compared with the favorable to thrombolysis subgroup. The χ(2) tests indicated that the information presentation format and the context of thrombolysis influenced participants' choices of thrombolysis and revealed a framing effect in different subgroups. CONCLUSIONS The preference for thrombolysis was influenced by the positive vs negative framing scenarios, the format of item presentation, the context of thrombolysis, and individual characteristics. Inconsistent results may be due to participant heterogeneity and the evaluation of limited factors in previous studies. Based on a decision model of thrombolysis, physicians should consider the effects of positive vs negative framing and should seek a neutral tone when presenting the facts, providing an important reference point for health persuasion in other clinical domains.
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Affiliation(s)
- Jingjing Gong
- From the Departments of Neurology (J.G., J.F., W.Z., W.Y., Y. Huang) and Radiology (X.W.), General Hospital of Beijing Command PLA; Centre of Psychology (Y.Z.), Air Force Aviation Medicine Research Institute; Department of Psychological Medicine (Y. Hou), 309 Hospital of PLA, Beijing; School of Psychology (H.L.), Beijing Normal University; and Department of Medical Psychology (D.M.), Fourth Military Medical University, Xi'an, China.
| | - Yan Zhang
- From the Departments of Neurology (J.G., J.F., W.Z., W.Y., Y. Huang) and Radiology (X.W.), General Hospital of Beijing Command PLA; Centre of Psychology (Y.Z.), Air Force Aviation Medicine Research Institute; Department of Psychological Medicine (Y. Hou), 309 Hospital of PLA, Beijing; School of Psychology (H.L.), Beijing Normal University; and Department of Medical Psychology (D.M.), Fourth Military Medical University, Xi'an, China
| | - Jun Feng
- From the Departments of Neurology (J.G., J.F., W.Z., W.Y., Y. Huang) and Radiology (X.W.), General Hospital of Beijing Command PLA; Centre of Psychology (Y.Z.), Air Force Aviation Medicine Research Institute; Department of Psychological Medicine (Y. Hou), 309 Hospital of PLA, Beijing; School of Psychology (H.L.), Beijing Normal University; and Department of Medical Psychology (D.M.), Fourth Military Medical University, Xi'an, China
| | - Weiwei Zhang
- From the Departments of Neurology (J.G., J.F., W.Z., W.Y., Y. Huang) and Radiology (X.W.), General Hospital of Beijing Command PLA; Centre of Psychology (Y.Z.), Air Force Aviation Medicine Research Institute; Department of Psychological Medicine (Y. Hou), 309 Hospital of PLA, Beijing; School of Psychology (H.L.), Beijing Normal University; and Department of Medical Psychology (D.M.), Fourth Military Medical University, Xi'an, China
| | - Weimin Yin
- From the Departments of Neurology (J.G., J.F., W.Z., W.Y., Y. Huang) and Radiology (X.W.), General Hospital of Beijing Command PLA; Centre of Psychology (Y.Z.), Air Force Aviation Medicine Research Institute; Department of Psychological Medicine (Y. Hou), 309 Hospital of PLA, Beijing; School of Psychology (H.L.), Beijing Normal University; and Department of Medical Psychology (D.M.), Fourth Military Medical University, Xi'an, China
| | - Xinhuai Wu
- From the Departments of Neurology (J.G., J.F., W.Z., W.Y., Y. Huang) and Radiology (X.W.), General Hospital of Beijing Command PLA; Centre of Psychology (Y.Z.), Air Force Aviation Medicine Research Institute; Department of Psychological Medicine (Y. Hou), 309 Hospital of PLA, Beijing; School of Psychology (H.L.), Beijing Normal University; and Department of Medical Psychology (D.M.), Fourth Military Medical University, Xi'an, China
| | - Yanhong Hou
- From the Departments of Neurology (J.G., J.F., W.Z., W.Y., Y. Huang) and Radiology (X.W.), General Hospital of Beijing Command PLA; Centre of Psychology (Y.Z.), Air Force Aviation Medicine Research Institute; Department of Psychological Medicine (Y. Hou), 309 Hospital of PLA, Beijing; School of Psychology (H.L.), Beijing Normal University; and Department of Medical Psychology (D.M.), Fourth Military Medical University, Xi'an, China
| | - Yonghua Huang
- From the Departments of Neurology (J.G., J.F., W.Z., W.Y., Y. Huang) and Radiology (X.W.), General Hospital of Beijing Command PLA; Centre of Psychology (Y.Z.), Air Force Aviation Medicine Research Institute; Department of Psychological Medicine (Y. Hou), 309 Hospital of PLA, Beijing; School of Psychology (H.L.), Beijing Normal University; and Department of Medical Psychology (D.M.), Fourth Military Medical University, Xi'an, China.
| | - Hongyun Liu
- From the Departments of Neurology (J.G., J.F., W.Z., W.Y., Y. Huang) and Radiology (X.W.), General Hospital of Beijing Command PLA; Centre of Psychology (Y.Z.), Air Force Aviation Medicine Research Institute; Department of Psychological Medicine (Y. Hou), 309 Hospital of PLA, Beijing; School of Psychology (H.L.), Beijing Normal University; and Department of Medical Psychology (D.M.), Fourth Military Medical University, Xi'an, China.
| | - Danmin Miao
- From the Departments of Neurology (J.G., J.F., W.Z., W.Y., Y. Huang) and Radiology (X.W.), General Hospital of Beijing Command PLA; Centre of Psychology (Y.Z.), Air Force Aviation Medicine Research Institute; Department of Psychological Medicine (Y. Hou), 309 Hospital of PLA, Beijing; School of Psychology (H.L.), Beijing Normal University; and Department of Medical Psychology (D.M.), Fourth Military Medical University, Xi'an, China.
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Interventions for tic disorders: An overview of systematic reviews and meta analyses. Neurosci Biobehav Rev 2016; 63:239-55. [PMID: 26751711 DOI: 10.1016/j.neubiorev.2015.12.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 11/24/2015] [Accepted: 12/28/2015] [Indexed: 02/05/2023]
Abstract
We conducted a comprehensive search and the overview included 22 systematic reviews (SRs) for treating tic disorders (TDs). Three SRs indicated typical antipsychotics (i.e., haloperidol, pimozide) were efficacious in the reduction of tic severity compared with placebo but with poor tolerability. Six SRs assessed the efficacy of atypical antipsychotics and indicated that atypical antipsychotics (i.e., risperidone, aripiprazole) could significantly improved tic symptoms compared with placebo or typical antipsychotics with less AEs. Four SRs indicated alpha adrenergic agonists (i.e., clonidine, guanfacine) could improve tic symptoms. Two SRs assessed the efficacy of antiepileptic drugs and indicated topiramate was a promising therapy. Six SRs evaluated the efficacy of behavior therapy and showed habit reversal therapy (HRT) and exposure and response prevention (ERP) were effective. One SR evaluated the efficacy deep brain stimulation (DBS) and indicated DBS is a promising treatment option for severe cases of TS. In conclusion, RCTs directly comparing different pharmacological treatment options are scarce. In practice, typical and atypical antipsychotics are often considered firstly while other pharmacological medications are suggested as alternatives in the case of treatment failure or contradictory outcomes. Behavioral therapies can be used either alone or in combination with medication.
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Evans J, Seri S, Cavanna AE. The effects of Gilles de la Tourette syndrome and other chronic tic disorders on quality of life across the lifespan: a systematic review. Eur Child Adolesc Psychiatry 2016; 25:939-48. [PMID: 26880181 PMCID: PMC4990617 DOI: 10.1007/s00787-016-0823-8] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2015] [Accepted: 01/19/2016] [Indexed: 01/30/2023]
Abstract
Gilles de la Tourette syndrome (GTS) and other chronic tic disorders are neurodevelopmental conditions characterized by the presence of tics and associated behavioral problems. Whilst converging evidence indicates that these conditions can affect patients' quality of life (QoL), the extent of this impairment across the lifespan is not well understood. We conducted a systematic literature review of published QoL studies in GTS and other chronic tic disorders to comprehensively assess the effects of these conditions on QoL in different age groups. We found that QoL can be perceived differently by child and adult patients, especially with regard to the reciprocal contributions of tics and behavioral problems to the different domains of QoL. Specifically, QoL profiles in children often reflect the impact of co-morbid attention-deficit and hyperactivity symptoms, which tend to improve with age, whereas adults' perception of QoL seems to be more strongly affected by the presence of depression and anxiety. Management strategies should take into account differences in age-related QoL needs between children and adults with GTS or other chronic tic disorders.
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Affiliation(s)
- Joel Evans
- Department of Neuropsychiatry, BSMHFT and University of Birmingham Medical School, Birmingham, UK
| | - Stefano Seri
- School of Life and Health Sciences, Aston University, Birmingham, UK
| | - Andrea E. Cavanna
- Department of Neuropsychiatry, BSMHFT and University of Birmingham Medical School, Birmingham, UK ,School of Life and Health Sciences, Aston University, Birmingham, UK ,Sobell Department of Motor Neuroscience and Movement Disorders, UCL and Institute of Neurology, London, UK
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Trillini MO, Müller-Vahl KR. Narcissistic vulnerability is a common cause for depression in patients with Gilles de la Tourette syndrome. Psychiatry Res 2015; 230:695-703. [PMID: 26548979 DOI: 10.1016/j.psychres.2015.10.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 10/01/2015] [Accepted: 10/28/2015] [Indexed: 12/11/2022]
Abstract
The aim of this study was to assess for the first time different dimensions of narcissistic self-regulation in a large cohort of adult patients with Gilles de la Tourette syndrome (GTS) (n=50). From preliminary studies it is suggested that narcissistic personality trait and disorder, respectively, are relatively uncommon and occur in only 6-10% of GTS patients. In this study we used the Narcissism Inventory (NI), a 163-items questionnaire that measures four different dimensions of narcissism. The main result was that the prevalence of narcissism strongly depends on the subtype of narcissism: while the vulnerable narcissism ("threatened self" and "hypochondriac self") was common, the "classic narcissistic self" (grandiose narcissism) was rare. From our data an association between comorbid depression and increased values of the "threatened self" and comorbid OCD with increased values of the "hypochondriac self" is suggested. Narcissism correlated positively with the personality domain neuroticism and had a significantly negative impact on patients' quality of life. Therefore it can be speculated that vulnerable narcissism is - among several others - one cause for depression in patients with GTS. These findings may open new psychotherapeutic perspectives in the treatment of depression in patients with GTS.
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Affiliation(s)
- Morounke O Trillini
- Clinic of Psychiatry, Socialpsychiatry and Psychotherapy Hannover Medical School, Germany
| | - Kirsten R Müller-Vahl
- Clinic of Psychiatry, Socialpsychiatry and Psychotherapy Hannover Medical School, Germany.
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McGuire JF, Ricketts EJ, Piacentini J, Murphy TK, Storch EA, Lewin AB. Behavior Therapy for Tic Disorders: An Evidenced-based Review and New Directions for Treatment Research. CURRENT DEVELOPMENTAL DISORDERS REPORTS 2015; 2:309-317. [PMID: 26543797 PMCID: PMC4629635 DOI: 10.1007/s40474-015-0063-5] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Behavior therapy is an evidenced-based intervention with moderate-to-large treatment effects in reducing tic symptom severity among individuals with Persistent Tic Disorders (PTDs) and Tourette's Disorder (TD). This review describes the behavioral treatment model for tics, delineates components of evidence-based behavior therapy for tics, and reviews the empirical support among randomized controlled trials for individuals with PTDs or TD. Additionally, this review discusses several challenges confronting the behavioral management of tics, highlights emerging solutions for these challenges, and outlines new directions for treatment research.
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Affiliation(s)
- Joseph F. McGuire
- Semel Institute of Neuroscience and Human Behavior, University of California Los Angeles
| | - Emily J. Ricketts
- Semel Institute of Neuroscience and Human Behavior, University of California Los Angeles
| | - John Piacentini
- Semel Institute of Neuroscience and Human Behavior, University of California Los Angeles
| | - Tanya K. Murphy
- Department of Pediatrics, University of South Florida
- Departments of Psychiatry and Behavioral Neurosciences, University of South Florida
- All Children’s Hospital, Johns Hopkins Medicine, St. Petersburg, FL
| | - Eric A. Storch
- Department of Pediatrics, University of South Florida
- Departments of Psychiatry and Behavioral Neurosciences, University of South Florida
- Department of Health Policy and Management, University of South Florida
- Department of Psychology, University of South Florida
- Rogers Behavioral Health – Tampa Bay
- All Children’s Hospital, Johns Hopkins Medicine, St. Petersburg, FL
| | - Adam B. Lewin
- Department of Pediatrics, University of South Florida
- Departments of Psychiatry and Behavioral Neurosciences, University of South Florida
- Department of Psychology, University of South Florida
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Trillini MO, Müller-Vahl KR. Patients with Gilles de la Tourette syndrome have widespread personality differences. Psychiatry Res 2015; 228:765-73. [PMID: 26112450 DOI: 10.1016/j.psychres.2015.04.043] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Revised: 01/09/2015] [Accepted: 04/09/2015] [Indexed: 10/23/2022]
Abstract
Only little is known about pathological personality traits in patients with Gilles de la Tourette syndrome (GTS). The aim of this study was to further investigate the prevalence of personality traits in adults with GTS. We used a variety of rating scales to assess not only personality traits, but also severity of tics, quality of life, and comorbidities (obsessive-compulsive disorder (OCD), attention deficit hyperactivity disorder (ADHD), depression), in a large group (n=50) of patients. Our major finding was that pathological personality traits are very common in patients with GTS encompassing a wide range of different personality traits, but most typically personality traits related to cluster C. Demand-anxious was the most common personality trait, while histrionic personality trait was absent. Patients' quality of life was more impaired by personality traits than comorbidities. Personality traits were more common in patients with comorbid OCD and depression, while comorbid ADHD had no influence. Our findings, therefore, corroborate the hypothesis that GTS plus OCD represents a more severe subtype of GTS, and support the assumption that OCD and depression, but not ADHD, are part of the GTS spectrum.
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Affiliation(s)
- Morounke O Trillini
- Clinic of Psychiatry, Socialpsychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg-Str. 1, D-30625 Hannover, Germany
| | - Kirsten R Müller-Vahl
- Clinic of Psychiatry, Socialpsychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg-Str. 1, D-30625 Hannover, Germany.
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Bothersome tics in patients with chronic tic disorders: Characteristics and individualized treatment response to behavior therapy. Behav Res Ther 2015; 70:56-63. [PMID: 25988365 DOI: 10.1016/j.brat.2015.05.006] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Revised: 05/03/2015] [Accepted: 05/09/2015] [Indexed: 12/25/2022]
Abstract
UNLABELLED This report examined the most frequently reported bothersome tics among individuals with chronic tic disorders and evaluated the improvement and remission of tics and their associated characteristics. Youths and adults (N = 240) were randomly assigned to receive the comprehensive behavioral intervention for tics (CBIT) or psychoeducation and supportive therapy (PST). At baseline, motor tics and tics with an urge were rated as more bothersome relative to vocal tics and tics without premonitory urges. The five most common bothersome tics included eye blinking, head jerks, sniffing, throat clearing, and other complex motor tics. While CBIT outperformed PST across tic type and urge presence, tics preceded by premonitory urges at baseline had higher severity at posttreatment across treatment condition. Six individual tic types had lower severity at posttreatment following CBIT relative to PST. Baseline urge presence was associated with tic remission for CBIT but not PST. Specific bothersome tics were more likely to remit with CBIT relative to PST. Findings suggest that individual tics respond and remit differently to CBIT relative to PST, with implications highlighting the negative reinforcement hypothesis in tic symptom maintenance. CLINICALTRIALS. GOV IDENTIFIERS NCT00218777; NCT00231985.
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Rudy BM, Lewin AB, Storch EA. Introduction to the Special Issue: Considerations of the Effects of Extra-Symptom Variables Among Youth With Chronic Tic Disorders and Tourette’s Syndrome. CHILDRENS HEALTH CARE 2015. [DOI: 10.1080/02739615.2014.948167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Robertson MM. A personal 35 year perspective on Gilles de la Tourette syndrome: assessment, investigations, and management. Lancet Psychiatry 2015; 2:88-104. [PMID: 26359615 DOI: 10.1016/s2215-0366(14)00133-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Accepted: 10/09/2014] [Indexed: 01/17/2023]
Abstract
After having examined the definition, clinical phenomenology, comorbidity, psychopathology, and phenotypes in the first paper of this Series, here I discuss the assessment, including neuropsychology, and the effects of Gilles de la Tourette syndrome with studies showing that the quality of life of patients with Tourette's syndrome is reduced and that there is a substantial burden on the family. In this paper, I review my local and collaborative studies investigating causal factors (including genetic vulnerability, prenatal and perinatal difficulties, and neuro-immunological factors). I also present my studies on neuro-imaging, electro-encephalograms, and other special investigations, which are helpful in their own right or to exclude other conditions. Finally, I also review our studies on treatment including medications, transcranial magnetic stimulation, biofeedback, target-specific botulinum toxin injections, biofeedback and, in severe refractory adults, psychosurgery and deep brain stimulation. This Review summarises and highlights selected main findings from my clinic (initially The National Hospital for Neurology and Neurosurgery Queen Square and University College London, UK, and, subsequently, at St George's Hospital, London, UK), and several collaborations since 1980. As in Part 1 of this Series, I address the main controversies in the fields and the research of other groups, and I make suggestions for future research.
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Affiliation(s)
- Mary M Robertson
- Department of Neurology, Tourette Clinic, Atkinson Morley Wing, St Georges Hospital, London University College London, London; Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK; Department of Psychiatry, University of Cape Town, South Africa.
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McGuire JF, Piacentini J, Brennan EA, Lewin AB, Murphy TK, Small BJ, Storch EA. A meta-analysis of behavior therapy for Tourette Syndrome. J Psychiatr Res 2014; 50:106-12. [PMID: 24398255 DOI: 10.1016/j.jpsychires.2013.12.009] [Citation(s) in RCA: 146] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Revised: 11/30/2013] [Accepted: 12/18/2013] [Indexed: 10/25/2022]
Abstract
Individual randomized controlled trials (RCTs) of habit reversal training and a Comprehensive Behavioral Intervention for Tics (collectively referred to as behavior therapy, BT) have demonstrated efficacy in reducing tic severity for individuals with Tourette Syndrome and Chronic Tic Disorders (collectively referred to as TS), with no examination of treatment moderators. The present meta-analysis synthesized the treatment effect sizes (ES) of BT relative to comparison conditions, and examined moderators of treatment. A comprehensive literature search identified eight RCTs that met inclusion criteria, and produced a total sample of 438 participants. A random effects meta-analysis found a medium to large ES for BT relative to comparison conditions. Participant mean age, average number of therapy sessions, and the percentage of participants with co-occurring attention deficit hyperactivity disorder (ADHD) were found to moderate treatment effects. Participants receiving BT were more likely to exhibit a treatment response compared to control interventions, and identified a number needed to treat (NNT) of three. Sensitivity analyses failed to identify publication bias. Overall, BT trials yield medium to large effects for TS that are comparable to treatment effects identified by meta-analyses of antipsychotic medication RCTs. Larger treatment effects may be observed among BT trials with older participants, more therapeutic contact, and less co-occurring ADHD.
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Affiliation(s)
- Joseph F McGuire
- Department of Psychology, University of South Florida, 4202 E. Fowler Avenue, PCD 4118G, Tampa, FL 33620, USA; Department of Pediatrics, University of South Florida Tampa, FL, USA.
| | - John Piacentini
- Semel Institute of Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, CA, USA
| | - Erin A Brennan
- Department of Pediatrics, University of South Florida Tampa, FL, USA
| | - Adam B Lewin
- Department of Psychology, University of South Florida, 4202 E. Fowler Avenue, PCD 4118G, Tampa, FL 33620, USA; Department of Pediatrics, University of South Florida Tampa, FL, USA; Departments of Psychiatry and Behavioral Neurosciences, University of South Florida Tampa, FL, USA
| | - Tanya K Murphy
- Department of Pediatrics, University of South Florida Tampa, FL, USA; Departments of Psychiatry and Behavioral Neurosciences, University of South Florida Tampa, FL, USA
| | - Brent J Small
- School of Aging Studies, University of South Florida Tampa, FL, USA
| | - Eric A Storch
- Department of Psychology, University of South Florida, 4202 E. Fowler Avenue, PCD 4118G, Tampa, FL 33620, USA; Department of Pediatrics, University of South Florida Tampa, FL, USA; Departments of Psychiatry and Behavioral Neurosciences, University of South Florida Tampa, FL, USA
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Conelea CA, Busch AM, Catanzaro MA, Budman CL. Tic-related activity restriction as a predictor of emotional functioning and quality of life. Compr Psychiatry 2014; 55:123-9. [PMID: 24156871 PMCID: PMC3858466 DOI: 10.1016/j.comppsych.2013.06.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2012] [Revised: 06/08/2013] [Accepted: 06/10/2013] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVES Tourette Syndrome (TS) is a chronic neuropsychiatric condition that frequently persists into adulthood. Existing research has identified demographic and symptom-level variables associated with psychopathology and poor quality of life in TS. However, behavior patterns associated with enhanced or adaptive psychological and global functioning among adults with TS have yet to be empirically identified. The current study examined whether tic-specific activity restriction is related to emotional functioning and quality of life in adults with TS. METHODS Participants were 509 adults from the Tourette Syndrome Impact Survey who completed self-report measures of demographics, tic severity, emotional functioning, quality of life, and tic-related general and social activity restriction. RESULTS Partial correlations controlling for tic severity indicated that tic-related general and social activity restriction were significantly correlated with lower quality of life and poorer emotional functioning. Hierarchical linear regression models indicated that activity restriction significantly predicted lower quality of life and poorer emotional functioning when controlling for tic severity and demographic variables. CONCLUSIONS Adults who restrict fewer activities due to tics, regardless of tic severity, experience greater quality of life and better emotional functioning. Clinically, adults with chronic tics may benefit from interventions focused on enhancing engagement in valued life activities.
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Affiliation(s)
- Christine A Conelea
- Rhode Island Hospital/Alpert Medical School of Brown University, Providence, RI, USA.
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Eddy CM, Cavanna AE. On being your own worst enemy: an investigation of socially inappropriate symptoms in Tourette syndrome. J Psychiatr Res 2013; 47:1259-63. [PMID: 23768869 DOI: 10.1016/j.jpsychires.2013.05.019] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Revised: 04/12/2013] [Accepted: 05/17/2013] [Indexed: 10/26/2022]
Abstract
Non-obscene socially inappropriate symptoms (NOSIS) in Tourette syndrome (TS) include urges to make insulting remarks about a person's physical characteristics (e.g. "big nose") and other socially disruptive behaviors (e.g. shouting "bomb" at an airport). We aimed to explore the characteristics of NOSIS in TS, and determine whether individuals who experienced NOSIS reported differences to those who did not in terms of quality of life (QoL) and common clinical symptoms. Finally we aimed to identify significant predictors of the presence of NOSIS. Patients were sixty patients with TS from a specialist outpatient clinic. They completed clinical measures assessing NOSIS, QoL, tic severity, premonitory urges for tics, depression, anxiety, obsessions and compulsions, attention problems, coprophenomena and conduct problems. Two-thirds of our sample admitted experiencing urges to make socially inappropriate remarks and/or carry out socially inappropriate actions. However, not all urges led to actions. Obsessions, attention problems, coprolalia and conduct problems were all significantly more common in patients with NOSIS than those without. Moreover, the presence of NOSIS was associated with significantly poorer QoL, and higher scores on measures of tic severity, obsessive-compulsive symptoms, attention problems and premonitory urges. However, only the presence of coprolalia and severity of obsessive-compulsive symptoms and premonitory urges were significant predictors of the presence of NOSIS. Our findings may imply that elevated self-consciousness and obsessionality could comprise risk factors for the development of NOSIS. As NOSIS exert a specific detrimental impact on QoL, these symptoms should be employed as a marker of therapeutic efficacy.
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Affiliation(s)
- Clare M Eddy
- Birmingham and Solihull Mental Health NHS Foundation Trust, Department of Neuropsychiatry, The Barberry, National Centre for Mental Health, Birmingham, UK.
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Müller-Vahl KR. Surgical treatment of Tourette syndrome. Neurosci Biobehav Rev 2012; 37:1178-85. [PMID: 23041074 DOI: 10.1016/j.neubiorev.2012.09.012] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Revised: 09/19/2012] [Accepted: 09/26/2012] [Indexed: 11/15/2022]
Abstract
In severely affected, treatment resistant patients with Tourette syndrome (TS) new therapeutic strategies are urgently needed. Since 1999, 34 studies including more than 90 patients have been performed to investigate the efficacy and safety of deep brain stimulation (DBS) in the treatment of tics resulting in the vast majority of patients in an improvement of tics and in some patients even of comorbidities. Both surgery-related (e.g., bleeding, infection) and stimulation-related adverse events (e.g., loss of energy, blurred vision) seem to occur only in a minority of patients and not to cause significant impairment, respectively. Since randomized controlled studies including a larger number of patients are still lacking, up to now, no definite conclusion can be drawn. Therefore, at present time DBS is recommended only in adult, treatment resistant, and severely affected patients. However, most experts have no doubt that DBS is indeed effective in the treatment of tics. Future studies should aim to identify which target in which patient is optimal depending on the individual symptomatology.
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Affiliation(s)
- Kirsten R Müller-Vahl
- Clinic of Psychiatry, Socialpsychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg-Str. 1, D-30625 Hannover, Germany.
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