A controlled study of Tourette syndrome-Revisited: A reply to the letter of Pauls et al (original) (raw)
Related papers
Tourette syndrome: clinical and psychological aspects of 250 cases
American Journal of Human Genetics, 1985
Tourette syndrome is a common hereditary neuropsychiatric disorder consisting of multiple tics and vocal noises. We summarize here clinical aspects of 250 consecutive cases seen over a period of 3 years. The sex ratio was four males to one female, and the mean age of onset was 6.9 years. Only 10% were Jewish, indicating that it is not more prevalent in Ashkenazi Jews. Only 33% had compulsive swearing (coprolalia), indicating that this is not necessary for the diagnosis. The most frequent initial symptoms were rapid eye-blinking, facial grimacing, and throat-clearing. In this series, it was clear that Tourette syndrome is a psychiatric as well as a neurological disorder. Significant discipline problems and/or problems with anger and violence occurred in 61%, and 54% had attention-deficit disorder with hyperactivity. Some degree of exhibitionism was present in 15.9% of males and 6.1% of females. Obsessive-compulsive behavior was seen in 32%. Other than tics and vocal noises, the most common parental complaints were of short temper and everything being a confrontation. There were no significant clinical differences between familial and sporadic cases.
Meta-analysis: Adulthood prevalence of Tourette syndrome
Progress in Neuro-Psychopharmacology and Biological Psychiatry, 2019
Background: Tourette syndrome (TS) is estimated to have a prevalence of 0.30-0.77% in school aged children. Longitudinal studies suggest that roughly half-to-two-thirds of children with TS experience a substantial improvement in tic symptoms during adolescence. By contrast, few studies have examined adulthood prevalence of TS. Accurate prevalence estimates across the lifespan are needed to support regulatory and public health decisions. Methods: We searched PubMED and EMBASE for studies that examined the prevalence of TS in adults. We conducted a random-effects meta-analysis of logit event rates to estimate prevalence of TS across studies. Too few studies are available to conduct moderator analysis or examine publication bias. We also examined the risk ratio of TS prevalence in adults for males compared to females. Results: Three studies involving 2,356,485 participants were included. There were significant differences in TS adulthood prevalence estimates between studies ranging from 49 to 657 cases of TS per million adults. Overall prevalence of TS in adulthood was estimated to be 118 cases of TS per million adults (95%CI: 19-751 cases per million adults). There was a large amount of heterogeneity between studies (I 2 = 99%) that was likely related to differences in their methods of identification of TS cases. By contrast, the male:female ratio of risk of adulthood TS was similar between studies with a Risk Ratio = 2.33 (95% CI: 1.72-3.16). Conclusion: Estimates of adulthood prevalence of TS are sparse and likely highly affected by differences in method of case identification. Diagnosis and diagnostic estimates of TS could be aided by including a requirement for impairment as well as potential remission criteria similar to other psychiatric conditions.
Prevalence of tics and Tourette syndrome in an inpatient adult psychiatry setting
Journal of psychiatry & neuroscience : JPN, 2001
Given the widely recognized genetic basis for Gilles de la Tourette syndrome (TS) and the suggestion that the putative TS gene(s) may be expressed as or associated with a variety of psychiatric illnesses, this study was undertaken to assess the prevalence of tics and TS in a psychiatric inpatient population. Cross-sectional study. 200 consecutive adult patients who were admitted to the psychiatric wards of University College London Teaching Hospitals. TS and related behaviours, as assessed by the comprehensive semi-structured National Hospital Interview Schedule. None of the 200 patients had definite TS, but 2 were observed to have motor tics; 10 had a history of tics (present for less than a year), and 7 reported a family history of tics. Thus, 19 (9.5%) inpatients qualified for inclusion in a broadly defined TS diathesis. These rates are significantly lower than those reported in a similar community based epidemiological study of adolescents (p = 0.018). Our findings do not suppor...
Clinical assessment of Tourette syndrome and tic disorders
Neuroscience & Biobehavioral Reviews, 2013
Tourette Syndrome (TS) is a neuropsychiatric disorder involving multiple motor and phonic tics. Tics, which usually begin between the ages of 6 and 8, are sudden, rapid, stereotyped, and apparently purposeless movements or sounds that involve discrete muscle groups. Individuals with TS experience a variety of different sensory phenomena, including premonitory urges prior to tics and somatic hypersensitivity due to impaired sensorimotor gating. In addition to other conditions, stress, anxiety, fatigue, or other heightened emotional states tend to exacerbate tics, while relaxation, playing sports, and focused concentration on a specific task tend to alleviate tic symptoms. Ninety percent of children with TS also have comorbid conditions, such as Attention deficit hyperactivity disorder (ADHD), Obsessive-compulsive disorder (OCD), or an impulse control disorder. These disorders often cause more problems for the child both at home and at school than tics do alone. Proper diagnosis and treatment of TS involves appropriate evaluation and recognition, not only of tics, but also of these associated conditions.
Acta Paediatrica, 2007
Aim: T o describe the symptoms, onset, heredity, pre-/pennatal events and socioeconomic status in Tourette syndrome (TS) and other tic disorders. Methods: From a total population of 4479 children, 25 (0.6%) with TS, 58 (1.3%) with chronic motor/ vocal tics (CMVT) and 214 (4.8%) with transient tics (TT) in the last year were found. A three-stage procedure was used: tic screening, telephone interview and clinical assessment. The TS group was compared with 25 children with TT and 25 controls without tics. Results: The mean age of the first symptoms of TS was significantly lower than the onset of CMVT. All except one with TS had contact with medical services. The tics of children with TS were significantly more severe than the tics of others. Younger age of onset of TS indicated more severe tics. Parents and siblings of children with TS had an increased prevalence of tic disorders, obsessive-compulsive behaviour (OCD), attention-deficithyperactivity disorder (ADHD) and depression. Eighty per cent had a first-degree relative with a psychiatric disorder. A non-significant increase with regards to reduced optimality score in the pre-, pen-or neonatal periods was found in children with TS compared to controls. No differences were found concerning socioeconomic status. Conclusion: Almost all children from a total population with TS have sought help from medical services. An increased prevalence of tics, OCD, depression or ADHD was found in the parentdsiblings of children with TS, which draws attention to the importance of thorough investigation of family members.
Clinical features of Tourette syndrome and tic disorders
Journal of Obsessive-Compulsive and Related Disorders, 2014
Background: Tourette syndrome (TS) is a neurodevelopmental disorder characterized by motor and vocal tics-rapid, repetitive, stereotyped movements or vocalizations lasting at least one year in duration. The goal of this article was to review the long-term clinical course of tics and frequently co-occurring conditions in children with TS. Methods: We conducted a traditional literature search to locate relevant articles regarding longterm outcome and prognosis in TS and tic disorders. Results: Tics typically have an onset between the ages of 4 and 6 years and reach their worstever severity between the ages of 10 and 12 years. By age 10 years, most children are aware of nearly irresistible somatosensory urges that precede the tics. A momentary sense of relief typically follows the completion of a tic. Over the course of hours, tics occur in bouts, with a regular intertic interval. Tics increase during periods of psychosocial stress, emotional excitement and fatigue. Tics can become "complex" in nature and appear to be purposeful. Tics can be willfully suppressed for brief intervals and can be evoked by the mere mention of them. Tics typically diminish during periods of goal-directed behavior. Over the course of months, tics wax and wane. By early adulthood, roughly three-quarters of children with TS will have greatly diminished tic symptoms and more than one-third will be virtually tic free. Conclusion: Although tics are the defining aspect of TS, they are often not the most enduring or impairing symptoms in children with TS. Indeed in TS tics rarely occur in isolation, and other coexisting conditions-such as behavioral disinhibition, hypersensitivity to a broad range of
Tourette Syndrome and Tic Disorders: A Decade of Progress
Journal of The American Academy of Child and Adolescent Psychiatry, 2007
Objective: This is a review of progress made in the understanding of Tourette syndrome (TS) during the past decade including models of pathogenesis, state-of-the-art assessment techniques, and treatment. Method: Computerized literature searches were conducted under the key words ''Tourette syndrome,'' ''Tourette disorder,'' and ''tics.'' Only references from 1996Y2006 were included. Results: Studies have documented the natural history of TS and the finding that tics usually improve by the end of the second decade of life. It has also become clear that TS frequently co-occurs with attention-deficit/hyperactivity disorder), obsessive-compulsive disorder, and a range of other mood and anxiety disorders.
Long term clinical course of Tourette syndrome
Brain and Development, 2012
Background: Recent studies using cluster analysis and factor analysis have suggested that Tourette Syndrome (TS) should no longer be considered a unitary condition. Material and methods: We retrospectively studied the long term clinical course of 100 TS patients. The patients were assessed at the onset and after 10 years follow-up to evaluate the severity of tic, the Obsessive Compulsive Disorder (OCD), the Attention Deficit Hyperactivity Disorder (ADHD) and the presence of anxiety and depression, rage attacks, self injuries behavior. Moreover at the follow-up they completed an evaluation scale on quality of life to assess the impairment in everyday life after 10 years of illness. Results: The "pure TS" clinical group (38 subjects) showed after 10 years follow-up that 58% carried on with the same clinical phenotype, whereas 42% changed in "TS + OCD" phenotype. Fifty-five percentage required pharmacological treatment. All the "TS + ADHD" clinical group (48 subjects) showed after 10 years follow-up a different clinical phenotype: 62% "TS pure" phenotype, 35% "TS + OCD" phenotype, 2% "TS + ADHD + OCD" phenotype. Sixty-five percentage of the subject required pharmacological treatment. The "TS + ADHD + OCD" clinical group (14 subjects) after 10 years follow-up showed that 14% carried on with the same clinical phenotype, whereas 8.3% presented "TS pure" phenotype and 92% presented "TS + OCD" phenotype. Seventy-one percentage were in need of therapy. With regards to quality of life, patients presented widespread impairment correlated to the presence of comorbid conditions. Conclusion: Our findings suggest that pure TS has quite a good long-term clinical course. By contrast, those who presented comorbid condition at the onset showed a more severe prognosis.
Neuropsychiatric Disease and Treatment, 2015
This study addressed several questions relating to the core features of Tourette syndrome (TS) including in particular coprolalia (involuntary utterance of obscene words) and copropraxia (involuntary and inappropriate rude gesturing). A cohort of 400 TS patients was investigated. We observed that coprolalia occurred in 39% of the full cohort of 400 patients and copropraxia occurred in 20% of the cohort. Those with coprolalia had significantly higher Yale Global Tic Severity Scale (YGTSS) and Diagnostic Confidence Index (DCI) total scores and a significantly higher proportion also experienced copropraxia and echolalia. A subgroup of 222 TS patients with full comorbidity data available were also compared based on whether they had pure-TS (motor and vocal tics only) or associated comorbidities and co-existent psychopathologies (TS-plus). Pure-TS and TS-plus groups were compared across a number of characteristics including TS severity, associated clinical features, and family history. In this subgroup, 13.5% had pure-TS, while the remainder had comorbidities and psychopathologies consistent with TS-plus. Thirty-nine percent of the TS-plus group displayed coprolalia, compared to (0%) of the pure-TS group and the difference in proportions was statistically significant. The only other significant difference found between the two groups was that pure-TS was associated with no family history of obsessive compulsive disorder which is an interesting finding that may suggest that additional genes or environmental factors may be at play when TS is associated with comorbidities. Finally, differences between individuals with simple versus complex vocal/motor tics were evaluated. Results indicated that individuals with complex motor/vocal tics were significantly more likely to report premonitory urges/sensations than individuals with simple tics and TS. The implications of these findings for the assessment and understanding of TS are discussed.