Tourette's syndrome
8 important questions on Tourette's syndrome
Tourette's Motor tics
- Simple motor tics
sudden, fleeting or fragmentary movements (blinking, grimacing, head jerking) - complex motor tics
several simple motor tics occurring in an orchestrated sequence or semi-purposeful movements (touching or tapping)
Tourette's phonic tics
- simple phonic tics
simple, unarticulated sounds (throat clearing, sniffing, grunting) - complex phonic tics
out-of-context syllables, words, phrases or paroxysmal changes in prosody
Tourette's complex tics may involve
- socially inappropriate or obscene gestures (copropraxia) or utterances (coprolalia)
- echo phenomena such as echolalia or echopraxia (repeating others movements)
- self-injurious tics such s cheek chewing, eye poking, or self hitting
- tics can be exacerbated by stress, fatigue and external stimuli
- intentional movements can attenuate tic occurence and concentration in activities tend to dissipate symptoms
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Tourette's premonitary urges
- uncomfortable bodily sensations prior to tics, and are temporarily relieved or reduced following tics
- discomfort from these urges can cause more dustress than the tics themselves
- >90% of adults with tourette's are aware of the urges (less in children and adolescents)
Tourette's Rage attacks
- in outbursts - Premonitary urges -> relief -> remorse
- studies suggest that rage attacks are positively correlated with triad of TS, ADHD, OCD
- ADHD and OCD may represent a similar disorder of inhibition
- Prevalence of ADHD in TS is 55%
Tourette's diagnosis and treatment
- Many patients with TS are undiagnosed
- potential long-term concequences of failed or delayed identification (e.g. behavioural problems)
- diagnosis after consulation of 2-3 professionals (range 1-16)
- delay from aonset of tics until diagnosis about 3 years
- due to a lack of knowledge and delay of initiation of necessary support
Tourette's habit reversal therapy
- teaching the patient to become aware off the premonitary urge preceding a tic, recognizing it, and developing a competing response incompatible with performing the tic
Tourette's Hayling sentence completion task
- sensitive to TS and deficits of TS patients (without comorbidity)
- measure of response inhibition
- two sets of 15 sentences with the last word missing
- sentences strongly cue a particular word
- 1st part - complete the sentences logically
2nd part - complete the sentences with a nonsensical ending word - increased number of errors in patients with TS for the nonsensical endings
- verbal inhibition is impaired in patients with TS
- could impair performance in other tasks
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