Podcast
Questions and Answers
The core diagnostic criteria of tic disorders include the presence of chorea or myoclonus.
The core diagnostic criteria of tic disorders include the presence of chorea or myoclonus.
False
Tics can be defined as rhythmic movements or vocalizations.
Tics can be defined as rhythmic movements or vocalizations.
False
Tourette's disorder is also known as Chronic Motor or Vocal Tic Disorder.
Tourette's disorder is also known as Chronic Motor or Vocal Tic Disorder.
False
Provisional Tic Disorder is characterized by the presence of stereotypies.
Provisional Tic Disorder is characterized by the presence of stereotypies.
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Tics are typically observed in the trunk and lower limbs of the body.
Tics are typically observed in the trunk and lower limbs of the body.
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Complex tics involve a single muscle group.
Complex tics involve a single muscle group.
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The severity of tics remains constant over time.
The severity of tics remains constant over time.
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Tics can be voluntarily suppressed in the most cranial body areas.
Tics can be voluntarily suppressed in the most cranial body areas.
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The variability of tics is limited to the type of movement or vocalization.
The variability of tics is limited to the type of movement or vocalization.
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The age range of 5 to 8 years is when most typical tics begin.
The age range of 5 to 8 years is when most typical tics begin.
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Up to 75% of people with TS experience a significant decline of tic symptoms by late adolescence.
Up to 75% of people with TS experience a significant decline of tic symptoms by late adolescence.
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The lifetime prevalence of any psychiatric comorbidity among TS patients is estimated at 50-60%.
The lifetime prevalence of any psychiatric comorbidity among TS patients is estimated at 50-60%.
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ADHD is the second most common comorbidity among TS patients, affecting up to 40% of them.
ADHD is the second most common comorbidity among TS patients, affecting up to 40% of them.
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Obsessive-compulsive symptomatology in TS is most often associated with counting and arranging behaviors.
Obsessive-compulsive symptomatology in TS is most often associated with counting and arranging behaviors.
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Up to 20% of patients with TS may develop mood disorders in their lifetime.
Up to 20% of patients with TS may develop mood disorders in their lifetime.
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The prevalence estimates of ASD in TS may be as low as 5%.
The prevalence estimates of ASD in TS may be as low as 5%.
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About 5% of youth with chronic tic disorders experience suicidal thoughts and/or behaviors.
About 5% of youth with chronic tic disorders experience suicidal thoughts and/or behaviors.
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ASD is associated with a lower risk of rage attacks/explosive outbursts in TS patients.
ASD is associated with a lower risk of rage attacks/explosive outbursts in TS patients.
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Only about 50% of pre-pubertal children are able to describe premonitory urges (PUs).
Only about 50% of pre-pubertal children are able to describe premonitory urges (PUs).
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Vocal tics can range from monosyllabic, meaningless vocal utterances to longer sentences of verbal language with a semantic content.
Vocal tics can range from monosyllabic, meaningless vocal utterances to longer sentences of verbal language with a semantic content.
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Complex tic-like repetitive behaviors include echophenomena, but not paliphenomena.
Complex tic-like repetitive behaviors include echophenomena, but not paliphenomena.
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Some tics may have a violent and deliberately self-harming quality.
Some tics may have a violent and deliberately self-harming quality.
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The ability to suppress tics is higher in children than in adults.
The ability to suppress tics is higher in children than in adults.
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Active tic suppression does not demand attention and may not distract from complex cognitive activities.
Active tic suppression does not demand attention and may not distract from complex cognitive activities.
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Relaxation and physical exercise may increase tic severity.
Relaxation and physical exercise may increase tic severity.
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Psychosocial stress is a minor factor that modulates tic severity.
Psychosocial stress is a minor factor that modulates tic severity.
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Tic-like rapid movements presenting in adulthood are always considered to have a functional origin.
Tic-like rapid movements presenting in adulthood are always considered to have a functional origin.
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The CSTC network is responsible for the regulation of emotions and mood in individuals with tic disorders.
The CSTC network is responsible for the regulation of emotions and mood in individuals with tic disorders.
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Reduced numbers and gene expression within excitatory glutamatergic interneurons have been found in TS patients.
Reduced numbers and gene expression within excitatory glutamatergic interneurons have been found in TS patients.
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Injection of the GABAA antagonist bicuculline in the nucleus accumbens leads to generation of tic-like rapid movements.
Injection of the GABAA antagonist bicuculline in the nucleus accumbens leads to generation of tic-like rapid movements.
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Structural neuroimaging studies have shown abnormalities in the amygdala and hippocampus of TS patients.
Structural neuroimaging studies have shown abnormalities in the amygdala and hippocampus of TS patients.
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The anterior cingulate cortex is activated at tic onset in TS patients.
The anterior cingulate cortex is activated at tic onset in TS patients.
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Defective excitatory mechanisms have been found in TS brains.
Defective excitatory mechanisms have been found in TS brains.
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A later age at onset is commonly associated with Tourette's disorder.
A later age at onset is commonly associated with Tourette's disorder.
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Education of patients and families is not a crucial phase of management for tic disorders.
Education of patients and families is not a crucial phase of management for tic disorders.
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Validated rating instruments for tics and associated behavioral symptoms are not necessary for guiding the management of tic disorders.
Validated rating instruments for tics and associated behavioral symptoms are not necessary for guiding the management of tic disorders.
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Dopamine antagonist drugs have been used for the treatment of tics for less than 20 years.
Dopamine antagonist drugs have been used for the treatment of tics for less than 20 years.
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Pimozide has been shown to be inferior to placebo in treating tics.
Pimozide has been shown to be inferior to placebo in treating tics.
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Risperidone has been shown to be less effective than haloperidol in treating tics.
Risperidone has been shown to be less effective than haloperidol in treating tics.
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Aripiprazole has been shown to be effective in treating tics only in children.
Aripiprazole has been shown to be effective in treating tics only in children.
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Sulpiride is a benzamide that is rarely associated with sedation.
Sulpiride is a benzamide that is rarely associated with sedation.
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Tiapride is a dopamine antagonist that is not commonly used in Europe.
Tiapride is a dopamine antagonist that is not commonly used in Europe.
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Fluphenazine has been shown to be superior to placebo in treating tics by multiple RCTs.
Fluphenazine has been shown to be superior to placebo in treating tics by multiple RCTs.
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Haloperidol has been shown to be more effective than pimozide in treating tics.
Haloperidol has been shown to be more effective than pimozide in treating tics.
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Risperidone has been shown to be effective in treating tics only in the short-term.
Risperidone has been shown to be effective in treating tics only in the short-term.
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Alpha-2 agonists have been used to treat tics for more than two decades.
Alpha-2 agonists have been used to treat tics for more than two decades.
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Guanfacine has a shorter half-life than clonidine.
Guanfacine has a shorter half-life than clonidine.
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Tetrabenazine is a postsynaptic dopamine blocker.
Tetrabenazine is a postsynaptic dopamine blocker.
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Botulinum toxin type A injections are only effective in treating vocal tics.
Botulinum toxin type A injections are only effective in treating vocal tics.
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Clonidine is considered a first-line therapy for tics in the United States and Canada.
Clonidine is considered a first-line therapy for tics in the United States and Canada.
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Guanfacine has a similar side effect profile to clonidine, but is more effective in treating tics.
Guanfacine has a similar side effect profile to clonidine, but is more effective in treating tics.
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Baclofen and topiramate are highly effective in treating tics.
Baclofen and topiramate are highly effective in treating tics.
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Clonidine requires monitoring for increased blood pressure.
Clonidine requires monitoring for increased blood pressure.
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Tetrabenazine is a highly effective treatment for tics, supported by multiple RCTs.
Tetrabenazine is a highly effective treatment for tics, supported by multiple RCTs.
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Guanfacine can be administered twice daily.
Guanfacine can be administered twice daily.
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A large-scale RCT has demonstrated the efficacy of nicotine in treating tics.
A large-scale RCT has demonstrated the efficacy of nicotine in treating tics.
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Omega-3 fatty acids have been shown to be ineffective in reducing tic severity.
Omega-3 fatty acids have been shown to be ineffective in reducing tic severity.
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Habit reversal training (HRT) is a type of behavioral therapy that targets underlying psychological issues.
Habit reversal training (HRT) is a type of behavioral therapy that targets underlying psychological issues.
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Comprehensive Behavioral Intervention for Tics (CBIT) is a type of pharmacological treatment for tics.
Comprehensive Behavioral Intervention for Tics (CBIT) is a type of pharmacological treatment for tics.
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Exposure and response prevention (ERP) has been shown to be superior to HRT in reducing tic severity.
Exposure and response prevention (ERP) has been shown to be superior to HRT in reducing tic severity.
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Delta-9-tetrahydrocannabinol has been shown to be highly effective in treating tics.
Delta-9-tetrahydrocannabinol has been shown to be highly effective in treating tics.
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Botulinum toxin injections have been shown to be effective in treating vocal tics.
Botulinum toxin injections have been shown to be effective in treating vocal tics.
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The main active compound of cannabis has been tested in multiple large-scale RCTs on children with TS.
The main active compound of cannabis has been tested in multiple large-scale RCTs on children with TS.
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Tetrabenazine is a commonly used treatment for tics, supported by strong evidence of efficacy.
Tetrabenazine is a commonly used treatment for tics, supported by strong evidence of efficacy.
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Habit reversal training (HRT) has been shown to be ineffective in reducing tic severity in children with TS.
Habit reversal training (HRT) has been shown to be ineffective in reducing tic severity in children with TS.
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Deep brain stimulation is a widely accepted treatment for mild cases of Tourette's syndrome.
Deep brain stimulation is a widely accepted treatment for mild cases of Tourette's syndrome.
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Neurofeedback modulation of EEG oscillatory activity has been shown to worsen ADHD and tic symptoms.
Neurofeedback modulation of EEG oscillatory activity has been shown to worsen ADHD and tic symptoms.
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Mindfulness-based stress reduction programmes have been shown to have no effect on tic symptoms.
Mindfulness-based stress reduction programmes have been shown to have no effect on tic symptoms.
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A cognitive psychophysiological model has been widely used to treat tics and associated metacognitive and perfectionist beliefs.
A cognitive psychophysiological model has been widely used to treat tics and associated metacognitive and perfectionist beliefs.
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Controlled trials for mindfulness-based stress reduction programmes and neurofeedback modulation of EEG oscillatory activity are abundant.
Controlled trials for mindfulness-based stress reduction programmes and neurofeedback modulation of EEG oscillatory activity are abundant.
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The centromedian/parafascicular-substantia periventricularis-nucleus ventralis oralis internus crosspoint of the thalamus is a rarely used target for deep brain stimulation in Tourette's syndrome.
The centromedian/parafascicular-substantia periventricularis-nucleus ventralis oralis internus crosspoint of the thalamus is a rarely used target for deep brain stimulation in Tourette's syndrome.
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Deep brain stimulation has been associated with major safety concerns in patients with Tourette's syndrome.
Deep brain stimulation has been associated with major safety concerns in patients with Tourette's syndrome.
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The application of adaptive approaches using looped paradigms that adapt stimulation parameters to real-time brain oscillatory activities is not being investigated for Tourette's syndrome.
The application of adaptive approaches using looped paradigms that adapt stimulation parameters to real-time brain oscillatory activities is not being investigated for Tourette's syndrome.
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The globus pallidus pars interna is not a commonly used target for deep brain stimulation in Tourette's syndrome.
The globus pallidus pars interna is not a commonly used target for deep brain stimulation in Tourette's syndrome.
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More research is not needed to increase knowledge of predictors of good response to cognitive-behavioral therapy and patient selection criteria.
More research is not needed to increase knowledge of predictors of good response to cognitive-behavioral therapy and patient selection criteria.
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A premonitory sensation is characterized by anxiety due to fear of harm to one's parents.
A premonitory sensation is characterized by anxiety due to fear of harm to one's parents.
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The primary outcome of performing a tic is the temporary relief of the premonitory sensation.
The primary outcome of performing a tic is the temporary relief of the premonitory sensation.
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An obsessive thought can involve a worry about something happening to the patient’s parents, accompanied by increased anxiety and autonomic arousal.
An obsessive thought can involve a worry about something happening to the patient’s parents, accompanied by increased anxiety and autonomic arousal.
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Performing a compulsion typically decreases the patient’s anxiety related to an obsessive thought in the long term.
Performing a compulsion typically decreases the patient’s anxiety related to an obsessive thought in the long term.
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The Yale Global Tic Severity Scale is used to evaluate tics in patients with Tourette's syndrome.
The Yale Global Tic Severity Scale is used to evaluate tics in patients with Tourette's syndrome.
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The performance of risk-related behavior in the context of impulsive behavior always leads to long-term satisfaction.
The performance of risk-related behavior in the context of impulsive behavior always leads to long-term satisfaction.
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Pharmacotherapy is only considered for treating tics after symptom-focused behavioral therapy has been attempted.
Pharmacotherapy is only considered for treating tics after symptom-focused behavioral therapy has been attempted.
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Compulsions are performed in a non-structured and random sequence.
Compulsions are performed in a non-structured and random sequence.
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Risk-taking behavior is associated with an immediate sense of dissatisfaction after being performed.
Risk-taking behavior is associated with an immediate sense of dissatisfaction after being performed.
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The Premonitory Urge for Tics Scale (PUTS) is used to evaluate anxiety and depression in patients with Tourette's syndrome.
The Premonitory Urge for Tics Scale (PUTS) is used to evaluate anxiety and depression in patients with Tourette's syndrome.
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Experiencing an intrusive thought related to the safety of one’s parents can lead to the performance of voluntary and repetitive actions.
Experiencing an intrusive thought related to the safety of one’s parents can lead to the performance of voluntary and repetitive actions.
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GTS-QOL stands for Generalized Tic Syndrome Quality of Life Scale.
GTS-QOL stands for Generalized Tic Syndrome Quality of Life Scale.
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Impulsive behavior often follows a buildup of a mental urge to act out a specific behavior despite the potential risk.
Impulsive behavior often follows a buildup of a mental urge to act out a specific behavior despite the potential risk.
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SNAP is an abbreviation for Swanson, Nolan and Pelham questionnaire, which is used to assess autism in patients with Tourette's syndrome.
SNAP is an abbreviation for Swanson, Nolan and Pelham questionnaire, which is used to assess autism in patients with Tourette's syndrome.
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Monitoring is indicated for patients with Tourette's syndrome who have no indication for treatment.
Monitoring is indicated for patients with Tourette's syndrome who have no indication for treatment.
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The Beck Depression Inventory (BDI) is used to evaluate disruptive behaviors in patients with Tourette's syndrome.
The Beck Depression Inventory (BDI) is used to evaluate disruptive behaviors in patients with Tourette's syndrome.
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Preference for behavioral treatment is considered before pharmacological treatment in the treatment decision tree for tics.
Preference for behavioral treatment is considered before pharmacological treatment in the treatment decision tree for tics.
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Academic and professional proficiency is an area of functioning considered in the assessment plan for Tourette's syndrome.
Academic and professional proficiency is an area of functioning considered in the assessment plan for Tourette's syndrome.
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A person must have both motor and vocal tics occurring simultaneously to be diagnosed with Tourette's Syndrome (TS).
A person must have both motor and vocal tics occurring simultaneously to be diagnosed with Tourette's Syndrome (TS).
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To be diagnosed with Persistent (Chronic) Motor or Vocal Tic Disorder, a person must have both motor and vocal tics.
To be diagnosed with Persistent (Chronic) Motor or Vocal Tic Disorder, a person must have both motor and vocal tics.
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A diagnosis of Provisional Tic Disorder can only be given if the tics have been present for no longer than 12 months in a row.
A diagnosis of Provisional Tic Disorder can only be given if the tics have been present for no longer than 12 months in a row.
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Individuals diagnosed with TS typically begin showing symptoms after the age of 18.
Individuals diagnosed with TS typically begin showing symptoms after the age of 18.
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Tics due to taking medicine or other drugs can be categorized under Tourette's Syndrome.
Tics due to taking medicine or other drugs can be categorized under Tourette's Syndrome.
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To diagnose TS, a person must have had tics occurring many times a day for almost every day.
To diagnose TS, a person must have had tics occurring many times a day for almost every day.
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Provisional Tic Disorder requires the same criteria as Persistent Tic Disorder except for the duration of tic presence.
Provisional Tic Disorder requires the same criteria as Persistent Tic Disorder except for the duration of tic presence.
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A person can be diagnosed with Persistent (Chronic) Motor or Vocal Tic Disorder if their tics began after turning 18.
A person can be diagnosed with Persistent (Chronic) Motor or Vocal Tic Disorder if their tics began after turning 18.
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A diagnosis of TS can be made even if the person has only one motor tic and no vocal tics.
A diagnosis of TS can be made even if the person has only one motor tic and no vocal tics.
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Persistent (Chronic) Motor or Vocal Tic Disorder never involves the occurrence of both motor and vocal tics.
Persistent (Chronic) Motor or Vocal Tic Disorder never involves the occurrence of both motor and vocal tics.
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Study Notes
Tic Disorders
- Characterized by recurrent, unwanted, discrete, non-goal-directed, non-rhythmic movements (motor tics) or vocalizations (vocal tics)
- Distinguished from other abnormal behaviors by:
- Repetitive and patterned character
- Variability of type of movement/vocalization and severity
- Association with premonitory urges
- Partial or complete suppressibility on demand
Types of Tic Disorders
- Three types of tic disorders included in DSM-5:
- Tourette's disorder (also called Tourette's syndrome, TS)
- Persistent (also called chronic) motor or vocal tic disorder
- Provisional tic disorder
Characteristics of Tics
- Highly variable within and across subjects, regarding:
- Muscle groups involved (and thus body location)
- Complexity
- Interference with normal voluntary behavior
- Tics follow a cranio-caudal gradient of frequency, with:
- Face, head, and proximal upper limbs being the most commonly affected
- Ability to suppress tics voluntarily being maximal in the least affected areas (trunk and lower limbs)
- Tics can be classified as:
- Simple (involving a single muscle group)
- Complex (involving coordinated sequences or combinations of movements/vocalizations)
Premonitory Urges and Sensory Features
- Premonitory urges (PUs) are uncomfortable sensations that:
- Build up in intensity immediately before tics
- Are markedly alleviated immediately after tic release
- Often, linked PUs and tics occur in the same body region
- Some patients report "just-right" phenomena, reiterating actions until they feel "just right"
- Somatic hypersensitivity or site sensitization: unusual focus on external stimuli, repetitive, faint, and poorly salient
Suppression of Tics
- Ability to suppress tics varies across patients and is higher in adults than children
- Suppressing tics leads to a rise in PU intensity, but quality or severity of PUs is not associated with the ability to hold tics in
- Rewards, relaxation, physical exercise, and reduced sympathetic tone can reduce tic severity
- Psychosocial stress, raised anxiety levels, and fatigue are important precipitants of tics
Tic Disorders in Adults
- Tic-like rapid movements presenting in adulthood may be labeled as tics, but some have a functional origin
- Differ from typical "organic" tics in:
- Female predominance
- Sudden onset, often precipitated by minor trauma or panic attacks
- Uncommon association with PUs or suppressibility
- Common suggestibility
- Lack of association with a family history of tic disorders or a personal history of ADHD or OCD
Epidemiology and Comorbidities
- Tics typically begin between 5 and 8 years of age, with 95% of cases starting between 4 and 13 years
- Severity peaks around puberty, and tics may spread beyond the cranio-cervical region
- Most prevalence studies have focused on pediatric populations, with a combined prevalence of:
- 0.77% for TS
- 1.61% for chronic tic disorders
- 2.99% for transient tic disorders
- 2.82% for all tic disorders
- Comorbidities include:
- ADHD (affecting up to 60% of TS patients)
- Obsessive-compulsive disorder (OCD)
- Anxiety disorders
- Mood disorders
- Conduct disorder/oppositional defiant disorder
- Autism spectrum disorder (ASD)
Pathogenesis
- Structural and functional abnormalities detected in TS patients at numerous levels of the cortico-striato-thalamo-cortical (CSTC) network
- Microscopic level: reduced numbers and gene expression within inhibitory GABAergic and cholinergic interneurons in sensorimotor parts of the striatum and internal segment of the globus pallidus
- Functional imbalance between inhibition/excitation in these structures was hypothesized
Management
- Comprehensive history and assessment using validated rating instruments are crucial in guiding management
- Education of patients and families is essential in optimizing understanding and acceptance of symptoms and identifying coping strategies
- Tics typically require active interventions when they are:
- Stigmatizing
- Socially or academically impairing
- Influencing mood and self-esteem
- Generating situational anxiety
- Pharmacological and behavioral approaches are used, with dopamine antagonist drugs being the most common treatment
Alpha-2 Agonists
- Clonidine and guanfacine are considered first-line therapy for tics in the US and Canada due to their favorable tolerability profile.
- Six RCTs demonstrated superiority of clonidine over placebo in both oral and transdermal formulations (0.05-3 mg).
- Guanfacine has a longer half-life than clonidine and can be administered once daily (0.5-4 mg).
- Two RCTs and two open-label studies confirmed the efficacy of guanfacine, especially in children with tic disorders.
Other Medications
- Tetrabenazine is a presynaptic dopamine depletor that acts by blocking the vesicular VMAT2 protein and displays minor postsynaptic D2 blockage.
- Baclofen and topiramate were found to be moderately effective in two medium-sized double-blind RCTs on patients of different ages.
- Botulinum toxin type A injections are useful for treating persistent, simple motor tics located to the upper face or neck, as well as for vocal tics, including coprolalic utterances.
- Delta-9-tetrahydrocannabinol, the main active compound of cannabis, has been tested in two small RCTs on adults with TS, showing a modest, but promising, benefit on some outcome measures and acceptable tolerability.
Behavioral Therapies
- Habit reversal training (HRT) is a highly effective treatment approach for tics, built on awareness training, competing response training, and social support.
- Six RCTs and other smaller observational studies demonstrated the efficacy of HRT in diminishing tic severity.
- Comprehensive Behavioral Intervention for Tics (CBIT) is an extension of HRT that complements it with function-based assessment, relaxation training, and psychoeducational interventions.
- CBIT has been shown to be highly effective in two large multi-site RCTs, with sustained improvements for more than 6 months and amelioration of familial distress, obsessive-compulsive symptoms, and anxiety.
Other Therapies
- Exposure and response prevention (ERP) is a behavioral therapy that has been adapted for tic treatment, relying on prolonged exposure to urges associated with sustained suppression of tics.
- Cognitive psychophysiological model has been tested in an open trial, aiming to change the background activity against which tics occur and treat associated metacognitive and perfectionist beliefs.
- Mindfulness-based stress reduction programs, aerobic exercise sessions, and neurofeedback modulation of EEG oscillatory activity have been tested in preliminary open-label studies, but controlled trials are lacking.
Neuromodulation Strategies
- Deep brain stimulation (DBS) remains the only active intervention that is extensively being investigated for adult TS patients who are deemed refractory to pharmacological and behavioral interventions.
- The main patient selection criteria for DBS in TS include refractoriness to pharmacological and behavioral interventions, severe tic symptoms, and presence of comorbid conditions.
- The most frequently used targets for DBS in TS are the centromedian/parafascicular-substantia periventricularis-nucleus ventralis oralis internus crosspoint of the thalamus and the globus pallidus pars interna.
Assessment Plan in Tourette's Syndrome
- Demographics to be considered: age, gender, ethnicity, education level, SES, and marital status
- Tic evaluation involves:
- Yale Global Tic Severity Scale
- Premonitory Urge for Tics Scale (PUTS)
- Engaging and listening to parents/partners
- Contextual Factors
- Comorbidities to be assessed:
- OCD
- ADHD
- Anxiety/depression
- Disruptive behaviors
- Autism
- Area of functioning to be evaluated:
- Engaging and listening to parents/partners
- Academic and professional proficiency
- Hobbies and recreational interests
- Aspirations
Decision Tree for the Treatment of Tics
- Tics assessment leads to:
- Psychoeducation
- No indication for treatment, with monitoring
- Indication for treatment with preference for behavioral treatment
- Symptom-focused behavioral therapy
- If still an indication for treatment, then:
- Pharmacotherapy
- If indication for treatment with preference for pharmacological treatment, then:
- Pharmacotherapy + behavioral therapy
- Polypharmacotherapy
Abbreviations
- CY-BOCS: [Children]Yale-Brown Obsessive-Compulsive Scale
- SNAP: Swanson, Nolan and Pelham questionnaire
- SCARED: Screen for Child Anxiety and Related Emotional Disorders
- BDI: Beck Depression Inventory
- BAI: Beck Anxiety Inventory
- DBRS: Disruptive Behavior Rating Scale
- ASSQ: Autism Spectrum Screening Questionnaire
- PUTS: Premonitory Urge for Tics Scale
- OCD: Obsessive-compulsive disorder
- GTS-QOL: Generalized Tic Syndrome Quality of Life Scale
Understanding Tics and Other Primary Tic Disorders
- Premonitory Sensation: an uncomfortable tension in the neck muscles, temporarily relieved by performing an abrupt 'head flick' movement
- Obsessive Thought: an intrusive thought accompanied by raised anxiety levels, temporarily relieved by performing a series of voluntary routine actions
- Risk-taking or Sensation-seeking: a mental urge to act out a specific behavior, potentially leading to self-harm, but with an immediate gratification
DSM-5 Criteria for Tic Disorders
Tourette's Syndrome (TS)
- Must have two or more motor tics and at least one vocal tic
- Must have had tics for at least a year
- Must have tics that begin before the age of 18
- Must have symptoms not due to taking medicine or other drugs, or due to having another medical condition
Persistent (Chronic) Motor or Vocal Tic Disorder
- Must fulfill the same criteria as TS, apart from the first criterion
- Must have one or more motor tics or vocal tics, but not both
Provisional Tic Disorder
- Must fulfill the same criteria as persistent, chronic tic disorder
- Tics have been present for no longer than 12 months in a row
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Description
Assessing the need for active intervention in patients with tics, considering impact on daily life, mood, and self-esteem. Identifying priority comorbidities is also crucial. Quiz covers tics, their impact, and intervention decisions.
