Self-esteem in adults with Tourette syndrome and chronic tic disorders: The roles of tic severity, treatment, and comorbidity

BackgroundTic disorders, in particular chronic tic disorder and Tourette syndrome, affect about 1% of the population. The current treatment of choice is pharmacological or behavioural, addressing tics or the premonitory urges preceding tic onset.AimsThe current study reports an open trial evaluating the effectiveness of a cognitive psychophysiological treatment addressing Tourette-specific sensorimotor activation processes rather than the tic.MethodForty-nine people with Tourette syndrome and 36 people with chronic tics completed 10 weeks of individual cognitive psychophysiological therapy. Outcome measures included two tic severity scales and psychosocial measures.ResultsPost-treatment both groups had significantly improved on the tic scales with strong effect sizes across tic locations and complex and simple tics, maintained at 6-month follow-up with further change in perfectionism and self-esteem.ConclusionsThe cognitive psychophysiological approach targeting underlying sensorimotor processes rather than tics in Tourette's and chronic tic disorder reduced symptoms with a large effect size.

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Moderators and predictors of response to behavior therapy for tics in Tourette syndrome

Neurology ◽

10.1212/wnl.0000000000003710 ◽

2017 ◽

Vol 88 (11) ◽

pp. 1029-1036 ◽

Cited By ~ 38

Author(s):

Denis G. Sukhodolsky ◽

Douglas W. Woods ◽

John Piacentini ◽

Sabine Wilhelm ◽

Alan L. Peterson ◽

...

Keyword(s):

Anxiety Disorders ◽

Psychiatric Disorders ◽

Tourette Syndrome ◽

Behavior Therapy ◽

Tic Disorders ◽

Predictors Of Response ◽

Tic Severity ◽

Chronic Tic Disorders ◽

The Difference ◽

Moderate Response

Objective:To examine moderators and predictors of response to behavior therapy for tics in children and adults with Tourette syndrome and chronic tic disorders.Methods:Data from 2 10-week, multisite studies (1 in children and 1 in adults; total n = 248) comparing comprehensive behavioral intervention for tics (CBIT) to psychoeducation and supportive therapy (PST) were combined for moderator analyses. Participants (177 male, 71 female) had a mean age of 21.5 ± 13.9 years (range 9–69). Demographic and clinical characteristics, baseline tic-suppressing medication, and co-occurring psychiatric disorders were tested as potential moderators for CBIT vs PST or predictors of outcome regardless of treatment assignment. Main outcomes measures were the Yale Global Tic Severity Scale Total Tic score and the Clinical Global Impression–Improvement score assessed by masked evaluators.Results:The presence of tic medication significantly moderated response to CBIT vs PST (p = 0.01). Participants showed tic reduction after CBIT regardless of tic medication status, but only participants receiving tic medication showed reduction of tics after PST. Co-occurring psychiatric disorders, age, sex, family functioning, tic characteristics, and treatment expectancy did not moderate response. Across both treatments, greater tic severity (p = 0.005) and positive participant expectancy (p = 0.01) predicted greater tic improvement. Anxiety disorders (p = 0.042) and premonitory urge severity (p = 0.005) predicted lower tic reduction.Conclusions:Presence of co-occurring attention-deficit/hyperactivity disorder, obsessive-compulsive disorder, or anxiety disorders did not moderate response to CBIT. Although participants on tic medication showed improvement after CBIT, the difference between CBIT and PST was greater for participants who were not on tic-suppressing medication.ClinicalTrials.gov identifiers:The child and adult CBIT studies are listed on clinical trials.gov (NCT00218777 and NCT00231985, respectively).Classification of evidence:This study provides Class I evidence that CBIT is effective in reducing tic severity across subgroups of patients with chronic tic disorders, although the difference between treatments was smaller for participants on tic-suppressing medications, suggesting reduced efficacy in this subgroup.

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Altered urinary tetrahydroisoquinoline derivatives in patients with Tourette syndrome: reflection of dopaminergic hyperactivity?

Journal of Neural Transmission ◽

10.1007/s00702-020-02289-6 ◽

2020 ◽

Author(s):

Philipp Capetian ◽

Veit Roessner ◽

Caroline Korte ◽

Susanne Walitza ◽

Franz Riederer ◽

...

Keyword(s):

Tourette Syndrome ◽

Diagnostic Value ◽

Tic Disorders ◽

Operating Characteristics ◽

Roc Curve Analysis ◽

Two Phase ◽

Dopaminergic Neurotransmission ◽

Hyperactivity Disorder ◽

The Central Nervous System ◽

Chronic Tic Disorders

AbstractTetrahydroisoquinolines (TIQs) such as salsolinol (SAL), norsalsolinol (NSAL) and their methylated derivatives N-methyl-norsalsolinol (NMNSAL) and N-methyl-salsolinol (NMSAL), modulate dopaminergic neurotransmission and metabolism in the central nervous system. Dopaminergic neurotransmission is thought to play an important role in the pathophysiology of chronic tic disorders, such as Tourette syndrome (TS). Therefore, the urinary concentrations of these TIQ derivatives were measured in patients with TS and patients with comorbid attention-deficit/hyperactivity disorder (TS + ADHD) compared with controls. Seventeen patients with TS, 12 with TS and ADHD, and 19 age-matched healthy controls with no medication took part in this study. Free levels of NSAL, NMNSAL, SAL, and NMSAL in urine were measured by a two-phase chromatographic approach. Furthermore, individual TIQ concentrations in TS patients were used in receiver-operating characteristics (ROC) curve analysis to examine the diagnostic value. NSAL concentrations were elevated significantly in TS [434.67 ± 55.4 nmol/l (standard error of mean = S.E.M.), two-way ANOVA, p < 0.0001] and TS + ADHD patients [605.18 ± 170.21 nmol/l (S.E.M.), two-way ANOVA, p < 0.0001] compared with controls [107.02 ± 33.18 nmol/l (S.E.M.), two-way ANOVA, p < 0.0001] and NSAL levels in TS + ADHD patients were elevated significantly in comparison with TS patients (two-way ANOVA, p = 0.017). NSAL demonstrated an AUC of 0.93 ± 0.046 (S.E.M) the highest diagnostic value of all metabolites for the diagnosis of TS. Our results suggest a dopaminergic hyperactivity underlying the pathophysiology of TS and ADHD. In addition, NSAL concentrations in urine may be a potential diagnostic biomarker of TS.

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The effects of Gilles de la Tourette syndrome and other chronic tic disorders on quality of life across the lifespan: a systematic review

European Child & Adolescent Psychiatry ◽

10.1007/s00787-016-0823-8 ◽

2016 ◽

Vol 25 (9) ◽

pp. 939-948 ◽

Cited By ~ 45

Author(s):

Joel Evans ◽

Stefano Seri ◽

Andrea E. Cavanna

Keyword(s):

Quality Of Life ◽

Systematic Review ◽

Tourette Syndrome ◽

Tic Disorders ◽

Chronic Tic Disorders

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The effect of shorter exposure versus prolonged exposure on treatment outcome in Tourette syndrome and chronic tic disorders – an open trial

International Journal of Psychiatry in Clinical Practice ◽

10.1080/13651501.2017.1418892 ◽

2018 ◽

Vol 22 (4) ◽

pp. 262-267 ◽

Cited By ~ 4

Author(s):

Jolande M. T. M. van de Griendt ◽

Maarten K. van Dijk ◽

Cara W. J. Verdellen ◽

Marc J. P. M. Verbraak

Keyword(s):

Treatment Outcome ◽

Tourette Syndrome ◽

Prolonged Exposure ◽

Open Trial ◽

Tic Disorders ◽

Chronic Tic Disorders

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Sleep difficulties in children with Tourette syndrome and chronic tic disorders: a systematic review of characteristics and associated factors

SLEEP ◽

10.1093/sleep/zsz308 ◽

2019 ◽

Vol 43 (6) ◽

Cited By ~ 6

Author(s):

Charlotte Hibberd ◽

Tony Charman ◽

Raj Seraya Bhatoa ◽

Sinem Tekes ◽

Tammy Hedderly ◽

...

Keyword(s):

Young People ◽

Tourette Syndrome ◽

Neurodevelopmental Disorders ◽

Sleep Problems ◽

Medication Use ◽

Tic Disorders ◽

Research Quality ◽

Children And Young People ◽

Chronic Tic Disorders ◽

Sleep Difficulties

Abstract Sleep difficulties are common in children and young people with Tourette syndrome and chronic tic disorders (TS/CTD). However, it is unclear whether sleep problems can be considered typical of the TS/CTD phenotype or whether they reflect concomitant factors such as individual patient characteristics (e.g. medication use), underlying neurodevelopmental disorders and/or co-occurring psychiatric symptoms. To help address this question, this review systematically explored types and frequency of sleep problems in children and young people with TS/CTD, while also examining the heterogeneity and methodological quality of studies. Psycinfo, Ovid Medline, Embase, and Web of Science databases were searched using a range of terms relating to tics, sleep and co-occurring psychopathology. Studies were considered that included a sample of children with TS/CTD (n > 5) for whom sleep difficulties were measured. Eighteen studies met criteria for inclusion in the review. Findings supported the high prevalence of sleep difficulties in children with TS/CTD, though estimates of sleep difficulties ranged from 9.7% to 80.4%. Twelve studies reported on other factors affecting sleep in this patient group including tic severity, comorbid psychopathological or neurodevelopmental disorders and medication use. Studies varied in terms of methodology, sample characteristics and research quality, but most concluded that children with TS/CTD experienced high levels of sleep difficulties with children with co-occurring anxiety most at risk. The current review highlights the need for further empirical investigation of sleep in children with TS/CTS, with a view to informing understanding and clinical management.

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