Implementation of the Mini-Child Tourette Syndrome Impairment Scale: Relationships to Symptom Severity and Treatment Decisions

Functional impairment is an important factor in Tic Disorder treatment decisions. We evaluated the mini Child Tourette Syndrome Impairment Scale (mini-CTIM) for correlation with symptom severity and association with interventions. A total of 61 randomly selected tic encounters were retrospectively analyzed for mini-CTIM correlation with symptom severity scores and compared between patients who received treatment and those who did not. Regression models identified factors associated with treatment decisions. Mini-CTIM-tic scores correlated with tic severity and mini-CTIM-non-tic scores correlated with attention-deficit hyperactivity disorder (ADHD) severity. Tic treatment was associated with higher child, but not parent, mini-CTIM-tic scores. Regression models identified that comorbidity treatment was predicted by ADHD severity, obsessive compulsive disorder severity, and parent but not child mini-CTIM-non-tic scores. These findings suggest children have valuable insight into their tic-related impairment, but parent assessment is important for evaluating comorbidity-related impairment. The mini-CTIM may be a useful clinical tool for assessing tic-related impairment.

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Phenotype Development in Adolescents With Tourette Syndrome: A Large Clinical Longitudinal Study

Journal of Child Neurology ◽

10.1177/0883073817729917 ◽

2017 ◽

Vol 32 (13) ◽

pp. 1047-1057 ◽

Cited By ~ 3

Author(s):

Camilla Groth ◽

Nanette Mol Debes ◽

Liselotte Skov

Keyword(s):

Longitudinal Study ◽

Tourette Syndrome ◽

Wide Spectrum ◽

Neurodevelopmental Disorder ◽

Obsessive Compulsive ◽

Compulsive Disorder ◽

Age Related ◽

Impairment Score ◽

Tic Severity ◽

Motor Tics

Tourette syndrome (TS) is a neurodevelopmental disorder characterized by frequent comorbidities and a wide spectrum of phenotype presentations. This study aimed to describe the development of phenotypes in TS and tic-related impairment in a large longitudinal study of 226 children and adolescents followed up after 6 years. The participants were clinically examined to assess tic severity and impairment, obsessive compulsive disorder (OCD), and attention-deficit/hyperactivity disorder (ADHD). The development in phenotypes changed toward less comorbidity with 40% TS-only (no OCD or ADHD) (TS without OCD or ADHD) at baseline and 55% at follow-up.Tic-related impairment was expected to improve with an age-related tic decline, but surprisingly the impairment score did not reflect the tic decline. Sex, vocal and motor tics, and OCD and ADHD severity were highly significantly correlated to the impairment score. Knowledge of TS phenotype development is used in clinical settings to guide patients and for genetic, etiological, and clinical research purposes.

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Psychosocial outcome and psychiatric comorbidity in older adolescents with Tourette syndrome: controlled study

The British Journal of Psychiatry ◽

10.1192/bjp.bp.109.071050 ◽

2010 ◽

Vol 197 (1) ◽

pp. 36-44 ◽

Cited By ~ 60

Author(s):

Daniel A. Gorman ◽

Nancy Thompson ◽

Kerstin J. Plessen ◽

Mary M. Robertson ◽

James F. Leckman ◽

...

Keyword(s):

Tourette Syndrome ◽

Psychosocial Functioning ◽

A Priori ◽

Psychosocial Outcomes ◽

Controlled Study ◽

Obsessive Compulsive ◽

Global Assessment Scale ◽

Compulsive Disorder ◽

Older Adolescents ◽

Tic Severity

BackgroundChildren with Tourette syndrome generally experience improvement of tics by age 18 years, but psychosocial and comorbidity outcomes at this age are unclear.AimsTo compare psychosocial outcomes and lifetime comorbidity rates in older adolescents with Tourette syndrome and controls. We hypothesised a priori that individuals with Tourette syndrome would have lower Children's Global Assessment Scale (CGAS) scores.MethodA total of 65 individuals with Tourette syndrome, identified in childhood, and 65 matched community controls without tic or obsessive–compulsive disorder (OCD) symptoms were assessed around 18 years of age regarding psychosocial functioning and lifetime psychiatric disorders.ResultsCompared with controls, individuals with Tourette syndrome had substantially lower CGAS scores (P=10−8) and higher rates of attention-deficit hyperactivity disorder (ADHD), major depression, learning disorder and conduct disorder (P⩽0.01). In the participants with Tourette syndrome, poorer psychosocial outcomes were associated with greater ADHD, OCD and tic severity.ConclusionsClinically ascertained children with Tourette syndrome typically have impaired psychosocial functioning and high comorbidity rates in late adolescence.

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Parent and Patient Perceptions of Functional Impairment Due to Tourette Syndrome: Development of a Shortened Version of the Child Tourette Syndrome Impairment Scale

Journal of Child Neurology ◽

10.1177/0883073817702782 ◽

2017 ◽

Vol 32 (8) ◽

pp. 725-730 ◽

Cited By ~ 6

Author(s):

Kara S. Francis Barfell ◽

Ryan R. Snyder ◽

Kelly M. Isaacs-Cloes ◽

Jordan F. Garris ◽

Alyssa R. Roeckner ◽

...

Keyword(s):

Factor Analysis ◽

Tourette Syndrome ◽

Assessment Tool ◽

Correlation Coefficients ◽

Patient Perceptions ◽

Published Data ◽

Obsessive Compulsive ◽

Compulsive Disorder ◽

Hyperactivity Disorder ◽

Tic Severity

The Child Tourette Syndrome Impairment Scale (CTIM) rates 37 problems in school, social, and home domains separately for tics and for comorbid diagnoses. However, a shorter version would be easier to implement in busy clinics. Using published data from 85 children with Tourette syndrome, 92 controls, and parents, factor analysis was used to generate a “mini-CTIM” composed of 12 items applied to tic and comorbid diagnoses. Child- and parent-rated mini-CTIM scores were compared and correlated across raters and accounting for clinician-rated tic severity and presence of attention-deficit hyperactivity disorder (ADHD) and obsessive-compulsive disorder (OCD). The mini-CTIM achieved domain Cronbach alphas ranging from 0.71 to 0.94 and intra-item correlation coefficients ranging from 0.84 to 0.96. The resulting scale correlated with clinician-rated tic severity and reflected the presence of ADHD and OCD. The mini-CTIM appears promising as a practical assessment tool for tic- and non–tic-related impairment in children with Tourette syndrome.

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Validation of the University of São Paulo Sensory Phenomena Scale:Initial Psychometric Properties

CNS Spectrums ◽

10.1017/s1092852900020319 ◽

2009 ◽

Vol 14 (6) ◽

pp. 315-323 ◽

Cited By ~ 59

Author(s):

Maria Conceição Rosario ◽

Helena Silva Prado ◽

Sonia Borcato ◽

Juliana Belo Diniz ◽

Roseli Gedanki Shavitt ◽

...

Keyword(s):

Pearson Correlation ◽

Sao Paulo ◽

Clinical Interview ◽

São Paulo ◽

Obsessive Compulsive ◽

Compulsive Disorder ◽

Severity Scores ◽

Tic Severity ◽

Axis I ◽

The University

AbstractIntroduction: Although obsessions and compulsions comprise the main features of obsessive-compulsive disorder (OCD), many patients report that their compulsions are preceded by a sense of “incompleteness” or other unpleasant feelings such as premonitory urges or a need perform actions until feeling “just right.” These manifestations have been characterized as Sensory Phenomena (SP). The current study presents initial psychometric data for a new scale designed to measure SP.Methods: Seventy-six adult OCD subjects were probed twice. Patients were assessed with an open clinical interview (considered as the “gold standard”) and with the following standardized instruments: Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Axis I Disorders, Yale-Brown Obsessive-Compulsive Scale, Dimensional Yale-Brown Obsessive-Compulsive Scale, Yale Global Tic Severity Scale, Beck Anxiety Inventory, and Beck Depression Inventory.Results: SP were present in 51 OCD patients (67.1%). Tics were present in 16 (21.1%) of the overall sample. The presence of SP was significantly higher in early-onset OCD patients. There were no significant differences in the presence of SP according to comorbidity with tics or gender. The comparison between the results from the open clinical interviews and the University of São Paulo Sensory Phenomena Scale (USP-SPS) showed an excellent concordance between them, with no significant differences between interviewers. The inter-rater reliability between the expert raters for the USP-SPS was high, with K=.92. The Pearson correlation coefficient between the SP severity scores given by the two raters was .89.Conclusion: Preliminary results suggest that the USP-SPS is a valid and reliable instrument for assessing the presence and severity of SP in OCD subjects.

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Obsessive-Compulsive Symptom Dimensions in Japanese Tourette Syndrome Subjects

CNS Spectrums ◽

10.1017/s1092852900027528 ◽

2010 ◽

Vol 15 (5) ◽

pp. 296-303 ◽

Cited By ~ 4

Author(s):

Yukiko Kano ◽

Toshiaki Kono ◽

Kurie Shishikura ◽

Chizue Konno ◽

Hitoshi Kuwabara ◽

...

Keyword(s):

Tourette Syndrome ◽

Total Sample ◽

Tic Disorders ◽

Global Assessment Of Functioning ◽

Severity Scale ◽

Obsessive Compulsive ◽

Symptom Dimensions ◽

Severity Scores ◽

Tic Severity ◽

Obsessive Compulsive Symptom

ABSTRACTObjectives: To investigate the current and lifetime frequency and severity of obsessive-compulsive (OC) symptom dimensions in Tourette syndrome (TS) patients, and how these dimensions affect clinical characteristics.Methods: Forty TS outpatients (29 males, 11 females) were interviewed with the Dimensional Yale-Brown Obsessive-Compulsive Scale (DY-BOCS), the Yale Global Tic Severity Scale (YGTSS), the Shapiro Tourette Syndrome Severity Scale, and the Global Assessment of Functioning (GAF).Results: OC symptoms were present in 80% of the total sample. The miscellaneous and the symmetry dimensions were the most frequent at the “current” and “lifetime” surveys, respectively. The aggression dimension had the smallest difference between “worst ever” and current ratings among the all OC symptom dimensions. TS patients with the aggression dimension (n=7) had significantly lower scores in the GAF scale and higher frequencies of coprolalia. There were significant correlations between the YGTSS severity scores and specific DY-BOCS dimensions.Conclusion: OC symptoms are frequent in TS subjects and there were differences in the frequency, severity, and course of the OC symptom dimensions. These results emphasize the need for future longitudinal studies using a dimensional approach for the evaluation of OC symptoms in tic disorders.

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Elevated Expression of SLC6A4 Encoding the Serotonin Transporter (SERT) in Gilles de la Tourette Syndrome

Genes ◽

10.3390/genes12010086 ◽

2021 ◽

Vol 12 (1) ◽

pp. 86

Author(s):

Mathis Hildonen ◽

Amanda M. Levy ◽

Christina Dahl ◽

Victoria A. Bjerregaard ◽

Lisbeth Birk Møller ◽

...

Keyword(s):

Tourette Syndrome ◽

Serotonin Transporter ◽

Neurodevelopmental Disorder ◽

Control Group ◽

Obsessive Compulsive ◽

Expression Levels ◽

Compulsive Disorder ◽

Hyperactivity Disorder ◽

Elevated Expression ◽

Gene Expression Levels

Gilles de la Tourette syndrome (GTS) is a complex neurodevelopmental disorder characterized by motor and vocal tics. Most of the GTS individuals have comorbid diagnoses, of which obsessive-compulsive disorder (OCD) and attention deficit-hyperactivity disorder (ADHD) are the most common. Several neurotransmitter systems have been implicated in disease pathogenesis, and amongst these, the dopaminergic and the serotonergic pathways are the most widely studied. In this study, we aimed to investigate whether the serotonin transporter (SERT) gene (SLC6A4) was differentially expressed among GTS individuals compared to healthy controls, and whether DNA variants (the SERT-linked polymorphic region 5-HTTLPR, together with the associated rs25531 and rs25532 variants, and the rare Ile425Val variant) or promoter methylation of SLC6A4 were associated with gene expression levels or with the presence of OCD as comorbidity. We observed that SLC6A4 expression is upregulated in GTS individuals compared to controls. Although no specific genotype, allele or haplotype was overrepresented in GTS individuals compared to controls, we observed that the LAC/LAC genotype of the 5-HTTLPR/rs25531/rs25532 three-locus haplotype was associated with higher SLC6A4 mRNA expression levels in GTS individuals, but not in the control group.

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Investigation of gene–environment interactions in relation to tic severity

Journal of Neural Transmission ◽

10.1007/s00702-021-02396-y ◽

2021 ◽

Author(s):

Mohamed Abdulkadir ◽

Dongmei Yu ◽

Lisa Osiecki ◽

Robert A. King ◽

Thomas V. Fernandez ◽

...

Keyword(s):

Tourette Syndrome ◽

Association Studies ◽

Autism Spectrum ◽

Environment Interaction ◽

Genome Wide Association Studies ◽

Nucleotide Polymorphisms ◽

Linear Regression Models ◽

Compulsive Disorder ◽

Gene Environment ◽

Tic Severity

AbstractTourette syndrome (TS) is a neuropsychiatric disorder with involvement of genetic and environmental factors. We investigated genetic loci previously implicated in Tourette syndrome and associated disorders in interaction with pre- and perinatal adversity in relation to tic severity using a case-only (N = 518) design. We assessed 98 single-nucleotide polymorphisms (SNPs) selected from (I) top SNPs from genome-wide association studies (GWASs) of TS; (II) top SNPs from GWASs of obsessive–compulsive disorder (OCD), attention-deficit/hyperactivity disorder (ADHD), and autism spectrum disorder (ASD); (III) SNPs previously implicated in candidate-gene studies of TS; (IV) SNPs previously implicated in OCD or ASD; and (V) tagging SNPs in neurotransmitter-related candidate genes. Linear regression models were used to examine the main effects of the SNPs on tic severity, and the interaction effect of these SNPs with a cumulative pre- and perinatal adversity score. Replication was sought for SNPs that met the threshold of significance (after correcting for multiple testing) in a replication sample (N = 678). One SNP (rs7123010), previously implicated in a TS meta-analysis, was significantly related to higher tic severity. We found a gene–environment interaction for rs6539267, another top TS GWAS SNP. These findings were not independently replicated. Our study highlights the future potential of TS GWAS top hits in gene–environment studies.

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Disgust proneness predicts obsessive-compulsive disorder symptom severity in a clinical sample of youth: Distinctions from negative affect

Journal of Affective Disorders ◽

10.1016/j.jad.2017.02.017 ◽

2017 ◽

Vol 213 ◽

pp. 118-125 ◽

Cited By ~ 4

Author(s):

Bunmi O. Olatunji ◽

Chad Ebesutani ◽

Jingu Kim ◽

Bradley C. Riemann ◽

David M. Jacobi

Keyword(s):

Negative Affect ◽

Obsessive Compulsive Disorder ◽

Symptom Severity ◽

Clinical Sample ◽

Obsessive Compulsive ◽

Compulsive Disorder ◽

Obsessive Compulsive Disorder Symptom ◽

Disorder Symptom ◽

Disgust Proneness

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Disturbed Monitoring and Response Inhibition in patients with Gilles De La Tourette Syndrome and Co-Morbid Obsessive Compulsive Disorder

Behavioural Neurology ◽

10.1155/2003/832906 ◽

2003 ◽

Vol 14 (1-2) ◽

pp. 29-37 ◽

Cited By ~ 45

Author(s):

Sandra Verena Müller ◽

Sönke Johannes ◽

Berdieke Wieringa ◽

Axel Weber ◽

Kirsten Müller-Vahl ◽

...

Keyword(s):

Executive Functions ◽

Obsessive Compulsive Disorder ◽

Tourette Syndrome ◽

Response Inhibition ◽

Error Detection ◽

Neuropsychological Tests ◽

Cognitive Domain ◽

Control Group ◽

Obsessive Compulsive ◽

Compulsive Disorder

Objective:Fronto-striatal dysfunction has been discussed as underlying symptoms of Tourette syndrome (TS) with co-morbid Obsessive Compulsive Disorder (OCD). This suggests possible impairments of executive functions in this disorder, which were therefore targeted in the present study.Results:A comprehensive series of neuropsychological tests examining attention, memory and executive functions was performed in a group of 14 TS/OCD in co-occurrence with OCD patients and a matched control group.Results:While attentional and memory mechanisms were not altered, TS/OCS patients showed deficits in executive functions predominately in the areas of response inhibition and action monitoring.Conclusions:These findings provide further evidence for a substantial impairment of the frontal-striatal-thalamic-frontal circuit. We propose that the deficits in monitoring, error detection and response inhibition constitute the major impairment of TS/OCD patients in the cognitive domain.

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