Treating Aggression and Self-destructive Behaviors by Stimulating the Nucleus Accumbens: A Case Series

Self-destructive and aggressive behaviors can have a significant impact on the quality of life of affected individuals and their carrers. While deep brain stimulation (DBS) has been applied to the treatment of self-destructive and aggressive behaviors in isolated cases, clinical data on this treatment modality are still lacking. We therefore assessed responses to treatment with bilateral DBS of the nucleus accumbens in six patients with severe self-destructive and aggressive behaviors. Three patients had Tourette syndrome and three had other underlying predispositions including obsessive compulsive disorder, cerebral palsy, encephalitis, and epilepsy. Patients were followed up for between 2 and 7 years, and patients were assessed using the Modified Overt Aggression Scale (six patients) and the Buss-Perry Aggression Questionnaire (three patients able to complete the questionnaire on their own). DBS reduced self-destructive and aggressive behaviors by 30–100% and by an average of 74.5%. Patients with Tourette syndrome responded better to DBS and improved by 27.3% according to the Buss-Perry Aggression Questionnaire. These results suggest that nuclei accumbens stimulation may be an effective treatment for aggressive and self-destructive behaviors regardless of etiology.

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The Effects of Comorbid Obsessive-Compulsive Disorder and Attention-Deficit Hyperactivity Disorder on Quality of Life in Tourette Syndrome

Journal of Neuropsychiatry ◽

10.1176/appi.neuropsych.11080181 ◽

2012 ◽

Vol 24 (4) ◽

pp. 458-462 ◽

Cited By ~ 50

Author(s):

Clare M. Eddy ◽

Andrea E. Cavanna ◽

Mariangela Gulisano ◽

Paola Calì ◽

Mary M. Robertson ◽

...

Keyword(s):

Quality Of Life ◽

Attention Deficit Hyperactivity Disorder ◽

Obsessive Compulsive Disorder ◽

Tourette Syndrome ◽

Attention Deficit ◽

Obsessive Compulsive ◽

Compulsive Disorder ◽

Hyperactivity Disorder

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Deep Brain Stimulation of the Nucleus Accumbens and Bed Nucleus of Stria Terminalis for Obsessive-Compulsive Disorder: A Case Series

World Neurosurgery ◽

10.1016/j.wneu.2014.12.024 ◽

2015 ◽

Vol 83 (4) ◽

pp. 657-663 ◽

Cited By ~ 27

Author(s):

Lucrezia Islam ◽

Angelo Franzini ◽

Giuseppe Messina ◽

Silvio Scarone ◽

Orsola Gambini

Keyword(s):

Deep Brain Stimulation ◽

Nucleus Accumbens ◽

Brain Stimulation ◽

Case Series ◽

Stria Terminalis ◽

Obsessive Compulsive ◽

Bed Nucleus ◽

Compulsive Disorder ◽

Deep Brain ◽

Stimulation Of

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The Effectiveness of Lurasidone Add-On for Residual Aggressive Behavior and Obsessive Symptoms in Antipsychotic-Treated Children and Adolescents with Tourette Syndrome: Preliminary Evidence from a Case Series

Children ◽

10.3390/children8020121 ◽

2021 ◽

Vol 8 (2) ◽

pp. 121

Author(s):

Marco Colizzi ◽

Riccardo Bortoletto ◽

Leonardo Zoccante

Keyword(s):

Aggressive Behavior ◽

Children And Adolescents ◽

Tourette Syndrome ◽

Case Series ◽

Preliminary Evidence ◽

Obsessive Compulsive ◽

Compulsive Disorder ◽

Effective Option ◽

Potential Benefits ◽

The Stability

Children and adolescents with Tourette syndrome may suffer from comorbid psychological and behavioral difficulties, primarily Attention-Deficit Hyperactivity Disorder-related manifestations including impulsive, aggressive, and disruptive behavior, and Obsessive-Compulsive Disorder-related disturbances. Often, such additional problems represent the major cause of disability, requiring their prioritization above the tic symptomatology. Here, we present six cases of children and adolescents with treatment-resistant Tourette syndrome aged 11–17 years, whose symptoms, especially the non-tic symptoms such as aggressive behavior and obsessive symptoms, failed to respond adequately to at least two different antipsychotics and, where deemed appropriate, to a combination with a medication with a different therapeutic indication or chemical class (e.g., antidepressant or anticonvulsant). Such symptomatic manifestations were significantly reduced by the time of the subsequent control visit planned 30 days later, by using lurasidone as an add-on therapy to risperidone or aripiprazole (all p ≤ 0.009). No significant neuromotor or metabolic side effects were reported in all cases in a follow-up period ranging from 4 months to 6 months, supporting the stability of the observed clinical improvement. While still investigational, the preliminary evidence presented here gives reason to hope that lurasidone could possibly be an effective option in Tourette syndrome, warranting further investigation of its potential benefits in neurodevelopmental conditions.

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Clinical Features of Tourette Syndrome

Journal of Child Neurology ◽

10.1177/0883073819877335 ◽

2019 ◽

Vol 35 (2) ◽

pp. 166-174 ◽

Cited By ~ 6

Author(s):

Chandler E. Gill ◽

Katie Kompoliti

Keyword(s):

Quality Of Life ◽

Diagnostic Criteria ◽

Tourette Syndrome ◽

Clinical Features ◽

Psychiatric Symptoms ◽

Medical Condition ◽

Obsessive Compulsive ◽

Characteristic Appearance ◽

Compulsive Disorder

Tourette syndrome is a multifaceted disorder characterized by multiple motor and at least one vocal tics that start in childhood, persist for at least 1 year, and cannot be attributed to another medical condition or exposure to medications/drugs. Clinical diagnostic criteria are available, and identification of tics is typically straightforward based on characteristic appearance and features. Diagnostic uncertainty can rarely arise in cases of mild tics, atypical features, certain psychiatric comorbidities, and other non-tic movement disorders. Comorbid psychopathology, including attention-deficit hyperactivity disorder (ADHD) and obsessive-compulsive behaviors/obsessive-compulsive disorder, affects the majority of patients and is correlated with disease severity and the presence of additional psychiatric behaviors. The severity of tics often improves after adolescence, whereas psychiatric symptoms typically persist. The subset of patients in whom tics persist into adulthood experience higher rates of anxiety, and lower self-esteem, socioeconomic status, and quality of life; the relative contribution of motor tics and psychopathology is not fully understood. This article summarizes the clinical features of Tourette syndrome, including major diagnostic criteria, unique features of tics, and key aspects that differentiate tics from common mimics and chameleons. Comorbid psychiatric conditions and their impact on phenotype and quality of life are described. Finally, current understanding of the natural history is summarized, including limited research in adults with Tourette syndrome.

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Eating Disorders and Tourette Syndrome: A Case Series of Comorbidity and Associated Obsessive-Compulsive Symptomatology

CNS Spectrums ◽

10.1017/s109285290001141x ◽

1999 ◽

Vol 4 (2) ◽

pp. 77-80, 86 ◽

Cited By ~ 5

Author(s):

Angela S. Guarda ◽

Janet Treasure ◽

Mary M. Robertson

Keyword(s):

Eating Disorders ◽

Anorexia Nervosa ◽

Obsessive Compulsive Disorder ◽

Tourette Syndrome ◽

Case Series ◽

Obsessive Compulsive ◽

Obsessive Compulsive Symptoms ◽

Compulsive Disorder

AbstractThere is a well-established overlap in phenomenology between anorexia nervosa and obsessive-compulsive disorder, and between obsessive-compulsive symptoms and Tourette syndrome (TS). Five cases of eating disorders in patients with obsessive-compulsive symptoms and TS are presented. The identification of four similar cases in the literature putatively marks a subset of eating disorders with a link to TS and to obsessive-compulsive symptomatology. This association may reflect a common underlying neurobiologic imbalance.

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Performance monitoring in obsessive-compulsive disorder: insights from internal capsule/nucleus accumbens deep brain stimulation

NeuroImage Clinical ◽

10.1016/j.nicl.2021.102746 ◽

2021 ◽

pp. 102746

Author(s):

Thomas Schüller ◽

Theo O.J. Gruendler ◽

Ezra E. Smith ◽

Juan Carlos Baldermann ◽

Sina Kohl ◽

...

Keyword(s):

Deep Brain Stimulation ◽

Nucleus Accumbens ◽

Obsessive Compulsive Disorder ◽

Brain Stimulation ◽

Performance Monitoring ◽

Internal Capsule ◽

Obsessive Compulsive ◽

Compulsive Disorder ◽

Deep Brain

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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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Mindfulness-based and acceptance-based programmes in the treatment of obsessive–compulsive disorder: a study protocol for a systematic review and meta-analysis

BMJ Open ◽

10.1136/bmjopen-2021-050329 ◽

2021 ◽

Vol 11 (6) ◽

pp. e050329

Author(s):

Johannes Julian Bürkle ◽

Johannes Caspar Fendel ◽

Stefan Schmidt

Keyword(s):

Systematic Review ◽

Depressive Symptoms ◽

Obsessive Compulsive Disorder ◽

Meta Analysis ◽

Sensitivity Analyses ◽

Secondary Outcome ◽

Controlled Trials ◽

Obsessive Compulsive ◽

Compulsive Disorder

IntroductionCognitive–behavioural therapy (CBT) with exposure and response prevention is the recommended standard for the treatment of obsessive–compulsive disorder (OCD). However, a high proportion of patients refuse this treatment, do not respond or relapse shortly after treatment. Growing evidence suggests that mindfulness-based and acceptance-based programmes (MABPs) are an effective option for the treatment of OCD. This systematic review and meta-analysis will examine the effectiveness of MABPs in treating OCD. We also aimed to explore potential moderators of the programmes’ effectiveness.Methods and analysisWe will systematically search MEDLINE, Embase, PsycINFO, PSYINDEX, Web of Science, CINAHL and Cochrane Register of Controlled Trials (no language restrictions) for studies that evaluate the effect of MABPs on patients with OCD. We will conduct backward and forward citation searches of included studies and relevant reviews and contact corresponding authors. The primary outcome will be pre-post intervention change in symptom severity. A secondary outcome will be change in depressive symptoms. Two reviewers will independently screen the records, extract the data and rate the methodological quality of the studies. We will include both controlled and uncontrolled trials. Randomised controlled trials will be meta-analysed, separately assessing between-group effects. A second meta-analysis will assess the within-group effect of all eligible studies. We will explore moderators and sources of heterogeneity such as the specific programme, study design, changes in depressive symptoms, hours of guided treatment, control condition and prior therapy (eg, CBT) using metaregression and subgroup analyses. We will perform sensitivity analyses using follow-up data. A narrative synthesis will also be pursued. We will use the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system to assess the quality of the evidence.Ethics and disseminationEthical approval is not required. Results will be published in peer-reviewed journals and presented at international conferences.

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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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