Tourette’s syndrome & tic disorders – definition, symptoms, diagnosis, treatment

The DSM-5, or the 5th edition of the diagnostic
and statistical manual, lists three major types of tic disorders: Tourette’s syndrome,
which is the most well known, persistent motor or vocal tic disorder, and provisional tic
disorder. Individuals with these disorders all suffer
from tics, which are quick, nonrhythmic movements or vocalizations that happen over and over,
and are not caused by some other disorder like Huntington’s disease or substance abuse. For example, individuals might feel the urge
to spontaneously and repeatedly clap their hands, make a facial grimace, or grunt or
even perform hidden movements like moving the tongue. Although these movements might be appropriate
in some situations, the fact that they are repeated even in inappropriate situations
is why they are considered abnormal. In addition to having a tic, there are three
additional criteria that are used to help classify individuals into one of the three
types of tic disorders. Criteria A is the number of motor or vocal
tics, criteria B is the duration of the tic disorder, and criteria C is the age of the
person when he or she started having tics. For a diagnosis of tourette’s disorder,
an individual must have multiple motor tics, and at least one vocal tic, however, these
do not have to happen at the same time. The important thing here is that both motor
and verbal tics are present. The frequency of individual tics might change
over time, but they need to persist for at least one year. Finally, the tics must have started before
the age of 18, and in fact they most often appear between the ages of 4 and 6. Of the three types of tic disorders, Tourette’s
is considered to be the most severe. For a diagnosis of persistent motor or vocal
tic disorder, also called chronic tic disorder, an individual must have either a single or
multiple motor tics or vocal tics—but not both. Like Tourette’s the tics have to persist
for at least 1 year and must have started before the age of 18. Finally, for a diagnosis of provisional tic
disorder, an individual must have a single, or multiple, motor and/or verbal tics, but
they must be present for less than 1 year since their onset, and they appear before
the age of 18, Tics can be simple or complex. Simple tics are relatively short in duration,
lasting milliseconds, and can include behaviors like eye blinks, which would be motor, or
throat clearing, which would be verbal. Complex tics typically last longer, sometimes
over a second, and are usually a combination of simple tics, like shaking one’s head
while shrugging their shoulders. Complex motor tics can also include echopraxia,
which is a tic-like repetition of the movements of others, as well as copropraxia—tics involving
obscene gestures. Complex verbal tics can include echolalia,
which is repeating the last word or phrase that they heard from others, palilalia, which
is a repetition of a person’s own words or phrases, or coprolalia, which is saying
inappropriate words or obscenities. Tic disorders are often most severe before
puberty—between the ages of 10 and 12—and usually decrease in severity afterwards. Sometimes, individuals might notice a specific
feeling or urge that occurs before the onset of a tic—like an itch before reaching to
scratch. Tics also tend to become more common or more
severe during periods of anxiety, excitement, or exhaustion. There is no cure for tourette’s and other
tic disorders, but tics can be managed through a combination of therapy and medications. Cognitive behavioral therapy can help individuals
identify triggering events or feelings that precede tics, and habit reversal training
can help someone learn to do movement that are incompatible with the tics, like engaging
opposing muscle groups, which would be like smiling if the tic is a frown. Since tics tend to lessen when the person
is calm, reducing anxiety or depression can also help. There are also a number of medications that
can be used to control tics, but these are only used in the most severe cases. For example, antipsychotic medications such
as haldol and risperidone, and some epilepsy medications can be effective, although they
often cause unwanted side-effects. ADHD medication can also help some individuals
focus on, and therefore control, their tics. In some severe cases, botox injections to
the site of the tic can help to minimize their appearance. Alright, as a quick recap, tic disorders are
repetitive, non-voluntary movements or vocalizations that appear before the age of 18. These tics can be simple, for example barely
noticeable eye blinks, as well as complex, like compulsively producing really distracting
gestures. Thanks for watching, you can help support
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