psychiatrist in-dubai-
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Tic Disorder
Psychiatrist in dubai
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Tic
• Sudden, rapid, usually stereotyped, predominantly clonic, irresistible movement -> relieve of symptom. Can be controlled by will for short time but reappear as soon as attention is diverted.
• They correspond to purposive coordinated act which normally serve the organism
• Blinking, sniffing, throat cleaning, neck , shoulder or generalized
• Seen transiently in children, mentally retarded
• Adult – relieved by sedation, psychotherapy
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Simple Tics • Motor -- Eye blinking, head jerking, shoulder shrugging and
facial grimacing.
• Vocal -- Throat clearing, yelping and, noises, sniffing and
tongue clicking
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Complex tics • Motor -- Jumping, touching other people or things, smelling,
twirling about, and only rarely, self- injurious actions including
hitting or biting oneself.
• Vocal -- Uttering words or phrases out of context and
coprolalia
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Tic disorders
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Transient Chronic
TS Motor
Vocal
Simple Complex
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Georges Gilles de la Tourette (1857-1904
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Gilles de la Tourette syndrome
• Incidence : 0.03 – 0.05% M:F - 3:1
• Prevalence: 0.5-1%
• Onset - mean 7 y (2-15y) 95% < 11y
• 1/3rd family members have tics
• Motor tics:
• Rapid abrupt, intermittent, present in sleep, multifocal simple or complex
• Involve face, eyes, and proximal extremities
• Vary spontaneously, Echopraxia, Copropraxia
• Vocal tics
• Involuntary, words, grunts, bark, sniff, snuts, squeals, echolalia, coprolalia
Coprolalia • The uncontrolled, often obsessive use of obscene or
scatological language, cursing, ethnic slurs
• Thought to possessed by the devil.
• Ostracized from their communities or punished for behaviors 5/5
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• Intellect
• Normal, nonspecific right hemispheric dysfunction
• Attention disorder, hyperactivity
• Personality
• Obsessive compulsive
• Self deterministic
• Anxiety, depression, alcoholism
• Modification
• Increased by stress, anxiety,
• Decreased by relaxation, fever
• Course: Natural remission and waxing and waning of severity
• Other features: Soft neurological sign • Altered tone
• Mild incoordination
• Babinski’s sign
• No sensory sign
• Association • Migraine ( 5HT disorder)
• Sec. compressive neuropathy and myelopathy due to violent tics
• Sleep disorder – somnambulism, sleep terror, ↓ REM sleep, ↑ stage 3-4 sleep,
• EEG and Evoked potential normal • Pre-movement EEG potential absent (subcortical origin)
Association
• ADHS – 60-80%
• OCD
• Conduct disorder
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Pathophysiology
• Midbrain, basal ganglionic dopaminergic dysfunction (turnover ↓ receptor hypersensitivity)
• 5HT – Associated with migraine
• NA – Improve with clonidine
• Cholinergic – Improve with physostigmine
• GABA – Clonazepam relieve symptom
• Encephalin → dopamine release. Opioid agonist N2O relieve symptom
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Pathogenesis
• Anatomical: prefrontal cortex and caudate nucleus
• Biochemical: Dopamine
• Genetics: AD (Chr 4p and 8p)
• Immunological: PANDAS
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Diagnostic Criteria • Multiple motor tics
• One or more vocal tics
• No known cause
• Age of onset less than 18 years.
• A duration of greater than one year.
“Tourette Syndrome Study Group (1993)”
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DSM IV Criteria of Tourette syndrome • Age of onset between 5-15y
• Multiple motor tics
• Multiple vocal tics
• Ability to suppress movement voluntarily for min to hours
• Variation in the intensity of symptom over weeks to months
• Duration of more than a year
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DD
Clinical Tourette Jumpers (France)
Latah (Malacia)
Myrichit (Russia)
Tics + - - -
Startle myoclonus
- + + ?
Compulsive movement
+ + + -
Echopraxia + + + +
Echolalia + + + +
Coprolalia + - + - Powered by
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Progression
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PANDAS
• OCD/Tic tic disorder
• Onset 3-12 years
• Episodic course of symptom severity
• Association with group A Beta-hemolytic streptococcal infection
• Association with neurological abnormalities
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Treatment
• Education
• Tic: Anti Dopamine
• Associated disorder:
ADHS/OCD
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Prognosis
• Marked improvement in late
teens or early twenties.
• They get better, not worse, as
they mature
• TS patients have a normal life
span.
• 1/ 3 of patients experience
remission of tic symptoms in
adulthood.”
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Samuel Johnson 1709-1784 “Good English Dictionary
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