Tic disorders
Tic disorders: Excerpt from Professional Guide to Diseases (Eighth Edition)
Including Tourette syndrome, chronic motor or vocal tic disorder, and transient tic disorder, tic disorders are similar pathophysiologically but differ in severity and prognosis. All tic disorders, commonly known simply as tics, are involuntary, spasmodic, recurrent, and purposeless motor movements or vocalizations. These disorders are classified as motor or vocal and as simple or complex. (See Classifying tics.) Tics begin before age 18. Transient tics are usually self-limiting, but Tourette syndrome follows a chronic course with remissions and exacerbations. Some people who have very mild tics don’t seek treatment.
Causes and incidence
Although their exact cause is unknown, tic disorders occur more in certain families, suggesting a genetic cause. Tics commonly develop when a child experiences overwhelming anxiety, usually associated with normal maturation. Tics may be precipitated or exacerbated by the use of phenothiazines or central nervous system stimulants or by head trauma.
All tic disorders are three times more common in boys than in girls. About 2% of the population has Tourette syndrome.
Signs and symptoms
Assessment findings vary according to the type of tic disorder. Inspection, coupled with the patient’s history, may reveal the specific motor or vocal patterns that characterize the tic as well as the frequency, complexity, and precipitating factors. The patient or his family may report that the tics occur sporadically many times per day. (See Stress disorders with physical signs.)
Note whether certain situations exacerbate the tics. All tic disorders may be exacerbated by stress, and they usually diminish markedly during sleep. The patient also may report that they occur during activities that require concentration, such as reading or sewing.
Determine whether the patient can control the tics. Most patients can do so, with conscious effort, for short periods.
Psychosocial assessment may reveal underlying stressful factors, such as problems with social adjustment, lack of self-esteem, and depression.
Diagnosis
For characteristic findings in patients with this condition, see Diagnosing tic disorders.
Treatment
Behavior modification and operant conditioning can help treat certain tic disorders. Psychotherapy can help the patient uncover underlying conflicts and issues as well as deal with the problems caused by the tics. Tourette syndrome is best treated with medications and psychotherapy.
No medications are helpful in treating transient tics. Haloperidol is the drug of choice for treating Tourette syndrome. Pimozide (an oral dopamine-blocking drug) and clonidine are alternative choices. Tetrabenazine has been used but is associated with depression of movement. Antianxiety agents may be useful in dealing with secondary anxiety, but they don’t reduce the severity or frequency of the tics.
Special considerations
❑ Offer emotional support and help the patient prevent fatigue.
❑ Suggest that the patient with Tourette syndrome contact the Tourette Syndrome Association to obtain information and support.
❑ Help the patient identify and eliminate any avoidable stress and learn positive new ways to deal with anxiety.
❑ Encourage the patient to verbalize his feelings about his disorder. Help him to understand that the movements are involuntary; he shouldn’t feel guilty or blame himself for them.
Pictures
Book Source Details
- Book Title: Professional Guide to Diseases (Eighth Edition)
- Author(s): Springhouse
- Year of Publication: 2005
- Copyright Details: Professional Guide to Diseases (Eighth Edition), Copyright © 2005 Lippincott Williams & Wilkins.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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