11 - tic disorders, trichotillomania, and enuresis Flashcards
(15 cards)
What is tourette’s disorder and its criteria?
- a tic is a sudden, rapid, recurrent, nonrhythmic motor movement or vocalization
→ associated with a feeling of relief
→ a tic is not connected to a thought, rather a sensation or urge
A. Both multiple and motor and one or more vocal tics (snoring, uttering a sound) have been present at some time during the illness, although not necessarily concurrently (not necessarily at the same time)
B. The tics may wax and wane in frequency but have persisted for more than 1 year since first tic onset
C. Onset is before age 18 years
D. The disturbance is not attributable to the physiological effects of a substance (e.g., cocaine) or another medical condition (Huntington’s disease)
What is persistent (chronic) motor or vocal tic disorder and its criteria?
A. Single or multiple motor or vocal tics have been present during the illness, but not both motor and vocal (fewer tics in total)
B. The tics may wax and wane in frequency but have persisted for more than 1 year since first tic onset
C. Onset is before age 18 years
D. The disturbance is not attributable to the physiological effects of a substance (e.g., cocaine) or another medical condition (Huntington’s disease)
E. Criteria have never been emt for Tourette’s disorder
- Specify if:
→ With motor tics only
→ With vocal tics only
What are tic disorders in general?
→ Tics = sudden, rapid, recurrent, nonrhythmic motor movements or vocalizations
→ Wax and wane in severity
→ Premonitory sensation = local uncomfortable sensation that precedes tic
→ Triggers: discussing tic, observing a gesture or sound in someone else
→ Tics are categorized as simple or complex
→ Usually begins pre-puberty
→ Heritability is 70-85%
→ Tics are common in childhood but usually transient
→ Tourette’s disorder is 3 to 9 per 1000 in Canada in school age children
→ Males are diagnosed more than females 2 to 4:1
What is the YGTSS?
The Yale global tic severity scale
- This is a questionnaire filled out by a parent that assesses motor and vocal tics
- Contains information like…
–> is it current?
–> age of onset
–> motor tics such as: eye movements, nose, mouth, tongue movement, or facial grimacing, head jerks, movements, shoulder jerks, arm or hand movements
–> vocal tics such as: coughing, throat clearing, sniffing, whistling, animal or bird noises, other simple phonic tics, rude or obscene words or phrases, repeating what someone else said, repeating smt they themselves said, change in volume or pitch
What is the main tic disorder intervention?
Comprehensive behavioural intervention for tics (CBIT)
- based on another intervention HRT (habit reversal training)
- do a functional analysis to see where the tics are occurring - very often the tics change over time
- the attention training is just getting really good at monitoring the sensation, but then waiting a bit before actually doing it
→ then, engage in a competing response while experiencing the sensation
→ they’re very specific responses depending on the tic, you have to be able to do it anywhere and can’t be hard or painful to do
→ p.ex: if a tic is in the neck, you train them to tense their neck - while the urge will increase at first, it will eventually decrease
→ you’re supposed to hold the competing response for at least a minute or until the urge goes away
→ helps to feel like they have control over the sensation
→ sometimes they’ll also do breathing exercises for vocal tics; if it’s a word, you’ll breathe in through the mouth and out through the nose – if it’s a nose tic, you’ll breathe in through the mouth and out through the mouth
True or false: Tics are not typically common in childhood.
False: tics are common in childhood and common for them to spontaneously occur in somebody, and usually they resolve on their own with no intervention at all
→ but some will have more common and extreme tics that require intervention
What is trichotillomania, its criteria and symptoms?
A. Recurrent pulling out of one’s hair, resulting in hair loss
B. Repeated attempts to decrease or stop hair pulling
C. The hair pulling causing clinically significant distress or impairment in social, occupational, or other important areas of functioning
D. The hair pulling or hair loss is not attributable to another medical condition (p.ex: dermatological condition)
E. The hair pulling is not better explained by the symptoms of another mental disorder (p.ex: attempts to improve a perceived defect or flaw in appearance in body dysmorphic disorder)
→ Repeated hair pulling
→ More common: scalp (sometimes just one part of the scalp), eyebrows, and eyelids
→ Less common: underarm, facial, pubic
→ Hair-related rituals (e.g., touching hair to lips, eating it, rolling it)
→ May be preceded by a tingling sensation and followed by pleasurable sensation
→ Significant hair loss possible
→ Wax and wane in severity but often chronic if untreated
→ Usually begins at or after puberty
→ May worsen premenstrually
→ people will often have a specific way to pull the hair, or a specific spot or length of hair
Trichotillomania is related to the body’s ___ system. Explain this.
Endogenous system
→ p.ex: eating spicy food, the spice leads to pain but a subgroup of people like that sensation and find the pain pleasurable
→ with this disorder, the hair pulling brings this same sensation
→ like the sexual response cycle: a form of stimulation that is sought in a specific area of the body with a building of pleasure and anticipation, and the hair pulling is the most intense positive feeling
What is the intervention for trichotillomania?
Habit reversal training
1) Awareness training
2) Competing response
3) Environmental changes (p.ex:wearing gloves that make it difficult to pull hair)
- it’s always easier the longer you go without pulling, but once you restart it’s hard to reset
- difficult to treat, because what we’re often trying to do is CBIT, but since the pulling itself is playing on the endogenous system, and we try to reward the child for not pulling hairs, there’s nothing that can really match that pleasure feeling that we can offer them
- often the hair pulling happens when your mind is elsewhere; showering, watching tv, etc.
→ can shave head, the sensation isn’t the same there
→ with eyelash pulling, can just wear false eyelashes since it’s not connected to the endogenous system
What is the criteria for enuresis?
A. Repeated voiding of urine into bed or clothes, whether involuntary or intentional
B. The behaviour is clinically significant as manifested by either a frequency of at least twice a week for at least 3 consecutive months or the presence of clinically significant distress or impairment in social, academic (occupational), or other areas of functioning
C. Chronological age is at least 5 years (or equivalent developmental level)
D. The behaviour is not attributable to the physiological effects of a substance (p.ex: a diuretic, an antipsychotic medication) or another medical condition (p.ex: diabetes, spina bifida, a seizure disorder)
- Specify whether:
→ Nocturnal only: Passage of urine only during night time sleep (most common)
→ Diurnal only: Passage of urine during walking hours
→ Nocturnal and diurnal: A combination of the 2 subtypes
when its lasting longer or is more frequent than is expected at someone’s age, that’s when we really look into it and take concern
What is the most common type of enuresis?
Nocturnal only
What is the intervention for enuresis?
Behavioural intervention: wetness alarm
→ a little clip on pyjama collar which sounds an alarm to wake child up with a line that connects to pants that alerts the child when there’s wetness
→ this allows the child to stop urinating and go to the bathroom to clean up and go back to bed
→ some kids don’t wake up or don’t sense the wetness, so this alarm helps them wake up when they do wet the bed
What is the goal of a wetness alarm?
- The goal is for the child to…
–> recognize the need to pass urine
–> wake to go to the toilet or hold on
–> learn over time to hold on or to wake spontaneously and stop wetting the bed
A wetness alarm should be used until a minimum of __ ___ of uninterrupted dry nights
2 weeks
A reward system with positive rewards can be given to a child with enuresis; rewards can be given for…
- drinking recommended levels of fluid during the day
- using the toilet to pass urine before sleep
- help with management (p.ex: changing sheets)
