Flashcards in Tourette's Syndrome Deck (17):
What are tics?
Sudden, involuntary, repetitive movements or vocalisations
What are the 2 kinds of motor tics + definition?
Simple motor tics = sudden, fleeting or fragmentary movements
Complex motor tics = several simple motor tics occuring in an orchestrated sequence or semi-purposeful movements
What are the 2 kinds of phonic tics + definitions?
Simple phonis tics = simple, unarticulated sounds
Complex phonic tics = out of context syllables, words, phrases or paroxysmal changes in prosody
Give some examples of complex tics
- Copropraxia = socially inappropriate gestures
- Copralalia = socially inappropriate utterances
- Echolalia = repeating other's words
- Echopraxia = reapeating other's gestures
- Self injurous such as cheeck chewing
What are premonitory urges?
Uncomfortable or aversive bodily sensations occuring prior to tics.
What is the prevalence rate of TS?
3-8 in 1000
At what age do symptoms peak at severity and when is there a stabilisation of symptoms (no sustained worsening or improvement)?
Peak in symptom severity = 9-12 years
Stabilisation = after 30s
Which npsy. test battery administered to children with TS is the best predictor of tic severity and global psychosocial functioning 7,5 years later, and what does it measure?
The Purdue Pegboard; test of fine motor skills
What is the etiology of TS?
- strong (polygenetic) component
- increased activity of DA and other neurotransmitters (e.g. serotonin)
- disinhibition of several circuits in the cortico-striatal-thalamic areas
What is the development of TS (neurologically)?
Abnormality in basal ganglia output systems and impairment in frontal inhibition of this output
-> information that ordinarily would be inhibited from reaching other areas of the brain is unfiltered
What disorders have high comorbidity with TS?
ADHD, OCD and behavioral/impulse problems
What are rage attacks?
Premonitory feelings of tension -> followed by relief -> followed by remorse
Studies suggest they are positively correlated with a triad of TS, ADHD and OCD
What are the prevalences and onset of comorbid ADHD and OCD with TS?
ADHD: 55%, often precede the onset of tic symptoms
OCD: 20-40%, symptoms present after tics have reached their peak severity
-> comorbid psychiatric disorders are more likely to persist into adulthood
Name two treatmens of TS
Habit Reversal Therapy = teachting the patient to become aware of the premonitory urge and develop a competing response incompatible with performing the tic
Pharmacotherapy = effective treatment, recommended if the tics are causing significant distress or functional impairment (examples: neuroleptics, benzodiazepines)
Name 3 areas of the frontostriatal cortex circuit that might be involved in processing of cognition?
1) Dorsolateral prefrontal cortex
-> cognitive flexibility, memory and attention
2) Orbitofrontal cortex
-> reinforcement (reward) and reversal learning, inhibition
3) Anterior cingulate cortex
-> conflict monitoring and resolution, inhibition
Is the hypothesis 'impairments of executive functioning in TS' true?
No: TS is not associated with consistent executive impairments (only robust evidence: inhibition impairment)