Tourette's Syndrome
...ic phenotypes. This is shown in Figure 1 following. They believe that TS and OCD to be products of internal changes and environmental psychosocial changes. These changes working together, for a person who is carrying a gene that causes them to be vulnerable are more likely to develop TS and/or OCD. Tourette’s syndrome is a chronic neuro-psychiatric disorder which onsets during childhood and some grow out of after puberty. This also supports that sex-hormone modulation is a partial cause (Piek, 1998). Also males are diagnosed as having TS more often than females by a ratio of 3.5:1 (Comings, 1990). By some, Tourette’s syndrome is believed to be a hereditary disorder passed along throughout families. Some people are therefore carriers without even knowing that another person within their genetic family even has the disorder. It is not known exactly how this gene is passed on, but it is known to be more frequent in males. The Gts gene also has an effect on people with ADHD and conduct disorder. It is thought that there may be a gene on the X chromosome that modifies the Gts gene and causes it to be active and cause TS more often in males (Comings, 1990). Diagnosis There is no specific test for TS, only the patients’ history and their clinical presentation. The diagnostic criteria for tic disorders according to the DSM-IV are as follows: I. Diagnostic Criteria for Tourette’s Syndrome (307.23) A. Both multiple motor and one or more vocal tics have been present at some time during the illness, although not necessarily concurrently. B. The tics occur many times a day (usually in bouts), nearly every day or intermittently throughout a period of more than a year; and during this period, there was never a tic-free period of more than three consecutive months. C. The disturbance causes marked distress or significant impairment in social, occupational, or other areas of functioning. D. Onset before age 18 years. E. The disturbance is not due to the direct physiological effects of a substance (e.g., stimulants) or a general medical condition (e.g., Huntington’s chorea or post-viral encephalitis). II. Diagnostic Criteria for Chronic Motor or Vocal Tic Disorder (307.22) A. Single or multiple motor or vocal tics, but not both, have been present at some time during the illness. B. The tics occur many times a day, nearly every day, or intermittently throughout a period of more than a year. During this period there was never a tic-free interval of more than three months. C. The disturbance causes marked distress or significant impairment in social, occupational, or other areas of functioning. D. Onset before age 18 years. E. The disturbance is not due to the direct physiological effects of a substance (e.g., stimulants) or a general medical condition (e.g., Huntington’s chorea or post-viral encephalitis). F. Criteria have never been met for Tourette’s Disorder. III. Diagnostic Criteria for Transient Tic Disorder (307.21) A. Single or multiple motor and/or vocal tics. B. The tics may occur many times a day, nearly every day for at least four weeks, but for no longer than 12 consecutive months. C. The disturbance causes marked distress or significant impairment in social, occupational, or other areas of functioning. D. Onset before age 18 years. E. Disturbance is not due to the direct physiological effects of a substance (e.g., stimulants) or a general medical condition (e.g., Huntington’s chorea or post-viral encephalitis). F. Criteria have never been met for Tourette’s Disorder. IV. Diagnostic Criteria for Tic Disorder Not Otherwise Specified (307.20) This category is for a tic disorder that does not meet the criteria for a specific tic disorder. Examples include tics lasting less than four weeks or tics with onset after age 18 years (Leckman & Cohen, 1999). Tourette’s syndrome is the most severe tic disorder. It has an onset during childhood with eye blinking and jerky head movements. As the syndrome more fully develops and the child ages, they tend to have more complex tics and movements. Vocal tics usually begin one to two years after the onset of motor tics (Leckman & Cohen, 1999). Treatment Tourette’s syndrome is often treated with cognitive therapy and counseling. People with this disorder receive help with organization and structure and some behavior management. When they have severe tics, some drugs are used to help control them. Some commonly used drugs include: haldol, clonidine, fluoxetine, clomipramine, plus others (Copeland, 1995). When treating TS there are different types of drugs that are used, such as those for tics, and ADHD, and depression and conduct disorder. The tics are said to be the easiest to treat, that the behaviors are the most bothersome and hardest to treat. That is helped with therapy. To treat the tics, doctors give patients dopamine receptor antagonists and 2beta-norepinephrine receptor agonists. ADHD is treated with stimulant medications, tricyclic antidepressants, and 2beta-norepinephrine receptor agonists. Depressed patie...