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Tourette Syndrome: Training for Law Enforcement
Tourette Syndrome: Training for Law Enforcement 42-40 Bell Blvd., Suite 205, Bayside, NY 11361 tourette.org 888-4TOURET Understanding Tourette Syndrome & Tic Disorders: The Basics Tourette Syndrome (TS) is a type of Tic Disorder. Tics are involuntary, sudden, rapid repetitive movements and vocalizations. Tics are the defining feature of a group of childhood-onset, neurodevelopmental conditions. There are two types of tics— motor (movements) and vocal (sounds). As seen in the chart below, tics range from head shaking to throat clearing. You may see someone doing more than one tic at a time. It is important to note that you might encounter someone uttering obscenities, racial statements, or socially inappropriate phrases (corprolalia). However, only 1 in 10 individuals present this type of tic. It is also possible that you might encounter someone acting out obscene gestures (copropraxia). These tics, like all others, are involuntary. Types of Tics TYPES SIMPLE COMPLEX Motor Tics SUDDEN, BRIEF MOVEMENTS: MOVEMENTS ARE OFTEN Some Examples: Eye blinking, head shaking, face SLOWER AND MAY SEEM grimacing, shoulder shrugging, PURPOSEFUL IN APPEARANCE: abdominal tensing, or arm jerking Touching, tapping, hopping, squatting, skipping, jumping, or copropraxia (obscene gestures) Vocal Tics SUDDEN SOUNDS OR NOISES: WORDS OR PHRASES THAT Some Examples: Sniffing, coughing, spitting, OFTEN OCCUR OUT OF grunting, throat clearing, CONTEXT: Syllables, words or snorting, animal noises, phrases (“shut up”, “stop that”), squeaking, or shouting coprolalia (uttering of obscen- ities), palilalia (repeating own words), echolalia (repeating others’ words) Tic Challenges in Social Situations Tics can increase in high stress situations, such as being stopped by law enforcement. -
Tourette's Syndrome
Tourette’s Syndrome CHRISTOPHER KENNEY, MD; SHENG-HAN KUO, MD; and JOOHI JIMENEZ-SHAHED, MD Baylor College of Medicine, Houston, Texas Tourette’s syndrome is a movement disorder most commonly seen in school-age children. The incidence peaks around preadolescence with one half of cases resolving in early adult- hood. Tourette’s syndrome is the most common cause of tics, which are involuntary or semi- voluntary, sudden, brief, intermittent, repetitive movements (motor tics) or sounds (phonic tics). It is often associated with psychiatric comorbidities, mainly attention-deficit/hyperac- tivity disorder and obsessive-compulsive disorder. Given its diverse presentation, Tourette’s syndrome can mimic many hyperkinetic disorders, making the diagnosis challenging at times. The etiology of this syndrome is thought to be related to basal ganglia dysfunction. Treatment can be behavioral, pharmacologic, or surgical, and is dictated by the most incapacitating symp- toms. Alpha2-adrenergic agonists are the first line of pharmacologic therapy, but dopamine- receptor–blocking drugs are required for multiple, complex tics. Dopamine-receptor–blocking drugs are associated with potential side effects including sedation, weight gain, acute dystonic reactions, and tardive dyskinesia. Appropriate diagnosis and treatment can substantially improve quality of life and psychosocial functioning in affected children. (Am Fam Physician. 2008;77(5):651-658, 659-660. Copyright © 2008 American Academy of Family Physicians.) ▲ Patient information: n 1885, Georges Gilles de la Tourette normal context or in inappropriate situa- A handout on Tourette’s described the major clinical features tions, thus calling attention to the person syndrome, written by the authors of this article, is of the syndrome that now carries his because of their exaggerated, forceful, and provided on p. -
The ICD-10 Classification of Mental and Behavioural Disorders : Clinical Descriptions and Diagnostic Guidelines
ICD-10 ThelCD-10 Classification of Mental and Behavioural Disorders Clinical descriptions and diagnostic guidelines | World Health Organization I Geneva I 1992 Reprinted 1993, 1994, 1995, 1998, 2000, 2002, 2004 WHO Library Cataloguing in Publication Data The ICD-10 classification of mental and behavioural disorders : clinical descriptions and diagnostic guidelines. 1.Mental disorders — classification 2.Mental disorders — diagnosis ISBN 92 4 154422 8 (NLM Classification: WM 15) © World Health Organization 1992 All rights reserved. Publications of the World Health Organization can be obtained from Marketing and Dissemination, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel: +41 22 791 2476; fax: +41 22 791 4857; email: [email protected]). Requests for permission to reproduce or translate WHO publications — whether for sale or for noncommercial distribution — should be addressed to Publications, at the above address (fax: +41 22 791 4806; email: [email protected]). The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers' products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. -
Practical Child Psychiatry: the Clinician's Guide
Practical Child Psychiatry: The Clinician's Guide Bryan Lask Sharon Taylor Kenneth P Nunn BMJ PUBLISHING GROUP Practical Child Psychiatry: The clinician’s guide This Page Intentionally Left Blank This Page Intentionally Left Blank Practical Child Psychiatry: The clinician’s guide Bryan Lask Professor of Child and Adolescent Psychiatry, St George's Hospital Medical School, University of London, London, UK and Huntercombe Hospital, Maidenhead, UK Sharon Taylor Specialist Registrar in Child Psychiatry, Academic Unit of Child and Adolescent Psychiatry, Imperial College of Science, Technology and Medicine, St Mary’s Campus, London, UK Kenneth P Nunn Professor of Child Psychiatry, University of Newcastle and Director of Inpatient Child Psychiatry, John Hunter Hospital, Newcastle, New South Wales, Australia © BMJ Publishing Group 2003 BMJ Books is an imprint of the BMJ Publishing Group All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording and/or otherwise, without the prior written permission of the publishers. First published in 2003 by BMJ Books, BMA House, Tavistock Square, London WC1H 9JR www.bmjbooks.com British Library Cataloguing in Publication Data A catalogue record for this book is available from the British Library ISBN 0 7279 1593 2 Typeset by SIVA Math Setters, Chennai, India Printed and bound in Spain by Graphycems, Navarra Contents Preface vii Foreword ix Acknowledgements xiii Section I: A bird’s eye view 1 1. Background 3 2. Assessment 14 Section II: The clinical picture 19 3. Fears and anxieties 21 4. Post-traumatic stress disorder 34 5. -
Neurological Features of Gilles De La Tourette's Syndrome
J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp.36.1.1 on 1 February 1973. Downloaded from Journal of Neurology, Neurosurgery, and Psychiatry, 1973, 36, 1-9 Neurological features of Gilles de la Tourette's syndrome RICHARD D. SWEET, GAIL E. SOLOMON, HENRIETTE WAYNE, ELAINE SHAPIRO, AND ARTHUR K. SHAPIRO From the Departments of Neurology and Psychiatry, Cornell University Medical College, New York, New York 10021, U.S.A. SUMMARY Clinical neurological examinations of 22 patients with Gilles de la Tourette's syndrome and written reports of examinations of seven other patients are reported. Half the personally exam- ined patients had minor motor asymmetries in addition to the typical motor and vocal tics found in all the patients. Thirty-six per cent of patients were left handed or ambidextrous. Electroencephalo- grams performed on 17 of the 22 patients showed non-specific abnormalities in 12 of them. These findings suggest that a neurological disorder underlies Tourette's syndrome, but they do not clarify its nature. Protected by copyright. Tics may be defined as brief purposeless move- (Yeh, McNay, and Goldberg, 1969). It has been ments of a body part which occur at random suggested that a dopamine excess may underlie intervals and cannot be suppressed for long Tourette's syndrome (Snyder, Taylor, Coyle, and periods oftime. Wilson (1927) believed they were Meyerhoff, 1970), but the actual anatomical or psychogenic in origin, while others have empha- pathophysiological abnormality which might sized developmental (Balthasar, 1957) or in- cause Tourette's syndrome and be controlled by flammatory disorders (Creak and Guttman, haloperidol is still unknown. -
Tourette Syndrome— Much More Than Tics Moving Beyond Misconceptions to a Diagnosis
Cover article LOWELL HANDLER First of two parts Tourette syndrome— much more than tics Moving beyond misconceptions to a diagnosis By Samuel H. Zinner, MD Far more people have heard of Tourette syndrome than know what it actually looks and sounds like—or how it feels to the person who has it. That’s a major reason the diagnosis of this condition—the most severe tic disorder—is often missed. A change of perception begins with understanding the breadth and variability of symptoms and being aware of comorbidity. ore than a century has passed since the ical figures (including the Roman Emperor Claudius, French neurologist Georges Gilles de la Wolfgang Amadeus Mozart, and 18th century English Tourette first described the condition literary scholar Samuel Johnson) testify to the wide- that bears his name, a name familiar to spread awareness of TS across cultures and time, de- the lay public and health professionals spite (or perhaps because of) its perceived rarity. So it alike. Once considered so rare that neurologists might seems that the medical community trailed the un- Mexpect to witness the disorder perhaps once in their trained community by centuries in recognizing the professional lifetime, Tourette syndrome (TS) is, in syndrome. fact, common enough that virtually all pediatricians From the time of its initial medical description in will have several patients with this condition in their 1885 until the 1960s, medical experts viewed TS as a practice. Yet, despite its name recognition and the psychological disorder, and treatment was customarily number of people it affects, TS often goes undiag- directed toward psychotherapy. -
The Portrayal of Tourette Syndrome in Film and Television Samantha Calder-Sprackman, Stephanie Sutherland, Asif Doja
ORIGINAL ARTICLE COPYRIGHT ©2014 T HE CANADIAN JOURNAL OF NEUROLOGICAL SCIENCES INC . The Portrayal of Tourette Syndrome in Film and Television Samantha Calder-Sprackman, Stephanie Sutherland, Asif Doja ABSTRACT: Objective: To determine the representation of Tourette Syndrome (TS) in fictional movies and television programs by investigating recurrent themes and depictions. Background: Television and film can be a source of information and misinformation about medical disorders. Tourette Syndrome has received attention in the popular media, but no studies have been done on the accuracy of the depiction of the disorder. Methods: International internet movie databases were searched using the terms “Tourette’s”, “Tourette’s Syndrome”, and “tics” to generate all movies, shorts, and television programs featuring a character or scene with TS or a person imitating TS. Using a grounded theory approach, we identified the types of characters, tics, and co-morbidities depicted as well as the overall representation of TS. Results: Thirty-seven television programs and films were reviewed dating from 1976 to 2010. Fictional movies and television shows gave overall misrepresentations of TS. Coprolalia was overrepresented as a tic manifestation, characters were depicted having autism spectrum disorder symptoms rather than TS, and physicians were portrayed as unsympathetic and only focusing on medical therapies. School and family relationships were frequently depicted as being negatively impacted by TS, leading to poor quality of life. Conclusions: Film and television are easily accessible resources for patients and the public that may influence their beliefs about TS. Physicians should be aware that TS is often inaccurately represented in television programs and film and acknowledge misrepresentations in order to counsel patients accordingly. -
Adulthood Outcome of Tic and Obsessive-Compulsive Symptom Severity in Children with Tourette Syndrome
ARTICLE Adulthood Outcome of Tic and Obsessive-Compulsive Symptom Severity in Children With Tourette Syndrome Michael H. Bloch, BA; Bradley S. Peterson, MD; Lawrence Scahill, MSN, PhD; Jessica Otka, BA; Lily Katsovich, MS; Heping Zhang, PhD; James F. Leckman, MD Background: Tourette syndrome (TS) is a childhood- Main Outcome Measures: Expert-rated tic and OCD onset neuropsychiatric disorder that is characterized by symptom severity at follow-up interview an average of both motor and phonic tics. One half to two thirds of chil- 7.6 years later (range, 3.8-12.8 years). dren with TS experience a reduction or complete reso- lution of tic symptoms during adolescence. At least one Results: Eighty-five percent of subjects reported a re- third of adults with TS have comorbid obsessive- duction in tic symptoms during adolescence. Only in- compulsive disorder (OCD). creased tic severity in childhood was associated with increased tic severity at follow-up. The average age at worst- Objectives: To clarify the clinical course of tic and OCD ever tic severity was 10.6 years. Forty-one percent of pa- symptoms in children with TS and determine if baseline tients with TS reported at one time experiencing at least clinical measurements in childhood are associated with moderate OCD symptoms. Worst-ever OCD symptoms future symptom severity in late adolescence and early occurred approximately 2 years later than worst-ever tic adulthood. symptoms. Increased childhood IQ was strongly associ- ated with increased OCD severity at follow-up. Design: Prospective cohort study. Conclusion: Obsessive-compulsive disorder symp- Setting: Yale Child Study Center tic and OCD outpa- tient specialty clinic. -
Gilles De La Tourette Y Su Síndrome Gilles De La Tourette and His Syndrome
Palacios L. ACTA NEUROLÓGICA COLOMBIana Reflexión Gilles de la Tourette y su síndrome Gilles de la Tourette and his syndrome Leonardo Palacios Sánchez (1), Laura Daniela Vergara Méndez (2), Arianna Valeria Martínez Camacho (3), Sebastián Canal Piñeros (3), Laura Mora Muñoz (3) RESUMEN Georges Albert Brutus Edouard Gilles de la Tourette nació y se crio dentro de una época esplendorosa de Francia. Se destacó por sus méritos como estudiante y fue educado para que tuviera una brillante carrera como médico. Su paso por el hospital Pitie-Salpêtrière fue algo fundamental en su vida, ya que allí conoció al profesor Jean-Martin Charcot quien le brindó la oportunidad y las herramientas para estudiar su pasión, la Neurología, de una manera amplia la y dedicarse a otros casos interesantes dedicados a la mente humana. Gracias a esto pudo describir la patología que hoy nos compete como el síndrome de La Tourette. Su estudio y su incansable curiosidad permitieron además involucrarse no sólo con este síndrome sino que ayudó a hacer múltiples descripciones de otras patologías e incursionó en el nuevo campo del hipnotismo. Sin embargo, su muerte prematura, debido a una enfermedad hoy en día curable, hizo que se truncara la maravillosa mente de este neurólogo que, muy seguramente, hubiese aportado más conocimiento de la época a nuestro saber actual. PALABRAS CLAVE: Gilles de la Tourette. Tics. Coprolalia trastornos del movimiento. Jean Martin Charcot (DeCS). SUMMARY Georges Albert Edouard Brutus Gilles de la Tourette was born and raised in an era of French splendor; he was an outstanding student, educated to have a brilliant career as a doctor. -
Update on Tourette Disorder
7/26/2019 Update on Tourette Disorder REBECCA K. LEHMAN, MD, FAAN ASSOCIATE PROFESSOR OF CLINICAL PEDIATRICS (CHILD NEUROLOGY) PALMETTO HEALTH-UNIVERSITY OF SOUTH CAROLINA MEDICAL GROUP PRISMA HEALTH CHILDREN’S HOSPITAL-MIDLANDS AUGUST 9, 2019 1 Disclosures Financial disclosures: Reimbursement from TAA for travel to MAB meeting and lectures. Participating (Sub-I/PI/Rater) in clinical trials for Neurocrine, Teva, and Emalex. Reimbursed for travel to investigator meetings. No other financial conflicts. All of the treatments for Tourette Disorder are off- label, with the following exceptions: Haloperidol (3 years and older) Pimozide (12 years and older) Aripiprazole (6-18 years) Tetrabenazine (orphan drug designation for children 5- 16 years) 2 1 7/26/2019 Objectives By the end of the lecture, attendees should be able to: Describe the clinical characteristics of tics Define Tourette Disorder (Syndrome) Review the symptom criteria for the diagnosis of PANDAS (Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal Infections) Examine the controversies surrounding the diagnosis and treatment of PANDAS List the neuropsychiatric conditions that commonly co-occur with TD Outline the range of management strategies for TD Identify resources that are available for patient education and support 3 What are tics? Movements or vocalizations that are: Sudden Abrupt Transient Repetitive Coordinated (stereotyped) 4 2 7/26/2019 Premonitory Urge Leckman JF, Walker DE, Cohen DJ, 1993. 5 Other Characteristics of Tics -
Tourette Syndrome and Related Tic Disorders (PDF)
117 TOURETTE SYNDROME AND RELATED TIC DISORDERS NEAL R. SWERDLOW JAMES F. LECKMAN to conceptualize tics in TS as ‘‘movement-equivalents’’ of Each movement is preceded by certain preliminary sensory obsessions and compulsions, and the apparent connections signals and is in turn followed by sensory impressions at the end of the action. Each movement is the result of a voluntary with OCD and attention-deficit/hyperactivity disorder capitulation to a demanding and relentless urge accompanied (ADHD) raise hope that by solving the TS ‘‘model,’’ we by an extraordinarily subtle sensation that provokes and fuels will understand a family of disorders that collectively affects the urge. Successively sharper movements build up to a cli- close to 10% of the population. By all accounts, the TS max—a climax that never comes (1). model should be readily solvable, like a practice question before the really tough questions on an examination. Al- though we still lack clear answers for many of the complex questions raised by this syndrome, this chapter reviews the A MODEL NEUROPSYCHIATRIC DISORDER current state of progress in understanding the clinical fea- tures and neurobiology of TS and related tic disorders. Biological models allow investigators to extrapolate from simple to complex systems, to generate and test hypotheses, and to grasp schema that are within range of our intellect, TICS: MOTOR, PHONIC, AND BEYOND as we reach to conceptualize things beyond this range. Tourette syndrome (TS) is a ‘‘model neuropsychiatric disor- The DSM-IV describes tics as ‘‘sudden, rapid, recurrent, der’’ (2,3) that seems tantalizing in its simplicity. The ge- nonrhythmic, stereotyped movements or vocalizations,’’ but netic basis is stronger than any common neuropsychiatric the self-assessments by Dr. -
Cognitive Tic-Like Phenomena in Gilles De Latourette Syndrome
Journal of Clinical Medicine Article Cognitive Tic-Like Phenomena in Gilles de la Tourette Syndrome Piotr Janik 1, Anna Dunalska 1,* , Natalia Szejko 1,2 and Andrzej Jakubczyk 3 1 Department of Neurology, Medical University of Warsaw, Banacha 1a Str., 02-097 Warsaw, Poland; [email protected] (P.J.); [email protected] (N.S.) 2 Department of Bioethics, Medical University of Warsaw, Zwirki˙ i Wigury 63 Str., 02-091 Warsaw, Poland 3 Department of Psychiatry, Medical University of Warsaw, Nowowiejska 27 Str., 00-665 Warsaw, Poland; [email protected] * Correspondence: [email protected]; Tel.: +48-513-036-549; Fax: +(0-22)-599-18-57 Abstract: Coprolalia and echophenomena repeated in the patients’ mind (CTPh—cognitive tic- like phenomena) have been rarely recognized as part of Gilles de la Tourette syndrome (GTS) symptomatology and their assignment to tics, OCD or other psychopathologies has not been settled. The aim of the paper was to assess the incidence and clinical associations of CTPh in GTS, and to establish if CTPh belong to the tic spectrum. We performed a prospective, one-registration study on a cohort of 227 consecutive patients with GTS. CTPh were diagnosed during the interview and defined as brief, sudden, involuntary thoughts that had corresponding complex vocal tics. CTPh occurred at some point in the lives of 34 (15.0%) patients. The median age at onset of CTPh was 14.5 years (IQR: 10.5–17.5). CTPh were found more frequently in adults, with the most frequent onset in adolescence (44.1%). Four mental phenomena resembling tics were recognized: echolalia (n = 17), coprolalia (n = 16), palilalia (n = 13) and repeating of words in the mind (n = 7).