Neurobehavioural Correlates of Abnormal Repetitive Behaviour
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Neurobiology of the Premonitory Urge in Tourette Syndrome: Pathophysiology and Treatment Implications
View metadata, citation and similar papers at core.ac.uk brought to you by CORE HHS Public Access provided by Aston Publications Explorer Author manuscript Author ManuscriptAuthor Manuscript Author J Neuropsychiatry Manuscript Author Clin Neurosci Manuscript Author . Author manuscript; available in PMC 2017 April 28. Published in final edited form as: J Neuropsychiatry Clin Neurosci. 2017 ; 29(2): 95–104. doi:10.1176/appi.neuropsych.16070141. Neurobiology of the premonitory urge in Tourette syndrome: Pathophysiology and treatment implications Andrea E. Cavanna1,2,3,*, Kevin J Black4, Mark Hallett5, and Valerie Voon6,7,8 1Department of Neuropsychiatry Research Group, BSMHFT and University of Birmingham, Birmingham, UK 2School of Life and Health Sciences, Aston University, Birmingham, UK 3University College London and Institute of Neurology, London, UK 4Departments of Psychiatry, Neurology, Radiology, and Anatomy & Neuroscience, Washington University School of Medicine, St. Louis, MO, USA 5Human Motor Control Section, Medical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA 6Department of Psychiatry, University of Cambridge, Cambridge, UK 7Behavioural and Clinical Neurosciences Institute, Cambridge, UK 8Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK Abstract Motor and vocal tics are relatively common motor manifestations identified as the core features of Tourette syndrome. Although traditional descriptions have focused on objective phenomenological -
Final Program
FINAL PROGRAM 2nd Pan American Parkinson’s Disease and Movement Disorders Congress JUNE 22-24, 2018 MIAMI, FLORIDA, USA www.pascongress2018.org Table of Contents About MDS ...............................................................................................................................................................................................................................................2 About MDS-PAS Section ...........................................................................................................................................................................................................................3 Continuing Medical Education (CME) Information ....................................................................................................................................................................................4 Hilton Miami Downtown Floor Plan .........................................................................................................................................................................................................4 Schedule-At-A-Glance .............................................................................................................................................................................................................................5 Session Definitions ...................................................................................................................................................................................................................................6 -
The Clinical Presentation of Psychotic Disorders Bob Boland MD Slide 1
The Clinical Presentation of Psychotic Disorders Bob Boland MD Slide 1 Psychotic Disorders Slide 2 As with all the disorders, it is preferable to pick Archetype one “archetypal” disorder for the category of • Schizophrenia disorder, understand it well, and then know the others as they compare. For the psychotic disorders, the diagnosis we will concentrate on will be Schizophrenia. Slide 3 A good way to organize discussions of Phenomenology phenomenology is by using the same structure • The mental status exam as the mental status examination. – Appearance –Mood – Thought – Cognition – Judgment and Insight Clinical Presentation of Psychotic Disorders. Slide 4 Motor disturbances include disorders of Appearance mobility, activity and volition. Catatonic – Motor disturbances • Catatonia stupor is a state in which patients are •Stereotypy • Mannerisms immobile, mute, yet conscious. They exhibit – Behavioral problems •Hygiene waxy flexibility, or assumption of bizarre • Social functioning – “Soft signs” postures as most dramatic example. Catatonic excitement is uncontrolled and aimless motor activity. It is important to differentiate from substance-induced movement disorders, such as extrapyramidal symptoms and tardive dyskinesia. Slide 5 Disorders of behavior may involve Appearance deterioration of social functioning-- social • Behavioral Problems • Social functioning withdrawal, self neglect, neglect of • Other – Ex. Neuro soft signs environment (deterioration of housing, etc.), or socially inappropriate behaviors (talking to themselves in -
Tourrete-Syndrome.Pdf
ISSN : 2376-0249 International Journal of Volume 2 • Issue 8• 1000360 Clinical & Medical Imaging August, 2015 http://dx.doi.org/10.4172/2376-0249.1000360 Case Blog Title: Tourrete Syndrome Rajarshi Sannigrahi1, Ajay Manickam1*, Shaswati Sengupta1, Jayanta saha1, SK Basu1 and Sunetra Mondal2 1Department of ENT and Head Neck Surgery, RG Kar Medical College and Hospital, Kolkata, India 2Vivekananda institute of medical science. Kolkata India Introduction Tourette syndrome is an inherited neuropsychiatric disorder with onset in childhood; it is characterized by multiple motor tics and at least one vocal tic. The occurrence of tics wax and wane with time can be suppressed voluntarily and are frequently preceded by a premonitory urge. Tourette is defined as a part of spectrum of tic disorders which include provisional, transient or persistent tics. The prevalence of tourrete is 0.4% to 3.8% among children between 5 to 18 years [1]. The tourette syndrome can be associated with use of obscene words and derogatory remarks but this is present in only a few cases [2]. Eye blinking, coughing, throat clearing, sniffing and facial movements are the common type of tics. Tourrete does not affect intelligence or life expectancy. To urrete is often associated with comorbid condition such as attention deficit hyperactivity disorder (ADHD) and obsessive compulsive disorder(OCD). These conditions often cause more functional impairment than the tics. Case Study 6 year old female patient presented in the ENT opd with recurrent sore throat. On examination bilateral tonsillitis was seen. During examination frequent blinking of eyes, grimacing, frowning and frequent protrusion of tongue was observed. -
Catatonia: an Under-Recognised, Acutely Treatable Condition in Young People with Intellectual Disability/ASD
Catatonia: an under-recognised, acutely treatable condition in young people with intellectual disability/ASD. Associate Professor David Dossetor The Children’s Hospital at Westmead Area Director for Mental Health Child Psychiatrist with a Special interest in Intellectual Disability A case example inaudible words in the consultation and didn’t A 15-year-old girl with Down Syndrome was referred to respond to questions. She had waxy flexibility and neurology due to a neurocognitive decline over a two- mild increased muscle tone. She drew a few small month period. She had been socially active, happy, indistinct pictures and was eventually able to write cheeky, talkative and an enthusiastic school attender. her name. She appeared to respond to unseen She had acquired basic self-care and hygiene skills, stimuli. There was no access to her internal mental and achieved primary school educational skills. At a state but she did laugh to herself regularly, out of school swimming carnival, the girl was severely context. It was not possible to assess her cognitive sunburnt. That night she became a little delirious and skills. was uncharacteristically incontinent; this incontinence persisted. The next day she was found sitting in bed The girl was diagnosed with a psychotic disorder with with arms out stiff and staring blankly. A GP review catatonic features and started on olanzapine 2.5mg revealed nothing, with a normal urine screen. Over the three times daily (tds), adding 0.5mg lorazepam tds next month she became progressively quieter until she a week later which was increased to 1mg tds two became mute. She also became apathetic and lost weeks later. -
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. -
Tourette's Syndrome: a Review from a Developmental Perspective
Isr J Psychiatry Relat Sci - Vol. 47 - No 2 (2010) Tourette's Syndrome: A Review from a Developmental Perspective Tamar Steinberg, MD, 1 Robert King, MD, 2 and Alan Apter, MD 1 1 The Harry Freund Neuro-Psychiatric Clinic, Schneider Children's Medical Center, Petah Tikva, Israel 2 Yale Child Study Center, New Haven, Connecticut, U.S.A. izations. Simple motor tics are sudden, fleeting or ABSTRACT fragmentary movements such as blinking, grimacing, head jerking, or shoulder shrugs. Complex motor tics The object of this review is to summarize some of the consist of several simple motor tics occurring in an recent developments in the understanding of Tourette’s orchestrated sequence or semi-purposeful movements, Syndrome which can be regarded as the prototype of a such as touching or tapping; these may also have a more developmental psychopathological entity. The review sustained, twisting, and dystonic character (2). covers the following topics: tics and their developmental Simple phonic tics consist of simple, unarticulated course; sensory phenomena related to tics including sounds such as throat clearing, sniffing, grunting, measurement of these phenomena; pathophysiology squeaking, or coughing. Complex phonic tics consist of of tics and compensatory phenomena and the parallel out-of-context syllables, words, phrases or paroxysmal development of the various psychiatric comorbidities as changes of prosody. they emerge over the life span. Finally there is an attempt Complex tics may involve socially inappropriate or to summarize the major points and future directions. obscene gestures (copropraxia) or utterances (coprola- lia), as well as echo phenomena, such as echolalia or echopraxia (repeating others’ words or gestures), which exemplify the suggestibility of tics. -
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. -
2018 Celebration of Research
UNIVERSITY OF FLORIDA COLLEGE OF MEDICINE 2018 Celebration of Research Welcome from the Dean The annual University of Florida College of Medicine Celebration of Research affords me the opportunity to say Thank You. Thank you for the late nights, the papers written and reviewed, the grant proposals that have been funded and those that will be resubmitted, the patience that you have shown with the varied hurdles placed in the pathway of research. But most importantly, thank you for the passion that you employ to move the boundary of science knowledge forward. Your research vision and the work of your research teams are appreciated and valued. The discoveries and inventions that result from the basic, translational, population and clinical research at our university are transforming medicine. Thank you for your dedication to creating a healthier future for all. The College of Medicine stands proudly behind your efforts. Michael L. Good, MD Dean, UF College of Medicine Celebration of Research 3 POSTER SESSION & RECEPTION Monday, February 19, 2018 5:30pm – 8:30pm Stephen C. O’Connell Center Slow down and smell the roses The 2018 Celebration is already here. Where did the year go? 2017 was indeed another remarkable year of continued growth and progress for research within the College of Medicine, and 2018 is already off to a great start. We have all been running and seem a bit out of breath. Now it is time to slow down and appreciate the breadth and depth of the College of Medicine’s research endeavors and recognize how our research is directed at fundamental, timely, and significant areas of human health. -
Sensory Dysfunction in Children with Tourette Syndrome
Sensory Dysfunction in Children with Tourette Syndrome by Nasrin Shahana, MBBS A Dissertation Submitted inPartial Fulfillment of theRequirements for the Degree ofDoctor of Philosophyin Neuroscience University of Cincinnati Cincinnati Children’s Hospital 12th August 2015 Committee Members James Eliassen, PhD (Chair) Matthew R. Skelton, PhD Michael P. Jankowski, PhD Jennifer J. Vannest, PhD Donald L. Gilbert, MS, MD (Advisor) 1 ABSTRACT Sensory Dysfunction in Children with Tourette Syndrome By Nasrin Shahana, MBBS The University of Cincinnati, 2015 Under the Supervision of Donald L. Gilbert, MS, MD Prime symptoms of Tourette Syndrome (TS) constitute motor and vocal tics but observation from clinical standpoints as well as parents or individual patient’s observation has provided evidence for sensory abnormalities associated with TS. One of the well-known phenomenon is tic related premonitory urges (PU’s), described as recurring, intrusive sensory feelings such as discomfort, pressure etc. that precede and in some cases compel performance of tics. Sensory sensitivity or intolerance is often reported to be related to being sensitive to the external sensory information such as intolerance to clothing tags. Some report urges to have subconsciously copying movements (echopraxia) or speech (echolalia) of others. Patients often complain about their tics being enhanced by certain sensory stimuli like sounds or lights. With the exception of Premonitory Urges (PU’s), most of the sensory symptoms have not been addressed by standard clinical practice. PU’s can be evaluated with a standard clinical rating scale called Premonitory Urges in Tourette Syndrome (PUTS) which tends to be well correlated with tics. PU’s seem to be a critical distinguishing factor between TS and other movement disorders. -
Tourette Syndrome in Children
Focus | Clinical Tourette syndrome in children Valsamma Eapen, Tim Usherwood UP TO 20% OF CHILDREN exhibit rapid jerky peak severity at the age of approximately movements (motor tics) that are made 10–12 years, and typically improve by without conscious intention as part of a adolescence or thereafter.6 Background Gilles de la Tourette syndrome (GTS), developmental phase that often lasts a few 1 characterised by motor and vocal tics, weeks to months. Similarly, involuntary has a prevalence of approximately 1% sounds, vocalisations or noises (vocal or Clinical features in school-aged children. Commonly phonic tics) such as coughing and even In addition to simple motor and vocal/ encountered comorbidities of GTS brief screams or shouts may be observed in phonic tics, complex tics may be present include attention deficit hyperactivity some children for brief periods of time. Tics (Table 1). Some complex tics – such as disorder (ADHD) and obsessive- lasting for a few weeks to months are known spitting, licking, kissing, etc – may be compulsive behaviour/disorder (OCB/ OCD). Genetic factors play an important as ‘transient tic disorder’. When single misunderstood or misinterpreted and part in the aetiology of GTS, and family or multiple motor or vocal tics – but not a may result in the young person getting members may exhibit tics or related combination of both – have been present in trouble, especially if these tics include disorders such as ADHD, OCB or OCD. for more than one year, the term ‘chronic involuntary and inappropriate obscene tic disorder’ is used. When both (multiple) gesturing (copropraxia) or copying the Objective The aim of this article is to present a motor and (one or more) vocal tics have been movements of other people (echopraxia). -
The ICD-10 Classification of Mental and Behavioural Disorders Diagnostic Criteria for Research
The ICD-10 Classification of Mental and Behavioural Disorders Diagnostic criteria for research World Health Organization Geneva The World Health Organization is a specialized agency of the United Nations with primary responsibility for international health matters and public health. Through this organization, which was created in 1948, the health professions of some 180 countries exchange their knowledge and experience with the aim of making possible the attainment by all citizens of the world by the year 2000 of a level of health that will permit them to lead a socially and economically productive life. By means of direct technical cooperation with its Member States, and by stimulating such cooperation among them, WHO promotes the development of comprehensive health services, the prevention and control of diseases, the improvement of environmental conditions, the development of human resources for health, the coordination and development of biomedical and health services research, and the planning and implementation of health programmes. These broad fields of endeavour encompass a wide variety of activities, such as developing systems of primary health care that reach the whole population of Member countries; promoting the health of mothers and children; combating malnutrition; controlling malaria and other communicable diseases including tuberculosis and leprosy; coordinating the global strategy for the prevention and control of AIDS; having achieved the eradication of smallpox, promoting mass immunization against a number of other