psychiatrist in-dubai-

Tic Disorder

Psychiatrist in dubai

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Tic

• Sudden, rapid, usually stereotyped, predominantly clonic, irresistible movement -> relieve of symptom. Can be controlled by will for short time but reappear as soon as attention is diverted.

• They correspond to purposive coordinated act which normally serve the organism

• Blinking, sniffing, throat cleaning, neck , shoulder or generalized

• Seen transiently in children, mentally retarded

• Adult – relieved by sedation, psychotherapy

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Simple Tics • Motor -- Eye blinking, head jerking, shoulder shrugging and

facial grimacing.

• Vocal -- Throat clearing, yelping and, noises, sniffing and

tongue clicking

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Complex tics • Motor -- Jumping, touching other people or things, smelling,

twirling about, and only rarely, self- injurious actions including

hitting or biting oneself.

• Vocal -- Uttering words or phrases out of context and

coprolalia

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Tic disorders

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Transient Chronic

TS Motor

Vocal

Simple Complex

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Georges Gilles de la Tourette (1857-1904

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Gilles de la Tourette syndrome

• Incidence : 0.03 – 0.05% M:F - 3:1

• Prevalence: 0.5-1%

• Onset - mean 7 y (2-15y) 95% < 11y

• 1/3rd family members have tics

• Motor tics:

• Rapid abrupt, intermittent, present in sleep, multifocal simple or complex

• Involve face, eyes, and proximal extremities

• Vary spontaneously, Echopraxia, Copropraxia

• Vocal tics

• Involuntary, words, grunts, bark, sniff, snuts, squeals, echolalia, coprolalia

Coprolalia • The uncontrolled, often obsessive use of obscene or

scatological language, cursing, ethnic slurs

• Thought to possessed by the devil.

• Ostracized from their communities or punished for behaviors 5/5

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• Intellect

• Normal, nonspecific right hemispheric dysfunction

• Attention disorder, hyperactivity

• Personality

• Obsessive compulsive

• Self deterministic

• Anxiety, depression, alcoholism

• Modification

• Increased by stress, anxiety,

• Decreased by relaxation, fever

• Course: Natural remission and waxing and waning of severity

• Other features: Soft neurological sign • Altered tone

• Mild incoordination

• Babinski’s sign

• No sensory sign

• Association • Migraine ( 5HT disorder)

• Sec. compressive neuropathy and myelopathy due to violent tics

• Sleep disorder – somnambulism, sleep terror, ↓ REM sleep, ↑ stage 3-4 sleep,

• EEG and Evoked potential normal • Pre-movement EEG potential absent (subcortical origin)

Association

• ADHS – 60-80%

• OCD

• Conduct disorder

5/5/2016

Pathophysiology

• Midbrain, basal ganglionic dopaminergic dysfunction (turnover ↓ receptor hypersensitivity)

• 5HT – Associated with migraine

• NA – Improve with clonidine

• Cholinergic – Improve with physostigmine

• GABA – Clonazepam relieve symptom

• Encephalin → dopamine release. Opioid agonist N2O relieve symptom

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Pathogenesis

• Anatomical: prefrontal cortex and caudate nucleus

• Biochemical: Dopamine

• Genetics: AD (Chr 4p and 8p)

• Immunological: PANDAS

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http://www.emedicine.com/cgi-bin/foxweb.exe/makezoom@/em/makezoom?picture=/websites/emedicine/neuro/images/Large/967neu0664-04.jpg&template=izoom2

Diagnostic Criteria • Multiple motor tics

• One or more vocal tics

• No known cause

• Age of onset less than 18 years.

• A duration of greater than one year.

“Tourette Syndrome Study Group (1993)”

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DSM IV Criteria of Tourette syndrome • Age of onset between 5-15y

• Multiple motor tics

• Multiple vocal tics

• Ability to suppress movement voluntarily for min to hours

• Variation in the intensity of symptom over weeks to months

• Duration of more than a year

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DD

Clinical Tourette Jumpers (France)

Latah (Malacia)

Myrichit (Russia)

Tics + - - -

Startle myoclonus

- + + ?

Compulsive movement

+ + + -

Echopraxia + + + +

Echolalia + + + +

Coprolalia + - + - Powered by






Progression

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PANDAS

• OCD/Tic tic disorder

• Onset 3-12 years

• Episodic course of symptom severity

• Association with group A Beta-hemolytic streptococcal infection

• Association with neurological abnormalities

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Treatment

• Education

• Tic: Anti Dopamine

• Associated disorder:

ADHS/OCD

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http://www.ich.ucl.ac.uk/factsheets/index.html




Prognosis

• Marked improvement in late

teens or early twenties.

• They get better, not worse, as

they mature

• TS patients have a normal life

span.

• 1/ 3 of patients experience

remission of tic symptoms in

adulthood.”

5/5/2016

Samuel Johnson 1709-1784 “Good English Dictionary

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