18.5 - Tourette's

Question 1

How does Tourettes differ from schizophrenia, bipolar MDD and anxiety disorders?

Answer 1

the specificity of its symptoms

Question 2

explain the case of RG

Answer 2

developed tics at 15

Question 3

what are tics

Answer 3

involuntary, repetitive, stereotyped movements or vocalizations

Question 4

what is a symptom Tourettes shares with schizophrenia

Answer 4

echolalia

Question 5

how effective was RG’s medication

Answer 5

99% symptom elimination

Question 6

What is of the utmost importance for the wellbeing of those with Tourettes

Answer 6

the understanding of their peers, family and friends, as well as their support - really all the difference in outcomes

Question 7

when does Tourettes onset

- what are symptoms usually like at onset? Do they remain this way?

Answer 7

typically early in life (childhood, adolescence)

• some motor tics life eye blinking, head movements
• no, they gradually become more complex and severe

Question 8

describe some common complex motor tics

Answer 8

hitting and touching objects,
squatting
hoppin
twirling 
lewd gestures

Question 9

what are common verbal tics

Answer 9

1. inarticulate sounds like barking
2. Coprolalia (swearing)
3. echolalia
4. palilalia - repetition of ones own words

Question 10

Do Tourette’s symptoms ever stop worsening? explain

Answer 10

Yes, they tend to peak after a few years, then gradually subside

Question 11

what is the prevalence of Tourettes

Answer 11

0.3-1% of the pop

Question 12

are there gender differences in prevalence?

- describe

Answer 12

yes, males 4x more frequent in childhood

- less profound as they mature

Question 13

Is there a genetic component to Tourettes?

Answer 13

yes - 50% conc. in monozygotic, 10% in dy

Question 14

what two disorders do some Tourettes patients display symptoms of

Answer 14

ADHD, OCD, or both

Question 15

can Tourettes patients control their tics?

Answer 15

• yes and no

- they are involuntary, but they can be temporarily suppressed with concentration and effort

Question 16

how have we misunderstood the nature of tic suppression

Answer 16

believed it would result in a rebound, where they become more frequent and extreme
- this is not the case

Question 17

why is the neural basis of Tourettes more amenable to study than the other disorders in this chpt

Answer 17

bc its fuckin obviously Tourettes - well defined with clearly observable symptoms

Question 18

what are the impediments to the study of Tourettes

Answer 18

1. lack of a strong link to a particular gene
2. greatest - symptoms subside with age, means ppl rarely are under care for the disorder when they die, tf no postmortem studies

Question 19

what does the lack of availability of post mortem brain studies mean for our studies on the neural pathology underlying Tourettes
- why is this a problem

Answer 19

study is based entirely on brain imaging studies

- hard to conduct bc of the requirement of the patients to stay motionless

Question 20

where has most of the research on cerebral pathology in this disorder led us?
- describe the findings about this area

Answer 20

to focus on the striatum (caudate plus putamen)

• smaller striata volumes
• fMRI activity in PFC and caudate nuclei during tic suppression

Question 21

what do the activations of PFC and caudate nuclei during tic suppression tell us (in theory0

Answer 21

that decision to suppress tics emerges from PFC, which initiates suppression by acting on the caudate nuclei

Question 22

what other area of the brain has been implicated in Tourettes? describe (ie - types of synapses, role this seems to play)

Answer 22

the cortical-striatal-thalamic-cortical brain circuits,

• dopaminergic and GABAergic signalling therein
• brain circuits are implicated in motor learning including habit formation

Question 23

are brain differences in Tourettes localized to the striatum and the cortical-striatal-thalamic-cortical structures?

Answer 23

Nope, they seem to be widespread

• example - thinning in the sensorimotor cortex grey matter
• particularly prominent in areas controlling the face, mouth and larynx

Question 24

where does treatment for Tourettes typically begin

Answer 24

not with tics

• patients, family members, friends and teachers are education about the syndrome
• then treatment focusses on the ancillary emotional problems like anxiety and depressin

Question 25

when to we start to treat tics

Answer 25

only once we have educated the support group and treated ancillary emotional problems

Question 26

how do we treat tics

Answer 26

usually with antipsychotics

• reduce tics by around 70%
• very often refuse to take them bc of the adverse effects

Question 27

what is the success of antipsychotics in treating tics amenable to

Answer 27

the belief that the disorder is related to an abnormality in the cortical-striatal-thalamic-cortical circuit, bc this signal relies heavily on dopamine