Tic Disorder

Question 1

Define

Answer 1

Tics = fast, repetitive muscle movements that result in sudden and difficult to control body jolts or sounds

Common, appear around 5yo, not usually serious, most disappear by adulthood
* May come and go over several years
* 1 in 3 rules (1 in 3 won’t have tics as an adult, 1 in 3 have mild tics, 1 in 3 will have severe tics)

Genetic component  can occur alongside OCD and ADHD

Tourette’s = chronic and multiple tics  no cure; treatments the same as the below
* Tics must begin before 18yo
* Must persist for longer than 1 year
* Exclude any other cause

Question 2

Signs and symptoms

Answer 2

Brought about by triggers, focussing on them can make them worse

Types = motor, vocal or phonic types; e.g.

• Blinking
• eye rolling
• grimacing
• shoulder shrugging
• jerking of the head or limbs
• Clicking fingers
• Coughing, grunting
• Repeating sound or phrase

Question 3

Investigations/ Treatment

Answer 3

Self-help (sleep & stress management, don’t draw attention to tic, don’t tell child off for it, etc.)

Very debilitating:
* Habit reversal therapy (learn movements to “compete” with tics, so tics can’t happen at the same time)
* Exposure with response prevention / ERP(help the child get used to the unpleasant sensations that are often felt just before a tic, which can stop the tic occurring)

Medications:
* 1st line = antipsychotics (i.e. risperidone) – N.B. SEs: weight gain, blurred vision, constipation, dry mouth

2nd line:

• Clonidine – treat tics and ADHD at the same time
• Clonazepam
• Tetrabenazine – treats tics that are caused by an underlying condition (i.e. Huntington’s)
• Botulinum toxin – injected into the certain muscle but only last <3m
• Surgery  deep brain stimulation therapy (for severe Tourette’s syndrome)