Tic disorders, Trichotillomania, and Enuresis Flashcards
Premonitory sensation:
- feeling that you have before a behaviour, very strong sensation to do the behaviour
- uncomfortable feelings that occur before tics, such as an itch, tingle, or tension
-Once you do the behaviour you have a sense of relief
Tic:
- sudden, rapid, recurrent, nonrhythmic motor movements or vocalizations
- brief motor movement, somewhat involuntary
- can be motor or vocal
- happens again and again which can interfere with someone’s life
How do tics differ from repetitive behaviours in autism?
- repetitive behaviours are rhythmic and pleasant
- tics are unwanted
How do tics differ from compulsion behaviours in OCD?
- compulsions are performed for a reason, there is a function to prevent a feared outcome
- they are also unwanted
Tourettes Disorder:
- multiple motor tics and one or more vocal tics
- the tics wax and wane in frequency but have persisted for more than a year since onset
- onset before 18yrs old
- not caused my physiological responses to a substance or medical condition
Persistent (chronic) Motor or Vocal Tic Disorder:
- a single or multiple motor OR vocal tic, not both
- the tics wax and wane in frequency but have persisted for more than a year since onset
- onset before 18yrs old
- not caused my physiological responses to a substance or medical condition
What can trigger a tic in a tic disorder?
discussing tic, observing a gesture or sound in someone else
Are tics heritable?
Heritability is 70-85%
Are tics common in childhood?
- Tics are common in childhood but usually transient
- Most common course is it resolves on it’s own
In school age children how common is tourette’s? what is the ratio of males to females?
3-9 per 1000
2-4 : 1
What is the yale global tic severity scale (YGTSS)?
- Scale/interview used in the assessment of tics
What is the first line of treatment for tic disorders? describe it:
CBIT: Comprehensive Behavioural Intervention for Tics
Part 1: awareness training - becoming aware of the premonitory sensation - be aware that the urge is building
Part 2: Once aware of it you need to come up with a planned competing response, can do anywhere, doesn’t hurt, not hard to do, makes it impossible to actually do the tic behaviour
- Sensation will decrease if you do it long enough for most
- when tic comes back you must do the competing response right away
Trichotillomania
- reccurrent pulling out of one’s hair resulting in hair loss
- repeated attempt to decrease or stop hair pulling
- hair pulling causes significant distress or impairment in function of life
- not explained or attributal to medical conditions or other mental disorders
What disorder is Trichotillomania in the same category as? do people agree?
same category of OCD in the DSM - but people disagree with this, they both include a repeating behaviour, but don’t have the same underlying structure
not driven primarily by anxiety
More common areas for hair pulling vs. less common
common: scalp, eyebrows, and eyelids
less common: underarm, facial, pubic
What are some other key features of trichotillomania?
- Hair-related rituals (e.g., touching to lips, eating, rolling)
- May be preceded by a tingling sensation and followed by pleasurable sensation
- Wax and wane in severity but often chronic if untreated
- Usually begins at or after puberty
- May worsen premenstrually
- driven by pleasure + positive emotion
Trichotillomania intervention
HRT: Habit Reversal training
- Awareness training of urge to full hair
- Competing response: clasping hands together
- give a reward like candy - Environmental changes (ex: wearing gloves or hats)
hard to intervene when things play into an endogenous reward system
Enuresis:
- repeated voiding of urine into bed or clothes whether involuntary or intentional
- frequency of at least twice a week for at least 3 consecutive months or the presence of clinically significant distress or impairment in functioning of life
- at least 5 years
- not attributable to physiological effects of substance or another medical condition
what are the specifications for enuresis?
- nocturnal only: only during nighttime sleep
- diurnal only: during waking hours
- nocturnal and diurnal: combination of the 2 subtypes above
first line of treatment for bed-wetting:
wetness (enuresis) alarm:
- alarm is connected to collar and wire goes down and connects to pants
-detects wetness
- works very well
- Connects urge to pee to the alarm sound so they eventually associate the urge to waking up and going to the bathroom
- use the alarms until min of 2 weeks goes by without bed wetting
- positive rewards may be given for agreed behaviour - recommended
