Tourette's Syndrome

Question 1

What are tics?

Answer 1

Sudden, involuntary, repetitive movements or vocalisations

Question 2

What are the 2 kinds of motor tics + definition?

Answer 2

Simple motor tics = sudden, fleeting or fragmentary movements

Complex motor tics = several simple motor tics occuring in an orchestrated sequence or semi-purposeful movements

Question 3

What are the 2 kinds of phonic tics + definitions?

Answer 3

Simple phonis tics = simple, unarticulated sounds

Complex phonic tics = out of context syllables, words, phrases or paroxysmal changes in prosody

Question 4

Give some examples of complex tics

Answer 4

• Copropraxia = socially inappropriate gestures
• Copralalia = socially inappropriate utterances
• Echolalia = repeating other’s words
• Echopraxia = reapeating other’s gestures
• Self injurous such as cheeck chewing

Question 5

What are premonitory urges?

Answer 5

Uncomfortable or aversive bodily sensations occuring prior to tics.

Question 6

What is the prevalence rate of TS?

Answer 6

3-8 in 1000

Question 7

At what age do symptoms peak at severity and when is there a stabilisation of symptoms (no sustained worsening or improvement)?

Answer 7

Peak in symptom severity = 9-12 years

Stabilisation = after 30s

Question 8

Which npsy. test battery administered to children with TS is the best predictor of tic severity and global psychosocial functioning 7,5 years later, and what does it measure?

Answer 8

The Purdue Pegboard; test of fine motor skills

Question 9

What is the etiology of TS?

Answer 9

• strong (polygenetic) component
• increased activity of DA and other neurotransmitters (e.g. serotonin)
• disinhibition of several circuits in the cortico-striatal-thalamic areas

Question 10

What is the development of TS (neurologically)?

Answer 10

Abnormality in basal ganglia output systems and impairment in frontal inhibition of this output
-> information that ordinarily would be inhibited from reaching other areas of the brain is unfiltered

Question 11

What disorders have high comorbidity with TS?

Answer 11

ADHD, OCD and behavioral/impulse problems

Question 12

What are rage attacks?

Answer 12

Premonitory feelings of tension -> followed by relief -> followed by remorse
Studies suggest they are positively correlated with a triad of TS, ADHD and OCD

Question 13

What are the prevalences and onset of comorbid ADHD and OCD with TS?

Answer 13

ADHD: 55%, often precede the onset of tic symptoms
OCD: 20-40%, symptoms present after tics have reached their peak severity
-> comorbid psychiatric disorders are more likely to persist into adulthood

Question 14

Name two treatmens of TS

Answer 14

Habit Reversal Therapy = teachting the patient to become aware of the premonitory urge and develop a competing response incompatible with performing the tic

Pharmacotherapy = effective treatment, recommended if the tics are causing significant distress or functional impairment (examples: neuroleptics, benzodiazepines)

Question 15

Name 3 areas of the frontostriatal cortex circuit that might be involved in processing of cognition?

Answer 15

1) Dorsolateral prefrontal cortex
- > cognitive flexibility, memory and attention
2) Orbitofrontal cortex
- > reinforcement (reward) and reversal learning, inhibition
3) Anterior cingulate cortex
- > conflict monitoring and resolution, inhibition

Question 16

Is the hypothesis ‘impairments of executive functioning in TS’ true?

Answer 16

No: TS is not associated with consistent executive impairments (only robust evidence: inhibition impairment)

Question 17

What are weaknesses of neuropsychological research of TS? (5)

Answer 17

• small samples
• often no control for comorbidities
• no control groups for typically developing children
• no control of medication use
• conscious tic supression may influence cognitive functioning