Tic disorder

Tic disorder
Examples of tics
SpecialtyNeurology, psychiatry
SymptomsSudden, rapid, nonrhythmic movements or sounds[1]
ComplicationsPsychological distress[2]
Usual onsetAround 5 years old[1]
TypesTourette disorder, persistent tic disorder, provisional tic disorder, other specified and unspecified tic disorders[1]
Risk factorsFamily history[2]
Diagnostic methodBased on symptoms after ruling out other similar conditions[1][3]
Differential diagnosisADHD, myoclonus, cocaine intoxication, Huntington disease, postviral encephalitis[1][3]
TreatmentEducation and reassurance[3]
PrognosisGenerally good[3]
FrequencyUp to 4%[3]

Tic disorders are a group of disorders that present with either motor or vocal tics.[1] Tics are sudden, rapid, nonrhythmic movements or sounds.[1] They can vary from simple blinking to more complex such as speaking a group of words.[1] In tic disorders this occur repeatedly.[1] They can often be consciously stopped for a period of time.[1] Complications may include psychological distress.[2]

There are four types: Tourette disorder, persistent tic disorder, provisional tic disorder, and other specified and unspecified tic disorders.[1] They represent different severities with Tourette's being the most severe.[1] The first three by definition, have an onset before the age of 18.[1]

Risk factors include family history.[2] Associated condition include ADHD, obsessive compulsive disorder, and depression.[1] Episodes may be triggered by stress, excitement, or lack of sleep.[1] Diagnosis is based on symptoms after ruling out other conditions that may present similarly.[1][3] Similar conditions include ADHD, myoclonus, cocaine intoxication, Huntington disease, or postviral encephalitis.[1][3]

Most cases can be managed with education and reassurance.[3] Occasionally behavioral therapy or medication may be used.[3] Tic disorders affect up to 4% of people, while Tourette's affects about 1 in 200 school aged children.[1][3] Males are affected about 3 times as often as females.[1] Onset is often around 5 years of age, is most severe around 11 years of age, and gets better in later childhood.[1] Those with mild to moderate tics generally have good outcomes.[1]

Diagnosis

Further information: Tic § Differential diagnosis

Tics should be distinguished from other causes of tourettism, stereotypies, chorea, dyskinesias, myoclonus and obsessive-compulsive disorder.[1]

DSM-5

The fifth revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published in May 2013, classifies Tourette syndrome and tic disorders as motor disorders listed in the neurodevelopmental disorder category.[1]

Tic disorders, in ascending order of severity, are:[1]

  • 307.20 Other specified tic disorder (specify reason)
  • 307.20 Unspecified tic disorder
  • 307.21 Provisional tic disorder
  • 307.22 Persistent (chronic) motor or vocal tic disorder (specify motor or vocal)
  • 307.23 Tourette's disorder

Developmental coordination disorder and stereotypic movement disorder are also classified as motor disorders.[4][5]

ICD-10

Tic disorders are defined similarly by the World Health Organization (ICD-10 codes).[6]

ICD10 diagnosis codes are:[7]

  • F95.0 Transient tic disorder
  • F95.1 Chronic motor or vocal tic disorder
  • F95.2 Combined vocal and multiple motor tic disorder [Gilles de la Tourette]
  • F95.8 Other tic disorders
  • F95.9 Tic disorder, unspecified

Treatment

Education, and a "watch and wait" strategy, are the only treatment needed for many, and the majority of individuals with tics do not seek treatment. When needed, management of tic disorders is similar to management of Tourette syndrome.[3]

Epidemiology

Tic disorders are more common among males than females.[1]

At least one in five children experience some form of tic disorder, most frequently between the ages of seven and twelve.[8][9] As many as 1 in 100 people may experience some form of tic disorder, usually before the onset of puberty.[10] Tourette syndrome is the more severe expression of a spectrum of tic disorders, which are thought to be due to the same genetic vulnerability. Nevertheless, most cases of Tourette syndrome are not severe. Although a significant amount of investigative work indicates genetic linkage of the various tic disorders, further study is needed to confirm the relationship.[11]

History

DSM-IV-TR

In the fourth revision of the DSM (DSM-IV-TR), tic disorders were classified as follows:[12]

  • Transient tic disorder consisted of multiple motor and/or phonic tics with duration of at least 4 weeks, but less than 12 months.
  • Chronic tic disorder was either single or multiple motor or phonic tics, but not both, which were present for more than a year.
  • Tourette syndrome was diagnosed when both motor and phonic tics were present for more than a year.
  • Tic disorder NOS was diagnosed when tics were present, but did not meet the criteria for any specific tic disorder.

DSM-IV-TR to DSM-5

DSM-5 was published in 2013, updating DSM-IV-TR, which was published in 2000. The following changes were made:[1][13][14][4]

  • The word stereotyped was removed from tic definition: stereotypies and stereotypic movement disorder are frequently misdiagnosed as tics or Tourette syndrome.[15] The definition of tic was made consistent for all tic disorders, and the word stereotyped was removed to help distinguish between stereotypies (common in autism spectrum disorders) and tic disorders.[16]
  • Provisional tic disorder approximately replaced transient tic disorder: because initially presenting tics may eventually be diagnosed as chronic tic disorder or Tourette's, transient suggested it could only be defined in retrospect (though that perception did not follow the DSM-IV-TR definition).[8] The term provisional "satisfies experts with a more systematic epidemiological approach to disorders", but should not imply that treatment might not be called for.[16]
  • Differentiation of chronic motor or vocal tic disorder: DSM-5 added a specifier to distinguish between vocal and motor tics that are chronic. This distinction was added because higher rates of comorbid diagnoses are present with vocal tics relative to motor tics.[16]
  • Now includes as Tourette's Disorder patients with tics who experienced a 3-month or longer remission since the first tic, as long as the first tic was at least a year ago.
  • Stimulant use as a cause removed: there is no evidence that the use of stimulants causes tic disorders.[16][17]
  • New categories, Other specified and Unspecified: for tic disorders that result in significant impairment to the individual yet do not meet the full criteria for other tic disorders.[1] The new categories account for tics with onset in adulthood,[1] or tics triggered by other medical conditions or illicit drug use.[16]

References

  1. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders (Fifth ed.). Arlington, VA: American Psychiatric Publishing. pp. 81–85. ISBN 978-0-89042-555-8.
  2. 1 2 3 4 Cath, DC; Hedderly, T; Ludolph, AG; Stern, JS; Murphy, T; Hartmann, A; Czernecki, V; Robertson, MM; Martino, D; Munchau, A; Rizzo, R; ESSTS Guidelines, Group. (April 2011). "European clinical guidelines for Tourette syndrome and other tic disorders. Part I: assessment". European child & adolescent psychiatry. 20 (4): 155–71. doi:10.1007/s00787-011-0164-6. PMID 21445723.
  3. 1 2 3 4 5 6 7 8 9 10 11 Roessner, V; Plessen, KJ; Rothenberger, A; Ludolph, AG; Rizzo, R; Skov, L; Strand, G; Stern, JS; Termine, C; Hoekstra, PJ; ESSTS Guidelines, Group. (April 2011). "European clinical guidelines for Tourette syndrome and other tic disorders. Part II: pharmacological treatment". European child & adolescent psychiatry. 20 (4): 173–96. doi:10.1007/s00787-011-0163-7. PMID 21445724.
  4. 1 2 "Highlights of changes from DSM-IV-TR to DSM-5" (PDF). American Psychiatric Association. 2013. Archived from the original (PDF) on February 3, 2013. Retrieved June 5, 2013.
  5. ↑ Robertson MM, Eapen V (October 2014). "Tourette's: syndrome, disorder or spectrum? Classificatory challenges and an appraisal of the DSM criteria" (PDF). Asian J Psychiatr (Review). 11: 106–13. doi:10.1016/j.ajp.2014.05.010. PMID 25453712. Archived from the original (PDF) on 2020-02-16. Retrieved 2020-02-09.
  6. ↑ Swain JE, Scahill L, Lombroso PJ, King RA, Leckman JF. "Tourette syndrome and tic disorders: a decade of progress". J Am Acad Child Adolesc Psychiatry. 2007 Aug;46(8):947–68 doi:10.1097/chi.0b013e318068fbcc PMID 17667475
  7. ↑ ICD Version 2006. Archived 2009-03-15 at the Wayback Machine World Health Organization. Retrieved on 2007-05-24.
  8. 1 2 Black KJ, Black ER, Greene DJ, Schlaggar BL. Provisional Tic Disorder: What to tell parents when their child first starts ticcing. Archived 2020-02-25 at the Wayback Machine F1000Research 2016, 5:696 doi:10.12688/f1000research.8428.1
  9. ↑ Tourette Syndrome Fact Sheet. National Institutes of Health (NIH). Retrieved on 2005-03-23.
  10. ↑ Tourette Syndrome Fact Sheet. National Institutes of Health (NIH). Retrieved on 2005-03-23.
  11. ↑ Swerdlow NR. "Tourette syndrome: current controversies and the battlefield landscape". Current Neurology and Neuroscience Reports. 5 (5): 329-31. doi:10.1007/s11910-005-0054-8 PMID 16131414
  12. ↑ Evidente VG. "Is it a tic or Tourette's? Clues for differentiating simple from more complex tic disorders". Postgraduate medicine. 108 (5): 175-6, 179-82. PMID 11043089 Retrieved on 2007-05-24
  13. ↑ Neurodevelopmental disorders. American Psychiatric Association. Retrieved on December 29, 2011.
  14. ↑ Moran, M. "DSM-5 provides new take on neurodevelopment disorders". Archived 2014-10-29 at the Wayback Machine Psychiatric News. January 18, 2013;48(2):6–23. doi:10.1176/appi.pn.2013.1b11
  15. ↑ Ellis CR, Pataki C. "Background: Childhood Habit Behaviors and Stereotypic Movement Disorder". Medscape. Archived from the original on October 21, 2013. Retrieved October 6, 2013.
  16. 1 2 3 4 5 Plessen KJ. Tic disorders and Tourette's syndrome. Eur Child Adolesc Psychiatry. 2013 Feb;22 Suppl 1:S55–60. doi:10.1007/s00787-012-0362-x
  17. ↑ Black, KJ. ADHD medications and tics. Archived 2020-07-29 at the Wayback Machine February 17, 2018. tics.wustl.edu/adhd-medications-and-tics/
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