Tic disorder

Tic disorders are defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM) based on type (motor or phonic) and duration of tics (sudden, rapid, nonrhythmic movements).[1] Tic disorders are defined similarly by the World Health Organization (ICD-10 codes).[2]

Tic disorder
Examples of tics
SpecialtyNeurology, psychiatry

Classification

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.[3]

Tic disorders, in ascending order of severity, are:[3]

  • 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

ICD10 diagnosis codes are:[6]

  • 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

Diagnosis
Further information: Tic § Differential diagnosis

Tics should be distinguished from other causes of tourettism, stereotypies, chorea, dyskinesias, myoclonus and obsessive-compulsive disorder.[3]

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.[7] The first line of treatment is behavioural therapy, followed by medication (most often aripiprazole) if the former is unsuccessful.[8]

Although behavioural therapy is the recommended first treatment, many people with tics do not access it due to the lack of trained psychotherapists.[8]

Epidemiology

Tic disorders are more commonly diagnosed in males than females.[3]

At least one in five children experience some form of tic disorder, most frequently between the ages of seven and twelve.[9][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.

From 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:[3][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).[9] 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.[3] The new categories account for tics with onset in adulthood,[3] or tics triggered by other medical conditions or illicit drug use.[16]

References
  1. "DSM-IV-TR: Tourette's Disorder". Diagnostic and Statistical Manual of Mental Disorders (4th text revision (DSM-IV-TR) ed.). American Psychiatric Association. 2000. ISBN 0-89042-025-4.
  2. Swain JE, Scahill L, Lombroso PJ, King RA, Leckman JF (August 2007). "Tourette syndrome and tic disorders: a decade of progress". Journal of the American Academy of Child and Adolescent Psychiatry. 46 (8): 947–968. doi:10.1097/chi.0b013e318068fbcc. PMID 17667475.
  3. 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.
  4. "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". Asian Journal of Psychiatry (Review). 11: 106–113. doi:10.1016/j.ajp.2014.05.010. PMID 25453712.
  6. "ICD Version 2006". World Health Organization. Retrieved 24 May 2007.
  7. Roessner V, Plessen KJ, Rothenberger A, Ludolph AG, Rizzo R, Skov L, Strand G, Stern JS, Termine C, Hoekstra PJ (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. PMC 3065650. PMID 21445724.
  8. Müller-Vahl KR, Szejko N, Verdellen C, Roessner V, Hoekstra PJ, Hartmann A, Cath DC (March 2022). "European clinical guidelines for Tourette syndrome and other tic disorders: summary statement". European Child & Adolescent Psychiatry. 31 (3): 377–382. doi:10.1007/s00787-021-01832-4. PMC 8940881. PMID 34244849.
  9. Black KJ, Black ER, Greene DJ, Schlaggar BL (2016). "Provisional Tic Disorder: What to tell parents when their child first starts ticcing". F1000Research. 5: 696. doi:10.12688/f1000research.8428.1. PMC 4850871. PMID 27158458.
  10. "Tourette Syndrome Fact Sheet". National Institutes of Health (NIH). Archived from the original on 23 March 2005. Retrieved 23 March 2005.
  11. Swerdlow NR (September 2005). "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. S2CID 26342334.
  12. Evidente VG (October 2000). "Is it a tic or Tourette's? Clues for differentiating simple from more complex tic disorders". Postgraduate Medicine. 108 (5): 175–6, 179–82. doi:10.3810/pgm.2000.10.1257. PMID 11043089. S2CID 43162987.
  13. Neurodevelopmental disorders. American Psychiatric Association. Retrieved on December 29, 2011.
  14. Moran M (18 January 2013). "DSM-5 provides new take on neurodevelopment disorders". Psychiatric News. 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. Retrieved October 6, 2013.
  16. Plessen KJ (February 2013). "Tic disorders and Tourette's syndrome". European Child & Adolescent Psychiatry. 22 (Suppl 1): S55–60. doi:10.1007/s00787-012-0362-x. PMID 23224240. S2CID 12611042.
  17. Black KJ (17 February 2018). "ADHD medications and tics". Department of Psychiatry. Washington University in St. Louis.

Further reading
  • The Tourette Syndrome Classification Study Group (October 1993). "Definitions and classification of tic disorders. The Tourette Syndrome Classification Study Group". Archives of Neurology. 50 (10): 1013–6. doi:10.1001/archneur.1993.00540100012008. PMID 8215958.
  • Walkup JT, Ferrão Y, Leckman JF, Stein DJ, Singer H (June 2010). "Tic disorders: some key issues for DSM-V". Depression and Anxiety. 27 (6): 600–10. doi:10.1002/da.20711. PMID 20533370. S2CID 5469830.
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