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1.
Medicine (Baltimore) ; 99(28): e20918, 2020 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-32664087

RESUMO

RATIONALE: Reversible posterior leukoencephalopathy syndrome (RPLS) is a rare neuropathic syndrome with typical clinical and radiological features. There are large amounts of risk factors resulting in RPLS, those including hypertension, eclampsia, neoplasia treatment, renal failure, systemic infections, chemotherapy, and immunosuppressive therapy after organ transplantation. PATIENT CONCERNS: A 27-year-old male patient was admitted for a 2-week history of paroxysmal tic of limbs along with consciousness disorder. Blood pressure elevation was discovered for the first time on admission, and the highest record was 210/150 mmHg during hospitalization. Neurological examinations were positive among mental state, speech, reaction and pathological reflex. The computed tomography scan of the abdomen demonstrated a mass derived from right adrenal gland. The magnetic resonance imaging of the brain showed reversible lesions in the centrum ovale, paraventricular, area and corpus callosum. DIAGNOSES: After control of blood pressure and rationally preoperative preparation, the mass was radically resected and verified to be pheochromocytoma by postoperative pathologic findings. He was diagnosed as having RPLS due to adrenal pheochromocytoma. INTERVENTIONS: The right adrenal gland mass was completely removed after 2 weeks of α-blockers and ß-blockers to treat hypertension. OUTCOMES: One week after surgery, the cerebral lesions of RPLS gradually faded and the blood pressure was easy to control well. LESSONS: A few case reports of RPLS related to pheochromocytomas had been documented in the literature. Therefore, we believe that pheochromocytomas may be a potential risk factor of RPLS. If patients receive timely diagnosis and treatment, it can often lead to a favorable prognosis.


Assuntos
Encéfalo/diagnóstico por imagem , Feocromocitoma/complicações , Feocromocitoma/cirurgia , Síndrome da Leucoencefalopatia Posterior/etiologia , Neoplasias das Glândulas Suprarrenais/patologia , Adulto , Assistência ao Convalescente , Encéfalo/patologia , Criança , Transtornos da Consciência/etiologia , Feminino , Hospitalização , Humanos , Hipertensão/diagnóstico , Hipertensão/tratamento farmacológico , Hipertensão/etiologia , Imagem por Ressonância Magnética/métodos , Masculino , Exame Neurológico/métodos , Feocromocitoma/diagnóstico por imagem , Síndrome da Leucoencefalopatia Posterior/diagnóstico , Fatores de Risco , Transtornos de Tique/etiologia , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
2.
Artigo em Russo | MEDLINE | ID: mdl-32621477

RESUMO

The article represents a review of modern literature on tics and Tourette's syndrome in paediatric population and describes recent advances in neurogenetics, neuroanatomy and neurotransmitter heterogeneity of the disease pathogenesis. The analysis of the literature supports the plausibility of transformation of tics and Tourette's syndrome from psychiatric disorders into neurological disorders (according to ICD-11) based on recent data on neurophysiology and functional neuroanatomy. Neuroanatomy of motor behaviour is described as the most complex self-regulating neural network of thalamo-cortical loop, basal ganglia in combination with the limbic system, insular and cingulate cortex with involvement of hippocampus, subthalamic region and cerebellum. The evaluation of pharmaceutical treatment options has been carried out, including a review of successful local experience in treating tics in paediatric patients with hopantenic acid, topiramate and neuropeptides of cortexin.


Assuntos
Transtornos de Tique , Tiques , Síndrome de Tourette , Gânglios da Base , Cerebelo , Criança , Humanos
3.
Expert Opin Pharmacother ; 21(5): 567-580, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32286097

RESUMO

Introduction: Though many unanswered questions about the pathophysiology of Tourette Syndrome remain, several pharmacotherapies for tics have been studied, with varying results in terms of efficacy and the strength of evidence.Areas covered: This literature review encompasses pharmacotherapies for tics. The pharmacotherapies discussed in this review include: alpha agonists, antipsychotics, topiramate, botulinum toxin, and dopamine depleters.Expert opinion: Once the presence of tics is confirmed and psychoeducation and support are provided to patients and caregivers, one must examine the degree of tic-related impairment and the presence of psychiatric comorbidities. These factors influence treatment decisions as the presence of comorbidity and related impairment may shift the treatment target. When selecting a medication for tics, the presence of ADHD (the most frequent comorbidity) strengthens the case for choosing an alpha agonist. The case for antipsychotic medications is strongest when tic-related impairment is severe and/or the tics are refractory to more conservative measures. All medications require drug safety monitoring procedures and reevaluation over time.


Assuntos
Agonistas alfa-Adrenérgicos/uso terapêutico , Antipsicóticos/uso terapêutico , Transtornos de Tique/tratamento farmacológico , Tiques/tratamento farmacológico , Agonistas alfa-Adrenérgicos/administração & dosagem , Agonistas alfa-Adrenérgicos/efeitos adversos , Antipsicóticos/administração & dosagem , Antipsicóticos/efeitos adversos , Benzamidas/administração & dosagem , Benzamidas/efeitos adversos , Benzamidas/uso terapêutico , Toxinas Botulínicas/administração & dosagem , Toxinas Botulínicas/efeitos adversos , Toxinas Botulínicas/uso terapêutico , Comorbidade , Humanos , Transtornos de Tique/epidemiologia , Transtornos de Tique/psicologia , Tiques/epidemiologia , Tiques/psicologia , Síndrome de Tourette/tratamento farmacológico , Síndrome de Tourette/epidemiologia , Síndrome de Tourette/psicologia
4.
Brain ; 143(3): 906-919, 2020 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-32125364

RESUMO

The defining character of tics is that they can be transiently suppressed by volitional effort of will, and at a behavioural level this has led to the concept that tics result from a failure of inhibition. However, this logic conflates the mechanism responsible for the production of tics with that used in suppressing them. Volitional inhibition of motor output could be increased to prevent the tic from reaching the threshold for expression, although this has been extensively investigated with conflicting results. Alternatively, automatic inhibition could prevent the initial excitation of the striatal tic focus-a hypothesis we have previously introduced. To reconcile these competing hypotheses, we examined different types of motor inhibition in a group of 19 patients with primary tic disorders and 15 healthy volunteers. We probed proactive and reactive inhibition using the conditional stop-signal task, and applied transcranial magnetic stimulation to the motor cortex, to assess movement preparation and execution. We assessed automatic motor inhibition with the masked priming task. We found that volitional movement preparation, execution and inhibition (proactive and reactive) were not impaired in tic disorders. We speculate that these mechanisms are recruited during volitional tic suppression, and that they prevent expression of the tic by inhibiting the nascent excitation released by the tic generator. In contrast, automatic inhibition was abnormal/impaired in patients with tic disorders. In the masked priming task, positive and negative compatibility effects were found for healthy controls, whereas patients with tics exhibited strong positive compatibility effects, but no negative compatibility effect indicative of impaired automatic inhibition. Patients also made more errors on the masked priming task than healthy control subjects and the types of errors were consistent with impaired automatic inhibition. Errors associated with impaired automatic inhibition were positively correlated with tic severity. We conclude that voluntary movement preparation/generation and volitional inhibition are normal in tic disorders, whereas automatic inhibition is impaired-a deficit that correlated with tic severity and thus may constitute a potential mechanism by which tics are generated.


Assuntos
Inibição Psicológica , Córtex Motor/fisiologia , Transtornos de Tique/psicologia , Adulto , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Desempenho Psicomotor/fisiologia , Priming de Repetição , Estimulação Magnética Transcraniana , Adulto Jovem
5.
Behav Modif ; 44(1): 114-136, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-30146896

RESUMO

The aim of this study is to evaluate a cognitive-behavioral treatment for children and adolescents with tic disorder including habit reversal training (HRT) in a sample of children and adolescents (n = 27). Multiple outcome measures were used to assess the effects of the treatment on tic symptoms. In addition, impairment/subjective burden ratings and the self-efficacy to control tics were assessed. A within-subject design with two phases (8 weeks diagnostic; 16 sessions treatment) was analyzed using multilevel modeling (MLM). During the treatment phase, significant improvements in tic symptoms, impairment, and self-efficacy to control tics were found on most outcome measures. Treatment effects were found on the clinical rating of tic symptoms (Yale Global Tic Severity Scale [YGTSS]), the self-efficacy to control tics, and the video-observed motor tic frequency by comparing the improvements during treatment with the course of the outcome measures during the preceding diagnostic phase.


Assuntos
Terapia Comportamental , Hábitos , Autoeficácia , Transtornos de Tique/terapia , Adolescente , Criança , Feminino , Humanos , Masculino , Índice de Gravidade de Doença , Transtornos de Tique/diagnóstico , Transtornos de Tique/psicologia , Resultado do Tratamento , Adulto Jovem
6.
Handb Clin Neurol ; 165: 123-153, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31727209

RESUMO

A combination of motor and phonic tics is the hallmark of Tourette syndrome (TS). This complex neuropsychiatric disorder is often associated with psychiatric comorbidities such as attention-deficit hyperactivity disorder and obsessive-compulsive disorder. The first step in management is to establish the diagnosis of TS, avoiding potential diagnostic confounders (such as compulsions, stereotypies, or habits). Once a diagnosis of TS is made, a discussion with the patient and family about the level of impairment and presence or absence of comorbidities will guide the decision and choice of treatment. Not every patient with TS will need active treatment. When needed, active treatment falls into one of the following three categories: behavioral, pharmacologic, and nonpharmacologic. This chapter summarizes and reviews the evidence base supporting these treatments. It also discusses the evidence base and approach to the treatment of common psychiatric comorbidities. A treatment algorithm based on published data and expert consensus is proposed.


Assuntos
Síndrome de Tourette/diagnóstico , Síndrome de Tourette/terapia , Inibidores da Captação Adrenérgica/uso terapêutico , Agonistas de Receptores Adrenérgicos alfa 2/uso terapêutico , Terapia Comportamental/métodos , Estimulação Encefálica Profunda/métodos , Diagnóstico Diferencial , Humanos , Transtorno Obsessivo-Compulsivo/diagnóstico , Transtorno Obsessivo-Compulsivo/psicologia , Transtorno Obsessivo-Compulsivo/terapia , Transtornos de Tique/diagnóstico , Transtornos de Tique/psicologia , Transtornos de Tique/terapia , Síndrome de Tourette/psicologia
7.
Exp Brain Res ; 237(12): 3449-3459, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31734785

RESUMO

Tic-related OCD (obsessive-compulsive disorder) was introduced as an OCD subtype in the DSM-5 based mainly on family and clinical data that showed differences between OCD in dependence of accompanying tics. Little is known, however, regarding neurocognitive differences between subtypes. We used the stop-signal task to examine whether differences exist in response inhibition between OCD patients without tics (n = 21), patients with tic-related OCD (n = 12), and 21 healthy controls. The groups were carefully matched for gender, age and level of education. The stop-signal reaction time (SSRT) and inhibition-related N2 and P3 were used to examine behavioral and neural correlates of response inhibition and inhibition-related processes. In the SSRT, no difference was found between groups. P3 amplitude was larger in tic-free compared to tic-related OCD and healthy controls. No group differences were found in the N2 amplitude. For tic-related OCD, SSRT data indicate intact response inhibition, and P3 data indicate intact neural aftereffects of inhibition like the evaluation of the outcome. This is similar to what is found in patients with TD and may, thus, be interpreted as a support for shared mechanisms in relation to TD. In OCD, alterations in P3 amplitude indicate hyperactivity in the evaluation of the outcome of the inhibition process. This is in line with hyperactivity generally found in performance monitoring in OCD.


Assuntos
Córtex Cerebral/fisiopatologia , Potenciais Evocados/fisiologia , Inibição Psicológica , Transtorno Obsessivo-Compulsivo/fisiopatologia , Desempenho Psicomotor/fisiologia , Tempo de Reação/fisiologia , Transtornos de Tique/fisiopatologia , Adolescente , Adulto , Idoso , Eletroencefalografia , Potencial Evocado P300/fisiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtorno Obsessivo-Compulsivo/etiologia , Transtornos de Tique/complicações , Adulto Jovem
8.
Neurol Neurochir Pol ; 53(5): 335-340, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31621889

RESUMO

CLINICAL RATIONALE FOR THE STUDY: Gilles de la Tourette syndrome (GTS) is a childhood onset disorder characterised by motor and vocal tics. Different types of motor tics may occur in GTS, including dystonic tics (DTs). Although DTs have been recognised as part of GTS symptomatology, little is known about their risk factors or about how often and at what age they appear in affected individuals. AIM OF THE STUDY: The aim of our study was to investigate lifetime prevalence and clinical correlations of DTs in a Polish cohort of GTS patients. MATERIAL AND METHODS: We performed a prospective, one-registration study in a cohort of 207 consecutive ambulatory patients (mean age: 16.5 ± 9.4 years, 131 children, 162 males) with GTS. Duration of GTS was 9.0 ± 8.0 years (range: 1-39 years). DTs were diagnosed during the interview. DTs were defined as slower and lasting longer than typical clonic tics, abnormal dystonia-like movements that led to a sustained, but not fixed, posture. RESULTS: DTs occurred at some point in the lifetime of 73.9% (n = 153) of patients. The prevalence of DTs in adults and children was almost the same (p = 0.963). Age at onset of DTs was 9.9 ± 5.2 years with the most frequent onset in children (7-11 years, 74.4%, n = 64), followed by adolescence (12-18 years; 17.4%, n = 15) and adulthood (≥ 18 years, 8.1%, n = 7). DTs occurred 3.7 ± 4.2 years after tic onset. On average, patients suffered from 1.8 ± 1.7 types of DTs. The most frequent manifestations of DTs were: eyes (tightening resembling blepharospasm 84.3%, n = 129 and oculogyric crisis 45.8%, n = 70), trunk (dystonic postures 59.5%, n = 91), jaw (bruxism 34.6%, n = 53), neck (30.7%, n = 47), upper limb (26.1%, n = 40), and foot (20.9%, n = 32). Multivariate logistic regression analysis showed significant associations of DTs with the total number of simple, and the total number of complex, tics. CONCLUSIONS AND CLINICAL IMPLICATIONS: DTs are early and frequent symptoms of GTS. They tend to localise in the facial area. DTs occur more frequently in individuals with a higher number of tics and probably add to the global impairment caused by tics.


Assuntos
Transtornos de Tique , Tiques , Síndrome de Tourette , Adolescente , Adulto , Criança , Humanos , Masculino , Polônia , Estudos Prospectivos , Adulto Jovem
10.
Fortschr Neurol Psychiatr ; 87(10): 577-589, 2019 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-31627240

RESUMO

Tic disorders typically start in early childhood and can be classified into provisional tic disorder (tics last <12 months) and chronic tic disorders (tics last > 12 months). The widely known chronic tic disorder Tourette's syndrome is featuring multiple motor and vocal tics. Tics are typically waxing and waning in frequency and intensity. Concentration and relaxation might decrease tics, whereas stress and excitement might increase tics. Psychiatric comorbidities, like obsessive-compulsive disorder, ADHD, depression and anxiety are common. The etiology is multifactorial with genetic and environmental interactions leading to a dysregulation of cortico-striato-pallido-thalamo-cortical networks.A correct diagnosis and psychoeducation are essential for patients as well as their relatives. Additional therapies are needed for patients with severe tics that cause physical impairment or great psychosocial stress. It is crucial to also treat psychiatric comorbidities. Psychotherapeutic interventions for tics include progressive muscle relaxation, habit reversal training, exposure and response prevention and comprehensive behavioral intervention for tics. First-line psychopharmacological treatment in Europe contains aripiprazole, tiapride and risperidone, which are all used off-label for tic disorders. Haloperidol remains the only approved medication for the pharmacotherapy of tics in Germany, but is rarely used due to its side effects. Cannabinoids gain interest as a new pharmacological option, but are mainly offered within the frame of studies.


Assuntos
Transtornos de Tique , Tiques , Europa (Continente) , Haloperidol/uso terapêutico , Humanos , Uso Off-Label , Transtornos de Tique/terapia , Tiques/terapia , Síndrome de Tourette/terapia
11.
Neurology ; 93(17): 750-758, 2019 10 22.
Artigo em Inglês | MEDLINE | ID: mdl-31551261

RESUMO

Within the broad spectrum of movement disorders, tics and functional tic-like movements belong to a particular clinical category. Both types of movements are within the range of normal movement kinematics and muscle synergies, but appear repetitive and without appropriate context embedment. Historically, there have been many attempts to separate the 2 types of movements, but because of their phenomenological overlap, clinical distinction may be prone to error, and misdiagnoses may often occur. Most importantly, the 2 types of movement may coexist. Here, we review the available literature on the 2 types of motor phenomena and demonstrate some of the difficulties in distinguishing tics from functional tic-like movements on clinical grounds. We also highlight similarities and differences in pathophysiologic characteristics, documenting the significance of action monitoring, attentional allocation, and behavioral reinforcement in both types of movements, as well as in their risk factors. We discuss the overlap of current behavioral treatments for tics and functional tic-like movements and emphasize implications of diagnostic mislabeling. Such implications include the need to tailor behavioral treatment approaches to individual phenomenological profiles and guiding decision making for severe patients requiring invasive interventions, such as deep brain stimulation. A deeper insight from clinicians with respect to persisting challenges in classifying and differentiating these motor phenomena could accelerate the development of reliable clinical and physiologic markers (i.e., next generation phenotyping) and a neurobiology-driven therapeutic approach for these motor phenomena.


Assuntos
Transtornos de Tique/diagnóstico , Tiques/diagnóstico , Animais , Diagnóstico Diferencial , Humanos
12.
Artigo em Inglês | MEDLINE | ID: mdl-31413891

RESUMO

Background: Trends in the use of antipsychotics and alpha agonists for the treatment of tic disorders in Canadian children, and how closely these trends align with evidence-based guidelines on the pharmacotherapy of tic disorders, have not been explored. Methods: IQVIA's Canadian Disease and Therapeutic Index, a survey-based data set, was used to identify prescription patterns by physicians. Respondents recorded all patient visits during a 48-hour period in each quarter of the year, including patient age, gender, drug recommendation and therapeutic indication. Recommendations for alpha agonists and antipsychotics from 2012 to 2016 were analysed for children and adolescents with tic disorders. Results: Risperidone and clonidine were the most commonly recommended medications for tic disorders over the study period, with 36,868 and 35,500 recommendations in 2016, respectively. Recommendations for clonidine increased over the study period, whereas those for risperidone decreased. Guanfacine (approved in Canada in 2013) was used less frequently than clonidine. Clonidine was more frequently recommended than antipsychotics in children younger than 6, in whom antipsychotic recommendations were uncommon. Aripiprazole was the second most commonly recommended antipsychotic for tic disorders, with 22,892 recommendations in 2016. Of the first-generation antipsychotics, pimozide was most commonly recommended (11,334 recommendations in 2016); haloperidol was infrequently recommended. Discussion: The trends observed are in line with guideline recommendations reflected in the decreasing use of risperidone, and the growing use of clonidine and guanfacine. The growing use of aripiprazole is likely due to emerging evidence from clinical trials supporting its efficacy for tics. Recommendations for pimozide and haloperidol were limited, likely due to the greater adverse effects associated with these medications.


Assuntos
Antipsicóticos/uso terapêutico , Prescrições/estatística & dados numéricos , Transtornos de Tique/tratamento farmacológico , Síndrome de Tourette/tratamento farmacológico , Adolescente , Aripiprazol/uso terapêutico , Criança , Pré-Escolar , Feminino , Guanfacina/uso terapêutico , Humanos , Lactente , Masculino , Farmacoepidemiologia , Risperidona/uso terapêutico , Transtornos de Tique/epidemiologia
13.
Continuum (Minneap Minn) ; 25(4): 936-958, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31356288

RESUMO

PURPOSE OF REVIEW: The purpose of this article is to present current information on the phenomenology, epidemiology, comorbidities, and pathophysiology of tic disorders and discuss therapy options. It is hoped that a greater understanding of each of these components will provide clinicians with the necessary information to deliver thoughtful and optimal care to affected individuals. RECENT FINDINGS: Recent advances include the finding that Tourette syndrome is likely due to a combination of several different genes, both low-effect and larger-effect variants, plus environmental factors. Pathophysiologically, increasing evidence supports involvement of the cortical-basal ganglia-thalamocortical circuit; however, the primary location and neurotransmitter remain controversial. Behavioral therapy is first-line treatment, and pharmacotherapy is based on tic severity. Several newer therapeutic agents are under investigation (eg, valbenazine, deutetrabenazine, cannabinoids), and deep brain stimulation is a promising therapy. SUMMARY: Tics, defined as sudden, rapid, recurrent, nonrhythmic motor movements or vocalizations, are essential components of Tourette syndrome. Although some tics may be mild, others can cause significant psychosocial, physical, and functional difficulties that affect daily activities. In addition to tics, most affected individuals have coexisting neuropsychological difficulties (attention deficit hyperactivity disorder, obsessive-compulsive disorder, anxiety, mood disorder, disruptive behaviors, schizotypal traits, suicidal behavior, personality disorder, antisocial activities, and sleep disorders) that can further impact social and academic activities or employment.


Assuntos
Tiques/complicações , Tiques/diagnóstico , Síndrome de Tourette/complicações , Síndrome de Tourette/diagnóstico , Criança , Humanos , Masculino , Transtornos de Tique/complicações , Transtornos de Tique/diagnóstico , Transtornos de Tique/fisiopatologia , Tiques/fisiopatologia , Síndrome de Tourette/fisiopatologia , Adulto Jovem
14.
Methods Mol Biol ; 2011: 547-571, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31273721

RESUMO

Tourette syndrome (TS) is a complex disorder characterized by repetitive, sudden, and involuntary movements or vocalizations, called tics. Tics usually appear in childhood, and their severity varies over time. In addition to frequent tics, people with TS are at risk for associated problems including attention deficit hyperactivity disorder (ADHD), obsessive-compulsive disorder (OCD), anxiety, depression, and problems with sleep. TS occurs in most populations and ethnic groups worldwide, and it is more common in males than in females. Previous family and twin studies have shown that the majority of cases of TS are inherited. TS was previously thought to have an autosomal dominant pattern of inheritance. However, several decades of research have shown that this is unlikely the case. Instead, TS most likely results from a variety of genetic and environmental factors, not changes in a single gene. In the past decade, there has been a rapid development of innovative genetic technologies and methodologies, as well as significant progress in genetic studies of psychiatric disorders. In this review, we will briefly summarize previous genetic epidemiological studies of TS and related disorders. We will also review previous genetic studies based on genome-wide linkage analyses and candidate gene association studies to comment on problems of previous methodological and strategic issues. Our main purpose for this review will be to summarize the new genetic discoveries of TS based on novel genetic methods and strategies, such as genome-wide association studies (GWASs), whole exome sequencing (WES), and whole genome sequencing (WGS). We will also compare the new genetic discoveries of TS with other major psychiatric disorders in order to understand the current status of TS genetics and its relationship with other psychiatric disorders.


Assuntos
Predisposição Genética para Doença , Transtornos de Tique/genética , Síndrome de Tourette/genética , Epigênese Genética , Estudos de Associação Genética , Ligação Genética , Marcadores Genéticos , Estudo de Associação Genômica Ampla , Humanos , Fenótipo , Prevalência , Característica Quantitativa Herdável , Pesquisa , Transtornos de Tique/diagnóstico , Transtornos de Tique/epidemiologia , Transtornos de Tique/terapia , Síndrome de Tourette/diagnóstico , Síndrome de Tourette/epidemiologia , Síndrome de Tourette/terapia
15.
Psychiatry Res ; 273: 662-671, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-31207850

RESUMO

The aim of this pilot study is to evaluate the efficacy of a resource activation (RA) program as an alternative intervention for children and adolescents with tic disorders. RA interventions focus on the strengths and abilities of the patients. This is expected to improve the patients' perceptions regarding their own resources, which may indirectly result in a reduction of tic symptoms, impairment and comorbid conditions. A within-subject design with two phases (8 weeks diagnostic; 16 sessions treatment) was analyzed using multilevel modeling (n = 24). During the treatment phase, significant reductions of tics were found in clinical rating (Yale Global Tic Severity Scale; YGTSS), parent rating and video observation (motor tics). Moreover, an improvement was shown on most tic-related impairment and subjective burden (SB) ratings. No significant improvement was found regarding comorbid problems and self-esteem. Compared to the preceding diagnostic phase, a significant incremental treatment effect emerged in clinical rating of tic symptoms (YGTSS) and video observation (motor tics). This pilot study provides first hints that RA may represent an effective treatment for reducing tic symptoms, impairment and SB. However, further research is needed in order to establish RA as an effective treatment for tic disorders.


Assuntos
Psicoterapia/métodos , Transtornos de Tique/terapia , Adolescente , Criança , Doença Crônica , Feminino , Recursos em Saúde , Humanos , Masculino , Análise Multinível , Projetos Piloto , Escalas de Graduação Psiquiátrica , Autoimagem , Índice de Gravidade de Doença , Inquéritos e Questionários , Transtornos de Tique/psicologia , Resultado do Tratamento
16.
Medicine (Baltimore) ; 98(22): e15816, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31145316

RESUMO

BACKGROUND: Aripiprazole is widely used in the management of tic disorders (TDs), we aimed to assess the safety of aripiprazole for TDs in children and adolescents. METHODS: A systematic literature review was performed in the databases of MEDLINE, Embase, the Cochrane Library and 4 Chinese databases, from inception to February 2019. All types of studies evaluating the safety of aripiprazole for TDs were included. The quality of studies was assessed using the Cochrane Risk of Bias tool, the Newcastle-Ottawa Scale tool, the National Institute of Clinical Excellence, the CARE (Case Report) guidelines according to types of studies. Risk ratio (RR) and incidence rate with a 95% confidence interval (CI) were used to summarize the results. RESULTS: A total 50 studies involving 2604 children met the inclusion criteria. The result of meta-analysis of randomized controlled trials showed that there was a significant difference between aripiprazole and haloperidol with respect to rate of somnolence (RR = 0.596, 95% CI: 0.394, 0.901), extrapyramidal symptoms (RR = 0.236, 95% CI: 0.111, 0.505), tremor (RR = 0.255, 95% CI: 0.114, 0.571), constipation (RR = 0.148, 95% CI: 0.040, 0.553), and dry mouth (RR = 0.141, 95% CI: 0.046, 0.425). There was a significant difference between aripiprazole and placebo in the incidence rate of adverse events (AEs) for somnolence (RR = 6.565, 95% CI: 1.270, 33.945). The meta-analysis of incidence of AEs related to aripiprazole for case series studies revealed that the incidence of sedation was 26.9% (95% CI: 16.3%, 44.4%), irritability 25% (95% CI: 9.4%, 66.6%), restlessness 31.3% (95% CI: 13%, 75.1%), nausea and vomiting 28.9% (95% CI: 21.1%, 39.5%), and weight gain 31.3% (95% CI: 10.7%, 91.3%). CONCLUSION: Aripiprazole was generally well tolerated in children and adolescents. Common AEs were somnolence, headache, sedation, nausea, and vomiting. Further high-quality studies are needed to confirm the safety of aripiprazole for children and adolescents with TDs.


Assuntos
Antipsicóticos/uso terapêutico , Aripiprazol/uso terapêutico , Transtornos de Tique/tratamento farmacológico , Adolescente , Antipsicóticos/administração & dosagem , Antipsicóticos/efeitos adversos , Aripiprazol/administração & dosagem , Aripiprazol/efeitos adversos , Criança , Haloperidol/uso terapêutico , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto
17.
J Clin Psychiatry ; 80(3)2019 04 23.
Artigo em Inglês | MEDLINE | ID: mdl-31050232

RESUMO

OBJECTIVE: To investigate incidences, cumulative incidence rates, and risk factors of diagnosed mental disorders in a complete nationwide birth cohort across the entire period of childhood and adolescence. METHODS: Based on nationwide Danish registries, the entire cohort of all children born in 1995 was followed up to December 31, 2013. Data for children who migrated during the period were censored in the time analyses, and death before age 18 years was considered a competing risk. Incidence rates and cumulative incidence rates for any first-time-diagnosed mental disorder and 10 major categories of mental disorders according to ICD-10 criteria were calculated for 68,982 individuals. In addition, the effects of age, sex, and further child- and family-related risk factors on mental disorders were analyzed. RESULTS: The incidences of any mental disorder, substance use disorders, depression, and anxiety disorders showed an increase in adolescence, whereas those for autism spectrum disorders, attention-deficit/hyperactivity disorder, conduct disorder, and tic disorder increased during childhood and decreased thereafter. Males had higher incidence rates of any mental disorders, substance use disorders, autism spectrum disorders, ADHD, conduct disorder, and tic disorder. Females had higher risks for depressive, anxiety, obsessive-compulsive, and eating disorders. Several other risk and protective factors for any mental disorder were identified. The cumulative incidence rate at age 18 years amounted to 11.02% for any mental disorder. CONCLUSIONS: These findings provide the most comprehensive estimates of the development, incidence rates, and contributing risk factors of registered mental disorders for the entire period of childhood and adolescence that have been calculated so far.


Assuntos
Transtornos Mentais/epidemiologia , Transtornos Mentais/terapia , Adolescente , Transtornos de Ansiedade/diagnóstico , Transtornos de Ansiedade/epidemiologia , Transtornos de Ansiedade/psicologia , Transtornos de Ansiedade/terapia , Transtorno do Deficit de Atenção com Hiperatividade/diagnóstico , Transtorno do Deficit de Atenção com Hiperatividade/epidemiologia , Transtorno do Deficit de Atenção com Hiperatividade/psicologia , Transtorno do Deficit de Atenção com Hiperatividade/terapia , Transtorno do Espectro Autista/diagnóstico , Transtorno do Espectro Autista/epidemiologia , Transtorno do Espectro Autista/psicologia , Transtorno do Espectro Autista/terapia , Criança , Estudos de Coortes , Transtorno da Conduta/diagnóstico , Transtorno da Conduta/epidemiologia , Transtorno da Conduta/psicologia , Transtorno da Conduta/terapia , Dinamarca/epidemiologia , Transtorno Depressivo/diagnóstico , Transtorno Depressivo/epidemiologia , Transtorno Depressivo/psicologia , Transtorno Depressivo/terapia , Transtornos da Alimentação e da Ingestão de Alimentos/diagnóstico , Transtornos da Alimentação e da Ingestão de Alimentos/epidemiologia , Transtornos da Alimentação e da Ingestão de Alimentos/psicologia , Transtornos da Alimentação e da Ingestão de Alimentos/terapia , Feminino , Humanos , Incidência , Masculino , Transtornos Mentais/diagnóstico , Transtornos Mentais/psicologia , Transtorno Obsessivo-Compulsivo/diagnóstico , Transtorno Obsessivo-Compulsivo/epidemiologia , Transtorno Obsessivo-Compulsivo/psicologia , Transtorno Obsessivo-Compulsivo/terapia , Fatores de Proteção , Fatores de Risco , Fatores Sexuais , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/psicologia , Transtornos Relacionados ao Uso de Substâncias/terapia , Transtornos de Tique/diagnóstico , Transtornos de Tique/epidemiologia , Transtornos de Tique/psicologia , Transtornos de Tique/terapia
18.
Neurologist ; 24(3): 93-108, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31045720

RESUMO

BACKGROUND: Tourette syndrome (TS) and other chronic tic disorders are clinically heterogenous and cause physical discomfort, social difficulties, and emotional distress. In addition to tics, TS patients have a variety of behavioral comorbidities, including obsessive-compulsive disorders and attention-deficit hyperactivity disorders. TS treatment is multidisciplinary, involving behavioral therapy, oral medications, and botulinum toxin injections. METHODS: Relevant studies on pharmacological and surgical treatment options for TS and other chronic tic disorders, their limitations and current recommendations were reviewed using the PubMed search till April 2, 2018. Besides, the reference lists of the retrieved publications were manually searched to explore other relevant studies. This review aims to discuss the progress in pharmacological and surgical treatment options for TS and other chronic tic disorders. RESULTS AND CONCLUSIONS: Both typical and atypical antipsychotic agents are mainstays of pharmacological treatment of TS and other chronic tic disorder patients; however, their use is limited by serious side effects considering their potential of dopamine blockade. Because of the phenotypic variability, no medication has proven effective for all persons with TS and other chronic tic disorders. Botulinum toxin has emerged as a good therapeutic option, especially for focal and dystonic tics. But, their uses are limited by lack of sufficient evidence and high cost. Surgical treatment is considered in medically refractory and severely disabled tics patients. Deep brain stimulation has replaced lesional surgeries; however, there is uncertainty regarding the selection of patients and target of stimulation.


Assuntos
Transtornos de Tique/tratamento farmacológico , Transtornos de Tique/cirurgia , Síndrome de Tourette/tratamento farmacológico , Síndrome de Tourette/cirurgia , Anticonvulsivantes/uso terapêutico , Antipsicóticos/uso terapêutico , Humanos , Procedimentos Neurocirúrgicos/métodos , Parassimpatolíticos/uso terapêutico , Resultado do Tratamento
19.
Neurology ; 92(19): 896-906, 2019 05 07.
Artigo em Inglês | MEDLINE | ID: mdl-31061208

RESUMO

OBJECTIVE: To make recommendations on the assessment and management of tics in people with Tourette syndrome and chronic tic disorders. METHODS: A multidisciplinary panel consisting of 9 physicians, 2 psychologists, and 2 patient representatives developed practice recommendations, integrating findings from a systematic review and following an Institute of Medicine-compliant process to ensure transparency and patient engagement. Recommendations were supported by structured rationales, integrating evidence from the systematic review, related evidence, principles of care, and inferences from evidence. RESULTS: Forty-six recommendations were made regarding the assessment and management of tics in individuals with Tourette syndrome and chronic tic disorders. These include counseling recommendations on the natural history of tic disorders, psychoeducation for teachers and peers, assessment for comorbid disorders, and periodic reassessment of the need for ongoing therapy. Treatment options should be individualized, and the choice should be the result of a collaborative decision among patient, caregiver, and clinician, during which the benefits and harms of individual treatments as well as the presence of comorbid disorders are considered. Treatment options include watchful waiting, the Comprehensive Behavioral Intervention for Tics, and medication; recommendations are provided on how to offer and monitor these therapies. Recommendations on the assessment for and use of deep brain stimulation in adults with severe, treatment-refractory tics are provided as well as suggestions for future research.


Assuntos
Transtornos de Tique/terapia , Tiques/terapia , Síndrome de Tourette/terapia , Terapia Comportamental , Aconselhamento , Humanos , Transtornos de Tique/psicologia , Tiques/psicologia , Síndrome de Tourette/psicologia
20.
Neurology ; 92(19): 907-915, 2019 05 07.
Artigo em Inglês | MEDLINE | ID: mdl-31061209

RESUMO

OBJECTIVE: To systematically evaluate the efficacy of treatments for tics and the risks associated with their use. METHODS: This project followed the methodologies outlined in the 2011 edition of the American Academy of Neurology's guideline development process manual. We included systematic reviews and randomized controlled trials on the treatment of tics that included at least 20 participants (10 participants if a crossover trial), except for neurostimulation trials, for which no minimum sample size was required. To obtain additional information on drug safety, we included cohort studies or case series that specifically evaluated adverse drug effects in individuals with tics. RESULTS: There was high confidence that the Comprehensive Behavioral Intervention for Tics was more likely than psychoeducation and supportive therapy to reduce tics. There was moderate confidence that haloperidol, risperidone, aripiprazole, tiapride, clonidine, onabotulinumtoxinA injections, 5-ling granule, Ningdong granule, and deep brain stimulation of the globus pallidus were probably more likely than placebo to reduce tics. There was low confidence that pimozide, ziprasidone, metoclopramide, guanfacine, topiramate, and tetrahydrocannabinol were possibly more likely than placebo to reduce tics. Evidence of harm associated with various treatments was also demonstrated, including weight gain, drug-induced movement disorders, elevated prolactin levels, sedation, and effects on heart rate, blood pressure, and ECGs. CONCLUSIONS: There is evidence to support the efficacy of various medical, behavioral, and neurostimulation interventions for the treatment of tics. Both the efficacy and harms associated with interventions must be considered in making treatment recommendations.


Assuntos
Antipsicóticos/uso terapêutico , Terapia Comportamental/métodos , Estimulação Encefálica Profunda , Transtornos de Tique/terapia , Tiques/terapia , Síndrome de Tourette/terapia , Humanos , Transtornos de Tique/tratamento farmacológico , Transtornos de Tique/psicologia , Tiques/tratamento farmacológico , Tiques/psicologia , Síndrome de Tourette/tratamento farmacológico , Síndrome de Tourette/psicologia
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