Premonitory Awareness Facilitates Tic Suppression: Subscales of the Premonitory Urge for Tics Scale and a New Self-Report Questionnaire for Tic-Associated Sensations.

Awareness of premonitory urge in Tourette syndrome (TS) may facilitate tic suppression; however, previous studies have not supported this observation. We aimed to clarify the relationship between tic-associated sensation and tic suppression by identifying the subtypes of tic-associated sensations, including the Premonitory Urge for Tics Scale (PUTS). We developed a new questionnaire called "Rumination and Awareness Scale for tic-associated sensations" (RASTS) to assess the two additional aspects of tic-associated sensations: the intensity of somatosensory hyperawareness and the ability to identify signals of emerging tics. Sixty-two individuals with TS participated in the study (mean age = 19.2 ± 10.3 years). All participants completed the RASTS, PUTS, and Tic Suppression Scale. Of all participants, 41 were evaluated by the Yale Global Tic Severity Scale (YGTSS), while another group of 41 completed both the Leyton Obsessional Inventory-Child Version (LOI-CV) and the Tics Symptom Self-Report (TSSR). Factor analyses including nine items of the PUTS and the RASTS were conducted, and their relationships with patients' tic suppression ability were examined. The results support using RASTS for the two supposed dimensions (rumination about sensation and premonitory awareness) for assessing the two different tic-associated sensations, and PUTS for three dimensions for assessing the two types of quality of premonitory urges and intensity of premonitory urges. Premonitory awareness correlated with tic suppression ability. Conversely, rumination about sensation, PUTS total score, and the three subscales of PUTS correlated with obsessive-compulsive symptoms. In summary, being aware of signals for emerging tics facilitated self-initiated tic suppression, while ruminative tic-associated sensations did not. This study provides new insights into behavioral therapy for tics by identifying two distinct aspects of tic-associated sensations that include premonitory urges.

Changes in Sensory Phenomena, Tics, Obsessive-Compulsive Symptoms, and Global Functioning of Tourette Syndrome: A Follow-Up After Four Years.

Sensory phenomena and related features of Tourette syndrome are related to poorer quality of life. Therefore, sensory phenomena might also have a negative impact on global functioning. However, the influence of sensory phenomena, tics, and obsessive-compulsive symptoms (OCS) on global functioning after several years of usual treatment has not been investigated. Twenty out of 45 Japanese patients with Tourette syndrome who had previously undergone an evaluation of these clinical features were assessed again after an average of four years. We conducted a panel of assessments for premonitory urges, broader sensory phenomena, tic severity, OCS, and global functioning. Based on Pearson's correlation coefficient, current global functioning was significantly negatively correlated with previous tics and marginally negatively correlated with previous broader sensory phenomena. Current global functioning was marginally correlated with change in tics. Change in global functioning was significantly correlated with change in OCS and marginally correlated with change in premonitory urges. Due to the small sample size, it was not possible to use a multiple regression analysis to conclude that sensory phenomena, tics, and OCS predict global functioning in adolescents and adults with TS. However, it was suggested that further investigation of this relationship would be meaningful.

The effects of comorbid Tourette symptoms on distress caused by compulsive-like behavior in very young children: a cross-sectional study.

BACKGROUND: Many children 4 to 6 years old exhibit compulsive-like behavior, often with comorbid Tourette symptoms, making this age group critical for investigating the effects of having comorbid Tourette symptoms with compulsive-like behavior. However, these effects have not yet been elucidated: it is unclear whether having comorbid tics with compulsive-like behavior leads to lower quality of life. This cross-sectional study aims to investigate the effect of comorbid Tourette symptoms on distress caused by compulsive-like behavior in very young children. METHODS: Self-administered questionnaires were distributed to guardians of children aged 4 to 6 attending any of the 59 public preschools in a certain ward in Tokyo, Japan. The questionnaire contained questions on the presence of Tourette symptoms, the presence of specific motor and vocal tics, frequency/intensity of compulsive-like behavior, and the distress caused by compulsive-like behavior, which was rated on a scale of 1 to 5. Additionally, questions on autism spectrum disorder (ASD) traits, attention-deficit/hyperactivity disorder (ADHD) traits, internalizing behavior traits, and externalizing behavior traits were included in the questionnaire as possible confounders of distress caused by compulsive-like behavior. Wilcoxon rank-sum tests were conducted to compare the distress caused by compulsive-like behavior and frequency/intensity of compulsive-like behavior between children in the Tourette symptoms group and the non-Tourette symptoms group. Furthermore, a stepwise regression analysis was performed to assess the effects of the independent variables on distress caused by compulsive-like behavior. Another stepwise regression analysis was performed to assess the relationship between distress caused by compulsive-like behavior and the presence of five specific motor and vocal tics. RESULTS: Of the 675 eligible participants, distress due to compulsive-like behavior was significantly higher in children in the Tourette symptoms group compared to the non-Tourette symptoms group (2.00 vs 1.00, P < 0.001). Stepwise regression analysis showed that frequency/intensity of compulsive-like behavior, being in the Tourette symptoms group, ASD traits, and internalizing behavior traits were predictors of distress due to compulsive-like behavior. Two specific tics, repetitive noises and sounds and repetitive neck, shoulder, or trunk movements, were significant predictors of distress due to compulsive-like behavior. CONCLUSIONS: Comorbid Tourette symptoms may worsen distress caused by compulsive-like behavior in children 4 to 6 years old, and specific motor and vocal tics may lead to greater distress.

Expert consensus on pharmacotherapy for tic disorders in Japan.

OBJECTIVE: We aimed to clarify the current status of pharmacotherapy for tic disorders and comorbidities in Japan. We used a systematic survey to collate the consensus of Japanese experts and compare it with the recent international evidence. METHODS: We devised a questionnaire on pharmacotherapy for tics and comorbidities and sent it to Japanese experts on tic disorders. Based on the response to the first survey, we revised the questionnaire and conducted a second survey to determine the consensus among the experts on a 4-point Likert scale by the Delphi method. RESULTS: The first survey revealed variability in preferred medications and dosages among the experts in Japan. However, we were able to build a general consensus on pharmacotherapy for tic disorders and comorbidities based on the second survey. Aripiprazole and risperidone were the first- and second-line medication for tic disorders, respectively. Agonists of α-2 adrenergic receptors were seldom prescribed. Fluvoxamine was the first-line medication for comorbid obsessive-compulsive disorder, and atomoxetine for comorbid attention deficit/hyperactivity disorder. CONCLUSIONS: This study will help Japanese physicians choose medications for tic disorders more judiciously and will improve the quality of tic pharmacotherapy in Japan.

Sensory phenomena and obsessive-compulsive symptoms in Tourette syndrome following deep brain stimulation: Two case reports.

Here, we assess sensory phenomena (SP) and obsessive-compulsive symptoms (OCS) in two patients with refractory Tourette syndrome (TS) before and after deep brain stimulation (DBS) targeting the centromedian-parafascicular complex (CM-Pfc)-ventral oral nuclei of the bilateral thalami. Based on changes in these clinical features, we also aimed to elucidate useful information regarding the use of DBS in TS. We administered the Yale Global Tic Severity Scale (YGTSS) to assess tics, the Premonitory Urge for Tics Scale (PUTS) for premonitory urges, the University of São Paulo Sensory Phenomena Scale (USP-SPS) for broader SP, the Dimensional Yale-Brown Obsessive-Compulsive Scale (DY-BOCS) for OCS, and the Global Assessment of Functioning (GAF) scale for global functioning. We report on two male patients who showed consistent improvement in tics, premonitory urges, and global functioning two years after DBS. In contrast, there were differences between the patients in broader SP, including "just right" perceptions, and OCS. Our results suggest that systematic assessment of a wide range of SP and OCS dimensions is necessary to elucidate the usefulness of DBS in TS.

Self-initiated coping with Tourette's syndrome: Effect of tic suppression on QOL.

OBJECTIVE: Because of the semi-voluntary nature of tics, patients with Tourette' syndrome (TS) often report self-initiated coping with tics. Our goals were to understand the experiences of self-initiated coping with tics by individuals with TS (e.g., suppression frequency, suppression ability, and side effects of tic suppression), and investigate the effects of tic control on quality of life (QOL). METHOD: One hundred participants with TS (38 children and 62 adults) answered a questionnaire concerning tic control, QOL, and other clinical characteristics. RESULT: Fifty-eight percent of the participants always or frequently tried to suppress tics daily. In contrast, over 90% felt uncomfortable or incomplete when they suppressed tics and needed concentration or extra effort to suppress them. Thirty-four percent could suppress tics for less than one minute and 65% could suppress tics for less than 10min. Higher subjective satisfaction with tic control was positively correlated with life satisfaction and QOL. CONCLUSION: Individuals with TS often attempt self-initiated coping in their daily lives, especially through tic suppression, despite experiencing subjective discomfort and being aware that the duration of tic suppression is often limited. Moreover, it was found that their subjective satisfaction with tic control and effective tic suppression might have a positive influence on their life satisfaction and QOL. Thus, self-initiated coping with tics is vital for improving the QOL of individuals with TS and intervention aimed at enhancing subjective satisfaction with tic control could help manage TS.

Sensory phenomena related to tics, obsessive-compulsive symptoms, and global functioning in Tourette syndrome.

OBJECTIVES: Sensory phenomena, including premonitory urges, are experienced by patients with Tourette syndrome (TS) and obsessive-compulsive disorder (OCD). The goal of the present study was to investigate such phenomena related to tics, obsessive-compulsive symptoms (OCS), and global functioning in Japanese patients with TS. METHODS: Forty-one patients with TS were assessed using the University of São Paulo Sensory Phenomena Scale (USP-SPS), the Premonitory Urge for Tics Scale (PUTS), the Yale Global Tic Severity Scale (YGTSS), the Dimensional Yale-Brown Obsessive-Compulsive Scale (DY-BOCS), and the Global Assessment of Functioning (GAF) Scale. RESULTS: USP-SPS and PUTS total scores were significantly correlated with YGTSS total and vocal tics scores. Additionally, both sensory phenomena severity scores were significantly correlated with DY-BOCS total OCS scores. Of the six dimensional OCS scores, the USP-SPS scores were significantly correlated with measures of aggression and sexual/religious dimensions. Finally, the PUTS total scores were significantly and negatively correlated with GAF scores. CONCLUSIONS: By assessing premonitory urges and broader sensory phenomena, and by viewing OCS from a dimensional approach, this study provides significant insight into sensory phenomena related to tics, OCS, and global functioning in patients with TS.

[Development of the Subjective Urge Scale and its usefulness in people with tic disorders].

The impulsivity of people with tic disorder has been a recent focus of attention. This study aimed to investigate this phenomenon in people with and without tics in a non-clinical setting, focusing on the subjective urge experienced prior to impulsive behavior. In Study 1, we created a scale to measure the strength of subjective urges. This scale, which was found to comprise three subscales, had high internal consistency and high generalizability. In Study 2, using the scale developed in Study 1, we showed that people with tics felt stronger subjective urges than people without tics. This suggests that the relation between tics and impulsivity exists not only among people in clinical settings but also in non-clinical settings. Also, subjective urges significantly affect the severity of depression and this elfect was pronounced in people with tics in this study. Thus. we should consider the presence or absence of tics when we discuss impulsivity, in particular the effect of subjective urges on depression.

Fast convergence to equilibrium for long-chain polymer melts using a MD/continuum hybrid method.

Effective and fast convergence toward an equilibrium state for long-chain polymer melts is realized by a hybrid method coupling molecular dynamics and the elastic continuum. The required simulation time to achieve the equilibrium state is reduced compared with conventional equilibration methods. The polymers move on a wide range phase space due to large-scale fluctuation generated by the elastic continuum. A variety of chain structures is generated in the polymer melt which results in the fast convergence to the equilibrium state.