Prognosis of rapid onset functional tic-like behaviors: Prospective follow-up over 6 months.

BACKGROUND AND PURPOSE: The prognosis of rapid onset functional tic-like behaviors (FTLBs) is unknown. This prospective cohort study describes the course and treatment of rapid onset FTLBs in adolescents (n = 20) and adults (n = 9) previously reported in two case series. METHODS: Yale Global Tic Severity Scale (YGTSS) scores were compared between first clinical presentation and 6-month follow-up assessment. All treatments used for FTLBs and any psychiatric comorbidities were recorded. RESULTS: In adolescents with FTLBs, motor tics, vocal tics, total tics, impairment, and global scores on the YGTSS significantly improved at 6 months, with a mean decrease in the YGTSS global score of 31.9 points, 95% confidence interval (CI) 15.4, 48.4, p = .0005. In adults with FTLBs, only impairment and global scores significantly improved, with a mean decrease in the YGTSS global score of 19.6 points, 95% CI -3.2, 42.3, p = .04. Selective serotonin reuptake inhibitors (SSRIs) and cognitive behavioral therapy (CBT) for anxiety and depression were the most used treatment in both age groups. CONCLUSIONS: This prospective study suggests that adolescents have a better prognosis than adults with FTLBs. Management of comorbidities with SSRIs and CBT seems effective.

Nocturnal Enuresis in Older People: Where Is the Evidence and What Are the Gaps?

While there is extensive literature regarding nocturnal enuresis in children and young adults, relatively little research explores this problem in older people. This scoping review sought to identify knowledge gaps and provide research direction specifically for older, institutionalized adults with nocturnal enuresis. A comprehensive search of 8 electronic databases and the gray literature was undertaken. Studies focusing on the causes, symptoms, and treatment of nocturnal enuresis in older people were retrieved. A broad search strategy including all adults was employed in order to capture all relevant publications. Articles were then excluded by title and abstract such that only those relevant to the older adult and institutionalized populations remained. Relevant articles were identified by title and language. Further reading of the abstract allowed inclusion and a final full reading of the articles allowed all authors to map research activity and identify knowledge gaps. After duplicates and nonrelevant articles were eliminated, we identified 7 articles on nursing home residents and 2 involving older people living in psychiatric institutions. Published literature focused on causes and treatment with either desmopressin or aversive behavioral therapy. No study included a comprehensive continence assessment or controlled for comorbid conditions. Identified gray literature focused on general continence information for the public and nonspecialist clinicians. We conclude that there is a dearth of evidence relevant to this troublesome condition. Gaps in the evidence base include a lack of standardized terminology and limited research focusing on the epidemiology, pathophysiology, and treatment of nocturnal enuresis, all of which suggest a rich research agenda for future investigation.