A pediatric neurobehavioral treatment challenge.

Tourette 's syndrome (TS) currently has very limited FDA approved treatment options, despite the fact that TS and other pediatric tic disorders are not uncommon and can cause significant emotional and physical distress for patients and their families. For providers who regularly see these conditions in practice this inadequacy is highly frustrating on the treatment side as there are such limited options to offer to these families, and the outcome to hope for is not highly optimistic. The outcome of this case presentation is an example of how health care providers can use clinical knowledge in combination with evidence-based practice to advocate for their patients and find new solutions that could be, and in this case were, life changing. It promotes providers to advocate for their patients and expand their knowledge. The final medication treatment utilized in this case is currently off label, however the method of finding and obtaining the treatment explained in the case additionally reveal to readers how to cautiously but judiciously make off label treatment decisions that can be important to practice and patient outcomes. In the course of this case the off-label medication use decision was backed by scientific literature and ongoing FDA studies as well as consulting with a collaborating psychiatrist. The subject matter and method of reasoning within this case also promote psychiatric providers use of evidence-based practice and implementation of science into active practice.

Update of studies about prepulse inhibition in psychiatric disorders / 中华行为医学与脑科学杂志

Prepulse inhibition ( PPI) is the suppression of the startle reflex when the startling stim-ulus is preceded by a non-startling stimulus ( the prepulse) . It is an operational measurement of sensorimotor gating mechanism to help the brain adapt to the complex environment,which could be top-down modulated by attention and other higher cognitive processes. Deficits of PPI and the top-down modulation of PPI are closely related to psychiatric diseases. Research papers published from January 2001 to October 2016 related to PPI in psychiatric disorders were searched in the Chinese and English databases. Results showed that schizo-phrenic patients and their relatives showed deficits in baseline PPI as well as the attentional modulation of PPI,and more importantly,the attentional modulation of PPI rather than the baseline PPI was more related to the symptom severity. Patients with Tourette'' s syndrome showed PPI impairment,while patients with obsess-ive compulsive disorder had lower levels of PPI. PPI deficits in bipolar disorder patients were gender-depend-ent. Studying PPI and the top-down modulation of PPI could provide a basis to study the interaction of senso-ry processing and attention,and facilitate the researches of neural mechanism underlying the deficits of senso-ry gating. To establish advanced paradigms of PPI,new cognitive components could be introduced,such as at-tention,emotion,motor control,compulsivity and so on,thus improving the specificity of PPI test and promo-ting the PPI test as new biomarker and endophenotype in various psychiatric disorders.

Perfil neuropsicológico na Síndrome de Tourette: um estudo de caso / Tourette Syndrome neuropsychological profile: a study case

Neste artigo discutiremos os principais achados da avaliação neuropsicológica de um adolescente com Síndrome de Tourette (ST), uma desordem neurodesenvolvimental rara que se caracteriza pela presença de tiques motores e/ou sonoros que, comumente, emergem na infância ou início da adolescência. Apesar da extensa avaliação de todas as funções cognitivas, pretendemos aqui centrar nossa discussão sobre as funções quesão apontadas pela literatura como relevantes para a compreensão do perfil cognitivo neste quadro. Os resultados do caso aqui relatado são compatíveis com a literatura, e sugerem preservação intelectual e da memória de longo prazo, bem como déficits no funcionamento executivo, rebaixamento da velocidade psicomotora e mental, e da memória imediata. A discussão desse caso, dada a raridade do quadro, pode contribuir para a compreensão do funcionamento cognitivo de adolescentes com a ST. Finalmente, discutiremos aspectos importantes para a qualidade da avaliação neuropsicológica e encaminhamentos terapêuticos para os portadores desta síndrome. (AU)

This article discusses findings resulting from the neuro-psychological assessment of an adolescent with Tourette Syndrome (TS), a rare neurodevelopmental disorder characterized by the manifestation of physical and/or audible tics that emerge in childhood or early adolescence. Although we performed an extensive assessment of all cognitive functions, our reported findings focus on those functions that are described in priorresearch as relevant to the understanding of the cognitive profile of patients with this condition. The findings reported here are consistent with other reports and suggest that intellectual and long-term memory potentials are preserved, while noting deficiencies in executive functioning, reduced speed of mental and psycho-motor functions, and decreased recent memory capacity. Given the rarity of this diagnosis, our reporting of this case should contribute to the understanding of cognitive function in adolescents with TS. In addition, this article highlights and describes factors that affect the quality of neuropsychological assessment and facilitate accurate therapeutical diagnosis and referral for TS carriers. (AU)

Perfil neuropsicológico na Síndrome de Tourette: um estudo de caso / Tourette Syndrome neuropsychological profile: a study case

Neste artigo discutiremos os principais achados da avaliação neuropsicológica de um adolescente com Síndrome de Tourette (ST), uma desordem neurodesenvolvimental rara que se caracteriza pela presença de tiques motores e/ou sonoros que, comumente, emergem na infância ou início da adolescência. Apesar da extensa avaliação de todas as funções cognitivas, pretendemos aqui centrar nossa discussão sobre as funções quesão apontadas pela literatura como relevantes para a compreensão do perfilcognitivo neste quadro. Os resultados do caso aqui relatado são compatíveiscom a literatura, e sugerem preservação intelectual e da memória de longo prazo, bem como déficits no funcionamento executivo, rebaixamento da velocidade psicomotora e mental, e da memória imediata. A discussão desse caso, dada a raridade do quadro, pode contribuir para a compreensão do funcionamento cognitivo de adolescentes com a ST. Finalmente, discutiremos aspectos importantes para a qualidade da avaliação neuropsicológica e encaminhamentos terapêuticos para os portadores desta síndrome.

This article discusses findings resulting from the neuro-psychological assessment of an adolescent with Tourette Syndrome (TS), a rare neurodevelopmental disorder characterized by the manifestation of physical and/or audible tics that emerge in childhood or early adolescence. Although we performed an extensive assessment of all cognitive functions, our reported findings focus on those functions that are described in priorresearch as relevant to the understanding of the cognitive profile of patients with this condition. The findings reported here are consistent with other reports and suggest that intellectual and long-term memory potentials are preserved, while noting deficiencies in executive functioning, reduced speed of mental and psycho-motor functions, and decreased recent memory capacity. Given the rarity of this diagnosis, our reporting of this case should contribute to the understanding of cognitive function in adolescents with TS. In addition, this article highlights and describes factors that affect the quality of neuropsychological assessment and facilitate accurate therapeutical diagnosis and referral for TS carriers.

Tics: los trastornos del movimiento más frecuentes en los niños / Tics: the most frequent movement disorders in children

Los tics son los trastornos del movimiento más frecuentes en los niños y su mayor prevalencia es en la edad escolar. La mayoría son transitorios, pero algunos pueden tener repercusiones negativas en los ámbitos escolar, familiar y social, que pueden llevar a fracaso escolar, baja autoestima y disfunción social. Algunos de los tics se relacionan con el trastorno de déficit de atención e hiperactividad (TDAH) y con otras enfermedades que requieren diagnóstico oportuno y adecuado tratamiento. En esta revisión sobre los tics se incluyen los siguientes aspectos: epidemiología, etiología, factores de riesgo, caracterización, enfermedades asociadas, diagnóstico, tratamiento y pronóstico.

Tics are the most frequent movement disorders during childhood; their highest prevalence occurs during school age. Most tics are transient but some of them may have serious repercussions from the educational, familial, and social points of view, leading to school failure, low self-esteem, and social dysfunction. Some tics are related to the attention-deficit hyperactivity disorder, and to other diseases that should be opportunely and adequately treated. In this review on tics the following aspects are included: epidemiology, etiology, risk factors, characterization, associated diseases, diagnosis, treatment, and prognosis.

Comparative study of Tourette' s syndrome animal models induced by chemical factors / 中华行为医学与脑科学杂志

Objective To provide theoretical and experimental proof for selecting and implying Tourette's syndrome(TS) animal models, validities of four TS models induced by chemical factors were compared. Methods Four TS models,namely AMP model,APO model,DO1 model and IDPN model were built up by using different chemical modeling agents. Through detecting spontaneous movement, climbing time and monoamine transmitters levels in striatum, four TS animal models were compared and evaluated from three levels of validities-face, prediction,construct. Results Compared with control group, spontaneous movement times raised ( t = 4. 746, P =0. 000) and level of DOPAC ( (0.99 ± 0. 177 ) ng/mg) in striatum increased (P = 0.029 ), and level of NE in striatum decreased in AMP model group( (0.11 ± 0.033 )ng/mg, P = 0.012). Compared with control group, climbing time prolonged (P = 0. 004) and levels of DA ( ( 10. 19 ± 1.23 ) ng/mg), 5-HT ( ( 0. 54 ± 0.08 ) ng/mg) in striatum raised(P=0. 019, P=0. 002),at the same time ,levels of DOPAC( (0.63 ±0.11 )ng/mg),HVA ((0.45 ±0.04 ) ng/mg) in striatum reduced (P ＜ 0.01 ) in APO model group; Compared with control group, levels of DA ( ( 13.66 ± 1.55 ) ng/mg), DOPAC( (0.80 ±0. 11 ) ng/mg), HVA( ( 1.04 ± 0.14) ng/mg) grew downwards in striatum of DOI model mice(P=0.029,P=0.001, P= 0.004). Compared with control group, level of 5-HT in striatum increased in IDPN300 group ( (0.77 ± 0.09) ng/mg, P = 0.031 ). ConclusionFace validity of AMP model is temporal and that of IDPN model is steady and persistent. AMP model,APO model and DOI model possess predictive validity. AMP model,APO model,DOI model and IDPN model have potentiality of becoming construct validity model.