Effects of tic suppression: ability to suppress, rebound, negative reinforcement, and habituation to the premonitory urge.

The comprehensive behavioral intervention for tics (CBIT) represents a safe, effective non-pharmacological treatment for Tourette's disorder that remains underutilized as a treatment option. Contributing factors include the perceived negative consequences of tic suppression and the lack of a means through which suppression results in symptom improvement. Participants (n = 12) included youth ages 10-17 years with moderate-to-marked tic severity and noticeable premonitory urges who met Tourette's or chronic tic disorder criteria. Tic frequency and urge rating data were collected during an alternating sequence of tic freely or reinforced tic suppression periods. Even without specific instructions regarding how to suppress tics, youth experienced a significant, robust (72%), stable reduction in tic frequency under extended periods (40 min) of contingently reinforced tic suppression in contrast to periods of time when tics were ignored. Following periods of prolonged suppression, tic frequency returned to pre-suppression levels. Urge ratings did not show the expected increase during the initial periods of tic suppression, nor a subsequent decline in urge ratings during prolonged, effective tic suppression. Results suggest that environments conducive to tic suppression result in reduced tic frequency without adverse consequences. Additionally, premonitory urges, underrepresented in the literature, may represent an important enduring etiological consideration in the development and maintenance of tic disorders.

Parenting stress and related factors in parents of children with Tourette syndrome.

The objective of this study was to assess the stress of parents and its influencing factors in caring for children with Tourette syndrome. A total of 150 subjects, either fathers or mothers of children diagnosed with Tourette syndrome between the ages of 6 and 12, were recruited by purposive sampling from the membership roster of the Taiwan Tourette Family Association. Study tools included a Parenting Stress Index Form and Social Support Index Form. The standardized score for parent perception of parenting stress was 83.5. The main stressor of parents of children with Tourette syndrome was found to be child care difficulties. A correlation was found between parenting stress and child gender, age, school situation and disease severity; parent age and family income. A significant negative correlation (r=-.459, p<.01) was found between social support and parenting stress. It was revealed that social support had a significant effect on parenting stress in this study. Multiple linear regression analysis found disease severity and family income to be the variables with the greatest predictive power for parenting stress, explaining 42% of total variance. Results showed that factors affecting parenting stress included family income and disease severity. These findings should help clinical professionals develop more effective health care strategies to address the needs of children with Tourette syndrome and their parents.

El uso de los nuevos antipsicóticos atípicos en el síndrome de Gilles de la Tourette / Use of atypical antipsychotics in Tourette´s syndrome

El síndrome de GiIles de la Tourette (SGT) es un trastorno neuropsiquiátrico con tics motores y vocales crónicos y una elevada comorbilidad y síntomas secundarios. Se han venido usando agonistas alfa-2 (clonidina) o antipsicóticos clásicos (haloperidol, pimocida) con buena eficacia pero mala tolerancia (Efectos adversos). Revisamos la literatura existente sobre eficacia y tolerancia de los nuevos antipsicóticos (clozapina, risperidona, olanzapina, quetiapina, amisulpride, ziprasidona) en esta patología

Tourette's syndrome is a neuropsychiatric disorder characterized by chronic motor and vocal tics and a high comorbidity and associated symptoms. Usually, alpha-2 agonists (clonidine) or typical antipsychotics (haloperidol, pimozide) have been used with a good efficacy but they are poorly tolerated (adverse effects). We review here the existing evidences on efficacy and tolerance for the new antipsychotics (clozapine, risperidone, olanzapine, quetiapine, amisulpride, ziprasidoné) on this disorder

Uso de risperidona en el síndrome de Tourette / Risperidone in the treatment of Tourette syndrome

Introducción: El uso de neurolépticos clásicos en el síndrome de Tourette (ST) se ve limitado por sus efectos secundarios, especialmente la discinesia tardía. Estudios recientes muestran la risperidona como un fármaco eficaz con un perfil benigno de efectos adversos. Objetivos: Analizar en nuestro ámbito el empleo de risperidona en el ST y evaluar su eficacia y tolerabilidad. Material y métodos: Revisión retrospectiva de siete pacientes con ST tratados con risperidona, controlados en el Servicio de Neurología del Hospital «Sant Joan de Déu-Clínic» de Barcelona. Resultados: La edad media de comienzo del síndrome es de 5,7 años. Cuatro asocian otros trastornos neuropsiquiátricos, principalmente, el trastorno por déficit de atención con hiperactividad (TDAH). Cinco habían recibido tratamiento neuroléptico previo (tres con haloperidol). Existe mejoría de los tics en cuatro casos y de la comorbilidad en dos. Cuatro refieren efectos adversos, siendo el aumento de peso el más prevalente. Hasta día de hoy, ninguno ha presentado discinesia tardía. Conclusiones: La risperidona se muestra como fármaco eficaz en el tratamiento del ST. Sus efectos adversos suelen ser bien tolerados, con baja incidencia de síntomas extrapiramidales (EPS), por lo que parece una alternativa válida en el tratamiento de los niños con ST

Introduction: The use of typical neuroleptic agents in Tourette syndrome (TS) is limited by their troublesome side effects such as tardive dyskinesia. Recent studies have suggested that risperidone may be an efficacious and safe drug in the treatment of this syndrome. Objectives: To analyze the use of risperidone in TS in our hospital and to evaluate its efficacy and tolerability. Material and methods: We carried out a retrospective review of the seven TS patients treated with risperidone in our Neurology Department. Results: The mean age at onset was 5.7 years. Four patients presented comorbid neuropsychiatric conditions, most frequently attention-deficit hyperactivity disorder (ADHD). Five children had received neuroleptics previously (haloperidol in three cases). Tics improved in four patients and the comorbid disorders in two. Four children developed side effects, weight gain being the most prevalent. No patient has developed tardive dyskenesia. Conclusions: Risperidone shows efficacy in the treatment of TS. Its side effects are generally well tolerated. Extrapyramidal symptoms are infrequent. Consequently, risperidone may be a useful alternative in the treatment of children with TS

[Study on the prevalence of tic disorders in schoolchildren aged 7-16 years old in Wenzhou].

OBJECTIVE: To study the epidemiological features of tic disorders (TD) among schoolchildren in Wenzhou area. METHODS: Stratified cluster sampling was carried out to investigate TD in 9742 schoolchildren aged 7 to 16 years old in Wenzhou. RESULTS: The average prevalence rate of TD among school-age children was 104/10 000 (166/10 000 for males, 29/10 000 for females). There was a significantly higher prevalence rate for males than that for females (chi(2) = 43.96, P < 0.001, prevalence ratio = 5.7, prevalence ratio 95% CI: 3.20 - 10.30). The prevalence rates of clinical subtypes in males was significantly higher than that of females while pupils was significantly higher than that in high school students (chi(2) = 11.33, P < 0.01, prevalence ratio = 2.2, prevalence ratio 95% CI: 1.37 - 3.43). Prevalence rate of transient tic disorders (TTD), chronic motor vocal tic disorder (CMVTD), tourette syndrome (TS) were 34/10 000, 27/10 000 and 43/10 000 respectively with the highest among 9-10 years old group. The mean onset age of TD was 8.5 +/- 2.8 years. The peak of onset was among 6-10 year olds. The rate of delayed diagnosis of the disorders was 69.3% and the median in delayed diagnosis was 1.0 year. CONCLUSION: TD is a common disease with high rate of misdiagnoses among schoolchildren in Wenzhou area. Physicians and population should be trained to identify the syndromes and to practice correct diagnosis and effective treatment as early as possible.

Creating tic suppression: comparing the effects of verbal instruction to differential reinforcement.

The purpose of this study was to compare two methods designed to produce tic reduction in 4 children with Tourette's syndrome. Specifically, a verbal instruction not to engage in tics was compared to a verbal instruction plus differential reinforcement of zero-rate behavior (DRO). Results showed that the DRO-enhanced procedure yielded greater reductions in tic frequency.

Premonitory sensory phenomena and suppressibility of tics in Tourette syndrome: developmental aspects in children and adolescents.

Although premonitory sensory phenomena (PSP) and suppressibility of tics (SPT) are important in Tourette syndrome not only when behavioural therapeutic approaches in children are considered, there is a lack of developmental information on these phenomena. Therefore, a cross-sectional survey of these factors in children and adolescents was carried out. Rates of PSP and SPT were gathered using a questionnaire for the assessment of Tourette syndrome. The 254 outpatients (212 males, 42 females) with Tourette syndrome investigated had an age range of 8 to 19 years, normal intelligence, and diagnosis according to DSM-IV-TR/ICD-10. To test for developmental effects, the total group was stratified into three age groups (8 to 10, 11 to 14, and 15 to 19 years). Data were statistically evaluated using chi2 tests. Of the 254 participants, 37% reported PSP, while 64% were able to suppress their tics. Only a subgroup of 119 patients gave unequivocal answers to both questions and only 60% of these experienced both PSP and SPT. Statistically significant stepwise increases were found at two different age levels. One was around 10 years (PSP 'Yes' or 'No' and SPT), the other around age 14 (PSP 'Yes'). There was no influence of tic duration and age at tic onset on PSP/SPT. The reported data suggest that PSP is experienced rarely in younger children with Tourette syndrome and is not a necessary prerequisite for SPT. Increasing PSP with age merely seems to reflect cognitive development rather than intrinsic aspects of Tourette syndrome. In children under 10 years of age, SPT might require more awareness of tics than in older age groups. Developmental aspects of PSP and SPT should be taken into consideration when studies of cognitive behavioural treatment for children and adolescents with Tourette syndrome are planned.

Nicotine attenuates DOI-induced head-twitch response in mice: implications for Tourette syndrome.

Tourette syndrome (TS), a chronic neuropsychiatric disorder, is characterized by motor and vocal tics. Preliminary clinical studies indicate possible therapeutic benefits of nicotine in the treatment of Tourette's syndrome (TS). It has been proposed that twitches of the head in mice or twitches of head and shoulders in rats following administration of the selective 5HT(2A/C) agonist DOI (1-)2,5-dimethoxy-4-iodophenyl-2-aminopropane, can serve as an animal model of tics in TS. In this study, the effects of acute and chronic administration of nicotine on DOI-induced head twitch response (HTR) in male albino ICR mice were evaluated. Both acute and chronic nicotine (daily injections for 10 days) reduced the DOI-induced HTR. Moreover, chronic administration of DOI (1 mg/kg/day for 10 days) resulted in 65% increase in [125I]alpha-bungarotoxin binding in cerebellum and 41% increase in striatal [3H]cytisine binding. However, the acute inhibitory effects of nicotine were not blocked by pretreatment with the nicotinic antagonist, mecamylamine. Indeed, at higher doses, mecamylamine also reduced the DOI-induced HTR. The data suggest that both nicotine and mecamylamine may be of therapeutic potential in the treatment of some symptoms of TS.

Fluvoxamine in the treatment of obsessive-compulsive disorder and related conditions.

The mainstay of the pharmacologic treatment of obsessive-compulsive disorder (OCD) is a 10- to 12-week trial of a potent serotonin reuptake inhibitor (SRI) at an adequate dose. Double-blind, placebo-controlled trials have established the anti-obsessive-compulsive (OC) efficacy of five different SRIs. One of the most thoroughly studied of these SRIs is fluvoxamine, the focus of this article. Fluvoxamine's pharmacologic and pharmacokinetic properties, its efficacy, and guidelines for its clinical use in OCD and related disorders are briefly reviewed. Potential drug-drug interactions are discussed and placed in clinical perspective. The management of common SRI-induced side effects is also addressed. Recent comparative studies suggest that fluvoxamine may be equivalent in efficacy to clomipramine, yet better tolerated. Fluvoxamine shows promise in the treatment of several so-called OC-spectrum disorders, but additional controlled trials are needed.

Does nicotine have beneficial effects in the treatment of certain diseases?

Although tobacco smoking has long been associated with diseases of the lungs and cardiovascular system, numerous studies have demonstrated a negative association between tobacco smoking and ulcerative colitis, and the neurodegenerative diseases, Alzheimer's disease (AD) and Parkinson's disease (PD). The evidence suggests that nicotine--the main pharmacologically active ingredient of tobacco--appears to be responsible for this effect. Pure nicotine has no known carcinogenic properties and can be administered in numerous ways including transdermal patches and tablets. As a therapeutic agent, its association with tobacco can be likened to morphine and opium smoking. There is ample clinical evidence to suggest that nicotine could be beneficial in the treatment of some patients with diseases. Pharmacologically, nicotine acts on cholinergic (nicotinic-specific) receptors which are depleted in AD and PD. Nicotinic receptors also interact closely with several neurotransmitters including dopamine, which is implicated in both PD and Gilles de la Tourettes's syndrome. There is no doubt that tobacco smoking can be harmful and no-one should be encouraged to smoke. However, although nicotine has many harmful side-effects, it may have therapeutic value or at the very least be a useful tool for future drug development.

Grupo de autoayuda ASTA

Informe sobre el grupo de autoayuda para pacientes y familiares, que promueve la actividad grupal de investigación y difusión de la enfermedad

Grupo de autoayuda ASTA

Informe sobre el grupo de autoayuda para pacientes y familiares, que promueve la actividad grupal de investigación y difusión de la enfermedad