This disorder
is characterized either by rapid, recurrent, uncontrollable movements
or by vocal outbursts, but not both, that have been present nearly
daily for more than a year without a period free of the problem longer
than three months. These repeated uncontrollable bursts of activity
or speech are called tics.
This Tic Disorder
is diagnosed when either motor (Rapid, recurrent movement of the arms,
legs, or other areas) or vocal (Vocalizations) grunts, abdominal ar
diaphragmatic contractions. But not both - see
Tourette's tics (sudden, rapid, recurrent, nonrhythmic, stereotyped
motor movement or vocalization) are experienced persistently.
Single or multiple motor or vocal tics (i.e., sudden, rapid, recurrent,
nonrhythmic, stereotyped motor movements or vocalizations), but not
both, have been present at some time during the illness.
The tics occur many times a day nearly every day or intermittently
throughout a period of more than 1 year, and during this period there
was never a tic-free period of more than 3 consecutive months.
The disturbance causes marked distress or significant impairment in
social, occupational, or other important areas of functioning.
The onset is before age 18 years.
The disturbance is not due to the direct physiological effects of
a substance (e.g., stimulants)
or a general medical condition (e.g., Huntington's disease or postviral
encephalitis).
Criteria have never been met for Tourette's
Disorder.
Associated
Features:
There may be
other symptoms, such as mental coprolalia -sudden, intrusive, senseless
thoughts of socially unacceptable or obscene words, phrases, or
sentences that differ from true obsessions in that no attempt is
made to ignore, suppress, or neutralize the thoughts, obsessions,
and compulsions.
Differential
Diagnosis:
Some disorders have similar symptoms. The clinician, therefore, in
his diagnostic attempt, has to differentiate against the following
disorders which need to be ruled out to establish a precise diagnosis.
Obssessive-Compulsive
Disorder.
Attention-Deficit/Hyperactivity
Disorder.
Asperger's Disorder.
Schizophrenia.
Tics secondary to drugs (medication
or abuse).
Stereotypical Movement
Disorder.
Obsessive-Compulsive
Disorder.
Neurologic Medical and Drug-related
Disorders Associated with Tics.
Abnormal Movements (associated with medical conditions).
Neurologic, primary and secondary.
General Medical conditions.
Drug-related tics.
Cause:
The incidence
of chronic motor or vocal tic disorder is more common than the better
known Tourette's Syndrome. The
incidence of Chronic Motor or Vacal Tic disorder ranges from 1 to
2%. It is, however, rare compared to the common short-lived childhood
tic (transient tic disorder). Tics appear to get worse during emotional
stress and are absent during sleep. It is thought that chronic tics
are a variant of Tourette’s
Syndrome and to have an underlying genetic cause.
Prognosis for children who develop this disorder
between the ages of 6 to 8 are good. Symptoms may last 4 to 6 years
and then abate in early adolescence.
Treatment:
Treatment
of chronic motor or vocal tic disorder depends on its severity, the
distress it causes to the patient, and the effects the tics have on
school or job performance. Medication and psychotherapy are used only
when there is substantial interference with ordinary activities.
Counseling
and Psychotherapy [ See
Therapy Section ]:
Psychotherapy General
Pharmacotherapy
[ See Psychopharmacology
Section ] :
Drugs used to
treat tics have a limited rate of success and a relatively high level
of side effects:
Pimozide.
Risperidone.
