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.
