Anger symptoms and “delinquent” behavior in Tourette syndrome with and without attention deficit hyperactivity disorder

Cavanna, Andrea E.; Cavanna, Stefano; Monaco, Francesco

doi:10.1016/j.braindev.2007.08.012

Cited by 11 publications

(9 citation statements)

References 3 publications

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“…Comorbidities may provide the underlying structure for the broad range of phenotypic expression, and as such, are a key variable to explicating the complexity of the clinical profile. Largely, pure GTS does not typically present with severe motor or executive dysfunction, although these individuals are suggested to exhibit more obsessive–compulsive and self-injurious behavior and are more “delinquent” than GTS + ADHD, likely as a result of rage or anger (Robertson 2000; Rizzo et al 2007; Cavanna et al 2008). GTS comorbid with ADHD presents with appreciable cognitive and behavioral disability, and GTS co-occurring with both ADHD and OCD presents as more heritable with motor tics appearing at an earlier age (Grados and Mathews 2008, 2009).…”

Section: Introductionmentioning

confidence: 99%

Putting the Pieces Together in Gilles de la Tourette Syndrome: Exploring the Link Between Clinical Observations and the Biological Basis of Dysfunction

2016

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Gilles de la Tourette syndrome is a complex, idiopathic neuropsychiatric disorder whose pathophysiological mechanisms have yet to be elucidated. It is phenotypically heterogeneous and manifests more often than not with both motor and behavioral impairment, although tics are its clinical hallmark. Tics themselves present with a complex profile as they characteristically wax and wane and are often preceded by premonitory somatosensory sensations to which it is said a tic is the response. Highly comorbid with obsessive–compulsive disorder and attention deficit-hyperactivity disorder, it is purported to be an epigenetic, neurodevelopmental spectrum disorder with a complex genetic profile. It has a childhood onset, occurs disproportionately in males, and shows spontaneous symptomatic attenuation by adulthood in the majority of those afflicted. Although not fully understood, its neurobiological basis is linked to dysfunction in the cortico-basal ganglia–thalamo–cortical network. Treatment modalities for Tourette syndrome include behavioral, pharmacological and surgical interventions, but there is presently no cure for the disorder. For those severely affected, deep brain stimulation (DBS) has recently become a viable therapeutic option. A key factor to attaining optimal results from this surgery is target selection, a topic still under debate due to the complex clinical profile presented by GTS patients. Depending on its phenotypic expression and the most problematic aspect of the disorder for the individual, one of three brain regions is most commonly chosen for stimulation: the thalamus, globus pallidus, or nucleus accumbens. Neurophysiological analyses of intra- and post-operative human electrophysiological recordings from clinical DBS studies suggest a link between tic behavior and activity in both the thalamus and globus pallidus. In particular, chronic recordings from the thalamus have shown a correlation between symptomatology and (1) spectral activity in gamma band power and (2) theta/gamma cross frequency coherence. These results suggest gamma oscillations and theta/gamma cross correlation dynamics may serve as biomarkers for dysfunction. While acute and chronic recordings from human subjects undergoing DBS have provided better insight into tic genesis and the neuropathophysiological mechanisms underlying Tourette syndrome, these studies are still sparse and the field would greatly benefit from further investigations. This review reports data and discoveries of scientific and clinical relevance from a wide variety of methods and provides up-to-date information about our current understanding of the pathomechanisms underlying Tourette syndrome. It gives a comprehensive overview of the current state of knowledge and addresses open questions in the field.

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Section: Introductionmentioning

confidence: 99%

Putting the Pieces Together in Gilles de la Tourette Syndrome: Exploring the Link Between Clinical Observations and the Biological Basis of Dysfunction

2016

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“…Indeed, medical literature has documented the presence of aggressive incidents, including self-injurious behaviors 4 and intermittent episodes of explosive anger (sometimes also referred to as "rage attacks"), in the presence of neuropsychiatric comorbidities, such as ADHD. [5][6][7] In summary, these 3 cases help raise awareness over the differences between repetitive allo-aggression and primary tics. The potential legal ramifications of such behaviors, which may have different etiologies, should be clearly distinguished from tics and their associations.…”

Section: Discussionmentioning

confidence: 94%

“…Indeed, medical literature has documented the presence of aggressive incidents, including self‐injurious behaviors 4 and intermittent episodes of explosive anger (sometimes also referred to as “rage attacks”), in the presence of neuropsychiatric comorbidities, such as ADHD. 5 , 6 , 7 …”

Section: Discussionmentioning

confidence: 99%

Aggression Toward Others Misdiagnosed as Primary Tics

Kurvits

Mainka

Cavanna

et al. 2021

Movement Disord Clin Pract

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BackgroundBackground: Tics describe a wide range of sudden and repetitive behaviors. Their multifaceted clinical features may resemble other explosive behaviors, including repetitive episodes of aggression toward others (allo-aggression) reported by subjects without tics. Here, we document 3 exemplary cases that help disentangle allo-aggressive behaviors from tics. Cases Cases: We report 3 cases who presented with an array of complex repetitive behaviors, most notably alloaggression (eg, sudden kicking, hitting, slapping and biting others, or pushing someone off a bike), which were misdiagnosed as primary tics. In all cases, additional symptoms, such as blackouts, feeling of being controlled by different personalities, or being empowered by repetitive behaviors, and examination pointed toward different neuropsychiatric diagnoses. Conclusions Conclusions: Repetitive allo-aggressive behaviors are not part of the range of motor manifestations of tics. This observation not only has important medico-legal implications but is also relevant for the overall perception of Tourette syndrome and other primary tic disorders.Among the range of hyperkinetic movement disorders, tics have the widest phenomenological variability and most closely resemble voluntary actions. Any type of brief and sudden movement or sound can also be a tic, and it may often be very difficult to distinguish between tics and other explosive repetitive phenomena, including more complex behaviors. 1 This issue has important clinical implications because correct phenomenological labelling and etiological classification will determine appropriate treatment selection.Most recently, we came across 3 patients who presented with sudden and repetitive episodes of aggression toward others (alloaggressive behaviors), such as throwing objects and biting or kicking others, which were initially misdiagnosed as primary tics. Clinical history and examination subsequently pointed toward different neuropsychiatric diagnoses. Given the medico-legal importance of this issue and the implications it carries both for diagnosis and the overall perception of tic disorders, including media depictions, we describe the characteristics of these cases and discuss the phenomenon of allo-aggression in the context of tics. Case Series Case 1Case 1 is an adolescent female, who, a few months before current presentation, had suddenly (overnight) developed repetitive behaviors, including head and whole-body thrusting, arm flailing, repetitive vocalizations, coprophenomena (eg, showing the middle finger while shouting different obscene words), and allo-aggression. She would abruptly and repetitively kick, hit or slap others, often specific people. She reported having no control over these behaviors, which she needed to let out, often as the result of a mounting inner tension. She reported that her behaviors were often determined by other personalities taking control

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“…Patients with GTS alone were reported to have similar levels of aggression, delinquency, and conduct difficulties to unaffected controls. It is difficult to know, however, whether these behaviors are related to GTS-specific anger symptoms or comorbid ADHD (Cavanna, Cavanna, & Monaco, 2008;Rizzo et al, 2007).…”

Section: Comorbidities: Attention-deficit and Hyperactivity Disordermentioning

confidence: 99%

An Introduction to the Clinical Phenomenology of Tourette Syndrome

Martino¹,

Madhusudan²,

Zis³

et al. 2013

International Review of Neurobiology

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Anger symptoms and “delinquent” behavior in Tourette syndrome with and without attention deficit hyperactivity disorder

Cited by 11 publications

References 3 publications

Putting the Pieces Together in Gilles de la Tourette Syndrome: Exploring the Link Between Clinical Observations and the Biological Basis of Dysfunction

Putting the Pieces Together in Gilles de la Tourette Syndrome: Exploring the Link Between Clinical Observations and the Biological Basis of Dysfunction

Aggression Toward Others Misdiagnosed as Primary Tics

An Introduction to the Clinical Phenomenology of Tourette Syndrome

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