Challenges in the Diagnosis and Assessment in Patients with Tourette Syndrome and Comorbid Obsessive-Compulsive Disorder

Abstract

Tourette syndrome (TS) is characterized by the presence of vocal and motor tics with an onset in childhood. In almost 80% of patients psychiatric comorbidities coexist, particularly, attention deficit/hyperactivity disorder (ADHD), obsessive-compulsive disorder (OCD) or behavior (OCB), depression, anxiety, rage attacks, and self-injurious behaviour (SIB). In this review, we discuss current state of the art regarding diagnosis and assessment of tics and OCD in patients with TS as well as challenges related to differential diagnosis between tics and OCD-related phenomena based on a systematic literature search. While in most cases clinical symptoms can be easily classified as either tics or OCB/OCD, some phenomena lay on the frontier between tics and compulsions/obsessions. For example, compulsions may resemble tics and, vice versa, sequences of motor tics may be misdiagnosed as compulsions. Accordingly, the terms “compulsive tics” and “cognitive tics” have been introduced. The most common and typical OCD symptom in patients with TS are “just right” phenomena, which also may show an overlap with tics, since patients may perform tics repeatedly until this feeling is achieved. Similarly, repetitive behaviors in patients with TS may manifest in a more “tic-like” or a more “OCD-like” type. Furthermore, SIB shows similarities with both tics and OCD. Until today, it is unclear how to classify this symptom best, although from most recent research a closer relationship between SIB and tics is suggested. In this review, in addition, we illustrate differences of the clinical spectrum of OCD in patients with TS compared to those with “pure OCD” without tics. To assess tics, the revised version of the Yale Global Tic Severity Scale (YGTSS-R) should be used, while for the assessment of OCD, the Yale Brown Obsessive Compulsive Disorder Scale (Y-BOCS) is recommended. Finally, we briefly summarize treatment strategies for tics and OCB/OCD in patients with TS.

Comparing the ‘When’ and the ‘Where’ of Electrocortical Activity in Patients with Tourette Syndrome, Body-Focused Repetitive Behaviors, and Obsessive Compulsive Disorder

“…It refers to a feeling that something is not just as it should be [65]. Mainly present in OCD, along with the feeling of incompleteness until a compulsion is judged correctly carried out, in TS, it could take the form of repeating a tic or a specific sequence of tics a certain number of times until that feeling is achieved [66]. This repetitive sequencing could mostly take place in a specific phenotype of what is believed to be "Tourettic OCD", a hybrid condition between OCD and TS.…”

Target-Specific Effects of Deep Brain Stimulation for Tourette Syndrome: A Systematic Review and Meta-Analysis

“…Surprisingly, the current findings partly differ from what we know from previous reports and are not entirely consistent with the functionally distinction of sensorimotor, associative, and limbic pathways. It should be noted that TS is no pure motor disorder (132). Heterogeneity and complexity of the disorder might partly explain the tic improvement following amGPi DBS and OCD symptom improvement after pvlGPi DBS (131,133).…”

The Obsessive–Compulsive Symptoms in Tic Disorders and the Psychometric Properties of Children’s Yale–Brown Obsessive–Compulsive Scale: An Evidence-Based Survey in a Chinese Sample

“…There were three reasons that account for this attention. First, both the OCS and TS present repetitive behaviors and often have “just right” phenomenon, which leads to difficulties in their differential diagnosis ( 14 ). Second, SIB is present in 35% of patients with TS, and the presence of SIB is associated with obsessive–compulsive behavior ( 15 ).…”