Disruptive Behavior in Children With Tourette's Syndrome: Association With ADHD Comorbidity, Tic Severity, and Functional Impairment

Sukhodolsky, Denis G.; Scahill, Lawrence; Zhang, Heping; Peterson, Bradley S.; King, Robert A.; Lombroso, Paul J.; Katsovich, Lily; Findley, Diane B.; Leckman, James F.

doi:10.1097/00004583-200301000-00016

Cited by 269 publications

(212 citation statements)

References 42 publications

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“…In clinic populations, approximately 65% of children with TS meet the diagnostic criteria for Attention Deficit with Hyperactivity Disorder [10]. In addition, over half also have significant obsessive-compulsive symptoms, and approximately 30% meet the diagnostic criteria for obsessive-compulsive disorder (OCD).…”

Section: Tourette Syndromementioning

confidence: 99%

Tourette syndrome and obsessive–compulsive disorder

Lombroso

Scahill

2008

Brain and Development

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Tourette syndrome and obsessive-compulsive disorder are neuropsychiatric disorders that have sparked considerable interest over the decades. They are the focus of research for a remarkable diversity of disciplines, ranging from neuroimagers and prenatal epidemiologists to experts in the neural circuits that connect the cortex with the basal ganglia, as well as neuroimmunologists focusing on brain-based autoimmune phenomena. Several hypotheses have been put forward to explain the onset and exacerbation of these illnesses. Here we discuss the clinical phenomenology and treatment options that are currently available. New psychopharmacological agents are being used that are based on a greater understanding of the neurobiology and are being used in combination with behavioral interventions. Longitudinal clinical investigations into clinical symptoms and the natural course are providing additional clues on the underlying pathophysiology. Recent advances in research models are also reviewed in an attempt to clarify some of the molecular etiologies that lead to these disorders. KeywordsTorrette syndrome; obsessive-compulsive disorder; basal ganglia; autoimmune disorders; streptococcal infections; neuroleptic treatment Tourette syndrome (TS) and obsessive-compulsive disorder (OCD) are model neuropsychiatric disorders that have been the subject of medical interest for centuries [1]. Many explanations have been suggested for the etiology of tics and OCD symptoms and have included genetic factors, the influence of toxins, psychological, and infectious processes. There have been significant advances of our understanding of the neurobiological mechanisms at work in these disorders, as well as improvements in the treatments available. Several reviews on more specialized aspect of TS, OCD and related disorders have appeared over the last several years [2][3][4]. Here we concentrate on the clinical features of tic disorders and OCD and discuss evidence-based interventions for these disorders. Tourette syndromeTourette syndrome is one of several tic disorders that are classified either by their type (motor or phonic tic) or their duration (transient or chronic). The diagnosis of a transient tic is made if the tics are present for less than 12 months. If the tics persist for more than 12 months, they

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Section: Tourette Syndromementioning

confidence: 99%

Tourette syndrome and obsessive–compulsive disorder

Lombroso

Scahill

2008

Brain and Development

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“…Indeed, increased tics after stimulant exposure may only occur in a minority of cases with this combined syndrome. 148 Given the added disability attributable to ADHD in children and adolescents with TS, 170 aggressive treatment of ADHD in these cases is warranted. After a review of the alternatives and the family's preference, treatment may start with an ␣-2 agonist (guanfacine or clondine) or stimulant medication.…”

Section: Pharmacotherapy Of Adhd In Children and Adolescents With Tsmentioning

confidence: 99%

“…170,188,189 A variety of medications, including anticonvulsants, lithium, propranolol, psychostimulants, clonidine, and antipsychotics, have been used clinically in TS patients, but there are no controlled studies. An open trial of paroxetine (average dose 33.3 mg/day) in 45 patients with TS and explosive anger outbursts showed a significant decrease in both intensity and frequency of outbursts in 76% (n ϭ34).…”

Section: Aggression and Explosive Behaviormentioning

confidence: 99%

Contemporary assessment and pharmacotherapy of Tourette syndrome

et al. 2006

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Summary:To develop a guide to clinical assessment and pharmacotherapy for children and adults with Tourette syndrome (TS), we reviewed published literature over the past 25 years to identify original articles and reviews on the assessment and pharmacological treatment of Tourette syndrome, attention-deficit/hyperactivity disorder (ADHD) and obsessivecompulsive disorder (OCD). The literature search also included a survey of reviews published in book chapters. The assessment section was compiled from several reviews. Pharmacological treatments were classified into those with strong empirical support (as evidenced by two positive placebo-controlled studies for tics, OCD, or ADHD in TS samples); modest empirical support (one positive placebo-controlled study), or minimal support (open-label data only). We conclude that accurate diagnosis, including identification of comorbid conditions, is an essential step toward appropriate treatment for patients with TS. In many patients with TS, symptom management requires pharmacotherapy for tics or coexisting conditions. The evidence supporting efficacy and safety for medications used in patients with TS varies. But this evidence offers the best guide to clinical practice.

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“…3 According to recent community-based studies, the prevalence of TS in school-aged children ranges from one to eight per 1,000. 4 According to Robertson, TS affects at least 1% of the population worldwide. 5,6 The etiopathogenesis of TS is unknown, but may be associated with a disturbance in the striatalthalamic-cortical (mesolimbic) pathway, which leads to a disinhibition of the motor and limbic system.…”

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confidence: 99%

Tourette's syndrome and associated disorders: a systematic review

Ferreira

Pio-Abreu

Januário

2014

Trends Psychiatry Psychother.

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Objective: To compile data on Tourette's syndrome (TS), tics and associated disorders. Methods: A systematic review of the literature was conducted using the 5S levels of organization of healthcare research evidence (systems, summaries, synopses, syntheses, studies), based on the model described by Haynes. The search keywords were Tourette, tics and comorbidity, which were cross-referenced. Studies provided by publishers and articles being processed on July 31, 2013, were also included. Results: Of all studies retrieved during the search, 64 were selected because they analyzed the epidemiology, clinical features and etiopathogenesis of TS and its comorbidities. TS is classified as a hyperkinetic movement disorder, and at least 90% of the patients have neuropsychiatric comorbidities, of which attention deficit hyperactivity and obsessive-compulsive disorders are the most common. The syndrome is clinically heterogeneous and has been associated with a dysfunction of cortico-striatal-thalamic-cortical circuits involving various neurotransmitters. Although its genetic etiology has been widely studied, other factors may be important to understand this syndrome and its associated disorders. Conclusions: TS is a neurodevelopmental disorder that results from the impact of stress factors on a vulnerable biological substrate during the critical periods of neurodevelopment. The study of TS and its comorbidities may contribute, at different levels, to the understanding of several neuropsychiatric disorders of clinical and therapeutic relevance. Keywords: Attention deficit disorder with hyperactivity, comorbidity, obsessive-compulsive disorder, tics, Tourette's syndrome. ResumoObjetivo: Compilar o conhecimento existente sobre a síndrome de Tourette (ST), tiques e patologias associadas. Metodologia: Foi realizada uma revisão sistemática da literatura usando os níveis 5S (sistemas, sumários, sinopses, sínteses e estudos) de organização de evidência de pesquisa em saúde, com base no modelo proposto por Haynes. Os termos de busca foram Tourette, tiques e comorbidades, completados por pesquisa por referência cruzada. Os artigos fornecidos pelos editores e aqueles a serem processados para publicação em 31 de julho de 2013 também foram incluídos. Resultados: De todos os artigos encontrados durante a pesquisa, 64 foram selecionados porque analisavam a epidemiologia, as características clínicas e a etiopatogenia da ST. A ST define-se como um distúrbio hipercinético do movimento, e pelo menos 90% dos pacientes apresentam comorbidades neuropsiquiátricas, das quais as mais comuns são a perturbação de déficit de atenção com hiperatividade e a perturbação obsessivo--compulsiva. Esta síndrome é clinicamente heterogênea e tem sido relacionada com a disfunção dos circuitos córtico-estriado--tálamo-corticais envolvendo vários neurotransmissores. Apesar de sua etiologia genética ter sido amplamente estudada, outros fatores podem ser importantes para entender esta síndrome e as perturbações relacionadas. Conclusões: A ST resulta de uma p...

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Disruptive Behavior in Children With Tourette's Syndrome: Association With ADHD Comorbidity, Tic Severity, and Functional Impairment

Cited by 269 publications

References 42 publications

Tourette syndrome and obsessive–compulsive disorder

Tourette syndrome and obsessive–compulsive disorder

Contemporary assessment and pharmacotherapy of Tourette syndrome

Tourette's syndrome and associated disorders: a systematic review

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