Evidence-based treatment of Tourette’s disorder and chronic tic disorders

Essoe, Joey K.-Y.; Grados, Marco A.; Singer, Harvey S.; Myers, Nicholas S.; McGuire, Joseph F.

doi:10.1080/14737175.2019.1643236

Cited by 25 publications

(21 citation statements)

References 128 publications

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“…Tics usually start at childhood with a peak age between 7 to 15 years and persist to late adolescence or even early adulthood (Zhang & Li, 2015). TS is associated with attention deficit hyperactivity disorder, obsessive‐compulsive disorder, and emotional disorder, which may severely influence children's social adaptation ability (Deeb et al., 2019; Ekinci & Erkan, 2020; Essoe et al., 2019; Kuhn & Huys, 2019). So far, the pathophysiology of TS is still not fully clear, and there are very few safe and effective drugs for treating TS.…”

Section: Introductionmentioning

confidence: 99%

Immune function changes of the IDPN‐induced Tourette syndrome rat model

Liu

Wang²,

2021

Intl J of Devlp Neuroscience

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There may be immunologic alternations during Tourette syndrome (TS) development. This study aimed to determine the immune function changes in different aspects (spleen or thymus index, plasma cytokines, and T cell) in an 3,3′‐iminodipropionitrile (IDPN)‐induced rat model of TS. Male Sprague‐Dawley rats were assigned to control and TS groups. The control group received intraperitoneal infections of normal saline (5 ml kg−1 day−1), and the TS rats were injected with IDPN (150 mg kg−1 day−1). The spleen and thymus indices were calculated. The expression of anti‐inflammatory cytokines and inflammatory cytokines TNF‐α, in peripheral blood were measured by ELISA and Western blotting. The proportion of CD3+, CD4+, CD8+, Treg, Th1, and Th2 cells were determined by fluorescence‐activated cell sorting analysis. After 1 week of IDPN treatment, TS rats had decreased spleen and thymus weights versus control. The plasma levels of IL‐4, IL‐10, IL‐12, IFN‐γ, and TNF‐α were significantly increased, while no significant difference in TGF‐β was found. Flow cytometry analysis demonstrated that TS rats had significantly reduced CD3+ and CD4+ cells in spleen, without any change in the proportion of CD8+ cells. Furthermore, the ratio of Treg cells (CD4+/CD25+/FoxP3+) was decreased in TS rats; simultaneously, Th1 cells (CD4+/IFN‐γ+) and Th2 cells (CD4+/IL4+) were dramatically increased. Together, IDPN can trigger immune dysfunction through impairment of matured Th cells, in particular for the Treg subset.

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Section: Introductionmentioning

confidence: 99%

Immune function changes of the IDPN‐induced Tourette syndrome rat model

Liu

Wang²,

2021

Intl J of Devlp Neuroscience

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“…Behavioral interventions were carried out using a structured protocol, which included all the usual components of HRT and CBIT. 4 , 19 Additional ERP was used in one patient for control of tics and in four patients for the treatment of OCD. Supportive sessions were carried out with both the patients and the caregivers for improving their understanding of the treatment, helping them deal with the emotional and social consequences of the illnesses, and enhancing their motivation for treatment.…”

Section: Discussionmentioning

confidence: 99%

“…However, the only ones with proven efficacy are HRT, CBIT, and ERP. [4][5][6][7][8] Therefore, the current consensus on management of TD recommends psychoeducation when tics are transient or mild, behavioral interventions for tics of moderate severity, and combined treatment with medications (alpha-2 agonists or antipsychotics) T ourette's disorder (TD) is a childhood-onset complex neurodevelopmental disorder characterized by multiple motor and vocal tics, frequently accompanied by comorbid psychiatric disorders. 1 The overall in-and HRT, CBIT, or ERP when the tics are severe.…”

Section: Practical Psychotherapymentioning

confidence: 99%

“…1 The overall in-and HRT, CBIT, or ERP when the tics are severe. [4][5][6] The principal components of HRT are awareness training (self-detection of premonitory urges and tics), competing response training (learning voluntary behaviors physically incompatible with tics), and caregiver support (enhancing the patients' awareness and encouragement by caregivers). CBIT utilizes these core HRT components along with relaxation training, psychoeducation, and functional intervention (identifying events that worsen tic severity and developing strategies to manage them in daily life).…”

Section: Practical Psychotherapymentioning

confidence: 99%

“…However, the only ones with proven efficacy are HRT, CBIT, and ERP. 4 – 8 Therefore, the current consensus on management of TD recommends psychoeducation when tics are transient or mild, behavioral interventions for tics of moderate severity, and combined treatment with medications (alpha-2 agonists or antipsychotics) and HRT, CBIT, or ERP when the tics are severe. 4 – 6 …”

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confidence: 99%

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Behavior Therapy for the Treatment of Tourette’s Disorder in India: A Patient Series from an Indian General Hospital Psychiatric Unit

Varadharajan

Chakrabarti

Sahoo

et al. 2020

Indian Journal of Psychological Medicine

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Reports on behavioral interventions for the treatment of Tourette’s disorder (TD) from India are limited. This patient series describes the usefulness and feasibility of conducting behavioral interventions for patients with TD from an Indian general hospital psychiatric unit. Behavioral treatments in these seven consecutively treated adult/adolescent patients with TD included all components of habit reversal treatment, comprehensive behavioral intervention for tics, and exposure with response prevention in some patients. Patients were predominantly male, with adolescent-onset severe TD, typical features and psychiatric comorbidities, and poor response to multiple medications prior to the institution of behavior therapy. In addition to long delays in diagnosis, none of the patients or their caregivers had been informed by the doctors they had consulted earlier about TD or the need for behavioral treatments before attending our center. Institution of behavioral treatments along with medications led to a 75% reduction in the severity of tics and reduction in comorbid symptoms. Patients and caregivers also reported similar rates of improvement as well as reductions in subjective distress and caregiver burden. Five patients have been followed up for seven months to seven years; apart from one patient, all others have had only minor exacerbations of tics during this period. This limited experience suggests that behavior therapies for TD can be successfully implemented in low-resource, non-specialized Indian settings. They are effective, and gains from such treatment are usually enduring.

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Taxonomy and utility in the diagnostic classification of mental disorders

et al. 2021

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Objective One strategy for improving the clinical utility of mental health diagnostic systems is to better align them with how clinicians conceptualize psychopathology in practice. This approach was used in International Classification of Diseases 11th Revision (ICD‐11) development, but its underlying assumption—a link between taxonomic “fit” and clinical utility—remains untested. Methods Using data from global mental health clinician samples (combined N = 5404), we investigated the association between taxonomic fit and clinical utility in mental disorder categories. Results The overall association between fit and utility was positive (r = 0.19) but statistically not different from zero (95% confidence interval [CI]: −0.06, 0.43) in this small sample (N = 39 ICD/DSM categories). However, a positive association became clear after correcting for outliers (r = 0.34 [0.05, 0.58] or higher). Further insights were apparent for specific diagnoses given their locations in the scatterplot. Conclusions Results suggest a positive link between taxonomic fit and clinical utility in mental disorder diagnoses, highlighting future research directions.

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Evidence-based treatment of Tourette’s disorder and chronic tic disorders

Cited by 25 publications

References 128 publications

Immune function changes of the IDPN‐induced Tourette syndrome rat model

Immune function changes of the IDPN‐induced Tourette syndrome rat model

Behavior Therapy for the Treatment of Tourette’s Disorder in India: A Patient Series from an Indian General Hospital Psychiatric Unit

Taxonomy and utility in the diagnostic classification of mental disorders

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