Gilles de la Tourette’s Syndrome

Gilles de la Tourette’s Syndrome

first recognized by Georges Gilles de la Tourette in 1885
undergone many name changes ("maladie de tic", "Wandering Jew Disease"). Believed for some time to be strictly organic (Scahill, Ort, and Hardin, 1993).
Shapiro (1978) first recognized "Tourette’s Syndrome" as a psychological disorder.
tics and twitches typically manifest between the ages of 7-10, although associated conditions (ex. ADHD) may appear earlier (sometimes leading to misdiagnosis).
prevalence estimates vary depending on definition of disorder , *1 in 20 000 ,*1 in 200 (TSFC), *18 in 100 (Comings, 1990)

        2:1 (Rutter and Hemming, 1970)
        9:1 (Burd et. al., 1986)
        1.7:1 (Apter et. al., in press)

TICS and TWITCHES and JERKS, oh my…..

(appear to be) sudden, rapid, recurrent, nonrhythmic motor movements or vocalizations

experienced as irresistible, but can be suppressed for varying lengths of time.
various tics and/or the entire disorder wax and wane over time, environment, and personal arousal level.
aggravated by anxiety, stress, boredom, fatigue, and excitement (Robertson, 1989).
sleep, alcohol, orgasm, fever, relaxation, and intense concentration reduce or eliminate tics (Robertson, 1989).
like a cognitive "itch". The more one attempts to actively inhibit the urge the worse the desire becomes, and the greater the demand on cognitive resources becomes.
Tourette’s preys most on actions that are frequent, habituated, and stereotyped.

Tics? Tip of the Iceberg

*self (confusion, depression -- regard as globally bad)

*family (misperceive, misinterpret. Poor bonds)

*peers (ridicule, ostracism)

Reconceptualizations of TS, OCD, ADHD, etc…... Generalized Disinhibition Disorder (Comings, 1990)

The Gts Gene(s): semi-dominant, semi-recessive.
This gene is responsible for disinhibited behaviour, which may manifest in various realms, including motor, learning and memory, anxiety level, frontal lobe syndromes, and obsessive-compulsive behaviour
Evidence suggests that TS’ers have inherited 2 Gts genes. Carriers of 1 Gts gene have lesser disinhibitory problems, or no symptoms.

DSM-IV Criteria

Both multiple motor and one or more vocal tics have been present at some time during the illness, although not necessarily concurrently.
The tics occur many times a day (usually in bouts) 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 (ex. stimulants) or a general medical condition (ex. Huntington’s disease or postviral encephalitis).

CONDITIONS HIGHLY COMORBID WITH TS