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Tics and Tourette's syndrome (Clinical presentation (Tourette's…
Tics and
Tourette's syndrome
Clinical
presentation
Tourette's syndrome
Motor tics: clonic, tonic, dystonic, jerks, blinks, nods, gestures
Vocal tics: grunting, coughing, humming, squeaking,
swearing (copralalia)
Idiopathic tic disorder
Blinking/frowning
Sniffing
Throat clearing
Grunting
Diagnosis
Examination
Developmental exam
Any delay
MSE
Any signs of underlying mental health disorder
e.g. anxiety, depression, psychosis
History
PPH
Known psychiatric problems
PMH
Growth and development
Known medical conditions
PC/HPC
Type of tics (motor, vocal, both)
DH
Meds, allergies
FH
Transient tic disorder, Tourette's,
other mental health disorders
SH
Social support, living arrangements,
school/occupation, smoking, alcohol, drugs
Management
Transient tic
disorder
Conservative
Information, advice, support
Tourette's
syndrome
Conservative
Information, advice, support
Psychological
CBT
Indcation: 1L
MOA: retrains thinking patterns
to dissociate actions and compulsions,
habit reversal techniques
Medical
Antipsychotics
Indication: serious Tourette's
E.g. risperidone, haloperidol, clonidiine
Prognosis
Transient tic disorder
Resolves spontaneously
over months/years
Tourette syndrome
Chronic disorder, persists medium term
Can resolve with treatment
Definition
Movement disorder of a quick,
sudden, coordinated movement
Epidemiology
Idiopathic tics
Common in children
Onset ~8y
M>F
Tourette's syndrome
Uncommon
Pathophysiology
Idiopathic tics
Transient disorder
Occurs when inactive not when concentrating
May be worsened by anxiety
Tourette's syndrome
Tics are voluntary but unwanted
Relives an odd sensation
Associated with OCD and ADHD
May involve structural brain changes, including the thalamus