Prospective follow‐up study of youth and adults with onset of functional tic‐like behaviours during the COVID‐19 pandemic

Abstract

Background and purposeVery little is known about the long‐term prognosis of patients with functional tic‐like behaviours (FTLBs). We sought to characterize the trajectory of symptom severity over a 12‐month period.MethodsPatients with FTLBs were included in our prospective longitudinal child and adult clinical tic disorder registries at the University of Calgary. Patients were prospectively evaluated 6 and 12 months after their first clinical visit. Tic inventories and severity were measured with the Yale Global Tic Severity Scale (YGTSS).ResultsEighty‐three youths and adults with FTLBs were evaluated prospectively until April 2023. Mean YGTSS total tic severity scores were high at baseline, with a mean score of 29.8 points (95% confidence interval [CI] = 27.6–32.1). Fifty‐eight participants were reevaluated at 6 months, and 32 participants were reevaluated at 12 months. The YGTSS total tic severity score decreased significantly from the first clinical visit to 6 months (raw mean difference = 8.9 points, 95% CI = 5.1–12.7, p < 0.0001), and from 6 to 12 months (raw mean difference = 6.4 points, 95% CI = 0.8–12.0, p = 0.01). Multivariable linear regression demonstrated that tic severity at initial presentation and the presence of other functional neurological symptoms were associated with higher YGTSS total tic scores at 6 months, whereas younger age at baseline, receiving cognitive behavioural therapy for anxiety and/or depression, and prescription of selective serotonin reuptake inhibitors were associated with lower YGTSS total tic scores at 6 months.ConclusionsWe observed a meaningful improvement in tic severity scores in youth and adults with FTLBs over a period of 6–12 months.

Time is ticking for TikTok tics: A retrospective follow‐up study in the post‐COVID‐19 isolation era

“…The CGI data gathered at follow‐up visits from August 2022 to January 2023 showed that approximately three‐fourths of patients had improvement in FTLBs, independent of comorbid diagnoses. This is in keeping with findings across other sites (Howlett et al., 2022 ; Nilles et al., 2023 ; Prato et al., 2022 ) and in contrast to tic disorders which tend to be more treatment‐resistant. The cessation of COVID‐19 isolation protocols likely reduced the burden of depression and anxiety.…”

“…This rate of improvement is similar to patients who received therapy without an SSRI or SSNRI (78%). This finding is consistent with well-studied outcomes for anxiety and depression that have shown that treatment with therapy alone is equally effective compared to treatment with SSRIs at 6-month follow-up (March et al, 2007), Other studies have also found that the CBT and SSRIs were effective for promoting symptom improvement (Howlett et al, 2022;Nilles et al, 2023).…”

“…Among our study cohort, 48 (86%) patients pursued psychotherapy, with 34% also receiving CBIT. While other studies have examined the role of psychotherapy for anxiety/depression, such as cognitive behavioral therapy (CBT) or CBIT in treating FTLBs (Nilles et al., 2023 ), our study included a larger cohort of patients receiving CBIT for functional tics. We found that CBIT conferred no additional benefit.…”

“…Following the onset of the COVID‐19 pandemic, adolescent and adult patients (Nilles et al., 2023 ), mostly without a prior history of tics, presented with acute onset of FTLBs to clinics and emergency departments worldwide (Malaty et al., 2022 ; Müller‐Vahl et al., 2022 ). The increase in FTLBs coinciding with the COVID‐19 lockdown was so rapid and widespread that it was described as a “pandemic within a pandemic” (Olvera et al., 2021 ).…”

What are the Key Phenomenological Clues to Diagnose Functional Tic‐Like Behaviors in the Pandemic Era?

“…A quick recognition of FTLBs versus tics is very important in the clinic, because misdiagnosis of FTLBs can lead to escalation of potentially deleterious treatments. Currently, proposed management of FTLBs includes psychoeducation, behavioral interventions and treatment of mental health comorbidities 17,25,29–31 …”