Repetitive Behaviours in Patients with Gilles de la Tourette Syndrome: Tics, Compulsions, or Both?

Abstract

BackgroundRepetitive behaviours (RB) in patients with Gilles de la Tourette syndrome (GTS) are frequent. However, a controversy persists whether they are manifestations of obssessive-compulsive disorder (OCD) or correspond to complex tics.Methods166 consecutive patients with GTS aged 15–68 years were recruited and submitted to extensive neurological, psychiatric and psychological evaluations. RB were evaluated by the YBOCS symptom checklist and Mini International Neuropsychiatric Interview (M.I.N.I), and classified on the basis of a semi-directive psychiatric interview as compulsions or tics.ResultsRB were present in 64.4% of patients with GTS (107/166) and categorised into 3 major groups: a ‘tic-like’ group (24.3%–40/166) characterised by RB such as touching, counting, ‘just right’ and symmetry searching; an ‘OCD-like’ group (20.5%–34/166) with washing and checking rituals; and a ‘mixed’ group (13.2%–22/166) with both ‘tics-like’ and ‘OCD-like’ types of RB present in the same patient. In 6.3% of patients, RB could not be classified into any of these groups and were thus considered ‘undetermined’.ConclusionsThe results confirm the phenomenological heterogeneity of RB in GTS patients and allows to distinguish two types: tic-like behaviours which are very likely an integral part of GTS; and OCD-like behaviours, which can be considered as a comorbid condition of GTS and were correlated with higher score of complex tics, neuroleptic and SSRIs treatment frequency and less successful socio-professional adaptation. We suggest that a meticulous semiological analysis of RB in GTS patients will help to tailor treatment and allow to better classify patients for future pathophysiologic studies.Trial RegistrationClinicalTrials.gov NCT00169351

Neuromodulation for Obsessive–Compulsive Disorder

“…Tourette's disorder, associated with both motor tics and OCD-like symptoms, supports the idea that a single neural substrate can produce both motor and psychiatric illness. Tourette's and OCD exhibit significant comorbidity and genetic associations, highlighting the etiological importance of the basal ganglia in OCD symptoms [12][13][14]. Basal ganglia circuit dysfunction is thought to play a role in the generation of both motor and OCD symptoms in Tourette's syndrome [15,16].…”

Rare missense neuronal cadherin gene (CDH2) variants in specific obsessive-compulsive disorder and Tourette disorder phenotypes

“…[1][2][3][4][5][6] Compulsive, repetitive and tic/TD-like behaviors in rodent models have been associated with variants in single genes such as Sapap3 and Slitrk5. [7][8][9][10] Recently, single-nucleotide polymorphisms (SNPs) within the canine neuronal cadherin gene (CDH2) were shown to confer a significant risk for canine compulsive disorder (CCD).…”

Tics and Tourette Syndrome

“…4 In contrast, in GTS, they are largely a result of an inner urge and are most often associated with symmetry behaviors, "just right" experiences, and repetitive touching. 4,21,22 However, in certain cases, these behaviors overlap and may also change with development, in support of the pathophysiologic commonalities between OCD and GTS suggested also by genetic and imaging findings. 23,24 Of note, comorbid OCD in a large sample of children and adolescents with GTS (n 5 5060) was found to be associated with ADHD, mood and anxiety disorders, conduct disorder/oppositional defiant disorder, and ASD.…”

“…18,20 From a clinical point of view, the presence of OCS/OCB/OCD may pose diagnostic difficulties in certain motor behaviors encountered in GTS patients that seem to fall between the phenomenological spectra of tics and obsessions/compulsions. 4,21,22 However, characteristic clinical features aid the diagnostic distinction and classification between different phenomena. For example, in pure OCD, obsessions that lead to compulsions are sources of major anxiety and discomfort, are intrusive and disruptive (or "ego-dystonic"), and are commonly related to fears of contamination and/or causing harm.…”