The roles of anxiety and depression in connecting tic severity and functional impairment

Lewin, Adam B.; Storch, Eric A.; Conelea, Christine A.; Woods, Douglas W.; Zinner, Samuel H.; Budman, Cathy L.; Scahill, Lawrence; Compton, Scott N.; Walkup, John T.; Murphy, Tanya K.

doi:10.1016/j.janxdis.2010.08.016

Cited by 46 publications

(29 citation statements)

References 41 publications

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“…Despite the different schedules, the results were remarkably consistent, and also concordant with adult data in the main, showing that GTS patients have a reduced QoL when compared with normative data and healthy individuals; employment status, tic severity, as well as greater emotional and behavioural difficulties, OCB, OCD, ADHD, anxiety and depression, all affect the QoL. In addition, functional impairment is increased with patients with GTS 50 51. On the other hand, Eddy et al 48 did not find similar results but in contrast to the other studies that tic severity affected QoL.…”

Section: The Effect Of Gts On the Patient And The Family (Quality Of supporting

confidence: 78%

The Gilles De La Tourette syndrome: the current status

Robertson

2012

Arch Dis Child Educ Pract Ed

162

115

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Gilles de la Tourette syndrome (GTS) is characterised by multiple motor and one or more vocal/phonic tics. GTS was once thought to be rare, but many relatively recent studies suggest that the prevalence is about 1% of the worldwide community, apart from in Sub-Saharan Black Africa. Comorbidity and coexistent psychopathology are common, occurring in about 90% of clinical cohorts and individuals in the community. The most common comorbidities are attention deficit hyperactivity disorder, obsessive-compulsive behaviours, and disorder, and autistic spectrum disorders, while the most common coexisting psychopathologies are depression, anxiety and behavioural disorders such as oppositional defiant and conduct disorder. There has been an increasing amount of evidence to show that the quality of life in young people is reduced when compared with normative data or healthy control populations. It is widely accepted that most cases of GTS are inherited, but the genetic mechanisms appear much more complex than previously understood, as evidenced by many recent studies; indeed, there have been suggestions of 'general neurodevelopmental genes' which affect the brain development after which the 'specific GTS gene(s)' may further affect the phenotype. Other aetiopathogenetic suggestions have included environmental factors such as neuro-immunological factors, infections, prenatal and peri-natal difficulties and androgen influences. Few studies have addressed aetiology and phenotype, but initial results are exciting. The search for endophenotypes has followed subsequently. Intriguing neuroanatomical and brain circuitry abnormalities have now been suggested in GTS; the most evidence is for cortical thinning and a reduction in the size of the caudate nucleus. Thorough assessment is imperative and multidisciplinary management is the ideal. Treatment should be 'symptom targeted', and in mild cases, psycho-education and reassurance for the patient and the family may be sufficient. Behavioural treatments such as Comprehensive Behavioural Intervention for Tics including Habit Reversal Training have been shown to be significantly better than other behavioural/psychological treatments and 'placebo'. Medication is often necessary for moderately affected individuals. In more severe cases, medical treatment is not simple and referral to an expert may be advisable. In general, neuroleptics and clonidine or guanfacine are the medications of choice for the tics. Other treatments which may be needed for loud and severe phonic tics include botulinum toxin. In severe adult GTS patients who are refractory to medication and other therapies, deep brain stimulation looks promising.

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Section: The Effect Of Gts On the Patient And The Family (Quality Of supporting

confidence: 78%

The Gilles De La Tourette syndrome: the current status

Robertson

2012

Arch Dis Child Educ Pract Ed

162

115

View full text Add to dashboard Cite

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“…together, the results of these studies highlight the importance of addressing the psychological wellbeing of patients with GTS as a way to improve their self-concept throughout childhood, adolescence and early adulthood (34,35) . Of note, the findings of clinical studies published in the last few years suggested the potential efficacy of broader interventions focused on the adverse psychosocial consequences of tics (36,37) .…”

Section: Discussionmentioning

confidence: 90%

A preliminary examination of self-concept in older adolescents and young adults with Gilles de la Tourette syndrome

Silvestri

Chiarotti

Baglioni

et al. 2017

European Journal of Paediatric Neurology

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Gilles de la Tourette syndrome (GTS) is a childhood-onset neuropsychiatric disorder characterised by multiple tics and often associated with behavioural problems. Although there is evidence of significantly reduced self-esteem in children and adolescents with GTS, little is known about perceived self-concept and its clinical determinants at the transition age between adolescence and adulthood. We therefore set out to investigate self-concept in a clinical sample of young patients with GTS at this crucial age for personal development. In addition to standard demographic and clinical data, we collected self-ratings using a standardised battery of psychometric instruments, as well as the Multidimensional Self Concept Scale, a comprehensive questionnaire developed to assess self-concept in subjects aged 9 to 19 years, tapping into the social, competence, affect, academic, family, and physical domains. We found that patients diagnosed with at least one comorbid psychiatric disorder ("GTS-plus" phenotype) reported significantly lower self-concept than patients with "pure GTS", whereas tic-related variables had no impact on self-concept. Anxiety symptoms were the main determinants of self-concept, especially trait anxiety with regard to social and affective domains. Affective symptoms could also have a negative impact on the physical, affective, competence, and social domains of self-concept. Routine screening for these co-morbid conditions should be recommended in all patients with GTS seen at transition clinics from paediatric to adult care, in order to implement effective treatment interventions whenever possible.

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“…Lewin et al expanded on the work by Conelea et al in their internet-based survey of 500 adult patients with CTD to investigate whether the relationship between tic severity and both functional impairment and QOL was moderated by the presence of anxiety and depression [46]. The authors found a strong correlation between tic severity and functional impairment, especially in patients suffering from anxiety and depression.…”

Section: Studies Of Health Related-quality Of Life In Gilles De La Tomentioning

confidence: 99%

Health-Related Quality of Life in Gilles de la Tourette Syndrome: A Decade of Research

Cavanna

David

Bandera

et al. 2013

Behavioural Neurology

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Abstract. Gilles de la Tourette syndrome (GTS) is a neurodevelopmental condition characterised by multiple motor and phonic tics and associated behavioural problems, carrying a significant burden on patients' lives. Although the term health related-quality of life (HR-QOL) has only been used in recent years, several studies have long addressed the impact of GTS on physical, psychological and social aspects of wellbeing of both children and adults with GTS. We set out to answer the question "Is HR-QOL affected by GTS and, if so, in what domains?" by conducting a systematic literature review of published original studies addressing HR-QOL in both children and adult patients with GTS. This review focuses on the current evidence on the impact of GTS on patients' lives, mainly informed by studies using generic functional impairment and HR-QOL measures from the last decade, and expands on the new opportunities introduced by the recently developed GTS-specific HR-QOL scales (GTS-QOL and GTS-QOL-C&A). Analysis of the first decade of studies specifically addressing HR-QOL in GTS suggests that co-morbid conditions are key factors in determining HR-QOL in young patients, whilst the picture is more complex in adults with GTS. These findings offer some general directions for both current clinical practice and future research. Keywords: Gilles de la Tourette syndrome, health-related quality of life, functional impairment, tics, behavioural problems The functional impact of Gilles de la Tourette syndrome across the lifespanGilles de la Tourette syndrome (GTS) is a life-long neurodevelopmental disorder defined by the presence of multiple motor and phonic tics [1]. Tics are repetitive, uncontrollable movements or vocalizations that usually present in childhood but may change with re- * Corresponding author: Dr. Andrea Eugenio Cavanna, MD, PhD., Department of Neuropsychiatry, The Barberry National Centre for Mental Health, 25 Vincent Drive, Birmingham B15 2FG, UK. Tel.: +44 0121 3012317; Fax: +44 0121 3012291; E-mail: cavanna77@tin.it. gard to their location, frequency and severity over time [2]. GTS affects approximately 1% of school-age youngsters and is three to four times more common in males than females [3]. GTS is increasingly recognised as a complex disorder, with a wide spectrum of associated behavioural problems that can accompany the motor and phonic tics. These problems include ticrelated symptoms (ranging from socially inappropriate statements to actual self-harm) and co-morbid psychiatric disorders, such as obsessive-compulsive disorder (OCD) and attention-deficit hyperactivity disorder (ADHD) [4,5]. Large studies conducted both in clinical populations [2,6] and in the community [7] have consistently found that only about 10% of individuals with GTS do not present with behavioural co-morbidities.

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The roles of anxiety and depression in connecting tic severity and functional impairment

Cited by 46 publications

References 41 publications

The Gilles De La Tourette syndrome: the current status

The Gilles De La Tourette syndrome: the current status

A preliminary examination of self-concept in older adolescents and young adults with Gilles de la Tourette syndrome

Health-Related Quality of Life in Gilles de la Tourette Syndrome: A Decade of Research

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