Tourette syndrome and obsessive–compulsive disorder

Abstract

Tourette syndrome and obsessive-compulsive disorder are neuropsychiatric disorders that have sparked considerable interest over the decades. They are the focus of research for a remarkable diversity of disciplines, ranging from neuroimagers and prenatal epidemiologists to experts in the neural circuits that connect the cortex with the basal ganglia, as well as neuroimmunologists focusing on brain-based autoimmune phenomena. Several hypotheses have been put forward to explain the onset and exacerbation of these illnesses. Here we discuss the clinical phenomenology and treatment options that are currently available. New psychopharmacological agents are being used that are based on a greater understanding of the neurobiology and are being used in combination with behavioral interventions. Longitudinal clinical investigations into clinical symptoms and the natural course are providing additional clues on the underlying pathophysiology. Recent advances in research models are also reviewed in an attempt to clarify some of the molecular etiologies that lead to these disorders. KeywordsTorrette syndrome; obsessive-compulsive disorder; basal ganglia; autoimmune disorders; streptococcal infections; neuroleptic treatment Tourette syndrome (TS) and obsessive-compulsive disorder (OCD) are model neuropsychiatric disorders that have been the subject of medical interest for centuries [1]. Many explanations have been suggested for the etiology of tics and OCD symptoms and have included genetic factors, the influence of toxins, psychological, and infectious processes. There have been significant advances of our understanding of the neurobiological mechanisms at work in these disorders, as well as improvements in the treatments available. Several reviews on more specialized aspect of TS, OCD and related disorders have appeared over the last several years [2][3][4]. Here we concentrate on the clinical features of tic disorders and OCD and discuss evidence-based interventions for these disorders. Tourette syndromeTourette syndrome is one of several tic disorders that are classified either by their type (motor or phonic tic) or their duration (transient or chronic). The diagnosis of a transient tic is made if the tics are present for less than 12 months. If the tics persist for more than 12 months, they

Neurobiology of the Premonitory Urge in Tourette’s Syndrome: Pathophysiology and Treatment Implications

“…Tics characteristically present with a wide range of severity, from mild twitches that go unnoticed to forceful movements and loud noises that cause injury and call other people’s attention {10}. Moreover, 90% of patients present with co-morbid psychiatric disorders {31–33}, most commonly obsessive-compulsive disorder (OCD) {34–36} and attention-deficit and hyperactivity disorder (ADHD) {37,38}, although both affective disorders {39,40} and impulse control disorders {41–43} have also been shown to be associated with TS. Disease-specific health-related quality of life measures for patients with TS {44} have allowed a more accurate assessment of the differential impact of tics and behavioral symptoms on patients’ wellbeing {45}.…”

Histaminergic modulation in Tourette syndrome

“…Around 90% of patients with TS are diagnosed with co-morbid psychiatric disorders [16,18,19]. The most common behavioral co-morbidities are obsessivecompulsive disorder [20,21] and attention deficit and hyperactivity disorder [22,23], although affective disorders [24] and impulse control disorders [25][26][27] have been reported more commonly in patients with TS than in the general population.…”

Generalized Anxiety Disorder and Social Anxiety Disorder in Youth: Are They Distinguishable?

“…It may be that GAD and SAD are more closely related than other types of anxiety disorders. For example, while OCD is currently grouped with the anxiety disorders in DSM-IV, genetic evidence and comorbidity profiles suggest it may be more closely related to tic disorders such as Tourette's Disorder (e.g., Lombroso & Scahill, 2008). Thus, examination of the relationship of OCD to other childhood anxiety disorders may indicate that OCD is more distinct from the other disorders than they are from each other.…”