A 17-year-old boy presents to an outpatient psychiatry clinic with the chief complaint of facial tics and verbal outbursts. He reports that he experienced his first tic at 5 years of age, when he developed a repetitive nonrhythmic throat clearing in response to the persistent sensation that he had an unrelieved itch in the back of his throat. By 7 years of age, the throat-clearing persists, joined by forceful nasal exhalations and eye-blinking. As a teenager, he has all the old tics present together plus occasional bursts of shouted obscenities, racial slurs, and vulgarities that cause him great psychological distress as they often occur in the public setting. What is true of the verbal and motor tics that characterize this individual’s illness?
A. Increased frequency of tics occurs when patients are asleep
B. The majority of tics take the form of coprolalia (swearing or vulgarity)
C. There is a higher incidence of tics in females than males
D. There is a strong link between tics and obsessive-compulsive disorder (OCD)
E. Tics are exacerbated by use of dopaminergic agents
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EXPLAINATION-
Tourettes Syndrome is a neurological illness, which usually begins during childhood. This disorder is distinctive due to quick, sudden movements that an individual makes but is unable to control. The earliest signs of Tourettes Syndrome are small, recurrent movements known as tics, which most commonly occur in the eyes, nose, arms, face and limbs. Tourettes Syndrome is usually diagnosed if these rapid movements continue for a year or more.
More noticeable cases of this disorder can include much larger movements, sometimes involving the whole body and also verbal tics. Verbal outbursts commonly occur alongside the physical movements, including mumbling sounds, sudden shouting, barking and even Coprolalia. Coprolalia is the most socially upsetting symptom of tourettes syndrome and involves the use of obscene words or phrases, however the sufferer is unable to control his or her outbursts. Coprolalia only occurs in approximately 5 - 15% of sufferers but is the most well known symptom of tourettes. This is thought to be due to representations of sufferers in the media and the way they are perceived in TV shows and films.
Symptoms:
Small rapid movements (motor tics), eg. blinking, facial expressions and head or shoulder jerking
Simple vocalizations (vocal tics), eg. continuous throat-clearing, sniffing and grunting
Complex motor tics involving larger movements or a combination
Complex vocal tics involving words and phrases
Coprolalia (rare outburst of swear words)
Head banging, lip biting and eye poking are more self-destructive symptoms
Common Associated Conditions:
Echolalia (repeating other's words)
Echopraxia (repeating other's actions)
Palilalia (repeating your own words or thoughts)
Obsessive compulsive disorder (OCD)
Attention deficit hyperactivity disorder (ADHD)
Learning disabilities
Short temper or mood swings
Causes:
Unfortunately there is no one cause of Tourettes Syndrome therefore there is no cure for the disorder. There are a number of factors that are thought to influence the development of the illness which are listed below.
Genetic Factors
Research has shown that there is a 50% chance of a parent with tourettes passing the gene on to their child.
This doesn't however mean the child will suffer from tourettes syndrome, it could mean they inherit a mild tic disorder or an obsessive disorder.
Research indicated that in Tourettes Syndrome, there is an imbalance of several neurotransmitters such as serotonin and dopamine, which are chemicals in the brain that carry signals to nerve cells.
Gender Factors
With this particular illness it is three times more likely for a son to inherit the disorder than the daughter of a person with tourettes syndrome. However, only a small percentage of children who inherit the gene will ever have to seek medical help.
Other factors
Emotional or physical health
Stress
Medical Help and Treatment:
Individuals with mild symptoms don't often need medication, but if the tics are moderate to severe and interfere with the normal functioning of their everyday life, treatment is often required. The treatments available at the moment do not completely eliminate Tourette syndrome, however they can make life a lot more manageable.
Counselling and psychotherapy can also be effective ways of helping the sufferer; although this is not a psychological disorder, sessions can help the individual cope with additional social and emotional issues that the illness can cause.
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