What is Tic disorder, and how it is connected with tourette syndrome?

Tic disorder, as described in Diagnostics and statistical manual of mental disorders (DSM-5) is a motor disorder, which comes under the category of neurodevelopmental disorders. Tic disorder is categorized by the presence of tics that occur in isolation, irrespective of other symptoms. Sometimes, tics occur as a result of stress or anxiety and it may be inherited in an individual from the parent who has tics. Tic disorder involves a number of different types of tics.

Tics refer to the problem of rapid, repetitive movement of body parts like face, hands, shoulders and legs. It is called as motor tics. Often, unusual sounds or voices are also produced like sniffing or throat clearing, referred to as vocal tics. Tics are involuntary in nature and hence the person has no control over it. Mostly tics are mild and so hardly gets to be noticed while in some cases, they are severe and happens to occur frequently which may affect person’s life on a personal as well as social level.

Also Read: Conduct Disorder: Signs and Diagnosis

Tics usually starts during childhood and with time, either the symptoms may go away completely or gets improvised after several years. It mostly peeks in childhood and then the symptoms may gets reduced in adulthood. The person having tic disorder doesn’t gets an urge before getting tics and the tics can’t get suppressed by the individual if they wants to.

There are two types of tic disorder based on it’s duration:

1) Provisional tic disorder:

It was earlier known as a transient tic disorder. Provisional tics lasts for not more than a year and is not severe as such. The provisional tic disorder can be seen to affect 3-5% of the population and is more prevalent in men then women, especially boys. Both motor and vocal tics happens to occur in the provisional tic disorder.

2) Persistent tic disorder:

It is also known as chronic tic disorder as it persists for longer period of time. Persistent tic disorder is seen to affect less than 1% of population and may lead to more complex situation called Tourette syndrome. People having Tourette syndrome have both motor and vocal tics.
Tic disorder is marked by the presence of various kinds of tics as the only symptom while in Tourette syndrome, one of the many symptoms includes having tics. The presence of two major type of tics, motor and vocal, is mandatory for the diagnosis in case of tourette syndrome which persists for a longer period of time and is quite severe as compared to tic disorder.

Also Read: Behavioural Disorders in Children

In other words, having tics alone does not means that a person has tourette syndrome, however it could certainly mean that the person might have tic disorder.

Tourette syndrome: Causes, symptoms, criteria and the treatment

Tourette syndrome is a neurological syndrome, which occurs when a person make repetitive movements or twitches and unwanted, unbearable sounds. It can’t be cured and symptoms may persist for lifelong. Tourette syndrome in some people may occur along with Attention deficit/ hyperactivity disorder (ADHD) or obsessive compulsive disorder (OCD).

Causes of Tourette syndrome

The cause of tourette syndrome is still unknown, but there are number of various possibilities due to which the syndrome may occur.

• Genetics: Tourette syndrome may gets inherited from the previous generation. There are 50% chance of getting tourette syndrome by the child from their parents who have tourette syndrome. Also, the Prevalence rate is more in boys as compared to girls.
• Infections: Tourette syndrome may be caused due to infections by streptococcus bacteria. The extent of infection varies from mild to severe and may change the composition of the brain leading to neurological changes.
• Disorders: It has been seen that Tourette syndrome may gets associated with various other disorders like attention deficit hyperactivity disorder (ADHD), Obsessive compulsive disorder (OCD), Dyslexia. They may appear together as well.

Symptoms of Tourette syndrome

Physical symptoms of tourette syndrome includes rolling or blinking of eyes repeatedly, making unusual facial expressions, jerking head or shrugging shoulders, wrinkling the nose, clicking fingers. Symptoms also involves engaging in compulsive behaviours like touching objects or other persons without any reason. Impulsive behaviours like running, jumping and twirling around can also be seen in people having tourette syndrome.

Also Read: Narcissistic Personality Disorder (NPD)

People having Tourette syndrome also seem to be sniffing, grunting or coughing. They may often repeat words, phrases or make irregular sounds while conversing with others and sometimes use obscene words or gestures to insult or embarrass other people. Medical diagnosis is required for the disorder which takes place by determining the history of signs and symptoms and it’s severity in a person.

Criteria for diagnosis of tourette syndrome

• Presence of vocal and motor tics, both (same timing is not a factor of consideration).
• Onset of appearance of symptoms or tics is before 18 years of age.
• Tics don’t result or effects of any medical conditions or isn’t caused due to intake of any medicines.
• Tics should occur several times a day (nearly everyday) and cause impairment in social and personal life. Also, the symptoms of disorder must continue for more than a year.
• Tics change over time like its location, severity, type (vocal and motor), complexity.

The diagnosis of tourette syndrome sometimes may get misinterpreted due to it’s nature of common symptoms which can be seen to be associated with other disorders too. So, in order to avoid getting mislead or misinterpret the condition, the diagnosis along with blood tests and imaging techniques such as MRI or CT scan is to be included.

Treatment of tourette syndrome

Tourette syndrome can’t be cured completely, but it can be treated. If tics are mild, it could be taken care by taking precautions like avoiding stressful situations or relaxing when feeling tired. However, if the symptoms of tourette syndrome is severe, it can be treated with the help of interventions and therapies. Therapies and Medications used for the treatment of tourette syndrome:

Behaviour therapy:

Behavior therapy also called as comprehensive behavioral intervention for tics (CBIT) includes habit reversal training that can help in treating tics. In habit reversal training, the tics are first monitored, then the urges of the behaviour or situations that lead to tics are predicted and observed, to overcome them by teaching voluntary moves to the patient that are incompatible with the tics and may oppose the urge. The new behaviour is learned and practiced to avoid the occurrence of tics by making a competing response. It helps in reduction and in some cases, elimination of tics.
Although, one needs to make sure that tics doesn’t takes place due to our will but still it can be controlled by changing the behaviour.

Deep brain stimulations(DBS) :

Deep brain stimulation is an invasive treatment method for tourette syndrome. It is used when the symptoms of tourette syndrome are severe and are not responding to any other treatment or medications. DBS involves inserting a battery operated medical device in the brain which delivers electrical signals or stimulations to the areas of brain that controls the movement or production of sounds. This method of treatment is still not seen to be a viable method for treating tourette syndrome due to safety concerns and its effectiveness.

Relaxation techniques:

Stress leads to tics in a person or may overexagerate the tics, so in order to reduce or cope up with stress, relaxation techniques are used like breathing along with muscle tensing and relaxing.

Medications:

Antidepressants such as fluoxetine (Prozac, sarafem), that also controls the sadness, anxiety and antiseizure Medications like topiramate(topamax) can be used to treat tics. Botox injections, injected into the person’s affected muscle, could also help in relieving simple, milder version of tics.

Also Read: Autism Spectrum Disorder: Causes, Symptoms, Types and Treatment

Some antipsychotics like resperidone (risperdol), pimozide (Orap), haloperidol (Haldol), aripiprazol, fluphenazine blocks or lessen the dopamine and helps control the tics by altering the effects of chemicals in the brain that controls the body movements. These are also called neuroleptics. Tetrabenazine (xenazine) can also be taken but it is not recommended so often by the experts as it seems to cause severe depression.

Note: We advised to take professional opinion before taking any medication

Management Strategies:

As it has been seen that Tourette syndrome can be associated with other disorders like Attention deficit hyperactivity disorder(ADHD), it can be treated by taking ADHD Medications such as methylphenidate (metadate CD, retalin LA, etc.) and also the medications like Adderall XR, dexedrine, which contains dextroamphetamine that helps in increasing concentration and pay more attention. Self care tips that could help reduce tics along with therapies and Medications includes having a good night’s sleep on a comfortable bed and in right posture, eating healthy and avoiding stressful situations. Also, staying preoccupied with some work or doing activities that one likes and could help in keeping them busy will also help with the symptoms. Don’t keep focussing on tics or worry about the occurrence of tics, diverting mind to somewhere else would help relieve anxiety and thereby the tics.

Individual and societal impact

People having tics remain undiagnosed or unchecked, it may worsen the condition or gets severe which may lead to embarrassment, getting bullied. It could also lead to social isolation in the fear of getting judged or mocked by others around. The symptoms may cause pain or discomfort due to its severity. People may hurt themselves. Their condition interferes with the daily life activities and routine, at work or social settings. As a result, people having Tourette syndrome intend to harm themselves, gets angry and feel depressed or sad. We can create a supportive society and better environment for people with tourette syndrome, by raising awareness and understanding the condition in a non judgemental way.