Tourette's Disorder
The essential features of this disorder are multiple motor and one or more vocal
tics. These may appear simultaneously, or at different periods during the illness.
The tics occur many times a day, nearly every day or intermittently throughout a
period of more than one year. The anatomic location, number, frequency,
complexity, and severity of the tics change over time.
The tics typically involve the head and, frequently, other parts of the body,
such as the torso and upper and lower limbs. The vocal tics include various
sounds such as clicks, grunts, yelps, barks, sniffs, and coughs, or words.
Coprolalia, a complex vocal tic involving the uttering of obscenities, is present in
up to a third of cases. Complex motor tics involving touching, squatting, deep
knee bends, retracing steps, and twirling when walking are often present.
In approximately half the cases, the first symptoms to appear are bouts of a
single tic, most frequently eye-blinking, less frequently tics involving another part
of the face or the body. Initial symptoms can also include tongue protrusion,
squatting, sniffing, hopping, skipping, throat-clearing, stuttering, uttering sounds
or words, and coprolalia. Other cases begin with multiple symptoms, which may
include any combination of the previously described tics, and various noises such
as barks, grunts, screams, yelps, or snorts.
Associated features. There may be other symptoms, such as mental
coprolalia (sudden, intrusive, senseless thoughts of socially unacceptable or
obscene words, phrases, or sentences that differ from true obsessions in that no
attempt is made to ignore, suppress, or neutralize the thoughts), obsessions, and
compulsions.
In clinical samples, other mental disorders are frequently associated with
Tourette's Disorder, particularly Attention-deficit Hyperactivity Disorder and
Obsessive Compulsive Disorder. It is not clear if this co-morbidity also exists in
representative community samples.
Age at onset. The median age at onset is 7 years, and the great majority
have an onset before age 14. The disorder may appear as early as one year of
age.
Course. The disorder is usually lifelong, though periods of remission lasting
from weeks to years may occur. In some cases, the severity and frequency of the
symptoms diminish during adolescence and adulthood, and the symptoms do not
vary in severity over time as much as before. In other cases, the symptoms of the
disorder disappear entirely, usually by early adulthood.
Complications. Complications include physical injury, such as blindness due
to retinal detachment (from head-banging or striking oneself), orthopedic
problems (from knee-bending, neck-jerking, or head-turning), skin problems (from
picking), and, in rare cases, self-mutilation (from head-banging).
Prevalence. The estimated lifetime prevalence rate is at least 0.5 per
thousand.
Sex ratio. The disorder is at least three times more common in males than in
females.
Familial pattern. Tic Disorders are more common among first-degree biologic
relatives of people with Tourette's Disorder than among the general population.
Evidence suggests that Tourette's Disorder and Chronic Motor or Vocal Tic
Disorder may be inherited as a single autosomal dominant disorder.
In addition, there is some evidence that Obsessive Compulsive Disorder is
more common in first-degree biologic relatives of people with Tourette's Disorder
than in the general population and is another expression of the same underlying
disorder.
Differential diagnosis. Amphetamine Intoxication, many neuralgic disorders
(such as cerebrovascular accidents, Lesch-Nyhan syndrome, Wilson's
disease, Sydenham's chorea, Huntington's chorea, and multiple sclerosis),
Organic Mental Disorders, and Schizophrenia may present with abnormal
motor movements These disorders can readily be differentiated from
Tourette's Disorder because they have distinguishing symptoms, signs,
clinical course, and physiologic abnormalities as revealed by laboratory
tests; and none of them involve vocalizations similar to the clicks, grunts,
yelps, barks, sniffs, coughs, and words of Tourette's Disorder.
Diagnostic Criteria for Tourette�s Disorder)
A. Both multiple motor and one or more vocal tics have been present at some
time during the illness, although not necessarily concurrently.
B. The tics occur many times a day (usually in bouts), nearly every day or
intermittently throughout a period of more than one year.
C. The anatomic location, number, frequency, complexity, and severity of the
tics change over time.
D. Onset before age 21.
F. Occurrence not exclusively during Psychoactive Substance Intoxication or
known central nervous system disease, such as Huntington's chorea and
postviral encephalitis.
Chronic Motor or Vocal Tic Disorder
The essential features of this disorder are either motor or vocal tics, but not both
(as in Tourette's Disorder) the other characteristics of the disorder are generally
the same as Tourette's Disorder, except that the severity of the symptoms and
the functional impairment are usually much less.
Familial pattern. Both Chronic Motor or Vocal Tic Disorder and Tourette's
Disorder frequently occur in the same families and appear to be genetically
related.
Differential diagnosis. In Transient Tic Disorder, the duration of the disturbance
is always less than one year. In Tourette's Disorder there are both motor
and vocal tics. A rare disorder of adolescence and adulthood, sometimes
referred to as "psychogenic cough," or "chronic cough of adolescence," is
distinguished from Chronic Motor or Vocal Tic Disorder by the
monosymptomatic and intentional nature of the symptom.
(Diagnostic Criteria for Chronic Motor or Vocal Tic Disorder)
A. Either motor or vocal tics, but not both, have been present at some time
during the illness.
B. The tics occur many times a day, nearly every day, or intermittently
throughout a period of more than one year.
C. Onset before age 21.
D. Occurrence not exclusively during Psychoactive Substance Intoxication or
known central nervous system disease, such as Huntington's chorea and
postviral encephalitis.
Transient Tic Disorder
The essential feature of this disorder is single or multiple motor and/or vocal tics
that occur many times a day, nearly every day for at least two weeks, but for no
longer than twelve consecutive months. (Thus, the diagnosis is not made if there
is a history of Tourette's or Chronic Motor or Vocal Tic Disorder, both of which
require a duration of at least one year.)
The most common tic is eye-blinking or another facial tic. However, the whole
head, torso, or limbs may be involved. In addition, there may be vocal tics a
person may have only one or a number of tics; if the latter, the tics may be
performed simultaneously, sequentially, or randomly.
Age at onset. Age at onset is always during childhood or early adolescence,
and may be as early as two years of age.
Course. The tics may disappear permanently, or recur, especially during
periods of stress. In rare cases, after a period of partial remission, the person
may develop either Tourette's Disorder or Chronic Motor or Vocal Tic
Disorder.
Complications. No information.
Prevalence. Surveys of schoolchildren have reported that from 5% to 24%
have had a history of some kind of tic. However since these surveys do not
specify a minimum or a maximum duration, it is not known how applicable these
findings are to the prevalence of Tic Disorders.
Sex ratio. Most studies find the disorder three times more common in males
than in females.
Familial pattern. Tic Disorders are apparently more common in first-degree
biological relatives of people with Transient Tic Disorder than in the general
population.
Differential diagnosis. In Tourette's Disorder and Chronic Motor or Vocal Tic
Disorder, the duration of the disturbance is at least one year.
(Diagnostic Criteria for Transient Tic Disorder)
A. Single or multiple motor and/or vocal tics.
B. The tics occur many times a day, nearly every day for at least two weeks,
but for no longer than twelve consecutive months.
C. No history of Tourette's or Chronic Motor or Vocal Tic Disorder.
D. Onset before age 21.
E. Occurrence not exclusively during Psychoactive Substance Intoxication or
known central nervous system disease, such as Huntington's chorea and
postviral encephalitis.
Tic Disorder Not Otherwise Specified
Tics that do not meet the criteria for a specific Tic Disorder. An example is a Tic
Disorder with onset in adulthood.
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The essential features of this disorder are multiple motor and one or more vocal tics. These may appear simultaneously, or at different periods during the illness. The tics occur many times a day, nearly every day or intermittently throughout a period of more than one year. The anatomic location, number, frequency, complexity, and severity of the tics change over time.
The tics typically involve the head and, frequently, other parts of the body, such as the torso and upper and lower limbs. The vocal tics include various sounds such as clicks, grunts, yelps, barks, sniffs, and coughs, or words. Coprolalia, a complex vocal tic involving the uttering of obscenities, is present in up to a third of cases. Complex motor tics involving touching, squatting, deep knee bends, retracing steps, and twirling when walking are often present.
In approximately half the cases, the first symptoms to appear are bouts of a single tic, most frequently eye-blinking, less frequently tics involving another part of the face or the body. Initial symptoms can also include tongue protrusion, squatting, sniffing, hopping, skipping, throat-clearing, stuttering, uttering sounds or words, and coprolalia. Other cases begin with multiple symptoms, which may include any combination of the previously described tics, and various noises such as barks, grunts, screams, yelps, or snorts.
Associated features. There may be other symptoms, such as mental coprolalia (sudden, intrusive, senseless thoughts of socially unacceptable or obscene words, phrases, or sentences that differ from true obsessions in that no attempt is made to ignore, suppress, or neutralize the thoughts), obsessions, and compulsions.
In clinical samples, other mental disorders are frequently associated with Tourette's Disorder, particularly Attention-deficit Hyperactivity Disorder and Obsessive Compulsive Disorder. It is not clear if this co-morbidity also exists in representative community samples.
Age at onset. The median age at onset is 7 years, and the great majority have an onset before age 14. The disorder may appear as early as one year of age.
Course. The disorder is usually lifelong, though periods of remission lasting from weeks to years may occur. In some cases, the severity and frequency of the symptoms diminish during adolescence and adulthood, and the symptoms do not vary in severity over time as much as before. In other cases, the symptoms of the disorder disappear entirely, usually by early adulthood.
Complications. Complications include physical injury, such as blindness due to retinal detachment (from head-banging or striking oneself), orthopedic problems (from knee-bending, neck-jerking, or head-turning), skin problems (from picking), and, in rare cases, self-mutilation (from head-banging).
Prevalence. The estimated lifetime prevalence rate is at least 0.5 per thousand.
Sex ratio. The disorder is at least three times more common in males than in females.
Familial pattern. Tic Disorders are more common among first-degree biologic relatives of people with Tourette's Disorder than among the general population. Evidence suggests that Tourette's Disorder and Chronic Motor or Vocal Tic Disorder may be inherited as a single autosomal dominant disorder.
In addition, there is some evidence that Obsessive Compulsive Disorder is more common in first-degree biologic relatives of people with Tourette's Disorder than in the general population and is another expression of the same underlying disorder.
Differential diagnosis. Amphetamine Intoxication, many neuralgic disorders (such as cerebrovascular accidents, Lesch-Nyhan syndrome, Wilson's disease, Sydenham's chorea, Huntington's chorea, and multiple sclerosis), Organic Mental Disorders, and Schizophrenia may present with abnormal motor movements These disorders can readily be differentiated from Tourette's Disorder because they have distinguishing symptoms, signs, clinical course, and physiologic abnormalities as revealed by laboratory tests; and none of them involve vocalizations similar to the clicks, grunts, yelps, barks, sniffs, coughs, and words of Tourette's Disorder.
Diagnostic Criteria for Tourette�s Disorder)
A. Both multiple motor and one or more vocal tics have been present at some time during the illness, although not necessarily concurrently.
B. The tics occur many times a day (usually in bouts), nearly every day or intermittently throughout a period of more than one year.
C. The anatomic location, number, frequency, complexity, and severity of the tics change over time.
D. Onset before age 21.
F. Occurrence not exclusively during Psychoactive Substance Intoxication or known central nervous system disease, such as Huntington's chorea and postviral encephalitis.
Chronic Motor or Vocal Tic Disorder
The essential features of this disorder are either motor or vocal tics, but not both (as in Tourette's Disorder) the other characteristics of the disorder are generally the same as Tourette's Disorder, except that the severity of the symptoms and the functional impairment are usually much less.
Familial pattern. Both Chronic Motor or Vocal Tic Disorder and Tourette's Disorder frequently occur in the same families and appear to be genetically related.
Differential diagnosis. In Transient Tic Disorder, the duration of the disturbance is always less than one year. In Tourette's Disorder there are both motor and vocal tics. A rare disorder of adolescence and adulthood, sometimes referred to as "psychogenic cough," or "chronic cough of adolescence," is distinguished from Chronic Motor or Vocal Tic Disorder by the monosymptomatic and intentional nature of the symptom.
(Diagnostic Criteria for Chronic Motor or Vocal Tic Disorder)
A. Either motor or vocal tics, but not both, have been present at some time during the illness.
B. The tics occur many times a day, nearly every day, or intermittently throughout a period of more than one year.
C. Onset before age 21.
D. Occurrence not exclusively during Psychoactive Substance Intoxication or known central nervous system disease, such as Huntington's chorea and postviral encephalitis.
Transient Tic Disorder
The essential feature of this disorder is single or multiple motor and/or vocal tics that occur many times a day, nearly every day for at least two weeks, but for no longer than twelve consecutive months. (Thus, the diagnosis is not made if there is a history of Tourette's or Chronic Motor or Vocal Tic Disorder, both of which require a duration of at least one year.)
The most common tic is eye-blinking or another facial tic. However, the whole head, torso, or limbs may be involved. In addition, there may be vocal tics a person may have only one or a number of tics; if the latter, the tics may be performed simultaneously, sequentially, or randomly.
Age at onset. Age at onset is always during childhood or early adolescence, and may be as early as two years of age.
Course. The tics may disappear permanently, or recur, especially during periods of stress. In rare cases, after a period of partial remission, the person may develop either Tourette's Disorder or Chronic Motor or Vocal Tic Disorder.
Complications. No information.
Prevalence. Surveys of schoolchildren have reported that from 5% to 24% have had a history of some kind of tic. However since these surveys do not specify a minimum or a maximum duration, it is not known how applicable these findings are to the prevalence of Tic Disorders.
Sex ratio. Most studies find the disorder three times more common in males than in females.
Familial pattern. Tic Disorders are apparently more common in first-degree biological relatives of people with Transient Tic Disorder than in the general population.
Differential diagnosis. In Tourette's Disorder and Chronic Motor or Vocal Tic Disorder, the duration of the disturbance is at least one year.
(Diagnostic Criteria for Transient Tic Disorder)
A. Single or multiple motor and/or vocal tics.
B. The tics occur many times a day, nearly every day for at least two weeks, but for no longer than twelve consecutive months.
C. No history of Tourette's or Chronic Motor or Vocal Tic Disorder.
D. Onset before age 21.
E. Occurrence not exclusively during Psychoactive Substance Intoxication or known central nervous system disease, such as Huntington's chorea and postviral encephalitis.
Tic Disorder Not Otherwise Specified
Tics that do not meet the criteria for a specific Tic Disorder. An example is a Tic Disorder with onset in adulthood.