Clinical phenomenology of episodic rage in children with Tourette syndrome

New York University School of Medicine, New York City, USA.
Journal of Psychosomatic Research (Impact Factor: 2.74). 08/2003; 55(1):59-65. DOI: 10.1016/S0022-3999(02)00584-6
Source: PubMed


Episodic rage of unknown etiology causes significant morbidity in children with Tourette's syndrome (TS). Using modified Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria for intermittent explosive disorder (IED), we developed a screen and symptom questionnaire to explore rage attack phenomenology and to preliminarily investigate whether symptom clusters can identify clinical subgroups of TS children with rage attacks.
48 children with TS between ages 7 and 17 years consecutively presenting with rage attacks completed the Rage Attacks Screen and Questionnaire. Data was subjected to factor analysis. Cluster analytic procedures were used to identify clinical subgroups.
Final cluster solution revealed four homogeneous subgroups of TS children with rage who were differentiated by predominant clinical characteristics: specific urge resolution, environmentally secure reactivity, nonspecific urge resolution or labile nonresolving.
Episodic rage in TS has stereotypic features, but diverse and complex etiologies. Identifying particular symptom clusters may facilitate improved treatment strategies.

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Available from: K. Mark Sossin, Oct 29, 2015
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    • "Intense anger outbursts in response to trivial provocations may also persist across development and manifest across various psychiatric disorders. Due to an apparent lack of control, these behaviors have been referred to as rage attacks in severe mood dysregulation (Carlson 2007) and Tourette Syndrome (Budman et al. 2003) as well as meltdowns in children on the autism spectrum (Samson et al. 2015). "
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    DESCRIPTION: Review of behavioral interventions for anger, irritability and aggression in children and adolescents
    • "Although rage often occurs in response to frustration, rage is more severe and intense than typical 'tantrums', is inappropriate Contents lists available at ScienceDirect journal homepage: given the child's age and developmental stage (Budman et al., 2003), and is often one of the factors precipitating treatmentseeking (Carlson et al., 2009; Potegal et al., 2009a). Misdiagnosis can occur in the context of rage given the focus on superficial behavioral issues to the exclusion of underlying triggers. "
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    ABSTRACT: Episodic rage represents an important and underappreciated clinical feature in pediatric anxiety. This study examined the incidence and clinical correlates of rage in children with anxiety disorders. Change in rage during treatment for anxiety was also examined. Participants consisted of 107 children diagnosed with an anxiety disorder and their parents. Participants completed structured clinical interviews and questionnaire measures to assess rage, anxiety, functional impairment, family accommodation and caregiver strain, as well as the quality of the child's relationship with family and peers. Rage was a common feature amongst children with anxiety disorders. Rage was associated with a more severe clinical profile, including increased anxiety severity, functional impairment, family accommodation and caregiver strain, as well as poorer relationships with parents, siblings, extended family and peers. Rage was more common in children with separation anxiety, comorbid anxiety, attention deficit/hyperactivity disorder and behavioral disorders, but not depressive symptoms. Rage predicted higher levels of functional impairment, beyond the effect of anxiety severity. Rage severity reduced over treatment in line with changes in anxiety symptoms. Findings suggest that rage is a marker of greater psychopathology in anxious youth. Standard cognitive behavioral treatment for anxiety appears to reduce rage without adjunctive treatment. Copyright © 2015. Published by Elsevier Ireland Ltd.
    07/2015; DOI:10.1016/j.psychres.2015.07.071
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    • "Le niveau de base s'échelonne sur au moins trois semaines, avant que la première rencontre de thérapie ne soit planifiée et les grilles utilisées pour l'évaluation de rappel sont envoyées par courrier au moins trois semaines avant la rencontre d'évaluation par questionnaires (trois mois après l'intervention). Les parents et l'enseignant de l'enfant complètent le Rage attacks questionnaire (RAQ) (Budman et al., 2003) en mesure pré, post et rappel (i.e., avant le niveau de base, après la huitième séance et trois mois après le traitement). Ce questionnaire de 22 articles ne comporte pas de résultat global, car il vise à explorer la phénoménologie des ÉE et à évaluer la présence ou l'absence de caractéristiques spécifiques (p. "
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    ABSTRACT: For children with Tourette syndrome (TS), explosive outbursts (EO) can be more disruptive than tics to the child's functioning. This study evaluated the effectiveness of an innovative cognitive-behavioral intervention for decreasing frequency and intensity of EO. Five boys and one girl ranging in age from 9 to 12 years took part in the study. EO frequency and intensity were measured by systematic observation of events and by questionnaire, while tics and child's psychosocial functioning were measured by questionnaires. The children showed trends towards decreased EO frequency post treatment but no changes in EO intensity. Statistical analysis and questionnaires results revealed no significant change. Qualitative information indicated a benefit to the families following therapy.
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