Article

Tourette syndrome and comorbid early-onset schizophrenia

Department of Neuroscience, University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND 58202-9037, USA.
Journal of psychosomatic research (Impact Factor: 2.84). 12/2009; 67(6):515-23. DOI: 10.1016/j.jpsychores.2009.08.002
Source: PubMed

ABSTRACT A study of the shared phenomenology between Tourette syndrome (TS) and schizophrenia.
An illustrative case report is presented. We used a chart review of 399 clinically ascertained patients with TS to identify 10 cases meeting criteria for schizophrenia. From our 10 patients, salient clinical characteristics were then tabulated. We then extracted similar clinical characteristics from a previously published series of patients with comorbid TS and schizophrenia in order to combine cases and allow for a comparison between childhood-onset schizophrenia (COS), adolescent-onset schizophrenia (AdolOS), and adult-onset schizophrenia (AduOS) cases in these groups.
We found 10 cases of schizophrenia (all were males) in the 399 TS patients for a prevalence rate of 2.5% (95% CI 0.96-4.04). Mean age of tic onset for TS diagnostic criteria ranged from 2-14 years with a mean of 8.2 years. The mean age of diagnosis for schizophrenia was 14.2 (range 9-23 years). We found six cases of schizophrenia with onset of positive psychotic symptoms by 13 years of age, two cases with onset after 13 years of age and before 18 years of age, and two cases with onset after 18 years of age. Attention deficit hyperactivity disorder was present at a higher rate (70%) than one would expect in a clinically ascertained group of patients with TS. Comparison between COS, AdolOS and AduOS in our pooled cases noted a sex bias skewed toward males. Catatonic symptoms may be more likely in child or adolescent onset cases and negative symptoms more likely in AduOS cases.
The 2.5% prevalence of schizophrenia in our TS sample exceeds the 1% expected rate of schizophrenia in the general population (chi-square=9.14; P=.0025). The six cases of COS (before 13 years of age) exceeds the expected rate of 1-2 per 100,000 (chi-square=4499; P=.0001). The 752-fold increase in observed rates of comorbid TS and COS over expected rates suggests a role for unknown common underlying etiologic factors. Based on clinical features, patients with TS and comorbid COS, AdolOS, or AduOS do not have different conditions. We conclude with suggestions for further research.

Full-text

Available from: Chun-Zi Peng, Nov 26, 2014
0 Followers
 · 
104 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: Schizophrenia is often associated with other physical and mental problems. Generalised anxiety disorder is notably one of the comorbid disorders that is often linked to schizophrenia. The association of polythematic delusions and of ideas resulting from generalised anxiety disorder complicates the exercise of the corresponding cognitive therapy, for the resulting ideas are most often inextricably intertwined. In what follows, we endeavour to propose a methodology for the differential treatment of polythematic delusions inherent to schizophrenia when combined with ideas originating from generalised anxiety disorder. We propose, with regard to the corresponding content of delusions, an analysis which, under certain conditions, allows one to separate the content associated with polythematic delusions and that which relates to generalised anxiety disorder, in order to facilitate the exercise of the corresponding cognitive therapy.
    World Pumps 11/2011; DOI:10.1016/j.jtcc.2011.07.012
  • [Show abstract] [Hide abstract]
    ABSTRACT: Recognizing positive psychotic symptoms and their diagnostic context in youth is challenging. A large minority say they "hear things others do not hear," though they seldom present with complaints of hallucinations or delusions. Few have schizophrenia spectrum disorder, but many have other psychiatric disorders. Frequently, they have psychotic symptoms for an extended period before diagnosis. Clinicians should understand psychotic symptoms and their differential diagnoses. This article reviews the epidemiology, associated diagnoses, and prognosis of hallucinations and delusions in youth. Strategies for optimizing the clinical diagnostic interview, appropriate laboratory tests, indications for psychological testing, and rating scales are reviewed.
    Child and adolescent psychiatric clinics of North America 10/2013; 22(4):655-73. DOI:10.1016/j.chc.2013.06.005 · 2.88 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Tourette syndrome (TS) is often accompanied by other symptoms and syndromes. The two best-known co-morbidities are Attention Deficit Hyperactivity Disorder (ADHD) and Obsessive Compulsive Disorder (OCD), but also other conditions like rage-attacks, depression, and sleeping disturbances are frequent in persons with TS. Both in clinical cohorts and in population-based cohorts the prevalence of co-morbidities is high. The presence of co-morbid ADHD and/or OCD has an impact on psychosocial, educational, and neuropsychological consequences of TS and it is associated with higher rates of other co-morbid disorders, like rage, anxiety, and conduct disorders. The symptoms of a co-morbid disorder might appear prior to the time that tics reach clinical attention. The TS phenotype probably changes during the course of the disease. The exact aetiology of the co-occurrence of co-morbid disorders and TS is not known, but they probably all are neurotransmitter disorders. European guidelines recommend first-choice pharmacological treatment, but randomised double-blinded trials are needed. Professionals need to be aware of the close relationship between TS and co-morbidities in order to give the patients the right treatment and support.
    Behavioural neurology 11/2012; 27(1). DOI:10.3233/BEN-120275 · 1.64 Impact Factor