Gilles de la Tourette's syndrome (GTS) consists of multiple motor tics and one or more phonic tics. Psychopathology occurs in approximately 90% of GTS patients, with attention-deficit/hyperactivity disorder (ADHD) and obsessive-compulsive disorder (OCD) being common. Depression is common, with a lifetime risk of 10% and a prevalence of between 1.8% and 8.9%. Depression and depressive symptoms are found to occur in 13% and 76% of GTS patients attending specialist clinics, respectively. In controlled studies embracing over 700 GTS patients, the patients were significantly more depressed than controls in all but one instance. In community and epidemiological studies, depression in GTS individuals was evident in two of five investigations. Clinical correlates of depression in people with GTS appear to be: tic severity and duration, the presence of echophenomena and coprophenomena, premonitory sensations, sleep disturbances, obsessive-compulsive behaviors/OCD, self-injurious behaviors, aggression, conduct disorder (CD) in childhood, and, possibly, ADHD. Depression in people with GTS has been shown to result in a lower quality of life, potentially leading to hospitalization and suicide. The etiology of depression appears to be multifactorial. Bipolar affective disorder (BAD) and GTS may be related in some individuals. However, it is noted that sample sizes in most of these studies were small, and it is unclear at the present time as to why BAD may be overrepresented among GTS patients.
"Standard of care are dopamine-blocking drugs—typical and atypical antipsychotics, only two of which, haloperidol and pimozide are FDA-approved for the indication, although a host of other medications have been used, including topiramate, tetrabenazine, SSRIs, and benzodiazepines, all of which, including the antipsychotics, appear to have limited efficacy. DBS and even ECT has been applied to varying degrees of success (Ward et al. 2010; Burdick et al. 2010; Motlagh et al. 2013; Robertson 2006). "
"The most common are attention-deficit/hyperactivitiy disorder (ADHD) and obsessive-compulsive disorder (OCD)
. Depression, anxiety, self-injurious behaviours (SIB) and conduct disorders (CD) are also common in adult GTS subjects
[7,9]. Major handicaps for patients affected by GTS are delayed diagnosis, non-specialist management, and inadequate educational and social support
[Show abstract][Hide abstract] ABSTRACT: Background
Few studies have used standardized QOL instruments to assess the quality of life (QOL) in Gilles de la Tourette Syndrome (GTS) patients. This work investigates the QOL of adult GTS patients and examines the relationships between physical and psychological variables and QOL.
Epidemiological investigation by anonymous national postal survey of QOL of patients of the French Association of Gilles de la Tourette Syndrome (AFGTS) aged 16 years or older. The clinical and QOL measures were collected by four questionnaires: a sociodemographic and GTS-related symptoms questionnaire, the World Health Organization Quality Of Life questionnaire (WHOQOL-26), the Functional Status Questionnaire (FSQ), and a self-rating questionnaire on psychiatric symptoms (SCL-90), all validated in French. We used stepwise regression analysis to explicitly investigate the relationships between physical and psychological variables and QOL domains in GTS.
Questionnaires were posted to 303 patients, of whom 167 (55%) completed and returned them. Our results, adjusted for age and gender, show that patients with GTS have a worse QOL than the general healthy population. In particular, the “Depression” psychological variable was a significant predictor of impairment in all WHOQOL-26 domains, psychological but also physical and social.
The present study demonstrates a strong relationship between QOL in GTS and psychiatric symptoms, in particular those of depression.
"Early-onset BD is likely to present poor prognosis and outcome . Although a subject of debate, ADHD and TS have been reported as frequent comorbid disorders in BD patients  . Early developmental abnormalities in the brain have been proposed as the pathogenesis of these childhood psychiatric disorders . "
[Show abstract][Hide abstract] ABSTRACT: There is compelling evidence for an association between structural brain deformities and psychiatric disorders. We report the case of an adolescent boy who was diagnosed with both attention-deficit/hyperactivity disorder and Tourette's syndrome. A full-blown manic episode occurred when he was 13 years old. During his admission to a psychiatric ward, closed-lip schizencephaly in the left frontal lobe and the right parietal lobe was identified through brain imaging. Effective control of his manic symptoms was achieved with quetiapine monotherapy within 3 weeks. This case report implies that the pathophysiology of psychiatric disorders, especially in young patients with multiple comorbid conditions, may be associated with abnormalities in the anatomical and functional development of the brain.
General hospital psychiatry 01/2012; 34(6):702.e1-3. DOI:10.1016/j.genhosppsych.2011.12.004 · 2.61 Impact Factor
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