Tourette’s Syndrome and/or Tics

A neurological condition where the part of the brain that control movements (basal ganglia) is affected causing random sounds and involuntary (uncontrollable) movements of parts of the body (tics), this condition is diagnosed if symptoms occur over a period of months.

• It usually starts at the age of seven and gets worst throughout their teenage years.
• Boys are affected more than girls.
• 66% will see an improvement in symptoms with no longer requiring medication.
• 33% will have symptoms throughout their life, but symptoms become milder as one gets older.

• Patients often report that their tics are preceded by a subjective feeling of mounting inner tension and that this is temporarily relieved by tic expression.

Crossley E & Cavanna AE. Sensory phenomena: Clinical correlates and impact on quality of life in adult patients with Tourette syndrome. Psychiatry Research 2013;209:705–710. doi: 10.1016/j.psychres.2013.04.019

Diagnosis Criteria

The DSM-5 lists four criteria for Tourette syndrome (DSM-5 code 307.23):

1. The presence of both motor and vocal/phonic tics at some time during the illness (not necessarily concurrently);

2. The persistence of tics for more than one year since first tic onset, irrespective of the duration of tic-free periods;

3. The onset age before 18 years;

4. The absence of underlying organic causes for the tics.

American Psychiatric Association (APA). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Washington, DC: American Psychiatric Association 2013.

The condition can be associated with other behavioural conditions common examples include:

• Attention deficit hyperactivity disorder (ADHD) – short memory span and not able to stay still for long.
• Obsessive compulsive disorder (OCD) – obsessive thoughts and behaviour (please note: this disorder is because of psychological anxiety caused by intrusive (obsessional) thoughts, whereas tics are driven by premonitory urges that are more physical in nature and are often described as sensations of somatic discomfort, pain or tension)
  • For example: in patients with Tourette syndrome there is a significantly higher prevalence of concerns for symmetry, evening-up behaviours, obsessional counting (arithmomania), ordering and “just-right” perceptions, whereas patients with pure OCD have a higher rate of concerns for contamination and cleaning/washing rituals.
• Oppositional Defiant Disorder (ODD)-persons negative and hostile to adults and senior figures.
• Conduct Disorder (CD)-aggression towards other and break laws.
• Rage
• Anxiety
• Depression