Tic disorders are a group of three disorders that include Tourette syndrome, chronic motor or vocal tic disorder, and transient tic disorder. Although they're similar pathophysiologically, these disorders differ in severity and prognosis.
All tic disorders, commonly known simply as "tics," are involuntary, spasmodic, recurrent, and purposeless motor movements or vocalizations. These disorders are classified as motor or vocal and as simple or complex. Tics begin before age 18. The median age of onset for Tourette syndrome is age 7, but this disorder can occur as early as age 2. All tic disorders are three times more common in males than in females.
Transient tics usually are self-limiting, but Tourette syndrome follows a chronic course characterized by remissions and exacerbations.
Tics commonly develop when a child experiences overwhelming anxiety, usually associated with normal maturation. Tics may be precipitated or exacerbated by the use of phenothiazines and central nervous system (CNS) stimulants or by head trauma.
Tics appear to get worse during emotional stress and are absent during sleep. It is thought that all types of chronic tics are variants of Tourette's Syndrome and have an underlying genetic cause. The gene or genes involved have not been discovered yet.
Effective treatment requires correction of the underlying psychopathology by identifying and resolving the sources of the patient's anxiety, stress, and intrapsychic conflict. Without correction of the underlying psychopathology, pressuring the patient to control the tics will be unsuccessful; he can do so only briefly and then only with intense effort. Behavior modification techniques and operant conditioning have been successful when the patient experiences tics that are mild.
No medications are helpful in treating transienttics. Haloperidol is considered the drug of choice if the patient has Tourette syndrome. Pimozide, an oral dopamine-blocking drug, may be substitUted in patients who can't tolerate or don't respond well to haloperidol. Alternatively, clonazepam or clonidine may be prescribed.
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