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| Tourette syndrome (TS) |
Tourette syndrome (TS) is a neurobehavioral disorder characterized by the onset of multiple motor tics and at least one vocal tic before the age of 18. These tics must occur frequently, many times a day, for more than a year, without extended periods of tic-free intervals exceeding three months, and must not be attributable to substance abuse or other medical conditions. The tics, which include both vocalizations and motor movements, are sudden, repetitive, stereotyped, fast, and subjectively experienced as irresistible by the individuals affected. They can affect various body parts, including limbs, head, and torso, compromising social and occupational functioning and often causing discomfort and embarrassment.
There are two types of tics: simple and complex. Simple tics involve brief, repetitive movements or sounds that affect a limited number of muscle groups, while complex tics consist of more elaborate movement patterns that engage multiple muscle groups.
Individuals with Tourette syndrome typically report experiencing unpleasant sensations immediately before the onset of a tic, known as premonitory sensations, which diminish after the tic occurs.
The disorder usually begins in childhood with gradual onset, often peaking during adolescence. However, the course of Tourette syndrome varies widely, with some individuals experiencing chronic symptoms persisting into adulthood, while others may experience spontaneous remission over time. It is observed that Tourette syndrome is more prevalent in males than in females, with a ratio of 3 to 1.
The exact cause of Tourette syndrome remains unclear, although genetic factors are believed to play a significant role. Neuroanatomical and neuroimaging studies suggest that dysfunction of the dopaminergic system in the basal ganglia, responsible for controlling body movements, may contribute to the pathogenesis of the disorder.
Tourette syndrome may also co-occur with other psychiatric disorders such as attention deficit hyperactivity disorder (ADHD), obsessive-compulsive disorder (OCD), mood disorders, and anxiety disorders.
Treatment of Tourette syndrome
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| Tourette syndrome (TS) |
After a thorough assessment and diagnosis process, pharmacological treatment may be considered under the guidance of a specialist physician (such as a neurologist, psychiatrist, or neuropsychiatrist), particularly in cases of moderate to severe severity marked by frequent and complex tics that significantly affect the patient's daily functioning. For such cases, a multidisciplinary treatment approach involving both pharmacological and psychological therapies is recommended.
Psychological interventions, including cognitive behavioral treatments, may be beneficial and have shown some effectiveness in symptom management, as outlined in the European clinical guidelines for Tourette Syndrome and other tic disorders (2011). Specific interventions include Habit Reversal Training and behavioral techniques focused on contingency management and exposure with response prevention (ERP). These interventions aim to help patients gradually acclimate to the underlying urge associated with tics, effectively managing symptoms and reducing related anxiety.
Habit Reversal Training, rooted in cognitive-behavioral principles, involves collaboration with a skilled psychologist-therapist as part of a multidisciplinary treatment team. The objective is to enhance the patient's awareness of sensory cues and premonitory impulses that trigger tics. Following the ABC behavioral model, patients learn to recognize triggers, the onset of tics, and their consequences. Subsequently, they acquire alternative, adaptive behaviors to replace the targeted tic, which are reinforced through contingency management techniques. Additionally, techniques such as breathing exercises and relaxation methods may also be utilized.
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