Tic disorders

Definition

 * sudden, rapid involuntary movements or vocalization without purpose e.g. constant blinking
 * temporarily suppressible → followed by an urge to do the tic

Types of tic disorders

 * Tourette syndrome
 * sporadic transient tic disorder (in 25% of children): persistance < 1 year
 * persistent motor/vocal tic disorder (> 1 year)

Types of tics

 * motor tic x vocal tic
 * simple tic (e.g. grunting) x complex tic (e.g. echolalia)

At what age does it manifest?

 * must be in childhood (before 18 years) → this is a diagnostic criteria

Etiology

 * multifactorial etiology, association with ADHD and OCD

Clinical features

 * multiple times per day
 * vocal: coprolalia, throat clearing, grunting, lip smacking, barking
 * motor: facial grimacing, blinking, shoulder shrugging, twisting of the body

Diagnosis

 * clinically tics are present for > 1 year, diagnosed before the age of 18, presence of multiple motor tics

Treatment

 * Behavioral therapy
 * Treatment of psychiatric comorbidities (e.g. methylphenidate for ADHD)
 * in some cases: atypical antipsychotics, benzodiazepines, antidepressants

DDx for tics

 * huntington, tardive dyskinesia, seizures, psychic stress