(Tourette syndrome)

tics are as repeated, sudden, rapid, non-rhythmic muscle movements defined, including noises or sounds. Tourette’s syndrome is diagnosed when people have both motor and vocal tics for> 1 year. The diagnosis is made clinically. Tics only be treated if they interfere with the activities of the child or his self-image. The treatment can include cognitive behavioral therapy and clonidine or an antipsychotic medication.

Tics vary in severity; they occur in about 20% of children, many of whom have not been evaluated or diagnosed. Tourette’s syndrome, the most severe form, occurs in 3 to 8/1000 children. The ratio men: women is 3: 1.

tics are as repeated, sudden, rapid, non-rhythmic muscle movements defined, including noises or sounds. Tourette’s syndrome is diagnosed when people have both motor and vocal tics for> 1 year. The diagnosis is made clinically. Tics only be treated if they interfere with the activities of the child or his self-image. The treatment can include cognitive behavioral therapy and clonidine or an antipsychotic medication. Tics vary in severity; they occur in about 20% of children, many of whom have not been evaluated or diagnosed. Tourette’s syndrome, the most severe form, occurs in 3 to 8/1000 children. The ratio men: women is 3: 1. The tics begin before the age of 18 years (usually between the ages of 4 to 6 years); they take in severity to a peak between the ages of about 10 to 12 years and decrease during adolescence. Most tics eventually disappear spontaneously. In about 1% of children tics remain, however, persist into adulthood. The etiology is unknown, but tic disorders tend to be familial. In some families, they occur with a dominant pattern with incomplete penetrance. Comorbidities Comorbidities are common. Children with tics may include one or more of the following disorders: attention deficit disorder and hyperactivity (ADHD) Obsessive Compulsive Disorder (OCD) Separation anxiety learning disorders These disorders often affect more children’s development and well-being than the tics. ADHD is the most common co-morbidity and sometimes the tics occur for the first time when children are being treated with ADHD with stimulant; these children are likely to have an underlying tendency to tics. Young people (and adults) could nhaben depression bip substance abuse classification tic disorders are (DSM-5) divided by the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition in three categories: Tourette syndrome (Gilles de la Tourette’s syndrome): Both motor as and vocal tics have been present for> 1 year. Persistent (chronic) tic disorder: Single or multiple motor or vocal tics (but not both motor and vocal) ave for> 1 year been present. Preliminary tic disorder: Single or multiple motor and / or vocal tics have been present for> 1 year. In all categories, the starting age must be <18 years, and the problem can not be due to the physiological effects of a substance (eg. As cocaine) or other disease (eg. As Huntington's disease, post viral encephalitis). Symptoms and complaints Patients tend to show at a given time the same set of tics although the Tics tend to vary in type, intensity and frequency over a period of time. You can occur several times in an hour and then subside or hardly occur for a period of ? 3 months. Usually tics do not occur during sleep. Tics can be. Motorized or vocal Simple or complex (types of tics.) Simple tics are a very short movement or vocalization, usually without social importance. Complex tics take longer and may include a combination of simple tics. act intended it (his d. e. recognizable gestures or words) complex tics can appear to have social significance and. However However, although some patients can suppress its own for a short time (seconds to minutes) their tics and feel some a warning impulse to perform the tic, tics are not intentionally and do not constitute misconduct. Stress and fatigue can worsen tics, but the tics are often strongest when the body is relaxed, such as watching TV. Tics can be reduced if patients are busy with tasks (eg. As a school or work activities). Tics often limit the motor coordination. Light tics often cause few problems, but severe tics, especially Coprolalia (which is rare), are physically and / or socially restrictive. Sometimes tics are explosive, appear in their insertion and be constant in the course of the day. Sometimes children with explosive tic outbreaks and / or related obsessive compulsiveness a streptococcal infection; this is a phenomenon which is sometimes referred to as "pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections" (PANDAS). Many researchers believe that PANDAS is different from the spectrum of tic disorders. Types of tics classification Motorized reaction vocal Simply blinking Grimacing head jerking shrug grunting or barking sniff or snort hawking complex combinations of simple tics (eg, head turning and shrug.) Copropraxia: use sexual or obscene gestures echopraxia: imitation of another person's movements Coprolalia: express social unangemesser words (eg. as profanity, ethnic slurs) Echolalia: Repeat own words or the words of another person Diagnosis Clinical Investigation The diagnosis is made clinically. To distinguish a Tourette syndrome of transient tic disorder, the patient must be monitored over time. Tourette's syndrome is diagnosed when people have both motor and vocal tics for> 1 year. Therapy Cognitive Therapy Sometimes clonidine or antipsychotic treatment of comorbidities Treatment for suppression of tics is recommended only if they significantly affect the activities or the self-image of children. The treatment does not alter the natural course of the disease. Often, the treatment can be avoided if doctors help the children and their families to understand the natural history of tics, and if school personnel can help ensure that classmates understand the disorder. Sometimes the natural waxing and waning of tics gives the impression that the tics have responded to a particular treatment. called a type of behavioral therapy, comprehensive behavioral therapy for tics (CIBT), could help some older children to reduce the control or the number or severity of their tics. It includes cognitive behavioral therapy as reversal of habits (learning a new behavior to replace the Tic), awareness of tics and relaxation techniques. Drugs in some patients acts clonidine 0.05-0.1 mg po 1 to 4 times daily. Side effects such as fatigue can limit the increase in the daily dosage. Hypotension is rare. Antipsychotics may be required, for example, risperidone Being 0.25 to 1.5 mg p. o. twice daily haloperidol 0.5 to 2 mg p. o. twice or thrice daily pimozide 1 to 2 mg p.o. twice daily olanzapine 2.5 to 5 mg p. o. once / day fluphenazine is also effective in suppressing tics. It is chosen the lowest dose for each drug that makes tics bearable. The drugs are tapered off as soon as the tics disappear. The side effects of antipsychotics, such as dysphoria, parkinsonism, akathisia and late dyskinesia are rare, but limit their usefulness. The use of low daily doses and higher doses reduces the night Nebenwirkungen.Behandlung of comorbidities, the treatment of comorbidities is important. ADHD can sometimes be successfully treated with low doses of stimulants without aggravation of the tics, but an alternative treatment (eg. As atomoxetine) may be preferred. When the obsessive or compulsive traits are bothersome, an SSRI can be useful. Children who have tics and problems at school, should be tested for learning disabilities and supplied as needed with support. Important points tics are repeated, sudden, rapid, non-rhythmic muscle movements or vocalizations that develop <18 years in children. Tics are common, but the most serious manifestation of tics, Coprolalia is rare. Simple tics are a very short movement or vocalization (z. B. head twitching, grunting), usually without social importance. Complex tics seem to have a social significance (d. E. Recognizable gestures or words) and thus act intentionally, but are not. The use of cognitive behavioral therapy, the use of clonidine or antipsychotics are used and can reduce heavy or annoying tics, which also tend to decrease over time, although some may persist into adulthood. Comorbidities (eg. As ADHD, obsessive-compulsive disorder) are common and must also be diagnosed and treated.

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