This document discusses tic disorders, including Tourette's disorder. It defines tics as involuntary muscle contractions or vocalizations. There are simple and complex motor and vocal tics. Tourette's disorder is characterized by both multiple motor and at least one vocal tic for over a year. Onset is before age 18. It occurs more in males than females and is associated with ADHD and OCD. While the cause is unknown, dopamine and endogenous opioids may play a role. Treatment includes haloperidol. Transient tic disorder involves single or multiple tics for less than a year.

1. TIC DISORDER

2. TIC DISORDERTICS- RAPID AND REPETITIVE MUSCLE CONTRACTIONS RESULTING IN MOVEMENTS OR VOCALIZATIONS WHICH ARE INVOLUNTARY TYPES:SIMPLE MOTOR TICS- FUNCTIONALLY SIMILARMUSCLE GROUPSEYE BLINKING, SHRUGGING OF SHOULDER, NECK JERKINGSIMPLE VOCAL TIC- COUGHING,THROAT CLEARING, GRUNTING, SNIFFINGCOMPLEX MOTOR TICS- SMELLING OF OBJECTS, GROOMING BEHAVIOR, ECHOPRAXIA, COPROPRAXIACOMPLEX VOCAL TICS- REPEATING WORDS AND PHRASES OUT OF CONTEXT (COPROLALIA, ECHOLALIA)WAX AND WANE DECREASED BY SLEEP, RELAXATION OR ABSORPTION IN AN ACTIVITY

3. TOURETTE’S DISORDERDIAGNOSTIC CRITERIAA. BOTH MULTIPLE MOTOR AND ONE OR MORE VOCAL TICS HAVE BEEN PRESENT AT SOMETIME DURING THE ILLNESS, ALTHOUGH NOT NECESSARILY CONCURRENTLYB. THE TICS OCCUR MANY TIMES A DAY (USUALLY IN BOUTS) nearly everyday or intermittently throughout a period of more than one year AND DURING THIS PERIOD THERE WAS NEVER A TIC FREE PERIOD OF MORE THAN 3 CONSECUTIVE MONTHSC. THE ONSET IS before 18 years of ageD. the disturbance is not due to direct physiological effects of a drug or a general medical condition

4. Tourette’s DisorderLifetime prevalence 4 to 5 per 10,0005 to 30 children per 10,000 onset of motor component by age 7 vocal tics by 11 years3 males: 1 femaleFamilial illnessAssociation with ADHD and OCD? Dopamine, endogenous opiods

5. Tourette’s Disorder? Post streptococcal syndromeCLINICAL FEATURESTics may occur as early as 2 yearsInitial tics in the face and neck progress downwardMost frequent initial symptom eye blink tic, followed by head tic and facial grimace

6. Tourette’s DisorderPRODROME: IRRITABILITY, ATTENTION DIFFICULTIES, POOR FRUSTRATION TOLERANCEOBSESSIVE COMPULSIVE SYMTOMS OCCUR AFTER ONSETCOPROLALIA IN 1/3 OF CASESNO SPECIFIC LABORATORY OR DIAGNOSTIC TESTTREATMENT - HALOPERIDOL

7. DIFFERENTIAL DIAGNOSIS1.CHRONIC MOTOR OR VOCAL TIC DISORDERA. SINGLE OR MULTIPLE MOTOR OR VOCAL TICS BUT NOT BOTH, HAVE BEEN PRESENT AT SOMETIME DURING THE ILLNESSB. TICS OCCUR MANY TIMES A DAY NEARLY EVERYDAY OR INTERMITTENTLY THROUGHOUT A PERIOD OF MORE THAN O9NE YEAR AND DURING THIS PERIOD THERE WAS NEVER A TIC FREE PERIOD OF MORE THAN 3 CONSECUTIVE MONTHSC. THE ONSET IS BEFRORE 18 YEARSD. THE DISORDER IS NOT DUE TO THE PHYSIOLOGICAL EFFECTS OF A SUBSTANCEE. A CRITERIA HAVE NEVER BEEN MET FOR TOURETTE’S DISORDER

8. DIFFERENTIAL DIAGNOSISTRANSIENT TIC DISORDERA. SINGLE OR MULTIPLE MOTOR AND OR VOCAL TICSB. THE TICS OCCUR MANY TIMES A DAY NEARLY EVERYDAY FOR AT LEAST 4 WEEKS BUT FOR NO LONGER THAN 12 CONSECUTIVE MONTHSC. ONSET BEFORE 18 YEARSD AND E (SIMILAR TO CHRONIC MOTOR TIC)DO NOT DEVELOP TO A MORE SERIOUS TIC DISORDER,MAY APPEAR DURING STRESS