Tourette's disorder is a neurological condition characterized by involuntary, rapid, and repetitive motor and vocal tics. It was first described in 1885 by George Gilles de la Tourette based on observations of patients exhibiting motor and vocal tics as well as coprolalia, palilalia, and echolalia. The lifetime prevalence is estimated to be 1 in 100 people, with onset typically around age 7. Co-occurrence of conditions like ADHD and OCD is also common. While the exact causes are unknown, genetic factors and abnormalities in dopamine transmission in the brain are thought to play a role. Treatment may involve behavioral therapy and medication to manage symptoms.
Tourette syndrome (TS) is a neurological
disorder characterized by repetitive, stereotyped, involuntary movements and
vocalizations called tics. The disorder is named for Dr. Georges Gilles de la
Tourette, the pioneering French neurologist who in 1885 first described the
condition in an 86-year-old French noblewoman.
The early symptoms of TS are typically
noticed first in childhood, with the average onset between the ages of 3 and 9
years. TS occurs in people from all ethnic groups; males are affected about
three to four times more often than females. It is estimated that 200,000
Americans have the most severe form of TS, and as many as one in 100 exhibit
milder and less complex symptoms such as chronic motor or vocal tics. Although
TS can be a chronic condition with symptoms lasting a lifetime, most people
with the condition experience their worst tic symptoms in their early teens,
with improvement occurring in the late teens and continuing into adulthood.
Tourette syndrome (TS) is a neurological
disorder characterized by repetitive, stereotyped, involuntary movements and
vocalizations called tics. The disorder is named for Dr. Georges Gilles de la
Tourette, the pioneering French neurologist who in 1885 first described the
condition in an 86-year-old French noblewoman.
The early symptoms of TS are typically
noticed first in childhood, with the average onset between the ages of 3 and 9
years. TS occurs in people from all ethnic groups; males are affected about
three to four times more often than females. It is estimated that 200,000
Americans have the most severe form of TS, and as many as one in 100 exhibit
milder and less complex symptoms such as chronic motor or vocal tics. Although
TS can be a chronic condition with symptoms lasting a lifetime, most people
with the condition experience their worst tic symptoms in their early teens,
with improvement occurring in the late teens and continuing into adulthood.
School Project I presented in November 2009. Brief description: "Tourette Syndrome (TS) is a neurological disorder characterized by tics: involuntary, rapid, sudden movements or vocalizations that occur repeatedly in the same way. The cause has not been established and as yet there is no cure."
School Project I presented in November 2009. Brief description: "Tourette Syndrome (TS) is a neurological disorder characterized by tics: involuntary, rapid, sudden movements or vocalizations that occur repeatedly in the same way. The cause has not been established and as yet there is no cure."
Anxiety disorder anxiety meaning anxiety attackanandyuvaraj
Hi, I am Leo, In this powerpoint presentation, we can learn about how this anxiety is shown on our body stress and how to solve the whole anxiety problems. for more details go here anxietyr.blogspot.com
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Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
2. •Do you know what is Tourette’s Disorder?
•Do you know anyone with this disorder?
3. Origin of the Disorder LabelOrigin of the Disorder Label
• Itard
– Physician in 1825
– Observed client with tics & copralalia
• Gilles de la Tourette
– Physician in 1885
– Wrote first detailed reports on disorder
4. Zentall 2004 4
TOURETTE SYNDROME
• a physical disorder of the brain which causes involuntary
movements (motor tics) and involuntary vocalizations (vocal
tics)
• Prevalence: 1 in 2,500 people in US
• Boys outnumber girls 3 to 1
• Tics
– begin before age 21 (typically around age 7)
– change in location, frequency, severity
– last a lifetime
– must be present for at least a year for diagnosis
– other symptoms may also be present
5. TICS MOVEMENTS
• Tics are involuntary, sudden, rapid, recurrent,
nonrhythmic, stereotyped motor movements
or vocalizations.
7. Zentall 2004 7
EXAMPLES OF TICS
• VOCAL: Simple:
throat-clearing
sniffing
coughing
grunting
spitting
yelling
belching
• VOCAL: Complex:
animal sounds
repeating words or phrases
out of context
coprolalia
palilalia
echolalia
8. • Coprolalia is the use of obscene words or phrases.
• Echolalia is the repetition of the last-heard words of
others.
• Palilalia is the repetition of one’s own words.
9. 4 TYPES OF TIC DISORDERS
• Tourette’s Disorder
• Transient Tic Disorder
• Chronic Motor or Vocal Tic Disorders
• Tic Disorder not otherwise specified.
11. Zentall 2004 11
WARNING SIGNS
• Most develop
– eye tic first
– facial tics or involuntary sounds
– others within weeks or months
• common examples: head jerks, grimaces, hand-to-face movements
• Symptoms can:
– change over time
– vary (frequency, type, or intensity)
– increase in intensity during early adolescence (12-15)
– improve in less extreme cases during adulthood
12. • Tourette’s Disorder was 1st
decribed in a
patient in 1885 by George Gilles de la
Tourette.
• He noted several similar symptoms among
several patients and these symptoms
included multiple motor tics, coprolia,
palilalia, and echolalia.
13. PREVALENCE
• The lifetime prevalence of Tourette’s Disorder
is estimated to be 4 to 5 persons per 10,000
people.
14. AGE GROUP
• This disorder occurs by the age 7 and vocal
tics emerge at age 11.
• This disorder occurs about 3 times more often
in boys than girls.
15. 15
Children’s Quotes
• “I was devastated when I found out I had TS. I thought I was going to be a
normal boy. But I’m not. My life is awful. I feel like I’m missing out on a lot of
things because of my tics. I will feel a lot better if my tics go. If they don’t I will
learn to put up with them.” (Neil, 9yrs)
• “I used to get asked why I blinked all the time and everyone used to get angry
at me because I couldn’t help looking at them and I always get harassed.”
• “My teacher treats me like an angel and manages my TS really well. The other
students try to be understanding as my teacher has told them all about TS.”
(Neil, 9yrs)
• Lyle who is 9 years has Aspergergs and TS, and says he feels like he’s in prison
when he is at school.
16. DISORDER ASSOCIATION
• There’s a relation between Tourette’s
disorder, ADHD( attention deficit hyperactivity
disorder) and OCD (Obsessive Compulsive
Disorder).
22. • Stuttering
– abnormal breathing
pattern
– embarrassing physical
characteristics
– can substitute more
acceptable speech
patterns
– support groups
– periods of fluency
• Tourette’s
–abnormal
breathing pattern
–embarrassing tics
–can substitute
more acceptable
tics
–support groups
–tic free periods
subgroup of
Touretters who
stutter, and
stutterers with
Tourette’s
23. CRITERIA FOR TOURETTE’S DISORDER
• Multiple motor tics and one or more vocal tics have
been present at some time during the illness
• Tics occur many times a day, nearly everyday or
throughout a period of more than 1 year and they
are never tic-free for more than 3 months
• The onset is before the age of 18 years
24. Zentall 2004 24
DSM-IV
• onset before age 18
• person has both multiple motor and one or more verbal tics
• tics occur many times a day (usually in clusters), nearly every day
or intermittently for more than a year
--------------------------
25. CRITERIA
• The disturbance is not due to the direct
physiological effects of a substance or a
general medical condition.
» DSM-IV
26. TREATMENTS
• Pharmacological treatments are most effective for
Tourette’s disorder, but patients with mild cases
may not require medications.
Psychotherapy will help patients cope with the
symptoms, personality, and behavioral tendencies;
however, it is ineffective as a primary treatment.
27. Zentall 2004 27
Facts
• Tics can worsen with the use of caffeinated
beverages, cough syrup, recreational drugs and
diet medication
• Identical twins, whose genes are identical, may
have tics that differ in the intensity and
frequency. This means that non-genetic factors
underlie these differences.
(Neuroscience for Kids-Tourette Syndrome.)
29. SOCIALIZATION
• Children with Tourette’s disorder or any tic disorder
can be socially strained.
• Severe social, academics, and vocational
consequences can reap havoc on a child’s social life.
• Socialization can be damaged so severe that suicide
is contemplated in some cases.
30. 30
Academics
• Normal levels of
intelligence
• Personal distress
• Low self esteem &
social problems
• School failure
• Tics can make simple
routine activities
difficult - ex. reading &
writing
• Cause anxiety
• Involuntary multiple
motor and vocal tics
• Obsessive compulsive
tendencies
• Short attention span /
ADD
• High anxiety
• Learning disabilities
31. Zentall 2004 31
Treatment
Strategies• Provide access to a private
room for tension and tic
release
• Offer short breaks
• Break long assignments
into smaller parts
• Allow movement around
the room
• Have a rest/safe area- Ex.
bean bag chair
• Try to ignore tic behaviors
that are not seriously
disruptive
(Wilson, Jeni. Shrimpton, Bradely. Planning Learning for
students with Tourette Syndrome. Student
Disability Conference, 2003).
• Modify abusive vocal
tic patterns
• Modify socially
inappropriate or
disruptive vocal tics /
noises
• Monitor expressive
suprasegmentals
• Monitor receptive
language
development and
processing (LLD)
• Teach good vocal
hygiene habits
32. PROGNOSIS
• Tourette’s disorder is usually a chronic,
lifelong disease with relative remissions and
exacerbations.
• Initial symptoms may decrease, persist, or
increase, and old symptoms may be replaced
by new ones.
33. PROGNOSIS
• Severely afflicted persons may have serious
emotional problems, including major
depressive disorder.
• Some of these difficulties appear to be
associated with Tourette’s disorder.
35. FACTS OF INTERESTFACTS OF INTEREST
• Genetic predisposition
– autosomal (non-sex chromosome) dominant
– male has 99% chance; female has 70% chance
• Incidence
– 1 in 2,500
– 3 to 1 male/female
• Characteristics fluctuate over time
• Onset before age 18; average 7 years
36. Linkage AnalysisLinkage Analysis
• Somatic cells contain paired chromosomes, one
from each parent
• At gamete formation, paired chromosomes coil
around each other and exchange material
• Portions of DNA close together tend to be inherited
together
• Many genes take same form in everyone
• Some genes have several different versions (alleles)
• Noncoding “junk” DNA can vary considerably
between people; can be genetic marker to identify
parent DNA
37. • Genetic investigations have supported the role of both
dopamine D4 receptor gene (DRD4) and dopamine
transporter gene (DAT1) in the vulnerability to the
disorder.
• The DRD4 gene has been postulated as a candidate
gene for attention-deficit-hyperactivity disorder
– Lower DA binding in basal ganglia
– Increased DA transport in frontal lobes
38. Dopamine
• Up to 40% of OCD patients do not respond to SSRIs
• Cocaine worsens compulsions in Tourette syndrome
• Family studies show OCD and Tourettes are linked
leading
• Use of older antipsychotics that block DA receptors
added to ongoing SSRI reduces severity of symptoms in
resistant clients (especially those with Tourettes)
40. • Tourettes: believed to be caused by
abnormally high dopamine levels in some part
of brain
41. MEDICATIONS
• Haloperidol is the most frequently prescribed
drug for Tourette’s disorder.
• As many as 70 to 90% of patient’s symptoms
decrease with this drug and this drug is used
on 80% of the patients.
Tourettes =
conventional
antipsychotics and
SSRIs
Haloperidol
–somewhat effective
–strange side effects:
halucinations
42. SUMMARY COMMENTSSUMMARY COMMENTS
• Tourette’s Syndrome difficult to diagnose
due to variability of symptoms
• Primary intervention in pharmacological
treatment; not always accepted by adults
due to side effects
• Can have significant social, emotional,
vocational impact
• Team approach with SLP as member
43. Responsibility to Tourette’s patients
• Clinicians should prescribe the proper diagnosis and
prognosis to the patient with Touette’s disorder.
• Parents should ensure that their child receive proper
care for this disorder.
• Parents should have open communication with the
child(ren) to know what he/she is feeling.
Editor's Notes
TOURETTES SYNDROME: definition-(see slide)
In most cases teachers did not approach parents about what is happening at school unless there were major behavioral or learning problems. This has meant that often parents are largely unaware of what is going on. Parents are grateful for a teachers interest to discuss their child’s TS. Parents of students with TS want teachers to realize that it is a real condition needing special attention even though it is not obvious, want teachers to be flexible, understand the loss of concentration that comes with TS and the impact this has on their schooling and how they feel about themselves, if their child or another student with TS requests extra time for completing work don’t think that it’s an excuse. Look at it compassionately. Put yourself in their situation. It’s not as straight forward as for a normal child. What’s two or three days more? Encourage students to be positive, ignore tics and realize they have TS before handing down punishments, and understand that they need a bit more one-on-one to help them keep on a level with the classroom.
Obsessions: Obsessions are unwanted thoughts or ideas that occur often and persistently and are experienced involuntarily (Mayo Clinic Health Information Website). They appear over and over again and gives the individual a feeling of being out of control. The person doesn’t want to have the ideas and finds them invading, bothersome, and senseless (Obsessive-Compulsive Foundation Website). The individual with OCD recognizes that the obsessions are not imposed from without, instead they are a product of their own mind. The individual tries to ignore or suppress the obsessions (Rapoport, 1990). People with OCD say the symptoms feel like a case of mental hiccups that won’t go away (Obsessive-Compulsive Foundation Website). Compulsions: Compulsions are defined as repetitive, purposeful, intentional behaviors performed in response to an obsession. Many individuals with OCD are not aware of any specific reason for their compulsions. They just know that performing these actions will relieve their anxiety and prevent them from feeling bad (Rapoport, 1990). The person with OCD does not get pleasure from the compulsions, instead they are used to get relief from the discomfort that comes form obsessions (Obsessive-Compulsive Foundation Website).
. Compulsions Compulsions are repetitive behaviors, the goal of which is to prevent or reduce anxiety or distress, not to provide pleasure or gratification. In most cases, the person feels driven to perform the compulsion to reduce the distress that accompanies an obsession, or to prevent some dreaded event or situation. In some cases, individuals perform rigid or stereotyped acts according to idiosyncratically elaborated rules, without being able to indicate why they are doing them. By definition, compulsions are either clearly excessive or are not connected in a realistic way with what they are designed to neutralize or prevent. The most common compulsions involve washing and cleaning, counting, checking, requesting or demanding assurances, repeating actions, and ordering. (Alarcon 1991) . Obsessions Obsessions are persistent ideas, thoughts, impulses, or images that are experienced as intrusive and inappropriate and that cause marked anxiety or distress. The most common obsessions are repeated thoughts about contamination, repeated doubts, a need to have things in a particular order, aggressive or horrific impulses, and sexual imagery. The thoughts, impulses, or images are not simply excessive worries about real-life problems and are unlikely to be related to a real-life problem.
Boys more likely to have tics, and girls to have OC symptoms; but both can have any of the symptoms of TS (Note: main reason for including it as a separate subtype is the co-occurrence of TS symptoms with other SEH disorders; With co-occurring ADD or ADHD, symptoms of attention disorders often appear before motor or vocal tics do. MEDS for ADHD can actually make tics worse or hasten their appearance. But there are some that can be used--discuss later AGRRESSION- connection between TS and aggression is not yet clear but may have to do with difficulty regulating aggression (aggression also occurs more frequently in TS if already have hyperactivity, impulsivity, or ADD)
DSM-IV: Differential Diagnosis= involves comparing child’s behavior with the behavior of children with other disorders that might produce the same symptoms. A way of ruling out what disorders child does NOT have, and determining what disorder he does have. -may rule out head trauma, brain tumors, epilepsy, autistic disorders, muscular dytrophy or transient tic disorder( occurs less that 12 consecutive months), cerebral palsy, Parkinson’s disease-- A Pediatric Neurologist (medical doctor specializing in diagnosing and treating neurological disorders in children) or a Neuro-Psychiatrist ( also knows about OCD, depression, bi-polar disorders, ADHD-and more familiar with medications used to treat associated difficluties) may help with diagnosis.
Tic suppression requires much energy and can cause stress which may interfere with a student’s ability to concentrate on classroom tasks. Peers negative responses to tics can cause anxiety, which in turn increase tics and generate self-doubt. Even if a teacher is accepting of tics, students may still try to suppress tics because of concern for unwanted reactions from peers. Children with Tourettes are not usually disruptive students but can be labeled as naughty and weird.
Accommodate to students individual needs. A learning plan should consider the many dimensions of TS, including the physical, social-emotional, medical, and psychological needs. Collaborate with children, parents, teachers, and sometimes counselors. Parental involvement is usually highly desired, although this can be difficult for parents. Parental stress associated with dealing with schools, usually for modifying for their child, are reported. Since the syndrome causes excessive movement, interruptions, tension and pain, it makes simple routine activities like reading and writing more difficult (Robertson and Baron-Cohen, 1998) Frustration is another problem for children with TS and some emotional difficulties, such as anxiety and depression (Bruun and Bruun, 1994). Because of all this, it is hard for these students to make friends.
Recent research using the Positron Emission Tomography (PET) scan of the brain has shown that the brain patterns of a patients suffering from OCD are different than those seen with other disorders and mental illnesses. This bears out to show that possibly OCD is caused by a neurobiological malfunction involving the brains use of the neurotransmitter Serotonin (Sourcebook, p 279). As with any physical illness and or mental illness treatment should be sought as soon as the disorder is noticeable. The sooner the better is a phrase that applies. This can prevent the OCD from reaching a severe level of dysfunction if treatment is sought and followed through. It is extremely difficult for person’s with OCD to admit they have a problem, because in the early stages it can be ignored by the patient or passed of as this is no big deal. Then, later in life it becomes a big deal and they may be so embarrassed that they do not seek help (Griest,1990). According to the DSM-IV, a specifier can be added to the diagnosis when the patient does not recognize the obsession or the compulsion as excessive or unreasonable (p 419).