Tic Disorder

Sudden, non-rhythmic & repetitive movements and/or vocalisations >1 year 

Persistent tick disorder – either motor or vocal Provisional < 1 year

Often mimic some aspect of normal behaviour

↑ if stressed or excited

↓ when calm or focused activities, & asleep

Average onset 5-6 years Risks – genetics, ADHD< OCD, Often decrease adolescents/adulthood

4M : F

Transient vs. Chronic

Complicated by a range of other MH problems

• ADHD – 50%
• ODD/CD
• Anxiety/Depression

• Simple Motor: eye blinking, grimacing, nose twitching, neck jerking, arm jerking etc etc 

• Complex Motor: Slower than simple tics and often associated with orchestrated or purposeful movements eg. Hopping, clapping, touching objects, gyrating etc
  • Copropraxia – obscene gestures
  • Echopraxia – mimicking others’ actions/movements

• Simple Vocal: mouth clearing, cough, spit, whistling, “uh uh”, “eee” 

• Complex Vocal: words and/or phrases
  • Coprolalia – obscene, aggressive or socially unacceptable (5-15% only)
  • Echolalia – repeating others’ words
  • Palilalia – repeating one’s own words

T

• History of both Motor and Vocal tics, though may not be concurrent
• Numerous times/day
• Present for > 1 year; never more than 3 months tic-free 
• Not due to a medical condition or substance use

Management

• Psychosocial Interventions
• Typical Antipsychotics (dopamine antagonists)
  • Haloperidol
  • Pimozide (Orap)
• Atypical Antipsychotics
  • Risperidone 
• Adrenergic agonists
  • Clonidine 
  • Others (co-morbidities)
  • ADHD
    • Stimulants
    • Atomoxetine 
  • Mood and anxiety disorders
    • SSRI’s