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