View Full Version : General Tic and Tourette's information


zarazz
04-23-09, 01:41 AM
I am aware of the Tourette's FAQ sticky but I felt I have obtained information that is either updated or not present in the FAQ so I felt I could share the knowledge that I have gained from many sources both analytical and clinical

What is a Tic?: A tic is a sudden, repetitive, non-rhythmic, stereotyped motor movement or vocalization involving discrete muscle groups. More specifically a tic is an action preformed repeatedly in order to relieve a feeling of a “buildup of tension” in a localized area of the body. Much like an itch, cough, or sneeze, a tic is a conscious action preformed to neutralize an increasingly uncomfortable physical feeling. Because a tic is not a completely conscious action it is classified as semi-conscious.

Distinctions Between Tics, Compulsions, and Spasms: An OCD type compulsion is preformed due to anxiety, a spasm is not only generally involving only one muscle instead of a muscle group but also is completely involuntary.

Different Types of Tics: There are two different types of tics Motor, including but not limited to those involving moving body parts such as the eyes, and neck. And Vocal or Phonic tics, which are tics that create a vocal sound. Examples of a vocal tic are grunting sounds, humming, and blurting out words.
Furthermore there are two subcategories of tics: Complex and Simple
-A simple motor tic would be a quick, yet repetitive movement such as rapidly blinking, jerking of the head, or shrugging.
-A complex motor tic would be involving more than one muscle group or a dystonic* movement, which would be holding a certain position for a period of time instead of it just being a quick movement, for example, holding the eyelids shut rather than blinking.
-A simple vocal tic could be coughing, throat clearing or simple animal sounds.
-A complex vocal tic can be whistling, blurting out words, or the repetition of one’s own or other’s words, or phrases.

*Dystonic postures as tics should be distinguished from the disorder “Dystonia”

Causes of Tics: The current scientific knowledge suggests that tic disorders are genetic. However, this does not mean that either parents have to have tics, tic disorders have been linked to the area of the brain known as the basal ganglia, which is also the part of the brain associated with ADD/HD and OCD. There are also acquired causes of tics, with the exception of PANDAS http://en.wikipedia.org/wiki/PANDAS these do not count towards diagnoses of a tic disorder. For a list of conditions and methods of acquiring tics that do not count towards diagnoses of a tic disorder see http://en.wikipedia.org/wiki/Tourettism .

The Effects of Stimulants on Tics: There is much debate as to the effect that central nervous system meds such as Ritalin and Adderal on tics. As it stands the most recent studies suggest that these meds do not cause tics instead they may exacerbate pre-existing tics. The exacerbation may be mistaken for the development of tics because it is not uncommon for tic disorders to be so mild that they go unnoticed. If this is the case the tic disorder can only become evident when stimulants are present, which would explain why when most people report having developed tics due to stimulants they continue to have the tic long after the stimulant is out of the system.

Specific Tic Disorders: According to the DSM IV Diagnostic Criteria Manual there are 4 different diagnosable tic disorders. The disorders and basic criteria are as follows.
* Transient tic disorder consists of multiple motor and/or phonic tics with duration of at least 4 weeks, but less than 12 months. It is estimated that about 20% of children experience a Transient tic at some point.
* Chronic tic disorder is either single or multiple motor or phonic tics, but not both, which are present for more than a year.
* Tourette's disorder is diagnosed when both motor and phonic tics are present for more than a year, and tics are present before the age of 18.
*Tic Disorder NOS (Not Otherwise Specified) is diagnosed when tics are present, but do not meet the criteria for any specific tic disorder.

Tourette’s Syndrome/Disorder (TS): Tourette’s is probably the most widely known of all mental disorders and at the same time the most misunderstood. The media and general public have stereotyped TS as being purely Coprolalia, which is the exclamation of “socially taboo,” or profane words or phrases. In truth Coprolalia is only present at some time in 5-10% of people with TS. Tic Disorders are part of a spectrum including ADD/HD and OCD. Therefore symptom severity can vary between people. Most cases of TS are mild and cause minimal distress. The tics of Tourette’s are often most severe in the preteen years and in most cases gradually diminish as the person goes through the teen years.

No_More_Light
04-23-09, 04:04 PM
this was a very informative add-on.

zarazz
04-23-09, 06:15 PM
I'm glad it proved useful

Driver
04-23-09, 08:12 PM
You've omitted your references.

zarazz
04-23-09, 08:16 PM
You've omitted your references.
yes I am aware of that and I would like to mention this is a work in progress. I wanted to get something down before I go back over all my sources and post more information and a formal bibliography.

zarazz
04-24-09, 12:24 AM
Videos
Here is a very to-the-point video series about tourette's
http://www.videojug.com/interview/types-of-tic-2

I HIGHLY suggest that if you want physical examples of tics go to
http://www.youtube.com/user/Tictionary





here is a list of some of my sources please note that not one of these sources is taken to be Completely true. The information I have posted has been as conservative and non-patient specific as I could

Websites and Organizations
http://www.aacap.org/cs/root/facts_for_families/tic_disorders
http://www.tsa-usa.org/
http://www.tourettesyndrome.net/
http://www.tourettes-disorder.com/
http://www.ncpamd.com/Stimulants.htm
http://www.ninds.nih.gov/disorders/tourette/detail_tourette.htm
http://www.minddisorders.com/Py-Z/Tic-disorders.html
http://childbrain.com/ticdisorder.shtml
http://emedicine.medscape.com/article/1182258-overview
http://serendip.brynmawr.edu/bb/neuro/neuro02/web1/bweiss.html
http://www.psychnet-uk.com/dsm_iv/transient_tic_disorder.htm
http://www.geocities.com/Hollywood/2219/diag.html
http://members.tripod.com/~tourette13/
http://www.who.int/en/
http://web.archive.org/web/20050322170245/http://www.tsa-usa.org/research/definitions.html
http://kidshealth.org/teen/diseases_conditions/brain_nervous/tourette.html
http://www.bellaonline.com/articles/art29827.asp
http://www.addforums.com/forums/archive/index.php/t-22660.html
http://www.wemove.org/cgi-bin/ultimatebb.cgi?ubb=get_topic;f=7;t=000087;p=0

zarazz
04-24-09, 01:30 AM
Most Common Tics: The tics in Tourette's are often different from person to person. However, There are some tics that seem to be more common.
Vocal

-Breathing tic: Results in heavy breathing, gasping, feeling of being short of breath. The tic involves the diaphragm and possibly the lungs. This is a complex tic.

-Sniffing tic: A basic tic that involves sucking in air through the nostrils.

-Grunting tic: A basic tic that generally stems from coughing, often described as being a dry cough from the back of the throat.

Motor
As motor tics go, usually the first of tics to show up is involving the face. These tics can include blinking, nose scrunching, and facial grimacing.


As common vocal tics involve the lungs and diaphragm, common motor tics involve the face.



and a note to mods, feel free to merge these additional posts to the main article.

Driver
04-24-09, 01:41 AM
It should be noted that the mere presence of tics does not a diagnosis of Tourette's make. Tourette's is simply one of many tic disorders.

zarazz
04-24-09, 06:02 PM
it is
Specific Tic Disorders: According to the DSM IV Diagnostic Criteria Manual there are 4 different diagnosable tic disorders. The disorders and basic criteria are as follows.
* Transient tic disorder consists of multiple motor and/or phonic tics with duration of at least 4 weeks, but less than 12 months. It is estimated that about 20% of children experience a Transient tic at some point.
* Chronic tic disorder is either single or multiple motor or phonic tics, but not both, which are present for more than a year.
* Tourette's disorder is diagnosed when both motor and phonic tics are present for more than a year, and tics are present before the age of 18.
*Tic Disorder NOS (Not Otherwise Specified) is diagnosed when tics are present, but do not meet the criteria for any specific tic disorder.


I suppose I can expand upon this, but it would be kind of hard considering that tic disorders, once secondary causes are ruled out, are diagnosed completely based on symptoms. This is why most practicing psychiatrists prefer the term "syndrome" over "disorder" because a syndrome is just a collection of symptoms and not really much more.

Crazygirl79
04-24-09, 07:48 PM
Thank you very much Zarazz..this is helpful.

I know what having vocal tics are like..I have them all the time.

Selena

zarazz
04-28-09, 10:44 PM
-Difference between Tics and Compulsions-
I believe that establishing a clear line between tics and compulsions is important because not only are the definitions of the two very similar, but it is not at all uncommon for someone with tics to also have OCD.

First and foremost a compulsion, unlike a tic, is triggered by anxiety whereas a tic is triggered by an urge that is anatomically isolated. Unfortunately it is not that simple when specific instances of the two are singled out. Difficulties in distinguishing the two are due to how the often subconscious nature of some tics and “ritualized” responses to compulsions can result in the action being preformed without the person performing the action ever aware of the anxiety or the “urge of a tic” being present.
When this happens the best way to assess whether the action is a tic or compulsion is to look at the nature of the action and the presence of an External Trigger for the action.

For Example…

If you automatically clap your hands 3 times when you walk into a room then chances are that is a compulsion due to the fact that you walking into the room triggered the action.

If you clap your hands while going about your daily business then it is most likely a tic because the action had no specific trigger.

Now, When it comes to more complex tics the line becomes even more blurred. For complex tics such as Coprolalia in which the tic is to blurt out the most socially taboo word or phrase in that situation (yelling “Bomb!” in an airport etc.) then you are dealing with a tic that has an external trigger. I theorize that complex tics, such as Coprolalia, are not one or the other but instead are a “compulsive tic.” This is supported by the studies that show that complex tics with triggers, such as Coprolalia, are much more prevalent in those with a tic disorder, usually Tourette's, comorbid with OCD.

Note: Anxiety can cause an exacerbation of tics and this is to not be mistaken for a primary trigger seeing as any instance of high emotion will often cause this exacerbation unlike Compulsions which are very specific to anxiety caused by obsessions.

Hallmarks of Tourette's:
There are several key signs of Tourette's over most other tic disorders. Some of these hallmarks are included in the DSM IV's diagnostic criteria such as,
*Tics present before age 18
*Both Phonic and Motor tics are present at some point

Halmarks not included in diagnostic criteria:
*Common morbidity with OCD and ADD/HD
*Ever changing anatomical location, frequency, number, and complexity of tics
*Tics usually start around the Ages of 4-6
*Decrease in tics through adolescence after peaking in severity around age 8-13 (not always the case)

Driver
04-28-09, 10:53 PM
To further muddy the waters; tics can be exacerbated/brought on by anxiety, thus making it appear it was triggered directly.

roseblood
05-10-09, 08:07 AM
I went through a phase, can't remember how long it lasted, of wanting the two sides of my body to feel equal pressure in close enough to equal order, so for example if I touched something with one hand I'd feel very uncomfortable unless I touched it with the other hand. That wasn't equal enough because I'd done one first, so I'd do the same in reverse order, and then those four touches also in reverse order, and so on until I lost track of the sequence. I don't know that I'd call the urge anxiety, but it was something unpleasant. To this day, if I make myself think about that difference in pressure, I can bring back those feelings and urges, though not as strongly.

I've seen other people describe this same urge and assumed it was part of obsessive compulsive disorder, as I've been fairly sure that I had that as a child although it was undiagnosed. Now I'm wondering if that and possibly other things were tics instead? What do you think? My other symptoms of OCD, which were present for at least several years although not all simultaneously, were intrusive thoughts, brushing my teeth until I had badly receding gums (luckily my jaw structure means this isn't visible unless I pull my lips away), avoiding direct contact with sunlight at almost any cost and walking around with clothing over my head or keeping in other people's shadows, and a few other things. Apart from the intrusive thoughts and sunlight obsession, could these have actually been sensory tics or compulsive tics? I absolutely hated the idea of anyone seeing my teeth until I'd brushed them, so there was an obsessive element to it, but I also couldn't stop thinking about how they felt, and assumed that the obsession was making me imagine that they felt too warm or strange while unbrushed.

I'm wondering because that might expain why I haven't met the criteria for OCD for so long (I should probably disclose that my mum thinks I still do, but I disagree) despite never getting help for it. Maybe it was itself mild but made more impairing by a comorbid transitory tic disorder? My best guess had been that I have only a slight predisposition towards OCD and that it took a period of enormous stress for it to manifest itself, yet I've been almost as stressed or possibly as stressed since then without developing much like that again. Anyway, this is mainly just curiosity, but it might be worthwhile to have a better sense of what it was in case these tendencies come back (the more subtle residual signs fluctuate a lot) and I want to get them treated.

zarazz
05-11-09, 08:01 PM
The touching sounds like a tic. You described it as not really being anxiety but instead an uncomfortable feeling, which is a great way to describe the feeling associated with a tic. The only unfortunate thing is that "uncomfortable" is a very broad term. The other things you were talking about are, without a doubt, compulsions and obsessions. The link between Compulsions and Tics is that they are often not only comorbid, but also complementary. As for brushing you teeth. it sounds like that was an obsession/compulsion. The key element here being that you were consiouse about people seeing your teeth if they weren't brushed. However, it is not impossible, sensory tics usually don't involve teeth brushing, instead, a tic involving the teeth would more likely be the urge to assert pressure on the jaw and gums, usually by means of cleanching teeth.

and just so it is clear, I am not a doctor, but I have done some research, ultimatly this is my opionion, you may agree or disagree.

martingibson
12-16-09, 08:31 PM
I'm a veteran reg ed/spec ed teacher with some experience and training with tourettes. One of my students has a diagnosis. Today was the first day I observed a tic. It was an eye roll after I told him to stay in at recess to finish his work.

Seriously?

Crazygirl79
12-16-09, 09:48 PM
Maybe he was ticcing because he was stressed Martin? Maybe he has it mildly? There are people with tics (myself included) who can suppress them enough to look as if they don't have tics at all but they resurface when a person is stressed.