TICS

TIC DISORDERS

Topics in Mental Health

By Shlomo Y. Radcliffe

What is a Tic Disorder?

The presence of tics- abrupt involuntary repetitive movements and sounds - form the basis of Tic Disorders. The most common form of tics is Tourette’s disorder, or Tourette’s syndrome which is often accompanied by other disorders such as AD/HD and obsessive compulsive disorders. Tics are painless sudden purposeless behaviours that are either vocal or motor related. Tics are fairly common during childhood but tend to just resolve on their own. In some cases, however children’s tics persist over time, becoming more severe. Simple motor tics may involve any body movement such as blinking rapidly, making head jerks, shrugging shoulders and grimacing. Complex motor tics involve some combination of facial gestures, biting, sustained looks, obscene gestures and head banging, and these last longer than simple motor tics. Temporary tics usually last less than one year. The cause of tics is currently unknown.  Transient Tic Disorder is the mildest form of tics and is common in approximately 4%-24% of schoolchildren but it does not last for more than one year. For a diagnosis of Tourette’s syndrome patients must have displayed both multiple motor and one or more vocal tics at some time during illness, although it does not have to be at the same time. Tics will increase under any kind of stress.

Treatment of Tics

The most effective medication for tics today are neuroleptic medications including primozide (orap) and haloperidol (haldol). Other medications will often have side effects. No benefits have been shown for antibiotics. It is recommended to go for a holistic approach for treatment. Treatment should include the following: educating the patient and family about the disorder, collaboration with the school to create learning environment suited to needs of the child, completion of necessary diagnostics, comprehensive assessment of the child, therapy and if necessary medication.

Presently there is no cure for tics disorders but growing numbers of patients (73%) report that their tics disappeared or decreased greatly as they entered adolescence. Spontaneous remission rates for tics that persist past adolescence are currently extremely low. Therapy such as behavioural or cognitive-behavioural is suggested. Habit reversal with a 64%-100% success rate is the most commonly used technique to alleviate tics, combining relaxation exercises, awareness training and contingency management with positive reinforcement.

Alternative treatments that relieve stress may reduce the frequency of tics and in some cases, may contribute to an alleviation of the disorder. For instance, some people have found Bach Flower Therapy to be very helpful in reducing and/or eliminating tics.