Tic is a muscle contraction that comes into existence with instantaneous, often rate and involuntary actions or/and vocalizations and also it doesn’t serve any purpose. Tics’ frequency and intensity depends on different people and even it can show a change on same person on it’s progress. By the time, tics’ thickness and heaviness can increase or decrease, sometimes a tic can go out and another one can come in and also it can be shown in a consecution. (Singer, 1991) According to many researches’ results, tics are inflaming by stress and anxiety and sometimes tics can exceed its limit and passing the the olağan activities.
Tics are being classified in 2 different category as; Motor Tics and Vocal Tics and these categories divided into 4 variation as Simple Motor Tics, Complex Motor Tics, Simple Vocal Tics, Complex Vocal Tics. Motor Tics are containing movements like blinking, lip biting and Vocal Tics are including sounds like barking, throat clearing. The “simple” and “complex” differentiation is about the simplicity and complexity of the action or vocalization when it comes into existence. Simple Motor Tics are incoherent, brief, instantaneous movements, Complex Motor Tics are intentional and coordinated movements. Simple Vocal Tics can be any sound like sniffing, straining etc. Complex Vocal Tics are being divided into some categories; echolalia, palilalia, coprolalia. Echolalia is repeating someone’s spoken words. Palilalia is repeating own previous spoken words. And corprolalia is implying taboo words or clauses spontaneously, also corprolalia is a symptom of Tourette Syndrome.
There is a classification too, that is tic disorders’ categories which divided into 4 as; Transient Tic Disorder, Chronic Tic Disorder, Tourette’s Disorder and Tic Disorder NOS (Not Otherwise Specified). (DSM-IV TR, 2000)
Transient Tic Disorder shown in generally 5-10 years old children, it includes tics which shown in face like eye blinking is the most common type that can seen in this disorder but also it can show itself by sounds so vocal things. Transient Tic Disorder mostly seen when the children have so much stress and agilation.
Chronic Tic Disorder processes by years and it doesn’t change itself. There can be mentioned about chronic tic disorder when it has seen so process at least 1 year.
Tourette’s Disorder as known as Gilles De La Tourette Syndrome seen before 18 years old and it’s not about a stuff or a medical condition, so it’s not the result of a medical condition or usage of a medicine, it contains multiple motor tics, corprolalia and echolalia, it means multiple motor and one or more vocal tics. This disorder named of that because the first describer of that is Georgers Gilles De La Tourette (1875-1904). It causes distress and if the diagnosis can be early, it can block the negative effects of that on people’s emotional, social and work / school life. There is a similarity between Tourette’s Disorder and Chronic Tic Disorder, but there is one differentiation between them; Tourette’s Disorder includes more than 1 motor tics and also it has at least 1 “vocal tic”. (DSM-IV TR, 2000)
The diagnoses were determined by American Psychiatric Association with their publish “The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV TR)”. DSM-IV TR is used mostly for Tourette’s Disorder; “Both multiple motor and one or more vocal tics have been present at some time during the illness, although not necessarily concurrently. (A tic is a sudden, rapid, recurrent, nonrhythmic, stereotyped motor movement or vocalization.) The tics occur many times a day (usually in bouts) nearly every day or intermittently throughout a period of more than 1 year, and during this period there was never a tic-free period of more than 3 consecutive months. The onset is before age 18 years. The disturbance is not due to the direct physiological effects of a substance (e.g., stimulants) or a general medical condition (e.g., Huntington’s disease or postviral encephalitis)”. (DSM-IV TR, 2000)
The most common Diagnostic Criteria Books are DSM and ICD in the world. ICD so International Classification of Diseases were be developed by World Health Organization and now ICD-10 is the current version that people use. According to ICD, the diagnostic criteria of Tic Disorders are nearly similar with DSM-IV TR and there is a definition of tic disorder too in ICD-10; “A form of tic disorder in which there are, or have been, multiple motor and one or more vocal tics, although these need not have occurred concurrently. Onset is almost always in childhood or adolescence. A history of motor tics before development of vocal tics is common; the symptoms frequently worsen during adolescence, and it is common for the disorder to persist into adult life. The vocal tics are often multiple with explosive repetitive vocalisations, throat clearing, and grunting, and there may be the use of obscene words or phrases. Sometimes there is associated gestural echopraxia, which may also be of an obscene nature (copropraxia). As with motor tics, the vocal tics may be voluntarily suppressed for short periods, be exacerbated by stress, and disappear during sleep.” (ICD-10, 2010)
When the epidemology comes into the topic, tic disorders seen more in children than adults and also it’s more often in boys than girls. It seen 4-5 per 10.000. Motor factor occurs at 7 years old, vocal factor occurs in 11 years old. (DSM IV-TR, 2000) When the etiology, comes into the topic, according to the genetic factors issue, Tourette’s Disorder mostly seen in twins which is from monozygot less than seen in twins who is from dizygot.
Tourette’s Syndrome is a known type in Tic Disorders, and there are many researches about the relationship between Tourette’s Syndrome and Obsessive-Compulsive Disorder’s symptoms. These researches results shows that the coexistence of OCD symptoms in Tourette’s Disorder. It means the sum of Tourette’s Disorder and Obsessive-Compulsive Disorder, so the symptoms as “ordering”, “symmetry”, “counting”, “repetitive touching”. Only Obsessive-Compulsive Disorder’s symptoms are “fears of contamination”, “fears of harming others”. It can be seen “Attention-deficit/hyperactivity disorder” with tic disorder too.
DSM IV-TR Diagnostic Criteria for Tic Disorder NOS is “This category is for disorders characterized by tics that do not meet criteria for a specific tic disorder. Examples include tics lasting less than 4 weeks or tics with an onset after age 18 years.” According to DSM-IV-TR, diagnostic criteria of Transient Tic Disorder is, “Single or multiple motor and/or vocal tics (i.e. sudden, rapid, recurrent, nonrhythmic, stereotyped motor movements or vocalizations). The tics occur many times a day, nearly every day for at least 4 weeks, but for no longer than 12 consecutive months. The onset is before age 18 years. The disturbance is not due to the direct physiological effects of a substance (e.g. stimulants) or a general medical condition (e.g. Huntington’s disease or postviral encephalitis). Criteria have never been met for Tourette’s disorder or chronic motor or vocal tic disorder” (DSM-IV-TR, 2000)
And for Chronic Motor or Vocal Tic Disorder, it is “Single or multiple motor or vocal tics (i.e. sudden, rapid, recurrent,nonrhythmic, stereotyped motor movements or vocalizations), but not both, have been present at some time during the illness. The tics occur many times a day nearly every day or intermittently throughout a period of more than 1 year, and during this period there was never a tic-free period of more than 3 consecutive months. The onset is before age 18 years. The disturbance is not due to the direct physiological effects of a substance (e.g. stimulants) or a general medical condition (e.g.Huntington’s disease or postviral encephalitis). Criteria have never been met for Tourette’s disorder”. (DSM-IV-TR, 2000)
There are 3 treatment types for tic disorders. Tourette Disorder can be tried to treat by reducing the dopamine activity in brain. One of the treatment is psychotherapy, the other one is reversal treatment and the last one is anxiolytic agents. In the world, there is no a specific medicine for treating directly tics but some of the antipsychotic medicines can treat that. The most effective treatment medicines are containing haloperidol and pimozide, with that stuff, dopamine receptors are being blocked and finally the dopamine activity reduced.
There is a behavioral treatment too. “Habit Reversal Training” is a behavioral method for treating Tic Disorders. It contains; relaxation, biofeedback, hypnosis and massed negative practice. The actual soul of this method contains a real “relaxation” and it means, yoga, sports, meditation can be effective for the treatment because these kind of things provides relaxation in body and also mind and it absolutely effects to the psychology. There is a behavioral treatment method as “Cognitive Behavioral Therapy” and it’s being used for treatment of Obsessive-Compulsive Disorder. When OCD can seen with Tic Disorder, Cognitive Behavioral Therapy can be effective for the treatment of Tic Disorder with OCD. According to some experimental studies, there are some other treatments for Tic Disorders; for instance, dieting for health and less usage of caffeine can reduce the tics but it’s not a wide research that had proven so good.
There is not an exact prevention from tic disorders but according to some of the researches, if a pregnant woman protects herself from emotional stress during the pregnancy can helping to prevent from tic disorders because there is a relationship between tic disorders and stress…
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