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Tourette's

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Tourette syndrome: Is It Neurological or Psychological?

Tourette syndrome (TS), named for Dr. Georges Gilles de la Tourette, is a neurological disorder characterized by repetitive, stereotyped, involuntary movements and vocalizations called “tics” (National Institute of Neurological Disorders, 2012). For instance, someone with TS may repeatedly blink their eyes, shrug their shoulders or jerk their head. Early symptoms of TS are noticed in childhood between the ages of 3 and 9 and occurs in people for all ethnic groups. Males are affected about three to four times more often than females. An estimated 200,000 Americans have the most severe form of TS and as many as 1 in 100 exhibit milder and less complex symptoms such as chronic motor and vocal tics. Although there is no cure, one can live a normal life span with TS. Symptoms are worst during the early teen years and often lessen or become quiet or controlled into adulthood.
The most obvious symptoms of TS are called “tics” and are classified as either simple or complex (Mayo Clinic, 2012). Simple motor tics are sudden, brief, repetitive movements that involve a limited number of muscle groups. The most common simple tics include eye blinking, facial grimacing, head jerking, shoulder shrugging, finger flexing or sticking out the tongue. Simple vocal tics may include constant throat clearing, sniffing, hiccupping, yelling, or grunting.
Complex tics, on the other hand, are distinct, coordinated patterns of movements involving several muscle groups (NINDS). Complex motor tics could be include facial grimacing combined with a head twist and a shoulder shrug. Other complex motor tics may actually appear purposeful such as sniffing or touching things, touching other people, touching the nose, obscene gesturing, hopping or jumping. More complex vocal tics include words or phrases, or even using different tones of voice, repeating oneself or others, or swearing (Mayo Clinic).
The most dramatic and disabling tics include motor movement that result in self-harm (i.e. punching oneself in the face) or vocal tics including coprolalia (uttering socially inappropriate words), which only affects 10 to 15 percent of individuals with TS, or echolalia (repeating the words or phrases of others). Often times, tics are preceded with premonitory urges which help teach individuals to learn to control their tics. Tics worsen with excitement or anxiety. Certain physical experiences can trigger or worsen tics as well (NINDS). For example, tight collars may trigger neck tics, or hearing another person sniff or clear their throat may trigger similar sounds.
The cause of TS is unknown although current research points abnormalities in certain brain regions, the circuits that connect those regions and the neurotransmitters (NINDS). In order to be diagnosed, other disorders, such as Autism, must be ruled out as well as physiological effect of a substance or other medical condition because those unfamiliar with the symptoms may confuse tics with light seizures (TourettesSyndrome.org, 2008). Some doctors would need to verify that the patient has had both vocal and motor tics for at least a year or the existence of other neurological or psychiatric conditions. Blood, lab or imaging tests are not useful for diagnosing this disorder. In rare cases, MRIs, CTs and EEGs are used to rule out other conditions that might be confused with TS when the history or exam is atypical (NINDS). Some research even suggests that gender has a lot to do with it as well, but only because more boys are affected than girls.
Genetics is another possibility currently being researched. The specific genes involved in TS are still being defined. Only one genetic mutation has been identified as a rare cause of TS. Even though it hasn’t been proven, it’s believed that there’s a fifty percent chance of a mother passing the disorder to their children, especially if they have a son.
In addition to TS, you’re most likely to have other related conditions such as Attention Deficit – Hyperactivity Disorder (ADHD), Obsessive-Compulsive Disorder (OCD), depression, anxiety disorders, learning disabilities and sleeping disorders. Although most people experience fewer symptoms of TS as they go into adulthood, the other conditions may persist.
There is no cure, medication, or treatments for all individuals with TS; however, some symptoms, depending on their severity, can be controlled or suppressed with different drugs (Mayo Clinic). Clonidine is typically one of the first prescribed medications for a patient with Tourette’s. Another class of medications called neuroleptics are also used in treating tics. For many, psychobehavioral therapy and education are sufficient to help them manage the disorder (TourettesSyndrome.org).
Habitat reversal therapy is another heavily used treatment for TS. It teaches patients to use competing responses.
Because Tourette syndrome is a neurological disorder that affects bodily movements, it is directly related to physiological psychology. Current research supports that abnormalities in the basal ganglia (gray matter), frontal lobes (motor sensory), and cerebral cortex (outer layer of neural tissue) regions of the brain, the circuits that connect these regions, and the neurotransmitters (dopamine, serotonin, and norepinephrine) responsible for communication among nerve cells could be the main cause of TS. The complexity of the disorder makes it difficult to know for sure. The psychological aspects of Tourette’s mostly concern the different treatments or remedies used to control the symptoms, such as psychobehavioral therapy or meditation.
Also, because of the other conditions associated with TS, it could be considered to be psychological in a sense of the word. For instance, obsessive compulsive disorder (OCD) is an anxiety disorder that causes disruptions in one's daily life because of their overbearing thoughts and fears.
Initially, it was perceived that the disorder was purely neurological and could not be controlled. The constant, uncontrollable movements and noises made it seem as though they were unpredictable. However, with the information gained, it’s been realized that the disorder is much more complicated.

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