Psych 111 Term Paper on Tourettes Syndrome Essay Example
Psych 111 Term Paper on Tourettes Syndrome Essay Example

Psych 111 Term Paper on Tourettes Syndrome Essay Example

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  • Pages: 9 (2361 words)
  • Published: December 19, 2017
  • Type: Essay
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Over a century ago, French neurologist Gilles de la Tourette introduced the disorder known as Tourette's syndrome (TS), which is currently recognized as the leading cause of tics (Harvard Mental Health). To qualify for a TS diagnosis, an individual must show multiple motor tics along with at least one phonic or vocal tic and present symptoms before turning eighteen years old. These symptoms should persist for more than one year and are typically characterized by early signs such as quick eye blinking and mouth or nose twitches.

Additional motor tics encompass various actions such as head movement, teeth grinding, neck rotation, unusual positions, and muscle spasms. More elaborate tics involve facial expressions, crouching, deep knee bends, bowing, jumping, immoral gestures, and mimicking others' actions. Vocal or phonic tics comprise sniffing, clearing the throat, squeaking, barking,

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grunting, humming, blowing or sucking sounds, repetition of one's own or another's words, and uttering profanities known as coprolalia. While indecent gestures and language are the most noticeable tics, no more than 10% of those with this disorder exhibit these symptoms.

During adolescence, when physical appearance is especially valued, Tourette Syndrome (TS) may lead to increased psychological distress due to the peak severity of motor and phonic tics that occur during this stage of life. Tics may not be completely involuntary and can be compared to the urge to sneeze or scratch an itch. Individuals with TS may experience tension, tightness, or a vague sense of anxiety that drives them to repeat their tics until they feel satisfied.

Individuals who have Tourette Syndrome often attempt to hide their tics by passing them off as normal movements and sounds or suppressing them when

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around others. Tics can worsen due to stress, and they may occur during sleep; however, they typically diminish when the person is highly focused. Typically associated with children and teenagers, indications of this condition usually appear at approximately six years old on average. About 10% of young individuals encounter some type of tic disorder, but just 1% have Tourette Syndrome specifically. The majority of tics vanish without treatment before adulthood, and if they continue into adulthood, they usually become less severe over time.

TS, also known as chronic tics, is a disorder that predominantly affects boys and has a strong genetic component. Individuals with a family history of the condition have a 25% chance of developing it themselves, while identical twins have an even higher likelihood at a 90% concordance rate. In Asia in 2003, Chang conducted research on adolescent patients who met World Health Organization criteria for TS. The study included 38 male and 5 female patients seen at a specialized pediatric neurological clinic from January to March of that year. Clinical interviews were based on DSM-IV diagnostic criteria and involved self-report questionnaires such as Symptom-Checklist-90-R, Family APGAR, and Tic Symptoms questionnaire.

The average age for the beginning of motor tics among this group was 9.65 ± 3.7 years, with head and eye tics typically being the first noticeable symptoms. Coprolalia was seen in 44% (n = 19) of the patients. Similar results were observed in studies conducted in other parts of the world.

In older patients, emotional distress appears more strongly associated with symptoms of TS. Social difficulties are often experienced by individuals with TS, which could be due to the negative perceptions of

others towards the disorder. Researchers suggest attitude change strategies, including preventative disclosure, to mitigate the impact of such negative perceptions. However, no known research has been conducted to examine the effects of TS disclosure. To test this, 369 adults were asked to read different vignettes varying by gender.

The study focused on the design of preventive disclosure of disorders as opposed to non-disclosure, using a female character. Respondents answered questions about the presented vignette character, resulting in four factors after factor analysis: social rejection, attributions of substance abuse, perceptions of psychological and medical problems, and general concern. These results suggest that preventive disclosure of Tourette Syndrome may decrease social rejection, minimize concern, and reduce perceptions of substance abuse. Character gender had no significant effect. The study discussed limitations and future research directions.

In the context of the crucial role that neural oscillations play in maintaining normal CNS function, this article reviews the available anatomic and electrophysiological findings in TS. Neurons form oscillating networks of different sizes and frequencies based on behavior that bias input selection and facilitate mechanisms for temporal representation, transfer, and long-term consolidation of information. Coherent network activity modulates sensorimotor gating and focused motor actions. Dysrhythmic networks result in a loss of control over sensory information and motor action. Medications and surgical interventions used to treat TS have electrophysiological effects that alleviate these aberrant oscillations. Successful behavioral treatments involve the willful training of prefrontal cortex regions for tic suppression and competing motor responses to unwanted sensory urges, making these regions effective modulators of aberrant thalamocortical rhythms. (Leckman, Vaccarino, Kalanthini & Rothenberger, 2007)

Studying neural oscillations may enhance understanding of Tourette Syndrome (TS), a

complex disorder. Research has suggested that TS involves abnormalities in the thalamus (Lee, Yoo, Cho Ock, Lim & Panych 2006). To investigate this hypothesis further, MRI volumetric scans were performed on 18 untreated boys with TS aged between 7 and 14 years old, as well as 16 healthy individuals. The thalamic volume was manually parcellated within defined anatomical boundaries. Results indicated that boys with TS had a significantly larger left thalamus than their healthy counterparts.

The initial expectations were not met as there was no observable difference in thalamic volume on the right side between two groups. However, children diagnosed with Tourette syndrome (TS) showed reduced levels of rightward asymmetry in their thalamic volume compared to healthy counterparts, indicating an anomaly. Leckman, Vaccarino, Kalanithi & Rothenberger carried out a case study to investigate potential connections between comorbid behavioral and mood problems and tic disorder severity in non-psychiatric TS children. The assessment involved using the Child Behavior Checklist and Yale Global Tic Severity Scale to evaluate 69 TS patients alongside 69 healthy controls. These findings provide additional confirmation of abnormal thalamic volume in pediatric Tourette syndrome.

Using comparison, correlation, and multiple linear regression analyses, we investigated the connections between severity of tic symptoms and behavioral problems in pediatric patients with Tourette Syndrome (TS). Our findings revealed that TS children exhibited lower scores on the CBCL competency subscales and total score while exhibiting higher scores on all behavioral problem subscales and total score, indicating reduced social competence compared to normal children. Additionally, we observed a positive correlation between the severity of tic symptoms and overall impairment in school and social competence among TS children. Upon further examination of common

behavioral and mood problems associated with TS, we discovered that delinquent behavior, thought problems, attention problems, aggressive behavior, and externalizing were all positively correlated with the severity of tic symptoms.

The discovery showed that children who only had TS had various behavioral issues, which were sometimes related to the severity of their tic symptoms. Brain scans have revealed that individuals with TS had unusual anatomical characteristics in their brains (Plessen et al, 2006). Specifically, prefrontal regions were larger and the corpus callosum (CC) area was smaller in children and young adults with TS than in healthy individuals. These anatomical features indicated neural plasticity that attenuated tic severity. Twenty boys with TS and 20 controls were evaluated for CC white matter connectivity using the Fractional Anisotropy (FA) index from diffusion tensor images. The study confirmed the hypothesis that children with TS would have reduced connectivity measures in CC fibers. There was no significant interaction between TS and region.

The reduction of FA in CC regions may indicate a decrease in interhemispheric fibers or lowered axonal myelination. Tic symptom severity did not directly correlate with FA values. Factors such as comorbid ADHD or OCD, medication exposure, and IQ did not account for group differences in connectivity measures. The study's discovery of diminished interhemispheric white matter connectivity sheds light on neural connectivity and plasticity in the brains of children with TS. While various behavioral therapies have been used in treating TS, controlled studies are limited. Treatment success has been seen with massed negative practice, contingency management, relaxation training, self-monitoring, and habit reversal.

The concept of utilizing exposure and response prevention as a treatment approach for Tourette Syndrome (TS) has been newly

developed. This strategy is founded on the concepts outlined by J. Bliss, who, as a TS sufferer, relayed his own personal encounters with the disorder. Bliss proposed that individuals with TS intentionally perform vocal and physical tics to alleviate unpleasant sensations. Research has increasingly explored the degree of voluntariness of tics and the presence of such sensations.

In their study, Hoogduin et al. introduce a novel treatment strategy for Tourette Syndrome involving exposure and response prevention in ten two-hour sessions. The method draws from Bliss' theory that intentional tic production by patients can alleviate unpleasant sensations associated with the syndrome. The objective is to intervene at the level of premonitory sensations and induce habituation to them through tic prevention, leading to decreased urge to produce tics and eventual discontinuation. Results of the study on four Gilles de la Tourette patients indicate positive response to the approach, with three exhibiting within-session habituation to premonitory sensations.

Exposure and response prevention treatment was administered to four patients diagnosed with severe GTS. The outcome of the treatment resulted in a decline in both motor and vocal responses, with varying degrees of improvement observed from case to case. After the treatment, tiquing behavior decreased between 68% (case IV) and 83% (case II), while it ranged from 50% (case IV) to 100% (case II) two months following follow-up. Although cases I and IV displayed less progress during follow-up, cases II and III presented further advancement. All four patients reported subjective enhancement that varied from 45% (case III) to 60% (case I) by the end of treatment.

During a 2-month monitoring period, it was observed that three patients experienced a decline in subjective improvement. Case

I exhibited no progress, while cases III and IV reported reductions of 30% and 40%, respectively. In contrast, case II demonstrated more improvement and believed to have achieved an overall recovery rate of 90%. According to J. Leckman (2002), it is common practice to utilize different methods for treating Tourette's syndrome.

This method involves educational and supportive measures that are suitable for managing any chronic illness. Given that both acute and chronic stress can worsen tic symptoms, addressing issues related to self-esteem, social coping, family dynamics, and school adjustment through psychotherapy may have a positive impact on tic severity, as well as anxiety and depression. Patient advocacy organizations like the Tourette's Syndrome Association's local chapters can provide essential support for families of newly diagnosed children by connecting them with experienced families. It is recommended that parents help their child build on their strengths. In many cases of uncomplicated Tourette's Syndrome, the use of anti-tic drugs is unnecessary as these interventions alone are effective in managing symptoms.

It is advisable to prioritize treating comorbidities such as hyperkinetic disorder, obsessive-compulsive disorder, depression, or a combination of any two or three disorders first in patients with tic disorders. This may potentially reduce the severity of tics since there are currently no optimal treatments for tics available. Both medications and techniques are not effective solely during severe tic episodes, and some medications have potential side effects that require prolonged use. In certain cases, stopping medication can be more challenging than starting it. Furthermore, drug trial outcomes can be complicated by the natural waxing and waning of tics.

Without any intervention, severe periods of tics will naturally decrease. It can be challenging

to differentiate between the effect of tic-suppressant medication and the natural reduction of symptoms, as these drugs typically take several weeks to take full effect. It is advisable to refrain from starting or increasing drug dosages at the onset of exacerbations. The only guaranteed method to prevent TS is for a parent with the condition to avoid reproducing. (References: Chang, H., Tu, M.)

The article titled "Tourette's Syndrome: Psychopathology in Adolescents" by Hoogduin and Wang (2004, August) was published in Psychiatry & Clinical Neurosciences, volume 58, issue 4, pages 353-358. The source was retrieved on April 1, 2008. The authors were Hoogduin and Verdellen, C.

, & Cath, D. (1997, June). The Treatment of Gilles de la Tourette's Syndrome: Four Case Studies Using Exposure and Response Prevention. Clinical Psychology & Psychotherapy, 4(2), 125-135.

On March 23, 2008, J. Leckman, F. Vaccarino, P. Kalanithi, and A. Rothenberger were retrieved.

(2006, June). The Journal of Child Psychology & Psychiatry published an annotation titled "Tourette syndrome: a relentless drumbeat - driven by misguided brain oscillations," authored by Leckman (2002, November 16). The article can be found in volume 47, issue 6, pages 537-550 and was retrieved on April 8, 2008.

The Psychology and Behavioral Sciences Collection database provides information on Tourette's syndrome as reported in the Lancet, Volume 360(9345), page 1577. The authors of the report are Lee, J. and Yoo, S. The information was retrieved on March 20, 2008 from the database. The original text is represented within HTML paragraph tags.

, Cho, S., Ock, S., Lim, M., and Panych, L.

(2006, January). Marcks, B., Berlin, K., and Woods, D. reported that boys with Tourette syndrome who were new to treatment had abnormal thalamic

volume. The study was retrieved on April 14, 2008.

The Psychology and Behavioral Sciences Collection database contains an article titled "Impact of Tourette Syndrome: A Preliminary Investigation of the Effects of Disclosure on Peer Perceptions and Social Functioning," written by Plessen, K., Gruner, R., and Davies, W. in 2007 during the spring. It was published in Psychiatry: Interpersonal & Biological Processes and has a volume number of 70 and issue number of 1. The article can be accessed using the retrieval date of April 3rd, 2008.The text inside the reads as:
", Lundervold, A. , Hirsch, J. , Xu, D. , Bansal, R."

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The following names are listed: Lundervold, A., Hirsch, J., Xu, D., and Bansal, R.

The corpus callosum of children with Tourette syndrome shows lower white matter connectivity, according to an article by et al. (2006, October) in the Journal of Child Psychology & Psychiatry (volume 47, issue 10). The findings were based on research that took place over that period and were published in pages 1013-1022.

On June of 2005, the Harvard Mental Health Letter retrieved information about Tourette's disorder, which was accessed on March 10, 2008.

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