Abstract
Tics are involuntary movements or sounds that are rapid, sudden, repetitive, and stereotyped. Tics are highly distinct from other movement disorders of childhood and are rarely confused with choreoathetoid movement dysfunctions. Tic disorders are classified by age of onset, duration of symptoms, and the presence or absence of vocal or phonic tics along with the usual motor tics. Key clinical features are their occurrence at random intervals and their apparent voluntary suppression for varying periods of time. The norm is for tics to occur without apparent cause, but they are sometimes triggered by environmental stimuli and are exacerbated by stress, fatigue, or underlying medical illness. Some patients frequently describe a premonitory sensory urge for which tics are voluntarily performed to relieve the urge. A waxing and waning course in severity as well as a change in anatomical location from time to time are also common features. Motor tics are subdivided into simple or complex types. Simple motor tics are fast, darting, meaningful muscular movements that occur in isolated muscle groups or in one anatomical location. They can be embarrassing and sometimes physically painful, such as jaw snapping or blepharospasm. Frequently, self-abusive acts that are the consequence of an unchecked simple motor tic (e.g., arm flailing) can be the cause of considerable distress to patients and families. Complex motor tics are often slower and more purposeful in appearance. These include hopping, clapping, or tensing of multiple muscle groups, touching objects or people, making obscene gestures, or engaging in socially inappropriate acts. Complex motor tics frequently are difficult to separate from compulsions when the activity is organized and ritualistic in character. Self-destructive behaviors such as head banging, eye poking, or biting are complex tics that require immediate intervention. Aggressive behavior toward others can be the result of complex tics, but the context for the patient is usually embarrassment and anxiety about restraining these untoward impulses.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Preview
Unable to display preview. Download preview PDF.
References
Achenbach, T. M., & Edelbrock, C. S. (1983). Manual for the Revised Child Behavior Checklist and Profile. Burlington, VT: University Associates in Psychiatry.
Barrett, R. P, Feinstein, C., & Hale, W. (1989). Effects of naloxone and naltrexone on self-injury: A double-blind, placebo controlled analysis. American Journal of Mental Deficiency, 93, 644–651.
Bennun, I. (1983). Depression and hostility in self-mutilation. Suicide and Life-Threatening Behavior, 13,71–84.
Bornstein, R. A., & Yang, V. (1991). Neuropsychological performance in medicated and unmedicated patients with Tourette’s disorder. American Journal of Psychiatry, 148,468–471.
Bruun, R. D. (1984). Gilles de la Tourette’s syndrome: An overview of clinical experience. Journal of the American Academy of Child Psychiatry, 23,126–133.
Bruun, R. D. (1988). The natural history of Tourette’s syndrome. In D. J. Cohen, R. D. Bruun, & J. E Leckman (Eds.), Tourette’s syndrome and tic disorders: Clinical understanding and treatment (pp. 22–39). New York: Wiley & Sons.
Caine, E. D., McBride, M. C., & Chiverton, P (1988). Tourette’s syndrome in Monroe County school children. Neurology, 38, 472.
Cohen, D. J., Young, J. G., & Nathanson, J. A. (1979). Clonidine in Tourette’s syndrome. Lancet,2,551–553.
Coid, J. M., Allolio, B., & Rees, L. H. (1983). Raised plasma metenkephalin in patients who habitually mutilate themselves. Lancet, ii, 545–546.
Comings, D. E., & Comings, B. G. (1985). Tourette syndrome: Clinical and psychological aspects of 250 cases. American Journal of Human Genetics, 37, 435–450.
Comings, D. E., & Comings, B. G. (1987). A controlled study of Tourette syndrome. I. Attention-deficit disorder, learning disorders, and school problems. American Journal of Human Genetics, 41,701–741.
Corbett, J. A., & Campbell, H. J. (1980). Causes of severe self-injurious behavior. In P Mittler & J. M. Dejong (Eds.), Mental retardation new horizons: Vol. II Biomedical aspects (pp. 285–292). University Park Press: Baltimore.
Davidson, P W., Keene, B. M., Carroll, M., & Rockowitz, R. J. (1983). Effects of naloxone on self-injurious behavior: A case study. Applied Research in Mental Retardation, 4, 1–4.
Elie, R., Albert, J., Cooper, S. F, Clermont, A., & Langlois, Y. (1977). Efficacy of SCH-12679 in the management of aggressive mental retardates. Current Therapeutic Research, 21, 786–795.
Erenberg, G. (1988). Pharmacologic therapy of tics in childhood. Pediatric Annals, 17, 395–404.
Frankel, M., Cummings, J. L., Robertson, M. M., Trimble, M. R., Hill, M. A., & Benson, D. F (1986). Obsessions and compulsions in Gilles de la Tourette’s syndrome. Neurology, 36, 378–382.
Gardner, A. R., & Gardner, A. J. (1975). Self mutilation, obsessionality and narcissism. British Journal of Psychiatry,127,127–132.
Goetz, C. G., Tanner, C. M., & Klawans, H. L. (1984). Fluphenazine and multifocal tic disorders. Archives of Neurology, 41, 271–272.
Goetz, C. G., Tanner, C. M., Wilson, R. S., Carroll, V. S., Como, P G., & Shannon, K. M. (1987). Clonidine and Gilles de la Tourette’s syndrome: Double-blind study using objective rating methods. Annals of Neurology,21, 307–310.
Golden, G. S. (1990). Tourette syndrome: Recent advances. Neurology Clinics, 8, 705–714.
Goldstein, M., Anderson, L. T., Reuben, R., & Dancis, J. (1985). Self-mutilation in Lesch-Nyhan disease caused by dopaminergic denervation. Lancet,9,338–339.
Gorea, E., & Lombard, M. C. (1984). The possible participation of a dopaminergic system in mutilating behavior in rats with forelimb deafferentation. Neuroscience Letters, 48, 75–80.
Harcherick, D. E, Leckman, J. F., Detlor, J., & Cohen, D. J. (1984). A new instrument for clinical studies of Tourette’s syndrome. Journal of the American Academy of Child Psychiatry, 23,153–160.
Jones, I. H., & Barraclough, B. M. (1978). Auto-mutilation in animals and its relevance to self-injury in man. Acta Psychiatrica Scandinavica, 58, 40–47.
Jones, C. C., Vallano, G., Ryan, E., Helsel, W. J., & Rancurello, M. D. (1991). Self-injurious behavior: Strategies for assessment and management. Psychiatric Annals, 21, 310–318.
King, R. A., Riddle, M. A., Chappell, P B., Hardin, M. T., Anderson, G. M., Lombroso, P, & Scahill, L. (1991). Emergency of self-destructive phenomenon in children and adolescents during fluoxetine treatment. Journal of the American Academy of Child and Adolescent Psychiatry, 30,179–186
Leckman, J. F, Detlor, J., Harcherik, D. E, Ort, S., Shaywitz, B. A., & Cohen, D. J. (1985). Short-and long-term treatment of Tourette’s syndrome with clonidine: A clinical perspective. Neurology, 35, 343–351.
Leckman, J. F, Hardin, M. T., Riddle, M. A., Stevenson, J., Ort, S., & Cohen, D. J. (1991). Clonidine treatment of Gilles de la Tourette’s syndrome. Archives of General Psychiatry, 48, 324–328.
Maletzky, B. M. (1974). Behavior recording as treatment: A brief note. Behavior Therapy, 5, 107–111.
Micev, V., & Lynch, D. M. (1974). Effect of lithium on disturbed severely mentally retarded patients. British Journal of Psychiatry, 125, 110.
Mikkelsen, E. J., Detlor, J., & Cohen, D. J. (1981). School avoidance and social phobia triggered by haloperidol in patients with Tourette’s disorder. American Journal of Psychiatry, 138, 1572–1576.
endick, T. H. (1981). Self-monitoring and self-administered overcorrection: The modification of nervous tics in children. Behavior Modification, 5, 75–84.
Pauls, D. L., & Leckman, J. E (1986). The inheritance of Gilles de la Tourette’s syndrome and associated behaviors: Evidence for an autosomal dominant transmission. New England Journal of Medicine, 315, 993–997.
Primeau, E, & Fontaine, R. (1987). Obsessive disorder with self-mutilation: A subgroup of responsive to pharmacotherapy. Canadian Journal of Psychiatry, 32, 699–701.
Ratzoni, G., Hermesh, H., Brandt, N., Lauffer, M., & Munitz, H. (1990). Clomipramine efficacy for tics, obsessions, and compulsions in Tourette’s syndrome and obsessive-compulsive disorder: A case study. Biological Psychiatry, 27, 95–98.
Regeur, L., Pakkenberg, B., Fog, R., & Pakkenberg, H. (1986). Clinical features and long-term treatment with pimozide in 65 patients with Gilles de la Tourette’s syndrome. Journal of Neurology, Neurosurgery, & Psychiatry, 49, 791–795.
Riddle, M. A., Hardin, M. T., King, R., Scahill, L., & Woolston, J. L. (1990). Fluoxetine treatment in children and adolescents with Tourette’s and obsessive compulsive disorder: Preliminary clinical experience. Journal of the American Academy of Child and Adolescent Psychiatry, 29, 45–48.
Robertson, M. M., Schnieden, V., & Lees, A. J. (1990). Management of Gilles de la Tourette syndrome using sulpiride. Clinical Neuropharmacology, 13, 229–235.
Robertson, M. M., Trimble, M. R., & Lees, A. J. (1989). Self-injurious behavior and the Gilles de la Tourette syndrome: A clinical study and review of the literature. Psychological Medicine, 19, 611–625.
Sallee, F. R., Pollock, B. G., Stiller, R. L., Stull, S., Everett, G., & Perel, J. M. (1987). Pharmacokinetics of pimozide in adults and children with Tourette’s syndrome. Journal of Clinical Pharmacology, 27, 776–781.
Sallee, E R., Rock, C., & Kunins, N. (1991). [Unpublished raw data.]
Sandyk, R. (1985). Naloxone abolishes self-injuring in a mentally retarded child. Annals of Neurology, 17, 520.
Sandyk, R., & Baithford, C. A. (1987). Deregulation of hypothalamic dopamine and opiode activity and the pathophysiology of self-mutilatory behavior in Tourette’s syndrome. Journal of Clinical Psychopharmacology, 7, 367.
Shapiro, A. K., Shapiro, E., & Eisenkraft, M. A. (1983). Treatment of Gilles de la Tourette syndrome with pimozide. American Journal of Psychiatry, 140, 1183–1186.
Shapiro, A. K., Shapiro, E., & Fulop, G. (1987). Pimozide treatment of tic and Tourette disorders. Pediatrics, 79, 1032–1039.
Shapiro, A. K., Shapiro, E., & Wayne, H. (1973). Treatment of Tourette syndrome with haloperidol, review of 34 cases. Archives of General Psychiatry, 28, 92–97.
Shapiro, E., Shapiro, A. K., Fulop, G., Hubbard, M., Mandeli, J., Nordlie, J., & Phillips, R. A. (1989). Controlled study of haloperidol, pimozide, and placebo for the treatment of Gilles de la Tourette’s syndrome. Archives of General Psychiatry, 46, 722–730.
Singer, H. S., Tune, L. E., Butler, I. J., Seifert, W. E., & Coyle, J. T. (1982). Dopaminergic dysfunction in Tourette syndrome. Annals of Neurology, 12, 361–366.
Singh, N. N., & Aman, M. G. (1981). Effects of thioridazine dosage on the behavior of severely mentally retarded persons. American Journal of Mental Deficiency,85, 580–587.
Stefl, M. E. (1983). The Ohio Tourette study. School of Planning, University of Cincinnati.
Szymanski, L., Kedesdy, J., Sulkes, S., & Cutler, A. (1987). Naltrexone in treatment of self-injurious behavior: A clinical study. Research Developmental Disabilities, 8, 179–190.
Thomas, E. J., Abrams, K. S., & Johnson, J. B. (1971). Self-monitoring and reciprocal inhibition in the modification of multiple tics of Gilles de la Tourette’s syndrome. Journal of Behavior Therapy & Experimental Psychiatry, 2, 159–171.
van der Kolk, B. A. (1989). The compulsion to repeat the trauma. Re-enactment, revictimization, and masochism. Psychiatric Clinics of North America,12, 389–411.
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 1994 Springer Science+Business Media New York
About this chapter
Cite this chapter
Head, L.A., Sallee, F.R. (1994). Tic Disorders. In: Hersen, M., Ammerman, R.T., Sisson, L.A. (eds) Handbook of Aggressive and Destructive Behavior in Psychiatric Patients. Springer, Boston, MA. https://doi.org/10.1007/978-1-4615-2403-8_24
Download citation
DOI: https://doi.org/10.1007/978-1-4615-2403-8_24
Publisher Name: Springer, Boston, MA
Print ISBN: 978-1-4613-6019-3
Online ISBN: 978-1-4615-2403-8
eBook Packages: Springer Book Archive