Showing papers on "Tourette syndrome published in 2001"

Tourette's Syndrome

Abstract: The French neurologist Georges Gilles de la Tourette first described this syndrome, which consists of motor tics sometimes accompanied by uncontrollable noises or utterances, attention-deficit–hyperactivity disorder, obsessive–compulsive disorder, and poor impulse control. Although the pathogenesis of the disorder remains obscure, tics may be treated effectively with haloperidol or pimozide, and other clinical features may also respond to pharmacologic therapy.

Regional Brain and Ventricular Volumes in Tourette Syndrome

Abstract: Background The pathophysiology of Tourette syndrome (TS) is thought to involve disturbances in cortico-striato-thalamo-cortical circuitry. The morphological characteristics of the cortical and associated white matter portions of these circuits have not been previously examined in TS subjects. Methods High-resolution anatomical magnetic resonance images were acquired in 155 TS and 131 healthy children and adults. The cerebrums and ventricles were isolated and then parcellated into subregions using standard anatomical landmarks. Results For analyses that included both children and adults, TS subjects were found to have larger volumes in dorsal prefrontal regions, larger volumes in parieto-occipital regions, and smaller inferior occipital volumes. Significant inverse associations of cerebral volumes with age were seen in TS subjects that were not seen in healthy controls. Sex differences in the parieto-occipital regions of healthy subjects were diminished in the TS group. The age-related findings were most prominent in TS children, whereas the diminished sex differences were most prominent in TS adults. Group differences in regional ventricular volumes were less prominent than in the cerebrum. Regional cerebral volumes were significantly associated with the severity of tic symptoms in orbitofrontal, midtemporal, and parieto-occipital regions. Conclusions Broadly distributed cortical systems are involved in the pathophysiology of TS. Developmental processes, sexual dimorphisms, and compensatory responses in these cortical regions may help to modulate the course and severity of tic symptoms.

Botulinum toxin for simple motor tics: a randomized, double-blind, controlled clinical trial

Abstract: Objective: To determine the effect of injections of botulinum toxin on simple motor tics. Background: Case series with unblinded assessments have reported improvement in tic frequency and associated urge with botulinum toxin. Methods: Patients with suitable simple motor tics were randomized to receive botulinum toxin and placebo in a double blind, crossover design. All outcomes compared week 2 to baseline measurements. The primary outcome measure was the number of treated tics per minute on a videotape segment. Secondary outcome measures were number of untreated tics per minute, the Shapiro Tourette Syndrome Severity Scale score, a numerical assessment of the urge to perform the treated tic (0 to 4), the premonitory sensation associated with the treated tic (0 to 4), and the patient’s global impression of change. Results: Eighteen patients completed the study. The median relative change in treated tics per minute with botulinum toxin was −0.39 (or a 39% reduction) versus 0.058 (or a 5.8% increase) with placebo (net effect −0.37, p = 0.0007). The average change in urge scores (score range 0 to 4) was −0.46 in the treatment phase and +0.49 in the placebo phase (net effect 0.94, p = 0.02). Other secondary outcome measures were not significantly different between the two groups. Conclusion: Botulinum toxin reduced treated tic frequency and the urge associated with the treated tic. Despite these changes, patients did not report an overall benefit from the treatment. Careful consideration of the contribution of the target tic to the patient’s disability is needed before making treatment decisions. Additional material related to this article can be found on the Neurology Web site. Go to www.neurology.org and scroll down the Table of Contents for the March 13 issue to find the title link for this article.

Juvenile and young adult mentally disordered offenders: the role of child neuropsychiatric disorders

Abstract: A retrospective study of the prevalence of child neuropsychiatric disorders was done involving pervasive developmental disorder (PDD), attention-deficit/hyperactivity disorder (ADHD), and Tourette syndrome in young offenders (15-22 years, n = 126) consecutively referred for presentencing forensic psychiatric investigation (FPI) in Stockholm, Sweden. Most offenders were referred for FPI because of serious offenses. Case report sheets were prepared, and retrospective neuropsychiatric DSM IV diagnoses were made by the first two authors. For best-estimated diagnoses, the case report sheets were then submitted to the fifth author, a child neuropsychiatrist with expertise in this area. Fifteen percent of the subjects had a definite diagnosis of ADHD, and another 15 percent had PDD, including 12 percent PDD not otherwise specified (NOS) and 3 percent Asperger syndrome. Autistic disorder was not found in any case. Tourette syndrome occurred in two percent of the cases. The rate of PDD is particularly striking. Neuropsychiatric diagnoses had been determined in the FPI in only a few cases. The contribution of constitutional problems to later criminal development may have been underestimated.

Paediatric autoimmune neuropsychiatric disorders associated with streptococcal infection (PANDAS).

Abstract: The evidence to date, both published and unpublished, which addresses the validity of the proposed unique subgroup of children with early and abrupt onset of obsessive--compulsive disorder (OCD) and/or tic disorders subsequent to streptococcal infections was reviewed. The aetiology of OCD and tic disorders is unknown, although it appears that both disorders may arise from a variety of genetic and environmental factors. Post-streptococcal autoimmunity has been postulated as one possible mechanism for some. The acronym PANDAS (for paediatric autoimmune neuropsychiatric disorders associated with streptococcal infections) has been given to a subgroup of paediatric patients who meet five inclusionary criteria: presence of OCD and/or tic disorder, pre-pubertal symptom onset, sudden onset or episodic course of symptoms, temporal association between streptococcal infections and neuropsychiatric symptom exacerbations, and associated neurological abnormalities. The proposed model of pathophysiology provides for several unique treatment strategies, including the use of antibiotic prophylaxis to prevent streptococcal-triggered exacerbations, and the use of immunomodulatory interventions (such as intravenous immunoglobulin or therapeutic plasma exchange) in the treatment severe neuropsychiatric symptoms. For the latter study group, long-term (2--5 yr) follow-up revealed continued symptom improvement for the majority of patients, particularly when antibiotic prophylaxis had been effective in preventing recurrent streptococcal infections. In addition, the episodic nature of the subgroup's illness provides for opportunities to study brain structure and function during health and disease, as well as allowing for investigations of the aetiologic role of anti-neuronal antibodies and neuroimmune dysfunction in both OCD and tic disorders. Although much research remains to be done, an increasing body of evidence provides support for the postulate that OCD and tic disorders may arise from post-streptococcal autoimmunity. The unique clinical characteristics of the PANDAS subgroup, the presence of volumetric changes in the basal ganglia, and the dramatic response to immunomodulatory treatments, suggest that symptoms arise from a combination of local, regional and systemic dysfunction. Ongoing research is directed at understanding the nature of the abnormal immune response, as well as identifying at-risk children, in order to provide for novel strategies of prevention and treatment.

Baclofen treatment in Tourette syndrome A double-blind, placebo-controlled, crossover trial

Abstract: Objective: To investigate the effectiveness of baclofen for the treatment of tics in children with Tourette syndrome (TS). Background: Baclofen, which contains both γ-aminobutyric acid (GABA) and phenylethylamine moieties, was suggested in an open-label protocol to be an effective treatment for TS. This is a double-blind, placebo-controlled study to investigate this medication in children with TS. Methods: Subjects received, in a randomized sequence, 4-week medication cycles of baclofen (20 mg three times daily) and placebo with a 2-week intervening washout period between the cycles. Outcome measures included the Clinical Global Impression (CGI) scale, and the Yale Global Tic Severity Scale (YGTSS), the latter including subscales for total tics and overall impairment. Measures were assessed at baseline and on days 28, 42, and 70 of the study. Results: Ten children (seven boys and three girls, aged 8 to 14) with TS participated. Nine subjects completed the protocol; one dropped out for psychosocial reasons. No major side effects were reported. The mean change in CGI score (−0.9) after 4 weeks of baclofen treatment as compared with placebo treatment showed a significant improvement (95% CI, −1.7 to −0.1; p = 0.04). All subjects showed some amelioration in total YGTSS score during baclofen treatment. The mean change in total YGTSS score (−14.7) approached significance (95% CI, −30.3 to 0.9; p = 0.06). Examination of differences between baclofen and placebo treatment groups expressed as a percent change from baseline showed that baclofen had a statistically significant effect on both outcome measures. Subscales of the YGTSS showed that the reduction in total tic scores was primarily due to a reduction in the impairment score rather than a decrease in tics. Conclusions: Children with TS may benefit from treatment with baclofen, although improvements may be related to factors other than tics. Larger studies directly comparing baclofen against other tic-suppressing agents are recommended.

Decreased sleep quality and increased sleep related movements in patients with Tourette's syndrome.

Abstract: OBJECTIVE—Sleep quality and movement patterns across sleep stages in patients with Tourette's syndrome were examined to determine the influence of syndrome severity on sleep quality and the differential effect of sleep stages on tic and non-tic movements. METHODS—Twenty five patients with Tourette's syndrome (mean age 29 (SD 7) years) and 11 control subjects (29 (5) years) were studied by polysomnography and simultaneous split screen video monitoring to record standard sleep variables as well as to evaluate movements to differentiate between tics and regular movements. Severity of Tourette's syndrome during the day was assessed with the Tourette's syndrome severity scale. RESULTS—Sleep was significantly more disturbed in patients with Tourette's syndrome than in controls, with decreased sleep efficiency and slow wave sleep percentage, increased sleep latency, percentage of stage I, percentage of awakeness, number of awakenings, and sleep stage changes and more overall movements during sleep. Severity of Tourette's syndrome during the day correlated significantly and positive with number of awakenings and sleep stage changes and negatively with sleep efficiency. In addition to an increased number of regular movements patients had tics in all sleep stages. Tic frequency as well as frequency of regular movements was significantly higher in REM than in non-REM sleep which was also the case for regular movements of the controls. No disturbance of either REM sleep percentage or REM latency was found. CONCLUSION—Despite normal total sleep time and unaltered REM sleep variables patients with Tourette's syndrome have markedly disturbed sleep. Severity of the syndrome during the day is an important predictor of sleep alteration in patients. The increased rate of tics during REM sleep parallels the overall increased movement activity of patients during REM as well as non-REM sleep. The increased motor activity may be attributable to a state of hyperarousal rather than a disturbed cholinergic system.

Long-term follow-up of an epidemiologically defined cohort of patients with Tourette syndrome.

Abstract: The goal of this study was to collect prospective longitudinal information on the development of an epidemiologically defined cohort of patients with Tourette syndrome. These data may improve progn...

Repetitive behaviors in Tourette's syndrome and OCD with and without tics: what are the differences?

Abstract: Gilles de la Tourette Syndrome (GTS) and obsessive–compulsive disorder (OCD) share obsessive–compulsive phenomena. The aims of this study were to compare the OC symptom distribution between GTS and OCD and to investigate whether a subdivision of these phenomena into obsessions, compulsions and ‘impulsions’ is useful in distinguishing GTS and OCD patients. Thirty-two GTS, 31 OCD (10 with tics, 21 without tics) and 29 control subjects were studied using the Leiden repetitive behaviors semi-structured interview to assess GTS as well as OCD-related behaviors. Each reported repetitive thought or action was evaluated on the presence of anxiety and on goal-directedness. This information was used to define whether the behavior was an obsession, compulsion, or ‘impulsion’. Both the GTS and OCD study groups showed higher scores than control subjects on rating scales measuring depression, OC behavior and anxiety. In GTS, Y–BOCS severity scores and trait anxiety were lower than in the OCD groups. Furthermore, GTS patients differed from OCD patients in the distribution of symptoms. Aggressive repetitive thoughts, contamination worries and washing behaviors were reported more frequently by tic-free OCD, while mental play, echophenomena, touching and (self)-injurious behaviors were reported more frequently by GTS. OCD individuals with tics were intermediate, but closer to tic-free OCD. GTS individuals reported significantly more ‘impulsions’ and fewer obsessions and compulsions than OCD individuals with and without tics. Factor analysis revealed three factors accounting for 44% of the variance, resulting in an ‘impulsive’ factor related to GTS, a ‘compulsive’ factor related to OCD and an ‘obsessive’ factor related to tic-free OCD. In conclusion, OCD individuals reported more anxiety and goal-directedness associated with their behaviors than did GTS subjects. The distinction between obsessions, compulsions and impulsions is of importance in identifying Tourette-related vs. non-Tourette-related repetitions.

Altered inhibition of motor responses in Tourette Syndrome and Obsessive–Compulsive Disorder

Abstract: Objectives– The Gilles de la Tourette Syndrome (TS) and Obsessive Compulsive Disorder (OCD) have been shown to display impaired cognitive and motor inhibition. This study investigated inhibitory mechanisms of motor responses in order to expand the understanding of sensorimotor integration processes in both disorders. We hypothesized that both patient groups would display altered frontal inhibitory activity. Material and methods– To this end event-related brain potentials (ERPs) were recorded in a STOP-paradigm in groups of TS and OCD patients and in a control group. The paradigm required the execution of a motor response after a “go” signal was given and the occasional suppression of this response after a second “stop” signal occurred. Results– Behavioral parameters and Lateralized Readiness Potential (LRP) confirmed that both patient groups were well able to initiate motor responses. “Go” and “stop” stimuli elicited an enhanced frontal negative activity in both patient groups. In addition, “stop” stimuli were associated with a frontal shift of the NoGo-Anteriorization (NGA) in the TS group but not in the OCD group. Conclusions– The data are interpreted to indicate altered frontal inhibitory functions. Similarities and dissimilarities between the findings for TS and OCD are discussed with respect to other pathophysiologic aspects of the disorders.

Immediate and long term outcome after infrathalamic and thalamic lesioning for intractable Tourette's syndrome.

Abstract: OBJECTIVE—The surgical treatment of intractable Tourette's syndrome is controversial. Experience with 17 consecutive patients treated between 1970 and 1998 is reviewed and the efficacy and safety of surgical treatment is assessed. METHODS—These patients were retrospectively reclassified into subtypes according to the protocol of the Tourette's Syndrome Study Group. One patient was excluded from the study. Ventriculography based stereotactic zona incerta (ZI) and ventrolateral/ lamella medialis thalamotomy (VL/LM) were performed on all patients. The preoperative, postoperative, and late tic severities were assessed by the tic severity rating scale. The median follow up of 11 patients (65%) was 7 years (range 3.5-17 years) and six patients were lost to long term follow up. RESULTS—Median age was 23 years (range 11-40) at the time of surgery. Median duration of illness was 14 years (range 3-33). The mean preoperative motor and vocal tic severities were estimated to be 4.44 (SD 0.63) and 3.81 (SD 0.66), respectively. Unilateral ZI lesioning and VL/LM lesioning selected by asymmetry of symptoms provide an effective control of tic severity (p motor and vocal<0.001). In attenuation of contralateral symptoms, a second surgical intervention in the relevant side could reduce tic severity sufficiently (p motor<0.01; p vocal<0.005). Transient complications occurred in 68% of patients. Only one permanent complication was registered in six patients followed up after unilateral surgery. Two out of five patients followed up after bilateral surgery had disabling side effects of surgery. CONCLUSIONS—ZI and VL/LM lesioning provide a significant long term reduction of tic severity in intractable Tourette's syndrome. Adequate selection of the side of first intervention might prevent the patient from increased risk of bilateral surgery.

Oculomotor Abnormalities in Boys With Tourette Syndrome With and Without ADHD

Abstract: Objective To assess saccadic eye movements in boys with Tourette syndrome (TS) with and without attention-deficit hyperactivity disorder (ADHD), comparing performance with that of an age-matched group of male controls. Method Three different saccade tasks (prosaccades, antisaccades, and memory-guided saccades) were used to examine functions necessary for the planning and execution of eye movements, including motor response preparation, response inhibition, and working memory. The study included 14 boys with TS without ADHD (TS-only), 11 boys with TS and ADHD (TS+ADHD), and 10 male controls. Results Latency of prosaccades was prolonged in boys with TS (both with and without ADHD) compared with controls. Variability in prosaccade latency was greater in the groups of boys with TS+ADHD compared with both the TS-only and control groups. Response inhibition errors on both the antisaccade task (directional errors) and memory-guided saccade task (anticipatory errors) were increased in boys with TS+ADHD compared with those with TS-only. There were no significant differences among the three groups in accuracy of memory-guided saccades. Conclusions Oculomotor findings suggest that TS is associated with delay in initiation of motor response as evidenced by excessive latency on prosaccades. Signs of impaired response inhibition and variability in motor response appear to be associated with the presence of ADHD.

Control of volitional and reflexive saccades in Tourette's syndrome.

Abstract: Tourette's syndrome is characterized by involuntary tics and, although the underlying pathogenesis and pathophysiology of Tourette's syndrome remains unclear, it is suspected that basal ganglia structures are involved. The basal ganglia also play an important role in the control of saccadic eye movements and we therefore hypothesize that Tourette's syndrome patients have abnormal control of saccadic eye movements. In this study, 10 subjects with Tourette's syndrome and 10 age- and sex-matched controls performed four different oculomotor paradigms requiring the execution and/or suppression of reflexive and/or voluntary saccades. In the immediate saccade tasks, subjects were required to look either toward (pro-saccade task) or away from (anti-saccade task) a peripheral target as soon as it appeared. In the delayed saccade tasks, subjects were instructed to wait for a central fixation point to disappear before initiating eye movements. Among Tourette's syndrome subjects, saccadic reaction times were longer in all tasks. Saccadic amplitudes were smaller in Tourette's syndrome subjects, and they made more saccades to reach the eccentric target. The occurrence of direction errors (i.e. reflexive pro-saccades on anti-saccade trials) was normal in the immediate anti-saccade task, suggesting that the ability to inhibit reflexive saccades towards novel stimuli was not impaired in Tourette's syndrome. Timing errors (i.e. eye movements made prior to disappearance of the central fixation point in delayed saccade tasks) were significantly greater among Tourette's syndrome subjects. Moreover, these errors were predominantly made towards the first target of the remembered sequence in a delayed memory-guided sequential saccade task. These results indicate that the ability to inhibit or delay planned motor programmes is significantly impaired in Tourette's syndrome. We hypothesize that altered cortical-basal ganglia circuitry leads to reduced cortical inhibition making it harder for Tourette's syndrome subjects to withhold the execution of planned motor programmes.

Analyzing the influence of tic-related talk on vocal and motor tics in children with Tourette's syndrome.

Abstract: This study examined the effect of tic-related talk on the vocal and motor tics of 2 boys with Tourette's syndrome. Using ABAB withdrawal designs, the boys were alternately exposed to conditions with and without talk of their tics. For both boys, vocal tics markedly increased when talk pertained to tics and decreased when talk did not pertain to tics, but motor tic covariance was less consistent.

The genetics of Tourette syndrome.

Abstract: Twin and family studies demonstrate that Tourette syndrome (TS) is a genetic disorder. Early segregation analyses of family data were consistent with the hypothesis of autosomal dominant transmission; however, more recent studies suggest that the mode of inheritance is more complex. Current findings suggest that there are genes of major effect with other genes acting as modifiers. Several genome scans have been completed and several regions of interest have been identified that may harbor susceptibility genes for TS. Work is currently underway to replicate and extend these initial results.

A Family Study of Juvenile Obsessive—Compulsive Disorder:

Abstract: Objectives:To determine whether juvenile obsessive–compulsive disorder (OCD) is familial and whether the rate of Tourette syndrome (TS) and tic disorders is higher among relatives of patients with ...

Home alone: Methods to maximize tic expression for objective videotape assessments in Gilles de la Tourette syndrome

Abstract: Our objective was to test whether at-home videotapes yield enhanced information on tics compared to office-based videotapes and a patient questionnaire on the current anatomical distribution of tics. Ten subjects with Gilles de la Tourette syndrome (age range 8–49 years) who were seen for initial evaluation completed a check list of anatomical areas currently affected with tics, and underwent a videotape examination according to the Rush Videotape Protocol. Each patient/family conducted the same protocol at home at the same time of day within 48 hours. We rated two tapes in random order using the modified published scoring method for the Rush Video-based Tic Rating Scale. Two environments were compared, the doctor's office and at home, with videotapes taken in three conditions: patient engaged in relaxed conversation, patient quietly seated with filmer in the room, and patient quietly seated alone in the room. Data were analyzed using a 2-factor repeated-measures analysis of variance (ANOVA), followed by Wilcoxon signed rank tests. All patients provided excellent quality videotapes that could be scored without difficulty. Environment (office vs. home) and Condition (conversation, quiet with observer, quiet and alone) were both highly significant (P < .0001) and did not interact (P = .54). The highest tic scores for total tic impairment occurred at home with the patient alone (mean score 14.5), and the lowest yield occurred in the office with an observer present (mean score 5.4), the setting closest to the clinical neurological examination. The Home/Alone video segments revealed tics not otherwise seen. Patient questionnaires on body regions recorded more areas than observed in the office videotape, but patients were unaware of several tics captured on the Home/Alone segment. Patients can produce videotapes for objective tic assessments. Because at-home videotapes consistently yield higher tic expressions than in-office films and capture tics that are not appreciated by patients, this methodology is well-suited for enhanced retrieval of objective data on tic expression. © 2001 Movement Disorder Society.

The treatment of tics.

Abstract: Tics are the essential component of a variety of disorders, notably Tourette syndrome. Because the mere presence of tics does not require therapeutic intervention, criteria are essential for determining a functional disability. Suggested tic-suppressing treatments have been extremely diverse, including hydrotherapy, behavioral treatments, pharmacotherapy, botulinum toxin, immunomodulatory therapy, and surgery. This manuscript reviews each of these approaches with emphasis on more recent pharmacologic trials.

Influence of Treatment of Tourette Syndrome with Δ9-Tetrahydrocannabinol (Δ9-THC) on Neuropsychological Performance

Abstract: Previous studies have suggested that marijuana (cannabis sativa) and delta-9-tetrahydrocannabinol (delta9-THC), the major psychoactive ingredient of marijuana, are effective in the therapy of tics and associated behavioral disorders in Tourette Syndrome (TS). Because there is also evidence that cannabis sativa may cause cognitive impairment in healthy users, we performed a randomized double-blind placebo-controlled crossover trial for delta9-THC in 12 adult TS patients to investigate whether treatment of TS with a single dose of delta9-THC at 5.0 to 10.0 mg causes significant side effects on neuropsychological performance. Using a variety of neuropsychological tests, we found no significant differences after treatment with delta9-THC compared to placebo treatment in verbal and visual memory, reaction time, intelligence, sustained attention, divided attention, vigilance, or mood. Only when using the Symptom Checklist 90-R (SCL-90-R) did our data provide evidence for a deterioration of obsessive-compulsive behavior (OCB) and a trend towards an increase in phobic anxiety. However, these results should be interpreted with caution as SCL-90-R has known limitations on measuring OCB. We suggest that the increase in phobic anxiety is mainly due to the fact that a single-dose treatment rules out the possibility of administering the dosage slowly. In contrast to results obtained from healthy marijuana users, a single-dose treatment with delta9-THC in patients suffering from TS does not cause cognitive impairment. We therefore suggest that further investigations should concentrate on the effects of a longer-term therapy of TS with delta9-THC.

Candidate region for Gilles de la Tourette syndrome at 7q31.

Abstract: Gilles de la Tourette Syndrome (GTS) is a complex neuropsychiatric disorder characterized by motor and vocal tics. The cause of this syndrome is unknown, although based on family studies there is evidence of a strong genetic component. We report on a 13-year-old boy with GTS, minor physical anomalies, and a de novo partial duplication of chromosome 7q [dup(7)(q22.1-q31.1)]. The distal breakpoint in our patient is similar to the breakpoint of an apparently balanced familial translocation t(7;18) segregating with GTS. Together, these cases provide evidence that a gene located in the breakpoint region at 7q31 can be involved in the formation of GTS.

Psychopathology and personality characteristics in relation to blood serotonin in Tourette's syndrome and obsessive-compulsive disorder.

Abstract: Family studies suggest an interrelationship between Gilles de la Tourette Syndrome (GTS) and some forms of obsessive-compulsive disorder (OCD). Some authors consider GTS to be part of a serotonergically mediated cluster of OCD spectrum disorders. The present study was undertaken to compare measures of psychopathology, personality and blood serotonin between GTS and OCD (without tics), and to investigate whether an OCD spectrum hypothesis is supported for GTS. Fifteen GTS without OCD subjects, 21 tic with (+) OCD subjects, 15 OCD without tic subjects and 26 controls (all without serotonergic medication) were evaluated with self-rated and clinician-rated measures of psychopathology and personality. Whole blood serotonin (5-HT) and platelet monoamine oxidase activity (MAO) was measured, and Spearman's correlations were calculated between whole blood 5-HT, MAO and rating scale scores within the entire sample and within subgroups. There were main effects of OCD on anxiety, obsessive-compulsive, neuroticism and extraversion scores. There were main effects of tics on depression, obsessive-compulsive, trait anxiety and neuroticism scores, and on platelet MAO. There were interaction effects on platelet MAO, 5-HT, Yale-Brown Obsessive-Compulsive Rating Scale severity, trait anxiety and Eysenck Personality Questionnaire neuroticism scores. Platelet MAO activity was elevated in tic-free OCD subjects when compared to tic + OCD, GTS without OCD and controls. Whole blood 5-HT was lowered in tic + OCD patients in comparison to GTS without OCD and tic-free OCD subjects. Whole blood 5-HT and obsessive-compulsive severity were negatively correlated within OCD without tic patients and MAO and Leyton Obsessive Inventory scores were negatively related within GTS without OCD patients. The biochemical data of this study suggest that in tic + OCD and in tic-free OCD patients, 5-HT dysregulations play a role, but not necessarily in pure GTS. Serotonergic dysregulations within tic + OCD and tic-free OCD patients are distinct, suggesting differences in underlying pathophysiology. The finding that obsessions and compulsions can be associated with either 5-HT hypofunctionality or hyperfunctionality reveals a major weakness in the OCD spectrum theory, i.e. that the associations between obsessive-compulsive behaviours and 5-HT abnormalities are less specific than suggested by the original obsessive-compulsive spectrum model.

A family study of Tourette syndrome in Japan.

Abstract: Although the mode of inheritance remains in doubt, twin and family studies conducted mostly in the United States and western Europe suggest that genetic factors play an important role in the transmission and expression of Tourette syndrome (TS). In an effort to evaluate population-based genetic differences, we generated risk estimates for first-degree relatives of TS probands in Japan using methods similar to those utilized in recent Western studies. The subjects were 52 TS probands seen at an outpatient clinic of Tokyo University Hospital and their 165 first-degree relatives. All probands and one or more first-degree relatives in each family were interviewed concerning the presence of tic and obsessive-compulsive symptoms by expert clinicians. The age-corrected rates of TS, chronic motor tics, obsessive-compulsive disorder, and subclinical obsessive-compulsive symptoms in the first-degree relatives were 2.0%, 12.0%, 1.6%, and 7.0%, respectively. Rates of TS and related disorders in Japan appear to be much lower than those in recent Western family studies. If replicated, these data suggest that there may be differences in the nature and frequency of vulnerable alleles for TS and related disorders in the Japanese compared to European populations.

Obsessive-compulsive disorder and acquired toxoplasmosis in two children

Abstract: Two children presenting symptoms of obsessive-compulsive disorder (OCD) and with acquired toxoplasmosis are described and the possibility of a previously rarely reported association between OCD and acquired toxoplasmosis is discussed. Case 1 is a 14-year-old boy with Tourette syndrome (TS), attention deficit hyperactivity disorder (ADHD) in partial remission and a three-year history of OCD referred to our department due to an acute deterioration of obsessive-compulsive (OC) symptoms. Case 2 is an 11-year-old boy referred to our department because of a two-year history of OCD. The OC symptoms were observed immediately following an infection. In both cases laboratory tests confirmed the diagnosis of acquired toxoplasmosis. The pharmacological therapy of T.gondi infection without any psychopharmacological treatment caused remission or significant improvement regarding OC symptoms.