{{short description|Range of neurodevelopmental conditions}} {{Infobox medical condition (new) | name = Tic disorder | synonyms = | image = Tourette's tic long medium 192kbps.OGG | caption = Examples of tics | pronounce = | field = Neurology, psychiatry | symptoms = | complications = | onset = | duration = | types = | causes = | risks = | diagnosis = | differential = | prevention = | treatment = | medication = | prognosis = | frequency = | deaths = }} '''Tic disorders''' are defined in the ''Diagnostic and Statistical Manual of Mental Disorders'' (DSM) based on type (motor or phonic) and duration of tics (sudden, rapid, nonrhythmic movements).<ref name="BehaveNet">{{cite book | publisher = American Psychiatric Association | date = 2000 | url = http://behavenet.com/capsules/disorders/touretteTR.htm | chapter = DSM-IV-TR: Tourette's Disorder | title = Diagnostic and Statistical Manual of Mental Disorders | edition = 4th text revision (DSM-IV-TR) | isbn = 0-89042-025-4 }}</ref> Tic disorders are defined similarly by the World Health Organization (ICD-10 codes).<ref name=Swain>{{cite journal | vauthors = Swain JE, Scahill L, Lombroso PJ, King RA, Leckman JF | title = Tourette syndrome and tic disorders: a decade of progress | journal = Journal of the American Academy of Child and Adolescent Psychiatry | volume = 46 | issue = 8 | pages = 947–968 | date = August 2007 | pmid = 17667475 | doi = 10.1097/chi.0b013e318068fbcc }}</ref>
==Classification== ===DSM-5=== The fifth revision of the ''Diagnostic and Statistical Manual of Mental Disorders'' (DSM-5), published in May 2013, classifies Tourette syndrome and tic disorders as motor disorders listed in the neurodevelopmental disorder category.<ref name=DSM307.2/>
Tic disorders, in ascending order of severity, are:<ref name=DSM307.2/> * 307.20 Other specified tic disorder (specify reason) * 307.20 Unspecified tic disorder * 307.21 Provisional tic disorder * 307.22 Persistent (chronic) motor or vocal tic disorder (specify motor or vocal) * 307.23 Tourette's disorder
Developmental coordination disorder and stereotypic movement disorder are also classified as motor disorders.<ref name="Highlights">{{cite web |date=2013 |title=Highlights of changes from DSM-IV-TR to DSM-5 |url=http://www.psychiatry.org/File%20Library/Practice/DSM/DSM-5/Changes-from-DSM-IV-TR--to-DSM-5.pdf |url-status=dead |archive-url=https://web.archive.org/web/20130203165749/http://www.psychiatry.org/File%20Library/Practice/DSM/DSM-5/Changes-from-DSM-IV-TR--to-DSM-5.pdf |archive-date=February 3, 2013 |access-date=June 5, 2013 |publisher=American Psychiatric Association}}</ref><ref name="DSMAppraisal">{{cite journal | vauthors = Robertson MM, Eapen V | title = Tourette's: syndrome, disorder or spectrum? Classificatory challenges and an appraisal of the DSM criteria | journal = Asian Journal of Psychiatry | volume = 11 | pages = 106–113 | date = October 2014 | pmid = 25453712 | doi = 10.1016/j.ajp.2014.05.010 | type = Review | author-link2 = Valsamma Eapen }}</ref>
===ICD-10=== ICD10 diagnosis codes are:<ref>{{cite web | url = https://www.who.int/classifications/apps/icd/icd10online/?gf90.htm+f950 | title = ICD Version 2006 | publisher = World Health Organization | access-date = 24 May 2007 }}</ref> * F95.0 Transient tic disorder * F95.1 Chronic motor or vocal tic disorder * F95.2 Combined vocal and multiple motor tic disorder [Gilles de la Tourette] * F95.8 Other tic disorders * F95.9 Tic disorder, unspecified
==Diagnosis== {{further|Tic#Differential diagnosis}} Tics should be distinguished from other causes of tourettism, stereotypies, chorea, dyskinesias, myoclonus and obsessive-compulsive disorder.<ref name=DSM307.2/>
==Treatment== Education, and a "watch and wait" strategy, are the only treatment needed for many, and most individuals with tics do not seek treatment. When needed, management of tic disorders is similar to management of Tourette syndrome.<ref name=European>{{cite journal | vauthors = Roessner V, Plessen KJ, Rothenberger A, Ludolph AG, Rizzo R, Skov L, Strand G, Stern JS, Termine C, Hoekstra PJ | title = European clinical guidelines for Tourette syndrome and other tic disorders. Part II: pharmacological treatment | journal = European Child & Adolescent Psychiatry | volume = 20 | issue = 4 | pages = 173–96 | date = April 2011 | pmid = 21445724 | pmc = 3065650 | doi = 10.1007/s00787-011-0163-7 }}</ref> The first line of treatment is behavioural therapy, followed by medication (most often aripiprazole) if the former is unsuccessful.<ref name="Müller-Vahl_2022">{{cite journal | vauthors = Müller-Vahl KR, Szejko N, Verdellen C, Roessner V, Hoekstra PJ, Hartmann A, Cath DC | title = European clinical guidelines for Tourette syndrome and other tic disorders: summary statement | journal = European Child & Adolescent Psychiatry | volume = 31 | issue = 3 | pages = 377–382 | date = March 2022 | pmid = 34244849 | pmc = 8940881 | doi = 10.1007/s00787-021-01832-4 }}</ref>
Although behavioural therapy is the recommended first treatment, many people with tics do not access it due to the lack of trained psychotherapists.<ref name="Müller-Vahl_2022" />
==Epidemiology== Tic disorders are more commonly diagnosed in males than females, though females with primary tic disorder are more likely to present with a higher intensity and frequency of motor tics than males. <ref name=DSM307.2/><ref>{{cite journal |last1=Nilles |first1=C |last2=Martino |first2=D |last3=Fletcher |first3=J |last4=Pringsheim |first4=T |title=Have We Forgotten What Tics Are? A Re-Exploration of Tic Phenomenology in Youth with Primary Tics. |journal=Movement Disorders Clinical Practice |date=May 2023 |volume=10 |issue=5 |pages=764–773 |doi=10.1002/mdc3.13703 |pmid=37205249 |pmc=10187015 }}</ref> Additionally, children diagnosed with autism spectrum disorder are more likely to present with tics and tic disorders. <ref>{{cite journal |last1=Ueda |first1=K |last2=Black |first2=KJ |title=A Comprehensive Review of Tic Disorders in Children. |journal=Journal of Clinical Medicine |date=3 June 2021 |volume=10 |issue=11 |page=2479 |doi=10.3390/jcm10112479 |doi-access=free|pmid=34204991 |pmc=8199885 }}</ref>
At least one in five children experience some form of tic disorder, most frequently between the ages of seven and twelve.<ref name=tell-parents>{{cite journal | vauthors = Black KJ, Black ER, Greene DJ, Schlaggar BL | title = Provisional Tic Disorder: What to tell parents when their child first starts ticcing | journal = F1000Research | volume = 5 | issue = | pages = 696 | date = 2016 | pmid = 27158458 | pmc = 4850871 | doi = 10.12688/f1000research.8428.1 | doi-access = free }}</ref><ref name="Tourette Syndrome Fact Sheet">{{cite web | url = http://www.ninds.nih.gov/disorders/tourette/detail_tourette.htm | archive-url = https://web.archive.org/web/20050323092424/http://www.ninds.nih.gov/disorders/tourette/detail_tourette.htm | archive-date = 23 March 2005 | title = Tourette Syndrome Fact Sheet | work = National Institutes of Health (NIH) | access-date = 23 March 2005 }}</ref> Tourette syndrome is the more severe expression of a spectrum of tic disorders, which are thought to be due to the same genetic vulnerability. Nevertheless, most cases of Tourette syndrome are not severe. Although a significant amount of investigative work indicates genetic linkage of the various tic disorders, further study is needed to confirm the relationship.<ref name="pmid16131414">{{cite journal | vauthors = Swerdlow NR | title = Tourette syndrome: current controversies and the battlefield landscape | journal = Current Neurology and Neuroscience Reports | volume = 5 | issue = 5 | pages = 329–31 | date = September 2005 | pmid = 16131414 | doi = 10.1007/s11910-005-0054-8 | s2cid = 26342334 }}</ref>
== History == === DSM-IV-TR === In the fourth revision of the DSM (DSM-IV-TR), tic disorders were classified as follows:<ref name="pmid11043089">{{cite journal | vauthors = Evidente VG | title = Is it a tic or Tourette's? Clues for differentiating simple from more complex tic disorders | journal = Postgraduate Medicine | volume = 108 | issue = 5 | pages = 175–6, 179–82 | date = October 2000 | pmid = 11043089 | doi = 10.3810/pgm.2000.10.1257 | s2cid = 43162987 }}</ref> * Transient tic disorder consisted of multiple motor and/or phonic tics with duration of at least 4 weeks, but less than 12 months. * Chronic tic disorder was either single or multiple motor or phonic tics, but not both, which were present for more than a year. * Tourette syndrome was diagnosed when both motor and phonic tics were present for more than a year. * Tic disorder NOS was diagnosed when tics were present, but did not meet the criteria for any specific tic disorder.
=== From DSM-IV-TR to DSM-5 === DSM-5 was published in 2013, updating DSM-IV-TR, which was published in 2000. The following changes were made:<ref name=DSM307.2>{{Cite book | author= American Psychiatric Association | year= 2013 | title= Diagnostic and Statistical Manual of Mental Disorders | edition= Fifth | publisher= American Psychiatric Publishing | location= Arlington, VA | pages= [https://archive.org/details/diagnosticstatis0005unse/page/81 81–85] | isbn= 978-0-89042-555-8 | url= https://archive.org/details/diagnosticstatis0005unse/page/81 }}</ref><ref name=DSMV>[https://web.archive.org/web/20110510131026/http://www.dsm5.org/proposedrevision/Pages/NeurodevelopmentalDisorders.aspx Neurodevelopmental disorders.] American Psychiatric Association. Retrieved on December 29, 2011.</ref><ref name=Moran>{{cite journal | vauthors = Moran M | url = http://psychnews.psychiatryonline.org/newsarticle.aspx?articleid=1558424 | title = DSM-5 provides new take on neurodevelopment disorders | journal = Psychiatric News | date = 18 January 2013 | volume = 48 | issue = 2 | pages = 6–23 | doi = 10.1176/appi.pn.2013.1b11| url-access = subscription }}</ref><ref name=Highlights/> * The word ''stereotyped'' was removed from tic definition: stereotypies and stereotypic movement disorder are frequently misdiagnosed as tics or Tourette syndrome.<ref name=MedscapeBackground>{{cite web |vauthors=Ellis CR, Pataki C |url= http://emedicine.medscape.com/article/914071-overview#a0101 |title= Background: Childhood Habit Behaviors and Stereotypic Movement Disorder |publisher= Medscape |access-date= October 6, 2013}}</ref> The definition of ''tic'' was made consistent for all tic disorders, and the word ''stereotyped'' was removed to help distinguish between stereotypies (common in autism spectrum disorders) and tic disorders.<ref name="Plessen">{{cite journal |vauthors=Plessen KJ |date=February 2013 |title=Tic disorders and Tourette's syndrome |journal=European Child & Adolescent Psychiatry |volume=22 |issue=Suppl 1 |pages=S55–60 |doi=10.1007/s00787-012-0362-x |pmid=23224240 |s2cid=12611042}}</ref> * ''Provisional tic disorder'' approximately replaced ''transient tic disorder'': because initially presenting tics may eventually be diagnosed as chronic tic disorder or Tourette's, ''transient'' suggested it could only be defined in retrospect (though that perception did not follow the DSM-IV-TR definition).<ref name=tell-parents/> The term ''provisional'' "satisfies experts with a more systematic epidemiological approach to disorders", but should not imply that treatment might not be called for.<ref name=Plessen/> * Differentiation of chronic motor or vocal tic disorder: DSM-5 added a specifier to distinguish between vocal and motor tics that are chronic. This distinction was added because higher rates of comorbid diagnoses are present with vocal tics relative to motor tics.<ref name=Plessen/> * Now includes as Tourette's Disorder patients with tics who experienced a 3-month or longer remission since the first tic, as long as the first tic was at least a year ago. * Stimulant use as a cause removed: there is no evidence that the use of stimulants causes tic disorders.<ref name=Plessen/><ref name="stimulants-tics">{{cite web |last=Black |first=Kevin J. |date=17 February 2018 |title=ADHD medications and tics |url=https://tics.wustl.edu/adhd-medications-and-tics/ |publisher=Washington University School of Medicine }}</ref> * New categories, ''Other specified'' and ''Unspecified'': for tic disorders that result in significant impairment to the individual yet do not meet the full criteria for other tic disorders.<ref name=DSM307.2/> The new categories account for tics with onset in adulthood,<ref name=DSM307.2/> or tics triggered by other medical conditions or illicit drug use.<ref name=Plessen/>
== References == {{Reflist}}
== Further reading == {{refbegin}} * {{cite journal |vauthors=Dordain G |title=[The concept of tic in the history of abnormal movements] |language=French |journal=Rev Neurol (Paris) |volume=142 |issue=11 |pages=803–7 |date=1986 |pmid=3547545 }} * {{cite journal | vauthors = ((The Tourette Syndrome Classification Study Group)) | title = Definitions and classification of tic disorders. The Tourette Syndrome Classification Study Group | journal = Archives of Neurology | volume = 50 | issue = 10 | pages = 1013–6 | date = October 1993 | pmid = 8215958 | doi = 10.1001/archneur.1993.00540100012008 }} * {{cite journal | vauthors = Walkup JT, Ferrão Y, Leckman JF, Stein DJ, Singer H | title = Tic disorders: some key issues for DSM-V | journal = Depression and Anxiety | volume = 27 | issue = 6 | pages = 600–10 | date = June 2010 | pmid = 20533370 | doi = 10.1002/da.20711 | s2cid = 5469830 | doi-access = free }} {{refend}}
== External links == {{Commons}} {{Medical resources | DiseasesDB = 29465 | ICD10 = {{ICD10|F|95||f|90}} | ICD9 = {{ICD9|307.2}} | ICDO = | OMIM = | MedlinePlus = | eMedicineSubj = neuro | eMedicineTopic = 664 | MeshID = D013981 | SNOMED CT = 35042001 }}
{{Topics related to Tourette syndrome}} {{Emotional and behavioral disorders}}
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