Gilles de la Tourettes Syndrome TS

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Gilles de la Tourettes Syndrome (TS)

• Has TS a relationship with Obsessive Compulsive
  Disorder (OCD)?

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Gilles de la Tourettes Syndrome (TS)

• TS is a neuropsychiatric disorder of childhood
  onset
• TS combines motor and phonic tics.
• Tics are rapid, involuntary, repetitive,
  stereotyped, motor movements or phonic
  productions.

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Gilles de la Tourettes Syndrome (TS)

• Motor Tics start first (2-15 years)
• Vocal tics (8-15 years)
• Minority have echolalia, echopraxia, coprolalia,
  copropraxia
• ADHD in 25-50 of TS

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Gilles de la Tourettes Syndrome

• TS runs in families along with OCD
• Possibly due to dominant gene with incomplete
  penetrance
• OCD Symptoms in 70 of TS
• OCD found in 30-60 of TS

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Gilles de la Tourettes Syndrome

• TS patients and their families often have OCD
  symptoms thought to be an alternative expression
  of a TS gene (s) in TS families
• TS and OCD may be genetically heterogeneous

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Comorbidity of Anxiety and Depression
50 of panic disorder patients have depression
Panic Disorder
Specific Phobia
34 of specific phobia patients have depression
49 of PTSD patients have depression
PTSD
31 of SP patients have depression
Social Phobia
GAD
Depression
59 of GAD patients have depression
32 of OCD patients have depression
OCD
Source National Comorbidity Survey 69,400
patients
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Obsessive-compulsive disorder

• Obsessive-compulsive disorder (OCD) is classified
  in the Diagnostic and Statistical Manual of
  Mental Disorders, Fourth Edition as an anxiety
  disorder.
• It is characterized by distressing intrusive
  thoughts and/or repetitive actions that interfere
  with the individual's daily functioning.

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Obsessive-compulsive disorder

• First full description by Sir Aubrey Lewis in
  1935
• Most patients have obsessions and compulsions,
  25 have just obsessions and 5 only compulsions
• 5 also have Tourette's Disorder
• 25 have some tics

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Obsessive Compulsive Disorder

• Yale-Brown OCD Scale (0-4)
• Measures the following for both obsessions and
  compulsions.
• Time. Resistance.
• Distress. Control.
• Interference.

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Obsessive Compulsive Disorder
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Stigma and Obsessive Compulsive Disorder

• Obsession Perfume Launched by the design house
  of Calvin Klein in 1985, OBSESSION is classified
  as a refreshing, oriental fragrance.
• This feminine scent possesses a blend of
  vanilla, amber, orange blossom, oakmoss and other
  oriental spices. It is recommended for daytime
  wear.

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Obsessive Compulsive DisorderHypothesis
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Obsessive Compulsive Disorder-Brain Based
Hypotheses

• OCD is linked with dysfunction in
  Orbitofrontal-striatal brain circuits (Cummings
  JL 1993)
• Selective basal ganglia dysfunction underlies
  pure OCD (Rapoport 1990)

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Obsessive Compulsive Disorder

• OCD is associated with striatal illnesses e.g.
  Sydenhams Chorea and Gilles de La Tourettes
  Syndrome (Rapoport 1989)

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Obsessive Compulsive Disorder
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Gilles de la Tourettes SyndromeTreatment

• Support-Psychoeducation
• Behavioural -Stress management
• Medication-low dose Haloperidol, SSRI
• Clonidine or Atypical Neuroleptics also used

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OCD Treatment

• Mainstays of treatment of OCD include
• Pharmacotherapy
• Cognitive Behaviour therapy
• Education and family interventions
• Very rarely neurosurgical treatment in refractory
  cases.