Tic Disorders Dr. Laura Veneroni, psychologist lauraveneroni@yahoo.

it What are tics are movements, gestures or expressions sudden, rapid, repetitive, arrhythmic, and stereotyped. Typically reproduce some aspects of normal behavior . Are perceived as irresistible, but can be suppressed for varying periods of ti me. All forms of tics may be exacerbated by stress and diminish during activitie s that require concentration (such as reading or sewing) and usually disappear d uring sleep. Appear mostly to the 6-7 years. The tics are preceded by a feeling of tension that has temporarily suspended the download represented through the e xecution of the tic itself. Often followed by feelings of shame and guilt, often reinforced by the environment. Classifications Both engines vocal tics can be c lassified as simple or complex, although the border is not well defined. - The m ost common simple motor tics include winking, twisting neck, shrugs, facial grim aces and coughing. - The vocal tics include rather simple activities like his th roat, grunt, sniff, snort and bark. - The complex motor tics occur with intentio nal acts as facial expressions, gestures of the limbs or head. Include mimic mov ements or actions as the rehabilitation, jumping, touching, stamping his feet an d smelling an object. In extreme cases, these movements may be obscene (copopras sia) or self-injury. - The complex vocal tics are formed by repetition of words or phrases out of context, coprolalia (use of socially unacceptable words, frequ ently obscene), the palilalia (repetition of sounds or your own words) el'ecoali a (repetition of sound word or phrase heard last). More complex tics include eco cinesi (imitation of the movements of others). The evolution of behavior over ti me ticcosi can be distinguished: ⠢ The transient tics, including vocal and motor tics that persist at least 4 weeks but not more than 12 consecutive months [DSM IV, 1994]. The typical onset is between 3 and 10 years and disappear spontaneou sly. Are more frequent. ⠢ Tics chronic condition that can be observed in both ch ildren and adults, with onset before 18 years. The tics occur many times a day f or a period exceeding one year without a period of three consecutive months free from symptoms. There are motor tics or vocal tics but not both. This feature al lows the differential diagnosis of Tourette's disorder in which are present at both motor tics and tic voice [DSM IV, 1994]. In the past h ave described the increased frequency of tics in people with behavioral problems (capriciousness, restlessness, phobias, "only children"). Epidemiology The dise ase has a high frequency ticcosa. It is believed that the prevalence of tics in the general population varied from 4% to 19% during the elementary school, while the prevalence of Tourette syndrome varies from 0.5% to 3.8% (Dooley, 2006). Ti c behaviors are more common among males than females. Differential diagnosis mus t distinguish tics from other abnormal movements that have neither the character nor the sudden appearance stereotyped, choreic movements, gestures to conjure s ome forms of severe obsessive (swipe your feet on the ground, repeatedly touch a n object), stereotypes psychotic ( often characterized by bizarre gestures), abn ormal movements that can accompany some neurological diseases. The differentiati on between these conditions and tic disorder is usually made on clinical grounds and the manner of presentation and evolution of the disorder. Some typical feat ures of tics, as being sudden, paroxysmal scanned and deleted, are rarely associ ated in the absence of a genuine tic disorder. There are no tests to confirm the diagnosis of tic disorder (Cassano, 2002). Careful history, an assessment of fa mily history, neurological examination observation of the child are usually suff icient to put the descriptive diagnosis of Tic Disorder. Meaning The meaning of the tic is not unique. Initially, the tics can conduct a simple motor reaction t o a situation of momentary anxiety (separation, illness ...) that shows the ease of some children to move into the sphere with the motor, psychological conflict s and tensions. The association with the instability of the conduct in fact freq uent. The persistence of behavior ticcoso but may represent a possible mode of e xpression and subsequent conflicts can mean next to lose his / her meaning (s) i nitial (s)€to become a way of being deeply anchored in the body. For some peopl e the tick can be considered a privileged way of discharge of tensions. And 'fre

quent association between tics and obsessive traits especially in people who are very controlling and that drastically repress any aggressive demonstration. The tick is found in these cases, according to the psychodynamic tradition, have bo th an aggressive value directly, through a crude symbolization, is self-punishin g, for the reversal of aggression on its own. It 's rare that a child speaks of his own symptoms, coming often to deny it. Frequently look submissive and passiv e is accompanied in reality oppositional conduct. The drawings may arise whether the rigor and perfectionism ; tics can appear suddenly stopping this controlled graphics. In other cases, th e tick is interpreted as manifestations of conversion hysteria, especially in ol der children or adolescents, often when the tics are following accidents or surg ery. In this case the tick lets you download the repressed tension, and the symb olic meaning of the tic will be different for each child (Marcelli, 1999). For a more archaic the tics may occur in children with psychotic personality organiza tions, which drive the download takes place in a living body which is so fragmen ted that they should always be checked and maintained under tension. Pathogenesi s always tics were considered a process which is exactly knight between mind and body, and as such is being studied both neurologists, psychiatrists and psychol ogists that. The psychological dimension is emphasized by the behavioral problem s frequently associated with tics and their temporal expression - often followin g a stressful event (the meaning is not necessarily negative) - but there are ma ny studies that consider a genetic and neuro-anatomical substrate. It appears th at some genetic factors are involved in transmission of the vulnerability of the disorder, suggesting a dominance autosomica penetration variable. The gene appe ars linked to some forms of attention deficit disorders / Hyperactivity Disorder and Obsessive-Compulsive Disorder. Neuroanatomical substrate, in particular sho ws the role of organic factors and the involvement of extrapyramidal "adaptive s ystem" to mediate dopamine, which modulates the individual reactions as emotiona l response to the environment. Therapeutic approach in most cases the resolution of the disorder is spontaneous and does not require any pharmacological interve ntion. The medical literature shows how the medication is to be reserved for the chronic and disabling, in addition to TS. However, a specific intervention may be useful not just when the tics are "serious", but when a child's development i s threatened in one of his fields. Although clinical activity in several types o f drugs are used, the most effective results are relatively selective antagonist s of D2 receptors, haloperidol and pimozide, with favorable responses about 70% [Shapiro et al., 1989]. The effective dose may vary widely from case to case. At the family level is necessary to treat anxiety that can occur following the ons et of tics. And 'good advise not to deal with ticks, not to restrict or overesti mated. The behavior of parents in the early manifestations of tics may be decisi ve in relation to evolution. Insistent scolding and prohibitions increase anxiet y and distress and bind directly to engine emissions. Treatment of patients can be so different - psychomotor therapy or relaxation are used mainly with older c hildren, when predominant symptoms such as motor behavior characterized by instability, disability and awkwardness and the tick has a mean ing reaction - psychotherapy in cases where the symptom is part of a neurotic or psychotic framework that gives meaning to the tics and strengthens it - behavio ral therapy of active deconditioning (by running the patient voluntarily in fron t of a mirror for half an hour every tick or every other day or the channel symp toms and replaced with less debilitating tick) if the symptom is predominantly a motor characterization - educational interventions and support may be especiall y useful where ticcosi behaviors have been misunderstandings on the part of the environment that has received them as volunteers and intentionally provocative. €Even a meeting between teachers and competent figure who can explain the meanin g of behavior and to manage ticcosi may be useful to ensure the child a positive and supportive climate in the classroom. The prognosis tic disorder is a comple x issue from the point of view of prognosis. Whatever the initial manifestation in fact, tics may become in time and have a high individual variability in the c

ourse. Whatever type of therapy taken there is a limited number of children, whi le improving, keep their tics and retain them into adulthood. Concluding Summary The ICT is a condition not serious, but still annoying for both the psychologic al consequences for children with both the difficulties often associated with be havioral (conduct uninhibited, intolerance to frustration, motor hyperactivity, obsessive-compulsive-like symptoms, poor reading and / or calculation, sleeping disorders) which often account for why the child reaches the consultation psicol ogicaneuropsichiatrica. The disease can lead to conflicts within the family: par ents may resort to behaviors points in an attempt to eliminate these behaviors a nd their failure may lead to further escalation of tension in the relationship. This conflict, as we have seen, reinforces the same mechanism that is causing th e behavior ticcoso that can arise from conflicts and stress. Approach to the chi ld with tics, the risk may be to focus on the symptom and not on its meaning on the comprehensive nature of the child, while of paramount importance that are co nsidered its overall development, its adaptive function, the his feelings, his l iving environment. References and More ... - Andreoli V, Cassano GB, Rossi R (ed s). Diagnostic and Statistical Manual of Mental Disorders DSM - IV. Masson, Mila n, 2002. - Dooley JM (2006). Tic disorders in childhood. Semin Pediatr Neurol, 1 3 (4) :231-42. - John B. Cassano, Paolo Pancheri, Luigi Pavan (ed.). Italian tre atise on psychiatry. CD-ROM, Masson, Milan, 2002. - Marcelli D., Child Psychopathology, Masson, Milano 1999. - Shapiro E, Shapiro AK, Fulop G, Hubbard M, Mandel J, Nordlie J, Phillips RA (1989). Controlled stud y of haloperidol, pimozide and placebo for the treatment of Gilles de la Tourett e's syndrome. January Arch Psychiatry, 46 (8) :722-30. Dr. Laura Veneroni, psychologist lauraveneroni@yahoo.it