Aprendizado
Tics and Tourette Syndrome
Tics are involuntary , rapid , repetitive, and stereotyped movements , arising from sudden way and have no particular rhythm . Some are examples of eye blinks and movements with the shoulders , but the symptoms can also occur in the form of sounds emitted by the patient ( vocalizations ) . Can be continuous or suddenly emerge as hits .
The intensity of ticks is variable. Some are barely noticeable , but others are quite complex , such as jumping or barking strong . There are also cases that are " camouflaged " in everyday attitudes , as the hair away from the face or smoothing their clothes . This case are only recognized by its repetitive nature .
The patient can avoid the tics , but with effort and emotional stress . Sometimes , the manifestations are preceded by an uncomfortable sensation, called premonitory and often followed by a feeling of relief. Usually disappear during sleep and decrease with alcohol intake or during activities that require concentration. Moreover, factors such as stress , fatigue , anxiety, and increasing the excitation intensity of the characteristic movements.
complex tics
Tics can be simple or complex . In the first case , are the most direct manifestations such as eye blinking , facial grimacing , twisting the nose or mouth , clenching , lift your shoulders , move your fingers and shake his head or neck . Among the vocalizations that category are " scratching " the throat , tongue clicking , shouting , whistling , rumbling and imitate animal sounds , such as grunts , howls , barks , and tinnitus .
Already complex tics can organize themselves and be ritualized . They resemble compulsions , preceded manifestations of cognitive phenomena or obsessions ( ideas , thoughts and images ) , usually accompanied by intense anxiety , palpitations , tremors and sweating . The difference is that the tics are preceded by a sense of obligation , of having to do something that acts as an increasing pressure that needs to be discharged . Furthermore , patients with tics report tactile or muscular sensations that anticipate repetitive behaviors ( premonitory sensations ) , which does not occur with the compulsions .
Tourette's syndrome
Holders of tics often have more than one type of manifestation. When they are multiple and involve both vocal and motor tics , not necessarily at the same time, featuring Tourette syndrome .
The disorder appears around the age of 7 , but this event can vary from 2 to 15 years. At first, simple motor tics occur as eye blinks . After 11 years on average , the child vocalizations , such as throat clearing , sniffling , coughing, exclamations and colloquialisms , among others . This order , however, can be reversed.
Tics can also manifest as an involuntary emission of obscene words or gestures ( coprolalia and copropraxia , respectively) . The coprolalia occurs in less than one third of cases and perhaps suffer some cultural influence, since it is more frequent in certain countries . In Denmark, for instance, is six times more common in Japan copropraxia This , in turn , affects 1 % to 21 % of patients. At least half of the cases , can also repeat words heard ( echolalia ) , the observed gestures ( echopraxia ) or the speech itself ( palilalia ) occur.
estimates
It is estimated that one third of patients experience complete remission at the end of adolescence , the other third improves tics . The rest will probably continue with the problem unchanged during adulthood . Still, there are reports of disappearance of tics spontaneously in 3 % to 5 % of cases .
After Tourette syndrome settles , the symptoms vary in intensity , especially in adolescence . Some behavior disorders usually appear with the disease , such as hyperactivity , self-injury , behavioral problems and learning beyond the obsessive - compulsive disorder ( OCD ) . Studies suggest that more than 40 % of patients with Tourette syndrome also have OCD and about 90 % , obsessional symptoms .
There are cases in which disorders are associated with more concern than the tics . Tourette syndrome is rarely serious and does not always require treatment with medications . Many people go through life with tics without major problems .
causes
About 1 % of the world population has Tourette syndrome, since the milder and not diagnosed until the more severe forms . Tics tend to affect up to 20% of children , but usually disappear spontaneously within three months. Otherwise , there is suspicion of chronic tics or Tourette's syndrome.
The cause of the disease is unknown but it is known that there is an influence of genetic and neurobiological factors . Family studies of patients indicate that there is a genetic predisposition to the syndrome of transmission . Between identical twins ( monozygotic ) , when a brother is affected in over 50% of cases the other also has the disease . If they are not identical , this percentage is 10 % . When all types of tick are included , not just Tourette's syndrome , the concordance rate between monozygotic twins increases to 77 % .
Investigations suggest that there is also a relationship between problems in pregnancy and the occurrence of the disease in the child . Some show a 1.5 times higher incidence of complications during pregnancy in patients with tics than in healthy individuals . However , not all studies were able to demonstrate this correspondence .
Psychological factors may also have great influence on the development of the disorder . Tics worsen , for example, in the presence of stressful events not necessarily unpleasant . Already found that there is an association between the content of tics , his early and important events in the lives of children with the disease .
searches
Studies with magnetic resonance imaging showed that there are changes in some brain structures known as the basal ganglia and corpus callosum of patients with the syndrome . CT scans are more accurate , that work on the issue of subatomic particles ( positrons and photons ) , revealed that these patients generally have lower activity in some brain regions , called frontal and temporal cortex , cingulate cortex , striatum and thalamus .
Numerous studies suggest that Tourette syndrome is influenced by a neurochemical substrate . The main theory of this line is that , in individuals with the disorder , there is an increased activity of dopamine , a substance that aids in the transmission of nerve impulses from one neuron to another . Drugs that inhibit the action of dopamine reduce the severity and frequency of tics , while drugs that stimulate its activity cause exacerbation of the manifestations .
The incidence of the syndrome is higher in males . Therefore , it is believed that ticks are related to the influence of male hormones in the central nervous system. There are reports of exacerbation associated with overuse of androgenic steroids , anabolic muscle mass that increase symptoms . In other cases , the tics intensify in the premenstrual period , which shows a relation of the problem with the hormonal balance .
Some researchers also suggest that there is a relationship between tics and other disorders and antibodies that attack the brain ( antineurais ) , produced by the body to fight infections caused by streptococci . This theory is based on the fact that some people begin to exhibit tics or worsen their condition after suffering throat infections . Studies in Project Spectrum Disorders Obsessive - Compulsive Disorder ( PROTOC ) , Institute of Psychiatry , Faculty of Medicine, USP , showed that rheumatic fever, a later complication of strep throat that is associated with immunological changes , can increase the chance of have Tourette syndrome in both inpatients and their families .
treatment
Treatment of Tourette's syndrome involves psychosocial and pharmacologic therapy . Before starting, you should make an assessment of tics , as regards the location , frequency, intensity , complexity, and interference in daily life . Aspects such as school and family environment, relationships and disorders associated with the problem should also be analyzed .
To date , no cure for tics and Tourette's syndrome, but medications can help relieve symptoms . It is estimated that 60 % of patients need of such treatment . The philosophy of therapy is conservative : the doses are as low as possible to avoid the patient to take medication unnecessarily . Even with the aid of drugs , the tics do not completely disappear .
In certain cases, it indicates whether psychotherapy , including guidance to parents, families and teachers . It is important that everyone is well informed about the disease , its characteristics and ways of dealing with the patient . Should avoid stigmatization and overprotective attitudes , because the child can perceive and manipulate illness to get what you want .
There are reports of healing with behavioral psychotherapy . In this context , the technique known as habit reversal has proved the most suitable . Is based on educating patients to realize when the tics will occur and then try to delete them , modify them, or replace them with other, less hassle . An unpleasant and embarrassing manifestation , like waving to strangers , can be modified , with effort and training to a more acceptable attitude or imperceptible , like going hand in hair or body.
Most patients with tics and Tourette syndrome has great improvement in early adulthood , with decreased symptoms or adaptation to more stable and moderate tics . The most significant reduction occurs around age 20. The evolution is often unstable . The severity in childhood does not indicate how will the evolution. Therefore , in most cases , psychosocial and educational approach is the most important element , because it helps the patient and family understand the symptoms and learn how to deal with them without the need for medication .
Frequent examples of tics
Simple tics
tics Complexes
engines
Flashing eyes; Eye Jerking ( deviations of the eyeball ), facial grimacing , twisting movements of the nose and mouth, jaw popping , clenching ; stand shoulder ; movements of the fingers ; kicks ; abdominal tension or other parts body , shaking head , neck , or other body parts .
Facial gestures ; stretch of language; maintenance of certain looks , gestures of hands , clapping , throwing or playing , pushing , touching the face ; movements " housekeeping " ; skip , tap your foot , crouch , jump , bend , spin or rotate the floor ; spin ; squirm ; dystonic posturing ; ocular deviations ( rotating the eyes upward or sideways ) ; lick hands , fingers or objects ; touching , hitting or check parts of the body , other persons or objects ; kiss ; fix ; pinching ; writing the same letter or word , go back over the steps themselves; lentificados movements or inhibition, hitting his head , biting his mouth , lips or other body part ; " poke " wounds or eyes , and echopraxia copropraxia .
vocals
Scratching the throat ; sniff ; spit ; pop the tongue or jaw ; Crowing , snoring , wheezing , barking , whistling , screaming, grunting , gurgling, moaning , howling , whistling , humming , slurping and countless other sounds .
Sudden inappropriate utterances of complex syllables , words - " Oops " , " oops " , short phrases and including palilalia , coprolalia and echolalia . Other speech abnormalities such as blocking of speech .
Adapted from Hanna . (1995).
Ana Gabriela Hounie is deputy coordinator of PROTOC ; Euripides Miguel is associate professor in the department of psychiatry and coordinator of Project Spectrum Disorders Obsessive - Compulsive Disorder ( PROTOC ) of the Institute of Psychiatry FMUSP.Contato : [email protected]
(11) 3085-2978
To learn more :
http://www.astoc.org
http://www.protoc.com.br
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Aprendizado
Tics and Tourette Syndrome
Tics and Tourette Syndrome
Tics are involuntary , rapid , repetitive, and stereotyped movements , arising from sudden way and have no particular rhythm . Some are examples of eye blinks and movements with the shoulders , but the symptoms can also occur in the form of sounds emitted by the patient ( vocalizations ) . Can be continuous or suddenly emerge as hits .
The intensity of ticks is variable. Some are barely noticeable , but others are quite complex , such as jumping or barking strong . There are also cases that are " camouflaged " in everyday attitudes , as the hair away from the face or smoothing their clothes . This case are only recognized by its repetitive nature .
The patient can avoid the tics , but with effort and emotional stress . Sometimes , the manifestations are preceded by an uncomfortable sensation, called premonitory and often followed by a feeling of relief. Usually disappear during sleep and decrease with alcohol intake or during activities that require concentration. Moreover, factors such as stress , fatigue , anxiety, and increasing the excitation intensity of the characteristic movements.
complex tics
Tics can be simple or complex . In the first case , are the most direct manifestations such as eye blinking , facial grimacing , twisting the nose or mouth , clenching , lift your shoulders , move your fingers and shake his head or neck . Among the vocalizations that category are " scratching " the throat , tongue clicking , shouting , whistling , rumbling and imitate animal sounds , such as grunts , howls , barks , and tinnitus .
Already complex tics can organize themselves and be ritualized . They resemble compulsions , preceded manifestations of cognitive phenomena or obsessions ( ideas , thoughts and images ) , usually accompanied by intense anxiety , palpitations , tremors and sweating . The difference is that the tics are preceded by a sense of obligation , of having to do something that acts as an increasing pressure that needs to be discharged . Furthermore , patients with tics report tactile or muscular sensations that anticipate repetitive behaviors ( premonitory sensations ) , which does not occur with the compulsions .
Tourette's syndrome
Holders of tics often have more than one type of manifestation. When they are multiple and involve both vocal and motor tics , not necessarily at the same time, featuring Tourette syndrome .
The disorder appears around the age of 7 , but this event can vary from 2 to 15 years. At first, simple motor tics occur as eye blinks . After 11 years on average , the child vocalizations , such as throat clearing , sniffling , coughing, exclamations and colloquialisms , among others . This order , however, can be reversed.
Tics can also manifest as an involuntary emission of obscene words or gestures ( coprolalia and copropraxia , respectively) . The coprolalia occurs in less than one third of cases and perhaps suffer some cultural influence, since it is more frequent in certain countries . In Denmark, for instance, is six times more common in Japan copropraxia This , in turn , affects 1 % to 21 % of patients. At least half of the cases , can also repeat words heard ( echolalia ) , the observed gestures ( echopraxia ) or the speech itself ( palilalia ) occur.
estimates
It is estimated that one third of patients experience complete remission at the end of adolescence , the other third improves tics . The rest will probably continue with the problem unchanged during adulthood . Still, there are reports of disappearance of tics spontaneously in 3 % to 5 % of cases .
After Tourette syndrome settles , the symptoms vary in intensity , especially in adolescence . Some behavior disorders usually appear with the disease , such as hyperactivity , self-injury , behavioral problems and learning beyond the obsessive - compulsive disorder ( OCD ) . Studies suggest that more than 40 % of patients with Tourette syndrome also have OCD and about 90 % , obsessional symptoms .
There are cases in which disorders are associated with more concern than the tics . Tourette syndrome is rarely serious and does not always require treatment with medications . Many people go through life with tics without major problems .
causes
About 1 % of the world population has Tourette syndrome, since the milder and not diagnosed until the more severe forms . Tics tend to affect up to 20% of children , but usually disappear spontaneously within three months. Otherwise , there is suspicion of chronic tics or Tourette's syndrome.
The cause of the disease is unknown but it is known that there is an influence of genetic and neurobiological factors . Family studies of patients indicate that there is a genetic predisposition to the syndrome of transmission . Between identical twins ( monozygotic ) , when a brother is affected in over 50% of cases the other also has the disease . If they are not identical , this percentage is 10 % . When all types of tick are included , not just Tourette's syndrome , the concordance rate between monozygotic twins increases to 77 % .
Investigations suggest that there is also a relationship between problems in pregnancy and the occurrence of the disease in the child . Some show a 1.5 times higher incidence of complications during pregnancy in patients with tics than in healthy individuals . However , not all studies were able to demonstrate this correspondence .
Psychological factors may also have great influence on the development of the disorder . Tics worsen , for example, in the presence of stressful events not necessarily unpleasant . Already found that there is an association between the content of tics , his early and important events in the lives of children with the disease .
searches
Studies with magnetic resonance imaging showed that there are changes in some brain structures known as the basal ganglia and corpus callosum of patients with the syndrome . CT scans are more accurate , that work on the issue of subatomic particles ( positrons and photons ) , revealed that these patients generally have lower activity in some brain regions , called frontal and temporal cortex , cingulate cortex , striatum and thalamus .
Numerous studies suggest that Tourette syndrome is influenced by a neurochemical substrate . The main theory of this line is that , in individuals with the disorder , there is an increased activity of dopamine , a substance that aids in the transmission of nerve impulses from one neuron to another . Drugs that inhibit the action of dopamine reduce the severity and frequency of tics , while drugs that stimulate its activity cause exacerbation of the manifestations .
The incidence of the syndrome is higher in males . Therefore , it is believed that ticks are related to the influence of male hormones in the central nervous system. There are reports of exacerbation associated with overuse of androgenic steroids , anabolic muscle mass that increase symptoms . In other cases , the tics intensify in the premenstrual period , which shows a relation of the problem with the hormonal balance .
Some researchers also suggest that there is a relationship between tics and other disorders and antibodies that attack the brain ( antineurais ) , produced by the body to fight infections caused by streptococci . This theory is based on the fact that some people begin to exhibit tics or worsen their condition after suffering throat infections . Studies in Project Spectrum Disorders Obsessive - Compulsive Disorder ( PROTOC ) , Institute of Psychiatry , Faculty of Medicine, USP , showed that rheumatic fever, a later complication of strep throat that is associated with immunological changes , can increase the chance of have Tourette syndrome in both inpatients and their families .
treatment
Treatment of Tourette's syndrome involves psychosocial and pharmacologic therapy . Before starting, you should make an assessment of tics , as regards the location , frequency, intensity , complexity, and interference in daily life . Aspects such as school and family environment, relationships and disorders associated with the problem should also be analyzed .
To date , no cure for tics and Tourette's syndrome, but medications can help relieve symptoms . It is estimated that 60 % of patients need of such treatment . The philosophy of therapy is conservative : the doses are as low as possible to avoid the patient to take medication unnecessarily . Even with the aid of drugs , the tics do not completely disappear .
In certain cases, it indicates whether psychotherapy , including guidance to parents, families and teachers . It is important that everyone is well informed about the disease , its characteristics and ways of dealing with the patient . Should avoid stigmatization and overprotective attitudes , because the child can perceive and manipulate illness to get what you want .
There are reports of healing with behavioral psychotherapy . In this context , the technique known as habit reversal has proved the most suitable . Is based on educating patients to realize when the tics will occur and then try to delete them , modify them, or replace them with other, less hassle . An unpleasant and embarrassing manifestation , like waving to strangers , can be modified , with effort and training to a more acceptable attitude or imperceptible , like going hand in hair or body.
Most patients with tics and Tourette syndrome has great improvement in early adulthood , with decreased symptoms or adaptation to more stable and moderate tics . The most significant reduction occurs around age 20. The evolution is often unstable . The severity in childhood does not indicate how will the evolution. Therefore , in most cases , psychosocial and educational approach is the most important element , because it helps the patient and family understand the symptoms and learn how to deal with them without the need for medication .
Frequent examples of tics
Simple tics
tics Complexes
engines
Flashing eyes; Eye Jerking ( deviations of the eyeball ), facial grimacing , twisting movements of the nose and mouth, jaw popping , clenching ; stand shoulder ; movements of the fingers ; kicks ; abdominal tension or other parts body , shaking head , neck , or other body parts .
Facial gestures ; stretch of language; maintenance of certain looks , gestures of hands , clapping , throwing or playing , pushing , touching the face ; movements " housekeeping " ; skip , tap your foot , crouch , jump , bend , spin or rotate the floor ; spin ; squirm ; dystonic posturing ; ocular deviations ( rotating the eyes upward or sideways ) ; lick hands , fingers or objects ; touching , hitting or check parts of the body , other persons or objects ; kiss ; fix ; pinching ; writing the same letter or word , go back over the steps themselves; lentificados movements or inhibition, hitting his head , biting his mouth , lips or other body part ; " poke " wounds or eyes , and echopraxia copropraxia .
vocals
Scratching the throat ; sniff ; spit ; pop the tongue or jaw ; Crowing , snoring , wheezing , barking , whistling , screaming, grunting , gurgling, moaning , howling , whistling , humming , slurping and countless other sounds .
Sudden inappropriate utterances of complex syllables , words - " Oops " , " oops " , short phrases and including palilalia , coprolalia and echolalia . Other speech abnormalities such as blocking of speech .
Adapted from Hanna . (1995).
Ana Gabriela Hounie is deputy coordinator of PROTOC ; Euripides Miguel is associate professor in the department of psychiatry and coordinator of Project Spectrum Disorders Obsessive - Compulsive Disorder ( PROTOC ) of the Institute of Psychiatry FMUSP.Contato : [email protected]
(11) 3085-2978
To learn more :
http://www.astoc.org
http://www.protoc.com.br
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- Tics Und Tourette-syndrom
Tics und Tourette-Syndrom Tics sind unwillkürliche , schnelle , sich wiederholende und stereotype Bewegungen , die sich aus plötzlichen Weg und haben keinen bestimmten Rhythmus . Einige Beispiele von Augenbewegungenblinkt und mit den Schultern , aber...
- Les Tics Et Le Syndrome Gilles De La Tourette
Les tics et le syndrome Gilles de la Tourette Les tics sont involontaires, rapides , répétitifs , et des mouvements stéréotypés , résultant de façon soudaine et n'ont pas de rythme particulier . Certains sont des exemples de clignote et...
- Deficit Disorder Attention Deficit Hyperactivity Disorder
Deficit Disorder Attention Deficit Hyperactivity Disorder What is it? The hyperactivity and attention deficit disorder is more commonly seen problem in children and is based on symptoms of inattention ( very distracted person) and hyperactivity ( very...
- The Importance Of The Psychoanalytic Theory Of Sigmund Freud For The Formation Of The Educational Psychologist .
The importance of the psychoanalytic theory of Sigmund Freud for the formation of the educational psychologist . It is essential for professional psychopedagogists expert knowledge...
- The Importance Of The Psychoanalytic Theory Of Sigmund Freud For The Formation Of The Educational Psychologist .
The importance of the psychoanalytic theory of Sigmund Freud for the formation of the educational psychologist . It is essential for the professional educational psychologist expert...