Original articlePsychopathology in children and adolescents with Tourette's syndrome: A controlled study
Introduction
Tourette's syndrome (TS) is a neuropsychiatric disorder characterized by the presence of multiple motor tics plus one or more vocal (phonic) tics [1]. Opinions differ regarding its aetiology: many authors argue for an organic substrate involving neural basal ganglia circuits, while others draw attention to genetic influences, perinatal pathogenic noxae, infectious and autoimmune factors [2]. Others still have hypothesized a role for psychological factors in the onset and maintenance of the tic symptomatology [3].
TS is often associated with a broad spectrum of psychopathological and behavioural disorders, which are frequently the main reason for seeking medical help [4], [5]. Numerous studies have reported the presence of obsessive–compulsive symptoms [5], [6], [7], and of attention-deficit hyperactivity disorder (ADHD) [7], [8], [9], [10], in a large percentage of subjects affected by TS. In addition to these psychopathological manifestations, self-harm behaviour [11], anxious traits [12], [13], depression [4], personality disorders [14], aggressive and antisocial behaviours, conduct disorder and learning difficulties [5], [15] have also emerged as important features.
However, the literature contains few controlled studies that, using standardized scales for the assessment of behavioural and psychopathological aspects, have investigated TS specifically in children and adolescents [4], [16], [17], [18].
We conducted a case–control study in which standardized tests were used to assess psychopathological and behavioural features associated with TS in young subjects and to verify the reproducibility of the few data published on this topic to date.
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Material and methods
The study sample was made up of 17 patients (14 males and three females), aged 7.3–17.4 years (mean age 11.4, SD=3.02 years), with TS diagnosed according to DSM-IV criteria [1], and consecutively referred for a first outpatient or inpatient consultation to the Department of Child Neurology and Psychiatry at the C. Mondino Institute of Neurology between January 2000 and December 2002. In-depth, anamnestic interviews were conducted with all the parents of the recruited patients, who had first
Results
Seventeen TS subjects (14 males and three females), aged between 7.3 and 17.4 years (mean age: 11.4, SD=3.02 years) were recruited, together with 17 age- and sex-matched controls (Table 1). The TS subjects recorded a mean Y-GTSS score of 56, SD=14.24 (range 28–81).
We excluded acquired Tourettism by means of laboratory-instrumental tests: cupraemia (17/17), ceruloplasmin (17/17), cupriuria (17/17), acanthocytes (17/17), ANA test (5/17), MRI (10/17) or brain CT scan (2/17), and EEG (14/17) were
Discussion
The results of this study, relating to a sample of children and adolescents with TS recruited at a single institute, show a significantly higher prevalence of psychopathological and behavioural disorders compared with a healthy sex- and age-matched control group. This is in accordance with findings reported in the few controlled studies on young TS patients published to date [4], [16], [17], [18]. The fact that similar results have also been obtained in a non-clinical population [5] provides
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