Tic disorders are defined in the ''

Diagnostic and Statistical Manual of Mental Disorders The ''Diagnostic and Statistical Manual of Mental Disorders'' (DSM; latest edition: DSM-5-TR, published in March 2022) is a publication by the American Psychiatric Association (APA) for the classification of mental disorders using a common langu ...

'' (DSM) based on type (motor or phonic) and duration of tics (sudden, rapid, nonrhythmic movements). Tic disorders are defined similarly by the

World Health Organization The World Health Organization (WHO) is a specialized agency of the United Nations responsible for international public health. The WHO Constitution states its main objective as "the attainment by all peoples of the highest possible level o ...

(

ICD-10 ICD-10 is the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD), a medical classification list by the World Health Organization (WHO). It contains codes for diseases, signs and symptoms ...

codes).

Classification

DSM-5

The fifth revision of the ''

'' (

DSM-5 The ''Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition'' (DSM-5), is the 2013 update to the '' Diagnostic and Statistical Manual of Mental Disorders'', the taxonomic and diagnostic tool published by the American Psychiatri ...

), published in May 2013, classifies

Tourette syndrome Tourette syndrome or Tourette's syndrome (abbreviated as TS or Tourette's) is a common neurodevelopmental disorder that begins in childhood or adolescence. It is characterized by multiple movement (motor) tics and at least one vocal (phonic) ...

and tic disorders as motor disorders listed in the

neurodevelopmental disorder Neurodevelopmental disorders are a group of disorders that affect the development of the nervous system, leading to abnormal brain function which may affect emotion, learning ability, self-control, and memory. The effects of neurodevelopmenta ...

category. Tic disorders, in ascending order of severity, are: * 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 Developmental coordination disorder (DCD), also known as developmental motor coordination disorder, developmental dyspraxia or simply dyspraxia from the word 'praxis' meaning to do or act, is a neurodevelopmental disorder characterized by impaire ...

and stereotypic movement disorder are also classified as motor disorders.

ICD-10

ICD10 diagnosis codes are: * F95.0 Transient tic disorder * F95.1 Chronic motor or vocal tic disorder * F95.2 Combined vocal and multiple motor tic disorder illes de la Tourette* F95.8 Other tic disorders * F95.9 Tic disorder, unspecified

Diagnosis

Tics should be distinguished from other causes of

tourettism Tourettism refers to the presence of Tourette-like symptoms in the absence of Tourette syndrome, as the result of other diseases or conditions, known as "secondary causes". Tourette syndrome (TS) is an inherited neurological condition of multiple ...

stereotypies A stereotypy (, or ) is a repetitive or ritualistic movement, posture, or utterance. Stereotypies may be simple movements such as body rocking, or complex, such as self-caressing, crossing and uncrossing of legs, and marching in place. They are ...

chorea Chorea (or choreia, occasionally) is an abnormal involuntary movement disorder, one of a group of neurological disorders called dyskinesias. The term ''chorea'' is derived from the grc, χορεία ("dance"; see choreia), as the quick movem ...

dyskinesia Dyskinesia refers to a category of movement disorders that are characterized by involuntary muscle movements, including movements similar to tics or chorea and diminished voluntary movements. Dyskinesia can be anything from a slight tremor of ...

myoclonus Myoclonus is a brief, involuntary, irregular (lacking rhythm) twitching of a muscle or a group of muscles, different from clonus, which is rhythmic or regular. Myoclonus (myo "muscle", clonic "jerk") describes a medical sign and, generally, is ...

and obsessive-compulsive disorder.

Treatment

Education, and a " watch and wait" strategy, are the only treatment needed for many, and the majority of individuals with tics do not seek treatment. When needed, management of tic disorders is similar to management of Tourette syndrome. The first line of treatment is

behavioural therapy Behaviour therapy or behavioural psychotherapy is a broad term referring to clinical psychotherapy that uses techniques derived from behaviourism and/or cognitive psychology. It looks at specific, learned behaviours and how the environment, or oth ...

, followed by medication (most often

aripiprazole Aripiprazole, sold under the brand names Abilify and Aristada among others, is an atypical antipsychotic. It is primarily used in the treatment of schizophrenia and bipolar disorder. Other uses include as an add-on treatment in major depressiv ...

) if the former is unsuccessful. Although behavioural therapy is the recommended first treatment, many people with tics do not access it due to the lack of trained psychotherapists.

Epidemiology

Tic disorders are more commonly diagnosed in males than females. At least one in five children experience some form of tic disorder, most frequently between the ages of seven and twelve. 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.

History

DSM-IV-TR

In the fourth revision of the DSM (

DSM-IV-TR The ''Diagnostic and Statistical Manual of Mental Disorders'' (DSM; latest edition: DSM-5-TR, published in March 2022) is a publication by the American Psychiatric Association (APA) for the classification of mental disorders using a common langua ...

), tic disorders were classified as follows: * 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

was published in 2013, updating DSM-IV-TR, which was published in 2000. The following changes were made:Neurodevelopmental disorders.

American Psychiatric Association The American Psychiatric Association (APA) is the main professional organization of psychiatrists and trainee psychiatrists in the United States, and the largest psychiatric organization in the world. It has more than 37,000 members are invo ...

. Retrieved on December 29, 2011. * The word ''stereotyped'' was removed from tic definition:

and stereotypic movement disorder are frequently misdiagnosed as tics or Tourette syndrome. 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 The autism spectrum, often referred to as just autism or in the context of a professional diagnosis autism spectrum disorder (ASD) or autism spectrum condition (ASC), is a neurodevelopmental condition (or conditions) characterized by difficulti ...

disorders) and tic disorders. * ''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). The term ''provisional'' "satisfies experts with a more systematic epidemiological approach to disorders", but should not imply that treatment might not be called for. * 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 In medicine, comorbidity - from Latin morbus ("sickness"), co ("together"), -ity (as if - several sicknesses together) - is the presence of one or more additional conditions often co-occurring (that is, concomitant or concurrent) with a primary ...

diagnoses are present with vocal tics relative to motor tics. * 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

stimulant Stimulants (also often referred to as psychostimulants or colloquially as uppers) is an overarching term that covers many drugs including those that increase activity of the central nervous system and the body, drugs that are pleasurable and inv ...

s causes tic disorders. * 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. The new categories account for tics with onset in adulthood, or tics triggered by other medical conditions or illicit drug use.

References

External links

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