Mood, anxiety disorders common in Tourette patients, emerge at a young age

March 9, 2015, University of California, San Francisco

A new study of Tourette syndrome (TS) led by researchers from UC San Francisco and Massachusetts General Hospital (MGH) has found that nearly 86 percent of patients who seek treatment for TS will be diagnosed with a second psychiatric disorder during their lifetimes, and that nearly 58 percent will receive two or more such diagnoses.

It has long been known that TS, which emerges in childhood and is characterized by troublesome motor and vocal tics, is often accompanied by other disorders, especially (ADHD) and obsessive-compulsive disorder (OCD). In many patients these "comorbid" conditions cause more distress and disability for patients than TS tics themselves.

But the size and rigor of the new study, conducted by an international group of researchers known as the Tourette Syndrome Association International Consortium for Genetics (TSAICG) and published in the February 11, 2015 online edition of JAMA Psychiatry, provides the most comprehensive and reliable picture of TS comorbidities to date, said Carol A. Mathews, MD, professor of psychiatry at UCSF and co-senior author of the new report.

"This is the biggest data set of its kind that I know of," Mathews said. "We've interviewed thousands of people and collected a huge wealth of clinical data, which has given us the opportunity to say something meaningful about the clinical presentation of Tourette syndrome."

Co-senior author Jeremiah Scharf, MD, PhD, of the MGH Psychiatric and Neurodevelopmental Genetics Unit (PNGU), an assistant professor of neurology at Harvard Medical School and TSAICG co-chair, said that the new findings should prove useful to his fellow neurologists, who often treat TS patients but may not be aware of the full spectrum of possible psychiatric comorbidities seen in the disorder.

"The origin of TS is in a part of the brain that is the overlap between neurology and psychiatry," said Scharf. "Knowing the range of diagnostic possibilities and forming collaborative teams with psychiatrists is important to successfully treat TS."

Led by first authors Matthew E. Hirschtritt, MD, MPH, a psychiatry resident at UCSF, and Paul C. Lee, MD, MPH, a former postdoctoral fellow at the MGH PNGU, the researchers analyzed diagnostic data for more than 1,300 TS patients gathered in consistent, highly structured interviews completed over the 16-year period from 1992 to 2008. In addition, to determine how comorbid conditions that are frequently seen in TS patients might run in families, the analysis also included diagnostic information from parents, siblings, and other relatives unaffected by TS.

As expected, the report found that ADHD and OCD are common among those with TS. Seventy-two percent of the TS patients studied received one of these two diagnoses, and nearly one-third were diagnosed with both ADHD and OCD. ADHD was seen to emerge as early as age 5 in TS patients, and OCD before 10 years of age.

But the results also show that mood disorders, , and disruptive behavior disorders are quite common in TS patients—about 30 percent of patients received one of these diagnoses—and that mood and anxiety disorders appear much earlier in life in TS patients than is typical in the general population.

"Anxiety and depression, which in the general population often emerge in adolescence and adulthood, are more likely to emerge early in life with TS, sometimes as early as age 5," said Scharf. "Social anxiety and ADHD often start in TS patients before tics even arise, which emphasizes the importance of screening young patients for these conditions."

Moreover, the researchers found that the risk of mood and anxiety disorders is related to OCD and ADHD diagnoses: both mood and anxiety disorders are significantly more common in TS patients with a concomitant diagnosis of OCD or of combined OCD and ADHD.

These observations are presumably a consequence of intertwined genetic relationships between these conditions, said Mathews. "We found that, while OCD and ADHD directly shared genetic relationships with TS, the other , such as mood and anxiety disorders, appear to share with ADHD and/or OCD, but not directly with TS. Perhaps of more relevance for clinicians, parental history of ADHD—but not tics or OCD —is associated with a nearly two-fold increase in the risk of having more than one co-occurring psychiatric disorder."

The researchers found relatively low rates of other psychiatric conditions, including eating disorders, psychosis, and substance abuse, among TS patients.

Mathews and Scharf cautioned that their results are potentially skewed because many TS patients never seek medical attention for the disorder. "This is a somewhat biased sample, because the patients we studied came to a clinic or through the Tourette Syndrome Association. People who come to a clinic for treatment tend to have more severe TS or they have other psychiatric symptoms," said Mathews. "But this work still gives clinicians a good idea of what they should be on the lookout for."

Explore further: First GWAS studies of obsessive-compulsive disorder and Tourette syndrome published

Related Stories

First GWAS studies of obsessive-compulsive disorder and Tourette syndrome published

August 14, 2012
Two papers that will appear in the journal Molecular Psychiatry, both receiving advance online release, may help identify gene variants that contribute to the risks of developing obsessive-compulsive disorder (OCD) or Tourette ...

Genetic analysis reveals insights into the genetic architecture of OCD, Tourette syndrome

October 24, 2013
An international research consortium led by investigators at Massachusetts General Hospital (MGH) and the University of Chicago has answered several questions about the genetic background of obsessive-compulsive disorder ...

New report tackles lack of understanding of Tourette Syndrome in teenagers

July 3, 2014
Scientists have found the first reliable evidence that physical activity and sport can help children with Tourette Syndrome to reduce and control their tics and could offer new paths for treatment and therapies.

'Brain training' overcomes tics in Tourette syndrome, study finds

April 18, 2014
(Medical Xpress)—Children with Tourette Syndrome (TS) may unconsciously train their brain to more effectively control their tics, a study led by experts at The University of Nottingham has confirmed.

Recommended for you

Junk food diet raises depression risk, researchers find

December 18, 2018
A diet of fast food, cakes and processed meat increases your risk of depression, according to researchers at Manchester Metropolitan University.

Looking on bright side may reduce anxiety, especially when money is tight

December 17, 2018
Trying to find something good in a bad situation appears to be particularly effective in reducing anxiety the less money a person makes, possibly because people with low incomes have less control over their environment, according ...

Levels of gene-expression-regulating enzyme altered in brains of people with schizophrenia

December 14, 2018
A study using a PET scan tracer developed at the Martinos Center for Biomedical Imaging at Massachusetts General Hospital (MGH) has identified, for the first time, epigenetic differences between the brains of individuals ...

Self-perception and reality seem to line-up when it comes to judging our own personality

December 14, 2018
When it comes to self-assessment, new U of T research suggests that maybe we do have a pretty good handle on our own personalities after all.

Video game players frequently exposed to graphic content may see world differently

December 13, 2018
People who frequently play violent video games are more immune to disturbing images than non-players, a UNSW-led study into the phenomenon of emotion-induced blindness has shown.

Researchers discover abundant source for neuronal cells

December 13, 2018
USC researchers seeking a way to study genetic activity associated with psychiatric disorders have discovered an abundant source of human cells—the nose.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.