Review
The psychopathological spectrum of Gilles de la Tourette syndrome

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Abstract

Gilles de la Tourette syndrome (GTS) holds a unique status as quintessentially neuropsychiatric condition at the interface between neurology (movement disorder) and psychiatry (behavioural condition). This is a reflection of the common observation that the vast majority of patients present with behavioural problems in association with the motor and vocal tics which define GTS. The present article focuses on the relationship between GTS and obsessive–compulsive disorder (OCD), attention-deficit and hyperactivity disorder (ADHD), affective disorders (both major depression and bipolar affective disorder), and personality disorders. Over the last decade, converging lines of research have pointed towards the concept of a ‘GTS spectrum’, encompassing motor phenomena and behavioural symptoms, with important implications for the clinical management of patients.

Highlights

► Gilles de la Tourette syndrome is a quintessentially neuropsychiatric condition. ► The vast majority of patients present with both motor and behavioural symptoms. ► Specific obsessive–compulsive symptoms can accompany the motor and vocal tics. ► Attention-deficit and hyperactivity disorder is a common co-morbidity in children. ► Co-morbid disorders have important implications for the management of patients.

Section snippets

Journey of a neuropsychiatric disorder

The Gilles de la Tourette syndrome (GTS) has captured the interest of both the public and scientific communities for similar reasons. To the public, the idea of a condition that compels the sufferer to transgress social norms is both fascinating and anxiety-provoking (Robertson and Cavanna, 2008, Monaco et al., 2009). To the scientific community, GTS is a condition that presents with symptoms which seemingly mock the divisions between neurology, psychiatry and psychology (i.e. motor,

On the complex nature of tics

Prior to Gilles de la Tourette's description of multiple tic disorders, there had been phenomenological descriptions by Itard, Trousseau and Hughlings-Jackson (Robertson and Cavanna, 2008). Perhaps the closest of these descriptions to the modern idea of GTS comes from Trousseau (Rickards et al., 2010). He described tics as common, non-painful, familial and most common around the face. He noted that the type and location of tics could change over time. He wrote about the occurrence of

The relationship between tics, compulsions and obsessions

At first inspection, tics do not appear to have much connection to compulsions and obsessions. The former are motor phenomena and the latter mental and behavioural phenomena. However, the common co-existence of these symptoms has led to a closer inspection (Worbe et al., 2010, Cath et al., 2011). On a basic level, tics, compulsions and obsessions are all things that people feel compelled to go through. They can be resisted at the expense of internal tension. Performance of the thought, movement

Attention-deficit and hyperactivity in Gilles de la Tourette syndrome

ADHD and GTS present with a high rate of co-morbidity: as many as 60–80% of young patients with GTS can fulfil current diagnostic criteria for co-morbid ADHD (Robertson, 2000, Cavanna et al., 2009a), and the clinical spectrum of these two neurodevelopmental disorders tends to overlap. However, the precise nature of the relationship between GTS and ADHD is complex and still debated. Whether the combination of GTS plus ADHD reflects a separate entity and not merely two-coexisting disorders, as

Affective disorders and personality in Gilles de la Tourette syndrome

Depression has long been found in association with GTS (e.g. Montgomery et al., 1982). There is now good evidence from both controlled and uncontrolled studies reviewed by Robertson (2006b) to support the view that affective disorders are common in patients with GTS, with a lifetime risk of 10%, and a prevalence of 1.8–8.9%. In patients with GTS seen at specialist clinics, depressive symptomatology was found to occur in between 13% and 76% of cases (Robertson, 2006b). Depression in people with

More than one Gilles de la Tourette syndrome?

As we have shown in the present article, our concept of GTS has evolved since Georges Gilles de la Tourette's first description in 1885, following a constant increase in scientific interest and publications about this condition (Mariam and Cavanna, 2012). Our current view is that GTS is a neurodevelopmental disorder consisting of multiple tics, and often associated with complex tic-related symptoms and behavioural problems. GTS is increasingly recognised as a relatively common lifelong

Acknowledgements

The authors are grateful to UK-Tourettes Action and USA-Tourette Syndrome Association for their continuing support.

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