Tourette Syndrome in Young People
Introduction history and other pertinent info diagnosis criteria, development of TS, and course of the disorder
Tourette syndrome was first reported and discovered by Jean-Marc Gaspard Itard in eighteen-twenty-five in a woman in France, but the disease was associated with coprolalia. The cases were first discovered in France in deaf patients and mental retardation, where they demonstrated tics. The womans Tourette sysdrome first signs were discovered on the Marquise de Dampierre, with invoicing cases of involuntary vocal and motor tics were in place (Al-Mosawi, 2018). Georges Gilles de la Tourette first described the disorder in eighteen eighty-five, where he described the disease's prevalence as both genetic and caused by environmental factors. Due to his description, the disorder got the name from the neurologist's name, thus named Tourette syndrome from his last name.
Disorders are illness in an individual body that disrupts either physical or mental functioning causing suffering, pain in an individual, or impairment of somebody. Cases of the condition are divided into various issues such as psychological disorder, personality disorder, psychotic disorder. The diagnosis of these disorders is made on psychiatric diagnostic where a diagnosis is made to test instances of mental disorder on the patients, especially for children and adolescence (Perrotta, 2019). Topics of neurodevelopment disorder are related to the coordination of neural systems because it affects the body’s brain and nervous system. Issues such as Tourette syndrome are among the neurological conditions that affect the brain and the nervous system of the victims involving the coordination of the body functions.
The Tourette syndrome symptom is sudden movements and sometimes vocal sounds that happen without realizing the activities' occurrence. The cases are repetitive and translated to motor tics and vocal tics depending on the movement or sound. Tourette syndrome (TS), motor tic, and sometimes vocal tic, is more common in teens and children and attacks the brain of the individual and the nervous system, causing a sudden and repetitive movement and sound. Tourette syndrome is transmitted from parent to offspring, thus considered a genetic disease or sometimes transmitted during the fetus’s development in the womb (Domènech, Cappi, & Halvorsen, 2021). The cases of Tourette syndrome are neurology disorder, thus associated with communication of the nervous system, especially in the brain of the victim. The symptoms are discovered mostly when the patient is at the early years of three to nine years, being more common in boys than in girls
An example of such a disorder is transient childhood tics associated with children at the age of five to eight years, but it can persist in life long. The condition is more common in males than females, with symptoms disappearing from adolescence to adulthood, but the symptoms persisting occasionally (Kim, et al. 2018). TS conditions are worse in childhood, especially when adolescents get into adolescence, improving as one gets into teens and sometimes early twenties. In some cases, the TS symptoms disappear during adolescence, but the condition does not worsen in youth, but the patient may learn to mask it. Despite the signs, TS is associated with other conditions in the patient like anxiety, causing the patient to cause harm themselves and sometimes develop obsession in the patient.
TS symptoms are involuntary, thus cause discomfort while suppressed or hidden from the public due to the patient's embarrassment. The diagnosis is done and verified to be TS after one year of observation by the doctor (Perrotta, 2019). The condition is identified through the motor and vocal tics, especially in teens. The cases of TS become suppressed when someone develops into adulthood. It can still be reduced by medication, usual neuroleptics for the tic suppression in children and adolescents. TS is also buried by focusing on something to facilitate concentration on the tic; this can be done through various activities to redirect their mental and physical energy. Behavioral activities and treatment have been done through training to reduce the patients' occurrence of tic symptoms. The patients have to deal with physical associated with appearance, emotional challenges related to embarrassment, and social challenges related to the way others treat them. The predisposing factors to the tics' development are the genetic factor, environmental factors, gender, and age.
Review on diagnosis criteria
The diagnosis of Tourette syndrome, according to the Diagnostic and Statistical Manual of Mental Disorders, can only be diagnosed when the tics have been exhibited for more than one year by the patient. For the condition to be considered TS, both the vocal and motor tics should be exhibited in this period, where the tics should operate simultaneously (Jones, & Ramphul, 2019). Similarly, tic development cases can be associated with substance consumption like cocaine making the occurrence of the diseases at the age eighteen and above not be associated with other causes of tics. The diagnosis of tics can only be made by observing the patient discover the motor and vocal tics and not through other means. The misdiagnosis of TS is associated with the disease having the mild, severe, and moderate expression of the disease's severity.
People diagnosed with TS and attention deficit hyperactive disorder (ADHD) are reported to have issues with disturbances in their sleep, a condition known as a sleep disorder. The disorder is associated with sleeping excessively during the daytime, insomnia, sleeping, walking, or sometimes sleep talking, where tic disorder cases were found to be persistent during sleep (Jiménez-Jiménez, et al. 2020). Sleeping disorder is thus one of the diagnosed cases of patients with TS and ADHD, where the issues are reported to be high where patients with this disorder have a high rate of sleeping disorder. Anxiety disorder, which is a symptom of TS and ADHD, is the most common cause of sleep disorder in these patients with a tic disorder, where a case of depression was reported to be expected in them. Patients with anxiety and depression symptoms are thus more susceptible to sleeping disorders in comorbidities and ADHD. In some patients, the sleeping disorder was associated with obesity and depression in patients, especially those diagnosed with TS.
neurobiological and other influences
Neurobiology in TS involves the neurodevelopment nature of the condition associated with the nervous system's infection, thus causing the patients' involuntary repetitive vocal and motor tics. The TS cases are usually related to other conditions in the victim's body, such as ADHD, disorders in the obsession with obsessive-compulsive disorder, anxiety and depression disorders, autism spectrum disorder (Paschou, & Müller-Vahl, 2017).). Despite the medication in place, this disorder's treatment only aims to eradicate the tics, both motor and vocal tics, rather than treating the condition. The leading cause of the lack of a cure for the disease is the disorder's unknown cause. It is further influenced by the grounds of the infections commonly non-genetic, making TS complicated pathogenesis. Despite the unknown cause of the syndrome, the frontal cortex, which includes the neurons and the thalamus, is associated with the condition's cause and the imbalance of hormones such as dopamine in the body.
The anatomical cause of the TS condition is associated with the overlapping of the genetic deviation, which affects the thalamus' volume, causing effects on the relay of the sensory signal in the body. The disturbance in the thalamus as the center of sensory transmission affects the relay of impulses from the brain to the body, making the tics familiar to TS and the symptoms expression. (Mufford, et al. 2019) The overlapping of genes is usually responsible for the TS. It’s known to cause brain circuitry problems, which in return affects the volume of the thalamus and the neuroimaging purpose of the frontal cortex. If the overlapping cases are reduced in an individual, T's occurrence cases are minimal as the neural network is not adversely affected in this case. Despite the effects of brain volume, the chances are not always associated with diseases in the victim’s body but are sometimes related to genetic issues.
The imbalance of hormones such as dopamine is one of the causes of tic development. It’s a primary transmitter in controlling motor reflexes and the thalamus to integrate and relay the sensory and motor functions. The effects and role of dopamine in TS development are demonstrated by the availability of dopaminergic agonists that causes an increase in the symptoms of TS (Godar, & Bortolato, 2017). Patients with TS and those without the condition are differentiated by the increased activation of the thalamus cortex due to the release of dopamine in their system. Dopamine receptor responsible for the therapeutic concerns to the patients with TS is through their ability to control the sensory cortex's repeated feedback responsible for detecting stimuli' availability. The overlap of the mechanisms in the release of dopamine and its effects on the sensory cortex makes the tool dependant on multiple entities, which overlap to bring the impact intended.
cultural and genetic issues
The TS aspects are affected by age, gender, and the tic disorder's demonstration are not dependent on culture but are rather neurobiological. The gender elements where males are more affected than females become familiar and the expression of TS in children and its disappearance as one gets into adolescence despite individual culture (Lee, et al. 2019). The cases are common to males but are more related to the brain system of the gender where aspects such as dopamine and aging are considered. The p[atient is the predisposing factor where the signs are demonstrated during childhood and appear to disappear during adolescence and adulthood. If the condition fails to disappear, it can be suppressed in adulthood or treated using therapy or medication on the patient. Despite the neurobiological nature of the condition, some cultural aspects are sensitive to the culture, such as depression, anxiety, and some external problems associated with an increased individual culture. The modification of the tic movement in the patients depends on how they are handled by society and how they handle themselves, thus making it a cultural factor. Ts can be considered a genetic cause, but sometimes it's associated with the development when the foetus is developing in the mother’s womb.
According to guidelines, in the treatment of tics, if the tics are not associated with pain, physical impairment, an embarrassment, the best treatment method for this case is to help the patient cope with the disorder through understanding the disease. The treatment cases should also involve both the caregiver and the child and the doctor in deciding the best means of treatment (Stafford, & Cavanna, 2020). The cases of increase the child's hope for future improvement of the condition are therapeutic measures to take. If the tics are affecting the patients' daily life activities, the doctor should first introduce the patient to the comp[rehesive behavioral intervention for tics. This involves the activities aimed at relaxation of the muscles through training on the reversal of the behavior.
Suppose the disorder has progressed in the individual to the patient having neurodevelopment and psychiatric conditions. The doctor involved should diagnose the patient to check on other disorders associated with TS, such as anxiety, mood, ADHD, an OBd disorder, where the administration and prescription of medicine for both cases apply (Cree, et al. 2018). In cases involving medication, injections of botulinum toxin apply for muscle relaxation on the tic-producing muscles. DBS's case can only be applied to the patient whose condition is resistant to both medication and behavioral therapy where brain stimulation is needed. If the cases persist to adulthood, the treatment can be done under the doctor's observation where cannabis Sativa is used.
Treatment of Tourette syndrome
The treatment of Tourette syndrome can be attained through medication or therapy to reduce the occurrence of the symptoms in the patient. Various medication types can be administered to control the expression of the tic’s movement on the patient. Still, most medicine has side effects, making them ineffective in treating the condition (Chadehumbe & Brown, 2019). The diagnosis of TS and ADHD is essential for estimating the therapy and medication administered to the children. The medicines on the disorder are dependent on whether the condition is moderate, severe, or mild. The treatment includes the medication that helps block the release of dopamine, thus reducing TS cases. Injection of botulinum into the muscle affected to relieve the tics, administering ADHD medication, and administering antidepressants to help control sadness and anxiety.
The patients' therapy is done through behavioral therapy, psychotherapy, and deep brain stimulation to reduce tic development cases. The behavioral therapy cases are done through reversal training to operate against the tic movements in an incompatible way with thetic. Psychotherapy helps the patients cope with Tourette syndrome and obsession, depression from social pressure or anxiety (Jankovic, 2020). The severe cases of tics call for special treatment where deep brain stimulation is used where it involves implanting developed battery-operated medical devices to stimulate the areas affected. The machine produces electrical stimulation and directs it to the target area where it has been affected, thus controlling the movement.
Recent research.
According to Marwitz, & Pringsheim, (2018). Clinical facilities of screening for anxiety and depression in children with an anxiety disorder in the children affected by TS were high; besides, the issues are also associated with mood disorders where these cases are familiar to them. The disorder diagnosis is made through screening of the patients for anxiety and depression, especially in children. The diagnosis requires that the children and adolescents be evaluated whether they meet the qualification on the diagnosis of both anxiety and depression while considering the symptom of the disorders in question. Diagnosis is where gender and age are considered during the diagnosis while assessing the relationship between tics and the anxiety and depressive symptoms. The children with high tic cases in extreme are reported to have increased chances of related disability had extreme cases of severe pressure and depressive symptoms.
According to Groth, et al. (2017). Tourette syndrome in childhood disorder is a neurodevelopment disorder associated with tics development; some comorbidities mostly arise. The issues of tics, both motor and vocal tics, usually reduce as one grows to adolescence. Still, comorbid obsessive-compulsive disorder (OCD) and attention deficit-hyperactivity disorder (ADHD) were to diagnose coexisting psychopathologies and appear to be retained even at becoming more dominant in the adolescent period. This disorder's expression was more changing, but changes are more common in patients who are not victims of comorbidity. TS expression is predicted by factors such as the individual's environment, the parent's genetic inheritance, inherited genes, and neurobiological factors caused by genetics, metabolic, and other biological factors.
According to Darrow, et al. (2017). Autism spectrum disorder is closely associated with tic disorder and comorbidity, where the genetic and neurobiological factor is in place at TS. Causes of autism were diagnosed where the characteristics of both cases were studied. The conclusion was found that tic disorder overlaps with autism disorder, where most patients with autism were found to have tic disorder cases. The repetitive behavior is almost the same in both cases of autism and tic disorder. It makes it even harder for the clinical officers to differentiate the two diseases when using (DSM-5) criteria used diagnosis of the two conditions. The cases reported a high case of anxiety and depression disease on the patients with autism and those with TS, indicating social impairment in both patients.
Different views on TS
The current knowledge on the general body health and the mortality rate for Tourette syndrome and extreme conditions of a tic disorder is limited compared to other chronic diseases. In these studies, the relationship of tic disorder with Tourette syndrome is identified while associating the condition with health conditions such as allergies respiratory diseases causing the tics (de la Cruz, & Mataix-Cols,2020). The mortality cases have associated the patients' risks of suicidal issues, mainly due to increased anxiety and depression cases. Cases of autoimmune diseases are linked to the genetic, where the parent's direct relatives with this condition have an increased autoimmune rate.
The sleeping disorder in children and adolescents with TS and chronic tic disorder is typical to these patients. The cause of this sleeping disorder is never determined and identified on its grounds as it is associated with factors such as patient characteristics and response to medication, the neurodevelopment disorder in the patient, or symptoms related to psychiatric disorders (Hibberd, et al.2020). Individual attributes in the patient also influence sleeping disorders associated with hormonal balance in the body or behavioural changes in the individual, such as hygiene. The sleeping disorder is more associated with the gender difference where the case is more common in females than in males. The most common cause of the sleeping disorder is medication, where some medicine causes loss of sleep to the victim.
Implication
APRN practices must administer the medication and prescription on the drugs to ensure that they have followed the right remedy. Treatment on the TS is determined through therapeutic means; thus, APRNs are required for the different therapy sessions (Efron, et al. 2020). These specialists are associated with specialists' activity by ensuring that the therapy is useful to the patient. The cases of diagnosis of the TS are done through observation for one year, thus requiring a specialist to ensure the consistent adherence of behavior in the patient. Most of this disorder causes depression and anxiety; therefore, it needs patient observation to reduce the causes of suicidal cases, thus reducing the causes of mortality.
Specialists such as nurses help the doctors observe the patient and administer them to the patient to develop and control the disorder. As most of the disorder can only be diagnosed through observation, the nurse's presence is essential to help identify the condition. The therapy treatment, especially treatment where the patient's behavior is modified by practicing the opposite of the tic, requires a physical therapist. This is to help the patient develop the skill necessary to help them tackle the tic through practice. The availability of this therapist is essential to the tics that can be controlled through therapy.
Areas where future development is needed
In the research on the cases of Tourette syndrome, the actual cause of the condition needs to be identified and studied to create clarity on the treatment by controlling the reason. They determine the therapy in terms of medication meant for treatment rather than preventing the symptom’s expression. The treatment measure should provide the patients with medication where the side effects are reduced to make them safe for the patient to mitigate other disorders' development. The tics effects in the brain thalamus need to be identified to remedy the movements due to failed response on the relay neurons in the patient’s brain.
In the treatment of the TS condition, additional research is needed to identify neuropathology cases where the disease models in animals can be done to help in the research. Neuroimaging will help understand the TS better concerning the diseases mental and neural networking associated with neural development. Genetic studies should help determine the genetic factors responsible for developing the condition as its genetically unknown. Understanding TS's genetic concept will help diagnose the disorder, its treatment, and identify the most effective therapy.
Conclusion
Tourette syndrome is a neurodevelopmental disorder associated with effects on the brain, especially the thalamus and the nervous system. The condition is related to sudden and repetitive movements and sounds labeled as a motor or vocal tic. The disorder is evident through the action and the symptoms of depression and anxiety, and sometimes moods swing in the victim. The causes of the TS are genetic, but others are developed from the foetus before the child's birth but the sometimes associated with cultural aspects. The social and cultural part is concerned with developing disorders such as mood, depression, or anxiety disorder. The treatment is through medication and therapy to suppress the occurrence of movement but not eradicate the condition. The disease's mortality rate is minimal, but the deaths are caused by cases of suicidal activities from disorders such as depression.
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