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Based on WANG Xugao's “thirty methods of treating the liver”， it is believed that the occurrence and development of childhood tic disorders follow the dynamic progression from liver qi disease to liver fire disease and then liver wind disease. The basic pathogenesis of three stages are characterized by binding constraint of liver qi， liver fire hyperactivity， and internal stirring of liver wind. Moreover， liver-blood deficiency and stagnation， and malnutrition of liver yin as the main point in terms of the imbalance of liver qi， blood， yin， and yang should be considered， as well as the imbalance relationship of the five zang organs such as the involvement of other organs and the gradually reach of the other organs. Guided by the principles of “thirty methods of treating the liver”， the treatment of tic disorders in liver qi stage should focus on soothing the liver and rectifying qi， soothing the liver and unblocking the collaterals， using Xiaochaihu Decoction （小柴胡汤） and Sini Powder （四逆散）. The treatment of tic disorders in liver fire stage involves clearing， draining and resolving liver heat， using Longdan Xiegan Decoction （龙胆泻肝汤）， Xieqing Pill （泻青丸）， Danggui Longhui Pill （当归龙荟丸）， and Huagan Decoction （化肝煎）. The treatment of tic disorders in liver wind stage involves extinguishing wind and subduing yang， using Lingjiao Gouteng Decoction （羚角钩藤汤） and Liuwei Dihuang Pill （六味地黄丸）. Throughout the treatment process， attention should be paid to harmonizing the liver's qi， blood， yin， and yang， as well as addressing the pathology of other organs.
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Tic disorders(TD)including Tourette syndrome are childhood-onset neurodevelopmental disorders characterized by motor and/or vocal tics that commonly affect children′s physical and mental health.More than half of TD patients also have attention deficit hyperactivity disorder(ADHD). The pathogenesis of TD is not clear, and it is believed to be related to the abnormal level of neurotransmitters caused by the dysfunction of the cortical-striatal-thalamic-cortical circuitry, and the disorder of neurotransmitters is also related to the pathogenesis of ADHD, but the current research results on the level of neurotransmitters in TD with comorbid ADHD are controversial, and even some neurotransmitters show completely opposite changes in the two diseases.This paper reviews the research progress of neurotransmitters in children with TD co-suffering from ADHD in recent years, in order to provide ideas for exploring its pathogenesis.
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OBJECTIVE@#To observe the effect of acupuncture combined with infantile tuina on intestinal flora and its efficacy in children with tic disorders (TD), and to explore its mechanism.@*METHODS@#A total of 15 children with TD were recruited as an observation group and 10 healthy children as a healthy control group. Regulating spleen and stomach acupuncture combined with infantile tuina were received in the observation group. First, acupuncture was applied to Zhongwan (CV 12), Tianshu (ST 25), Guanyuan (CV 4), Hegu (LI 4), Zusanli (ST 36), etc., and then abdominal massage and other tuina techniques were applied, once a day, 6 times a week, 2 weeks as a course of treatment, a total of 2 courses of treatment were required. No intervention was given in the healthy control group. In the observation group, Yale global tic severity scale (YGTSS) score and TCM syndrome score were compared before treatment and after 1 and 2 courses of treatment. 16S rRNA sequencing technology was used to detect the intestinal flora in the healthy control group and before and after treatment in the observation group.@*RESULTS@#After 1 and 2 courses of treatment, the scores of YGTSS and TCM syndrome in the observation group were lower than those before treatment (P<0.01, P<0.05). Compared with the healthy control group, the number of operational taxonomic units (OTU) and indexes of Chao1, Sobs, Ace and Shannon were decreased in the observation group before treatment (P<0.05, P<0.01). Compared with before treatment, the number of OTU and indexes of Chao1, Sobs, Ace and Shannon were increased in the observation group after treatment (P<0.01, P<0.05). Compared with the healthy control group, the relative abundance of Firmicutes in the observation group before treatment was decreased (P<0.001), while the relative abundance of Bacteroidetes, Bacteroides and Erysipelatoclostridium was increased (P<0.001, P<0.05). Compared with before treatment, the relative abundance of Bacteroidetes in the observation group was decreased (P<0.001) after treatment, while the relative abundance of Actinobacteria, Bifidobacterium and Atopobium was increased (P<0.05, P<0.01).@*CONCLUSION@#Acupuncture combined with infantile tuina based on the principle of regulating spleen and stomach could effectively improve TD symptoms in children, which may be related to regulating the diversity of intestinal flora, increasing beneficial bacteria, maintaining intestinal microecological balance, and playing a role in improving neurological disorders.
Subject(s)
Child , Humans , Gastrointestinal Microbiome , RNA, Ribosomal, 16S , Acupuncture Therapy , Spleen , Tic DisordersABSTRACT
Tic disorders are one of the common neurodevelopmental disorders in children, which are mainly managed by pharmacological and non-pharmacological treatment.Psychological interventions belong to the non-pharmacological treatment, which, however, have not yet been fully recognized and understood in China.The analyses on clinical effectiveness and availability to pediatric patients are limited.This study aims to interpret the clinical guidelines of psychological interventions for Tourette syndrome and other tic disorders by European Society for the Study of Tourette syndrome in the journal of European Child and Adolescent Psychiatry in 2021, aiming to provide reference for the psychological interventions of tic disorders in China.
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Tic disorders(TD)are a group of childhood-onset neuropsychiatric conditions.Due to sudden, aimless, rapid muscle contraction, patients with TD often have different forms of tic such as blinking, frown, shoulder shaking and voice clearing, which seriously affect their quality of life.However, the etiology of TD has not yet been clear, hence the aim of patients management is targeted to symptom relief until now.In fact, many studies have found that the pathogenesis of TD could be a combined effect of multiple factors, including genetic, immunological, psychological and environmental variables.Here, we reviews the results of recent studies on the etiology of TD, hoping to provide new ideas and directions for the etiological research on TD.
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Tic disorders(TD), a complex chronic neuropsychiatric disorder characterized by rapid, involuntary, non rhythmic, single or multiple muscle movements or vocal twitches, usually occurs in children aged from 2 to 15 years.TD has various clinical manifestations, which are usually related to various psychopathology or behavioral comorbidities, including attention deficit hyperactivity disorder, anxiety, depression and obsessive-compulsive disorder.The etiology and pathogenesis of TD are still not completely clear.Immune, genetic, neurobiochemical and environmental factors are generally recognized as factors related to the pathogenesis of TD.In recent years, the research on TD and genetic factors has gradually increased, but so far there is no clear conclusion on the pathogenic genes of TD.This paper only discusses the genes related to TD.
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Objective: Trichotillomania (TTM) is characterized by the pulling out of one's hair. TTM was classified as an impulse control disorder in DSM-IV, but is now classified in the obsessive-compulsive related disorders section of DSM-5. Classification for TTM remains an open question, especially considering its impact on treatment of the disorder. In this review, we questioned the relation of TTM to tic disorder and obsessive-compulsive disorder (OCD). Method: We reviewed relevant MEDLINE-indexed articles on clinical, neuropsychological, neurobiological, and therapeutic aspects of trichotillomania, OCD, and tic disorders. Results: Our review found a closer relationship between TTM and tic disorder from neurobiological (especially imaging) and therapeutic standpoints. Conclusion: We sought to challenge the DSM-5 classification of TTM and to compare TTM with both OCD and tic disorder. Some discrepancies between TTM and tic disorders notwithstanding, several arguments are in favor of a closer relationship between these two disorders than between TTM and OCD, especially when considering implications for therapy. This consideration is essential for patients.
Subject(s)
Humans , Male , Female , Trichotillomania/classification , Tourette Syndrome/classification , Obsessive-Compulsive Disorder/classification , Trichotillomania/etiology , Trichotillomania/therapy , Neurobiology , Comorbidity , Treatment Outcome , Diagnostic and Statistical Manual of Mental Disorders , NeuropsychologyABSTRACT
Objective: To observe the clinical efficacy of tuina manipulations in treating different types of tic disorders (TD). Methods: Eligible TD patients were classified into three types, transient tic disorders (TTD), chronic multiple tic disorders (CMTD) and Tourette syndrome (TS), according to their disease duration and severity. The three types of children were treated with the same tuina manipulations. Changes in the Yale global tic severity scale (YGTSS) score, effective rate for tic, and cervical spine imaging examination results (including asymmetry of the lateral atlanto-dental interval, broadened anterior atlanto-dental interval, C2 spinous process deviation, occipito-atlanto-axial flexion/ extension instability) were observed after 1-month and 3-month treatments respectively. Results: The YGTSS score changed significantly after 1-month and 3-month treatments compared with that before treatment (both P<0.01); the effective rate for TD was 46.6％ and 86.7％ respectively after 1-month and 3-month treatments; there were significant differences comparing the effective rate for tic between different types of TD after 1-month and 3-month treatments (all P<0.05); comparing the effective rate for tic after 1-month treatment with that after 3-month treatment for the same type, the intra-group differences were statistically significant [TTD group (P<0.01), CMTD group (P<0.01), TS group (P<0.05)]; the abnormal parameter rates in neck imaging examination after 3-month treatment were significantly different from those before treatment (all P<0.01). Conclusion: Tuina manipulation is effective for TTD, CMTD and TS. It can correct the abnormal alterations of patients' cervical vertebrae, and its efficacy for TTD is most significant.
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OBJECTIVES: This study investigates lay beliefs about the etiology and treatments of tic disorder and Tourette's syndrome, as well as identifying sociodemographic and personality variables affecting these beliefs among South Koreans. METHODS: In total, 673 participants (mean age 41.77±12.03 years) completed an online survey regarding their beliefs about tic disorder and Tourette's syndrome. The factors related to their lay beliefs about the disorders were analyzed, and the correlates were investigated. RESULTS: Results indicated that lay people in South Korea held strong beliefs that the causes of tic disorder and Tourette's syndrome lie within the parenting/psychological and neurological/biological categories, compared to the dietary/environmental one. Among the sociodemographic variables, sex, age, and levels of subjective mental health knowledge were primarily associated with the aforementioned beliefs. Familiarity with tic disorder and Tourette's syndrome was also associated with these beliefs. Among the personality traits investigated, extraversion and conscientiousness had significant influences on the beliefs people had about tic disorder and Tourette's syndrome. CONCLUSION: The results suggest that both policy makers and mental health service providers should adopt a strategic approach for developing and implementing health education interventions about tic disorder and Tourette's syndrome because individual sociodemographic variables, familiarity with the disorders, and personality traits are all associated with the beliefs about these disorders.
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Humans , Administrative Personnel , Extraversion, Psychological , Health Education , Korea , Mental Health , Mental Health Services , Recognition, Psychology , Tic Disorders , Tics , Tourette SyndromeABSTRACT
Involuntary movement of the cervical spine can cause damage to the cervical spinal cord. Cervical myelopathy may occur at an early age in involuntary movement disorders, such as tics. We report the case of a 21-year-old man with Tourette syndrome, who developed progressive quadriparesis, which was more severe in the upper extremities. The patient had abnormal motor tics with hyperflexion and hyperextension of the cervical spine for more than 10 years. High-signal intensity intramedullary lesions were observed at C3-4-5-6 level on T2 weighted magnetic resonance imaging. Examinations were performed for high-signal intensity intramedullary lesions that may occur at a young age, but no other diseases were detected. Botulinum toxin injection to the neck musculature and medication for tic disorders were administered. However, the myelopathy was further aggravated, as the involuntary cervical movement still remained. Therefore, laminoplasty was performed at C3-4-5-6, with posterior fixation at C2-3-4-5-6-7 to alleviate the symptoms. The neurological signs and symptoms improved dramatically. The management of tic disorders should be the first priority during treatment. However, surgical treatment may be necessary, if symptoms worsen after appropriate treatment.
Subject(s)
Humans , Young Adult , Botulinum Toxins , Cervical Cord , Dyskinesias , Laminoplasty , Magnetic Resonance Imaging , Neck , Quadriplegia , Spinal Cord Diseases , Spine , Spondylosis , Tic Disorders , Tics , Tourette Syndrome , Upper ExtremityABSTRACT
Objective To explore the effects of first-degree relatives' anxious traits on the anxious emotion in children with Tic disorders ( TD) . Methods A total of 31 children with TD and 32 normal chil-dren were assessed by The Screen for Child Anxiety Related Emotional Disorders ( SCARED) ,and their first-degree relatives were assessed by State-Trait Anxiety Inventory ( STAI) . The differences of first-degree rela-tives' personality traits between two groups were compared,and the effects of these personality traits on chil-dren's anxious emotion were further analyzed. Results Compared with the control group(36. 66±8. 24),the first-degree relatives of children with TD had higher scores in trait anxiety (40. 10±8. 24,P<0. 05),but there was no significant difference in state anxiety between TD group and control group((35. 00±9. 09) vs (40. 90 ±10. 21),P>0. 05). The school phobia in children with TD was positively correlated with the education lev-els of their mothers(r=0. 407,P<0. 05). Conclusion The first-degree relatives of children with TD are more anxious emotion than normal children. Children with TD are more likely to have school phobia if their mothers have better education.
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Objective To investigate the traits of anxiety characteristics and its influencing factors in children with tic disorders ( TD) . Methods 31 children with tic disorders and 32 normal children were assessed by the screen for child anxiety related emotional disorders(SCARED), eysenck personality ques-tionnaire(EPQ) for child,attachment security scale and egma minnen av bardndosnauppforstran(EMBU).In-dependent sample t-test was used to compare the differences in anxiety disorders between the children of the two groups,and Pearson correlation and multivariate linear step-by-step regression analysis were used to ana-lyze the effects of personality traits,parent-child attachment and parental education on anxiety. Results So-matization/panic and separation anxiety in TD((6.20±5.33),(4.87±3.18)) were higher than those in con-trol group((3.75±3.34),(3.06±2.61);both P<0.05).There was positive correlation between somatization/panic and children's personality of introversion-extroversion(E),psychoticism(P),excessive interference mother,the mother refusal and denial,mother severely punishment(r=0.580,0.427,0.399,0.674,0.575,P<0.05 or P<0.01),and negative correlation between somatization/panic and mother closeness(r=-0.365,P<0.05).Generalized anxiety was positively correlated with E,P,lie,excessive interference mother,the mother refusal and denial,mother severely punishment(r=0.604,0.543,0.526,0.365,0.613,0.395,P<0.05 or P<0.01) . Separation anxiety was positively correlated with E, lie, the mother refusal and denial ( r=0. 440, 0.401,0.365,P<0.05).Social phobia was positively correlated with excessive interference mother,the mother refusal and denial (r=0.367,0.482,P<0.05 or P<0.01).School phobia was not only positively associated with E, N, P, excessive interference mother, the mother refusal and denial, mother severely punished ( r=0.635,0.449,0.526,0.463,0.541,0.589,P<0.05 or P<0.01),but also negatively correlated with mother closeness(r=-0.394,P<0.05).The mother refusal and denial affected on somatization/panic and social pho-bia(accounted for 45.4％,23.2％) ,the mother refusal and denial and lie affected on generalized anxiety( ac-counted for 51.0％) ,E affected on separation anxiety( accounted for 19.3％) ,E and mother severely punish-ment affected on school phobia( accounted for 50.0％) ,the mother refusal and denial and E affected on total anxiety( accounted for 49.4％) . Conclusions Somatization/panic and separation anxiety in children with tic disorder is higher than that in normal children.Anxiety disorder is mainly affected by fewer mother's encour-agement and tolerance,and children's extroversion.
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Objective To analyze the correlation between blood lead,zinc levels and tic disorders(TD) in children.Methods One hundred and fourteen children with TD were chosen as observation group,and 100 healthy children were chosen as control group.The serum levels of lead and zinc were compared between the two groups,and the correlation between blood lead,zinc levels and TD was analyzed.Results The serum level of blood lead in the observation group was (70.8 ± 14.9) μg/L,which was higher than (50.9 ± 13.8),μg/L in the control group,the difference was statistically significant(t =4.932,P ＜ 0.05).The serum level of blood zinc in the observation group was (461.4 ±33.2)μg/L,which was lower than (501.5 ± 34.1)μg/L in the control group,the difference was statistically significant(t =5.217,P ＜ 0.05).The serum level of blood lead ≥60μg/L and the serum level of blood zinc ＜470μ g/L were significantly related with TD(OR =2.192,2.012,all P ＜ 0.05).Conclusion The blood lead and zinc levels are significantly correlated with TD in children.
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Objective To develop a sandplay analysis evaluation matrix for children with tic disor?ders. Methods 113 children were chosen as the study subjects . Based on the grounded theory,the open coding,correlated coding and core coding were carried out on coding elements for sandplay process to gain the third?level,second?level and first?level evaluation codes. The reliability and validity of the codes were tested.Results The sandplay analysis evaluation matrix for children with tic disorders was established inclu?ding 48 third?level,17 second?level and 3 first?level evaluation codes. The codes were proved to be reliable and valid through the comparison and conditional coding with query. Conclusion The sandplay analysis e?valuation matrix for children with tic disorders,which is established based on the grounded theory,is reliable and operable. It can be used as a tool to assess the psychological or behavioral problems of children with tic disorders dynamically.
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Objective]The paper summarizes the academic thoughts and clinical experience of Professor HAN Xinmin for treating Tic Disorders from view of wind-phlegm. [Methods] By learning from Professor HAN Xinmin, recording the relevant cases and analyzing typical cases, to sum up the knowledge of etiology and pathogenesis, treatment characteristics, as well as list one proved case. [Results]Professor HAN Xinmin holds that this disease origins from liver, involving lung, spleen and kidney. The key pathogenesis is the internal stir of wind and phlegm. Treatment follows the principles of dispelling pathogenic wind and eliminating phlegm, along with suppressing hyperactivity liver qi, dispersing lung qi, regulating spleen and tonifying kidney. The self-ordained Chinese herbal medicine prescription has achieved a satisfactory clinical curative effect. [Conclusion]Therapies of Professor HAN Xinmin on treating Tic Disorders have significant effect, which have the value of popularization and application.
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For tic disorders(TD),non -drug therapy including psychotherapy,behavioral intervention,neural regulation have demonstrated efficacy in reducing tic severity,managing co -occurring psychiatric symptoms and impro-ving life quality in addition to pharmacotherapy.Psychotherapy such as supportive psychotherapy,family intervention, school intervention can be major contributors to the development of evidence -based non -drug treatments.Different behavioural therapies that were used included positive reinforcement,extinction,massed negative practice,relaxation therapy,habit reversal training(HRT),exposure with response prevention,self -monitoring,contingency management, cognitive -behavioural therapy,assertiveness training,tension -reduction technique.Overall,HRT is the best -studied and most widely -used technique and there is sufficient experimental evidence to suggest that it is an effective treat-ment.Evidence suggests that exposure with response prevention and self -monitoring are effective,but comprehensive behavioral intervention for tics (CBIT)show more effective and durability of benefit over time.CBIT may promote nor-malization of aberrant cortico -striato -thalamo -cortical associative and motor pathways in individuals with tourette′s syndrome.Based on available evidence,recent published guidelines suggest that CBIT can be considered a first -line treatment for persons with TD.Neural regulation included electroencephalogram biofeedback,deep brain stimulation, transcranial magnetic stimulation are increasingly considered when tics become troublesome or even disabling or self -injurious despite optimal medical therapy.
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Objective To explore the correlation between self-concept and subjective quality of life among children with tic disorders (TD). Methods The Piers-Harris Children's Self-concept Scale (PHCSS) and the Inventory of Subjective Life Quality (ISLQ) were complet-ed by 65 children with TD and 71 normal children from March to September, 2015; and analyzed with single factor analysis, correlation analysis and multi factors regression analysis. Results There was no significant difference in PHCSS scores between the TD children with and normal ones (t0.05). The ISLQ scores of school life, self-awareness and cognitive component were less in the TD children than in the normal ones (t>2.051, P<0.05). The PHCSS subscores correlated with ISLQ subscores (P<0.05), except the following:PHCSS scores of behavior did not correlate with ISLQ scores of peer relationship, school life, living environment, self-awareness and cognitive com-ponent;PHCSS scores of intelligence and school environment did not correlate with ISLQ scores of family life, peer interaction and the liv-ing environment;PHCSS scores of physical appearance and properties did not correlate with ISLQ scores of family life and living environ-ment;PHCSS scores of anxiety did not correlate with ISLQ scores of family life, peer interaction and cognitive component;PHCSS scores of affiliation did not correlate with ISLQ scores of peer interaction;and PHCSS total score did not correlate with ISLQ scores of family life and living environment. PHCSS scores of affiliation were the factor related with the quality of life (β=0.301, P<0.05). Conclusion The quali-ty of life may be impaired in the children with TD, which may associate with the self-concept and need further intervention.
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Motor disorders in childhood include tic disorder, developmental coordination disorder, and stereotypic movement disorder. A tic is a sudden, rapid, repetitive and nonrhythmic movement (motor tics) or phonic production (phonic or vocal tics) that can occur at any part of the body. Developmental coordination disorder (DCD) is characterized by marked impairment in the acquisition and performance of motor skills. Stereotypic movement disorder is a common childhood disorder which repetitive, hard to control, aimless motor activity interrupts everyday life or causes self-infliction of a child. Despite increased attention and the growing scientific knowledge about motor disorders, there are limitations in our understanding and knowledge about the pathogenesis and the management of the disorders. Motor disorders can itself be the primary diagnosis, or can be secondarily diagnosed caused by other disorders, and accompany many neuropsychiatric disorders such as autism and attention deficit hyperactivity disorder (ADHD), which in turn impairs proper learning and socializing of the children with motor disorders. Therefore comprehensive medical history taking, continuous observation of the changes in symptoms, and systematic assessment considering the child's developmental stage and current adaptive capacity are needed. Behavioral therapy and pharmacological therapy are the two most often mentioned treatments of motor disorders.
Subject(s)
Adolescent , Child , Humans , Attention Deficit Disorder with Hyperactivity , Autistic Disorder , Diagnosis , Learning , Medical History Taking , Motor Activity , Motor Skills , Motor Skills Disorders , Stereotypic Movement Disorder , Tic Disorders , Tics , Tourette SyndromeABSTRACT
Tic disorders are common diseases in children,and may negatively impact the quality of life of those ones affected.There is no cure therapy for tics;treatment aims to diminish tic severity and frequency.Behavioral treatment is recommended as first line offer to patients in most cases.It is recognized that behavioral techniques,especially habit reversal training(HRT),can offer an effective alternative or complement to pharmacotherapy in this setting.HRT is the best-studied and most widely-used technique and there is sufficient experimental evidence to suggest that it can significantly reduce tic severity in both adults and children with Tourette syndrome and other tics.It consists of three primary components:awareness training,competing response training and social support.
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Tourette syndrome (TS) and tic disorders represent events of familiar magnitude characterized by involuntary movements and/or vocalization. To determine the prevalence of TS/tic disorders we studied a sample of 762 subjects (388 M, 374 F), between 1992 and 1997, age 6 to 43 years old, taken out of a population of 10,155 subjects (4,918 M, 5,237 F; age: 3-56 years old). A structured 4-item questionnaire, direct interview (multistaged), >1 yr follow-up, were used. 9,565 subjects (4,614 M, 4,951 F) sent back the questionnaires, 3,354 of these (1,671 M, 1,683 F) with positive answers to tics. 42 subjects (31 M, 11 F, age: 7-21 years old, mean: 11 years old) met the DSM-III-R criteria. The total minimal prevalence of TS is 0.43%, with a 3:1 ratio male/female. The minimal prevalence of chronic tic disorder is 2.27%. The total minimal prevalence for tic disorders at all is 2.91%. No special education students participation.
Síndrome de Tourette e transtornos de tiques representam eventos de magnitude familiar caracterizados por movimentos involuntários e/ou vocalização. Para determinar a prevalência de TS/transtornos de tiques, estudamos uma amostra de 762 indivíduos (286 M, 376 F), entre 1992 e 1997, de 6 a 43 anos de idade, retirados de uma população de 10.155 indivíduos (4.918 M, 5.237 F, idade: 3-56 anos). Questionário de avaliação inicial (4 itens), entrevista direta, follow-up >1 ano, foram utilizados. 9.565 indivíduos (4.614 M, 4.951 F) retornaram seus questionários, 3.354 (1.671 M, 1.683 F), com respostas positivas para tiques. 42 sujeitos (idade 31 M, 11 F, 7-21 anos, média: 11 anos) preencheram os critérios diagnósticos do DSM-III-R. A prevalência total mínima para TS é de 0,43% (3 M:1 F), e para transtornos de tiques crônicos é de 2,27%. A prevalência total mínima para transtornos dos tiques é 2,91%. Nenhuma participação de estudantes de classe especial.