Patient Centricity: Design and Conduct of Clinical Trials in Orphan Diseases: Third of Three Sets of Expanded Proceedings from the 2020 ISCTM Autumn Conference on Pediatric Drug Development

This article expands on a session, titled "Patient Centricity: Design and Conduct of Clinical Trials in Orphan Diseases," that was presented as part of a two-day meeting on Pediatric Drug Development at the International Society for Central Nervous System (CNS) Clinical Trials and Methodology (ISCTM) Autumn Conference in Boston, Massachusetts, in October 2020. Speakers from various areas of pediatric drug development addressed a variety of implications of including children in drug development programs, including implications for rare/orphan diseases. The speakers have written summaries of their talks. The session's lead Chair was Dr. Joan Busner, who wrote introductory and closing comments. Dr. Simon Day, regulatory consultant, outlined some of the past mistakes that have plagued trials that did not consult with patient groups in the early design phase. Dr. Atul Mahableshwarkar provided an industry perspective of a recent trial that benefited from the inclusion of patient input. Drs. Lucas Kempf and Maria Sheean provided regulatory input from the perspectives of the United States (US) Food and Drug Administration (FDA) and European Medicines Agency (EMA), respectively. Dr. Judith Dunn outlined a novel approach for assessing and rank ordering patient and clinician clinical meaningfulness and the disconnect that may occur. Dr. Busner provided closing comments, tied together the presented issues, and provided a synopsis of the lively discussion that followed the session. In addition to the speakers above, the discussion included two representatives from patient advocacy groups, as well as an additional speaker who described the challenges of conducting a pediatric trial in the US and European Union (EU), given the often competing regulatory requirements. This article should serve as an expert-informed reference to those interested and involved in CNS drug development programs that are aimed at children and rare diseases and seek to ensure a patient-centric approach.Copyright © 2023, Matrix Medical Communications. All rights reserved.

The impact of the COVID-19 pandemic on sleep in children with Tourette syndrome in Ireland and the United Kingdom.

STUDY OBJECTIVES: The aim of this mixed methods study was to gain an insight through qualitative and quantitative means into the impact of the COVID-19 pandemic on children with and without Tourette syndrome (TS). METHODS: Parents/guardians of children and adolescents with TS (n = 95; Mage = 11.2, SD = 2.68) and typically developing (TD) controls (n = 86; Mage = 10.7, SD = 2.8) in the UK and Ireland completed an online questionnaire examining sleep, with open-ended questions pertaining to their perceived impact of COVID-19 on the sleep of their children. Nine items from the SDSC were used to supplement qualitative data. RESULTS: A negative impact of the pandemic on the sleep of both groups was observed, including exacerbated tics, sleep deprivation, and anxiety, with particular disruption for children with TS. Parents of children with TS reported poorer sleep patterns than parents of TD children on the SDSC. Analyses showed that group and age predicted 43.8% of variance in sleep duration, F (4, 176) = 34.2, p < .001. CONCLUSIONS: Findings suggest that sleep patterns of children with TS may be more impacted by the pandemic than the average child. Given that there are generally more sleep issues reported in children with TS, further research is warranted in relation to the sleep health of children with TS in a post-pandemic era. By identifying sleep issues potentially persisting after COVID-19, the true impact of the pandemic on the sleep of children and adolescents with Tourette syndrome may be ascertained.

New-onset functional tics during the COVID-19 pandemic: Clinical characteristics of 105 cases from a single centre.

BACKGROUND AND PURPOSE: The COVID-19 pandemic has been associated amongst other things with a sharp increase in adolescents and young adults presenting acutely with functional tics. Initial reports have suggested clinically relevant differences between functional tics and neurodevelopmental tics seen in primary tic disorders such as Tourette syndrome. We aimed to provide confirmatory findings from the largest single-centre cohort to date. METHODS: In the present study we present data from 105 consecutive patients who developed functional tics during a 3-year period overlapping with the COVID-19 pandemic (April 2020-March 2023). All patients underwent a comprehensive neuropsychiatric assessment at a single specialist centre for tic disorders. RESULTS: Female adolescents and young adults accounted for 69% of our sample. Functional tics had an acute/subacute onset in most cases (75% with a peak of severity within 1 month). We found a disproportionately high frequency of complex movements (81%) and vocalizations (75%). A subset of patients (23%) had a pre-existing primary tic disorder (Tourette syndrome with functional overlay). The most common psychiatric co-morbidities were anxiety (70%) and affective disorders (40%). Moreover, 41% of patients had at least one functional neurological disorder in addition to functional tics. Exposure to tic-related social media content was reported by half of the patients. CONCLUSIONS: Our findings confirm substantial clinical differences between functional tics developed during the pandemic and neurodevelopmental tics. Both patient- and tic-related red flags support the differential diagnostic process and inform ongoing monitoring in the post-pandemic era.

Symptoms compatible with long COVID in an Italian pediatric cohort of Tourette patients with and without SARS­CoV­2 infection: a short-term follow-up assessment.

BACKGROUND: Tourette Syndrome (TS) is a childhood-onset neurodevelopmental disorder with a worldwide prevalence of about 0.3-1% of the population. During the pandemic caused by SARS-CoV-2 infection, the impact on the mental health of children and adolescents was very important. The persistence of symptoms in the post-acute phase of the disease has been termed Long COVID. The neuropsychiatric symptoms seem to be the most common impairment in children and adolescents with long COVID. OBJECTIVES: Considering the impact of pandemic on mental health, in this study we analyzed the long-term effects of SARS-CoV-2 infection in children and adolescents affected by TS. METHODS: We conducted an online questionnaire covering socio-demographic and clinical data among 158 patients affected by TS or chronic tic disorders (CTD), of which 78 participants reported a positive SARS-CoV-2 infection. Data were collected to investigate tic severity and both the comorbidities, as well as lockdown-related changes to daily life activities and, in case of infection of SARS-CoV-2, possible symptoms of acute infection and long COVID. Markers of systemic inflammation including C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), ferritin, iron, electrolytes, white blood cell counts, platelet cell counts levels, markers of liver, kidney and thyroid function were analyzed. First, all patients were screened with the Schedule for affective disorders and Schizophrenia for School age children-present and lifetime (Kiddie-SADS-PL) to rule out primary psychiatric disorders considered as criteria of exclusion. Then, all patients were clinically assessed at baseline (T0), and after three months (T1) through the administration of Yale Global Tic Severity Rating Scale (YGTSS), Multidimensional Anxiety Scale for Children (MASC), Child Depression Inventory (CDI) and Child Behavior Checklist (CBCL). RESULTS: Among the cohort of TS patients that contracted SARS-CoV-2 infection, 84.6% (n = 66) experienced any acute symptoms, and long COVID symptoms occurred in 38.5% (n = 30). A worsening of clinical symptoms of tics and eventually associated comorbidities occurred in 34.6% (n = 27) of TS patients that contracted SARS-CoV-2 infection. TS patients with or without SARS-CoV-2 infection showed an increase in the severity of tics and also behavioral, depressive and anxious symptoms. Instead, this increase was more evident in patients who contracted the infection than in patients who did not contract it. CONCLUSIONS: SARS-CoV-2 infection may have a role in the increase of tics and associated comorbidities in TS patients. Despite of these preliminary results, further investigations are necessary to improve knowledge about the acute and long-term impact of SARS-CoV-2 in TS patients.

Subjective impact of COVID-19 pandemic on youth with tic and OCD spectrum disorders

Objectives: This study investigated the perceived impact of the COVID-19 pandemic on youth with chronic tic disorders (CTD) and/or obsessive-compulsive disorder (OCD) based on subjective reports, objective measures, and parental feedback. This study also sought to investigate whether and how these reported experiences differed based on the presence of underlying tic and/or OCD spectrum diagnoses. Method(s): Children with CTD, OCD, and Tics + OCD and their parents were recruited to complete an online survey from July 2020 through April 2021. Forty-eight responses were received;child respondents had a median age of 12 years. Result(s): On average, youth reported that the pandemic negatively impacted them in several domains, particularly after-school activities, relationships with friends, and social/community gatherings. Despite the small sample size, youth with OCD appeared to experience a greater negative impact compared to other subgroups. Median screen use in this sample was 3-8 hours a day, and youth who reported > 8 hours on weekends trended towards increased depressive symptoms. Conclusion(s): Consistent with the physician-authors' clinical experiences, youth with CTD, OCD, and Tics + OCD and their parents reported a subjective negative impact of the pandemic on various symptoms and psychosocial domains. Going forward, if another lockdown loomed, it would be valuable to stay attuned to these vulnerable youth, particularly those with OCD symptoms, and consider providing support in specific psychosocial domains, such as relationship with peers and home life.Copyright © 2023 Elsevier Inc.

If you build it, will they come? Acceptability, feasibility, and uptake of TMS-based treatment for pediatric Tourette Syndrome

Background: Transcranial magnetic stimulation (TMS) treatment holds promise for pediatric neurological and psychiatric illnesses, but little is known about the acceptability, feasibility, and uptake of experimental TMS intervention in pediatric populations. The current study aimed to identify successful recruitment strategies and participation barriers in the CBIT+TMS Trial, an ongoing clinical trial testing TMS augmentation of behavior therapy for Tourette Syndrome in 12-21 year olds. Method(s): Participation involves 10 daily treatment sessions over two weeks plus pre/post neuroimaging and clinical assessments through 3-month follow-up. Recruitment data from November 2020 - August 2022 were examined for recruitment status, recruitment source, and reason for ineligibility or non-participation. Result(s): N = 171 individuals expressed interest in participation. Of these, 53% declined or passively declined participation, 45% completed phone screening, 19% were deemed ineligible, and 18% enrolled. The most successful recruitment strategies were community flyering, sharing information through a patient support organization, and provider referrals. The most commonly stated reasons for declining participation were related to time commitment and the need to travel to in-person appointments. Notably, participation was greatest during summer months. All enrolled participants have been retained through follow-up visits. Conclusion(s): TMS treatment is of interest to youth and parents in the TS community. As a comparison, a prior TS therapy trial screened =6 youth/month across three sites (Piacentini et al., 2010), whereas our single site is screening =4 youth/month. Stated reasons for declining participation related to schedule and travel feasibility rather than concerns about TMS. This recruitment period overlapped with the COVID-19 pandemic, which likely heightened these particular barriers. Future pediatric TMS research should include efforts to maximize efficacy within protocol schedules that are feasible for youth. Continued examination of factors contributing to pediatric TMS interest and uptake can help inform developmentally sensitive intervention and clinical trial protocols. Research Category and Technology and Methods Clinical Research: 10. Transcranial Magnetic Stimulation (TMS) Keywords: Tourette, Clinical Trial, Pediatric, FeasibilityCopyright © 2023

Rapid onset functional tic-like disorder outbreak: A challenging differential diagnosis in the COVID-19 pandemic

During the COVID-19 pandemic, several countries have observed an unexpected increase in the number of adolescents and young adults presenting with rapid onset functional tic-like behaviours after being exposed to social media content of others displaying a similar pattern of functional tics. Many of these patients have been referred to Movement Disorders Clinics with misdiagnoses of late-onset refractory Tourette Syndrome after failing different pharmacological treatments for tics. Tourette Syndrome is a well-known condition with clear clinical diagnostic criteria and which presents with the insidious onset of simple motor and phonic tics in a rostro-caudal evolution starting in early childhood. Clinical and demographic aspects can differentiate rapid onset functional tic-like behaviours from Tourette Syndrome, including the former having abrupt and explosive presentation of severe symptoms, later age of onset, female gender predominance, lack of suppressibility, comorbid anxiety and depression, atypical premonitory urge and history of exposure to social media content displaying tic-like behaviours. This new presentation of a functional neurological disorder may be explained in part by the relationship between social media exposure to tic-like behaviours, and maladaptive response to anxiety caused by life stressors (e.g. COVID-19 pandemic), especially in young individuals. Rapid onset functional tic-like behaviours may be considered a spreading neuropsychiatric disorder that is potentially fostered by the psychosocial impact caused by the COVID-19 pandemic. (PsycInfo Database Record (c) 2023 APA, all rights reserved) (French) Durant la pandemie de la COVID-19, plusieurs pays ont observe une hausse inattendue du nombre d'adolescents et de jeunes adultes presentant des comportements fonctionnels de type tic a apparition rapide apres avoir ete exposes au contenu des medias sociaux d'autres personnes affichant un modele semblable de tics fonctionnels. Nombre de ces patients ont ete adresses a des cliniques de trouble du mouvement avec des diagnostics fautifs de syndrome de Tourette refractaire d'apparition tardive apres avoir echoue a differents traitements pharmacologiques pour les tics. Le syndrome de Tourette est un trouble bin connu dont les criteres diagnostiques cliniques sont clairs et qui presente le debut insidieux de simples tics moteurs et phoniques dans une evolution rostro-caudale au debut de l'enfance. Les aspects cliniques et demographiques peuvent differencier l'apparition rapide de comportements fonctionnels de type tic du syndrome de Tourette, notamment parce que les premiers ont une presentation abrupte et explosive de symptomes graves, apparaissent a un age plus avance, ont une predominance chez le sexe feminin, manquent de suppressibilite, anxiete et depression comorbides, envie premonitoire atypique et antecedents d'exposition au contenu des medias sociaux affichant des comportements de type tic. Cette nouvelle presentation d'un trouble neurologique fonctionnel peut s'expliquer en partie par la relation entre l'exposition aux comportements de type tic dans les medias sociaux et la reponse inadaptee a l'anxiete causee par les stresseurs de la vie (p. ex., pandemie de la COVID-19), surtout chez les jeunes personnes. Les comportements fonctionnels de type tic a apparition rapide peuvent etre consideres comme un trouble neuropsychiatrique qui se propage et qui est potentiellement favorise par l'effet psychosocial cause par la pandemie de la COVID-19. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Rapid onset of functional tic-like behaviors among adolescent girls-Minnesota, September-November 2021.

Background: On October 15, 2021, the Minnesota Department of Health began investigating a school cluster of students experiencing tic-like behaviors thought to be related to recent COVID-19. The objective of this report is to describe the investigation, key findings, and public health recommendations. Methods: Affected students and proxies were interviewed with a standardized questionnaire including validated depression and anxiety screens. Results: Eight students had tic-like behaviors lasting >24 h after initial report with onset during September 26-October 30, 2021. All eight students were females aged 15-17 years. All students either had a history of depression or anxiety or scored as having more than minimal anxiety or depression on validated screens. Four students previously had confirmed COVID-19: the interval between prior COVID-19 and tic symptom onset varied from more than a year prior to tic symptom onset to at the time of tic symptom onset. Conclusion: The onset of tic-like behaviors at one school in Minnesota appeared to be related more to underlying mental health conditions than recent COVID-19. These findings highlight the need to better understand functional tic-like behaviors and adolescent mental health.

Impact of the COVID-19 pandemic on incidence of tics in children and young people: a population-based cohort study.

Background: Since the onset of the coronavirus (COVID-19) pandemic, clinicians have reported an increase in presentations of sudden and new onset tics particularly affecting teenage girls. This population-based study aimed to describe and compare the incidence of tics in children and young people in primary care before and during the COVID-19 pandemic in England. Methods: We used information from the UK Clinical Practice Research Datalink (CPRD) Aurum dataset and included males and females aged 4-11 years and 12-18 years between Jan 1, 2015, and Dec 31, 2021. We grouped the pre-pandemic period (2015-2019) and presented the pandemic years (2020, 2021) separately. We described the characteristics of children and young people with a first record of a motor or vocal tic in each time period. Incidence rates of tics by age-sex groups in 2015-2019, 2020, and 2021 were calculated. Negative binomial regression models were used to calculate incidence rate ratios. Findings: We included 3,867,709 males and females aged 4-18 years. Over 14,734,062 person-years of follow-up, 11,245 people had a first tic record during the whole study period. The characteristics of people with tics differed over time, with the proportion of females aged 12-18 years and the proportion with mental health conditions including anxiety increasing during the pandemic. Tic incidence rates per 10,000 person-years were highest for 4-11-year-old males in all three time periods (13.4 [95% confidence interval 13.0-13.8] in 2015-2019; 13.2 [12.3-14.1] in 2020; 15.1 [14.1-16.1] in 2021) but increased markedly during the pandemic in 12-18-year-old females, from 2.5 (2.3-2.7) in 2015-2019, to 10.3 (9.5-11.3) in 2020 and 13.1 (12.1-14.1) in 2021. There were smaller increases in incidence rates in 12-18-year-old males (4.6 [4.4-4.9] in 2015-2019; 4.7 [4.1-5.3] in 2020; 6.2 [5.5-6.9] in 2021) and 4-11-year-old females (4.9 [4.7-5.2] in 2015-2019; 5.7 [5.1-6.4] in 2020; 7.6 [6.9-8.3] in 2021). Incidence rate ratios comparing 2020 and 2021 with 2015-2019 were highest in the 12-18-year-old female subgroup (4.2 [3.6-4.8] in 2020; 5.3 [4.7-6.0] in 2021). Interpretation: The incidence of tics in children and young people increased across all age and sex groups during the COVID-19 pandemic, with a differentially large effect in teenage girls (a greater than four-fold increase). Furthermore, in those with tic symptoms, proportions with mental health disorders including anxiety increased during the pandemic. Further research is required on the social and contextual factors underpinning this rise in onset of tics in teenage girls. Funding: National Institute for Health Research Nottingham Biomedical Research Centre.

Experiences of Children and Young People Respondents to My Neuro Survey

My Neuro Survey represents the fourth iteration of our biennial national neurological patient experience survey. For the first time, the 2021/22 survey included a version specifically for children and young people affected by neurological conditions and those who support them. The survey ran online and in select clinics between October 2021 and February 2022. Questions covered key topics including the impact of Covid-19, diagnosis, access to treatment and care, mental health and wellbeing, transition and education. Six hundred and twenty-nine people shared their experiences through the children and young people's survey. Eighty-seven percent of respondents were parents, 11% were children and young people themselves while 2% reported as other. The most reported neurological conditions were epilepsy, Tourette Syndrome, hydrocephalus and autism. Key topics and findings from the experiences of children and young people and those who support them are touched on below. 56% (n = 317) of respondents said their condition made their mental wellbeing much worse. 63% (n = 349) of respondents reported that their mental health has worsened during the pandemic. Sixty-six percent of respondents reported their mental wellbeing needs were being met to a small extent (31%, n = 159) or most often, not at all (35%, n = 179). 85% (n = 250) applicable respondents reported that they had not been offered a named worker to support the transition process between pediatric and adult services but would find this helpful. Twenty-percent (n = 89) of applicable respondents reported not being given an explanation at diagnosis or when they were first told about their condition. The experiences of children and young peoples survey respondents helped to inform a series of national policy reports with targeted recommendations, 'Together for the 1 in 6', and a campaign calling on Governments across the UK to '#BackThe1in6' and set up a Neuro Taskforce. Our presentation would explore key findings in detail and highlight opportunities to improve patient experience.

Differentiating Functional Tic-Like Movements from Tourette-Related Tics

Functional tic-like movements or functional tic-like behaviours are functional symptoms that look like tics. There has been a sudden rise in these movements coinciding with the COVID-19 pandemic, prior to which functional tic-like movements were considered very uncommon. As a tertiary specialist Tourette clinic, we have seen our referrals multiply. The referring clinicians often diagnose these young people with Tourette syndrome. We want to describe the differentiating features between Tourette-related (typical) tics and functional tic-like movements based on our experience in London, with the help of data we have collected in a large number of adolescents and through the help of videos (both of typical tics and those of functional tic-like movements). We will also discuss some of the underlying factors that explain the rise of functional tic-like movements in young people. The main differentiating features of functional tics in our clinic (similar to other international specialist tic centres whom we collaborate with) are: (1) The comparatively late age of onset of functional movements (in adolescence) instead of (age 4-7 years) in Tourette-related/typical tics. (2) Change in prevalence by sex (F > M);majority cases are females in our clinic, in contrast the sex ratio in typical tics/Tourette is M > F (4:1). (3) A very abrupt onset over one to a few days in most cases. (4) Presence of complex motor and vocal behaviours, in fact complex tics being more common than typical tics (which is not the case in typical Tics). (5) Prominent involvement of the upper limbs (as opposed to movements starting in the eyes or face or minor sniffing or throat clearing). (6) A significant variability in movements and other symptoms depending upon the environment. We will discuss phenomenology of movements and why it may be better to describe these presentations as functional tic-like movements or behaviours rather than as functional-tics.

Functional tic-like behaviours during the COVID-19 pandemic: Follow-up over 12 months.

Background: Functional tics are included in the wide spectrum of functional movement disorders (FMDs). Their distinction from organic tics is challenging because they both phenomenologically present common features. During the COVID-19 pandemic, there has been an increase in functional tic-like behaviours in vulnerable children and adolescents after social media exposure. This study explores the phenomenology and course of a cohort of newly diagnosed functional tic-like behaviors. Methods: We analysed clinical data of 243 patients affected by tic disorders collected at outpatient Tourette Clinic, Child and Adolescent Neurology and Psychiatry Unit, Catania University. Among the clinical cohort with functional tic-like behaviors, we evaluated the clinical course of symptoms at follow-up visits after 6 and 12 months. Results: Among the cohort of 243 patients referred for evaluation at our centre, 11 were diagnosed with functional tic-like behaviours. The majority of participants with functional tic-like behaviours were female with a mean age of 15 years old and presented an explosive symptom's onset. At follow-up visit after 12 months, patients with functional tic-like behaviors showed a significant variation in the severity of tics and anxiety symptoms. Conversely, depressive, and obsessive-compulsive symptoms did not significantly differ during the follow-up. Conclusion: Our data suggest that several characteristics in clinical course and their phenomenology can help clinicians to distinguish functional tic-like behaviours from organic tics. Our results also suggest a better outcome for tics and anxiety symptoms respect on other comorbidities. A prompt diagnosis and management not only of tics but also comorbidities are recommended, as generally conventional pharmacotherapy for tics does not have positive effects on these patients.

TikTok Tourette's: Are We Witnessing a Rise in Functional Tic-Like Behavior Driven by Adolescent Social Media Use?

Perceptions of Tourette syndrome (TS) and tic disorders are often driven by social media. During the COVID-19 pandemic, social media consumption greatly increased, particularly in the adolescent population. In parallel with increased social media consumption, there has also been an increase in tic severity and functional tic-like behavior (FTLB). Given that many of the tic videos posted on social media are misleading, perpetuate false beliefs about TS, or reinforce tic-like behaviors, there is increasing concern that these videos are driving the rapid increase in FTLBs. Several studies have reviewed newly presenting cases of FTLB and have found shared characteristics, including that a higher proportion of affected individuals are female, there is a low proportion with a history of childhood or family tics, and symptom onset is typically acute and develops in the teenage years. In addition, the quality of the tics seen in association with FTLB mirrors many of the tics seen on popular social media channels, with higher rates of coprophenomena, tic attacks, and involvement of the trunk and extremities than is seen with typical tics. FTLBs are likely a specific subgroup of functional tics largely influenced by the portrayal of and growing popularity of functional tics posted on social media during the COVID-19 pandemic. However, several factors, including increased anxiety, social isolation, and social media use in general during the pandemic are likely also contributing factors to the surge of FTLBs seen recently. In this era of increased social media consumption, it will become increasingly important for clinicians to educate patients about where and how medical information is spread, to ensure the best possible diagnosis, treatment, and outcomes for patients.

A Follow-up Study on the Differences in Yale Global Tic Severity Scale (Ygtss) and Additional Outcome Measures in a Cohort of Participants in a Phase-2b Trial for the Treatment of Tourette's Syndrome before and after Restrictions Related to the Covid-19 Pandemic: A Continuation Study Assessing Group Differences Following Positive Results for the 2b Study

Background/Objective: This continuation study follows positive results of the Phase IIb study and aims to supplement findings with additional scale data and unblinded group membership. The goal is to further assess the potential impact of COVID-19 restrictions on symptom severity in additional domains captured by the Children's Depression Rating Scale-Revised (CDRS-R);Children's Yale-Brown Obsessive Compulsive Scale (CYBOCS);Swanson, Nolan, and Pelham (SNAP-IV);Pediatric Anxiety Scale (PARS);and Clinical Global Impression Scale-Severity (CGI-S). Design(s): Data was partitioned using the date of March 11, 2020. Baseline outcome measure data was analyzed. Additionally, individual item scores were considered across the two time periods, as were treatment group assignments. Descriptive statistics were computed using SPSS 27.0 and included mean, standard deviation, variance, and distribution measures. Result(s): YGTSS mean values under consideration did not appear to change significantly between the time periods before and after COVID-19 restrictions began, with total scores of 67.2 and 66.7, respectively. Mean baseline CY-BOCS scores of 7.45 (before) and 7.55 (after) also showed similar stability to PARS (11.7 before and 12 after) and CDRS (29 before and 27.5 after), with similar stability noted in the CGI-S. Conclusion(s): While clinically, it might be typical for symptoms of Tourette's syndrome to be susceptible to stressors, this was not demonstrated in relation to the COVID-19 pandemic by any significant differences in primary tic assessments or related/comorbid disorders. There did not appear to be significant differences in YGTSS, CY-BOCS, PARS, CDRS, or CGI-S domain scores or individual item scores before or after COVID-19 restrictions were in place.

Rapid onset functional tic-like disorder outbreak: A challenging differential diagnosis in the COVID-19 pandemic

(French) Durant la pandemie de la COVID-19, plusieurs pays ont observe une hausse inattendue du nombre d'adolescents et de jeunes adultes presentant des comportements fonctionnels de type tic a apparition rapide apres avoir ete exposes au contenu des medias sociaux d'autres personnes affichant un modele semblable de tics fonctionnels. Nombre de ces patients ont ete adresses a des cliniques de trouble du mouvement avec des diagnostics fautifs de syndrome de Tourette refractaire d'apparition tardive apres avoir echoue a differents traitements pharmacologiques pour les tics. Le syndrome de Tourette est un trouble bin connu dont les criteres diagnostiques cliniques sont clairs et qui presente le debut insidieux de simples tics moteurs et phoniques dans une evolution rostro-caudale au debut de l'enfance. Les aspects cliniques et demographiques peuvent differencier l'apparition rapide de comportements fonctionnels de type tic du syndrome de Tourette, notamment parce que les premiers ont une presentation abrupte et explosive de symptomes graves, apparaissent a un age plus avance, ont une predominance chez le sexe feminin, manquent de suppressibilite, anxiete et depression comorbides, envie premonitoire atypique et antecedents d'exposition au contenu des medias sociaux affichant des comportements de type tic. Cette nouvelle presentation d'un trouble neurologique fonctionnel peut s'expliquer en partie par la relation entre l'exposition aux comportements de type tic dans les medias sociaux et la reponse inadaptee a l'anxiete causee par les stresseurs de la vie (p. ex., pandemie de la COVID-19), surtout chez les jeunes personnes. Les comportements fonctionnels de type tic a apparition rapide peuvent etre consideres comme un trouble neuropsychiatrique qui se propage et qui est potentiellement favorise par l'effet psychosocial cause par la pandemie de la COVID-19. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

The changing landscape of childhood tic disorders following COVID-19.

The article describes classification, aetiology and features of typical tic disorders (Tourette syndrome) and their management with an additional focus on a surge in atypical tic presentations following the COVID-19 pandemic, often described as functional tics, or functional tic-like movements. We discuss what explains their atypical nature and what might underpin this increase in incidence. Lastly the article provides an overview of management of functional tics, so readers can understand how management of these differs from typical tic disorders.

Perceptions of Parents and Caregivers in New Zealand: Educational Experiences of their Children with Tourette Syndrome

Tourette Syndrome (TS) is a neurological disorder estimated to affect around 1% of children worldwide. Although advances in pharmacological and behavioural treatments appear promising, there is a paucity of research, especially in New Zealand, where little is known about parents' and caregivers' attitudes and experiences. The current study aimed to explore parents' and caregivers' attitudes and experiences of education for their child diagnosed with TS in New Zealand. Participants were also asked about any changes in tics during the COVID- 19 lockdowns. Parents with a child diagnosed with TS and members of the Tourette's Association New Zealand's patient support association were recruited for the survey. In total, 75 parents agreed to participate in the anonymous online survey during February and March 2021. A thematic analysis of participants' qualitative responses was completed. Five distinct themes emerged from the data: (1) Accommodations (2) Separate Space (3) Tics' interference with Learning (4) Tics and COVID- 19 Lockdown, and (5) Recommendations. Understanding parents' attitudes towards and experiences with TS is essential when identifying recommendations for school personnel, peer educational programs and clinical pathways in New Zealand. Suggestions for future research are discussed.

The 43rd Annual Meeting of the Canadian College of Neuropsychopharmacology November 4, 2021

OVERVIEW OF EVENTS 10:30 am Opening of Meeting 10:45 am Opening Remarks - Dr. Jeff Daskalakis, CCNP President 10:50 am Introduction - Dr. Cecilia Flores, CCNP Vice-President 11:00 am CCNP 2020 Young Investigator Award Presentation Caroline Ménard, PhD, Department of Psychiatry & Neuroscience, Université Laval: "Sex-specific vascular alterations and biomarkers underlie stress responses in mice mirrored in human depression" 11:50 am CCNP Next Generation Awardee Andrea H. Pantoja Urban, MSc, Integrated Program in Neuroscience, McGill University: "Short and long-term effects of social defeat stress in adolescent female mice" 12:05 pm CCNP Next Generation Awardee Orna Issler, PhD, Department of Neuroscience, Mount Sinai:"The sex-specific role for long noncoding RNAs in depression: from genome-wide patterns to behavioral readout" 12:20 pm Lunch/Break 12:50 pm CCNP 2020 Heinz Lehmann Award Presentation Martin Alda, MD, FRCPC, Department of Psychiatry, Dalhousie University: "Personalized long-term treatment of bipolar disorder" 1:40 pm CCNP Next Generation Awardee Mikaela K Dimick, BA, Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health: "Cerebral blood flow and core mood symptoms in youth bipolar disorder: evidence for region-symptom specificity" 1:55 pm CCNP Next Generation Awardee Sneha Chenji, PhD, Department of Psychiatry & Pediatrics, University of Calgary: "The effect of rTMS treatment on cortico-striatal-thalamo-cortical (CSTC) circuit connectivity in Tourette's syndrome: a pilot study" 2:10 pm Break 2:20 pm CCNP 2020 Innovations in Neuropsychopharmacology Award Presentation Jeffrey Meyer, MD, PhD, FRCPC, Department of Psychiatry, University of Toronto: "Imaging markers of gliosis and monoamine oxidase in major depressive disorder: implications for personalized prevention and treatment" 3:10 pm CCNP Next Generation Awardee Jasmine D. Cakmak, MSc, Neuroscience, Western University: "The functional and structural consequences of aberrant microglial activity in major depressive disorder" 3:25 pm CCNP Next Generation Awardee Kayla D. Stone, PhD, Department of Psychiatry, University of Calgary: "Dorsolateral prefrontal cortex neurometabolite concentrations in pediatric mild traumatic brain injury" 3:40 pm Break 3:50 pm Keynote Speaker Rémi Quirion, OC, CQ, PhD, FRSC, Chief Scientist of Quebec, Ministry of Economy & Innovation: "A less well travelled road: from neuroscientist to chief scientist and then came COVID-19" 4:50 pm Closing Remarks - Dr. Cecilia Flores, CCNP Vice President Acknowledgments: In keeping with CMA guidelines, program content and selection of speakers are the responsibility of the planning committee. Methods: Here, we characterized the enduring changes in histone modifications in the NAcc of mice exposed to chronic social defeat stress (CSDS), a validated model for the study of depression-like behaviours that separates mouse populations into susceptible (SUS) and resilient (RES) based on a social interaction test (SIT). Tissue from the NAcc of control, SUS, and RES mice was collected either 24 hours or 4 weeks after the SIT and processed for histone profiling via mass spectrometry. From the Department of Psychiatry, University of Alberta, Edmonton, AB, Canada (Yap, Luki, S. Hanstock, Lirette, Zhaoa, Aitchison, Le Melledo);the Department of Medical Genetics, University of Alberta, Edmonton, AB, Canada (Aitchison);the Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB, Canada (Aitchison);the Edmonton Mood and Anxiety Disorders Program, University of Alberta Hospital, Edmonton, AB, Canada (Aitchison);the Department of Biomedical Engineering, University of Alberta, Edmonton, AB, Canada (C. Hanstock, Seres);and the Royal Alexandra Hospital, Edmonton, AB, Canada (Shandro).