ABSTRACT
BACKGROUND AND AIM: Clinical services were severely affected globally during the COVID-19 pandemic. This study aimed to characterize the clinical experience of using botulinum toxin (BTX) injections during the COVID-19 pandemic. Method(s): This is a retrospective chart review of patients who received BTX injections from April 2019 to January 2022. Result(s): A total of 105 patients received an BTX injections, out of which 76 (72.4%) were men. The mean age of the patients was 47.9 +/- 15.1 years. The most common indication for receiving BTX injections was dystonia (n = 79;75.2%), followed by hemifacial spasm (n = 22;21%) and miscellaneous movement disorders (n = 4;3.8%). Focal dystonia (n = 45;57%) was the most frequent form of dystonia, followed by segmental dystonia (n = 24;30%). The percentage of generalized dystonia and hemidystonia was 12% and 1%, respectively. Cervical dystonia (44.4%), blepharospasm (17.8%), and writer's cramp (15.6%) were the most frequent forms of focal dystonia. The miscellaneous group included four patients (3.8%) with trigeminal neuralgia, Holmes tremor, dystonic tics, and hemimasticatory spasm. The mean ages of patients in the dystonia, hemifacial spasm, and the miscellaneous groups were 47.7 +/- 14.9 years, 49.2 +/- 14.0 years, and 44.2 +/- 26.0 years, respectively. The mean BTX dose was 131.6 +/- 104.1 U. The mean BTX doses for the dystonia group, hemifacial spasm, and the miscellaneous group were 158.7 +/- 105.3 U, 40.1 +/- 11.3 U, and 100.0 +/- 70.7 U, respectively. Conclusion(s): Most patients in our cohort had dystonia, followed by hemifacial spasm. Among the patients with dystonia, most had focal dystonia, with cervical dystonia being the most common movement disorder. The data obtained in our study is important to increase awareness of the effectiveness of BTX injections in patients with chronic disorders.Copyright © 2023 Annals of Movement Disorders.
ABSTRACT
[This corrects the article DOI: 10.3389/fneur.2023.1085948.].
ABSTRACT
The need for mental health services in primary care settings to address trauma remains a pressing issue for pediatrics. The existing literature supports the compatibility of Trauma-Informed Care Principles in Patient-Centered settings to address trauma, yet despite professional guidelines highlighting these models, a specific example within a primary care setting remains unrealized. This paper will conceptualize a Trauma Informed Medical Home model with Integrated Behavioral Health utilizing some aligning concepts such as safety, accessibility and collaboration found within the Trauma Informed Care and a Medical Home guideline. The resulting conceptualized model will represent a strengthened primary care setting where the delivery of mental health services using a trauma-informed lens can optimize patient-centered primary care medical home services.
ABSTRACT
Due to COVID-19, universities faced the challenge of moving to the virtual modality, carrying out processes of adaptation to the digital environment and integrating technological tools in classes. The objective of this study was to evaluate the digital skills of university teachers from two higher education institutions in Colombia. For data collection, the instrument implemented was the questionnaire on the digital competence of Higher Education teachers, which consists of 4 dimensions and 112 items. 105 teachers participated in the study, the study was quantitative, non-experimental and descriptive in scope. SPSS 22 software was used for data analysis and descriptive and correlational statistics were performed. Based on the results, it is highlighted that teachers use TIC in an instrumental way. The conclusions focus on the need to venture into content creation, augmented reality, innovation programs, strengthening research and the use of specific digital tools for each area of knowledge. A call is made to teachers and universities to continue promoting training and support programs to actively implement TIC in classes that require teacher qualification in educa-tional processes.
ABSTRACT
We conducted a cross-sectional study to compare the impact of social distancing and lifestyle changes that occurred during Corona Virus Disease 2019 (COVID-19) lockdown on children and adolescents with and without Neurodevelopmental Disorders (NDDs). An online questionnaire was administered in order to investigate the effects of NDD condition, socio-demographic status, familiar/home environment and COVID-19 exposure on their lives during a two months period of social isolation. We used logistic regression, focusing on five endpoints (remote learning, lifestyle, stress/anxiety, sociality, scolding) to define the extent of these effects. Most questions were paired up to parents and children, to verify the occurrence of agreement. 8305 questionnaires were analyzed, 1362 of which completed by NDDs and 6943 by controls. Results showed that the presence of a NDD, compared to controls, had a significant impact on: Remote Learning (i.e. subjects with NDDs experienced more difficulties in attending online classes and studying), Sociality (i.e. subjects with NDDs missed their schoolmates less), Scolding (i.e. subjects with NDDs were scolded more often) and Anxiety (i.e. subjects with NDDs were perceived by their parents as more anxious). Substantial agreement between parents and children arose from questions concerning Remote learning, Lifestyle and Scolding. The current study actually points out that having a NDD gives account for a stronger influence on school performance and on behavioral and psychological aspects, during a two months lockdown. Such results may provide useful information to governments and school authorities on how carrying through supportive strategies for youth affected by NDDs. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s12144-021-02321-2.
ABSTRACT
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.
Subject(s)
COVID-19 , Tic Disorders , Tics , Tourette Syndrome , Adolescent , Young Adult , Humans , Female , Tics/epidemiology , Tourette Syndrome/complications , Tourette Syndrome/epidemiology , Tourette Syndrome/diagnosis , Pandemics , COVID-19/epidemiology , Tic Disorders/epidemiology , Tic Disorders/diagnosis , Tic Disorders/psychologyABSTRACT
During 2020, the governments determined the elimination of face-to-face activities in schools and universities to avoid crowds in the classrooms due to the Covid-19 pandemic. This article aims to understand the impacts of remote and hybrid teaching in Higher Education during the Covid 19 pandemic, which started at the end of 2019 all over the world and brought significant changes in various sectors, including education. We have three specific, very clear and defined objectives, namely: (i) verify the challenges faced by teachers and students in HEIs;(ii) highlight pedagogical practices during distance learning and hybrid teaching and (iii) highlight what actions were taken in Higher Education during and after the pandemic. The methodology adopted in this work is a systematic bibliographical research. The results of the investigation indicate that the changes in Higher Education are here to stay, the hybrid model that includes face-to-face and distance education is already a reality for Higher Education institutions and also its main challenge.
ABSTRACT
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.
ABSTRACT
The confinement caused in Colombia by the health emergency of COVID-19, forced the replacement of face-to-face pedagogical practices by remote education mediated by communication and information technologies (ICT). Physical education teachers had the challenge of adapting the contents of a generally practical subject to the new reality in which digital media are protagonists. Adaptations that are complicated because students widely in public institutions in urban and rural contexts have difficulties in connecting to the Internet or availability of electronic equipment. The objective was to understand the conceptions of the pedagogical practice of seven physical education teachers in training, belonging to the Bachelor's degree program in Physical Education, Recreation and Sports of the University of Cauca - Colombia under the remote modality with high school students. Reflections on the ICT mediated teaching-learning process in two public educational institutions with the intrinsic case study methodology and research techniques such as observation and educational workshops are presented. It was found that the physical education class mediated by ICT requires configuring the contents according to the needs of the health emergency context, that there are strengths in the digital tools for the teaching-learning process, as well as weaknesses of the teachers in their management, it is evident that there are students with accessibility and limitation for the connection, which affects the monitoring of progress both in synchronous and asynchronous phases. Key words. Physical education, information technology, ICT, pandemic, teaching, learning. Alternate :El confinamiento provocado en Colombia por la emergencia sanitaria de la COVID-19, obligó a reemplazar las prácticas pedagógicas presenciales por la educación virtual mediada por las tecnologías de la comunicación y de la información (TIC). Los profesores de Educación Física tuvieron el reto de adecuar los contenidos de una asignatura generalmente práctica, a la nueva realidad en la que los medios digitales son protagonistas. Adaptaciones que resultan complicadas porque los educandos ampliamente en las instituciones públicas en el contexto urbano y rural presentan dificultades de conexión a internet o disponibilidad de equipos electrónicos. El objetivo fue comprender las concepciones de la práctica pedagógica de siete profesores de educación física en formación, pertenecientes al programa de Licenciatura en Educación Física, Recreación y Deportes de la Universidad del Cauca – Colombia, bajo la modalidad remota con estudiantes de básica secundaria. Se presentan las reflexiones sobre el proceso de enseñanza aprendizaje mediado por las TIC en dos instituciones educativas públicas con la metodología de estudio de caso intrínseco y técnicas de investigación como la observación y los talleres educativos. Se encontró que la clase de educación física mediada por las TIC requiere configurar los contenidos acordes a las necesidades del contexto de emergencia sanitaria, que existen fortalezas en las herramientas digitales para el proceso de enseñanza aprendizaje, así como debilidades de los profesores en su manejo, es evidente que hay estudiantes con accesibilidad y limitación para la conexión lo que afecta el seguimiento del progreso tanto en fase síncrono como asíncrono.Alternate :O confinamento causado na Colômbia pela emergência sanitária do COVID-19, obrigou a substituir práticas pedagógicas presenciais por educação virtual mediada por tecnologias de informação e comunicação (TIC). Os professores de Educação Física tiveram o desafio de adequar os conteúdos de uma disciplina geralmente prática à nova realidade em que as mídias digitais são protagonistas. Adaptações que são complicadas porque os alunos amplamente em instituições públicas no contexto urbano e rural têm dificuldades com conexão de internet ou disponibilidade de equipamentos eletrônicos. O objetivo foi compreender as concepções da prática pedagógica de sete professores de educação física em formação, pertencentes ao programa de Bacharelado em Educação Física, Recreação e Esportes da Universidade de Cauca - Colômbia, na modalidade remota com alunos do ensino médio. São apresentadas reflexões sobre o processo de ensino-aprendizagem mediado pelas TIC em duas instituições públicas de ensino com a metodologia intrínseca de estudo de caso e técnicas de pesquisa como observação e oficinas pedagógicas. Constatou-se que a aula de educação física mediada pelas TIC exige a configuração dos conteúdos de acordo com as necessidades do contexto de emergência em saúde, que há pontos fortes nas ferramentas digitais para o processo ensino-aprendizagem, bem como fragilidades dos professores em sua gestão , fica evidente que existem alunos com limitações de acessibilidade e conexão, o que prejudica o acompanhamento do andamento tanto na fase síncrona quanto na assíncrona. Palavras chave: Educação física, tecnologias de informação, TIC, pandemia, ensino, aprendizagem.
ABSTRACT
This study aims to assess the perception of families, having children attending nursery school, about learning mediated by information and communication technologies (ICTs) in times of COVID-19. Data is gathered by using an opinion questionnaire on family habits. The sample corresponds to 261 families of children ages 4 to 5 years old who participate on virtual classes at 38 educational institutions in the Province of Concepción (Chile). The results show that families acknowledge learning achievements mediated by ICTs. They also recognize the importance of ICTs' educational role in a virtual context. However, families state that they lack sufficient time and technological skills to support their children's learning at home. It is concluded that the families surveyed have a favorable perception of their children's learning through virtual education, but there is evidence that they face challenges to connect to the Internet, which affects achieving a consistent contribution in their children's educational processes. (English) [ FROM AUTHOR] Este estudio tiene como objetivo analizar la percepción de familias de niños que asisten al nivel de educación parvularia respecto del aprendizaje mediado con tecnologías de la información y comunicación (TIC), en tiempos de COVID-19. La recolección de datos se realiza mediante un cuestionario de opinión sobre prácticas familiares. La muestra corresponde a 261 familias de niños de 4 y 5 años que participan de clases virtuales en 38 establecimientos de la Provincia de Concepción (Chile). Los resultados muestran que las familias reconocen el logro de diversos aprendizajes mediados por las TIC, y la importancia de su rol educativo en contexto virtual. Sin embargo, declaran escaso conocimiento tecnológico y tiempo para apoyar a sus hijos en el hogar. Se concluye que las familias tienen una percepción favorable de los aprendizajes de sus hijos mediante la educación virtual, aunque, se evidencia que las familias presentan dificultades para conectarse a Internet, afectando su participación sistemática en el proceso educativo de sus niños. (Spanish) [ FROM AUTHOR] Copyright of Información Tecnológica is the property of Centro de Informacion Tecnologica (CIT) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)
ABSTRACT
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)
ABSTRACT
Background: Pediatric acute-onset neuropsychiatric syndrome (PANS) is characterized by a wide spectrum of symptoms, including the onset of obsessive-compulsive disorder and/or severely restricted food intake, associated with emotional symptoms, behavioral symptoms, developmental regression, and somatic symptoms. Among the possible triggering agents, infectious agents have been extensively explored. More recently, sporadic case reports describe a possible association between PANS and SARS-CoV-2 infection but data on clinical presentation and treatment are still scarce. Methods: We describe a case series (10 children) with acute onset or relapse of PANS symptoms after SARS-CoV-2 infection. Standardized measures (CBCL, CPRS, C-GAS, CGI-S, Y-BOCS, PANSS, and YGTSS) were used to describe the clinical picture. The efficacy of a pulse treatment with steroids for three consecutive months was assessed. Results: Our data suggest that the clinical presentation of the COVID-19-triggered PANS is largely similar to that reported in typical PANS, including acute onset, with OCD and/or eating disorders, and associated symptoms. Our data suggest that treatment with corticosteroids may be beneficial for both global clinical severity and global functioning. No serious adverse effects were observed. Both OCD symptoms and tics consistently improved. Among psychiatric symptoms, affective and oppositional symptoms appeared more sensitive to the steroid treatment than the other symptoms. Conclusion: Our study confirms that COVID-19 infection in children and adolescents could trigger acute-onset neuropsychiatric symptoms. Thus, in children and adolescents with COVID-19, a specific neuropsychiatric follow-up should be routinely included. Even if a small sample size and a follow-up with only two points (baseline and endpoint, after 8 weeks) limit the conclusions, it seems that steroid treatment in the acute phase may be beneficial and well tolerated.
ABSTRACT
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.
ABSTRACT
Objective: To describe a case of SARS-CoV-19-associated encephalitis in a neonate. Method(s): Case report. Report: A 9-day-old term neonate presented with two focal motor seizures (right upper limb jerking and facial twitching). He had a 1-day history of coryzal illness with reduced feeding, but was afebrile. Antenatal course was uneventful. He was born at term via vaginal delivery. He did not require resuscitation or admission to SCBU. Maternal history was notable for symptomatic SARS-CoV-19 infection at time of delivery. Two siblings subsequently tested positive for SARS-CoV-19. He had further seizures in the emergency department and was loaded with phenobarbitone. The infant was stabilised locally and transferred to a tertiary paediatric hospital for the management of neonatal sepsis. He never required respiratory support. However, he was diffusely hypotonic with poor suck, necessitating nasogastric feeding. Nasopharyngeal PCR was positive for SARS-CoV-19. Lumbar puncture microscopy was negative (WCC 6). All CSF bacterial and viral investigations were negative. CSF testing of SARS-CoV-19 was not available. Brain MRI revealed bilateral asymmetric areas of reduced diffusivity involving the subcortical white matter, medulla and the corpus callosum with frontal lobe predominance. He made a full neurologic recovery with supportive therapies and was discharged following a 9-day admission. He had no further clinical seizures and phenobarbitone was successfully weaned pre-discharge. Conclusion(s): In the absence of another aetiology or antenatal risk factor, SARS-CoV-19 infection was presumed causative in this case of focal seizures and white matter changes in this term neonate. White matter abnormalities on MRI imaging are reported in neonates with seizures in the context of other viral infections. Single case reports have been published of SARS-CoV-19 infection with associated abnormal MRI brain findings, particularly diffusion abnormalities of the corpus callosum, as seen in our case.
ABSTRACT
Background: There has been an increase in the occurrence of sudden onset functional tic-like behaviours (FTLBs) in adolescents during the COVID-19 pandemic, which has had a significant impact on the affected individual's quality of life and access to education. Support for the management of FTLBs following diagnosis is limited and, when it is available, waiting lists to receive such support are long. Objective(s): Our aim was to devise and evaluate psychoeducation materials to guide carers and schools in how best to support young people with the day-to-day management of FTLBs. Method(s): A 3-h clinician-led webinar for carers and an advice sheet for schools were developed. The webinar was attended by 20 carers and the advice sheet was sent to a selection of schools of young people attending our service. Carers attending the webinar completed a pre-and post-evaluation measure and feedback was gained on the advice sheet via consultation with schools and young people. Result(s): Results from the completed evaluation measures indicated an improvement in carers' understanding of FTLBs and their management and increased confidence in supporting their child with the movements both at home and school. Initial consultation with schools and young people regarding the advice sheet for schools suggests the resource increased their understanding of FTLBS and gave useful management strategies. Conclusion(s): Psychoeducation resources can serve as an important component of a wider support package for young people with FTLBs. We highlight the need for further evaluation of the effectiveness of such resources, in particular, any direct impact on FTLBs.
ABSTRACT
Behavioural therapy is the main form of symptomology management for tics, such as Exposure Response Prevention (ERP) and Habit Reversal Therapy (HRT), and is typically administered in person. Due to challenges presented by COVID-19, this was no longer possible, raising questions surrounding the effectiveness of alternative delivery methods. The current study assesses the efficacy of virtually delivered tic therapy in a group setting. Delivered by the Tics and Neurodevelopmental Movements Service (TANDeM) at the Evelina London Children's Hospital, combined ERP and HRT delivered virtually with externalised attention strategies is a pioneering combination and has not yet been explored. Method(s): Sixteen TANDeM patients attended a six-session virtual tic therapy group, each lasting 1 h. The Yale Global Tic Severity Scale (YGTSS) was completed for all patients prior to and following the group, and qualitative feedback was also gathered post-hoc regarding satisfaction and acceptability of the management techniques. Results and Conclusion(s): Patients' post-group YGTSS scores showed a statistically significant improvement compared to pre group scores, and all patients reported better management of tics after having attended the virtual group. 91.6% of attendees returned positive feedback for the virtual aspect, such as it being 'more accessible', and availability of 1:1 practice with clinicians. Twelve of 16 attendees reported learning combined ERP and HRT to manage their tics was the main attraction of the group. The cost-effective virtual group produced a significant improvement in patient outcome, suggesting it is an effective way of delivering tic therapy. The significant difference between pre-and post-group YGTSS scores provides a preliminary basis for delivering combined ERP and HRT alongside externalised attention strategies.
ABSTRACT
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.
ABSTRACT
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.
ABSTRACT
(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)