[ Psychiatric ] Child Psychiatry 4

Tourette Syndrome definition: Core clinical requirements

A neurodevelopmental tic disorder characterized by: multiple motor tics AND at least one vocal tic.

Tourette Syndrome diagnostic criteria: Duration threshold

Duration: > 1 year.

Tourette Syndrome diagnostic criteria: Age of onset limit

Onset: before age 18.

Tourette Syndrome tics (Motor): Clinical characteristics

Sudden, rapid, nonrhythmic movements.

Tourette Syndrome tics (Motor): Common examples

Include: Eye blinking, Facial grimacing, Shoulder shrugging, Head jerking.

Tourette Syndrome tics (Vocal/phonic): Common simple examples

Sudden sounds or utterances. Include: grunting, throat clearing, sniffing.

Tourette Syndrome tics (Vocal/phonic): Echolalia definition

Echolalia: repeating others' words or phrases.

Tourette Syndrome tics (Vocal/phonic): Coprolalia definition and clinical yield

Coprolalia: Involuntary utterance of obscene or socially inappropriate words. Present in a minority of patients, but very testable.

Tourette Syndrome clinical course: Symptom pattern over time

Wax and wane in severity.

Tourette Syndrome clinical course: Peak severity timing

Peak in early adolescence.

Tourette Syndrome clinical course: Long-term prognosis

May improve in adulthood.

Tourette Syndrome associated conditions: Most common comorbidities

ADHD (very common), OCD / obsessive-compulsive symptoms, Anxiety disorders.

Tourette Syndrome treatment (First-line): Non-pharmacologic modalities

Psychoeducation, Behavioral therapy: Habit reversal training (HRT), Comprehensive behavioral intervention for tics (CBIT).

Tourette Syndrome treatment (Pharmacologic): Alpha-2 agonists indication and examples

α2-agonists (especially with ADHD): clonidine, guanfacine.

Tourette Syndrome treatment (Pharmacologic): Antipsychotics examples

Antipsychotics: risperidone (commonly used), haloperidol (older option).

Tourette Syndrome treatment (Pharmacologic): VMAT inhibitor example and mechanism

Tetrabenazine: dopamine-depleting agent (VMAT inhibitor).

Conduct Disorder definition: Core concept and age threshold

The most serious disruptive behaviors. Pattern of behavior that violates rights of others <15y.

Conduct Disorder clinical features (TRAP): T component

Theft: breaking and entering, deceiving, non-confrontational stealing.

Conduct Disorder clinical features (TRAP): R component

Rule breaking: running away, skipping school, out late.

Conduct Disorder clinical features (TRAP): A component

Aggression: people, animals, weapons, forced sex.

Conduct Disorder clinical features (TRAP): P component

Property destruction