Emotional Lability in Children and Adolescents Affected by Tourette Syndrome

Abstract

Ninety-two patients with Tourette syndrome (TS) were studied to investigate the occurrence of emotional lability (EL) in TS, its relationship to comorbid conditions, and the risk of developing bipolar disorder (BD). Patients were divided in three clinical subgroups, according with child behavior checklist anxious/depressed, attention and aggressive scales: group (G) 1: score >210 (risk of development BD), G2: score >180 but < 210 (patients with EL), G3: score <180 (normal). In G1, 9.3% of patients with no “pure TS” were observed (TS + ADHD [attention deficit hyperactivity disorder], 23%); TS + OCD [obsessive compulsive disorder], 67%; TS + ADHD + OCD, 10%). In G2, 44.3% of patients with “pure TS” as “TS + comorbidity” were represented. In G3, 46% of patients with “TS + comorbidity” were observed, while 64% of patients with “pure TS” were represented. Our findings suggested that EL is a core feature in TS, related to mood and anxiety disorders. Comorbid conditions such as ADHD and OCD were important factors responsible of TS malfunctioning causing anxiety and depressive symptoms and increase the risk of developing BD.

Keywords

Tourette syndrome - emotional lability - bipolar disorder - ADHD - obsessive compulsive disorder

• References

• 1 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. DSM-IV-TR. 4th ed., revised. Washington, DC: American Psychiatric Association; 2002
• 2 Robertson MM. The Gilles de la Tourette syndrome: the current status. Arch Dis Child Educ Pract Ed 2012; 97 (5) 166-175
• 3 Channon S, Drury H, Gafson L, Stern J, Robertson MM. Judgements of social inappropriateness in adults with Tourette's syndrome. Cogn Neuropsychiatry 2012; 17 (3) 246-261
• 4 Kowalska A, Midro AT, Janik P, Gogol A, Służewski W, Rajewski A. Searching for Tourette's syndrome gene. Part 1. Heterogeneity of clinical phenotypes [in Polish]. Postepy Hig Med Dosw (Online) 2012; 66: 85-88
• 5 Robertson MM. Mood disorders and Gilles de la Tourette's syndrome: an update on prevalence, etiology, comorbidity, clinical associations, and implications. J Psychosom Res 2006; 61 (3) 349-358
• 6 Cavanna AE, Rickards H. The psychopathological spectrum of Gilles de la Tourette syndrome. Neurosci Biobehav Rev 2013; 37 (6) 1008-1015
• 7 Wechsler D. Wechsler Intelligence Scale for Children. 3rd ed. San Antonio, TX: The Psychological Corporation; 1991
• 8 Robertson MM, Eapen V. The National Hospital Interview Schedule for the assessment of Gilles de la Tourette. Int J Methods Psychiatr Res 1996; 6 (4) 203-226
• 9 Leckman JF, Riddle MA, Hardin MT , et al. The Yale Global Tic Severity Scale: initial testing of a clinician-rated scale of tic severity. J Am Acad Child Adolesc Psychiatry 1989; 28 (4) 566-573
• 10 Scahill L, Riddle MA, McSwiggin-Hardin M , et al. Children's Yale-Brown Obsessive Compulsive Scale: reliability and validity. J Am Acad Child Adolesc Psychiatry 1997; 36 (6) 844-852
• 11 March JS, Parker JD, Sullivan K, Stallings P, Conners CK. The Multidimensional Anxiety Scale for Children (MASC): factor structure, reliability, and validity. J Am Acad Child Adolesc Psychiatry 1997; 36 (4) 554-565
• 12 Kovacs M. Children's Depression Inventory (CDI). Italian ed. Firenze: Organizzazioni Speciali; 1988. (in Italian)
• 13 Conners K. Conner's Parents and Teacher Rating Scales. San Antonio, TX: The Psychological Corporation; 1978
• 14 Achenbach T. Manual for the Child Behavior Checklist 4–18. Burlington, VT: University Associate on Psychiatry; 1991
• 15 Biederman J, Petty CR, Monuteaux MC , et al. The Child Behavior Checklist-Pediatric Bipolar Disorder profile predicts a subsequent diagnosis of bipolar disorder and associated impairments in ADHD youth growing up: a longitudinal analysis. J Clin Psychiatry 2009; 70 (5) 732-740
• 16 Biederman J, Spencer T, Lomedico A, Day H, Petty CR, Faraone SV. Deficient emotional self-regulation and pediatric attention deficit hyperactivity disorder: a family risk analysis. Psychol Med 2012; 42 (3) 639-646
• 17 Steeves TD, Ko JH, Kideckel DM , et al. Extrastriatal dopaminergic dysfunction in Tourette syndrome. Ann Neurol 2010; 67 (2) 170-181
• 18 Müller-Vahl K, Dodel I, Müller N , et al. Health-related quality of life in patients with Gilles de la Tourette's syndrome. Mov Disord 2010; 25 (3) 309-314
• 19 Conelea CA, Busch AM, Catanzaro MA, Budman CL. Tic-related activity restriction as a predictor of emotional functioning and quality of life. Compr Psychiatry 2014; 55 (1) 123-129
• 20 Eddy CM, Rickards HE, Critchley HD, Cavanna AE. A controlled study of personality and affect in Tourette syndrome. Compr Psychiatry 2013; 54 (2) 105-110
• 21 Kerbeshian J, Burd L. Differential responsiveness to lithium in patients with Tourette disorder. Neurosci Biobehav Rev 1988; 12 (3-4) 247-250
• 22 Spencer T, Biederman J, Harding M, Wilens T, Faraone S. The relationship between tic disorders and Tourette's syndrome revisited. J Am Acad Child Adolesc Psychiatry 1995; 34 (9) 1133-1139
• 23 Bunse T, Wobrock T, Strube W , et al. Motor cortical excitability assessed by transcranial magnetic stimulation in psychiatric disorders: a systematic review. Brain Stimulat 2014; 7 (2) 158-169
• 24 Rizzo R, Curatolo P, Gulisano M, Virzì M, Arpino C, Robertson MM. Disentangling the effects of Tourette syndrome and attention deficit hyperactivity disorder on cognitive and behavioral phenotypes. Brain Dev 2007; 29 (7) 413-420
• 25 Rizzo R, Gulisano M, Calì PV, Curatolo P. Long term clinical course of Tourette syndrome. Brain Dev 2012; 34 (8) 667-673
• 26 Steinhausen HC, Nøvik TS, Baldursson G , et al; ADORE Study Group. Co-existing psychiatric problems in ADHD in the ADORE cohort. Eur Child Adolesc Psychiatry 2006; 15 (Suppl. 01) I25-I29
• 27 Eddy CM, Cavanna AE, Gulisano M, Calì P, Robertson MM, Rizzo R. The effects of comorbid obsessive-compulsive disorder and attention-deficit hyperactivity disorder on quality of life in Tourette syndrome. J Neuropsychiatry Clin Neurosci 2012; 24 (4) 458-462
• 28 Steinberg T, Shmuel-Baruch S, Horesh N, Apter A. Life events and Tourette syndrome. Compr Psychiatry 2013; 54 (5) 467-473