Instruct: Given a question, retrieve passages that can help answer the question.
Query: Are there medications for Tourettes?
Tourette syndrome (also Tourette's syndrome or TS) is an inherited neuropsychiatric disorder with onset in childhood, characterized by the presence of motor and phonic tics. Treatment of Tourette syndrome has the goal of managing symptoms to achieve optimum functioning, rather than eliminating symptoms; not all persons with Tourette's require treatment, and there is no cure or universally effective medication.[1][2][3] Explanation and reassurance alone are often sufficient treatment;[2] education is an important part of any treatment plan.[4]
A person with Tourette syndrome has about a 50% chance of passing the gene(s) to one of his/her children. Gender appears to have a role in the expression of the genetic vulnerability, with males more likely to express tics than females. Tourette syndrome is a condition of incomplete penetrance, meaning not everyone who inherits the genetic vulnerability will show symptoms. Tourette's also shows variable expression—even family members with the same genetic makeup may show different levels of symptom severity. The gene(s) may express as Tourette syndrome, as a milder tic disorder (transient or chronic tics), or as obsessive compulsive symptoms with no tics at all. Only a minority of the children who inherit the gene(s) will have symptoms severe enough to require medical attention. There is currently no way to predict the symptoms a child may display, even if the gene(s) are inherited.
The direction of current and future research in Tourette's was outlined in a 2005 journal article by the outgoing chairman of the TSA Scientific Advisory Board. Swerdlow divides the research landscape into five broad questions about Tourette's: what is it, who has it, what causes it, how it should be studied, and how it should be (medically) treated.
The Shapiros, working with the patient families who founded in 1972 the Tourette Syndrome Association (TSA, renamed to Tourette Association of America in 2015), advanced the argument that Tourette's is a neurological, rather than psychological, disorder, and worked to persuade the media to promote information about Tourette's. Although the original case reports of TS were by French neurologists, the "focus moved to New York in the 1970s" and "the centre for the most committed progress in TS continued to be the USA, facilitated by the success of the Tourette Syndrome Association".
Working with the New York patient families who founded the Tourette Syndrome Association (TSA, since renamed to TAA) in 1972, the Shapiros advanced the argument that Tourette's was neurological rather than psychological, and the medical view of Tourette syndrome was "freed from its century-long submission to discredited psychoanalytic theory". In 1978, the Shapiros published a "landmark book" on the disorder, "Gilles de la Tourette Syndrome". In 1981, Shapiro was chosen honorary co-president of the First International Tourette Syndrome Symposium, held in New York. Since the 1990s, a more neutral view of Tourette's is emerging as a condition involving an interaction between biological vulnerability and adverse environmental events.
Several documentaries have attempted to portray Tourette's syndrome accurately and to advocate for greater understanding of persons with Tourette's, while others focus on sensationalizing coprolalia. The Emmy Award-winning television documentary film "I Have Tourette's but Tourette's Doesn't Have Me" was produced by HBO in conjunction with the Tourette Syndrome Association, featuring children between the ages of six and 13. It was described by the "Cincinnati Enquirer" as "the best simple overview yet of Tourette's". "John's Not Mad" (1989) and "The Boy Can't Help It" (2000) are documentaries about a young man from Scotland, who has severe Tourette's and coprolalia. "Twitch and Shout" examines a society that is quick to judge a person who strays outside the limits of conventional behavior and was nominated for an Emmy. A 2007 British documentary, "Tourette De France", followed a group of teenagers with Tourette's on a trip to Paris; many of the teenagers featured in the program had coprolalia. "Movements and Madness: Gusti Ayu" is a documentary about the struggles of a young woman with severe Tourette's in a small village in Indonesia. A 2011 BBC documentary, "Tourettes: I Swear I Can Sing", followed aspiring musician Ruth Ojadi as she explains her experience of TS and her struggle to find self-confidence in her singing.
Pearce was not alone in diagnosing Johnson as having Tourette syndrome; in 1967 Lawrence C. McHenry Jr was the first to diagnose Johnson with the syndrome but in passing. It was not until Arthur K. Shapiro's "Gilles de la Tourette Syndrome" that the diagnosis was made clear through a comprehensive study, with Shapiro declaring, "Samuel Johnson ... is the most notable example of a successful adaptation to life despite the liability of Tourette syndrome". T. J. Murray had come to the same conclusion in a 1979 "British Medical Journal" paper. Murray based his diagnosis on various accounts of Johnson displaying physical tics, "involuntary vocalisations" and "compulsive behaviour".
Pearce was not alone in diagnosing Johnson as having Tourette syndrome; in 1967 McHenry Jr was the first to diagnose Johnson with the syndrome. It was not until Arthur K. Shapiro's "Gilles de la Tourette Syndrome" that the diagnosis was made clear, with Shapiro declaring, "Samuel Johnson ... is the most notable example of a successful adaptation to life despite the liability of Tourette syndrome". Murray had come to the same conclusion in a 1979 "British Medical Journal" paper. Murray based his diagnosis on various accounts of Johnson displaying physical tics, "involuntary vocalisations" and "compulsive behaviour".
I Have Tourette's but Tourette's Doesn't Have Me is a 2005 documentary film featuring children between the ages of six and thirteen with Tourette syndrome. The film examines the lives of more than a dozen children who have Tourette's, and explores the challenges they face.
A German psychiatrist examined the question of Mozart's diagnoses and concluded that "Tourette’s syndrome is an inventive but implausible diagnosis in the medical history of Mozart". Evidence of motor tics was found lacking and the notion that involuntary vocal tics are transferred to the written form was labeled "problematic". Neurologist and author Oliver Sacks published an editorial disputing Simkin's claim, and the Tourette Syndrome Association pointed out the speculative nature of this information. No Tourette's syndrome expert or organization has voiced concurrence that there is credible evidence to conclude that Mozart had Tourette's. One TS specialist stated that, "although some web sites list Mozart as an individual who had Tourette's and/or OCD, it's not clear from the descriptions of his behavior that he actually had either."
Tourettism refers to the presence of Tourette-like symptoms in the absence of Tourette syndrome, as the result of other diseases or conditions, known as "secondary causes".
There are no medications specifically designed to target tics, although some antipsychotics (for example, pimozide) have been FDA-approved for treating Tourette's. Medications which are used as primary treatment in other conditions are used with some success in treating tics. Neuroleptic medications (antipsychotics), such as haloperidol (brand name Haldol) or pimozide (brand name Orap), have historically been and continue to be the medications with the most proven efficacy in controlling tics. These medications work by blocking dopamine receptors, and are associated with a high side effect profile. The traditional antipsychotic drugs are associated with tardive dyskinesia when used long-term; and parkinsonism, dystonia, dyskinesia, and akathisia when used short-term. Additional side effects can be school phobia (a form of separation anxiety), depression, weight gain, and cognitive blunting (dulling of cognitive ability). Another traditional antipsychotic used in treating Tourette's is fluphenazine (brand name Prolixin), although the evidence supporting its use is less than that of haloperidol and pimozide.[6]
There are no specific medical or screening tests that can be used in diagnosing Tourette's; it is frequently misdiagnosed or underdiagnosed, partly because of the wide expression of severity, ranging from mild (the majority of cases) or moderate, to severe (the rare, but more widely recognized and publicized cases). Coughing, eye blinking, and tics that mimic unrelated conditions such as asthma are commonly misdiagnosed.
Other television and film productions depicting persons with TS, or using coprolalia as a plot device, include an episode of "Ally McBeal", in which Anne Heche portrays a woman with Tourette's whose leg tic causes her to run over and kill her boyfriend; "An Angel on my Tree", an episode of "Touched by an Angel" in which a father commits manslaughter in reaction to an event that involved his son who had Tourette's; an episode of "The Simpsons", in which Bart Simpson is mentioned to claimed to have Tourette's to excuse himself from a test; and an episode of "South Park", "Le Petit Tourette", in which Eric Cartman pretends to have Tourette's to get away with saying offensive things. The episode received a mixed reaction from the Tourette Syndrome Association, which commented that it provided useful information while at the same time perpetuating outright myths about coprolalia and Tourette syndrome.
After years of enduring a condition for which he had no name, Nick was finally correctly diagnosed with Tourette syndrome when he was twenty-one. Although Nick felt jubilant in finally having a name for his condition (after a fourteen-year wait), he was resentful that the medical profession had not detected the tell-tale signs of Tourette syndrome.
In 2015, the Tourette Syndrome Association changed its name to the Tourette Association of America. As of 2006, the Tourette Syndrome Association had contacts in more than 50 countries. The Tourette syndrome International database Consortium (TIC) brought together data on clinical samples of patients with Tourette syndrome from twenty-two countries (Argentina, Australia, Austria, Belgium, Brazil, Canada, Denmark, Germany, Hungary, Iceland, Israel, Italy, Japan, The Netherlands, Norway, People's Republic of China, Poland, South Africa, Sweden, Turkey, the US and the UK); Tourette's has also been studied in Chile, Colombia, Costa Rica, India, Indonesia, Korea, and Spain.
Tourette's is associated with several comorbid conditions, or co-occurring diagnoses, which are often the major source of impairment for an affected child. Most individuals with tics do not seek medical attention, so epidemiological studies of TS "reflect a strong ascertainment bias", but among those who do warrant medical attention, the majority have other conditions, and up to 50% have ADHD or OCD.
While often discussed, the Mozart/Tourette hypothesis has failed to sway mainstream opinion on this issue. Indeed, Kammer (2007) states that the work proposing the hypothesis has been "promptly and harshly" criticized. The critical commentary asserts both medical misdiagnosis and errors of Mozart scholarship. Kammer concluded that "Tourette's syndrome is an inventive but implausible diagnosis in the medical history of Mozart". Evidence of motor tics was found lacking and the notion that involuntary vocal tics are transferred to the written form was labeled "problematic". Neurologist and author Oliver Sacks published an editorial disputing Simkin's claim, and the Tourette Syndrome Association pointed out the speculative nature of this information. No Tourette's syndrome expert or organization has voiced concurrence that there is credible evidence to conclude that Mozart had Tourette's. One TS specialist stated that "although some websites list Mozart as an individual who had Tourette's or OCD, it's not clear from the descriptions of his behavior that he actually had either".
Causes and origins of tinnys Tourette syndrome have not been fully elucidated. Tourette syndrome (also called "Tourette's syndrome", "Tourette's disorder", "Gilles de la Tourette syndrome", "GTS" or "TS") is an inherited neurological disorder with onset in childhood, characterized by the presence of multiple motor tics and at least one phonic tic, which characteristically wax and wane. Tourette's syndrome occurs along a spectrum of tic disorders, which includes transient tics and chronic tics.
The exact cause of Tourette's is unknown, but it is well established that both genetic and environmental factors are involved. The overwhelming majority of cases of Tourette's are inherited, although the exact mode of inheritance is not yet known, and no gene has been identified. Tics are believed to result from dysfunction in the thalamus, basal ganglia, and frontal cortex of the brain, involving abnormal activity of the brain chemical, or neurotransmitter, dopamine. In addition to dopamine, multiple neurotransmitters, like serotonin, GABA, glutamate, and histamine (H3-receptor), are involved.
There is no cure for Tourette's and no medication which works universally for all individuals without significant adverse effects;[3] knowledge and understanding are the best treatments available for tics.[2][4] Management of the symptoms of Tourette's may include pharmacological, behavioral and psychological therapies. While pharmacological treatment is reserved for more severe symptoms, other types of treatments may help avoid or improve symptoms of depression or social isolation, and improve supportive family functioning. Educating the patient, family, and surrounding community (school, church, friends, etc.) is a key part of treatment.[1]
According to the fifth edition of the "Diagnostic and Statistical Manual of Mental Disorders" (DSM-5), Tourette’s may be diagnosed when a person exhibits both multiple motor and one or more vocal tics over the period of a year; the motor and vocal tics need not be concurrent. The onset must have occurred before the age of 18, and cannot be attributed to the effects of another condition or substance (such as cocaine). Hence, other medical conditions that include tics or tic-like movements—such as autism or other causes of tourettism—must be ruled out before conferring a Tourette's diagnosis. Since 2000, the DSM has recognized that clinicians see patients who meet all the other criteria for Tourette's, but do not have distress or impairment.
Secondary causes of tics (not related to inherited Tourette syndrome) are commonly referred to as tourettism. Dystonias, choreas, other genetic conditions, and secondary causes of tics should be ruled out in the differential diagnosis for Tourette syndrome. Other conditions that may manifest tics or stereotyped movements include developmental disorders, autism spectrum disorders, and stereotypic movement disorder; Sydenham's chorea; idiopathic dystonia; and genetic conditions such as Huntington's disease, neuroacanthocytosis, pantothenate kinase-associated neurodegeneration, Duchenne muscular dystrophy, Wilson's disease, and tuberous sclerosis. Other possibilities include chromosomal disorders such as Down syndrome, Klinefelter syndrome, XYY syndrome and fragile X syndrome. Acquired causes of tics include drug-induced tics, head trauma, encephalitis, stroke, and carbon monoxide poisoning. The symptoms of Lesch-Nyhan syndrome may also be confused with Tourette syndrome. Most of these conditions are rarer than tic disorders, and a thorough history and examination may be enough to rule them out, without medical or screening tests.
Tourette syndrome (TS or simply Tourette's) is a common neurodevelopmental disorder with onset in childhood, characterized by multiple motor tics and at least one vocal (phonic) tic. These tics characteristically wax and wane, can be suppressed temporarily, and are typically preceded by an unwanted urge or sensation in the affected muscles. Some common tics are eye blinking, coughing, throat clearing, sniffing, and facial movements. Tourette's does not adversely affect intelligence or life expectancy.
Tourette's is defined as part of a spectrum of tic disorders, which includes provisional, transient and persistent (chronic) tics. While the exact cause is unknown, it is believed to involve a combination of genetic and environmental factors. There are no specific tests for diagnosing Tourette's; it is not always correctly identified because most cases are mild and the severity of tics decreases for most children as they pass through adolescence. Extreme Tourette's in adulthood, though sensationalized in the media, is a rarity; tics are often unnoticed by casual observers.
In most cases, medication for tics is not necessary. Education is an important part of any treatment plan, and explanation and reassurance alone are often sufficient treatment. Many individuals with Tourette's go undiagnosed or never seek medical care. Among those who are seen in specialty clinics, attention-deficit hyperactivity disorder (ADHD) and obsessive–compulsive disorder (OCD) are present at higher rates. These co-occurring diagnoses often cause more impairment to the individual than the tics; hence, it is important to correctly identify associated conditions and treat them.
About 1% of school-age children and adolescents have Tourette's. It was once considered a rare and bizarre syndrome, most often associated with coprolalia (the utterance of obscene words or socially inappropriate and derogatory remarks), but this symptom is present in only a small minority of people with Tourette's. The condition was named by Jean-Martin Charcot (1825–1893) on behalf of his resident, Georges Albert Édouard Brutus Gilles de la Tourette (1857–1904), a French physician and neurologist, who published an account of nine patients with Tourette's in 1885.
During 1873 Tourette began medical studies at Poitiers. He later relocated to Paris where he became a student, amanuensis, and house physician of his mentor, the influential contemporary neurologist Jean-Martin Charcot, director of the Salpêtrière Hospital. Charcot also helped him to advance in his academic career. Tourette studied and lectured in psychotherapy, hysteria and medical and legal ramifications of mesmerism (modern-day hypnosis).
Mihok said that one of the early reasons he became an actor was because he had so much experience in hiding his Tourette's. He said the focus required of acting allows him to mask many of his tics. Mihok says the biggest misconception about Tourette's Syndrome is about vocal tics, called coprolalia. Not everyone with Tourette's does that: "Tics tend to wax and wane, not everybody's screaming obscenities all the time." Mihok said he took medication during high school for the Tourette's.