Karla Claudio-Campos1,2, Daniel Stevens3, Sang-Wahn Koo2, Alexa Valko2, Oscar Joseph Bienvenu3, Cathy B Budman4, Danielle C Cath5,6, Sabrina Darrow7,8, Daniel Geller9, Fernando S Goes3, Marco A Grados3, Benjamin D Greenberg10, Erica Greenberg9,11, Matthew E Hirschtritt6, Cornelia Illmann11, Franjo Ivankovic12, Robert A King13, James A Knowles14, Janice Krasnow3, Paul C Lee15, Gholson J Lyon16,17, James T McCracken18, Mary M Robertson19, Lisa Osiecki13, Mark A Riddle3, Guy Rouleau20, Paul Sandor21, Gerald Nestadt3, Jack Samuels3, Jeremiah M Scharf11,22, Carol A Mathews12. 1. Department of Pharmacotherapy and Translational Research, University of Florida College of Pharmacy, Gainesville, Florida, USA. 2. Department of Psychiatry, University of Florida College of Medicine, Gainesville, Florida, USA. 3. Department of Psychiatry and Behavioral Sciences Baltimore, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. 4. Department of Psychiatry, Zucker School of Medicine, Hempstead, New York, USA. 5. Department of Psychiatry, University of Groningen, Groningen, the Netherlands. 6. Department of Specialized Trainings, GGZ Drenthe Mental Health Institute, University Medical Center, Assen, the Netherlands. 7. School of Medicine, University of California, San Francisco, San Francisco, California, USA. 8. Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, USA. 9. Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA. 10. Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Butler Hospital, and Providence VA Medical Center, Providence, Rhode Island, USA. 11. Department of Psychiatry, Psychiatric and Neurodevelopmental Genetics Unit, Massachusetts General Hospital, Boston, Massachusetts, USA. 12. Department of Psychiatry and Genetics Institute, University of Florida College of Medicine, Gainesville, Florida, USA. 13. Yale Child Study Center and Department of Genetics, Yale University School of Medicine, New Haven, Connecticut, USA. 14. Department of Cell Biology, SUNY Downstate Medical Center College of Medicine, Brooklyn, New York, USA. 15. Department of Behavioral Health, Tripler Army Medical Center, Honolulu, Hawaii, USA. 16. Division of Human Genetics, Institute for Basic Research in Developmental Disabilities (IBR), Staten Island, New York, USA. 17. Biology PhD Program, The Graduate Center, The City University of New York, New York, New York, USA. 18. Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles School of Medicine, Los Angeles, California, USA. 19. Department of Psychiatry, University College of London, London, United Kingdom. 20. Department of Neurology and Neurosurgery, Montreal Neurological Institute-Hospital, McGill University, Montreal, Quebec, Canada. 21. Department of Psychiatry, University of Toronto and University Health Network, Toronto, Ontario, Canada. 22. Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Abstract
BACKGROUND: Persistent motor or vocal tic disorder (PMVT) has been hypothesized to be a forme fruste of Tourette syndrome (TS). Although the primary diagnostic criterion for PMVT (presence of motor or vocal tics, but not both) is clear, less is known about its clinical presentation. OBJECTIVE: The goals of this study were to compare the prevalence and number of comorbid psychiatric disorders, tic severity, age at tic onset, and family history for TS and PMVT. METHODS: We analyzed data from two independent cohorts using generalized linear equations and confirmed our findings using meta-analyses, incorporating data from previously published literature. RESULTS: Rates of obsessive-compulsive disorder (OCD) and attention deficit hyperactivity disorder (ADHD) were lower in PMVT than in TS in all analyses. Other psychiatric comorbidities occurred with similar frequencies in PMVT and TS in both cohorts, although meta-analyses suggested lower rates of most psychiatric disorders in PMVT compared with TS. ADHD and OCD increased the odds of comorbid mood, anxiety, substance use, and disruptive behaviors, and accounted for observed differences between PMVT and TS. Age of tic onset was approximately 2 years later, and tic severity was lower in PMVT than in TS. First-degree relatives had elevated rates of TS, PMVT, OCD, and ADHD compared with population prevalences, with rates of TS equal to or greater than PMVT rates. CONCLUSIONS: Our findings support the hypothesis that PMVT and TS occur along a clinical spectrum in which TS is a more severe and PMVT a less severe manifestation of a continuous neurodevelopmental tic spectrum disorder.
BACKGROUND: Persistent motor or vocal tic disorder (PMVT) has been hypothesized to be a forme fruste of Tourette syndrome (TS). Although the primary diagnostic criterion for PMVT (presence of motor or vocal tics, but not both) is clear, less is known about its clinical presentation. OBJECTIVE: The goals of this study were to compare the prevalence and number of comorbid psychiatric disorders, tic severity, age at tic onset, and family history for TS and PMVT. METHODS: We analyzed data from two independent cohorts using generalized linear equations and confirmed our findings using meta-analyses, incorporating data from previously published literature. RESULTS: Rates of obsessive-compulsive disorder (OCD) and attention deficit hyperactivity disorder (ADHD) were lower in PMVT than in TS in all analyses. Other psychiatric comorbidities occurred with similar frequencies in PMVT and TS in both cohorts, although meta-analyses suggested lower rates of most psychiatric disorders in PMVT compared with TS. ADHD and OCD increased the odds of comorbid mood, anxiety, substance use, and disruptive behaviors, and accounted for observed differences between PMVT and TS. Age of tic onset was approximately 2 years later, and tic severity was lower in PMVT than in TS. First-degree relatives had elevated rates of TS, PMVT, OCD, and ADHD compared with population prevalences, with rates of TS equal to or greater than PMVT rates. CONCLUSIONS: Our findings support the hypothesis that PMVT and TS occur along a clinical spectrum in which TS is a more severe and PMVT a less severe manifestation of a continuous neurodevelopmental tic spectrum disorder.
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