Download Neurological and anxiety disorders pp

What is Tourettes Syndrome?
• Inherited neurological condition
• 1/100 School children
• 300,000+ children and adults in the UK
• 1:4 girls to boys
• Complex condition with a wide spectrum
Symptoms
Relative likelihood of lifetime sensory tics in a given
region as based on a self-report of patients with TS
Causes
•The Basal Ganglia
-specialised brain cells involved in helping regulate the physical movements of the body
-higher brain functions such as motivation and decision-making
-temporary disruption scrambling decision making - sudden development unconscious motivation to perform an action
(the tic) that the conscious mind regards as both unwanted and unexplained
-MRI and PET scans show different structure
•Dopamine theory
-excessive levels for a person with TS effecting Basal Ganglia
-alternatively normal dopamine level but TS more sensitive to its effects
•Genetics
-inherited - 50%
-in twins if one has TS other ½ chance
•Childhood infection
-streptococcal throat infections, antibodies causing abnormal immune reaction
•Other possible environmental factors contributing to onset or severity:
-pregnancy and birth related problems
-complications during pregnancy,
-smoking during pregnancy,
-severe nausea and/or vomiting during the first trimester
-premature low birth weight children
MRI
Diagnosis
Other possibilities to rule out:
•
Allergies – sniffing, coughing
•
Vision problems - blinking
•
Autistic spectrum disorder
•
Dystonia – condition causing involuntary muscle spasms
•
Huntington's disease – genetic condition that can cause a range of symptoms including muscle twitching
Referral
•
Neurologist – a doctor who specialises in treating conditions that affect the brain and nervous system
•
Psychiatrist – a doctor who specialises in treating mental health conditions
•
Educational psychologist - a health professional who works with children who have learning, developmental or
behavioural difficulties
•
•
computerised tomography (CT) scan – where a series of X-Rays are taken to build up a detailed 3D image of the
brain
magnetic resonance imaging (MRI) scan – where strong fluctuating magnetic fields are used to produce a detailed
image of the inside of the brain
Confirming the diagnosis
•
Not caused by other medical conditions or medication
•
Tics started before the age of 18.
•
Several physical tics and at least one phonic tic.
•
Tics occur many times during the day, nearly every day
•
Tics have been present for at least a year.
Research and Treatment
• No cure at present
• Medication: alpha2-adrenergic agonists (release
noradrenaline, stabilize norepinephrine, clonidine), muscle
relaxants and neuroleptics (risperidone, benzimides)
• Therapy: behavioural, psychotherapy, muscle relaxation
• Surgery : Limbic leucotomy, Deep Brain Stimulation
Obsessive compulsive disorder
• Anxiety Disorder
• chronic (long-term) mental health condition
associated with obsessive thoughts and
compulsive behaviour
• OCD is one of the most common mental health
conditions. It is estimated that up to 3 in 100
adults and up to 5 in 100 children and teenagers
have OCD
Symptoms
Intrusive thoughts
-intentionally causing harm
-unintentionally causing harm
-fear of contamination
-need for symmetry or orderliness
-committing offensive acts
Common Compulsions
• cleaning
• hand washing
• checking – such as checking that doors
are locked, or that the gas or a tap is
off
• counting
• ordering and arranging
• hoarding
• asking for reassurance
• needing to confess
• repeating words silently
• prolonged thoughts about the same
subject
Causes
• Genetic
-No specific gene isolated
-But 4 times likely to inherit OCD if a family member has it
• Brain abnormalities
-Increased blood flow and activity
-Increased level of neurotransmitter serotonin
-Streptococcal throat infections, antibodies causing abnormal immune reaction
• Life events, coping mechanisms and
stress
PET scan showing increased brain
activity due to hyper-vigilance
Diagnosis
• GP questionnaire
• Psychiatrist
• Educational psychologist
Research and Treatment
• Based on severity
•
•
•
mild functional impairment – obsessive thinking and compulsive behaviour
occupy less than one hour of your day
moderate functional impairment – obsessive thinking and compulsive
behaviour occupy one to three hours of your day
severe functional impairment – obsessive thinking and compulsive behaviour
occupy more than three hours of your day
• CBT, psychotherapy
• Anti-anxiety medication
• Surgery : Limbic leucotomy, Deep Brain
Stimulation
Comorbidities
• Over 85 percent of people with TS have more
than just tics.
• 60% have OCD
• 70% have attention deficit hyperactivity disorder
(ADHD).
• More susceptible to fits of rage, depression and
sleep disturbances
• Co-morbidities often present more problems
than the tics and can be less visible.