Cultural influences on diagnosis and perception of Tourette syndrome in Costa Rica.
OBJECTIVE
Tourette syndrome (TS) is a neuropsychiatric disorder in which the pattern of symptom presentation can vary greatly between individuals. Although globally described, TS has not been well characterized in many parts of the world. Differences in individual and cultural perceptions of TS may impact its expression and recognition in some countries, confounding the identification of affected individuals. This study examines the phenomenology and presentation of TS in Costa Rica.


METHODS
Clinical data on 85 Costa Rican subjects with TS (aged 5-29 years) initially recruited for a genetic study between 1996 and early 2000 were obtained by direct interview and review of medical records.


RESULTS
The clinical characteristics of TS were similar to that found elsewhere. The gender ratio was 4.6:1, the mean age of onset was 6.1 years, and 20% of subjects had coprolalia. However, the perceived impact of TS was different. Many subjects denied that their TS caused impairment or distress, even when objective evidence of impairment was available.


CONCLUSIONS
TS in Costa Rica is phenomenologically similar to TS seen in other parts of the world, but differs in perceived impairment. In other countries where cultural forces affect disease definition, close scrutiny of symptom expression and possible adjustment of phenotype definition may be important.
Mathews
C A
CA
Department of Psychiatry, University of California at San Francisco, 401 Parnassus Avenue, Box NGL-0984, San Francisco, CA 94143, USA. cmathews@ngl.ucsf.edu
Herrera Amighetti
L D
LD
Lowe
T L
TL
van de Wetering
B J
BJ
Freimer
N B
NB
Reus
V I
VI
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003364:Costa Rica / Q000208:ethnology; D003466:Cultural Characteristics; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D011639:Public Opinion; D012720:Severity of Illness Index; D005879:Tourette Syndrome / Q000175:diagnosis* / Q000208:ethnology*