Repetitive behaviours in patients with Gilles de la Tourette syndrome: tics, compulsions, or both?
BACKGROUND
Repetitive behaviours (RB) in patients with Gilles de la Tourette syndrome (GTS) are frequent. However, a controversy persists whether they are manifestations of obsessive-compulsive disorder (OCD) or correspond to complex tics.


METHODS
166 consecutive patients with GTS aged 15-68 years were recruited and submitted to extensive neurological, psychiatric and psychological evaluations. RB were evaluated by the YBOCS symptom checklist and Mini International Neuropsychiatric Interview (M.I.N.I), and classified on the basis of a semi-directive psychiatric interview as compulsions or tics.


RESULTS
RB were present in 64.4% of patients with GTS (107/166) and categorised into 3 major groups: a 'tic-like' group (24.3%-40/166) characterised by RB such as touching, counting, 'just right' and symmetry searching; an 'OCD-like' group (20.5%-34/166) with washing and checking rituals; and a 'mixed' group (13.2%-22/166) with both 'tics-like' and 'OCD-like' types of RB present in the same patient. In 6.3% of patients, RB could not be classified into any of these groups and were thus considered 'undetermined'.


CONCLUSIONS
The results confirm the phenomenological heterogeneity of RB in GTS patients and allows to distinguish two types: tic-like behaviours which are very likely an integral part of GTS; and OCD-like behaviours, which can be considered as a comorbid condition of GTS and were correlated with higher score of complex tics, neuroleptic and SSRIs treatment frequency and less successful socio-professional adaptation. We suggest that a meticulous semiological analysis of RB in GTS patients will help to tailor treatment and allow to better classify patients for future pathophysiologic studies.


BACKGROUND
ClinicalTrials.gov NCT00169351.
Worbe
Yulia
Y
Centre d'Investigation Clinique INSERM CIC 9503, Pôle des Maladies du Système Nerveux, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, Université Pierre et Marie Curie-Paris 6, Paris, France.
Mallet
Luc
L
Golmard
Jean-Louis
JL
Béhar
Cécile
C
Durif
Franck
F
Jalenques
Isabelle
I
Damier
Philippe
P
Derkinderen
Pascal
P
Pollak
Pierre
P
Anheim
Mathieu
M
Broussolle
Emannuel
E
Xie
Jing
J
Mesnage
Valérie
V
Mondon
Karl
K
Viallet
François
F
Jedynak
Pierre
P
Ben Djebara
Mouna
M
Schüpbach
Michael
M
Pelissolo
Antoine
A
Vidailhet
Marie
M
Agid
Yves
Y
Houeto
Jean-Luc
JL
Hartmann
Andreas
A
D000293:Adolescent; D000328:Adult; D000368:Aged; D003192:Compulsive Behavior; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009771:Obsessive-Compulsive Disorder / Q000175:diagnosis / Q000523:psychology*; D020323:Tics / Q000175:diagnosis / Q000523:psychology; D005879:Tourette Syndrome / Q000175:diagnosis / Q000523:psychology*; D055815:Young Adult