title: Repetitive behaviours in patients with Gilles de la Tourette syndrome: tics, compulsions, or both?
abstract: 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.
authors.affiliation: 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.
authors.forename: Yulia
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authors.forename: Jean-Louis
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authors.forename: Cécile
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authors.lastname: Durif
authors.forename: Isabelle
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authors.forename: Philippe
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authors.lastname: Damier
authors.forename: Pascal
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authors.forename: Jing
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authors.forename: Marie
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authors.lastname: Vidailhet
authors.forename: Yves
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mesh_terms: 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