title: The Modulating Role of Stress in the Onset and Course of Tourette's Syndrome: A Review.
abstract: Accumulating data indicate a common occurrence of tic exacerbations and periods of psychosocial stress. Patients with Tourette's syndrome (TS) also exhibit aberrant markers of hypothalamic-pituitary-adrenal (HPA) axis activation. Based on these findings, a functional relationship between stress and tic disorders has been suggested, but the underlying mechanism of how stress may affect tic pathology remains to be elucidated. We suggest that dopaminergic and noradrenergic neurotransmission as well as immunology play a crucial role in mediating this relationship. Two possibilities of causal direction might be assumed: (a) psychosocial stress might lead to an exacerbation of tics via activation of HPA axis and subsequent changes in neurotransmission or immunology and (b) TS-related abnormalities in neurotransmission or immunology result in a higher vulnerability of affected patients to respond to psychosocial stress with a strong activation of the HPA axis. It may also be the case that both assumptions hold true and interact with each other.
authors: Department of Child and Adolescent Psychiatry, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Germany.
authors: Judith
authors: J
authors: Buse
authors: Institute of Biopsychology, Department of Psychology, Technische Universität Dresden.
authors: Clemens
authors: C
authors: Kirschbaum
authors: Child Study Center and Departments of Paediatrics, Psychiatry, and Psychology, Yale University School of Medicine, New Haven, CT, USA.
authors: James F
authors: JF
authors: Leckman
authors: Department of Pediatric and Adult Movement Disorders and Neuropsychiatry, Institute of Neurogenetics, University of Lübeck, Germany.
authors: Alexander
authors: A
authors: Münchau
authors: Department of Child and Adolescent Psychiatry, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Germany veit.roessner@uniklinikum-dresden.de.
authors: Veit
authors: V
authors: Roessner
mesh_terms: D006801:Humans; D006854:Hydrocortisone / Q000378:metabolism; D007030:Hypothalamo-Hypophyseal System / Q000503:physiopathology; D010913:Pituitary-Adrenal System / Q000503:physiopathology; D013312:Stress, Physiological / Q000276:immunology; D013315:Stress, Psychological / Q000150:complications* / Q000276:immunology; D009435:Synaptic Transmission / Q000276:immunology; D005879:Tourette Syndrome / Q000150:complications* / Q000503:physiopathology*
chemical_list: D006854:Hydrocortisone
keywords: HPA axis; Tourette’s syndrome; cortisol; dopamine; immunology; stress; tics