title: Tourette syndrome, co-morbidities and quality of life.
abstract: OBJECTIVE
  Tourette syndrome is often associated with attention deficit hyperactivity disorder, obsessive compulsive disorder and other co-morbidities, the presence of which can reduce health-related quality of life. The relationship between the number and type of co-morbidities and tic severity upon health-related quality of life has been insufficiently examined in Tourette syndrome populations and not at all in the Australian context. We hypothesised that an increased number of co-morbid diagnoses would be inversely related to health-related quality of life and that the presence of attention deficit hyperactivity disorder and obsessive compulsive disorder in particular would negatively impact health-related quality of life.
  
  
  METHODS
  In all, 83 people with a previously established diagnosis of Tourette syndrome, who responded to a letter of invitation sent to the Tourette Syndrome Association of Australia past-member database, formed the study sample. Participants completed the Gilles de la Tourette Syndrome-Quality of Life Scale and a short form of the National Hospital Interview Schedule to assess tics and related behaviours.
  
  
  RESULTS
  Participants with pure-Tourette syndrome had significantly better health-related quality of life than those with Tourette syndrome and three or more co-morbid diagnoses. Few differences were observed between the pure-Tourette syndrome and Tourette syndrome and one or two co-morbid diagnoses groups. Analysis of the impact of individual co-morbid disorders and Tourette syndrome symptoms on health-related quality of life indicated that attention deficit hyperactivity disorder exerted a significant negative effect, as did the presence of complex tics, especially coprolalia and copropraxia. When these variables were examined in multiple regression analysis, number of co-morbidities and the presence of coprophenomena emerged as significant predictors of health-related quality of life.
  
  
  CONCLUSIONS
  While tics are the defining feature of Tourette syndrome, it appears to be the presence of co-morbidities, attention deficit hyperactivity disorder, in particular, and coprophenomena that have the greater impact on health-related quality of life. This has implications for symptom-targeting in the treatment of Tourette syndrome since all available treatments are symptomatic and not disease modifying.
authors.affiliation: School of Psychiatry, University of New South Wales, Sydney, NSW, Australia Academic Unit of Child Psychiatry, South Western Sydney Local Health District (AUCS) & Ingham Institute, Liverpool, NSW, Australia v.eapen@unsw.edu.au.
authors.forename: Valsamma
authors.initials: V
authors.lastname: Eapen
authors.affiliation: Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.
authors.forename: Corina
authors.initials: C
authors.lastname: Snedden
authors.affiliation: School of Psychiatry, University of New South Wales, Sydney, NSW, Australia Academic Unit of Child Psychiatry, South Western Sydney Local Health District (AUCS) & Ingham Institute, Liverpool, NSW, Australia.
authors.forename: Rudi
authors.initials: R
authors.lastname: Črnčec
authors.affiliation: Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.
authors.forename: Anna
authors.initials: A
authors.lastname: Pick
authors.affiliation: School of Psychiatry, University of New South Wales, Sydney, NSW, Australia Centre for Healthy Brain Ageing (CHeBA), University of New South Wales, Sydney, NSW, Australia Neuropsychiatric Institute, Prince of Wales Hospital, Randwick, NSW, Australia.
authors.forename: Perminder
authors.initials: P
authors.lastname: Sachdev
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001008:Anxiety Disorders / Q000453:epidemiology / Q000523:psychology; D001289:Attention Deficit Disorder with Hyperactivity / Q000453:epidemiology* / Q000523:psychology; D019958:Attention Deficit and Disruptive Behavior Disorders / Q000453:epidemiology / Q000523:psychology; D001315:Australia / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D019955:Conduct Disorder / Q000453:epidemiology / Q000523:psychology; D003866:Depressive Disorder / Q000453:epidemiology* / Q000523:psychology; D005260:Female; D006801:Humans; D007859:Learning Disabilities / Q000453:epidemiology* / Q000523:psychology; D008297:Male; D008875:Middle Aged; D009771:Obsessive-Compulsive Disorder / Q000453:epidemiology* / Q000523:psychology; D011788:Quality of Life / Q000523:psychology*; D012559:Schizophrenia / Q000453:epidemiology; D012565:Schizophrenic Psychology; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology / Q000523:psychology; D005879:Tourette Syndrome / Q000453:epidemiology* / Q000523:psychology; D055815:Young Adult
keywords: Tourette syndrome; attention deficit hyperactivity disorder; obsessive compulsive disorder; quality of life