title: Comorbidities, Social Impact, and Quality of Life in Tourette Syndrome.
abstract: Tourette syndrome (TS) is more than having motor and vocal tics, and this review will examine the varied comorbidities as well as the social impact and quality of life (QoL) in individuals with TS. The relationship between any individual and his/her environment is complex, and this is further exaggerated in the case of a person with TS. For example, tics may play a significant role in shaping the person's experiences, perceptions, and interactions with the environment. Furthermore, associated clinical features, comorbidities, and coexisting psychopathologies may compound or alter this relationship. In this regard, the common comorbidities include attention-deficit hyperactivity disorder and disruptive behaviors, obsessive compulsive disorder, and autism spectrum disorder, and coexistent problems include anxiety, depression, and low self-esteem, which can all lead to poorer psychosocial functioning and QoL. Thus, the symptoms of TS and the associated comorbid conditions may interact to result in a vicious cycle or a downward spiraling of negative experiences and poor QoL. The stigma and social maladjustment in TS and the social exclusion, bullying, and discrimination are considered to be caused in large part by misperceptions of the disorder by teachers, peers, and the wider community. Improved community and professional awareness about TS and related comorbidities and other psychopathologies as well as the provision of multidisciplinary services to meet the complex needs of this clinical population are critical. Future research to inform the risk and resilience factors for successful long-term outcomes is also warranted.
authors.affiliation: School of Psychiatry, University of New South Wales, Sydney, NSW, Australia; Academic Unit of Child Psychiatry, Ingham Institute, Sydney South Western Local Health District, Sydney, NSW, Australia.
authors.forename: Valsamma
authors.initials: V
authors.lastname: Eapen
authors.affiliation: Department of Neuropsychiatry, Birmingham and Solihull Mental Health NHS Foundation Trust, Birmingham, UK; Aston Brain Centre, School of Life and Health Sciences, Aston University, Birmingham, UK; Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, University College London (UCL), London, UK.
authors.forename: Andrea E
authors.initials: AE
authors.lastname: Cavanna
authors.affiliation: Neuropsychiatry, University College London (UCL), London, UK; St Georges Hospital and Medical School, London, UK; Department of Psychiatry, University of Cape Town, Cape Town, South Africa.
authors.forename: Mary M
authors.initials: MM
authors.lastname: Robertson
keywords: Tourette syndrome; attention-deficit hyperactivity disorder; autism spectrum disorder; comorbidity; obsessive compulsive disorder; psychopathology; psychosocial; quality of life