Obsessivecompulsive disorder and tics in children and adolescents

Martine F. Flament and Nadia Chabane

Introduction Clinical features

Aqe.of.onset Sexratio Comorbidity Classification

Obsessive-compulsiye., disorder

Tic.. .disorders

Diagnosis and ..differential diagnosis

Epidemiology

Aetiology

Psychological.. factors Biochemical .factors Genetic.factors

Dysfunction.. of.the. iro.ntal-s.u.bco.rîic.alM.clrc.uits Autoim.mMne..factors

Course ..and...prognosis Treatment Evidence

Psychopharmacological.. treatment Cognitive-behavioMral ..therapy

Management

Possibilities ..fo.r..preve.n.tio.n

Conclusions

Chapter. References

Note Habit disorders are considered in Part 4, Se£tlORl.l3- Trichotillomania, including aspects relevant to young peop/e, is described in ChapterJ.13.2. Introduction

Although obsessive-compulsive disorder (OCD) has long been considered as an adult disorder, the child psychiatric literature contains early descriptions of typical cases. At the beginning of the twentieth century, Janet reported on a 5-year-old with classical obsessive-compulsive symptoms, and Freud described in his adult patients obsessional behaviours dating back from childhood, while speculating on the strong constitutional influence in the choice of these symptoms. In 1957 Kanner(1.) noted the resemblance and sometimes the association between compulsive movements and tics, and in 1955 Despert(2) described the first large series of obsessive-compulsive children (N = 68), noting the preponderance of males and the children's perception of the abnormality and undesirability of their behaviours.

Tics have been described since antiquity, but the first systematic reports are those of Itard, in 1825, and Gilles de la Tourette, in 1885, who noted the association between tic disorders and obsessive-compulsive symptoms, and speculated on the hereditary nature of the syndrome.

Over the past two decades, there has been a tremendous growth of interest and research on OCD and tic disorders. Significant advances have occurred regarding the phenomenology, epidemiology, genetics, neurophysiology, pathogenesis, and treatment of both disorders. The frequent association of OCD with tic disorders, as well as with other neuropsychiatric disorders, has led to a fascinating aspect of current neurobiological research—the possible localization of brain circuits mediating the abnormal behaviours. OCD and tic disorders now appear as model neurobiological disorders to investigate the role of genetic, neurobiological, and environmental mechanisms that interact to produce clinical syndromes of varying severity.

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