Tic disorders

In both DSM-IV and ICD-10, tic disorders are divided into four categories, according to duration of the symptoms and presence of vocal tics in addition to motor tics: Tourette's disorder, chronic motor or vocal tic disorder, transient tic disorder, and tic disorder not otherwise specified. By definition, all tic disorders must have onset before age 18 years (criterion D). In all, the disturbance causes marked distress or significant impairment in social, occupational, or other important areas of functioning (criterion C in DSM-IV), and is not due to the direct physiological effects of a substance or a general medical condition (criterion E in DSM-IV, and criterion C in ICD-10). Transient tic disorder is defined by single or multiple motor and/or vocal tics (criterion A) that occur many times a day, nearly everyday for at least 4 weeks, but for no longer than 12 consecutive months (criterion B). Both Tourette's disorder and chronic motor or vocal tic disorder each have a duration of more than 1 year, with no tic-free period of more than 3 months (criterion B). In Tourette's disorder, both multiple motor and one or more vocal tic have to be present, although not necessarily concurrently (criterion A), while in chronic motor or vocal tic disorder, either motor or vocal tics, but not both, have been present at some time during illness (criterion A).

The major difference between ICD-10 and DSM-IV concerns the comorbidity between Tourette's disorder and OCD. In ICD-10, it is stated that OCD cannot be diagnosed if the patient meets Tourette's disorder criteria, while both diagnoses may be given simultaneously in DSM-IV.

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