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Am J Psychiatry 1992; 149:1244-1251
Copyright © 1992 by American Psychiatric Association
Tics and Tourette's disorder: a 2- to 7-year follow-up of 54 obsessive- compulsive children
HL Leonard, MC Lenane, SE Swedo, DC Rettew, ES Gershon and JL Rapoport
Child Psychiatry Branch, NIMH, Bethesda, MD 20892.
OBJECTIVE: This study examined a hypothesized etiologic relationship
between Tourette's disorder and obsessive-compulsive disorder. METHOD:
Fifty-four children who had initially participated in treatment protocols
for obsessive-compulsive disorder (Tourette's disorder was an exclusionary
criterion) were reevaluated 2-7 years later with a neurological examination
and a structured interview to establish the presence or absence of tics and
Tourette's disorder. The children's first-degree relatives (N = 171) were
also screened for tic disorders. RESULTS: At baseline, 57% (N = 31) of the
patients had lifetime histories of tics. At follow-up, 59% (N = 32) had
lifetime histories of tics; eight of these (all males) met the criteria for
Tourette's disorder (six had developed the disorder, and two, it could be
argued in retrospect, might have met the criteria at baseline). The
patients with lifetime histories of tics had greater anxiety, a higher
ratio of CSF 5-hydroxyindoleacetic acid to homovanillic acid, and a younger
age at onset of obsessive-compulsive disorder than those without tics. The
patients with Tourette's disorder differed from other male patients only in
having an earlier age at onset of obsessive-compulsive disorder. Of the
first-degree relatives, 1.8% (N = 3) had Tourette's disorder, and 14% (N =
24) had a tic disorder. CONCLUSIONS: Except for their earlier age at onset
of obsessive-compulsive disorder, the patients with Tourette's disorder
were indistinguishable from those without. The apparent high rate of tics
and Tourette's disorder in the subjects and their relatives is consistent
with the hypothesis that in some cases, obsessive-compulsive disorder and
Tourette's disorder may be alternative manifestations of the same
underlying illness.
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