Original Research Reports Somatic Complaints in Childhood Tic Disorders MARY S. FRANK, M.D. KARL G. SIEG, M.D. GARY R. GAFFNEY, M.D.
Twenty-six children diagnosed with chronic tic disorders (/8 with Gilles de la Tourette syndrome and 8 with chronic motor tic disorder) were studied/or unexplained physical complaints. Compared to normal controls. an excess 0/ somatic complaints was found in the tic disorders group; this was similar to an excess 0/ somatic complaints in a mixed psychiatric clinic group. Medication produced no significant effect on somatic complaints/or patients in the tic and psychiatric clinic groups. Within the tic disorders group. no significant correlation was/ound between the increased somatic complaints and the severity 0/ anxiety. dysphoria. or movement disorder.
T
ourette syndrome (TS) consists of multiple motor and one or more vocal tics that vary with presentation and intensity over time. with a duration of at least 1 year. The median age of onset is 7 years. with the great majority of patients having onset before age 14. I Chronic motor tic (CMT) and chronic vocal tic (CVT) disorder respectively consist of either motor or vocal tics (but not both) of at least a I-year duration. I CMT and CVT are considered less morbid forms of illness in the spectrum of TSY Patients diagnosed with these disorders are commonly perceived as having frequent somatic complaints. Although one study reports hysteria in TS. 3 current literature fails to address the relation of CMT
Received December 15. 1989; revised August 20. 1990; accepted September 14. 1990. From the Neuropsychiatric Movement Disorders Clinic. the Division of Child and Adolescent Psychiatry. and the Depanment ofPsychiatry•University of Kansas Medical Center. Kansas City. Kansas. Address reprint requests to Dr. Gaffney. Department of Psychiatry. KUMC. 39th and Rainbow Boulevard. Kansas City. KS 66160. Copyright © 1991 The Academy of Psychosomatic Medicine. 396
or TS to increased somatic complaints. The purpose of this study is to evaluate the incidence of somatic complaints in children with tic disorders. METHODS Patients were seen and diagnosed (by G.R.G.) in a specialty clinic at the University of Kansas Medical Center. Division of Child Psychiatry. between August 1986 and March 1988. Subjects included a group of 26 patients diagnosed with chronic tic disorders. including 18 patients with TS and 8 patients with CMT. One comparison group included 46 child psychiatry clinic patients with mixed diagnoses. excluding tic disorders (Table 1). Patients were evaluated by obtaining medical and psychiatric histories. as wen as by physical examination. Diagnoses were made according to the American Psychiatric Association DSM-III-R. Comorbid disorders of the ticlTourette patients were identified and then stratified into three groups: disruptive behavior disorders, developmental disorders. affective disorders. and no comorbid disorder. When analyzed by group. no significant PSYCHOSOMATICS
Frank et al.
TABLE I. Distribution of patients and control subjects by diagnosis. sex. and medication Diagnostic Group Tic disorders Tourelte syndrome CMTgroup Mixed clinical group withoullics Normal control group Total subjects
TABLE 2.
Male
Female
Unmedicated
Medicated
Total
22
4
14
12
14
4
9
9
26 18
II
0
5
35 19
II II
36 30
3 10 0
8 46
76
26
llO
22
102
30
Mean ages (±SOl of patients and control subjects Patients
Diagnostic Group
Unmedicated
(n)
Medicated
(n)
Combined (n)
Chronic tic disorders
10.2±2.5 (14)
Il.ll±2.7 (12)
11.0±2.7 (26)
Mixed clinical group withoullics
10.6±3.4 (36)
11.5±2.6 (10)
IO.1l±3.3 (46)
Normal control group
TABLE 3.
9.4±5.4 (30)
9.4±5.4 (30)
Mean somatic complaint scores ± SO of patients and control subjects Patients
Diagnostic (;roup
Unmedicated (n)'
Medicated
(n)
Chronic tic disorders
2.9±2.3 (14)"
2.9±2.9 (12)"
Mixed clinical group without tics
2.3±2.7 (36)"
1.4±2.0 ( 10)"
Normal control group
0.7± 1.3 (30)
Combined (n)' 2.9±2.5 (26) 2.1±2.6 (46) 0.7±1.3 (30)
·p
Twenty-six children diagnosed with chronic tic disorders (/8 with Gilles de la Tourette syndrome and 8 with chronic motor tic disorder) were studied/or unexplained physical complaints. Compared to normal controls. an excess 0/ somatic complaints was found in the tic disorders group; this was similar to an excess 0/ somatic complaints in a mixed psychiatric clinic group. Medication produced no significant effect on somatic complaints/or patients in the tic and psychiatric clinic groups. Within the tic disorders group. no significant correlation was/ound between the increased somatic complaints and the severity 0/ anxiety. dysphoria. or movement disorder.
T
ourette syndrome (TS) consists of multiple motor and one or more vocal tics that vary with presentation and intensity over time. with a duration of at least 1 year. The median age of onset is 7 years. with the great majority of patients having onset before age 14. I Chronic motor tic (CMT) and chronic vocal tic (CVT) disorder respectively consist of either motor or vocal tics (but not both) of at least a I-year duration. I CMT and CVT are considered less morbid forms of illness in the spectrum of TSY Patients diagnosed with these disorders are commonly perceived as having frequent somatic complaints. Although one study reports hysteria in TS. 3 current literature fails to address the relation of CMT
Received December 15. 1989; revised August 20. 1990; accepted September 14. 1990. From the Neuropsychiatric Movement Disorders Clinic. the Division of Child and Adolescent Psychiatry. and the Depanment ofPsychiatry•University of Kansas Medical Center. Kansas City. Kansas. Address reprint requests to Dr. Gaffney. Department of Psychiatry. KUMC. 39th and Rainbow Boulevard. Kansas City. KS 66160. Copyright © 1991 The Academy of Psychosomatic Medicine. 396
or TS to increased somatic complaints. The purpose of this study is to evaluate the incidence of somatic complaints in children with tic disorders. METHODS Patients were seen and diagnosed (by G.R.G.) in a specialty clinic at the University of Kansas Medical Center. Division of Child Psychiatry. between August 1986 and March 1988. Subjects included a group of 26 patients diagnosed with chronic tic disorders. including 18 patients with TS and 8 patients with CMT. One comparison group included 46 child psychiatry clinic patients with mixed diagnoses. excluding tic disorders (Table 1). Patients were evaluated by obtaining medical and psychiatric histories. as wen as by physical examination. Diagnoses were made according to the American Psychiatric Association DSM-III-R. Comorbid disorders of the ticlTourette patients were identified and then stratified into three groups: disruptive behavior disorders, developmental disorders. affective disorders. and no comorbid disorder. When analyzed by group. no significant PSYCHOSOMATICS
Frank et al.
TABLE I. Distribution of patients and control subjects by diagnosis. sex. and medication Diagnostic Group Tic disorders Tourelte syndrome CMTgroup Mixed clinical group withoullics Normal control group Total subjects
TABLE 2.
Male
Female
Unmedicated
Medicated
Total
22
4
14
12
14
4
9
9
26 18
II
0
5
35 19
II II
36 30
3 10 0
8 46
76
26
llO
22
102
30
Mean ages (±SOl of patients and control subjects Patients
Diagnostic Group
Unmedicated
(n)
Medicated
(n)
Combined (n)
Chronic tic disorders
10.2±2.5 (14)
Il.ll±2.7 (12)
11.0±2.7 (26)
Mixed clinical group withoullics
10.6±3.4 (36)
11.5±2.6 (10)
IO.1l±3.3 (46)
Normal control group
TABLE 3.
9.4±5.4 (30)
9.4±5.4 (30)
Mean somatic complaint scores ± SO of patients and control subjects Patients
Diagnostic (;roup
Unmedicated (n)'
Medicated
(n)
Chronic tic disorders
2.9±2.3 (14)"
2.9±2.9 (12)"
Mixed clinical group without tics
2.3±2.7 (36)"
1.4±2.0 ( 10)"
Normal control group
0.7± 1.3 (30)
Combined (n)' 2.9±2.5 (26) 2.1±2.6 (46) 0.7±1.3 (30)
·p
