Descriptive Psychopathology: The Signs and Symptoms of ...

299 Chapter 12: Obsessive–compulsive behaviorsmore episodic and less severe than OCD patients without co-occurring manicdepression.47 Childhood onset OCD is also associated with early onset mooddisorder. 48 The pattern suggests the manic-depression dominates the clinicalpicture. 49 Patients with manic-depression, however, do not have an increasedrisk for the OCD spectrum, although they do binge eat (see below).The early emergence of OCD is also associated with PANDAS (see below),developmental disorders, and chromosomal aberrations (fragile-X). 50 When themania and OCD both are of late onset, secondary etiology such right-basalganglia stroke and stimulant abuse is found. 51Secondary OCD (other than PANDAS) typically emerges later in life than theprimary form. Secondary OCD is associated with Sydenham’s chorea, Parkinson’sand Huntington’s diseases, and basal ganglia stroke. 52Gilles de La Tourette’s syndrome (GTS 53 )In 1885, Georges Gilles de La Tourette described the syndrome named for him as“a nervous affliction” expressed as lack of motor coordination with associatedechophenomena. 54 GTS is now understood to be characterized by obsessions andcompulsions, tic disorder, and behavioral and sleep disturbances. Half of GTSpatients have classic OCD features. 55Tics are sudden, involuntary movements that can only be suppressed temporarilyand only with difficulty. Tics of the eyes and head are the most frequentinitial feature (about 50% of sufferers). They do not disappear during sleep.Simple tics evolve into shrugging and neck twisting and then semi-purposefulsniffing, squinting, touching, hitting or striking, jumping or foot stamping, headbanging, lip biting, eye gouging, smelling of hands and objects, twirling, squattingand deep knee bending, and repeated retracing of one’s steps. A third of patientssustain substantial injury from these actions. Most will also have uncomfortablesensory experiences of the face, head, neck, and extremities, termed sensory tics.These are temporarily relieved by performing a movement in the related body area.Tic disorders phenomenologically lie on a continuum. Fifteen to 20% ofprimary school children experience transitory tics problems, most commonlyprolonged blinking and other facial movements, and nose rubbing. Transitoryepisodes of a few weeks or months of vocalizations such as excessive throatclearing are less common. Repeated licking of the hands or touching the genitaliais reported. For some children these tic episodes persist for years. Others progressto the full GTS.Forced vocalizations are the first sign of illness in one-third of patients andconsist of repeated throat-clearing, clicking, teeth tapping and then the utteranceof words and short phrases. Grunting, coughing, barking, snorting, hissing,propulsive unintelligible sounds and screaming occur. Coprolalia, uncontrollable