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Tourette syndrome causes, signs and therapy
contents
- symptoms
- Social problems
- How can the syndrome be recognized??
- The social environment
- diagnosis
- A neuropsychiatric disorder
- causes
- Psychic consequences
- Desperate cases?
- aggressions
- therapy
- From the sick to the artist?
- Support Groups?
- The Tourette personality
- Insight into the brain
Tourette syndrome is a nervous disease with genetic causes. Key symptoms are tics, nervous twitching. It is a central nervous movement disorder. Affected are up to 0.9% of all children, in adults, the disorder occurs much less frequently. Since it is a biological disease, it is likely to be the same worldwide. Boys suffer from the disorder three times as often as girls.
The diagnosis is usually made in childhood. Image: Tourette syndrome / designer491 - fotolia symptoms
The main symptoms are the tics. These movements occur involuntarily, they start abruptly and sometimes are extremely extreme. These motor disturbances run individually or in series, but always in the same way.
These uncontrollable movements are accompanied by involuntary sounds, from words to croaks, coughing, shrieks, grunts, grunts, animal sounds or stereotypical exclamations, whistles, clucking their tongues, clearing their throat, squealing or giggling.
These tics usually show the affected as children, they increase and often increase during puberty. In some patients, the symptoms diminish after puberty, but most patients suffer from it throughout their lives.
The involuntary movements include: blinking, sneezing, throwing his head to one side, repeatedly pulling his shoulders up, throwing his head back, shaking with one or both hands, or bending the trunk sideways.
Affected jump, they touch other people, they smell of objects or people, some movements even lead to self-injury, for example, when patients hit their heads against the wall, or squeeze and twist their own skin.
More complex tics show up in the copying of the actions of others, that is, the echopraxia, or the imitation of their facial expressions. In addition, they speak the words of others like a parrot or, without triggers, emanate obscenities and aggressive concepts.
They also produce sentences that have no connection to the topic of a conversation, and they repeat the words that they themselves said (palilalia).
Social problems
This brings with it social problems. Copying the actions of others like a clown in the circus often interpret the aftereffects so that the person concerned makes fun of them. Skinning to bosses, friends, customers or strangers, calling them "asshole" in series or worse, or even separating words like "kill" has massive consequences.
Job loss, botched deals, insults, or a fist on the face are possible consequences.
In some people, the symptoms are permanent, in others at intervals, but then in series and again in other stressful situations. But the last ones do not necessarily have it any easier: Anyone who constantly shrugs his head or how a cat meows, stamps his social environment as "crazy", but it becomes clear that the tics are not meant personally.
On the other hand, whoever only grabs in stress situations, but otherwise behaves unobtrusively, others rather assume that he does that consciously. So who proves to be a "normal" employee, but just when crises talk with the boss quacks as a duck or "fuck" produces; Anyone who appears polite to customers, but is under time pressure, shouts at the buyer as a "pathetic wiper" - will not stay in a job for long.
How can the syndrome be recognized??
Some affected children have no explanation for their stingers; they do not know each other differently. Most parents then worry about the strange behavior. Unfortunately, they often suspect the wrong causes: they ask themselves what they have done wrong in education, they interpret the tics as restrained behavior and annoy, or they conclude on social triggers or psychological problems.
In fact, some socially-evoked diseases of the psyche have similar symptoms. Hospitalism, for example, the isolation of children in homes or concentration camps, caused motor disorders in series, which also run stereotyped, and the popular "Wackelkopf" discriminated. For animals in cramped enclosures, we talk about weaving when they stand in one place and constantly move their heads back and forth.
Because of the motor tics, worried parents sometimes conclude that their child is not physically busy or wants to attract attention. That would also be useful for mentally related problems - but that's not what Tourette's syndrome is.
The victims themselves feel "anticipation". For example, there is a tingling sensation in the abdomen, a feeling of tension in the neck, and immediately followed by a ticking. However, those affected usually do not notice twitching until they are already picking.
The social environment
The social environment, so parents, siblings, friends, classmates and colleagues are essential for the course of the disorder, especially the imprints of those affected in early childhood.
Such children are not learning disabilities compared to "normal", yet they often have problems at school. This is less due to the tics, but to the hyperactivity and the weakness of concentrating, which is often associated with Tourette syndrome.
The tics affect both the practical work in the school, for example, when the hand trembles while writing, but also bring social restrictions. For example, classmates sometimes make fun of the "quirks"; Anyone who grimaces in his face, repeats obscene words or jumps around in the classroom, is particularly suitable as a mocking object. This is especially true for puberty, when similar behavior by non-affected people serves the provocation.
Teachers are urged to integrate those affected into school life and find an individual solution. If they show motor symptoms that impede their writing, it helps to use computers instead of fountain pens; in the case of vocal thieves, they can leave the classroom.
If the social reactions to the symptoms lead to conspicuous behavior of the affected persons, be it sadness, depression or inner withdrawal, child psychiatry will help.
Parents can seek professional support to interpret the behavior. Children and teenagers with Tourette syndrome are first and foremost children and adolescents who, in addition to the problems of adolescence, have to process complaints that cause their disorder.
Parents are balancing between understanding, consistency and exaggerated care. Tourette patients can generally develop a "normal" everyday life, and overprotecting them is therefore wrong - especially for them, it is important to learn independence. This is the prerequisite for classifying and controlling the symptoms.
But when the parents take away all decisions from the "sick child," monitor his daily routine for well-meaning reasons, and thus take away his own experiences in the social environment, the child does not learn to distinguish between his "normal" behavior and his exhausts.
A child with Tourette syndrome therefore urgently needs experience in peer groups in order to firstly gain recognition and, secondly, to recognize the limits set by the group. Because the disorder is not a psychosocial illness, sufferers learn social rules as well as "healthy" children.
Conversely, peers learn to understand the behavior of a Tourette patient, if he is not constantly guarded in the seemingly secure home, but gets to know the world outside with other children.
Children who are mentally healthy themselves often integrate children with unusual behavior growing up with them, more open-minded than adults, who project their ideas of values and norms onto the "different". The common socialization also trains the frustration tolerance of those affected when other children make fun of them.
The parents are therefore faced with a challenge: they must let the "sick" child pass through no attacks that have nothing to do with the disorder, but at the same time do not condemn those affected for their Austicker.
In extreme cases, personalities are responsible for making their disorder responsible for any conspicuous behavior, failure at school, and any violation of rules, even if they have nothing to do with it.
If the parents give those affected a space to develop independently, they should set limits to him as much as a "normal" child.
In the best case, the child learns early on that it shows some peculiarities, but at the same time it is socially integrated and at the same time strives for social integration.
diagnosis
For this disorder, there are no time-consuming procedures such as a DNA or Blutanlayse. On the other hand, the diagnosis is considered safe if a patient shows the guiding symptoms. Unfortunately, therefore, the diagnosis is often very late, because it overlooks lighter forms of behavior.
However, if there is a suspicion, the doctor first examines the history of the patient, asking what tics they are, what exactly they are, how often and how intense they are, if they are gaining strength, and how much the patient is suppressing them can.
The degree of self-control is crucial. Lighter cases of Torette are reminiscent of "quirks". Although such behavioral problems can become pathological, they have nothing to do with the disorder. In particular, a "quirks" is not involuntary: For example, if someone gets used to scratching their necks out of embarrassment, and keeps this behavior in public, he may be in trouble. Although it is a quirk that has a psychological cause - but it can be controlled as a negative habit willful.
A Tourette patient can, with the best education and strong will, move his tics Although, reduce and integrate into everyday life, but not cancel.
A neuropsychiatric disorder
Tourette is a neuropsychiatric disease. This does not mean that those affected are mentally ill, such as psychotic people who can not distinguish between the unconscious and the outside world. Instead, for example, with the schizophrenic paranoia, the tics are more like epileptics that have no control over their bodies during a seizure, but otherwise perceive reality as "healthy".
Picture: Bilderzwerg - Fotolia Tourette patients are aware of their tics, and most of them suppress them on their own. Although the convulsions are involuntary, those affected control them to a limited extent. Often they feel their "discharge" beforehand and choose a quiet place for it, for example, by going alone in the park - comparable to a hiccup.
Non-sufferers know the suffering of patients from responding to such a hiccup. We are sitting in the seminar and have to "hicksen"; we suppress the sip, but it gets stronger. The pressure on our diaphragm goes up, so we go to the toilet until the hiccup is over. Or we lie in bed and feel a twitch in the body; then it's over and we relax. Similarly, a Tourette sufferer experiences it when the Austicker announce themselves.
Already students with the disorder are training in controlling the symptoms. Often they stay calm at school and do not tick until they are safe in their parents' home. Many sufferers are not about "undisciplined" as healthy. The opposite is the case: new studies show that those affected control their movements and language to a greater degree than non-affected people.
On the one hand, tics increase as emotions increase, in stress, anxiety, anger, grief, but also in euphoria and exuberance, and diminish when those relax or focus on a task. On the other hand, if the affected people suppress the symptoms, they break out just as they relax - for example, a patient comes home, lies down on the sofa, and starts to turn his head involuntarily.
causes
Nerve cells in the brain essentially control our movements; if these connections are disturbed, the movements involuntarily penetrate to the outside. Those affected can not stop unwanted motion and speech patterns, even if they want to.
The dopamine balance of patients is disturbed, and dopamine is responsible for transporting information, such as movement patterns, to which they are translated.
Tourette is inheritable, and this hereditary plant interacts with the social environment. Families of those affected very often have members with typical symptoms of the disorder.
Psychic consequences
The syndrome is therefore not a "mental illness" - Affected but often suffer from mental health problems, which in turn take the form of mental disorders.
Comorbidities are mainly attention deficit syndrome and obsessive-compulsive disorder. However, it remains unclear whether these are diseases in the clinical sense or behavior that resembles these diseases.
On the one hand, obsessive-compulsive disorder can be due to the neuronal structure of the tics - the tics are compulsive in that they follow the same pattern. On the other hand, many Tourette sufferers develop compulsive rituals to bring their "stingers" under control.
Those affected, for example, constantly check to see if the coffee maker is on or ask their parents for a ritual to go to bed. Parents need to repeat a sentence until it sounds "right". Those affected develop a perfectionism that is obscure to outsiders - everything has to be in the "right" place, and "wrong" words disturb the "symmetry".
Other abnormalities are similar to the Attention Deficit Disorder syndrome, and they even manifest at an age before the stingers begin. These sufferers show restlessness in their movements; they have difficulty concentrating; they start many things and hardly bring anything to an end; they can not listen and are easily distracted; they jump from one action to another; they talk all the time.
Such sufferers often slip into their "stingers" when they need to listen because someone else is talking - they are motor-deficient when they can not let off steam physically, because they have to concentrate mentally.
Then situations are the trigger for the tics, which seem to laypersons to be a lack of self-discipline or lack of education: to wait in school until it is their turn to listen to the conversation, to do the homework and then around to run…
The problems arising from the reaction to this behavior sometimes lead to depression. However, this is a social consequence of Tourette syndrome and not the syndrome itself: those affected are afraid to go to school; they feel "different", they are sad and lose the desire to live; they withdraw.
They know and fear triggers for their involuntary behavior and try to avoid them by rigidly structured everyday life. This goes so far that those affected exclude everything that is unfamiliar, for example, to distance themselves from their sexual partners, avoid necessary conflicts or stay in the same job for decades.
The coercion sometimes goes so far as to allow an affected person to focus on mental work in situations that cause strong emotions, such as solving math problems when his friends invite him into the football stadium.
The control of the symptoms is also associated with social problems. These are exacerbated when laypersons interpret the typical behavior as "bad behavior". Parents then give their children guilt feelings because they "do not adapt", teachers treat them like "troublemakers", and classmates classify them as "psychos".
Especially the (disgusting) symptoms described as coprolalia and co-practice make conflicts escalate: elementary school students are not neurologists, and a person who suddenly criticizes them for being obnoxious makes himself unpopular.
Desperate cases?
The good news is that sufferers are socially just as capable as "normal" children. Although teachers easily confuse the unusual behavior with dissocial disturbances, it has nothing to do with it.
Patients do not behave asocial - at least not because of their nervous disorder. Her "obscene" symptoms are as involuntary as the twitching of the eyelids.
In youth cultures like Gangsta-Rap, competition for the most obscene word creations belongs to the repertoire. The insults that emanate from the Tourette syndrome sufferers, but are detached from deliberate defamation.
Anyone who does not know that annoys these tics - or they unsettle him; For example, when he is standing alone next to a stranger looking in his direction, repeatedly repeating words like "bastard".
aggressions
Tourette patients are safe. They behave aggressively, but do not attack other people. They erupt in anger, but harm themselves by, for example, beating their own faces.
The aggression of the sick arises from their impulses, which push for expression. The patient can not control his feelings, so he experiences helplessness and tries to force his body to "obey". He feels, for example, a tug on the neck and "pushes back this outbreak" by banging his fist on the head.
therapy
The symptoms, ie the ticking, can not be healed, and the biological cause can not be contained. Psychotropic drugs can reduce symptoms, but most patients are not so limited as to justify the use of such drugs.
However, if the disease is severe and leads to obsessive-compulsive symptoms and codordbidities, various preparations help: tiapride, sulpiride, risperidone, pimozide or haloperidol.
There are also behavioral therapies that prove to be very effective because of the insight of most people affected. Regular advice from curative educators, educational teachers and physiotherapists is recommended.
The syndrome affects especially in the social area. Since many patients already control the oysters by themselves, behavioral training can significantly reduce the social impact.
Relaxation techniques mitigate the stressors that trigger the tics. Above all, music therapy offers a positive perspective, even to patients who become professional musicians. The nervous impulses can often be derived in the playing of instruments - especially when the entire body is in demand, for example on drums or organ.
Relaxation and stress relief relieve the symptoms. (Image: Jeanette Dietl / fotolia.com) Training helps against the physical consequences of the symptoms. So Hillie, a victim, went to a weight training studio. His motor ticks were expressed by constantly turning his head to the side. So he had gotten into a crooked gait, his shoulders and neck muscles twisting. Several years of strength training studio with an accomplished coach, who also knows about behavioral problems, not only brought the physical posture back into balance, but also alleviated the guiding symptoms.
Hillie still jerked sometimes after a long workout, but hardly any of his sports friends noticed that. At most, they were amazed at the tremendous amount of work Hillie managed to do by dumbbells. His coach also spoke hard but sincere plain text when told of everyday situations in which he brought his tics as an excuse. Finally, the person concerned found a permanent job at the Municipal Horticultural Office. First, he liked the work, and secondly, it was ideal for getting rid of his surplus energy - the hedges that he trimmed did not bother his tics in the least.
From the sick to the artist?
The Tourette Syndrome and the reactions to it often lead to restrictions of the affected person in everyday life.
But the good news is that Tourette, as well as certain forms of bipolar disorder or Asperger's Syndrome, can even be implemented positively.
Tourette is indeed a fault of impulse control; Those affected can control the involuntary symptoms to a certain degree. The neurologist Oliver Sacks sees in it a potential to turn the tics into creativity, when the patients implement the energy flowing into it, for example, in music.
This is confirmed by musicians who not only suffer from Tourette's syndrome - like the composer Tobias Ticker. He says he has no symptoms when working on his music. However, the "Austicker" would have become an integral part of his creative imagination.
The pianist Nick von Bloss even sees his Tourette syndrome as a gift: he channels the energy that offers this special feature into his music making. Sacks even sees certain types of music as "Tourette." Jazz and rock both offer heavy beats as well as the freedom of improvisation and thus correspond to the nervous tensions of those affected.
Affected persons often show a particularly good physical responsiveness - combined with urge to move. Martial arts, play the drums, play table tennis, basketball or even mountain bike, are therefore particularly suitable for them.
The syndrome lowers the motor inhibitions in the central nervous system, and those affected thus trigger faster movements than non-affected.
In general, the syndrome does not mean disability. Those affected work as doctors, as pilots, as engineers and as teachers. Overall, they are no less powerful than others.
Support Groups?
Shared pain is half of the pain; Should affected people therefore join self-help groups? Some patients refuse such an exchange with other affected persons: the syndrome includes the compulsive copying, and some patients "involuntarily" learned the tics of other Tourette's patients in addition to their own.
The Tourette personality
The Tourette syndrome itself is a biological peculiarity - not mental. However, according to Sacks, personality and syndrome combine in the socialization of those affected.
Although children control their symptoms, they also have problems developing an identity. They split the involuntary behavior as a "that's not me," but suffer from the fact that there is something in them that they can not grasp.
In the beginning, there is the bitter experience of "being outraged" in uncontrolled phases - but this happens in old age, where the questions "who am I?" And "what sets me apart from others?" Have top priority.
Especially in childhood, the social integration in friendships and in the parent house is essential for the development of a stable personality.
Insight into the brain
It is easy to confuse the vocal tics with asocial taunts, also because the "dirty words" seem seemingly purposeful. An affected child hissed in general stress situations, for example, "fuck", repeated the swear word "you sow" but against people - especially against the mother.
It's hard not to take such (seemingly) targeted insults personally.
However, these stirrers provided with content and addressees show how our brain works. Even a drunk loses impulse control: he defames the bartender and flies out of the pub, he gives love to potential sexual partners, or he throws around with money that he does not have. The next day, when he wakes up from the hangover, he is terribly sorry.
Other drugs like Chrystal Meth also have impulse control and people use it to lose their inhibitions.
Acts in affect judge judges as such with full awareness, because one who overpowers emotions does not have full control over his actions. Therefore, manslaughter is a lesser crime than murder.
We all know affect: When we are angry, we call our partner words that would make us feel more relaxed - even if we purposely use them in the situation. However, we do not have this "will" under control because our emotions are jammed.
The control that Tourette sufferers have over the timing and course of their tics shows that they are controllable to a degree - and then? In a milder form we know the situation: we quarrel and notice that if one word changes the other, we "explode". But let's go to the fresh air, keep our heads under cold water or take a deep breath - then we'll let off steam. ".
If we jeopardize frustrations, it helps to go into the woods and shout a hatred of hate into nature, or write down every dirty word we can think of in a diary. Then we feel cleansed.
The verbal thickeners of Tourette's patients work similarly, but control of the action itself is not possible. It does not matter to humans whether we control movements or articulate ourselves through language - our brain stores patterns and activates them. In the case of Tourette's disease, the mediation of these associations through consciousness into the outside world is disturbed - but the associations themselves also form "normals"..
Even the brain, in which the impulse control works, stores sounds and "bad words", as those affected by them expel. Also with the Tourette patient, stress situations trigger his tics. The unconscious, that is, the ensemble of remembered patterns, vocabulary and emotional images that we are constantly referring to, automatically form associations and arrange them.
In the dream, we experience dramatic stories that we do not control. In our unconscious we imagine actions that we never allowed to implement.
So, if Tourette patients seem to purposefully offend people, it actually happens involuntarily. For our unconscious is a pattern in which a curse word refers to subjects, not to objects or situations. Even an impulse set free in words thus "duels" against a person.
However, the brain forms meaningful narratives only in the interaction of the unconscious and the filter of the conscious. In the tics of the Tourette patients, however, this teamplay is suspended. Basic patterns run off without the consciousness adjusting them to the specific situation.
Animal sounds from those affected suggest that certain impulses are leaking directly out of the older parts of the brain where our evolutionary history is stored.
To put it simply, a stressed-out person, like the Tourette patient, feels the urge to relieve the stress - for example, by roaring or running. This stress is a negative experience that fits words that save the unconscious as negative. These include abusive words like "you pig".
Children who do not learn social behavior have no inhibitions about throwing "dirty words" at all, people who are aware of social codes have also saved these words, but are holding back with them - it's a social learning experience.
In the tics of Tourette sufferers, the inhibitions fall on biological grounds, and this betrays how our unconscious "ticks". In that sense, Tourette syndrome is not just a neurological disorder, but as such reveals much about how our "normal" brain works. (Somayeh Ranjbar)
Specialist supervision: Barbara Schindewolf-Lensch (doctor)
Literature:
- Uttom Chowdhury, Isobel Heyman: Tics and Tourette Syndrome: A Handbook for Parents and Professionals. New York 2004.
- James F. Leckman, Donald J. Cohen: Tourette's Syndrome Tics, Obsessions, Compulsions: Developmental Psychopathology and Clinical Care. New York 2002.
- Kirsten R. Müller-Vahl: Tourette syndrome and other tic disorders in childhood and adulthood, Berlin 2014.