- Simple Tics are sudden, brief and repetitive tics that only involve a limited number of muscle groups (eye blinking, head jerking, shoulder shrugging, eye darting, nose twitching, mouth movements, grunting, coughing, throat clearing, barking)
- Complex Tics are distinct, coordinated patterns of movements involve several muscle groups (touching or smelling objects, repeating observed movements, stepping in a certain pattern, obscene gesturing, bending or twisting, hopping, repeating own or others' words/phrases, using vulgar, obscene or swear words)

Symptoms of Tourette Syndrome

The causes of Tourette Syndrome are not clear, but there is evidence that it can be inhertied and that genetic factors are observed to be the most important factor in this diagnosis.
- Studies on Monozygotic twins show 53% concordance for TS and 77% for persistent (chronic) motor tics
- Studies on dizygotic twins show 8% concordance for TS and 23% concordance for persistent motor tics

Environmental factors such as sex-hormone exposure during brain development, psychosocial stressors, and perinatal insults are hypothesized to contribute to a multifactorial expression of TS.

Causes of Tourette Syndrome (TS)

- Attention Deficit Hyperactivity Disorder (ADHD)
- Obsessive Compulsive Disorder or Behaviors (OCD/OCB)
- Anxiety
- Learning disabilities
- Behavioral or conduct issues
- Problems falling or staying asleep
- Social skills deficits and social functioning difficulties
- Sensory processing issues

Common Co-occuring conditions with Tourette Syndrome

- Dopamine-blocking medications (used to suppress tics)
- Alpha-adrenergic agonists (clonidine and guanfacine)
- Stimulant medications (ethylphenidate and dextroamphetamine - can lessen ADHD symptoms in people with TS without causing more severe tics)
- Antidepressants (serotonin reuptake inhibitors like clomipramine, fluoxetine, fluvoxamine, paroxetine, and sertraline)
- Behavioral Treatments (awareness training and competing response training to reduce tics)
- Psychotherapy (to cope with disorder and accompanying problems like ADHS, depression, anxiety, or OCD)
- Iron Supplements (Shown to exert a benefical effect on tic frequency and severity)

Current Treatments of Tourette Syndrome

There is no test that is currently being used to diagnose Tourette syndrome. However these criteria are often used to diagnose this disorder:
- Both motor and vocal tics are present ( do not have to be present at the same time)
- Tics are present several times in the day (almost every day or at irregular intervals) for more than 1 year
- Tics are present and begin before the age of 18
- Tics are not a cause of medications, substances, or medical conditions
- Tics change over time (location, frequency, type, complexity, severity) 

Diagnosis of Tourette Syndrome

Patients with Tourette Syndrome can experience co-occurring disorders like:

- Attention Deficit Hyperactivity Disorder
- Obsessive-Compulsive Disorder
- Learning Difficulties
- Anxiety
- Mood issues
- Social skills and functioning disorders
- Sleeping issues

Complications of Tourette Syndrome

What are the risk factors and complications of Tourette syndrome? (n.d.). https://www.mymed.com/diseases-conditions/tourette-syndrome/what-are-the-risk-factors-and-complications-of-tourette-syndrome

Risk Factors of Tourette Syndrome

A type of neurodevelopmental disorder that is accompanied by multiple motor tics and at least one vocal tics.

University of Texas at Austin

-	Neurodevelopmental Disorders
-	Schizophrenia Spectrum and Other Psychotic Disorders
-	Bipolar Related Disorders
-	Depressive Disorders
-	Anxiety Disorders
-	Obsessive Compulsive & Related Disorders
-	Trauma- & Stressor- Related Disorders
-	Dissociative Disorders
-	Somatic Symptoms & Related Disorders
-	Feeding and Eating Disorders
-	Elimination Disorders
-	Sleep-Wake Disorders
-	Sexual Dysfunction
-	Gender Dysphoria
-	Disruptive, Impulse-Control, & Conduct Disorders
-	Substance-Related & Addictive Disorders
-	Neurocognitive Disorders
-	Personality Disorders
-	Paraphilic Disorders
-	Other Mental Disorders
-	Medication-Induced Movement Disorders & Other Adverse Effects of Medication
-	Other Conditions That May be a Focus of Clinical Attention


DSM-V Chapters

Tourette Syndrome

A type of sleep-wake disorder that is defined by recurrent episodes of excessive daytime sleepiness or augmented nighttime sleep.

Hypersomnia

This is a type of elimination disorder. Encopresis is the repeated passing of stool, that is usually involuntary, into clothing.

Encopresis

A second type of elimination disorder listed in DSM 5. Enuresis is also called urinary incontinence and results from the loss of bladder control ( in a patient who is old enough to control their bladder).

Enuresis 

Anxiety disorders are characterized by features of excessive fear and anxiety, as well as related behavioral disturbances. These symptoms are often not temporary and linger beyond typical expectations. Excessiveness of these symptoms is clinician diagnosed with cultural contexts taken into consideration.

Anxiety Disorders

Neurodevelopmental disorders are a class of conditions typically identified in childhood, characterized by developmental impairments across personal, social, academic, and intellectual domains. Key examples within this category include attention deficit/hyperactivity disorder (ADHD) and autism spectrum disorder.

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