Is psychiatry meaningless

Psychiatry, psychosomatics & psychotherapy

15.12.2017

Tics in adulthood: Understanding and acceptance by the environment are important

The first occurrence of tics in adulthood is rather the exception. However, they are a relatively common phenomenon in childhood and can persist into adulthood. Tic disorders can show very different degrees of severity and stress differently.

Tics are involuntary, repetitive, non-rhythmic movements or vocalizations that start suddenly, serve no purpose and are experienced as meaningless. They are a relatively common phenomenon in childhood and usually gradually subside completely by early adulthood. In some of those affected, however, the disease persists or recurs in adulthood. Tic disorders can show very different degrees of severity and stress differently. In the case of great psychological stress, behavioral therapy measures or medication can be helpful, as well as learning relaxation techniques. Therapeutic support is particularly important if there are additional mental illnesses. “There are those affected who have both motor and vocal tics, but do not suffer from them because they are weak and socially normal. Others, in turn, have very pronounced tics that have psychosocial consequences and make training or professional life more difficult and can severely limit performance and quality of life, ”reports Prof. Dr. Ulrich Voderholzer from the German Society for Psychiatry and Psychotherapy, Psychosomatics and Neurology (DGPPN) based in Berlin. "Therapeutic support is advisable for children and adults if they suffer from the disorder or have developed psychological comorbidities." The number and severity of concomitant illnesses often increases in line with the severity of the tics. The social problems associated with the clinical picture also weigh more heavily with pronounced tics.

Severe tic disorders can be extremely stressful and socially isolating

In addition to simple tics, which are mostly located in the face and head, complex movement sequences can also be part of the disorder, in which several muscle groups are involved. Combined vocal tics and multiple motor tics are known as Tourette's syndrome. “High-frequency, pronounced and very loud tic disorders can sometimes be a heavy burden for those affected. In addition to the physical exertion, dealing with the social environment is a great challenge, which often causes greater difficulties for those affected. “Other people are sometimes frightened, wondering or perhaps even feeling afraid for a moment because such symptoms do not fit into an expected behavior pattern. For fear of offending the person concerned, such a situation is usually not discussed in brief encounters. People with tic disorders are therefore often confronted with a counterpart who reacts embarrassed and insecure or who also feels embarrassing discomfort. Such everyday interpersonal situations can be extremely stressful and painful, ”explains Prof. Voderholzer. “As a result, sick people can sometimes develop fears of a negative confrontation and consequently avoid social contacts. Self-esteem problems through to depression are common consequences. ”80 to 90 percent of all patients with Tourette's syndrome not only have tics, but also other mental illnesses such as obsessive-compulsive disorder or ADHD.

Relaxation techniques can alleviate stress-related trigger situations

The tics can often be actively suppressed by those affected for a certain period of time. Depending on the situation, they often increase in certain moods, such as fear, anger, joy, but also stress. With strong concentration and relaxation, however, they often decrease. “Since the tics often intensify in stressful situations and emotional stress peaks, relaxation methods - such as progressive muscle relaxation - can be helpful. Although they are unable to eliminate the cause, they can alleviate typical triggering situations and reduce internal tensions, ”advises Prof. Voderholzer. In addition, so-called "Habit Reversal Training (HRT)" represents a successful therapeutic approach. Here, other behaviors that counteract tics can be learned, which help the person affected to control his unwanted behavior. In principle, however, only symptomatic therapy for tics is possible. The underlying cause is not treatable. Behavioral therapy methods are indicated, among other things, for the symptom-centered treatment of tics. Symptom-centered behavior therapy can reduce the frequency and intensity of tics and aims at self-management to control motor and vocal tics.
Drug therapy for tics is often measured by the severity of the disease and the associated psychosocial impairment. Mild forms of the course therefore often remain untreated with medication. Patients who show pronounced symptoms usually undergo drug treatment due to the increased level of suffering.

Tics go way beyond the control of those affected

"In addition, an enlightened, understanding environment that is free of prejudice and accepting is also helpful," emphasizes Prof. Voderholzer. "A good environment can make it easier for those affected to cope with a tic disorder so that treatment does not have to be considered." On the contrary, it is a medical disease that goes far beyond the control of the person affected.

The first occurrence of tics in adulthood is rather the exception. Most affected adults have had the disorder since childhood and can experience symptom-free periods in between. Dysregulations in certain circuits and neurotransmitter systems of the brain are assumed to be the cause of the tic disorders. Various factors can play a role in the development. The genetic makeup has a significant influence on this. Infectious diseases and certain risk constellations during pregnancy or in the womb also seem to be involved.

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