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Gilles de la Tourette's Syndrome with and without Obsessive-Compulsive Disorder Compared with Obsessive-Compulsive Disorder without Tics: Which Symptoms Discriminate?

CATH, DANIELLE C. M.D., Ph.D.1,2; SPINHOVEN, PHILIP Ph.D.2,3; VAN WOERKOM, THEO C. A. M. M.D., Ph.D.4; VAN DE WETERING, BEN J. M. M.D., Ph.D.5; HOOGDUIN, CEES A. L. M.D., Ph.D.6; LANDMAN, ANDREA D. M.D.7; ROOS, RAYMUND A. C. M.D., Ph.D.8; ROOIJMANS, HARRY G. M. M.D., Ph.D.2

Journal of Nervous & Mental Disease: April 2001 - Volume 189 - Issue 4 - pp 219-228
Articles

Stereotyped repetitive behaviors occur in Gilles de la Tourette's Syndrome (GTS) and obsessive-compulsive disorder (OCD). The present study was undertaken to compare the distribution of obsessive-compulsive and Tourette-related impulsive behaviors in GTS with (+) OCD, GTS without (−) OCD, tic-free OCD, and control subjects. Fourteen GTS + OCD, 18 GTS-OCD, 21 OCD-tic, and 29 control subjects were evaluated using a semistructured interview designed to assess GTS and OCD-related repetitive behaviors. Each reported item was evaluated on the presence of anxiety and goal-directedness. This information was subsequently used to define whether the repetitive behavior was an (anxiety-related) obsession or compulsion, or a (non-anxiety-related) OC-like behavior, impulsion. GTS + OCD subjects reported more overall Tourette-related impulsions than OCD-tic subjects, i.e., more mental play, echophenomena, and touching behaviors but similar frequencies of typical obsessive-compulsive behaviors. Further, GTS + OCD subjects exhibited more overall repetitive behaviors than GTS-OCD subjects, i.e., more Tourette-related impulsions as well as more obsessive-compulsive behaviors. The distribution of symptoms is similar in GTS with and without OCD, and differs from tic-free OCD. These differences suggest that GTS with OCD constitutes a form of GTS, not of OCD, although the possibility that GTS + OCD patients constitute a subgroup distinct from GTS and from OCD can not be excluded by this phenomenological study. Specific non-anxiety-related impulsions seem to discriminate between GTS and OCD-tic individuals. These impulsions possibly reflect differences in underlying mechanisms between GTS and OCD-tics.

1 Department of Psychiatry, GGZ Buitenamstel Outpatient Services, Lassusstraat 2, 1075 GV Amsterdam, The Netherlands. Send reprint requests to Dr. Cath.

2 Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands.

3 Division of Clinical and Health Psychology, Leiden University, Leiden, The Netherlands.

4 Department of Neurology, Leyenburg Hospital, The Hague, The Netherlands.

5 Department of Psychiatry, Erasmus University Medical Center, Rotterdam, The Netherlands.

6 Department of Psychology, Nijmegen University, Nijmegen, The Netherlands.

7 Psychiatric Hospital Endegeest, Oegstgeest, The Netherlands.

8 Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands.

© 2001 Lippincott Williams & Wilkins, Inc.