Psychiatric Nursing

Introduction

Tic disorders are characterised by the presence of tics. Tic is an abnormal involuntary movement (AIM) which occurs repetitively, rapidly and is purposeless in nature. Symptoms begin before the age of 18 years and not caused by medical condition.

Types

1. Motor tic -characterised by repetitive motor movements.
2. Vocal tic- characterised by repetitive vocalizations.
3. Tourette's syndrome - combined motor and vocal tics and coprolalia.

Motor Tics

Motor tics are earliest to appear, and begging in the head region progressing downwards. Motor tics can be simple or complex.

1. Simple motor tics: include eye blinking, grimacing, shrugging of shoulders, tongue protrusion.
2. Complex motor tics: these include stamping, jumping, hitting self, squatting, echokinesis (repetition of observed acts), copropraxia (obscene acts).

Vocal Tics

Vocal tics can also be simple or complex.

1. Simple Vocal Tics- include coughing, barking, throat-clearing, sniffing, clicking.
2. Complex Vocal Tics - include echolalia (repetition of heard phrases), palilalia (repetition of heard words), coprolalia (use of obscene words) and mental coprolalia (thinking of obscene words).

Etiology

1. leaning difficulties
2. neurological soft signs
3. abnormal EEG and ERP findings
4. Tourette's syndrome may be inherited

Treatment

• Pharmacotherapy with haloperidol, clonidine or pimozide
• Treatment of associated depression
• Behaviour therapy

References

1. Ahuja N.A short text book of psychiatry. 5th edn. New Delhi. Jaypee brothers medical publishers.2004.
2. GelderM,Gath D,Mayou R,Cowen P. New oxford text book of psychiatry. 4th edn.Oxford. Oxford university press.2004.
3. Kaplan HI, Sadok BJ. Synopsis of psychiatry-behavioural science or clinical psychiatry.9th edn. Hong Kong.William and Wilkinsons publications. 1998.
4. Kapoor B. Text book of psychiatric nursing. Publishers of medical and nursing books; Delhi: 2006.
5. Fortinash K M, Patricia A and Worret H. Psychiatric mental health nursing (3 rd edn) Mosby publications. 2001.