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Chapter: Essentials of Psychiatry: Childhood Disorders: Tic Disorders

Tic Disorders: Differential Diagnosis

Tics have many characteristics that differentiate them from the other movement disorders.

Differential Diagnosis

 

Differential Diagnosis of Tics

 

Tics have many characteristics that differentiate them from the other movement disorders. Perhaps most important to “ruling in” tics as a diagnostic possibility is the childhood history of simple motor tics in the face. Other movement disorders do not have a similar pattern of movement onset or location. There are atypical presentations of tic disorders that may resemble other movement disorders, but these would be unusual and would probably re-quire a consultation with a movement disorders expert.

 

Movement disorders such as chorea and dystonia are con-tinuous movements and can be distinguished from tics, which are intermittent. Paroxysmal dyskinesias, although episodic, are more often characterized by choreiform and dystonic move-ments, which are different from tics. Myoclonic movements and exaggerated startle responses are also intermittent movements but are usually large-muscle movements that occur in response to a patient-specific stimulus. Complex tics can be more difficult to differentiate from other complex movements such as manner-isms, gestures, or stereotypies. In a person with clear-cut motor tics, it may be difficult to differentiate a complex motor tic from a “camouflaged” tic (making a simple tic appear to be a purposeful action, e.g., an upward hand movement that the person turns into a hair smoothing gesture), mannerism, gesture, or stereotypy. Mannerisms or gestures are often not impairing; stereotypies tend to occur exclusively in children and adults with develop-mental disabilities and mental retardation (Jankovic, 1992).

 

It is also possible to have a tic disorder and another move-ment disorder. For example, tic movements can cooccur with dystonia. Similarly, it is not uncommon in tertiary referral cent-ers to see developmentally disabled children and adults with both tics and stereotypes.

 

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Essentials of Psychiatry: Childhood Disorders: Tic Disorders : Tic Disorders: Differential Diagnosis |


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