Journal articles on the topic 'Intervention des TIC'
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1
Friedrich, Julia, Tina Rawish, Annet Bluschke, Christian Frings, Christian Beste, and Alexander Münchau. "Cognitive and Neural Mechanisms of Behavior Therapy for Tics: A Perception–Action Integration Approach." Biomedicines 11, no. 6 (May 26, 2023): 1550. http://dx.doi.org/10.3390/biomedicines11061550.
Abstract:
European clinical guidelines recommend the use of Exposure and Response Prevention (ERP) and Comprehensive Behavioral Intervention for Tics (CBIT) as first-line treatments for tic disorders. Although ongoing efforts in research are being made to understand the mechanisms underlying these behavioral approaches, as of yet, the neurophysiological mechanisms behind behavioral interventions are poorly understood. However, this is essential to tailor interventions to individual patients in order to increase compliance and efficacy. The Theory of Event Coding (TEC) and its derivative BRAC (Binding and Retrieval in Action Control) provide a theoretical framework to investigate cognitive and neural processes in the context of tic disorders. In this context, tics are conceptualized as a phenomenon of enhanced perception–action binding, with premonitory urges constituting the perceptual and the motor or vocal expression constituting the action part of an event file. Based on this, CBIT is assumed to strongly affect stimulus–response binding in the context of response selection, whereas the effects of ERP presumably unfold during stimulus–response binding in the response inhibition context. Further studies are needed to clarify the neurophysiological processes underlying behavioral interventions to enable the individualization and further development of therapeutic approaches for tic disorders.
2
Hayes, Julie Anne. "TAC-TIC therapy: A non-pharmacological stroking intervention for premature infants." Complementary Therapies in Nursing and Midwifery 4, no. 1 (February 1998): 25–27. http://dx.doi.org/10.1016/s1353-6117(98)80010-3.
3
Speck, Patricia M., Michelle M. Tepper, Peng Li, and Elizabeth B. Dowdell. "Recognition of Trauma Informed Care Responses in Forensic Nurses." Journal of the Academy of Forensic Nursing 1, no. 2 (December 20, 2023): 3–18. http://dx.doi.org/10.29173/jafn677.
Abstract:
Trauma is universal, affecting health and behavioral choices. Trauma Informed Care (TIC) principles guide healthcare providers to avoid re-traumatization. States now mandate Trauma Informed Care (TIC) education. When implemented consistently, TIC benefits all. Adequate information integrating TIC principles in forensic nurse education exists. However, the application of TIC principles in forensic nurse practices remains elusive to measurement. The study's purpose is to explore forensic nurse knowledge before and following basic TIC interventional education, and recognition of TIC responses necessary to promote changes in behavior. The design is pre-, educational intervention, post-, and post-post survey that measures change in TIC intervention recognition. The analysis is a descriptive, correlational study to discover learning trends in practicing forensic nurses, determining the validity and reliability of the survey questions using an item response theory (IRT) model. Nineteen forensic nurses participated in the pre-test, intervention, post-, and/or post-post-test. The results revealed that nurses with >3 years’ and <10 years’ experience in nursing and forensic nursing are more likely to recognize TIC learning in a variety of situations. The authors summarize that moral conflict may influence choice in answers, reflecting a lack of recognition of TIC.
4
Piller, Aimee, and Ali Achord. "Defining Trauma-Informed Care in OT." American Journal of Occupational Therapy 76, Supplement_1 (July 1, 2022): 7610505061p1. http://dx.doi.org/10.5014/ajot.2022.76s1-po61.
Abstract:
Abstract Date Presented 04/01/2022 This qualitative study explored the construct of trauma-informed care (TIC) in pediatric OT. Grounded theory methodology revealed a central theme of OTs addressing TIC through direct and indirect interventions. Subthemes included support systems, targeting areas of difficulty, and characterization influencing intervention. The study concluded that therapists consider trauma and formulate interventions on the basis of the child’s needs from a holistic approach. Primary Author and Speaker: Aimee Piller Additional Authors and Speakers: Ali Achord
5
Jankowski, M. Kay, Karen E. Schifferdecker, Rebecca L. Butcher, Lynn Foster-Johnson, and Erin R. Barnett. "Effectiveness of a Trauma-Informed Care Initiative in a State Child Welfare System: A Randomized Study." Child Maltreatment 24, no. 1 (September 10, 2018): 86–97. http://dx.doi.org/10.1177/1077559518796336.
Abstract:
Trauma-informed care (TIC) initiatives in state child welfare agencies are receiving more attention, but little empirical evidence exists as to their efficacy. The purpose of this study was to assess changes in self-reported practices and perceptions of child welfare staff involved in a multifaceted, statewide TIC intervention. Ten child welfare offices were matched and randomized to an early or delayed cohort. Staff were surveyed at Time 1 prior to any intervention, Time 2 postintervention for Cohort 1, and Time 3 postintervention for Cohort 2. The survey covered six domains: trauma screening, case planning, mental health and family involvement, progress monitoring, collaboration, and perceptions of the state’s overall system performance. Linear mixed modeling assessed the effect of the intervention. Cohort by time interaction was significant for three intervention targets. We demonstrate, using a rigorous study design, the mixed results of a multimodal intervention to improve trauma-informed attitudes, practices, and system performance. TIC initiatives must account for complex, dynamic contextual factors.
6
Woods, Douglas W., Michael B. Himle, Jordan T. Stiede, and Brandon X. Pitts. "Behavioral Interventions for Children and Adults with Tic Disorder." Annual Review of Clinical Psychology 19, no. 1 (May 9, 2023): 233–60. http://dx.doi.org/10.1146/annurev-clinpsy-080921-074307.
Abstract:
Over the past decade, behavioral interventions have become increasingly recognized and recommended as effective first-line therapies for treating individuals with tic disorders. In this article, we describe a basic theoretical and conceptual framework through which the reader can understand the application of these interventions for treating tics. The three primary behavioral interventions for tics with the strongest empirical support (habit reversal, Comprehensive Behavioral Intervention for Tics, and exposure and response prevention) are described. Research on the efficacy and effectiveness of these treatments is summarized along with a discussion of the research evaluating the delivery of these treatments in different formats and modalities. The article closes with a review of the possible mechanisms of change underlying behavioral interventions for tics and areas for future research.
7
Fründt, Odette, Douglas Woods, and Christos Ganos. "Behavioral therapy for Tourette syndrome and chronic tic disorders." Neurology: Clinical Practice 7, no. 2 (March 24, 2017): 148–56. http://dx.doi.org/10.1212/cpj.0000000000000348.
Abstract:
AbstractPurpose of review:To summarize behavioral interventions for the treatment of primary tic disorders.Recent findings:Although tics were attributed to a disordered weak volition, the shift towards neurobiological models of tic disorders also transformed nonpharmacologic treatment practices. Current international guidelines recommend habit reversal training, comprehensive behavioral intervention, and exposure and response prevention as first-line therapies for tics. Appropriate patient selection, including age and presence of comorbidities, are salient clinical features that merit consideration. Evidence for further behavioral interventions is also presented.Summary:Currently recommended behavioral interventions view tics as habitual responses that may be further strengthened through negative reinforcement. Although availability and costs related to these interventions may limit their effect, Internet-based and telehealth approaches may facilitate wide accessibility. Novel nonpharmacologic treatments that take different approaches, such as autonomic modulation or attention-based interventions, may also hold therapeutic promise.
8
Ramezani, Fatemeh, Rasoul Heshmati, and Tooraj Hashemi Nosratabadi. "The effectiveness of mentalization-based therapy on parent-child interaction and parenting stress: a randomized controlled trial study on children with symptoms of tic disorders and their mothers." Applied Family Therapy Journal 4, no. 3 (2023): 199–214. http://dx.doi.org/10.61838/kman.aftj.4.3.13.
Abstract:
Aim: The main objective of this research was the effectiveness of mentalization-based therapy on parent-child interaction and parenting stress in a randomized controlled trial study on children with symptoms of tic disorders and their mothers. Methods: The method of the current research was quasi-experimental with a pre-test, post-test and follow-up plan with a control group. The research sample consisted of 30 mothers and their children with symptoms of tic disorders who had referred to counseling centers and clinics in Mako city in the second half of 2022. They were selected as available and randomly divided into two groups. Experiment and control (15 people in each group) were assigned. The experimental group participated in 15 sessions of the mentalization-based therapy group intervention program, and the control group did not receive any intervention. The subjects of both groups answered the questions of the parent-child relationship scale and the short form of the parental stress scale in the pre-test and post-test phases. Data analysis was done using mixed multivariate analysis of variance test. Results: The results of mixed multivariate analysis of variance indicated the effectiveness of mentalizing group therapy on improving the dimensions of parent-child relationship and parenting stress of children (P<0.001). Also, the results showed that mentalization intervention reduces the parenting stress scores of children with tic disorder symptoms (P<0.001). Conclusion: It can be concluded that the therapeutic mentalization group intervention is effective in improving the dimensions of the parent-child relationship and parenting stress of children with symptoms of tic disorder, and this treatment can be used to reduce the psychological problems of children with tic disorder. Symptoms of tic disorder.
9
Gilbertson, J., R. Moghrabi, S. W. Kirkland, K. Tate, W. Sevcik, N. Lam, B. H. Rowe, and C. Villa-Roel. "P054: Interventions aimed at improvement in emergency department related transitions in care for adult patients with atrial fibrillation and flutter: a systematic review." CJEM 20, S1 (May 2018): S76. http://dx.doi.org/10.1017/cem.2018.252.
Abstract:
Introduction: Introduction: Transitions in care (TiC) interventions have been proposed to improve the management and outcomes of patients in emergency departments (ED). The objective of this review was to examine the effectiveness of ED-based TiC interventions to improve outcomes for adult patients presenting to an ED with acute atrial fibrillation or flutter (AFF). Methods: Methods: A comprehensive search of eight electronic databases and various grey literature sources was conducted. Comparative studies assessing the effectiveness of interventions to improve TiC for patients presenting to the ED with acute AFF were eligible. Two independent reviewers completed study selection, quality assessment, and data extraction. When applicable, relative risks (RR) with 95% confidence intervals (CIs) were calculated using a random effects model and heterogeneity was reported among studies using I-square (I2) statistics. Results: Results: From 744 citations, seven studies were included, consisting of three randomized controlled trials (RCT), three before-after (B/A) studies, and one cohort study. Study quality ranged from unclear to low for the RCTs according to the risk of bias tool, moderate in the BA trials according to the BA quality assessment tool, and high quality of the cohort study according to the Newcastle Ottawa scale. The majority of interventions were set within-ED (n=5), including three clinical pathways/management guidelines and two within-ED observation units. Post-ED interventions (n=2) included patient education and general practitioner referral. Four studies reported a decreased overall hospital length of stay (LoS) for AFF patients undergoing TiC interventions compared to control, ranging from 26.4 to 53 hours; however, incomplete and non-standardized outcome reporting precluded meta-analysis. An increase in conversion to normal sinus rhythm among TiC intervention patients was noted, which may be related to increased utilization of electrical cardioversion among the RCTs (RR=2.16; 95% CI: 1.42, 3.30; I2=%), B/A studies (RR=2.69, 95% CI: 2.17, 3.33), and cohort study (RR=1.39; 95% CI: 1.24, 1.56). Conclusion: Conclusions: Within-ED TiC interventions may reduce hospital LoS and increase use of electrical cardioversion. However, no clear recommendations to implement such interventions in EDs can be generated from this systematic review and more efforts are required to improve TiC for patients with AFF.
10
Heijerman-Holtgrefe, Annet, Chaim Huyser, Cara Verdellen, Jolande van de Griendt, Laura Beljaars, Kees-Jan Kan, Ramón Lindauer, Daniëlle Cath, Pieter Hoekstra, and Lisbeth Utens. "Effectiveness of ‘Tackle Your Tics’, a brief, intensive group-based exposure therapy programme for children with tic disorders: study protocol of a randomised controlled trial." BMJ Open 12, no. 6 (June 2022): e058534. http://dx.doi.org/10.1136/bmjopen-2021-058534.
Abstract:
IntroductionThis paper outlines the study protocol for the Dutch Tackle Your Tics study in youth with tic disorders. Tourette syndrome and chronic tic disorders are prevalent neurodevelopmental disorders, placing considerable burden on youth and their families. Behavioural treatment is the first-line, evidence-based intervention for tic disorders, but tic reduction and availability remain relatively low. Patient associations stress the need for more accessible high-quality treatments, also focusing on improving quality of life. Therefore, the brief, intensive group-based treatment Tackle Your Tics was developed.Methods and analysisTackle Your Tics is a 4-day intensive and comprehensive group-based intervention for children and adolescents (9–17 years) with Tourette syndrome or a chronic tic disorder. The programme encompasses exposure and response prevention treatment and additional supporting components (coping strategies, relaxation exercises and parent support). To study the effectiveness of Tackle Your Tics and identify predictors/moderators at baseline, a single-blinded randomised controlled trial (n=104) is conducted, comparing Tackle Your Tics (n=52) with a waiting list condition lasting 3 months (n=52). Assessments are performed at similar time points for both groups: at baseline, after 4 weeks, and at 3 and 6 months of follow-up, on tic severity, quality of life and other psychosocial variables.Ethics and disseminationEthics approval has been obtained from the medical ethical committee of the Amsterdam Medical Centre (METC nr NL66340.018.18, v3 June 2020). Findings will be presented on national and international conferences, peer-reviewed scientific journals, patient organisation meetings and public media. Patient representatives are fully integrated as part of the research team. If Tackle Your Tics proves to be effective, it can expand evidence-based treatment possibilities for children and adolescents with tic disorders. Identifying the psychosocial predictors/moderators for the effectiveness of this intervention can provide personalised treatment advice in the future.Trial registration numberNL8052.
11
Houghton, David C., Jennifer R. Alexander, and Douglas W. Woods. "The Psychosocial Impact of Tic Disorders: Nature and Intervention." Journal of Developmental and Physical Disabilities 28, no. 2 (December 14, 2015): 347–65. http://dx.doi.org/10.1007/s10882-015-9467-8.
12
Barnes, Christopher, and Elvidina N. Adamson-Macedo. "Understanding the impact of newborn touch upon mothers of hospitalized preterm neonates." Journal of Human Growth and Development 32, no. 2 (June 23, 2022): 294–301. http://dx.doi.org/10.36311/jhgd.v32.13322.
Abstract:
Introduction: Many interventions have been designed to support the development of the preterm baby and minimise the complications of prematurity. However, there is limited evidence of the possible psychological benefits of touch to the mother when she is the one performing the support programme during the hospitalisation of her newborn. Objective: This study explored whether the type of touch provided to preterm neonates had an impact on maternal self-efficacy, self-esteem and maternal-to-infant attachment, as-well-as newborn weight gain. Methods: Using a randomised cluster trial, forty babies and their mothers were allocated to one of two groups receiving either a touch-based intervention (TAC-TIC; Touching And Caressing; Tender In Caring) or spontaneous touch. Results: Mothers who provided the touch-based intervention demonstrated greater increases in self-efficacy, self-esteem and attachment, and babies gained more weight than those using spontaneous touch. Conclusion: The results indicate that systematic touch interventions may be used to facilitate the mother-baby relationship as well as to promote newborn weight gain.
13
Storch, Eric A., Jessica E. Morgan, Nicole E. Caporino, Lindsay Brauer, Adam B. Lewin, John Piacentini, and Tanya K. Murphy. "Psychosocial Treatment to Improve Resilience and Reduce Impairment in Youth With Tics: An Intervention Case Series of Eight Youth." Journal of Cognitive Psychotherapy 26, no. 1 (2012): 57–70. http://dx.doi.org/10.1891/0889-8391.26.1.57.
Abstract:
Background: Many youth with tic disorders experience distress about having tics and how others may perceive them. Such symptoms are often more impairing and distressing than the tics themselves and negatively impact self-concept, psychosocial functioning, and quality of life. Objective: Although there exist pharmacological and behavioral treatments that target the frequency and severity of tics, no intervention has been developed specifically to help youth with tics cope with their condition and limit associated functional impairment and distress. With this in mind, we report an intervention case series of eight youth (ages 8–16 years) supporting the initial efficacy of a cognitive-behavioral therapy program entitled “Living with Tics” that promotes coping and resiliency among youth with tics. Method: Eight youth with a principal diagnosis of a tic disorder (i.e., Tourette syndrome [N = 6]; Chronic Tic Disorder [N = 2]) and associated psychosocial impairment participated. Assessments were conducted at screening, pretreatment, and posttreatment by trained raters. Treatment consisted of 10 weekly individual psychotherapy session focused on improving coping with having tics. Results: Six of eight youth were considered treatment responders. On average, participants exhibited meaningful reductions in tic-related impairment, anxiety, and overall tic severity as well as improvements in self-concept and quality of life. Conclusions: These data provide preliminary evidence for conducting a larger controlled trial to examine the utility of the Living with Tics psychosocial intervention for promoting adaptive functioning among youth with tics.
14
William Hunter, Jonte C. Taylor, Monica Bester, Sandra Nichols, and Carlomagno Panlilio. "Considerations for Incorporating Trauma-Informed Care Content within Special Education Teacher Preparation and Professional Development Programs." Journal of Special Education Preparation 1, no. 2 (November 29, 2021): 48–55. http://dx.doi.org/10.33043/josep.1.2.48-55.
Abstract:
Trauma-informed care (TIC) is the practice of consciousness and awareness of trauma that guides educators in developing academic and behavioral support for students with exceptionalities who have experienced trauma. TIC can support students from the lens of Positive Behavioral Intervention Supports (PBIS) and Social Emotional Learning (SEL) within Multi-Tiered Systems of Support (MTSS). The purpose of this article is to explore the integration of TIC practices within classrooms that utilize the MTSS framework and to assist pre-service and in-service teachers with implementing TIC practices within inclusive and restrictive K-12 learning environments.
15
Valentim, Patrícia Alexandra Pascoal, and Cláudia Mariana Julião Bacatum. "Meios digitais OFF para um sono ON: intervenção de enfermagem comunitária no sono das crianças." Revista Recien - Revista Científica de Enfermagem 12, no. 38 (June 17, 2022): 292–97. http://dx.doi.org/10.24276/rrecien2022.12.38.292-297.
Abstract:
Os meios digitais fazem parte da vida das crianças, embora se conste que o uso das TIC está associado a padrões de sono insatisfatórios. Trata-se de um estudo transversal descritivo desenvolvido através da metodologia do Planeamento em Saúde. A população alvo foi constituída por 74 crianças, e a amostra obtida foi composta por 48 alunos. O método de colheita de dados selecionado consistiu em parte da versão portuguesa do questionário Eu Kids Online 4. Constou-se que as TIC são utilizadas mais horas do que o recomendado, que existe crianças que dormem menos horas por dia que o aconselhado e que a dinâmica de como as TIC são utilizadas é desfavorável à promoção de hábitos de sono saudáveis. A intervenção desenvolvida visou promover a literacia em saúde e demonstrou que após as intervenções de enfermagem desenvolvidas houve uma aquisição de conhecimentos.
Descritores: TIC, Padrão de Sono, Crianças, Intervenção de Enfermagem Comunitária.
Digital media OFF for a sleep ON: community nursing intervention in children's sleep
Abstract: Digital media are part of children's lives, although it is known that the use of ICT is associated with unsatisfactory sleep patterns. This is a descriptive cross-sectional study developed using the Health Planning methodology. The target population consisted of 74 children, and the sample obtained was composed of 48 students. The selected data collection method consisted in part of the Portuguese version of the Eu Kids Online 4 questionnaire. It was found that ICTs (Information and Communication Technologies) are used for more hours than recommended, that there are children who sleep fewer hours a day than recommended and that the dynamics of how ICTs are used is unfavorable to promoting healthy sleep habits. The developed intervention aimed to promote health literacy and demonstrated that after the nursing interventions developed, there was an acquisition of knowledge.
Descriptors: ICT, Sleep Pattern, Kids, Community Nursing Intervention.
Medios digitales OFF para dormir ON: intervención comunitaria de enfermería en el sueño de los niños
Resumen: Los medios digitales forman parte de la vida de los niños, aunque se sabe que el uso de las TIC se asocia a patrones de sueño insatisfactorios. Se trata de un estudio descriptivo transversal desarrollado con la metodología de Planificación de la Salud, la población objetivo fue de 74 niños y la muestra obtenida estuvo compuesta por 48 estudiantes. El método de recogida de datos seleccionado consistió en parte de la versión portuguesa del cuestionario Eu Kids Online 4. Se encontró que las TIC (Tecnologías de la información y la comunicación) se utilizan durante más horas de las recomendadas, que hay niños que duermen menos horas al día de las recomendadas y que la dinámica de uso de las TIC es desfavorable para promover hábitos de sueño saludables. La intervención desarrollada tuvo como objetivo promover la alfabetización en salud y demostró que luego de desarrolladas las intervenciones de enfermería, hubo una adquisición de conocimientos.
Descriptores: TIC, Patrón del Sueño, Niños, Intervención Comunitaria de Enfermería.
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Soler, Nicolette, Chris Hardwick, Iain E. Perkes, David Dossetor, Paula Bray, and Russell C. Dale. "An exploratory study into an adapted use of the Alert Program for tic disorder in children." Australasian Psychiatry 27, no. 2 (December 3, 2018): 144–51. http://dx.doi.org/10.1177/1039856218815750.
Abstract:
Objectives: This preliminary study explored whether an adapted approach to the Alert Program, that uses sensorimotor strategies, might assist with management of tic disorders in children. The Alert Program, a program that uses sensorimotor strategies for self-regulation in children with neurodevelopmental disorders, had not been trialled with children with tic disorders. Methods: Ten children with tic disorder were assessed using the Dunn Sensory Profile 2 (SP2), the Yale Global Tic Severity Scale (YGTSS) and the Parent Tic Questionnaire (PTQ). Participants attended three 60–90-minute appointments with an occupational therapist and clinical psychologist for implementation of the adapted Alert Program. Results: The YGTSS showed tic reduction in all participants. The total YGTSS pre-intervention mean score of 46.5 improved to 17.7 post-therapy. Five participants reported no impairment post-therapy. PTQ scores reduced in nine participants. On the SP2, 30% of participants scored as having sensory sensitivities that impaired daily function. Conclusions: This exploratory study found trialling an adapted approach to the Alert Program that uses sensorimotor-based approach decreased tic severity in children with tic disorders. A randomised controlled trial is needed to establish the effectiveness and feasibility of this approach.
17
Chang, Hsiao-Ying, Vanessa Johnson, and Liza Marie Conyers. "Exploring the Impact of an Integrated Trauma-Informed HIV and Vocational Intervention for Black/African American Women Living with HIV." International Journal of Environmental Research and Public Health 20, no. 17 (August 25, 2023): 6649. http://dx.doi.org/10.3390/ijerph20176649.
Abstract:
Given the increased recognition of the role of social determinants of health on the prevalence of HIV in the United States, interventions that incorporate and address social determinants of HIV are essential. In response to the health disparities facing Black/African American women living with HIV, HIV activists and mental health specialists developed an innovative integrated HIV prevention and vocational development intervention, Common Threads, that underscores and addresses key economic and other social determinants of health experienced by Black/African American women within a trauma-informed care (TIC) framework. This research study applied grounded theory methods to conduct a qualitative study of Common Threads based on interviews with 21 women who participated in the Common Threads intervention. Participants shared several critical aspects of program components that reflected the TIC principles, endorsing a safe environment, trust building, and a sense of belonging. These components also encouraged transparency and promoted autonomy. Additionally, participants shared perceived program outcomes, including changes of knowledge and skills in four considering work domains (i.e., medical, psychosocial financial/legal resources, and vocational) that facilitate health and vocational development.
18
Hall, Charlotte Lucy, E. Bethan Davies, Per Andrén, Tara Murphy, Sophie Bennett, Beverley J. Brown, Susan Brown, et al. "Investigating a therapist-guided, parent-assisted remote digital behavioural intervention for tics in children and adolescents—‘Online Remote Behavioural Intervention for Tics’ (ORBIT) trial: protocol of an internal pilot study and single-blind randomised controlled trial." BMJ Open 9, no. 1 (January 2019): e027583. http://dx.doi.org/10.1136/bmjopen-2018-027583.
Abstract:
IntroductionTourette syndrome and chronic tic disorder are common, disabling childhood-onset conditions. Guidelines recommend that behavioural therapy should be offered as first-line treatment for children with tics. However, there are very few trained behaviour therapists for tics and many patients cannot access appropriate care. This trial investigates whether an internet-delivered intervention for tics can reduce severity of symptoms.Methods and analysisThis parallel-group, single-blind, randomised controlled superiority trial with an internal pilot will recruit children and young people (aged 9–17 years) with tic disorders. Participants will be randomised to receive 10 weeks of either online, remotely delivered, therapist-supported exposure response prevention behavioural therapy for tics, or online, remotely delivered, therapist-supported education about tics and co-occurring conditions. Participants will be followed up mid-treatment, and 3, 6, 12 and 18 months post randomisation.The primary outcome is reduction in tic severity as measured on the Yale Global Tic Severity Scale total tic severity score. Secondary outcomes include a cost-effectiveness analysis and estimate of the longer-term impact on patient outcomes and healthcare services. An integrated process evaluation will analyse quantitative and qualitative data in order to fully explore the implementation of the intervention and identify barriers and facilitators to implementation. The trial is funded by the National Institute of Health Research (NIHR), Health Technology Assessment (16/19/02).Ethics and disseminationThe findings from the study will inform clinicians, healthcare providers and policy makers about the clinical and cost-effectiveness of an internet delivered treatment for children and young people with tics. The results will be submitted for publication in peer-reviewed journals. The study has received ethical approval from North West Greater Manchester Research Ethics Committee (ref.: 18/NW/0079).Trial registration numbersISRCTN70758207andNCT03483493; Pre-results.
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Sakai, Tomohide, Kaori Tsuboi, Shinya Takarada, Mako Okabe, Hideyuki Nakaoka, Keijiro Ibuki, Sayaka W. Ozawa, et al. "Tachycardia-Induced Cardiomyopathy in an Infant with Atrial Flutter and Prolonged Recovery of Cardiac Function." Journal of Clinical Medicine 13, no. 11 (June 4, 2024): 3313. http://dx.doi.org/10.3390/jcm13113313.
Abstract:
Background: Tachycardia-induced cardiomyopathy (TIC) is caused by prolonged tachycardia, leading to left ventricular dilatation and systolic dysfunction with heart failure. Although TIC is more common in adults, it is rare in early infancy. Methods: Clinical testing was performed as part of medical evaluation and management. Next-generation sequencing (NGS) was conducted for a patient with TIC. A literature review on TIC was also conducted. Results: The case involved a 5-month-old infant referred to the hospital due to symptoms of heart failure lasting at least two months. The infant’s heart rate was 200 beats per minute, the left ventricular ejection fraction fell below 14%, and electrocardiograms showed atrial flutter, suggesting TIC. After cardioversion, there was no recurrence of atrial flutter, and cardiac function improved 98 days after tachycardia arrest. The NGS did not identify any pathogenic variants. The literature review identified eight early infantile cases of TIC. However, no previous reports described a case with such a prolonged duration of TIC as ours. Conclusions: This is the first report of a case of prolonged TIC in a child with the documented time to recover normal cardiac function. The improvement of cardiac function depends on the duration of TIC. Early recognition and intervention in TIC are essential to improve outcomes for infantile patients, as timely treatment offers the potential for recovery.
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Sukhodolsky, Denis G., Douglas W. Woods, John Piacentini, Sabine Wilhelm, Alan L. Peterson, Lily Katsovich, James Dziura, John T. Walkup, and Lawrence Scahill. "Moderators and predictors of response to behavior therapy for tics in Tourette syndrome." Neurology 88, no. 11 (February 15, 2017): 1029–36. http://dx.doi.org/10.1212/wnl.0000000000003710.
Abstract:
Objective:To examine moderators and predictors of response to behavior therapy for tics in children and adults with Tourette syndrome and chronic tic disorders.Methods:Data from 2 10-week, multisite studies (1 in children and 1 in adults; total n = 248) comparing comprehensive behavioral intervention for tics (CBIT) to psychoeducation and supportive therapy (PST) were combined for moderator analyses. Participants (177 male, 71 female) had a mean age of 21.5 ± 13.9 years (range 9–69). Demographic and clinical characteristics, baseline tic-suppressing medication, and co-occurring psychiatric disorders were tested as potential moderators for CBIT vs PST or predictors of outcome regardless of treatment assignment. Main outcomes measures were the Yale Global Tic Severity Scale Total Tic score and the Clinical Global Impression–Improvement score assessed by masked evaluators.Results:The presence of tic medication significantly moderated response to CBIT vs PST (p = 0.01). Participants showed tic reduction after CBIT regardless of tic medication status, but only participants receiving tic medication showed reduction of tics after PST. Co-occurring psychiatric disorders, age, sex, family functioning, tic characteristics, and treatment expectancy did not moderate response. Across both treatments, greater tic severity (p = 0.005) and positive participant expectancy (p = 0.01) predicted greater tic improvement. Anxiety disorders (p = 0.042) and premonitory urge severity (p = 0.005) predicted lower tic reduction.Conclusions:Presence of co-occurring attention-deficit/hyperactivity disorder, obsessive-compulsive disorder, or anxiety disorders did not moderate response to CBIT. Although participants on tic medication showed improvement after CBIT, the difference between CBIT and PST was greater for participants who were not on tic-suppressing medication.ClinicalTrials.gov identifiers:The child and adult CBIT studies are listed on clinical trials.gov (NCT00218777 and NCT00231985, respectively).Classification of evidence:This study provides Class I evidence that CBIT is effective in reducing tic severity across subgroups of patients with chronic tic disorders, although the difference between treatments was smaller for participants on tic-suppressing medications, suggesting reduced efficacy in this subgroup.
21
Haas, Martina, Ewgeni Jakubovski, Katja Kunert, Carolin Fremer, Nadine Buddensiek, Sebastian Häckl, Martina Lenz-Ziegenbein, et al. "ONLINE-TICS: Internet-Delivered Behavioral Treatment for Patients with Chronic Tic Disorders." Journal of Clinical Medicine 11, no. 1 (January 4, 2022): 250. http://dx.doi.org/10.3390/jcm11010250.
Abstract:
Comprehensive Behavioral Intervention for Tics (CBIT) is considered a first-line therapy for tics. However, availability of CBIT is extremely limited due to a lack of qualified therapists. This study is a multicenter (n = 5), randomized, controlled, observer-blind trial including 161 adult patients with chronic tic disorders (CTD) to provide data on efficacy and safety of an internet-delivered, completely therapist-independent CBIT intervention (iCBIT Minddistrict®) in the treatment of tics compared to placebo and face-to-face (f2f) CBIT. Using a linear mixed model with the change to baseline of Yale Global Tic Severity Scale-Total Tic Score (YGTSS-TTS) as a dependent variable, we found a clear trend towards significance for superiority of iCBIT (n = 67) over placebo (n = 70) (−1.28 (−2.58; 0.01); p = 0.053). In addition, the difference in tic reduction between iCBIT and placebo increased, resulting in a significant difference 3 (−2.25 (−3.75; −0.75), p = 0.003) and 6 months (−2.71 (−4.27; −1.16), p < 0.001) after the end of treatment. Key secondary analysis indicated non-inferiority of iCBIT in comparison to f2f CBIT (n = 24). No safety signals were detected. Although the primary endpoint was narrowly missed, it is strongly suggested that iCBIT is superior compared to placebo. Remarkably, treatment effects of iCBIT even increased over time.
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Woitecki, Katrin, and Manfred Döpfner. "Die Wirksamkeit der Reaktionsumkehr-Behandlung bei Kindern und Jugendlichen mit chronischen Tic-Störungen." Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie 39, no. 6 (November 2011): 387–97. http://dx.doi.org/10.1024/1422-4917/a000137.
Abstract:
Fragestellung: Mit der vorliegenden Studie soll das Training der Reaktionsumkehr erstmals im deutschen Sprachraum mit gruppenstatistischen Ansätzen auf seine Wirksamkeit hinsichtlich mehrerer Zielgrößen bei der Behandlung von Kindern und Jugendlichen mit chronischen Tic-Störungen überprüft werden. Die Intervention wird anhand eines Trainingsmanuals operationalisiert. Methodik: Es wurden 16 Kinder/Jugendliche behandelt. Es wurden sowohl Verhaltensbeobachtungen als auch Eltern-, Selbst- und klinische Urteile zur Erfassung der Tic-Symptomatik eingesetzt. Die Wirksamkeit einer Intensivinterventionsphase wird außerdem im Vergleich zu einer Minimalinterventionsphase untersucht. Ergebnisse: Die Studie liefert erste Hinweise auf die Akzeptanz und Effektivität des neu entwickelten Therapieprogramms. Schlussfolgerungen: Das Therapieprogramm erwies sich als gut einsetzbar. Weitere Studien sind jedoch notwendig, um die Wirksamkeit der Intervention abzusichern.
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Nutting, Ruth, Kari Nilsen, Rachel Engle, Kyle Wells, and Hannah Scoville. "Resident Physicians’ Perceptions of Trauma Informed Care: Findings from a Small-scale Descriptive Study." Kansas Journal of Medicine 16, no. 3 (October 30, 2023): 264–68. http://dx.doi.org/10.17161/kjm.vol16.21000.
Abstract:
Introduction. Screening for adverse childhood experiences (ACEs) is a significant component of trauma informed care (TIC), as intervention can mitigate negative health outcomes. The American Academy of Pediatrics has called on physicians to address toxic stress. However, as few as 4% of physicians with pediatric patients screen and intervene for ACEs. The authors of this study sought to: 1) understand resident physicians’ perceptions of TIC; 2) identify areas of training needed to improve screening and intervention of ACEs. Methods. This pilot study occurred in a large Midwestern Family Medicine residency and involved a convenience sample of 54 resident physicians. Participants completed a survey questionnaire, which included a total of 22 Likert-scale and open-ended questions. Descriptive frequencies were used to represent Likert-scale responses, and the open-ended questions were analyzed utilizing a thematic analysis approach. Results. Participants identified screening for ACEs as useful. However, they reported a lack of confidence in their ability to screen and intervene. Barriers to screening and intervention were also noted and included lack of time, discomfort in assessment, perceived inability to help, insufficient knowledge and skills, and competing primary care recommendations. Conclusions. Family Medicine residents value TIC. However, lack of confidence, competing primary care recommendations, and concern for receptiveness can deter residents from screening and intervention. Graduate medical education must focus on building systems of training that provide learners with the knowledge, skills, and resources to routinely screen and intervene for ACEs in primary care.
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Goldman, Kissel J., and Iser G. DeLeon. "A Review on Functional Analyses of Tics." Behavior Modification 44, no. 2 (October 29, 2018): 296–315. http://dx.doi.org/10.1177/0145445518809046.
Abstract:
Tic disorders are characterized by a class of responses assumed to be neurobiological in origin. Still, several studies have shown that tic frequency can be influenced by antecedent environmental events and social consequences. Prior reviews have summarized the effects of environmental events but have not examined relations between tic diagnosis, behavioral deficits (e.g., intellectual disability), tic topography, and the consequences observed to maintain tics. These variables might be important when attempting to predict or identify relevant consequences. A more thorough understanding of the variables that maintain and give rise to tics might also be useful in predicting responsiveness to treatment and intervention refinement. We reviewed and summarized results from the 13 attempts to experimentally identify maintaining consequences for tics (i.e., functional analyses) that have been published to date. We examined patterns of functions across tic diagnoses (i.e., Tourette’s syndrome or not), communication impairments (i.e., an intellectual disability or reported language difficulty), and tic topography. Results suggested that individuals with Tourette’s syndrome and those without communication impairments are more likely to have functional analysis outcomes consistent with automatic reinforcement, but exceptions in both directions highlight the utility of functional analysis in treating tics.
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Berrón Ruiz, Elena, Cristina Arriaga Sanz, and Emilia Campayo Muñoz. "Technological resources for the initial training of Music teachers: an intervention in the Spanish university context." Revista Electrónica de LEEME, no. 51 (June 5, 2023): 16. http://dx.doi.org/10.7203/leeme.51.25680.
Abstract:
En la enseñanza de la música, la evolución de la tecnología y la informática han impulsado nuevas prácticas metodológicas para el trabajo en el aula. Desde el ámbito de la educación superior, se presenta una investigación cualitativa basada en la aplicación de distintos recursos y herramientas digitales en la asignatura de “Formación Instrumental”, perteneciente a los Grados de Maestro en Educación Infantil y Primaria. Su objetivo general consiste en determinar la utilidad de las TIC para favorecer la formación inicial del profesorado de Música, el cual, a su vez, se concreta en dos objetivos específicos: conocer la percepción del estudiantado sobre las aplicaciones y recursos tecnológicos empleados en su proceso de aprendizaje, y valorar su inclinación a utilizar las TIC cuando ejerzan como docentes de Música. La recogida de datos se ha llevado a cabo a través de distintas técnicas e instrumentos, que incluyen cuestionarios, un grupo de discusión y el análisis de documentos. Entre los resultados, cabe destacar el carácter innovador que ha supuesto la utilización de las TIC en el aula, posibilitando un mayor aprovechamiento de las horas de clase e impulsando la autonomía y motivación del alumnado en el aprendizaje musical.
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Rachamim, Lilach, Hila Mualem-Taylor, Osnat Rachamim, Michael Rotstein, and Sharon Zimmerman-Brenner. "Acute and Long-Term Effects of an Internet-Based, Self-Help Comprehensive Behavioral Intervention for Children and Teens with Tic Disorders with Comorbid Attention Deficit Hyperactivity Disorder, or Obsessive Compulsive Disorder: A Reanalysis of Data from a Randomized Controlled Trial." Journal of Clinical Medicine 11, no. 1 (December 23, 2021): 45. http://dx.doi.org/10.3390/jcm11010045.
Abstract:
Attention deficit hyperactivity disorder (ADHD), obsessive compulsive disorder (OCD) and tic disorders (TD) commonly co-occur. In addition, specific inattention difficulties and poor impulse control are related to TD in the absence of comorbid ADHD. In this study we reanalyzed data from a recently completed study comparing internet-delivered, self-help comprehensive behavioral intervention for tics (ICBIT) with a waiting-list control group. The current study describes the effects of an (ICBIT) in children and adolescents with TD with and without comorbid diagnoses of ADHD or OCD at post intervention and over three- and six-month follow-up periods. Thirty-eight 7 to 18-year-olds completed the ICBIT. Of these, 16 were diagnosed with comorbid ADHD and 11 were diagnosed with OCD. A significant improvement in tic measures was found in all groups. Both the TD + ADHD and the TD − ADHD groups were similar in the magnitude of tic reduction from baseline to post-treatment, and at the three and six-month follow-up assessments. However, the TD + OCD group benefitted less from intervention than the TD—OCD group. There were meaningful reductions in parental reports of inattention, as well as hyperactive and impulsive symptoms at post intervention and over the 6-month follow-up period. Thus, ICBIT can be effectively delivered in the presence of comorbid ADHD or OCD symptomatology and may reduce symptoms of inattention and impulsivity. Larger studies of ICBIT in children and teens with TD and comorbid ADHD and OCD are needed to optimize responses to ICBIT.
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Landua, John, Ping Gong, and Michael T. Lewis. "Abstract 1689: Heterogeneity of tumor-initiating cell related signaling revealed by lentiviral signaling reporters in breast cancer patient-derived xenografts." Cancer Research 82, no. 12_Supplement (June 15, 2022): 1689. http://dx.doi.org/10.1158/1538-7445.am2022-1689.
Abstract:
Abstract Classical markers of tumor-initiating cells (TIC), aldehyde dehydrogenase 1 (ALDH1) activity and the cell-surface markers, CD44pos/CD24low/neg, show insufficient cell type specificity to identify TIC definitively, nor do they allow robust enrichment by FACS. As a consequence, analyses of TIC function and gene expression to date are not definitive. Identification and characterization of the TIC subpopulation is critically important in breast cancer since these cells are thought to mediate treatment resistance, as well as local and distant recurrence. This is particularly critical for “triple negative” breast cancer (TNBC), since currently there are no targeted therapies available for this clinical subtype. Lentiviral signaling reporter vectors allow purification of enriched TIC subpopulations thereby facilitating single cell analyses to identify distinct sets of cells with TIC features. We used a collection of fluorescent lentiviral reporters that enable visualization and flow cytometric enrichment of cells undergoing STAT3-, GLI-, WNT-, or OCT4/SOX2-mediated transcriptional activity. Our collection of patient derived xenograft (PDX) models of TNBC were infected with the lentiviral reporters, re-transplanted, and screened for reporter activity upon regrowth. TIC function of reporter-expressing cells relative to negative cells was assayed by mammosphere formation and limiting dilution transplantation. Reporter expressing cells with enriched TIC function were then analyzed by single cell RNAseq for expression of classical markers to identify the subset of cells most likely to represent the TIC subpopulation. Our results indicate that STAT3 and GLI transcriptional activity can serve as uniquely PDX-dependent indicators for TIC function for a subpopulation of cancer cells. Also, multiple potential TIC signaling pathways, including STAT3, GLI, WNT, and OCT4/SOX2, can be active in a single PDX model, but do not necessarily associate with TIC function, indicating TIC diversity in TNBC. These data in conjunction with treatment response and single-cell RNA-seq sheds light on the molecular diversity of TIC populations in TNBC, identifies candidate targets for therapeutic intervention, and will indicate whether TIC diversity is associated with differential response to different chemotherapeutic agents. Citation Format: John Landua, Ping Gong, Michael T. Lewis. Heterogeneity of tumor-initiating cell related signaling revealed by lentiviral signaling reporters in breast cancer patient-derived xenografts [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 1689.
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Kelly, Adam, Nicholas Collar, and Lindsay Hammons. "Refractory type I cryoglobulinaemia requiring serial amputations." BMJ Case Reports 16, no. 7 (July 2023): e253416. http://dx.doi.org/10.1136/bcr-2022-253416.
Abstract:
We present a rare case of a man in his 40s who presented with bilateral lower extremity necrosis. After an extensive workup, he was diagnosed with type I cryoglobulinaemia (TIC) based on severe vaso-occlusive symptoms, presence of serum cryoglobins and tissue biopsy showing small-vessel vasculitis. Treatment was multimodal and targeted both his underlying lymphoproliferative disorder (monoclonal gammopathy of undetermined significance) and inflammatory state. Steroids, plasmapheresis and immunotherapy were administered with temporary remission of symptoms. After discharge, patient continued to repeatedly present with progressive bilateral lower extremity necrosis and new upper extremity digital necrosis necessitating further pharmacological treatment and surgical intervention—bilateral above the knee amputation and multiple digital hand amputations. This case illustrates a severe example of TIC where diagnosis was difficult due to atypical presentation, and disease was refractory to multimodal therapies necessitating surgical intervention to achieve temporary remission.
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Li, Jingchun, Chenchen Xu, Yiqiang Li, Yuanzhong Liu, Hongwen Xu, and Federico Canavese. "Are early antero-posterior and lateral radiographs predictive of clubfoot relapse requiring surgical intervention in children treated by Ponseti method?" Journal of Children's Orthopaedics 16, no. 1 (February 2022): 35–45. http://dx.doi.org/10.1177/18632521221080478.
Abstract:
Purpose: To investigate the value of antero-posterior and lateral radiographs in predicting clubfoot relapse after treatment with the Ponseti method. Methods: This was a retrospective review of 104 children (157 feet) younger than 3 months of age with idiopathic clubfoot treated using the Ponseti method at our institution between January 2007 and December 2014. All patients underwent Achilles tenotomy and were divided into two groups according to the need for further surgery to correct the deformity: relapsed group (24 patients; 36 feet) and non-relapsed group (80 patients; 121 feet). All antero-posterior and lateral foot radiographs were performed less than 3 months after Achilles tenotomy. The talo-calcaneal (TC-AP) and talus-first metatarsal (TM-AP) angles were measured in the antero-posterior view, while the tibio-calcaneal (TIC-L), talus-first metatarsal (TM-L), and talo-calcaneal (TC-L) angles were measured in the lateral view. The multi-factor logistic regression model of the stepwise selection method was used to predict the relapse of clubfoot deformity from the potential predictive values. Results: The mean age at initial plain radiography examination was 99.45 ± 21.54 days. Differences in TC-AP, TM-AP, TC-L, and TIC-L between the two groups were statistically significant. However, only TM-AP and TIC-L were included in the “ risk of relapse” formula using the multi-factor logistic stepwise selection method. Conclusion: Early antero-posterior and lateral radiographs in children younger than 3 months of age at initial Ponseti treatment have positive predictive value for relapse. Reduced TM-AP angle and increased TIC-L were associated with an increased risk of relapse. Level of evidence: level III.
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Tilling, Florence, and Andrea E. Cavanna. "Relaxation therapy as a treatment for tics in patients with Tourette syndrome: a systematic literature review." Neurological Sciences 41, no. 5 (December 23, 2019): 1011–17. http://dx.doi.org/10.1007/s10072-019-04207-5.
Abstract:
Abstract Background Tourette syndrome (TS) is a neurodevelopmental condition characterized by the presence of multiple motor and phonic tics, often associated with co-morbid behavioural problems. Tics can be modulated by environmental factors and are characteristically exacerbated by psychological stress, among other factors. This observation has led to the development of specific behavioural treatment strategies, including relaxation therapy. Objective This review aimed to assess the efficacy of relaxation therapy to control or reduce tic symptoms in patients with TS. Methods We conducted a systematic literature review of original studies on the major scientific databases, including Medline, EMBASE, and PsycInfo, according to the standards outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Outcomes measures included both tic severity and tic frequency. Results Our literature search identified three controlled trials, with a total number of 40 participants (range: 6–18 participants). In all three studies, relaxation therapy decreased the severity and/or the frequency of tic symptoms. However, the only trial comparing relaxation therapy to two other behavioural techniques found relaxation therapy to be the least effective intervention, as it reduced the number of tics by 32% compared to 44% with self-monitoring and 55% with habit reversal. Discussion The results of this systematic literature review provide initial evidence for the use of relaxation therapy as a behavioural treatment intervention for tics in patients with TS. Caution is needed in the interpretation of these findings, because the reviewed trials had small sample sizes and there was high heterogeneity across the study protocols.
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Tooker, Maya, Kathryn Barber, Joseph McGuire, Flint Espil, Jordan Stiede, Jennifer Schild, Shannon Bennet, et al. "1011 Childhood Predictors and Adult Factors Associated with Long-Term Sleep Disturbance in Tourette’s Disorder." SLEEP 47, Supplement_1 (April 20, 2024): A434—A435. http://dx.doi.org/10.1093/sleep/zsae067.01011.
Abstract:
Abstract Introduction Tourette’s Disorder (TD) is a childhood-onset neurological disorder characterized by motor and vocal tics present beyond one year. Sleep disturbance presents in 80% of individuals with TD and rises with advancing age. Common clinical correlates are tic severity, functional impairment, female sex, and co-occurring psychiatric symptoms, including attention-deficit/hyperactivity disorder (ADHD), obsessive-compulsive disorder (OCD), anxiety and depression. However, we lack understanding of long-term predictors of sleep disturbance in TD. Therefore, this investigation examined childhood predictors and adolescent/adult factors associated with sleep disturbance in a treatment follow-up sample of adolescents/adults with TD. Methods Eighty participants of a randomized-placebo controlled trial of behavior therapy for tics in childhood (M = 11.47, SD = 2.42 years) received follow-up evaluation 11.7 (SD = 1.25) years later in adolescence/adulthood (M = 22.87, SD = 2.70 years). At baseline and long-term follow-up, an independent evaluator assessed tic severity tic-related impairment and psychiatric diagnosis via interviews. At baseline, children rated anxiety and depression, and parents rated ADHD, and provided demographic and psychiatric history (e.g., tic and stimulant medication status). At follow-up, adolescents/adults rated anxiety, depression, and ADHD severity, and reported tic medication and stimulant medication status since trial termination. Multiple linear regression analysis was performed without and with backward elimination to examine childhood predictors and adult factors (sex, tic and stimulant medication status, tic severity and impairment, anxiety, depression, and ADHD severity, OCD diagnosis) sleep disturbance (Pittsburgh Sleep Quality Index) at long-term follow-up. Results Childhood tic-related impairment significantly predicted sleep disturbance (β = 0.35, t = 2.66, p = .010). However, with backward elimination both childhood tic-related impairment (β = 0.32, t = 2.81, p = .007) and depression (β = 0.33, t = 2.92, p = .005) significantly predicted sleep disturbance. There were no significant adolescent/adult factors associated with sleep disturbance. However, backward elimination showed depression was associated with sleep disturbance (β = 0.46, t = 3.95, p < .001). Conclusion Findings highlight the role of tic-related impairment in childhood and depression in childhood and adulthood in sleep disturbance in adolescents/adults with TD. Findings suggest the utility of targeted intervention for tic-related impairment and depression to minimize their long-term influence on sleep in TD. Support (if any)
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Kohli, Nikita, and Andrew Blitzer. "Botulinum Toxin for the Treatment of Motor and Phonic Tics: A Case Report." Annals of Otology, Rhinology & Laryngology 129, no. 6 (January 6, 2020): 625–27. http://dx.doi.org/10.1177/0003489419898211.
Abstract:
Objective: To present a unique approach to the treatment of motor and phonic tics. Patient: A 26-year-old male presented with motor and phonic tics including grunting, coughing, and throat clearing. Intervention: The patient was treated with 2.5 units of onabotulinum toxin A (BoNT) to the facial mimetic musculature and 2.5 units to each supraglottic musculature via a transthyrohyoid membrane approach under fiberoptic visualization. Results: The patient experienced reduction in the frequency, intensity, and interference with daily life of motor and phonic tics on the Yale Global Tic Severity Scale (YGTSS). Conclusion: This patient experienced subjective and objective decreases in tic severity using a unique approach in the treatment of phonic tics. Results suggest a novel approach in the treatment of phonic tics and bolster the data regarding safe and effective use of BoNT for tic disorder. Level of evidence: Level V, case report.
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Montalbano, G. E., M. Rozenman, T. Peris, P. Tan, J. Piacentini, and E. Ricketts. "0997 The Sleep Disturbance Scale For Children In Youth With Tourette’S Disorder." Sleep 43, Supplement_1 (April 2020): A378—A379. http://dx.doi.org/10.1093/sleep/zsaa056.993.
Abstract:
Abstract Introduction Sleep disturbance is common in youth with Persistent Tic Disorders (PTDs), including Tourette’s Disorder. However, studies elucidating the nature of sleep problems in PTDs are limited. The present study examines the types of sleep disturbance present in youth with PTDs relative to healthy controls, and investigates the relationship between sleep disturbance and tic severity. Methods Participants were 56 youth ages 8 to 17 (M=11.9, SD=2.86), including individuals with PTDs (n=27), and healthy controls (n=29). An interviewer evaluated psychiatric diagnosis using the Anxiety Disorders Interview Schedule, and tic severity using the Yale Global Tic Severity Scale (YGTSS). Parents rated sleep using the Sleep Disturbance Scale for Children (SDSC), and tic severity using the Parent Tic Questionnaire (PTQ). Independent-samples t-tests and bivariate correlations were performed. Results Higher SDSC Total scores, t(30)=-3.74, p=.001) were found in youth with PTDs relative to healthy controls. Youth with PTDs endorsed elevated sleep disturbance with respect to: Disorders of Initiating and Maintaining Sleep, t(35)=-2.43, p=.02), Sleep-Wake Transition Disorders, t(37)=-3.04, p=.004), and Disorders of Excessive Somnolence, t(33)=-2.36, p=.02). No significant group differenceswere shown for Sleep Breathing Disorders, Disorders of Arousal, and Sleep Hyperhydrosis. There was a positive association between SDSC Total scores and YGTSS Total (p=.01, r=.56) and YGTSS Impairment scores (p= .03, r=.33). Finally, there was a positive relationship between SDSC Total and PTQ Total scores (p=.01, r=.61). Conclusion Findings suggest youth with PTDs are more likely to experience sleep disturbance than healthy children, particularly difficulties with sleep initiation and maintenance, abnormal movements during sleep, and daytime sleepiness. Further, there is a relationship between sleep disturbance and tic severity. Findings highlight the need for sleep screening and targeted sleep intervention in youth with PTDs. Support N/A
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Díaz Rosabal, Elena María, Jorge Manuel Díaz Vidal, Ana Elisa Gorgoso Vázquez, Yoennys Sánchez Martínez, Gleivis Riverón Rodríguez, and Damisela de la Cruz Santiesteban Reyes. "PRESENCIA DE LAS TIC EN LAS INVESTIGACIONES SOCIALES." Revista de Investigación en Tecnologías de la Información 6, no. 11 (June 2018): 19–24. http://dx.doi.org/10.36825/riti.06.11.004.
Abstract:
This article is product of a thematic revision on the use of Information and Communication Technologies (ICT) in the social investigations, are a part of the stagepropaedeutic for the execution of a project for the sake of characterizing the use of these technologies in the investigating process in Sociocultural's Gestation career for the Development at Granma's University, Cuba. The strategy methodological came under asystem through the methods of documentary and hermeneutical analysis that they enabled to examine, interpreting and comparing the literature specialized to come to an end than: The present-day studies point of the paradigm county qualitative to the recognition, that favors the intervention of them TIC in the investigating processes of the Social Sciences to propitiate the reconstruction of the social context for hisbetter interpretation and understanding.
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Ishii, Ryouhei, and Masahiro Hata. "Event-related potentials as possible indicators of behavioral intervention outcome in tic disorders." Clinical Neurophysiology 130, no. 6 (June 2019): 1027–28. http://dx.doi.org/10.1016/j.clinph.2019.04.001.
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Jee, Sandra H., Anne-Marie Conn, Andrea Milne-Wenderlich, Catherine Krafft, Michael Chen, Mackenzie Steen, and Jody Todd Manly. "Providing trauma-informed pediatric care for underserved populations: Reflections on a teaching intervention." Developmental Child Welfare 2, no. 1 (December 31, 2019): 21–36. http://dx.doi.org/10.1177/2516103219894599.
Abstract:
National organizations call for providing trauma-informed care (TIC) to those who have experienced adverse childhood experiences (ACEs) and to the population as a whole. All providers and staff are at risk for experiencing stress and burnout when they care for patients with multiple complex needs and insufficient resources. All are at risk but not all develop burnout. This study shares findings from a pilot project to implement training on ACEs and toxic stress in a busy urban pediatric primary care practice. Using a mixed-methods approach, we assessed pre and post self-reported knowledge and attitudes via surveys ( n = 52), baseline in-depth interviews ( n = 16), focus groups (three groups, n = 36), and follow-up interviews ( n = 13). After training, staff reported a marginally significant increase in rating the office as doing a good job meeting the needs of families around childhood trauma (72% vs. 46%, p = 0.057). Key themes from baseline in-depth interviews and focus groups identified the following: (1) pervasiveness of trauma and adversity among families in the practice, (2) empathy for families with significant social needs, (3) feelings of frustration to alleviate stressors identified during visits, (4) need for social support and coping mechanisms to alleviate workplace stress, and (5) receptiveness to enhance knowledge and understanding. Key themes from follow-up interviews and focus groups highlighted the impact of compassion fatigue and strategies to promote self-care. We discuss these findings and challenges in relation to providing TIC and professional development.
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Khan, Kareem, Chris Hollis, Charlotte L. Hall, Elizabeth Murray, E. Bethan Davies, Per Andrén, David Mataix-Cols, Tara Murphy, and Cris Glazebrook. "Fidelity of Delivery and Contextual Factors Influencing Children’s Level of Engagement: Process Evaluation of the Online Remote Behavioral Intervention for Tics Trial." Journal of Medical Internet Research 23, no. 6 (June 21, 2021): e25470. http://dx.doi.org/10.2196/25470.
Abstract:
Background The Online Remote Behavioral Intervention for Tics (ORBIT) study was a multicenter randomized controlled trial of a complex intervention that consisted of a web-based behavioral intervention for children and young people with tic disorders. In the first part of a two-stage process evaluation, we conducted a mixed methods study exploring the reach, dose, and fidelity of the intervention and contextual factors influencing engagement. Objective This study aims to explore the fidelity of delivery and contextual factors underpinning the ORBIT trial. Methods Baseline study data and intervention usage metrics from participants in the intervention arm were used as quantitative implementation data (N=112). The experiences of being in the intervention were explored through semistructured interviews with children (n=20) and parent participants (n=20), therapists (n=4), and referring clinicians (n=6). A principal component analysis was used to create a comprehensive, composite measure of children and young people’s engagement with the intervention. Engagement factor scores reflected relative uptake as assessed by a range of usage indices, including chapters accessed, number of pages visited, and number of log-ins. The engagement factor score was used as the dependent variable in a multiple linear regression analysis with various contextual variables as independent variables to assess if there were any significant predictors of engagement. Results The intervention was implemented with high fidelity, and participants deemed the intervention acceptable and satisfactory. The engagement was high, with child participants completing an average of 7.5 of 10 (SD 2.7) chapters, and 88.4% (99/112) of participants completed the minimum of the first four chapters—the predefined threshold effective dose. Compared with the total population of children with tic disorders, participants in the sample tended to have more educated parents and lived in more economically advantaged areas; however, socioeconomic factors were not related to engagement factor scores. Factors associated with higher engagement factor scores included participants enrolled at the London site versus the Nottingham site (P=.01), self-referred versus clinic referred (P=.04), higher parental engagement as evidenced by the number of parental chapters completed (n=111; ρ=0.73; P<.001), and more therapist time for parents (n=111; ρ=0.46; P<.001). A multiple linear regression indicated that parents’ chapter completion (β=.69; t110=10.18; P<.001) and therapist time for parents (β=.19; t110=2.95; P=.004) were the only significant independent predictors of child engagement factor scores. Conclusions Overall, the intervention had high fidelity of delivery and was evaluated positively by participants, although reach may have been constrained by the nature of the randomized controlled trial. Parental engagement and therapist time for parents were strong predictors of intervention implementation, which has important implications for designing and implementing digital therapeutic interventions in child and adolescent mental health services. International Registered Report Identifier (IRRID) RR2-10.1186/s13063-019-3974-3
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Chamberlain, Liam R., Charlotte L. Hall, Per Andrén, E. Bethan Davies, Joseph Kilgariff, Natalia Kouzoupi, Tara Murphy, and Chris Hollis. "Therapist-Supported Online Interventions for Children and Young People With Tic Disorders: Lessons Learned From a Randomized Controlled Trial and Considerations for Future Practice." JMIR Mental Health 7, no. 10 (October 23, 2020): e19600. http://dx.doi.org/10.2196/19600.
Abstract:
In recent years, research into internet-based cognitive behavioral therapy (iCBT) has suggested that therapist-guided digital interventions have greater engagement, adherence, and effectiveness than self-directed digital therapies. While research has focused on the effectiveness of, and adherence to, these interventions, less attention has been paid to their implementation in practice and what aspects of the therapist role support success. An understanding of the key factors related to the therapist role and intervention delivery is required if these iCBTs are to be applied in routine clinical care and outcomes optimized. In light of the coronavirus disease 2019 (COVID-19) pandemic, there is greater emphasis on allowing patients access to remote therapies. We report the experiences and reflections of 4 therapists and their 2 supervisors in delivering an online, therapist-supported intervention in a randomized controlled trial for children and young people with tic disorders (the Online Remote Behavioural Intervention for Tics [ORBIT] trial). Themes discussed include the importance of training, supervision, creating support documents/manuals, and record keeping. Alongside this are communication strategies used by therapists to encourage patient adherence and treatment effectiveness. These include rapport building, treatment personalization, and suggestions for overcoming non-engagement. These reflections offer important considerations for the delivery of iCBTs as well as implications associated with the implementation of these interventions in existing services and future research studies. We share thoughts on where iCBTs may sit in a stepped care model, how services may deal with comorbid conditions, and the potential role of iCBTs in collecting clinical data.
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Paulus, Theresa, Lynn Wernecke, Annik Lundie, Julia Friedrich, Julius Verrel, Tina Rawish, Anne Weissbach, et al. "The Role of the Left Inferior Parietal Cortex in Gilles de la Tourette Syndrome—An rTMS Study." Biomedicines 11, no. 3 (March 22, 2023): 980. http://dx.doi.org/10.3390/biomedicines11030980.
Abstract:
Increased activity in the left inferior parietal cortex (BA40) plays a role in the generation of tics in the Gilles de la Tourette syndrome (GTS). Thus, inhibitory repetitive transcranial magnetic stimulation (rTMS) applied to BA40 was hypothesized to alleviate symptoms in GTS. We investigated the immediate effects of single-session 1 Hz rTMS and sham stimulation delivered to the left BA40 on tics assessed with the Rush video protocol in 29 adults with GTS. There were no significant effects on tic symptoms following rTMS or sham stimulation. Moreover, there was no difference when comparing the effects of both stimulation conditions. Bayesian statistics indicated substantial evidence against an intervention effect. The left BA40 appears not to be a useful target for 1 Hz rTMS to modulate tic symptoms in GTS patients.
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Marcoux, T. Brian. "Adverse childhood experiences and trauma informed care: treating the whole patient with a more complete osteopathic approach." Journal of Osteopathic Medicine 121, no. 9 (July 22, 2021): 763–69. http://dx.doi.org/10.1515/jom-2020-0322.
Abstract:
Abstract In 1998, a seminal study identified a strong connection between participants’ exposures to adverse childhood experiences (ACEs) and the development of risk factors for serious health conditions later in life. More than two decades later, leaders in both policy and health care professions now appreciate the impact of social determinants of health, including the enormous societal costs incurred by deleterious experiences, and recognize that treating illness begins with prevention in early childhood. The trauma informed care (TIC) model offers a treatment approach that lends consideration to the traumatic experiences that impact a given patient and allows for more complete treatment by their physician. Delivering care under the TIC model encourages trauma identification, early intervention, system level awareness and policy change, and avoiding retraumatization in the therapeutic setting. Various programs across the country seek to employ these methods at the community, state, and federal level. Several programs aimed at introducing medical students to these principles have contributed to an incorporation of TIC within the physician pipeline. In this Commentary, the author proposes an expansion of the Tenets of Osteopathic Medicine with a fifth principle—considering the implications of a patient’s past formative experiences, their present life circumstances, and their future prospects—as a vehicle for instilling TIC principles ubiquitously throughout osteopathic medical training to develop physicians who treat the whole person more completely and are better equipped to manage this public health crisis.
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Andrén, Per, Filipa Sampaio, Helene Ringberg, Vera Wachtmeister, Moa Warnström, Kayoko Isomura, Kristina Aspvall, et al. "Internet-Delivered Exposure and Response Prevention for Pediatric Tourette Syndrome." JAMA Network Open 7, no. 5 (May 3, 2024): e248468. http://dx.doi.org/10.1001/jamanetworkopen.2024.8468.
Abstract:
ImportanceBehavior therapy is a recommended intervention for Tourette syndrome (TS) and chronic tic disorder (CTD), but availability is limited and long-term effects are uncertain.ObjectiveTo investigate the long-term efficacy and cost-effectiveness of therapist-supported, internet-delivered exposure and response prevention (ERP) vs psychoeducation for youths with TS or CTD.Design, Setting, And ParticipantsThis 12-month controlled follow-up of a parallel group, superiority randomized clinical trial was conducted at a research clinic in Stockholm, Sweden, with nationwide recruitment. In total, 221 participants aged 9 to 17 years with TS or CTD were enrolled between April 26, 2019, and April 9, 2021, of whom 208 (94%) provided 12-month follow-up data. Final follow-up data were collected on June 29, 2022. Outcome assessors were masked to treatment allocation throughout the study.InterventionsA total of 111 participants were originally randomly allocated to 10 weeks of therapist-supported, internet-delivered ERP and 110 participants to therapist-supported, internet-delivered psychoeducation.Main Outcomes And MeasuresThe primary outcome was within-group change in tic severity, measured by the Total Tic Severity Score of the Yale Global Tic Severity Scale (YGTSS-TTSS), from the 3-month follow-up to the 12-month follow-up. Treatment response was defined as 1 (very much improved) or 2 (much improved) on the Clinical Global Impression–Improvement scale. Analyses were intention-to-treat and followed the plan prespecified in the published study protocol. A health economic evaluation was performed from 3 perspectives: health care organization (including direct costs for treatment provided in the study), health care sector (additionally including health care resource use outside of the study), and societal (additionally including costs beyond health care [eg, parent’s absenteeism from work]).ResultsIn total, 221 participants were recruited (mean [SD] age, 12.1 [2.3] years; 152 [69%] male). According to the YGTSS-TTSS, there were no statistically significant changes in tic severity from the 3-month to the 12-month follow-up in either group (ERP coefficient, −0.52 [95% CI, −1.26 to 0.21]; P = .16; psychoeducation coefficient, 0.00 [95% CI, −0.78 to 0.78]; P &gt; .99). A secondary analysis including all assessment points (baseline to 12-month follow-up) showed no statistically significant between-group difference in tic severity from baseline to the 12-month follow-up (coefficient, −0.38 [95% CI, −1.11 to 0.35]; P = .30). Treatment response rates were similar in both groups (55% in ERP and 50% in psychoeducation; odds ratio, 1.25 [95% CI, 0.73-2.16]; P = .42) at the 12-month follow-up. The health economic evaluation showed that, from a health care sector perspective, ERP produced more quality-adjusted life years (0.01 [95% CI, −0.01 to 0.03]) and lower costs (adjusted mean difference −$84.48 [95% CI, −$440.20 to $977.60]) than psychoeducation at the 12-month follow-up. From the health care organization and societal perspectives, ERP produced more quality-adjusted life years at higher costs, with 65% to 78% probability of ERP being cost-effective compared with psychoeducation when using a willingness-to-pay threshold of US $79 000.Conclusions And RelevanceThere were no statistically significant changes in tic severity from the 3-month through to the 12-month follow-up in either group. The ERP intervention was not superior to psychoeducation at any time point. While ERP was not superior to psychoeducation alone in reducing tic severity at the end of the follow-up period, ERP is recommended for clinical implementation due to its likely cost-effectiveness and support from previous literature.Trial RegistrationClinicalTrials.gov Identifier: NCT03916055
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Einersen, Peter, Sanchayita Mitra, Reid Selby, Ernest E. Moore, Marguerite Kelher, Miguel Fragoso, Daran Schiller, et al. "Liver X Receptor (LXR) Is a Novel and Reversible Regulator of Trauma-Induced Coagulopathy." Blood 136, Supplement 1 (November 5, 2020): 2. http://dx.doi.org/10.1182/blood-2020-143292.
Abstract:
Trauma-induced coagulopathy (TIC) manifests as a bimodal disruption of normal fibrinolysis, where at the two extremes, fibrinolytic shutdown (TICFS) places the patient at increased risk for thromboembolism and post-injury multiple organ failure, and systemic hyperfibrinolysis (TICHF) results in excessive bleeding. Plasma proteomic profiles for 65 trauma patients were used to identify changes in the patient's plasma protein profile stratifying them by risk for TIC. A strong correlation was seen between total plasma protein concentration of individual patients and the concentration of coagulation proteins within that patient, suggesting that trauma-induced coagulation may be affected through a mechanism that controls the efflux of many coagulation proteins into the plasma (Figure 1). Pathway analysis, in addition to elucidating changes in the coagulation cascade, identified several proteins that are known to be regulated by the Liver X receptor/Retinoid X receptor (LXR/RXR), suggesting that LXR/RXR-mediated activity may regulate TIC (p=9.03E-26). Validation experiments in a rat model revealed that fibrinolytic response to an LXR antagonist and/or agonist can be observed in less than 60 minutes (Figure 2). Additionally, we show through reciprocal rescue of fibrinolysis that the TIC phenotypes (TICHF and TICFS) are one continuum and are ultimately co-reversible, where the reduced LXR signaling that causes sequestration of blood factors in the liver leading to excess bleeding or induced LXR signaling that causes excess efflux leading to thrombosis can be reversed through administration of the LXR agonist or antagonist, respectively. Thus, as modulation of LXR shows co-reversibility and rapid response, induction/inhibition of the LXR pathway provides a direct and novel therapeutic intervention in severely injured patients at risk for TIC. Disclosures No relevant conflicts of interest to declare.
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Galindo LLaguno, Salvador. "Las TIC como auxiliares lingüístico-didácticos en educación indígena." Tequio 3, no. 8 (January 2, 2020): 50–58. http://dx.doi.org/10.53331/teq.v3i8.9560.
Abstract:
This paper roughly describes the
achievements and failures in pedagogical attention
that the Mexican indigenous groups have received
through several projects and institutions, as well as
the Secretariat of Public Education, facing the lack of
their own didactic supplies and didactic intervention
materials developed through Information and
Communication Technologies (ICT). Afterward, ICT are
presented as a learning tool to achieve an intercultural
and bilingual education through the use of two types
of educational software and a mobile application, as
a result of an emerging process of linguistic research
and documentation with the participation of a
multidisciplinary group of professionals and native
speakers of the different languages from the state of
Oaxaca, Mexico.
Lastly, as something worth considering, a series of
recommendations for the design and insertion of ICT
in the plans and programs of study of the modality of
indigenous education in Mexico is presented, along
with the urging of producing multimedia educational
materials with linguistic and cultural diversity
approaches.
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Pollak, Kathryn I., Xiaomei Gao, Richard J. Chung, David Farrell, and Terrill Bravender. "Feasibility of a clinic-delivered adolescent and pediatrician communication intervention on patient participatory behaviors and behavior change: TIC TAC pilot study." Patient Education and Counseling 103, no. 2 (February 2020): 414–17. http://dx.doi.org/10.1016/j.pec.2019.08.025.
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Pringsheim, Tamara, Michael S. Okun, Kirsten Müller-Vahl, Davide Martino, Joseph Jankovic, Andrea E. Cavanna, Douglas W. Woods, et al. "Practice guideline recommendations summary: Treatment of tics in people with Tourette syndrome and chronic tic disorders." Neurology 92, no. 19 (May 6, 2019): 896–906. http://dx.doi.org/10.1212/wnl.0000000000007466.
Abstract:
ObjectiveTo make recommendations on the assessment and management of tics in people with Tourette syndrome and chronic tic disorders.MethodsA multidisciplinary panel consisting of 9 physicians, 2 psychologists, and 2 patient representatives developed practice recommendations, integrating findings from a systematic review and following an Institute of Medicine–compliant process to ensure transparency and patient engagement. Recommendations were supported by structured rationales, integrating evidence from the systematic review, related evidence, principles of care, and inferences from evidence.ResultsForty-six recommendations were made regarding the assessment and management of tics in individuals with Tourette syndrome and chronic tic disorders. These include counseling recommendations on the natural history of tic disorders, psychoeducation for teachers and peers, assessment for comorbid disorders, and periodic reassessment of the need for ongoing therapy. Treatment options should be individualized, and the choice should be the result of a collaborative decision among patient, caregiver, and clinician, during which the benefits and harms of individual treatments as well as the presence of comorbid disorders are considered. Treatment options include watchful waiting, the Comprehensive Behavioral Intervention for Tics, and medication; recommendations are provided on how to offer and monitor these therapies. Recommendations on the assessment for and use of deep brain stimulation in adults with severe, treatment-refractory tics are provided as well as suggestions for future research.
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Raymond, Sophia G., Jeremy S. Stern, and Helen Simmons. "6 Drug treatment of older patients presenting to a tic disorder clinic, a descriptive study." Journal of Neurology, Neurosurgery & Psychiatry 91, no. 8 (July 20, 2020): e10.2-e10. http://dx.doi.org/10.1136/jnnp-2020-bnpa.24.
Abstract:
AimsDrugs such as neuroleptics are known to have varying efficacy in the management of Tourette’s syndrome, and there is a particular lack of research about their efficacy when used for older patients presenting for treatment for the first time. Therefore, in this study, we aim to describe the outcomes of drug treatment in patients aged 40 years and older who presented to a Tic Disorder clinic.MethodThe Tic Disorder clinic letter database was used to search for patients who presented to the clinic aged 40+. Clinical information gleaned from the letters including age of onset, severity of symptoms, comorbidities and treatments offered was recorded in an Excel spreadsheet. Those patients with incomplete data were removed from the sample. The spreadsheet data was then used to describe the severity of tics in this cohort and the effectiveness of drugs for all patients who used them.ResultsThere were a total of 33 patients aged 40+ who presented to the Tic Disorder Clinic, that we could find a set of clinical notes on. Male: female ratio = 26:7 Tic severity was calculated from either clinical comment, or in most cases, the Yale Global Tic Severity Score (YGTSS). YGTSS of 1–19 is mild, 20–39: moderate and 40–50: severe. Patients with tics since childhood: 75.8%, late onset tics >40 yrs: 15.2%, unknown: 9%. 63.6% have had obsessionality, a common comorbidity of GTS, and 42.4% suffer with two or more psychiatric comorbidities. 25/33 patients tried drugs for tics, whether before or at presentation to this clinic. 40% of them found drugs beneficial; 60% did not, or experienced adverse reactions or were lost to follow up (see bar chart).ConclusionsOverall, even though this study shows that medications for tics is more likely to be unsuccessful or cause adverse effects, it was still effective in a substantial proportion of patients and thus may be a good intervention for some. The study also suggests that this may be more difficult cohort to monitor due to the frequency of absences to follow up.
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Pringsheim, Tamara, Yolanda Holler-Managan, Michael S. Okun, Joseph Jankovic, John Piacentini, Andrea E. Cavanna, Davide Martino, et al. "Comprehensive systematic review summary: Treatment of tics in people with Tourette syndrome and chronic tic disorders." Neurology 92, no. 19 (May 6, 2019): 907–15. http://dx.doi.org/10.1212/wnl.0000000000007467.
Abstract:
ObjectiveTo systematically evaluate the efficacy of treatments for tics and the risks associated with their use.MethodsThis project followed the methodologies outlined in the 2011 edition of the American Academy of Neurology's guideline development process manual. We included systematic reviews and randomized controlled trials on the treatment of tics that included at least 20 participants (10 participants if a crossover trial), except for neurostimulation trials, for which no minimum sample size was required. To obtain additional information on drug safety, we included cohort studies or case series that specifically evaluated adverse drug effects in individuals with tics.ResultsThere was high confidence that the Comprehensive Behavioral Intervention for Tics was more likely than psychoeducation and supportive therapy to reduce tics. There was moderate confidence that haloperidol, risperidone, aripiprazole, tiapride, clonidine, onabotulinumtoxinA injections, 5-ling granule, Ningdong granule, and deep brain stimulation of the globus pallidus were probably more likely than placebo to reduce tics. There was low confidence that pimozide, ziprasidone, metoclopramide, guanfacine, topiramate, and tetrahydrocannabinol were possibly more likely than placebo to reduce tics. Evidence of harm associated with various treatments was also demonstrated, including weight gain, drug-induced movement disorders, elevated prolactin levels, sedation, and effects on heart rate, blood pressure, and ECGs.ConclusionsThere is evidence to support the efficacy of various medical, behavioral, and neurostimulation interventions for the treatment of tics. Both the efficacy and harms associated with interventions must be considered in making treatment recommendations.
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Burd, L. "Ten-week comprehensive behavioural intervention for tics decreases tic severity compared to supportive therapy and education." Evidence-Based Mental Health 13, no. 4 (October 28, 2010): 123. http://dx.doi.org/10.1136/ebmh.13.4.123.
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Smith, Pamela, Gwenllian Moody, Eleanor Clarke, Julia Hiscock, Rebecca Cannings-John, Julia Townson, Adrian Edwards, et al. "Protocol for a feasibility study of a cancer symptom awareness campaign to support the rapid diagnostic centre referral pathway in a socioeconomically deprived area: Targeted Intensive Community-based campaign To Optimise Cancer awareness (TIC-TOC)." BMJ Open 12, no. 10 (October 2022): e063280. http://dx.doi.org/10.1136/bmjopen-2022-063280.
Abstract:
IntroductionRapid diagnostic centres (RDCs) are being implemented across the UK to accelerate the assessment of vague suspected cancer symptoms. Targeted behavioural interventions are needed to augment RDCs that serve socioeconomically deprived populations who are disproportionately affected by cancer, have lower cancer symptom awareness and are less likely to seek help for cancer symptoms. The aim of this study is to assess the feasibility and acceptability of delivering and evaluating a community-based vague cancer symptom awareness intervention in an area of high socioeconomic deprivation.Methods and analysisIntervention materials and messages were coproduced with local stakeholders in Cwm Taf Morgannwg, Wales. Cancer champions will be trained to deliver intervention messages and distribute intervention materials using broadcast media (eg, local radio), printed media (eg, branded pharmacy bags, posters, leaflets), social media (eg, Facebook) and attending local community events. A cross-sectional questionnaire will include self-reported patient interval (time between noticing symptoms to contacting the general practitioner), cancer symptom recognition, cancer beliefs and barriers to presentation, awareness of campaign messages, healthcare resource use, generic quality of life and individual and area-level deprivation indicators. Consent rates and proportion of missing data for patient questionnaires (n=189) attending RDCs will be measured. Qualitative interviews and focus groups will assess intervention acceptability and barriers/facilitators to delivery.Ethics and disseminationEthical approval for this study was given by the London—West London & GTAC Research Ethics (21/LO/0402). This project will inform a potential future controlled study to assess intervention effectiveness in reducing the patient interval for vague cancer symptoms. The results will be critical to informing national policy and practice regarding behavioural interventions to support RDCs in highly deprived populations.
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Zohar, J. "Is there a Role for Antipsychotics in OCD?" European Psychiatry 24, S1 (January 2009): 1. http://dx.doi.org/10.1016/s0924-9338(09)70353-0.
Abstract:
There are actually four types of situations where intervention with antipsychotics might be considered for the treatment of Obsessive compulsive disorder. Obsessive compulsive patients with poor insight (what was previously called ‘psychotic obsession’), schizophrenic patients with OCD, obsessive compulsive patients with tic disorder, and obsessive compulsive patients who did not respond to intervention with an adequate treatment of antiobsessive medication.The data supporting the role of antipsychotic medication in obsessive compulsives with poor insight are not convincing. However, at times the treatment dilemma (antipsychotic or antiobsessive) actually derives from diagnostic ambiguity; many of the very severe ego-syntonic obsessive compulsive patients may be erroneously diagnosed as schizophrenic, while they are actually severe OCD that should be treated with antiobsessive medication and not antipsychotic.The prevalence of OCD amongst schizophrenic patients ranges from 10-25% and has a negative effect on the prognosis for those substantial proportion of schizophrenic patients. Preliminary data implies that for this subset of patient (the schizo-obsessive patients) a combination of antipsychotic and antiobsessive medication might be useful.It is crucial to screen for tic disorder in patients with, OCD as this subset of patients responds (both in terms of obsession and tics) to a combination of typical antipsychotic and antiobsessive medication.Data in regard to augmentation of OCD patients who did not respond to treatment with SSRI suggest that risperidone might have a specific therapeutic potential in this subset of patients. The role of antipsychotics with 5HT1D properties like ziprasidone need to be studied.