Liam Davenport

September 26, 2016

VIENNA — Despite impulsive behaviors and vocal tics, patients with Tourette's syndrome (TS) are no more aggressive than healthy individuals, say Hungarian scientists, who urge compassion toward affected individuals.

Moreover, TS patients are significantly less aggressive than the general psychiatric population or those with attention-deficit/hyperactivity disorder (ADHD).

Lead researcher Péter Nagy, MD, Vadaskert Child and Adolescent Psychiatric Hospital, Budapest, Hungary, said: "Tourette's patients can show motor tics, like grimacing or arm movements, or certain vocal tics, and people may assume that this is an expression of suppressed or overt aggression. This is, in fact, not the case.

"The problem is not one of aggression but of understanding; Tourette's patients need support and acceptance, not rejection or fear."

The findings were presented here at the 29th European College of Neuropsychopharmacology (ECNP) Congress.

Important Findings

For the study, the researchers assessed aggression levels in 87 boys with TS (mean age, 9.7 years) using the parental version of the Inventory of Callous-Unemotional Traits (ICU) and the self-reported Reactive-Proactive Aggression Questionnaire (RPA).

The results were compared with data on both scales from a previous study that included 117 healthy control persons (mean age, 13.9 years), 494 individuals from the general pediatric psychiatric population (mean age, 13.6 years), and 161 boys with ADHD (mean age, 13.1 years).

There was no significant difference in total scores on the RPA between TS patients and healthy control persons, at 9.5 and 9.5, respectively (P = .20). In contrast, RPA total scores were significantly higher in the general clinical population and among those with ADHD, at 14.3 and 14.1, respectively (P < 0.00 for both).

A similar pattern was seen on the RPA reactive aggression subscale, at mean scores of 7.2 and 7.8 for TS patients and control persons (P = .35), but mean scores of 9.9 and 9.5 for the general clinical population and ADHD patients (P < .00). This relationship was repeated for the RPA proactive aggression subscale.

On the ICU total score, TS patients had a mean score of 25.0, which was not significantly different from that seen in healthy control individuals, at 23.8 (P = .16). Again, mean scores were significantly higher for the general clinical population and ADHD patients, at 35.1 and 36.9, respectively (P < .00).

The authors point out that the finding that aggression in TS is comparable to that in healthy individuals remains "true no matter if the parent of the child himself rates the individual level of aggression.

"This is an important finding that has to be communicated to both patients and laymen to facilitate the destigmatization of TS. The nature of impulsivity and aggression warrants further studies," they add.

Need for Greater Understanding

Commenting on the findings, Josefina Castro-Fornieles, MD, PhD, professor at the Department of Psychiatry and Clinical Psychobiology, University of Barcelona, Spain, and a member of the ECNP Child and Adolescent Disorders Scientific Advisory Panel, said there is a need "to increase the knowledge of families, teachers, and primary practitioners on the symptoms of Tourette's syndrome to improve their understanding of the disorder.

"This kind of study can help us to break down some of the mistaken ideas that both professionals and society have about this condition. This is especially important if we consider the psychosocial consequences in children and adolescents."

The study received no funding. The investigators have disclosed no relevant financial relationships.

29th European College of Neuropsychopharmacology (ECNP) Congress. Abstract P.7.b.024. Presented September 20, 2016.


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