RESUMEN
This article reflects discussion by the WHO ICD-11 Working Group on the Classification of Obsessive-Compulsive and Related Disorders. After reviewing the historical classification of tic disorders, this article discusses their placement in ICD-11. Existing problems with diagnostic labels and criteria, appropriate placement of the tic disorders category within the ICD-11 system, and pragmatic factors affecting classification are reviewed. The article ends with recommendations to (a) maintain consistency with the DSM-5 diagnostic labels for tic disorders, (b) add a minimum duration guideline for a provisional tic disorder diagnosis, (c) remove the multiple motor tic guideline for the diagnosis of Tourette disorder, and (d) co-parent the tic disorder diagnoses in the disorders of the nervous system and the mental and behavioral disorders categories, with secondary co-parenting in the obsessive-compulsive and related disorders and neurodevelopmental disorders sections.
Asunto(s)
Manual Diagnóstico y Estadístico de los Trastornos Mentales , Clasificación Internacional de Enfermedades , Trastornos de Tic/clasificación , Trastornos de Tic/diagnóstico , Humanos , Trastorno Obsesivo Compulsivo/clasificación , Trastorno Obsesivo Compulsivo/diagnóstico , Síndrome de Tourette/clasificación , Síndrome de Tourette/diagnósticoRESUMEN
This article reflects discussion by the WHO ICD-11 Working Group on the Classification of Obsessive-Compulsive and Related Disorders. After reviewing the historical classification of tic disorders, this article discusses their placement in ICD-11. Existing problems with diagnostic labels and criteria, appropriate placement of the tic disorders category within the ICD-11 system, and pragmatic factors affecting classification are reviewed. The article ends with recommendations to (a) maintain consistency with the DSM-5 diagnostic labels for tic disorders, (b) add a minimum duration guideline for a provisional tic disorder diagnosis, (c) remove the multiple motor tic guideline for the diagnosis of Tourette disorder, and (d) co-parent the tic disorder diagnoses in the disorders of the nervous system and the mental and behavioral disorders categories, with secondary co-parenting in the obsessive-compulsive and related disorders and neurodevelopmental disorders sections.
Asunto(s)
Humanos , Manual Diagnóstico y Estadístico de los Trastornos Mentales , Clasificación Internacional de Enfermedades , Trastornos de Tic/clasificación , Trastornos de Tic/diagnóstico , Trastorno Obsesivo Compulsivo/clasificación , Trastorno Obsesivo Compulsivo/diagnóstico , Síndrome de Tourette/clasificación , Síndrome de Tourette/diagnósticoRESUMEN
BACKGROUND: The relationship between childhood tic disorders and group A streptococcal (GAS) infections has been recently investigated by several research groups, but no systematic evaluation of laboratory indicators of GAS infections has been provided. OBJECTIVE: The aim of our study was to seek clinical and laboratory evidence of GAS infections in a large population of children affected with tic disorders. STUDY DESIGN: This investigation was a case-control study: 150 consecutive children presenting with tics were investigated for clinical and laboratory signs of streptococcal infections on the occasion of their first neuropsychiatric consultation. To compare the rate of exposition to GAS in a similar population, a control group of 150 children without tic disorders was examined during the same period. RESULTS: In children with tics, mean antistreptolysin O (ASO) titer (434 +/- 338 IU) was significantly higher compared with that of control subjects (155 +/- 126 IU); 38% of the children with tics compared with 2% of the control subjects (P <.001) had ASO titers > or =500 IU. Twenty-six children with tics (17%) had throat cultures positive for GAS, but in all cases, only few colonies per plate were isolated. Among the strains isolated, no prevalent T pattern or M type was observed. In children with tics a positive correlation between ASO titers and severity of tic disorder (measured by the Yale Global Tic Severity Scale) was found. CONCLUSION: Our results suggest that children with tic disorder could be a unique population in which GAS infection, or at least the exposure to streptococcal antigens, is correlated to the neurobehavioral disorder. Moreover, our data indicate a relationship between the severity of tic disorder and the magnitude of the serologic response to GAS antigens.
Asunto(s)
Infecciones Estreptocócicas/epidemiología , Infecciones Estreptocócicas/etiología , Streptococcus pyogenes , Trastornos de Tic/complicaciones , Antiestreptolisina/sangre , Estudios de Casos y Controles , Niño , Femenino , Hospitales Universitarios , Humanos , Masculino , Servicio Ambulatorio en Hospital , Prevalencia , Infecciones del Sistema Respiratorio/epidemiología , Infecciones del Sistema Respiratorio/etiología , Ciudad de Roma/epidemiología , Estaciones del Año , Índice de Severidad de la Enfermedad , Infecciones Estreptocócicas/sangre , Infecciones Estreptocócicas/inmunología , Infecciones Estreptocócicas/microbiología , Trastornos de Tic/clasificaciónAsunto(s)
Humanos , Síndrome de Tourette/diagnóstico , Trastornos de Tic/clasificación , Síndrome de Tourette/clasificación , Síndrome de Tourette/fisiopatología , Trastornos de Tic/complicaciones , Trastornos de Tic/fisiopatología , Diagnóstico Diferencial , Ansiedad/complicaciones , Trastorno Obsesivo Compulsivo/complicacionesAsunto(s)
Humanos , Trastornos de Tic/clasificación , Síndrome de Tourette/diagnóstico , Ansiedad/complicaciones , Trastornos de Tic/complicaciones , Trastornos de Tic/fisiopatología , Trastorno Obsesivo Compulsivo/complicaciones , Diagnóstico Diferencial , Síndrome de Tourette/clasificación , Síndrome de Tourette/fisiopatologíaRESUMEN
Los tics en la infancia constituyen una manifestación patológica muy frecuente. Son movimientos involuntarios, sin finalidad concreta y favorecidos pro factores emocionales. Existen tres grupos importantes que deben ser conocidos: tics transitorios, tics motores crónicos y tics múltiples o síndrome de Gilles de la Tourette. Los criterioe diagnósticos de los tics crónicos múltiples han variado con el transcurso de los años, hasta llegar a simplificarse por motivos de mayor conocimiento etiopatogénico. Es un síndrome con una incidencia relativamente frecuente. En este artículo se hace hincapié en el núcleo patológico obsesión-compulsivo, formas monosintomáticas y en la etiopatogenia orgánica del síndrome. Se citan las nuevas investigaciones con unas perspectivas de futuro apasionantes