In 2013, the American Psychiatric Association (APA) published the 5th edition of its Diagnostic and Statistical Manual of Mental Disorders (DSM‐5). In 2019, the World Health Assembly approved the ...11th revision of the International Classification of Diseases (ICD‐11). It has often been suggested that the field would benefit from a single, unified classification of mental disorders, although the priorities and constituencies of the two sponsoring organizations are quite different. During the development of the ICD‐11 and DSM‐5, the World Health Organization (WHO) and the APA made efforts toward harmonizing the two systems, including the appointment of an ICD‐DSM Harmonization Group. This paper evaluates the success of these harmonization efforts and provides a guide for practitioners, researchers and policy makers describing the differences between the two systems at both the organizational and the disorder level. The organization of the two classifications of mental disorders is substantially similar. There are nineteen ICD‐11 disorder categories that do not appear in DSM‐5, and seven DSM‐5 disorder categories that do not appear in the ICD‐11. We compared the Essential Features section of the ICD‐11 Clinical Descriptions and Diagnostic Guidelines (CDDG) with the DSM‐5 criteria sets for 103 diagnostic entities that appear in both systems. We rated 20 disorders (19.4%) as having major differences, 42 disorders (40.8%) as having minor definitional differences, 10 disorders (9.7%) as having minor differences due to greater degree of specification in DSM‐5, and 31 disorders (30.1%) as essentially identical. Detailed descriptions of the major differences and some of the most important minor differences, with their rationale and related evidence, are provided. The ICD and DSM are now closer than at any time since the ICD‐8 and DSM‐II. Differences are largely based on the differing priorities and uses of the two diagnostic systems and on differing interpretations of the evidence. Substantively divergent approaches allow for empirical comparisons of validity and utility and can contribute to advances in the field.
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.
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.
Hair pulling disorder (HPD; trichotillomania) and skin picking disorder (SPD) are relatively common and potentially severe psychiatric conditions that have received limited empirical attention. ...Researchers are increasingly recognizing the similarities and co-occurrence of HPD and SPD, and several authors have suggested that the two disorders should be categorized together in the DSM-5. In the present article, we critically examined the evidence for comorbidity of HPD and SPD, and reviewed a diverse literature pertaining to shared risk factors and similarities in clinical characteristics. Evidence suggests that the two disorders co-occur more often than can be expected by chance, have substantial similarities in a variety of clinical characteristics (e.g., symptom presentation and course of illness) and may have some distal risk factors in common (e.g., genetic vulnerabilities). Implications for classification in the DSM-5, clinical management and research on etiology were discussed.
► Hair pulling disorder (HPD) and Skin picking disorder (SPD) co-occur more often than chance would predict. ► HPD and SPD have substantial similarities in clinical characteristics and have overlapping risk factors. ► The two disorders likely share etiology and should be categorized together in the DSM-5.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
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 Neurologyʼs 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.
Abstract Symptoms of Tourette's syndrome vary in frequency and intensity. Although such variability may be the result of deficits in the underlying neurological system, tic expression can also be ...systematically impacted by contextual factors. This article reviews research on the impact of several contextual factors on tic expression and discusses implications for future research and treatment development.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
CONTEXT Tourette disorder is a chronic and typically impairing childhood-onset neurologic condition. Antipsychotic medications, the first-line treatments for moderate to severe tics, are often ...associated with adverse effects. Behavioral interventions, although promising, have not been evaluated in large-scale controlled trials. OBJECTIVE To determine the efficacy of a comprehensive behavioral intervention for reducing tic severity in children and adolescents. DESIGN, SETTING, AND PARTICIPANTS Randomized, observer-blind, controlled trial of 126 children recruited from December 2004 through May 2007 and aged 9 through 17 years, with impairing Tourette or chronic tic disorder as a primary diagnosis, randomly assigned to 8 sessions during 10 weeks of behavior therapy (n = 61) or a control treatment consisting of supportive therapy and education (n = 65). Responders received 3 monthly booster treatment sessions and were reassessed at 3 and 6 months following treatment. INTERVENTION Comprehensive behavioral intervention. MAIN OUTCOME MEASURES Yale Global Tic Severity Scale (range 0-50, score >15 indicating clinically significant tics) and Clinical Global Impressions–Improvement Scale (range 1 very much improved to 8 very much worse). RESULTS Behavioral intervention led to a significantly greater decrease on the Yale Global Tic Severity Scale (24.7 95% confidence interval {CI}, 23.1-26.3 to 17.1 95% CI, 15.1-19.1) from baseline to end point compared with the control treatment (24.6 95% CI, 23.2-26.0 to 21.1 95% CI, 19.2-23.0) (P < .001; difference between groups, 4.1; 95% CI, 2.0-6.2) (effect size = 0.68). Significantly more children receiving behavioral intervention compared with those in the control group were rated as being very much improved or much improved on the Clinical Global Impressions–Improvement scale (52.5% vs 18.5%, respectively; P < .001; number needed to treat = 3). Attrition was low (12/126, or 9.5%); tic worsening was reported by 4% of children (5/126). Treatment gains were durable, with 87% of available responders to behavior therapy exhibiting continued benefit 6 months following treatment. CONCLUSION A comprehensive behavioral intervention, compared with supportive therapy and education, resulted in greater improvement in symptom severity among children with Tourette and chronic tic disorder. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00218777
An increasing body of evidence has linked pathological body-focused repetitive behaviors (BFRBs) to excessive sensory sensitivity and difficulty modulating sensory inputs. Likewise, neurobiological ...evidence points to deficits in feed-forward inhibition and sensory habituation in conditions with similar symptomatology. There is currently little evidence regarding potential physiological sensory abnormalities in BFRBs. The current study compared 46 adults with pathological hair pulling and/or skin picking to 46 age-matched healthy control participants on a series of self-report measures and objective psychophysical tests of neurophysiological sensory functions. Persons in the BFRB group reported increased scores on the Sensory Gating Inventory (U = 320.50, p < .001) and all of its subscales (all p-values < .001), reflecting abnormal sensory experiences. The BFRB group also showed decreased tactile thresholds (increased sensitivity) (F1, 76 = 10.65, p = .002, ηp2 = .12) and deficient feed-forward inhibition (F1, 76 = 5.18, p = .026, ηp2 = .064), but no abnormalities in quickly-adapting sensory habituation were detected on an amplitude discrimination task. Performance on objective psychophysical tests was not associated with self-reported sensory gating symptoms or symptom severity. Implications of these results for the pathophysiology of BFRBs and related disorders are discussed.
•Sensory abnormalities in BFRBs are poorly understood.•Self-reports and psychophysical assessments of sensory processing were conducted.•Deficient sensory gating was reported in persons with BFRBs.•Abnormally low tactile detection thresholds were found in BFRBs.•Deficient feed-forward inhibition was demonstrated in BFRBs.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Trichotillomania, or chronic hairpulling, is a common condition that affects primarily women. The disorder can cause significant psychosocial impairment and is associated with elevated rates of ...psychiatric comorbidity. In this article, the phenomenology, etiology, assessment, and treatment of the disorder are discussed.
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