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The Cochrane Database of Systematic... Oct 2009Gilles de la Tourette Syndrome (GTS) is a developmental neuropsychiatric disorder characterised by the presence of chronic motor and phonic tics. Drugs currently used in... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Gilles de la Tourette Syndrome (GTS) is a developmental neuropsychiatric disorder characterised by the presence of chronic motor and phonic tics. Drugs currently used in the treatment of GTS either lack efficacy or are associated with intolerable side effects. There is some anecdotal and experimental evidence that cannabinoids may be effective in treating tics and compulsive behaviour in patients with GTS. There are currently no systematic Cochrane reviews of treatments used in GTS. There is one other Cochrane review being undertaken at present, on the use of fluoxetine for tics in GTS.
OBJECTIVES
To evaluate the efficacy and safety of cannabinoids as compared to placebo or other drugs in treating tics, premonitory urges and obsessive compulsive symptoms (OCS), in patients with GTS.
SEARCH STRATEGY
We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (in The Cochrane Library Issue 4 2008) , MEDLINE (January 1996 to date), EMBASE (January 1974 to date), PsycINFO (January 1887 to date), CINAHL (January 1982 to date), AMED (January 1985 to date), British Nursing Index (January 1994 to date) and DH DATA (January 1994 to date). We also searched the reference lists of located trials and review articles for further information.
SELECTION CRITERIA
We included randomised controlled trials (RCTs) comparing any cannabinoid preparation with placebo or other drugs used in the treatment of tics and OCS in patients with GTS.
DATA COLLECTION AND ANALYSIS
Two authors abstracted data independently and settled any differences by discussion.
MAIN RESULTS
Only two trials were found that met the inclusion criteria. Both compared a cannabinoid, delta-9-Tetrahydrocannabinol (Delta(9)THC), either as monotherapy or as adjuvant therapy, with placebo. One was a double blind, single dose crossover trial and the other was a double blind, parallel group study. A total of 28 different patients were studied. Although both trials reported a positive effect from Delta(9)THC, the improvements in tic frequency and severity were small and were only detected by some of the outcome measures.
AUTHORS' CONCLUSIONS
Not enough evidence to support the use of cannabinoids in treating tics and obsessive compulsive behaviour in people with Tourette's syndrome.
Topics: Cannabinoids; Dronabinol; Humans; Randomized Controlled Trials as Topic; Tourette Syndrome
PubMed: 19821373
DOI: 10.1002/14651858.CD006565.pub2 -
Neurological Sciences : Official... Feb 2024Tics and stereotypies are childhood-onset repetitive behaviours that can pose significant diagnostic challenges in clinical practice. Both tics and stereotypies are... (Review)
Review
BACKGROUND
Tics and stereotypies are childhood-onset repetitive behaviours that can pose significant diagnostic challenges in clinical practice. Both tics and stereotypies are characterised by a complex co-morbidity profile, however little is known about the co-occurrence of these hyperkinetic disorders in the same patient population.
OBJECTIVE
This review aimed to assess the relationship between tics and stereotypies when these conditions present in co-morbidity.
METHODS
We conducted a systematic literature review of original studies on co-morbid tics and stereotypies, according to the standards outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
RESULTS
Our literature search identified six studies of suitable sample size (n ≥ 40) presenting data on the association between tics and stereotypies in otherwise typically developing patients. A considerable proportion (23%) of patients diagnosed with stereotypic movement disorder present with co-morbid tics (range 18-43%). Likewise, the prevalence of primary stereotypies is increased in patients with tic disorders such as Tourette syndrome (8%, range 6-12%).
DISCUSSION
Tics and stereotypies can often develop in co-morbidity. The association of tics and stereotypies in the same patient has practical implications, in consideration of the different treatment approaches. Future research should focus on the assessment and management of both conditions, particularly in special populations (e.g. patients with pervasive developmental disorders).
Topics: Child; Humans; Comorbidity; Stereotypic Movement Disorder; Tic Disorders; Tics; Tourette Syndrome
PubMed: 37775616
DOI: 10.1007/s10072-023-07095-y -
Psychopathology 2023The majority of models on obsessive compulsive disorder (OCD) endorse a top-down perspective on the cognitive mechanisms underlying OCD functioning and maintenance,...
BACKGROUND
The majority of models on obsessive compulsive disorder (OCD) endorse a top-down perspective on the cognitive mechanisms underlying OCD functioning and maintenance, whereas a bottom-up perspective is rarely pursued.
OBJECTIVES
The aim of the study was to review the empirical literature on sensory phenomena (SP) and neurodevelopmental antecedents of OCD, which could support the conceptualization of an alternative, bottom-up perspective integrating neurodevelopmental and phenomenological levels of analysis on OCD.
METHODS
A systematic review according to PRISMA guidelines was performed in PubMed/MEDLINE, PsycInfo, the Cochrane Library, and Excerpta Medica Database (EMBASE) and focused on SP and "neurodevelopmental antecedents" (operationalized in early risk factors, neuroimaging signs, neurological soft signs, and sensory responsivity). The time interval was from inception up to March 31, 2022.
RESULTS
From the search in electronic databases, 48 studies were retained and reviewed. SP are highly prevalent in OCD patients and overrepresented in comparison with healthy controls. Similarly, OCD patients also present a higher prevalence of early environmental adversities and sensorimotor alterations in terms of neurological soft signs and sensory over-responsivity in the tactile and acoustic domains; additional findings included hypogyrification signs at neuroimaging. Both sensorimotor alterations and SP are associated with tic-related manifestations and poorer insight in OCD patients.
CONCLUSIONS
On the ground of established common subjective experience of SP and premorbid neurodevelopmental features, we hypothesized an explanatory model for OCD, which considers the possible pathophysiological role for altered corollary discharge and enhanced error detection in the neurodevelopment of SP and obsessions. SP may represent the subjective experiential resonance of an individual history of persistently inaccurate sensory predictions, whereas accompanying manifestations, such as the obsessive need for order and symmetry, may represent a compensatory attempt to mitigate SP. This neurodevelopmental-phenomenological bottom-up model, describing a dimensional gradient of sensorimotor alterations and related subjective experiences, may contribute to explain the dimensional affinity between OCD and schizophrenia spectrum disorders. Furthermore, this model could be useful for the early detection of subjects at higher risk of OCD.
Topics: Humans; Obsessive-Compulsive Disorder; Schizophrenia
PubMed: 36282066
DOI: 10.1159/000526708 -
Sensors (Basel, Switzerland) Nov 2019Sleep apnea is a sleep related disorder that significantly affects the population. Polysomnography, the gold standard, is expensive, inaccessible, uncomfortable and an... (Review)
Review
Sleep apnea is a sleep related disorder that significantly affects the population. Polysomnography, the gold standard, is expensive, inaccessible, uncomfortable and an expert technician is needed to score. Numerous researchers have proposed and implemented automatic scoring processes to address these issues, based on fewer sensors and automatic classification algorithms. Deep learning is gaining higher interest due to database availability, newly developed techniques, the possibility of producing machine created features and higher computing power that allows the algorithms to achieve better performance than the shallow classifiers. Therefore, the sleep apnea research has currently gained significant interest in deep learning. The goal of this work is to analyze the published research in the last decade, providing an answer to the research questions such as how to implement the different deep networks, what kind of pre-processing or feature extraction is needed, and the advantages and disadvantages of different kinds of networks. The employed signals, sensors, databases and implementation challenges were also considered. A systematic search was conducted on five indexing services from 2008-2018. A total of 255 papers were found and 21 were selected by considering the inclusion and exclusion criteria, using the preferred reporting items for systematic reviews and meta-analyses (PRISMA) approach.
Topics: Deep Learning; Humans; Neural Networks, Computer; Sleep Apnea Syndromes
PubMed: 31726771
DOI: 10.3390/s19224934 -
Neuroscience and Biobehavioral Reviews Jul 2013We conducted a meta-analysis of randomized, placebo-controlled trials to determine the efficacy of antipsychotic and alpha-2 agonists in the treatment of chronic tic... (Review)
Review
We conducted a meta-analysis of randomized, placebo-controlled trials to determine the efficacy of antipsychotic and alpha-2 agonists in the treatment of chronic tic disorders and examine moderators of treatment effect. Meta-analysis demonstrated a significant benefit of antipsychotics compared to placebo (standardized mean difference (SMD)=0.58 (95% confidence interval (CI): 0.36-0.80). Stratified subgroup analysis found no significant difference in the efficacy of the 4 antipsychotic agents tested (risperidone, pimozide, haloperidol and ziprasidone). Meta-analysis also demonstrated a benefit of alpha-2 agonists compared to placebo (SMD=0.31 (95% confidence interval CI: 0.15-0.48). Stratified subgroup analysis and meta-regression demonstrated a significant moderating effect of co-occurring ADHD. Trials which enrolled subjects with tics and ADHD demonstrated a medium-to-large effect (SMD=0.68 (95%CI: 0.36-1.01) whereas trials that excluded subjects with ADHD demonstrated a small, non-significant benefit (SMD=0.15 (95%CI: -0.06 to 0.36). Our findings demonstrated significant benefit of both antipsychotics and alpha-2 agonists in treating tics but suggest alpha-2 agonists may have minimal benefit in tic patients without ADHD.
Topics: Adrenergic alpha-Agonists; Age Factors; Animals; Antidiarrheals; Attention Deficit Disorder with Hyperactivity; Clinical Trials as Topic; Humans; Meta-Analysis as Topic; PubMed; Tic Disorders
PubMed: 23099282
DOI: 10.1016/j.neubiorev.2012.09.008 -
European Child & Adolescent Psychiatry Feb 2024A better understanding of the endocannabinoid system and a relaxation in regulatory control of cannabis globally has increased interest in the medicinal use of... (Review)
Review
A better understanding of the endocannabinoid system and a relaxation in regulatory control of cannabis globally has increased interest in the medicinal use of cannabinoid-based products (CBP). We provide a systematic review of the rationale and current clinical trial evidence for CBP in the treatment of neuropsychiatric and neurodevelopmental disorders in children and adolescents. A systematic search of MEDLINE, Embase, PsycINFO, and the Cochrane Central Register of Trials was performed to identify articles published after 1980 about CBP for medical purposes in individuals aged 18 years or younger with selected neuropsychiatric or neurodevelopmental conditions. Risk of bias and quality of evidence was assessed for each article. Of 4466 articles screened, 18 were eligible for inclusion, addressing eight conditions (anxiety disorders (n = 1); autism spectrum disorder (n = 5); foetal alcohol spectrum disorder (n = 1); fragile X syndrome (n = 2); intellectual disability (n = 1); mood disorders (n = 2); post-traumatic stress disorder (n = 3); and Tourette syndrome (n = 3)). Only one randomised controlled trial (RCT) was identified. The remaining seventeen articles included one open-label trial, three uncontrolled before-and-after trials, two case series and 11 case reports, thus the risk of bias was high. Despite growing community and scientific interest, our systematic review identified limited and generally poor-quality evidence for the efficacy of CBP in neuropsychiatric and neurodevelopmental disorders in children and adolescents. Large rigorous RCTs are required to inform clinical care. In the meantime, clinicians must balance patient expectations with the limited evidence available.
Topics: Child; Humans; Adolescent; Cannabinoids; Anxiety Disorders; Stress Disorders, Post-Traumatic; Tourette Syndrome
PubMed: 36864363
DOI: 10.1007/s00787-023-02169-w -
Translational Psychiatry Nov 2021There is emerging evidence demonstrating an association between maternal polycystic ovary syndrome (PCOS) and autism spectrum disorder (ASD) in children, however, the... (Meta-Analysis)
Meta-Analysis
There is emerging evidence demonstrating an association between maternal polycystic ovary syndrome (PCOS) and autism spectrum disorder (ASD) in children, however, the cumulative effect of maternal PCOS on the development of ASD or other neuropsychiatry disorders (NPD) in children and separately for males and females has not been examined. We sought to systematically evaluate the influence of maternal PCOS on a wide range of NPD including ASD, attention deficit hyperactivity disorder (ADHD), chronic tic disorder (CDT), other behavior disorders, anxiety, depression, bipolar disorder, schizophrenia in children as well as in women of reproductive age only. We queried electronic databases including PubMed, EMBASE, and Google Scholar, until March 2021. We used DerSimonian and Laird (D-L) random effects method to compute pooled effect size in terms of odds ratio (OR). Nineteen studies (1667851 mothers, 2260622 children) were included in this study. Mothers with PCOS had an increased odds of children diagnosed with ASD (OR = 1.40, p < 0.001), ADHD (OR = 1.42, p < 0.001), CTD (OR = 1.44, p = 0.001), anxiety (OR = 1.33, p < 0.001), as well as other behavioral symptoms (OR = 1.45, p < 0.001) in the adjusted analysis. The association between maternal PCOS and ASD (OR: 1.43 vs. 1.66), ADHD (OR: 1.39 vs. 1.54), and CTD (OR: 1.42 vs. 1.51) was found to be significantly consistent between males and females, respectively. Our data do not suggest increased fetal testosterone exposure is associated with increased autistic traits in children. However, PCOS was significantly associated with increased odds of a wide range of NPD in women themselves. Maternal PCOS is a risk factor for various NPD with a similar extent in their children regardless of their underlying comorbidities. Managing PCOS is essential for women's health as well as for their children's health. More research is needed to determine the mechanisms and links between maternal PCOS and NPD in children.
Topics: Attention Deficit Disorder with Hyperactivity; Autism Spectrum Disorder; Child; Female; Humans; Male; Mothers; Polycystic Ovary Syndrome; Tic Disorders
PubMed: 34750348
DOI: 10.1038/s41398-021-01699-8 -
Frontiers in Psychiatry 2022Tourette's syndrome (TS) is a childhood neurodevelopmental disorder characterized by sudden, repetitive, involuntary, and irregular muscle movement and vocalization....
BACKGROUND
Tourette's syndrome (TS) is a childhood neurodevelopmental disorder characterized by sudden, repetitive, involuntary, and irregular muscle movement and vocalization. Recently, non-pharmaceutical methods, such as behavioral therapy, psychotherapy, and deep brain stimulation, have been introduced as alternatives to pharmacological treatment for TS. This study aimed to systematically review and synthesize qualitative evidence on the experiences of children with TS and their caregivers. A meta-synthesis of qualitative evidence could help provide a comprehensive understanding of the challenges experienced by children with TS and their caregivers with the aim of providing more effective treatment and services for them.
MATERIALS AND METHODS
A systematic search was conducted using MEDLINE/PubMed, EMBASE, Cumulative Index to Nursing and Allied Health Literature, PsycARTICLES, and three Korean databases (Korean Medical Database, Research Information Sharing Service, and ScienceON) in July 2021. Studies were included if they collected and analyzed qualitative data from children with tic disorder or TS, or their caregivers. Qualitative research findings on the experiences and perspectives of children with TS and their caregivers were critically appraised and synthesized using the Joanna Briggs Institute methodology.
RESULTS
Eight eligible studies were included. The findings from these studies (i.e., themes or subthemes of qualitative research) were aggregated into categories (a group of similar findings) and synthesized findings (a group of categorized findings). Ultimately, the 60 findings were aggregated into 15 categories. Finally, four synthesized findings were derived from the 15 categories: (i) continuation of challenging daily life, (ii) denying that TS causes emotional distress, (iii) accepting and understanding TS as part of oneself, and (iv) looking to the future.
CONCLUSION
Children with TS and their caregivers experience physical and psychological distress and social deprivation. Avoiding and suppressing TS causes secondary distress such as guilt. However, seeking social support and accepting the disorder reduce the distress caused by symptoms and lays the foundation for later growth. Even in the face of adversity, children with TS and their caregivers find personal value and acquire a more open and optimistic attitude toward life. This review shows that acceptance-based therapy and social support should be provided for the treatment and management of TS.
PubMed: 36245875
DOI: 10.3389/fpsyt.2022.992905 -
Heliyon Oct 2022Tourette syndrome (TS) is an incurable neuropsychiatric disorder. Deep brain stimulation (DBS), repeat transcranial magnetic stimulation (rTMS), and behavioral therapy... (Review)
Review
Comparison of efficacy of deep brain stimulation, repeat transcranial magnetic stimulation, and behavioral therapy in Tourette syndrome: A systematic review and Bayesian Network Meta-Analysis.
BACKGROUND
Tourette syndrome (TS) is an incurable neuropsychiatric disorder. Deep brain stimulation (DBS), repeat transcranial magnetic stimulation (rTMS), and behavioral therapy (BT) are all effective treatments. However, the comparison of therapeutic effect of these three therapies is lacking.
METHODS
A systematic literature search was conducted for randomized controlled studies (RCT). A network meta-analysis by R4.04 software according to Bayesian framework were performed. Results were meta-analyzed and network meta-analyzed to evaluate and compare the efficacy of DBS, rTMS and BT in TS patients.
RESULTS
A total of 18 randomized controlled studies with 661 participants were included. The Yale Global Tic Severity Scale (YGTSS) and the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) were utilized to evaluate the symptoms of TS. All three treatments improved the tic symptoms of TS [DBS 12.11 (95%CI 7.58-16.65); rTMS 4.96 (95%CI 1.01-10.93); andBT 11.72 (95%CI 10.42-13.01)]; and obsessive-compulsive symptom [DBS 4.9 (95%CI 1.13-8.67); rTMS 5.28 (95%CI 0.21-10.77); and BT 1.61 (95%CI 0.74-2.48)]. The cumulative probability results showed that DBS had the best effect on the improvement of tic symptoms, followed by BT; and rTMS was ranked last. However, in terms of improvement of obsessional symptoms, rTMS was ranked first, DBS was ranked second, and BT was ranked last. In addition, the meta regression analysis of YGTSS in DBS, rTMS and BT has significant difference (P = 0.05).
LIMITATION
Due to the lack of quantitative indicators, we did not perform a network meta-analysis of the side effects of the three treatments.
CONCLUSION
Our study showed that DBS, rTMS, and BT are effective in TS. DBS causes the best improvement in tic symptoms, and rTMS is the most effective in improving the obsessive-compulsive symptoms.
PubMed: 36281376
DOI: 10.1016/j.heliyon.2022.e10952 -
JMIR Mental Health Feb 2019Mobile Therapeutic Attention for Patients with Treatment-Resistant Schizophrenia (m-RESIST) is an EU Horizon 2020-funded project aimed at designing and validating an... (Review)
Review
BACKGROUND
Mobile Therapeutic Attention for Patients with Treatment-Resistant Schizophrenia (m-RESIST) is an EU Horizon 2020-funded project aimed at designing and validating an innovative therapeutic program for treatment-resistant schizophrenia. The program exploits information from mobile phones and wearable sensors for behavioral tracking to support intervention administration.
OBJECTIVE
To systematically review original studies on sensor-based mHealth apps aimed at uncovering associations between sensor data and symptoms of psychiatric disorders in order to support the m-RESIST approach to assess effectiveness of behavioral monitoring in therapy.
METHODS
A systematic review of the English-language literature, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, was performed through Scopus, PubMed, Web of Science, and the Cochrane Central Register of Controlled Trials databases. Studies published between September 1, 2009, and September 30, 2018, were selected. Boolean search operators with an iterative combination of search terms were applied.
RESULTS
Studies reporting quantitative information on data collected from mobile use and/or wearable sensors, and where that information was associated with clinical outcomes, were included. A total of 35 studies were identified; most of them investigated bipolar disorders, depression, depression symptoms, stress, and symptoms of stress, while only a few studies addressed persons with schizophrenia. The data from sensors were associated with symptoms of schizophrenia, bipolar disorders, and depression.
CONCLUSIONS
Although the data from sensors demonstrated an association with the symptoms of schizophrenia, bipolar disorders, and depression, their usability in clinical settings to support therapeutic intervention is not yet fully assessed and needs to be scrutinized more thoroughly.
PubMed: 30785404
DOI: 10.2196/mental.9819