Functional Tic-like Behaviors: From the COVID-19 Pandemic to the Post-Pandemic Era
Abstract
:1. Introduction
2. Materials and Methods
2.1. Systematic Literature Search
2.2. Eligibility Criteria
3. Results
4. Discussion
5. Diagnostic Checklists for Functional Tic-Like Behaviors
6. Treatment of Functional Tic-Like Behaviors
7. Functional Tic-Like Behaviors in the Post-Pandemic Era
8. Open Questions
9. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
- Heyman, I.; Liang, H.; Hedderly, T. COVID-19 related increase in childhood tics and tic-like attacks. Arch. Dis. Child 2021, 106, 417. [Google Scholar] [CrossRef] [PubMed]
- Amorelli, G.; Martino, D.; Pringsheim, T. Rapid onset functional tic-like disorder outbreak: A challenging differential diagnosis in the COVID-19 pandemic. J. Can. Acad. Child Adolesc. Psychiatry 2022, 31, 144–151. [Google Scholar] [PubMed]
- Berg, L.; Pringsheim, T.M.; Martino, D. Sudden onset tic and tic-like presentations in older adolescents and adults. Curr. Dev. Disord. Rep. 2022, 9, 146–155. [Google Scholar] [CrossRef] [PubMed]
- Cavanna, A.E.; Purpura, G.; Nacinovich, R. Neurodevelopmental versus functional tics: The state of the art. Arch. Med. Health Sci. 2022, 10, 239–246. [Google Scholar] [CrossRef]
- Horner, O.; Hedderly, T.; Malik, O. The changing landscape of childhood tic disorders following COVID-19. Paediatr. Child Health 2022, 32, 363–367. [Google Scholar] [CrossRef] [PubMed]
- Cavanna, A.E.; Purpura, G.; Riva, A.; Nacinovich, R.; Seri, S. Functional tics: Expanding the phenotypes of functional movement disorders? Eur. J. Neurol. 2023, 30, 3353–3356. [Google Scholar] [CrossRef] [PubMed]
- Tan, E.-K. Psychogenic tics: Diagnostic value of the placebo test. J. Child Neurol. 2004, 19, 976–977. [Google Scholar] [CrossRef] [PubMed]
- Rather, A.; Cavanna, A.E. A case of pseudo-Tourette syndrome. J. Neurol. Neurosurg. Psychiatry 2011, 82, 14. [Google Scholar] [CrossRef]
- Baizabal-Carvallo, J.F.; Jankovic, J. The clinical features of psychogenic movement disorders resembling tics. J. Neurol. Neurosurg. Psychiatry 2014, 85, 573–575. [Google Scholar] [CrossRef] [PubMed]
- Ganos, C.; Erro, R.; Cavanna, A.E.; Bhatia, K.P. Functional tics and echophenomena. Park. Relat. Disord. 2014, 20, 1440–1441. [Google Scholar] [CrossRef] [PubMed]
- Baizabal-Carvallo, J.F.; Fekete, R. Recognizing uncommon presentations of psychogenic (functional) movement disorders. Tremor. Other Hyperkinet. Mov. 2015, 5, 279. [Google Scholar] [CrossRef]
- Demartini, B.; Ricciardi, L.; Parees, I.; Ganos, C.; Bhatia, K.P.; Edwards, M.J. A positive diagnosis of functional (psychogenic) tics. Eur. J. Neurol. 2015, 22, 527–532. [Google Scholar] [CrossRef] [PubMed]
- Ganos, C.; Edwards, M.J.; Müller-Vahl, K. “I swear it is Tourette’s!”: On functional coprolalia and other tic-like vocalizations. Psychiatry Res. 2016, 246, 821–826. [Google Scholar] [CrossRef] [PubMed]
- Ganos, C.; Martino, D.; Espay, A.J.; Lang, A.E.; Bhatia, K.P.; Edwards, M.J. Tics and functional tic-like movements: Can we tell them apart? Neurology 2019, 93, 750–758. [Google Scholar] [CrossRef] [PubMed]
- Rather, M.A.; Cavanna, A.E. Nonepileptic attack disorder and functional movement disorder: A clinical continuum? Epilepsy Behav. 2020, 106, 107028. [Google Scholar] [CrossRef] [PubMed]
- Baizabal-Carvallo, J.F.; Jankovic, J. Beyond tics: Movement disorders in patients with Tourette syndrome. J. Neural Transm. 2021, 128, 1177–1183. [Google Scholar] [CrossRef] [PubMed]
- Rakesh, K.; Kamble, N.; Yadav, R.; Bhattacharya, A.; Holla, V.V.; Netravathi, M.; Seshadri, S.; Pal, P.K. Pediatric functional movement disorders: Experience from a tertiary care centre. Can. J. Neurol. Sci. 2021, 48, 518–524. [Google Scholar] [CrossRef] [PubMed]
- Nilles, C.; Pringsheim, T.M.; Martino, D. The recent surge of functional movement disorders: Social distress or greater awareness? Curr. Opin. Neurol. 2022, 35, 485–493. [Google Scholar] [CrossRef]
- Hull, M.; Parnes, M.; Jankovic, J. Increased incidence of functional (psychogenic) movement disorders in children and adults amid the COVID-19 pandemic: A cross-sectional study. Neurol. Clin. Pract. 2021, 11, e686–e690. [Google Scholar] [CrossRef] [PubMed]
- Machado, M.; Tarrano, C.; Mesrati, F.; Roze, E.; Vidailhet, M.; Aubignat, M. Functional movement disorders during the COVID-19 pandemic: Back to Charcot’s era at the Salpêtrière. Mov. Disord. 2022, 37, 432–434. [Google Scholar] [CrossRef] [PubMed]
- Jack, R.H.; Joseph, R.M.; Coupland, C.A.C.; Hall, C.L.; Hollis, C. Impact of the COVID-19 pandemic on incidence of tics in children and young people: A population-based cohort study. EClinicalMedicine 2023, 57, 101857. [Google Scholar] [CrossRef] [PubMed]
- Hull, M.; Parnes, M. Tics and TikTok: Functional tics spread through social media. Mov. Disord. Clin. Pract. 2021, 8, 1248–1252. [Google Scholar] [CrossRef] [PubMed]
- Firestone, M.J.; Holzbauer, S.; Conelea, C.; Danila, R.; Smith, K.; Bitsko, R.H.; Klammer, S.M.; Gingerich, S.; Lynfield, R. Rapid onset of functional tic-like behaviors among adolescent girls—Minnesota, September–November 2021. Front. Neurol. 2023, 13, 1063261. [Google Scholar] [CrossRef] [PubMed]
- Buts, S.; Duncan, M.; Owen, T.; Martino, D.; Pringsheim, T.; Byrne, S.; McWilliams, A.; Murphy, T.; Malik, O.; Liang, H.; et al. Paediatric tic-like presentations during the COVID-19 pandemic. Arch. Dis. Child 2022, 107, e17. [Google Scholar] [CrossRef] [PubMed]
- Owen, T.; Silva, J.; Grose, C.; Bailey, A.; Robinson, S.; Anderson, S.; Ludlow, A.; Sharp, S.; Toghill, L.; Hedderly, T. Case report: Advice for schools on managing functional tic-like behaviours. Front. Psychiatry 2022, 13, 1001459. [Google Scholar] [CrossRef] [PubMed]
- Cavanna, A.E.; Purpura, G.; Riva, A.; Nacinovich, R.; Seri, S. New-onset functional tics during the COVID-19 pandemic: Clinical characteristics of 105 cases from a single centre. Eur. J. Neurol. 2023, 30, 2411–2417. [Google Scholar] [CrossRef] [PubMed]
- Fremer, C.; Szejko, N.; Pisarenko, A.; Haas, M.; Laudenbach, L.; Wegener, C.; Müller-Vahl, K.R. Mass social media-induced illness presenting with Tourette-like behavior. Front. Psychiatry 2022, 13, 963769. [Google Scholar] [CrossRef] [PubMed]
- Nagy, P.; Cserháti, H.; Rosdy, B.; Bodó, T.; Hegyi, M.; Szamosújvári, J.; Fogarasi, D.J.; Fogarasi, A. TikTok and tics: The possible role of social media in the exacerbation of tics during the COVID lockdown. Ideggyogy Sz. 2022, 75, 211–216. [Google Scholar] [CrossRef] [PubMed]
- Okkels, K.B.; Skov, L.; Klansø, S.; Aaslet, L.; Grejsen, J.; Reenberg, A.; Sørensen, C.B.; Debes, N.M.M.M. Increased number of functional tics seen in Danish adolescents during the COVID-19 pandemic. Neuropediatrics 2023, 54, 113–119. [Google Scholar] [CrossRef]
- Martino, D.; Hedderly, T.; Murphy, T.; Müller-Vahl, K.R.; Dale, R.C.; Gilbert, D.L.; Rizzo, R.; Hartmann, A.; Nagy, P.; Anheim, M.; et al. The spectrum of functional tic-like behaviours: Data from an international registry. Eur. J. Neurol. 2023, 30, 334–343. [Google Scholar] [CrossRef] [PubMed]
- Paulus, T.; Bäumer, T.; Verrel, J.; Weissbach, A.; Roessner, V.; Beste, C.; Münchau, A. Pandemic tic-like behaviors following social media consumption. Mov. Disord. 2021, 36, 2932–2935. [Google Scholar] [CrossRef] [PubMed]
- Pringsheim, T.; Ganos, C.; McGuire, J.F.; Hedderly, T.; Woods, D.; Gilbert, D.L.; Piacentini, J.; Dale, R.C.; Martino, D. Rapid onset functional tic-like behaviors in young females during the COVID-19 pandemic. Mov. Disord. 2021, 36, 2707–2713. [Google Scholar] [CrossRef] [PubMed]
- Pringsheim, T.; Martino, D. Rapid onset of functional tic-like behaviours in young adults during the COVID-19 pandemic. Eur. J. Neurol. 2021, 28, 3805–3808. [Google Scholar] [CrossRef] [PubMed]
- Han, V.X.; Kozlowska, K.; Kothur, K.; Lorentzos, M.; Wong, W.K.; Mohammad, S.S.; Savage, B.; Chudleigh, C.; Dale, R.C. Rapid onset functional tic-like behaviours in children and adolescents during COVID-19: Clinical features, assessment and biopsychosocial treatment approach. J. Paediatr. Child Health 2022, 58, 1181–1187. [Google Scholar] [CrossRef] [PubMed]
- Trau, S.P.; Quehl, L.; Tsujimoto, T.H.M.; Lin, F.C.; Singer, H.S. Creating a patient-based diagnostic checklist for functional tics during the COVID-19 pandemic. Neurol. Clin. Pract. 2022, 12, 365–376. [Google Scholar] [CrossRef]
- Andersen, K.; Jensen, I.; Okkels, K.B.; Skov, L.; Debes, N.M. Clarifying the differences between patients with organic tics and functional tic-like behaviors. Healthcare 2023, 11, 1481. [Google Scholar] [CrossRef] [PubMed]
- Baizabal-Carvallo, J.F.; Alonso-Juarez, M.; Jankovic, J. Contrasting features between Tourette syndrome and secondary tic disorders. J. Neural Transm. 2023, 130, 931–936. [Google Scholar] [CrossRef] [PubMed]
- Cavanna, A.E.; Purpura, G.; Riva, A.; Nacinovich, R.; Seri, S. Neurodevelopmental versus functional tics: A controlled study. J. Neurol. Sci. 2023, 451, 120725. [Google Scholar] [CrossRef]
- Berg, L.; Pringsheim, T.M.; Lerario, M.; Martino, D. Psychological factors associated with functional tic-like behaviours during the COVID-19 pandemic. Res. Child Adolesc. Psychopathol. 2024, in press. [CrossRef] [PubMed]
- Fremer, C.; Szejko, N.; Pisarenko, A.; Haas, M.; Laudenbach, L.; Wegener, C.; Müller-Vahl, K.R. What distinguishes patients with mass social media-induced illness presenting with Tourette-like behavior from those with Tourette syndrome? Results of a prospective cohort study. Eur. Arch. Psychiatry Clin. Neurosci. 2024, 274, 227–233. [Google Scholar] [CrossRef]
- Nilles, C.; Martino, D.; Berg, L.; Fletcher, J.; Pringsheim, T. What are the key phenomenological clues to diagnose functional tic-like behaviors in the pandemic era? Mov. Disord. Clin. Pract. 2024, 11, 398–402. [Google Scholar] [CrossRef] [PubMed]
- Szejko, N.; Fletcher, J.; Martino, D.; Pringsheim, T. Premonitory urge in patients with tics and functional tic-like behaviors. Mov. Disord. Clin. Pract. 2024, 11, 276–281. [Google Scholar] [CrossRef]
- Olvera, C.; Stebbins, G.T.; Goetz, C.G.; Kompoliti, K. TikTok tics: A pandemic within a pandemic. Mov. Disord. Clin. Pract. 2021, 8, 1200–1205. [Google Scholar] [CrossRef] [PubMed]
- Zea Vera, A.; Bruce, A.; Garris, J.; Tochen, L.; Bhatia, P.; Lehman, R.K.; Lopez, W.; Wu, S.W.; Gilbert, D.L. The phenomenology of tics and tic-like behavior in TikTok. Pediatr. Neurol. 2022, 130, 14–20. [Google Scholar] [CrossRef] [PubMed]
- Müller-Vahl, K.R.; Pisarenko, A.; Jakubovski, E.; Fremer, C. Stop that! It’s not Tourette’s but a new type of mass sociogenic illness. Brain 2022, 145, 476–480. [Google Scholar] [CrossRef]
- Page, M.J.; McKenzie, J.E.; Bossuyt, P.M.; Boutron, I.; Hoffmann, T.C.; Mulrow, C.D.; Shamseer, L.; Tetzlaff, J.M.; Akl, E.A.; Brennan, S.E.; et al. The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. Syst. Rev. 2021, 10, 89. [Google Scholar] [CrossRef] [PubMed]
- Centre for Reviews and Dissemination. Systematic Reviews: CRD’s Guidance for Undertaking Reviews in Healthcare; University of York: York, UK, 2008. [Google Scholar]
- Cavanna, A.E. ‘Le tic’: A short story on psychogenic tics by Guy de Maupassant. Rev. Neurol. 2022, 178, 628–629. [Google Scholar] [CrossRef] [PubMed]
- Malaty, I.A.; Anderson, S.; Bennett, S.M.; Budman, C.L.; Coffey, B.J.; Coffman, K.A.; Greenberg, E.; McGuire, J.F.; Müller-Vahl, K.R.; Okun, M.S.; et al. Diagnosis and management of functional tic-like phenomena. J. Clin. Med. 2022, 11, 6470. [Google Scholar] [CrossRef] [PubMed]
- Martino, D.; Ganos, C.; Pringsheim, T.M. Tourette syndrome and chronic tic disorders: The clinical spectrum beyond tics. Int. Rev. Neurobiol. 2017, 134, 1461–1490. [Google Scholar] [PubMed]
- Cavanna, A.E. Gilles de la Tourette syndrome as a paradigmatic neuropsychiatric disorder. CNS Spectr. 2018, 23, 213–218. [Google Scholar] [CrossRef] [PubMed]
- Eddy, C.; Cavanna, A.E. Tourette syndrome and obsessive compulsive disorder: Compulsivity along the continuum. J. Obs. Compuls. Relat. Disord. 2014, 3, 363–371. [Google Scholar] [CrossRef]
- Piedad, J.C.; Cavanna, A.E. Depression in Tourette syndrome: A controlled and comparison study. J. Neurol. Sci. 2016, 364, 128–132. [Google Scholar] [CrossRef]
- Abbasi, P.; Tanhaie, S.; Kazeminia, M. Prevalence of depression and anxiety in patients with Tourette syndrome; 1997 to 2022: A systematic review and meta-analysis. Ital. J. Pediatr. 2023, 49, 160. [Google Scholar] [CrossRef] [PubMed]
- Martino, D.; Cavanna, A.E.; Robertson, M.M.; Orth, M. Prevalence and phenomenology of eye tics in Gilles de la Tourette syndrome. J. Neurol. 2012, 259, 2137–2140. [Google Scholar] [CrossRef] [PubMed]
- Nilles, C.; Martino, D.; Fletcher, J.; Pringsheim, T. Have we forgotten what tics are? A re-exploration of tic phenomenology in youth with primary tics. Mov. Disord. Clin. Pract. 2023, 10, 764–773. [Google Scholar] [CrossRef] [PubMed]
- Nilles, C.; Martino, D.; Pringsheim, T. Testing the specificity of phenomenological criteria for functional tic-like behaviours in youth with Tourette syndrome. Eur. J. Neurol. 2024, 31, e16262. [Google Scholar] [CrossRef]
- Freeman, R.D.; Zinner, S.H.; Müller-Vahl, K.R.; Fast, D.K.; Burd, L.J.; Kano, Y.; Rothenberger, A.; Roessner, V.; Kerbeshian, J.; Stern, J.S.; et al. Coprophenomena in Tourette syndrome. Dev. Med. Child Neurol. 2009, 51, 218–227. [Google Scholar] [CrossRef] [PubMed]
- Eddy, C.M.; Cavanna, A.E. ‘It’s a curse!’: Coprolalia in Tourette syndrome. Eur. J. Neurol. 2013, 20, 1467–1470. [Google Scholar] [CrossRef] [PubMed]
- Arbuckle, A.L.; Bihun, E.C.; Schlaggar, B.L.; Black, K.J. Functional tic-like presentations differ strikingly from Provisional Tic Disorder. F1000Research 2023, 11, 1566. [Google Scholar] [CrossRef] [PubMed]
- Cox, J.H.; Seri, S.; Cavanna, A.E. Sensory aspects of Tourette syndrome. Neurosci. Biobehav. Rev. 2018, 88, 170–176. [Google Scholar] [CrossRef] [PubMed]
- Brandt, V.; Essing, J.; Jakubovski, E.; Müller-Vahl, K. Premonitory urge and tic severity, comorbidities, and quality of life in chronic tic disorders. Mov. Disord. Clin. Pract. 2023, 10, 922–932. [Google Scholar] [CrossRef] [PubMed]
- Rigas, A.; Mainka, T.; Pringsheim, T.; Münchau, A.; Malaty, I.; Worbe, Y.; Cavanna, A.E.; Lees, A.J.; Lang, A.E.; Martino, D.; et al. Distinguishing functional from primary tics: A study of expert video assessments. J. Neurol. Neurosurg. Psychiatry 2023, 94, 751–756. [Google Scholar] [CrossRef] [PubMed]
- Pringsheim, T.; Ganos, C.; Nilles, C.; Cavanna, A.E.; Gilbert, D.L.; Greenberg, E.; Hartmann, A.; Hedderly, T.; Heyman, I.; Liang, H.; et al. European Society for the Study of Tourette Syndrome 2022 criteria for clinical diagnosis of functional tic-like behaviours: International consensus from experts in tic disorders. Eur. J. Neurol. 2023, 30, 902–910. [Google Scholar] [CrossRef] [PubMed]
- Larsh, T.R.; Wu, S.W.; Gilbert, D.L. Comparison of impairment in functional tic disorders versus Tourette syndrome. Pediatr. Neurol. 2022, 134, 83–84. [Google Scholar] [CrossRef] [PubMed]
- Francis Barfell, K.S.; Snyder, R.R.; Isaacs-Cloes, K.M.; Garris, J.F.; Roeckner, A.R.; Horn, P.S.; Guthrie, M.D.; Wu, S.W.; Gilbert, D.L. Parent and patient perceptions of functional impairment due to Tourette syndrome: Development of a shortened version of the Child Tourette Syndrome Impairment Scale. J. Child Neurol. 2017, 32, 725–730. [Google Scholar] [CrossRef] [PubMed]
- Garris, J.F.; Huddleston, D.A.; Jackson, H.S.; Horn, P.S.; Gilbert, D.L. Implementation of the Mini-Child Tourette Syndrome Impairment Scale: Relationships to symptom severity and treatment decisions. J. Child Neurol. 2021, 36, 288–295. [Google Scholar] [CrossRef] [PubMed]
- Ludlow, A.K.; Anderson, S.; Robinson, S.; Owen, T.; Hedderly, T. An investigation into mothers’ experiences of their children’s functional tic-like behaviour and tic attacks. PLoS ONE 2024, 19, e0292742. [Google Scholar] [CrossRef] [PubMed]
- Maxwell, A.; Zouki, J.J.; Eapen, V. Integrated cognitive behavioral intervention for functional tics (I-CBiT): Case reports and treatment formulation. Front. Pediatr. 2023, 11, 1265123. [Google Scholar] [CrossRef] [PubMed]
- Duncan, M.; Pearman, Z.; Harrold, K.; Warren, A.; Evans, S.; McAllister, E.; Heyman, I.; Shavel-Jessop, S.; Murphy, T.; Liang, H. Evaluation of a psychoeducation group for children presenting with functional tic-like behaviours. Clin. Child Psychol. Psychiatry 2024, in press. [Google Scholar] [CrossRef] [PubMed]
- Hall, C.L.; Marston, L.; Khan, K.; Brown, B.J.; Sanderson, C.; Andrén, P.; Bennett, S.; Heyman, I.; Mataix-Cols, D.; Serlachius, E.; et al. The COVID-19 pandemic and its impact on tic symptoms in children and young people: A prospective cohort study. Child Psychiatry Hum. Dev. 2023, 54, 1499–1509. [Google Scholar] [CrossRef] [PubMed]
- Conte, G.; Baglioni, V.; Valente, F.; Chiarotti, F.; Cardona, F. Adverse mental health impact of the COVID-19 lockdown in individuals with Tourette syndrome in Italy: An online survey. Front. Psychiatry 2020, 11, 583744. [Google Scholar] [CrossRef] [PubMed]
- Mataix-Cols, D.; Ringberg, H.; Fernández de la Cruz, L. Perceived worsening of tics in adult patients with Tourette syndrome after the COVID-19 outbreak. Mov. Disord. Clin. Pract. 2020, 7, 725–726. [Google Scholar] [CrossRef] [PubMed]
- Termine, C.; Galli, V.; Dui, L.G.; Berlusconi, V.; Taras, R.; Vergani, M.; Lunardini, F.; Ferrante, S.; Cavanna, A.E. Self-reported impact of the COVID-19 pandemic and lockdown on young patients with tic disorders: Findings from a case-control study. Neurol. Sci. 2022, 43, 3497–3501. [Google Scholar] [CrossRef] [PubMed]
- Colreavy, E.; Keenan, L.; Downes, M. The impact of the COVID-19 pandemic on sleep in children with Tourette syndrome in Ireland and the United Kingdom. J. Clin. Sleep Med. 2023, 19, 1485–1493. [Google Scholar] [CrossRef] [PubMed]
- Larsh, T.R.; Wu, S.W.; Huddleston, D.A.; Lipps, T.D.; Gilbert, D.L. Differences in tic severity among adolescent girls and boys with Tourette syndrome during the pandemic. Neuropediatrics 2024, 55, 67–70. [Google Scholar] [CrossRef] [PubMed]
- Koźlik, M.; Kaźmierski, M.; Kaźmierski, W.; Lis, P.; Lis, A.; Łowicka, W.; Chamera, M.; Romanowska, B.; Kufel, J.; Cebula, M.; et al. Quality of life 6 months after COVID-19 hospitalisation: A single-centre Polish registry. J. Clin. Med. 2023, 12, 5327. [Google Scholar] [CrossRef] [PubMed]
- Prato, A.; Salerno, A.M.; Saia, F.; Maugeri, N.; Zanini, A.; Scerbo, M.; Barone, R.; Rizzo, R. Symptoms compatible with long COVID in an Italian pediatric cohort of Tourette patients with and without SARS-CoV-2 infection: A short-term follow-up assessment. BMC Pediatr. 2023, 23, 222. [Google Scholar] [CrossRef] [PubMed]
- Howlett, M.; Martino, D.; Nilles, C.; Pringsheim, T. Prognosis of rapid onset functional tic-like behaviors: Prospective follow-up over 6 months. Brain Behav. 2022, 12, e2606. [Google Scholar] [CrossRef] [PubMed]
- Prato, A.; Saia, F.; Milana, M.C.; Scerbo, M.; Barone, R.; Rizzo, R. Functional tic-like behaviours during the COVID-19 pandemic: Follow-up over 12 months. Front. Pediatr. 2023, 10, 1003825. [Google Scholar] [CrossRef] [PubMed]
- Mathew, A.; Abu Libdeh, A.; Patrie, J.; Garris, J. Outcome in pediatric functional tic disorders diagnosed during the COVID-19 pandemic. J. Neuropsychiatry Clin. Neurosci. 2023, 35, 393–397. [Google Scholar] [CrossRef] [PubMed]
- Tomczak, K.K.; Worhach, J.; Rich, M.; Swearingen Ludolph, O.; Eppling, S.; Sideridis, G.; Katz, T.C. Time is ticking for TikTok tics: A retrospective follow-up study in the post-COVID-19 isolation era. Brain Behav. 2024, 14, e3451. [Google Scholar] [CrossRef] [PubMed]
- Nilles, C.; Szejko, N.; Martino, D.; Pringsheim, T. Prospective follow-up study of youth and adults with onset of functional tic-like behaviours during the COVID-19 pandemic. Eur. J. Neurol. 2024, 31, e16051. [Google Scholar] [CrossRef] [PubMed]
- Voon, V.; Cavanna, A.E.; Coburn, K.; Sampson, S.; Reeve, A.; LaFrance, W.C., Jr. Functional neuroanatomy and neurophysiology of functional neurological disorders (conversion disorder). J. Neuropsychiatry Clin. Neurosci. 2016, 28, 168–190. [Google Scholar] [CrossRef] [PubMed]
- Kurlan, R.; Deeley, C.; Como, P.G. Psychogenic movement disorders (pseudo-tics) in a patient with Tourette’s syndrome. J. Neuropsychiatry Clin. Neurosci. 1992, 4, 347–348. [Google Scholar] [PubMed]
- Dooley, J.M.; Stokes, A.; Gordon, K.E. Pseudo-tics in Tourette’s syndrome. J. Child Neurol. 1994, 9, 50–51. [Google Scholar] [CrossRef] [PubMed]
- Cavanna, A.E.; Damodaran, L.; Purpura, G.; Nacinovich, R. Tourette syndrome with functional overlay: A case series. Arch. Med. Health Sci. 2022, 10, 312–316. [Google Scholar] [CrossRef]
- Müller-Vahl, K.R.; Pisarenko, A.; Fremer, C.; Haas, M.; Jakubovski, E.; Szejko, N. Functional tic-like behaviors: A common comorbidity in patients with Tourette syndrome. Mov. Disord. Clin. Pract. 2024, 11, 227–237. [Google Scholar] [CrossRef] [PubMed]
- Martindale, J.M.; Mink, J.W. The rise of functional tic-like behaviors: What do the COVID-19 pandemic and social media have to do with it? A narrative review. Front. Pediatr. 2022, 10, 863919. [Google Scholar] [CrossRef] [PubMed]
- Frey, J.; Black, K.J.; Malaty, I.A. TikTok Tourette’s: Are we witnessing a rise in functional tic-like behavior driven by adolescent social media use? Psychol. Res. Behav. Manag. 2022, 15, 3575–3585. [Google Scholar] [CrossRef] [PubMed]
- Haltigan, J.D.; Pringsheim, T.M.; Rajkumar, G. Social media as an incubator of personality and behavioral psychopathology: Symptom and disorder authenticity or psychosomatic social contagion? Compr. Psychiatry 2023, 121, 152362. [Google Scholar] [CrossRef] [PubMed]
- Bartholomew, R.E.; Wessely, S.; Rubin, G.J. Mass psychogenic illness and the social network: Is it changing the pattern of outbreaks? J. R. Soc. Med. 2012, 105, 509–512. [Google Scholar] [CrossRef] [PubMed]
- Mink, J.W. Conversion disorder and mass psychogenic illness in child neurology. Ann. N. Y. Acad. Sci. 2013, 1304, 40–44. [Google Scholar] [CrossRef]
- O’Sullivan, S. The Witches of Le Roy. In The Sleeping Beauties and Other Stories of Mystery Illness; Pantheon Books: New York, NY, USA, 2021; pp. 237–272. [Google Scholar]
- Giedinghagen, A. The tic in TikTok and (where) all systems go: Mass social media induced illness and Munchausen’s by internet as explanatory models for social media associated abnormal illness behavior. Clin. Child Psychol. Psychiatry 2023, 28, 270–278. [Google Scholar] [CrossRef] [PubMed]
- Pulman, A.; Taylor, J. Munchausen by internet: Current research and future directions. J. Med. Internet Res. 2012, 14, e115. [Google Scholar] [CrossRef] [PubMed]
- Stokel-Walker, C. Medical misinformation on social media: Are the platforms equipped to be the judge? BMJ 2024, 384, 2987. [Google Scholar] [CrossRef] [PubMed]
- Radhakrishnan, L.; Leeb, R.T.; Bitsko, R.H.; Carey, K.; Gates, A.; Holland, K.M.; Hartnett, K.P.; Kite-Powell, A.; DeVies, J.; Smith, A.R.; et al. Pediatric emergency department visits associated with mental health conditions before and during the COVID-19 pandemic—United States, January 2019–January 2022. MMWR Morb. Mortal. Wkly. Rep. 2022, 71, 319–324. [Google Scholar] [CrossRef] [PubMed]
Case Series | Year | Country | Setting | Sample Size (F, %) | Age of Onset (Mean, Range) | Main Findings |
---|---|---|---|---|---|---|
Hull and Parnes [22] | 2021 | United States | Specialist clinic | 6 (6, 100%) | 14 (13–16) | Explosive onset of features incongruous with TS; all patients reported exposure to a specific social media personality before symptom onset |
Buts et al. [24] | 2022 | United Kingdom | Specialist clinic | 34 (32, 94%) | 14 (8–17) | Co-morbid psychiatric and neurodevelopmental disorders were reported in 91% of patients (anxiety in 68%); previous diagnosis of tics in nearly half of the patients |
Fremer et al. [27] | 2022 | Germany | Specialist clinic | 32 (16, 50%) | 19 (10–53) | Previous psychiatric symptoms in nearly all patients; 47% of the patients had co-morbid TS |
Nagy et al. [28] | 2022 | Hungary | Specialist clinic | 5 (5, 100%) | 14 (10–16) | All the patients reported exposure to tic-like behavior on social media before symptom onset |
Owen et al. [25] | 2022 | United Kingdom | Specialist clinic | 10 (10, 100%) | 12 (9–14) | All the patients had co-morbid psychiatric conditions (mainly anxiety) |
Cavanna et al. [26] | 2023 | United Kingdom | Specialist clinic | 105 (76, 72%) | 23 (13–63) | Acute/subacute onset in most cases; most common psychiatric co-morbidities: anxiety (70%) and affective disorders (40%); half of the patients reported exposure to tic-like behavior on social media before symptom onset |
Firestone et al. [23] | 2023 | United States | High school | 8 (8, 100%) | 16 (15–17) | All patients had either prior or ongoing depression or anxiety; abrupt onset in all cases |
Martino et al. [30] | 2023 | International registry | Specialist clinics | 294 (255, 87%) | 15 (8–53) | Abrupt onset of symptoms in 70% of patients; most common psychiatric co-morbidities: anxiety (66%), depression (28%), ASD (24%), ADHD (23%); over half of the patients reported exposure to tic-like behavior on social media before symptom onset |
Okkels et al. [29] | 2023 | Denmark | Specialist clinic | 28 (27, 96%) | 14 (11–18) | Most of the patients reported previous trauma/precipitating event (pandemic-related lockdown in 40% of cases); almost two thirds of patients reported psychiatric symptoms/diagnoses; 96% reported exposure to tic-like behavior on social media before symptom onset |
Clinical Study | Year | Country | Setting | Sample Size—FTLB (F, %) | Age of Onset (Mean, Range) | Comparison Group—NT (F, %) | Main Findings |
---|---|---|---|---|---|---|---|
Paulus et al. [31] | 2021 | Germany | Specialist clinic | 13 (5, 38%) | 15 (12–18) | 13 (matched) | Compared to patients with NT, patients with FTLB developed after exposure to tic-like behavior on social media reported a more abrupt symptom onset, fewer spontaneous symptom fluctuations, more severe symptoms in the presence of others, more complex movements involving trunk/extremities, later symptom onset |
Pringsheim et al. [32] | 2021 | Canada | Specialist clinic | 20 (19, 95%) | 14 (13–15) | 270 (58, 21%) | Compared to patients with NT, patients with FTLB reported a more abrupt symptom onset, were more likely to be females, older at first visit, older at symptom onset, had higher severity and impairment scores, were more likely to have co-morbid anxiety or depressive disorders; all the patients with FTLB reported exposure to tic-like behavior on social media before symptom onset |
Pringsheim and Martino [33] | 2021 | Canada | Specialist clinic | 9 (9, 100%) | 15 (11–20) | 24 (6, 25%) | Compared to patients with NT, patients with FTLB after exposure to tic-like behavior on social media had an older age at onset, were more likely to be females, reported higher motor and vocal tic severity, more complex arm/hand motor tics, more complex vocal tics (including coprolalia), higher scores on all self-report measures of psychiatric symptoms |
Han et al. [34] | 2022 | Australia | Specialist clinic | 22 (22, 100%) | 14 (NA) | 163 (46, 28%) | Compared to patients with NT, patients with FTLB were more likely to be females, reported more complex tics, later age of onset, higher rates of anxiety/depression; 18% of the patients with FTLB reported exposure to tic-like behavior on social media before symptom onset |
Trau et al. [35] | 2022 | United States | Specialist clinic | 36 (34, 94%) | 14 (NA) | 119 (41, 34%) | A third group of 25 patients had both NT and FTLB (functional overlay); compared to patients with NT, patients with FTLB were more likely to be females, reported more complex and severe tics, more psychiatric co-morbidities; age at tic onset was not significantly different |
Andersen et al. [36] | 2023 | Denmark | Specialist clinic | 53 (50, 94%) | 14 (6–20) | 200 (61, 31%) | Compared to patients with NT, patients with FTLB were more likely to be females, were older at symptom onset, reported more complex tics, were less likely to have family members with tics, were more likely to have family members with a psychiatric disorder, were more likely to have experienced an adverse psychosocial event prior to symptom onset |
Baizabal-Carvallo et al. [37] | 2023 | United States | Specialist clinic | 21 (10, 48%) | 32 (NA) | 156 (34, 22%) | Compared to patients with NT, patients with FTLB were more likely to be females, reported more complex and severe tics, were more likely to be older at symptom onset, were less likely to report motor tics predominantly affecting the head/neck area |
Cavanna et al. [38] | 2023 | United Kingdom | Specialist clinic | 83 (59, 71%) | 21 (11–61) | 83 (matched) | Compared to patients with NT, patients with FTLB were more likely to present their symptoms acutely/subacutely at a later age; reported higher rates of anxiety and other functional neurological disorders; were less likely to report tic-related OCD and a family history of tics |
Berg et al. [39] | 2024 | Canada | Specialist clinic | 35 (32, 91%) | 17 (NA) | 22 (20, 91%) | Patients with FTLB reported significantly higher rates of major depressive disorder and panic disorder and rated their mental health as more severely declined than both patients with NT and neurotypical individuals; overall distress tolerance, resilient coping, suggestibility, hours on social media, and exposure to tic-like behavior on social media were not significantly different between groups |
Fremer et al. [40] | 2024 | Germany | Specialist clinic | 32 (16, 50%) | 19 (10–53) | 1032 (303, 29%) | Compared to patients with NT, patients with FTLB were more likely to be females and older at symptom onset, reported a higher rate of socially inappropriate symptoms, a lower rate of co-morbid ADHD and OCD; rates of co-morbid anxiety and depression and suppressibility of symptoms did not differ between the two groups |
Nilles et al. [41] | 2024 | Canada | Specialist clinic | 41 (40, 98%) | 16 (11–20) | 195 (49, 25%) | Compared to patients with NT, patients with FTLB were more likely to report copropraxia, complex vocal tics (including coprolalia), popping, whistling, simple head movements, self-injurious behaviors |
Szejko et al. [42] | 2024 | Canada | Specialist clinic | 40 (31, 78%) | 17 (NA) | 83 (30, 36%) | Compared to patients with NT, patients with FTLB were more likely to be females, reported more severe tics, were more likely to be older at symptom onset; among patients with FTLB there was a higher prevalence of gender diverse individuals; there were no significant differences in self-reported premonitory urges |
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. |
© 2024 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Cavanna, A.E.; Spini, L.; Ferrari, S.; Purpura, G.; Riva, A.; Nacinovich, R.; Seri, S. Functional Tic-like Behaviors: From the COVID-19 Pandemic to the Post-Pandemic Era. Healthcare 2024, 12, 1106. https://doi.org/10.3390/healthcare12111106
Cavanna AE, Spini L, Ferrari S, Purpura G, Riva A, Nacinovich R, Seri S. Functional Tic-like Behaviors: From the COVID-19 Pandemic to the Post-Pandemic Era. Healthcare. 2024; 12(11):1106. https://doi.org/10.3390/healthcare12111106
Chicago/Turabian StyleCavanna, Andrea Eugenio, Laura Spini, Silvia Ferrari, Giulia Purpura, Anna Riva, Renata Nacinovich, and Stefano Seri. 2024. "Functional Tic-like Behaviors: From the COVID-19 Pandemic to the Post-Pandemic Era" Healthcare 12, no. 11: 1106. https://doi.org/10.3390/healthcare12111106