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Mary M. Robertson - One of the best experts on this subject based on the ideXlab platform.
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Gilles de la Tourette syndrome in a cohort of deaf people
Asian journal of psychiatry, 2015Co-Authors: Mary M. Robertson, S. Roberts, S. Pillai, Valsamma EapenAbstract:Abstract We present six patients with Gilles de la Tourette syndrome (TS) who are also deaf. TS has been observed previously, but rarely reported in deaf people, and to date, so called “unusual” phenomenology has been highlighted. TS occurs almost worldwide and in all cultures, and the clinical phenomenology is virtually identical. In our cohort of deaf patients (we suggest another culture) with TS, the phenomenology is the same as in hearing people, and as in all other cultures, with classic motor and vocal/phonic tics, as well as associated phenomena including echo-phenomena, pali-phenomena and rarer copro-phenomena. When “words” related to these phenomenon (e.g. echolalia, palilalia, Coprolalia or mental Coprolalia) are elicited in deaf people, they occur usually in British Sign Language (BSL): the more “basic” vocal/phonic tics such as throat clearing are the same phenomenologically as in hearing TS people. In our case series, there was a genetic predisposition to TS in all cases. We would argue that TS in deaf people is the same as TS in hearing people and in other cultures, highlighting the biological nature of the disorder.
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are there distinct subtypes in tourette syndrome pure tourette syndrome versus tourette syndrome plus and simple versus complex tics
Neuropsychiatric Disease and Treatment, 2015Co-Authors: Valsamma Eapen, Mary M. RobertsonAbstract:This study addressed several questions relating to the core features of Tourette syndrome (TS) including in particular Coprolalia (involuntary utterance of obscene words) and copropraxia (involuntary and inappropriate rude gesturing). A cohort of 400 TS patients was investigated. We observed that Coprolalia occurred in 39% of the full cohort of 400 patients and copropraxia occurred in 20% of the cohort. Those with Coprolalia had significantly higher Yale Global Tic Severity Scale (YGTSS) and Diagnostic Confidence Index (DCI) total scores and a significantly higher proportion also experienced copropraxia and echolalia. A subgroup of 222 TS patients with full comorbidity data available were also compared based on whether they had pure-TS (motor and vocal tics only) or associated comorbidities and co-existent psychopathologies (TS-plus). Pure-TS and TS-plus groups were compared across a number of characteristics including TS severity, associated clinical features, and family history. In this subgroup, 13.5% had pure-TS, while the remainder had comorbidities and psychopathologies consistent with TS-plus. Thirty-nine percent of the TS-plus group displayed Coprolalia, compared to (0%) of the pure-TS group and the difference in proportions was statistically significant. The only other significant difference found between the two groups was that pure-TS was associated with no family history of obsessive compulsive disorder which is an interesting finding that may suggest that additional genes or environmental factors may be at play when TS is associated with comorbidities. Finally, differences between individuals with simple versus complex vocal/motor tics were evaluated. Results indicated that individuals with complex motor/vocal tics were significantly more likely to report premonitory urges/sensations than individuals with simple tics and TS. The implications of these findings for the assessment and understanding of TS are discussed.
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Movement disorders: Tourette syndrome--beyond swearing and sex?
Nature reviews. Neurology, 2013Co-Authors: Mary M. RobertsonAbstract:Gilles de la Tourette syndrome (GTS) is often perceived as the 'swearing disease', yet Coprolalia affects only 10–15% of individuals with this condition. As highlighted in a new study, GTS has many phenotypes, some of which are sex-related. Could gender—that is, culturally established roles—also affect the phenotype?
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PA.02 Tourettism in adults
Journal of Neurology Neurosurgery & Psychiatry, 2011Co-Authors: M A Maalik, Jeremy S. Stern, A Hafez, H Simmons, Mary M. RobertsonAbstract:Aims We investigated cases of Tourette syndrome (TS) with atypical chronology in terms of age of onset. According to DSM IV-TR onset of TS is by the age of 18. Most cases have their onset earlier at ages 5–10. Peak severity of tics is usually around the ages of 11–13 so that severe cases in adulthood represent a minority. We investigated the characteristics of patients (1) with an onset of symptoms in late adolescence (2) with apparent onset in adulthood and (3) other atypical cases with an early onset of mild symptoms followed by transition to significantly more severe tics after the age of 18. Methods Review of 220 patient records collected in a joint paediatric and adult Tic Disorder clinic was performed. Cases with onset over the age of 18, or of onset from 15–18 years old, or of childhood onset with late significant exacerbation over the age of 18 were selected for comparison with the remaining majority of cases who exhibited early onset and had been seen either as paediatric or adult referrals. Phenomenology of the tics and associated comorbidities were examined. Results Six adult-onset cases were identified and had a mean age of onset of 37.3 (21–57). Four were male and 4 had tics that were considered moderate or severe. None of these cases experienced premonitory sensations in association with their tics, a feature which is integral to most people with tics. Obsessionality milder than the criteria for OCD was present in half the cases, 2 had Coprolalia, and a family history of tics was present in two cases only. There were also 6 “late exacerbation” cases with a mean age of 25 years for the exacerbation and all had severe tics and Coprolalia as part of their late presentation. Most of these cases had a family history of tics or obsessionality and also significant histories of difficulties at birth/delivery. These cases all had premonitory sensations as would be expected from the control cases. Only four late adolescent-onset cases were found and, given the small number, they did not have features distinguishing them from control cases. Conclusions It is suggested that adult-onset cases of a phenotype otherwise consistent with the TS phenotype may be biologically different to childhood-onset cases. We found an unusual absence of premonitory sensations in this group and also less relevant family history than expected. Adult-onset TS is documented here and previously only in small numbers. Some previous data has considered cases of a childhood-onset mild tic disorder followed by later severe exacerbation as an adult-onset category. We separated this group and found they experienced premonitory sensations as usual but all had a distinctively severe disorder with Coprolalia.
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Pathological laughter in Gilles de la Tourette syndrome: an unusual phonic tic.
Movement disorders : official journal of the Movement Disorder Society, 2010Co-Authors: Andrea E Cavanna, Fizzah Ali, James F. Leckman, Mary M. RobertsonAbstract:Patients with Gilles de la Tourette syndrome (GTS) can display socially inappropriate behaviors as part of their multiform tic phenomenology. Pathological laughter (PL), defined as the presence of episodic and contextually inappropriate outbursts of laughter, has been detailed as a symptom of various psychiatric and neurological conditions. We present a case series of eight subjects diagnosed with GTS who reported PL as part of their tic repertoire. All subjects experienced PL as a simple phonic tic, accompanied by characteristic premonitory urges and significant impairment in social interactions. In addition, all patients presented with multiple tic-related symptoms (mainly self-injurious behaviors and echolalia, n = 7; palilalia, n = 6; Coprolalia/mental Coprolalia, n = 5), and six patients had comorbid conditions (in particular obsessive-compulsive disorder/behaviors, n = 7; attention-deficit hyperactivity disorder, n = 4). We suggest that the pathophysiological mechanisms underlying the expression of PL as a tic could involve a dissociation between frontostriatal and limbic networks.
Andrea E Cavanna - One of the best experts on this subject based on the ideXlab platform.
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Tourette's syndrome
BMJ (Clinical research ed.), 2013Co-Authors: Andrea E Cavanna, Stefano SeriAbstract:Tourette’s syndrome is a tic disorder that is often associated with behavioural symptoms. Diagnostic criteria are based on the presence of both motor and vocal tics; because of its varied presentations, the syndrome has the potential to be misdiagnosed. Prevalence is higher than commonly assumed; Coprolalia is relatively rare (10-30%) and not required for diagnosis. The syndrome can cause serious distress and compromise health related quality of life. The main management strategies include psychoeducation, behavioural techniques, and drugs. Service provision is patchy even in developed countries and patients of all ages often “fall through the net” between neurology and psychiatry.
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On being your own worst enemy: an investigation of socially inappropriate symptoms in Tourette syndrome.
Journal of psychiatric research, 2013Co-Authors: Clare M. Eddy, Andrea E CavannaAbstract:Non-obscene socially inappropriate symptoms (NOSIS) in Tourette syndrome (TS) include urges to make insulting remarks about a person's physical characteristics (e.g. "big nose") and other socially disruptive behaviors (e.g. shouting "bomb" at an airport). We aimed to explore the characteristics of NOSIS in TS, and determine whether individuals who experienced NOSIS reported differences to those who did not in terms of quality of life (QoL) and common clinical symptoms. Finally we aimed to identify significant predictors of the presence of NOSIS. Patients were sixty patients with TS from a specialist outpatient clinic. They completed clinical measures assessing NOSIS, QoL, tic severity, premonitory urges for tics, depression, anxiety, obsessions and compulsions, attention problems, coprophenomena and conduct problems. Two-thirds of our sample admitted experiencing urges to make socially inappropriate remarks and/or carry out socially inappropriate actions. However, not all urges led to actions. Obsessions, attention problems, Coprolalia and conduct problems were all significantly more common in patients with NOSIS than those without. Moreover, the presence of NOSIS was associated with significantly poorer QoL, and higher scores on measures of tic severity, obsessive-compulsive symptoms, attention problems and premonitory urges. However, only the presence of Coprolalia and severity of obsessive-compulsive symptoms and premonitory urges were significant predictors of the presence of NOSIS. Our findings may imply that elevated self-consciousness and obsessionality could comprise risk factors for the development of NOSIS. As NOSIS exert a specific detrimental impact on QoL, these symptoms should be employed as a marker of therapeutic efficacy.
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'It's a curse!': Coprolalia in Tourette syndrome.
European journal of neurology, 2013Co-Authors: Clare M. Eddy, Andrea E CavannaAbstract:BACKGROUND AND PURPOSE Coprolalia is a complex socially inappropriate vocal tic most frequently reported in the context of Tourette syndrome (TS) and widely portrayed as a cardinal characteristic of this condition throughout popular culture. This study investigated which clinical factors may predispose some patients with TS to experience Coprolalia and the impact of this symptom on quality of life. METHODS Participants were 60 patients with TS (39 males, mean age 32.15, SD 14.1 years) of whom 50% reported mental Coprolalia (urges) and 33% reported actual involuntary swearing as a tic. Relationships between the presence of Coprolalia and a range of clinical variables including severity of tics, obsessive-compulsive symptoms, attention problems, anxiety, depression, premonitory urges for tics and quality of life were investigated. RESULTS The presence of urges to utter obscene language was significantly related to non-obscene socially inappropriate symptoms and self-reported tic severity. Although experiencing socially inappropriate urges in general was correlated with the presence of mental Coprolalia, only the presence of more severe tics was a good indicator of outbursts of obscene vocal tics. Having Coprolalia was related to significantly poorer quality of life in TS. CONCLUSIONS As outbursts of Coprolalia exert a specific negative impact on quality of life clinicians should consider improvement in this symptom during evaluation of treatment efficacy.
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Ictal Coprolalia in a patient with temporal lobe epilepsy.
The Journal of neuropsychiatry and clinical neurosciences, 2013Co-Authors: Sara Panunzi, Francesco Cardona, Paola De Liso, Mario Brinciotti, Andrea E CavannaAbstract:[No abstract available
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Pathological Laughter in Gilles de la Tourette Syndrome: An Unusual Phonic Tic
WILEY-LISS, 2010Co-Authors: Andrea E Cavanna, James F. Leckman, Ali F, Mm RobertsonAbstract:Patients with Gilles de la Tourette syndrome (GTS) can display socially inappropriate behaviors as part of their multiform tic phenomenology. Pathological laughter (PL), defined as the presence of episodic and contextually inappropriate outbursts of laughter, has been detailed as a symptom of various psychiatric and neurological conditions. We present a case series of eight subjects diagnosed with GTS who reported PL as part of their tic repertoire. All subjects experienced PL as a simple phonic tic, accompanied by characteristic premonitory urges and significant impairment in social interactions. In addition, all patients presented with multiple tic-related symptoms (mainly self-injurious behaviors and echolalia, n = 7; palilalia, n = 6; Coprolalia/mental Coprolalia, n = 5), and six patients had comorbid conditions (in particular obsessive-compulsive disorder/behaviors, n = 7; attention-deficit hyperactivity disorder, n = 4). We suggest that the pathophysiological mechanisms underlying the expression of PL as a tic could involve a dissociation between frontostriatal and limbic networks. (C) 2010 Movement Disorder Societ
Joseph Jankovic - One of the best experts on this subject based on the ideXlab platform.
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Treatment of tics associated with Tourette syndrome
Journal of Neural Transmission, 2020Co-Authors: Joseph JankovicAbstract:Motor and phonic tics associated with Tourette syndrome (TS) can range in severity from barely perceptible to disabling and most patients have a variety of behavioral co-morbidities, particularly, attention deficit disorder and obsessive compulsive disorder. Therefore, therapy must be tailored to the individual needs of the patients. In addition to behavioral therapy, oral medications such as alpha agonists, dopamine depletors, anti-psychotics, and topiramate are used to control the involuntary movements and noises. Botulinum toxin injections are particularly effective in patients with troublesome focal motor and phonic tics, including Coprolalia. Deep brain stimulation may be considered for patients with “malignant” TS, that is, refractory to medical therapy. When appropriate therapy is selected and implemented, most patients with TS can achieve their full potential and lead essentially normal life.
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Tics and Tourette Syndrome: Phenomenology
Movement Disorders, 2015Co-Authors: Neepa Patel, Joseph JankovicAbstract:Tourette syndrome (TS) is a common neurologic and behavioral disorder, primarily characterized by the presence of motor and phonic tics. Tics are defined as brief and involuntary movements or sounds, often preceded by a premonitory sensation or urge. Some motor tics may be quite complex and phonic tics may manifest as semantically meaningful utterances, including profanities and obscenities (Coprolalia). The natural history of TS is a waxing and waning course with reduction in symptom severity in adulthood in majority of cases. Common behavioral comorbidities include obsessive-compulsive disorder, attention-deficit disorder, and impulse control disorder.
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Malignant Phonic Tics
Movement Disorder Emergencies, 2012Co-Authors: Joseph JankovicAbstract:Phonic tics are typically associated with motor tics and the combination usually suggests the diagnosis of Tourette syndrome. Although phonic tics are often mild, in some cases they may be severe and disabling. In addition to causing vocal cord and throat irritation, Coprolalia can be socially isolating and lead to adversarial and even legal difficulties for the affected individual. When such “malignant phonic tics” fail to improve with anti-dopaminergic drugs, botulinum toxin treatment or even deep brain stimulation may be required.
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Botulinum toxin injection into vocal cord in the treatment of malignant Coprolalia associated with Tourette's syndrome.
Movement disorders : official journal of the Movement Disorder Society, 1996Co-Authors: Burton L. Scott, Joseph Jankovic, Donald T. DonovanAbstract:We describe a 13-year-old boy with Tourette's syndrome (TS) manifested chiefly by severe Coprolalia, obsessive compulsive disorder, and attention deficit hyperactivity disorder. He was treated with unilateral injections of botulinum toxin to the vocal cord and experienced marked improvement in Coprolalia as well as marked reduction in the premonitory urges associated with the vocal tics and Coprolalia. As a result of the improvement, the patient was able to attend school and church and was able to socialize. Botulinum toxin may interfere with a sensory reflex arc required to perpetuate tics and Coprolalia in TS, possibly by reducing local build-up of tension or muscle contraction in affected areas.
Valsamma Eapen - One of the best experts on this subject based on the ideXlab platform.
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Gilles de la Tourette syndrome in a cohort of deaf people
Asian journal of psychiatry, 2015Co-Authors: Mary M. Robertson, S. Roberts, S. Pillai, Valsamma EapenAbstract:Abstract We present six patients with Gilles de la Tourette syndrome (TS) who are also deaf. TS has been observed previously, but rarely reported in deaf people, and to date, so called “unusual” phenomenology has been highlighted. TS occurs almost worldwide and in all cultures, and the clinical phenomenology is virtually identical. In our cohort of deaf patients (we suggest another culture) with TS, the phenomenology is the same as in hearing people, and as in all other cultures, with classic motor and vocal/phonic tics, as well as associated phenomena including echo-phenomena, pali-phenomena and rarer copro-phenomena. When “words” related to these phenomenon (e.g. echolalia, palilalia, Coprolalia or mental Coprolalia) are elicited in deaf people, they occur usually in British Sign Language (BSL): the more “basic” vocal/phonic tics such as throat clearing are the same phenomenologically as in hearing TS people. In our case series, there was a genetic predisposition to TS in all cases. We would argue that TS in deaf people is the same as TS in hearing people and in other cultures, highlighting the biological nature of the disorder.
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are there distinct subtypes in tourette syndrome pure tourette syndrome versus tourette syndrome plus and simple versus complex tics
Neuropsychiatric Disease and Treatment, 2015Co-Authors: Valsamma Eapen, Mary M. RobertsonAbstract:This study addressed several questions relating to the core features of Tourette syndrome (TS) including in particular Coprolalia (involuntary utterance of obscene words) and copropraxia (involuntary and inappropriate rude gesturing). A cohort of 400 TS patients was investigated. We observed that Coprolalia occurred in 39% of the full cohort of 400 patients and copropraxia occurred in 20% of the cohort. Those with Coprolalia had significantly higher Yale Global Tic Severity Scale (YGTSS) and Diagnostic Confidence Index (DCI) total scores and a significantly higher proportion also experienced copropraxia and echolalia. A subgroup of 222 TS patients with full comorbidity data available were also compared based on whether they had pure-TS (motor and vocal tics only) or associated comorbidities and co-existent psychopathologies (TS-plus). Pure-TS and TS-plus groups were compared across a number of characteristics including TS severity, associated clinical features, and family history. In this subgroup, 13.5% had pure-TS, while the remainder had comorbidities and psychopathologies consistent with TS-plus. Thirty-nine percent of the TS-plus group displayed Coprolalia, compared to (0%) of the pure-TS group and the difference in proportions was statistically significant. The only other significant difference found between the two groups was that pure-TS was associated with no family history of obsessive compulsive disorder which is an interesting finding that may suggest that additional genes or environmental factors may be at play when TS is associated with comorbidities. Finally, differences between individuals with simple versus complex vocal/motor tics were evaluated. Results indicated that individuals with complex motor/vocal tics were significantly more likely to report premonitory urges/sensations than individuals with simple tics and TS. The implications of these findings for the assessment and understanding of TS are discussed.
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Gilles de la Tourette Syndrome—A Case Report from Guyana in South America
Behavioural neurology, 1992Co-Authors: Valsamma Eapen, Mary M. RobertsonAbstract:A case of the Gilles de la Tourette syndrome from Guyana in South America is presented. The patient had a positive family history as well as Coprolalia, echolalia, and attention deficit disorder with hyperactivity. The family history and cross-cultural similarity emphasise the biological factors in the aetiology of the syndrome.
Yukiko Kano - One of the best experts on this subject based on the ideXlab platform.
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Preliminary Study of Behavioral Therapy for Tourette Syndrome Patients in Japan
Children's Health Care, 2014Co-Authors: Maiko Nonaka, Natsumi Matsuda, Toshiaki Kono, Miyuki Fujio, Lawrence Scahill, Yukiko KanoAbstract:Tourette syndrome (TS) is a chronic neurobehavioral disorder of childhood characterized by motor and vocal tics. The authors aimed to show the feasibility of Comprehensive Behavioral Intervention for Tics (CBIT) for pediatric Tourette syndrome patients in Japan. Seven subjects (age 9 to 20 years) were treated with CBIT. Changes in tic severity, premonitory urges, and subjective distress associated with tics were investigated over the course of 9 treatment sessions. Results showed that significant decrease of tic severity and improvement of their subjective distress of tics. However, the subjective distress from Coprolalia was difficult to change. The treatment for outburst of Coprolalia should be investigated more.
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Coprophenomena in Tourette syndrome.
Developmental medicine and child neurology, 2008Co-Authors: Roger D. Freeman, Kirsten Müller-vahl, Yukiko Kano, Samuel H. Zinner, Diane K. Fast, Larry Burd, Aribert Rothenberger, Veit Roessner, Jacob Kerbeshian, Jeremy S. SternAbstract:The aims of this descriptive study were to examine the prevalence and associations of coprophenomena (involuntary expression of socially unacceptable words or gestures) in individuals with Tourette syndrome. Participant data were obtained from the Tourette Syndrome International Database Consortium. A specialized data collection form was completed for each of a subset of 597 consecutive new patients with Tourette syndrome from 15 sites in seven countries. Coprolalia occurred at some point in the lifetime of 19.3% of males and 14.6% of females, and copropraxia in 5.9% of males and 4.9% of females. Coprolalia was three times as frequent as copropraxia, with a mean onset of each at about 11 years, 5 years after the onset of tics. In 11% of those with Coprolalia and 12% of those with copropraxia these coprophenomena were one of the initial symptoms of Tourette syndrome. The onsets of tics, coprophenomena, smelling of non-food objects, and spitting were strongly intercorrelated. Early onset of coprophenomena was not associated with its longer persistence. The most robust associations of coprophenomena were with the number of non-tic repetitive behaviors, spitting, and inappropriate sexual behavior. Although coprophenomena are a frequently feared possibility in the course of Tourette syndrome, their emergence occurs in only about one in five referred patients. Because the course and actual impact of coprophenomena are variable, additional prospective research is needed to provide better counseling and prognostic information.
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Tourette syndrome in Japan: A nationwide questionnaire survey of psychiatrists and pediatricians
Psychiatry and clinical neurosciences, 1998Co-Authors: Yukiko Kano, Masataka Ohta, Yoko NagaiAbstract:In order to shed light on the clinical picture of patients with Tourette syndrome (TS) treated at medical institutions in Japan, a nationwide survey covering both pediatric patients and psychiatric patients was conducted. We mailed 316 questionnaires on experience in treating TS cases and the patients' present conditions etc. to specialists such as psychiatrists and pediatricians. A total of 164 responded. The survey found 154 TS patients being treated at the time of survey, 45 (29.2%) had obsessive–compulsive symptoms (OCS), and 10 (6.5%) had family histories of TS. It was suggested that TS is often associated with OCS and that familial cases of TS are slightly less common in Japan than they are in the USA. Of the 116 respondents who described their experiences, 85 (73.2%) said that they had treated one or more patients displaying the symptoms of frequent Coprolalia, and 42 (36.2%) said that they had treated one or more patients suffering from developmental disorders. Based on these findings, we speculated that the rate of Coprolalia in Japan is a little higher than the previously reported 4% and that TS is often associated with developmental disorders.
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Clinical characteristics of Tourette syndrome
Psychiatry and clinical neurosciences, 1998Co-Authors: Yukiko Kano, Masataka Ohta, Yoko NagaiAbstract:The aim of the present study was to examine the clinical characteristics of Tourette syndrome (TS) in terms of symptomatology, outcome and organic and genetic factors, and to compare these with results of previous studies on TS in Western countries and in Japan, on the basis of precise information taken from a large number of TS patients under psychiatric treatment in Japan. There was a total of 64 TS patients (55 males and nine females) selected from those who visited our outpatient clinic from 1974 to 1993 and were found to meet the criteria for Tourette's disorder of DSM-III-R. The mean patient age at entry to the present study was 17.4 years (SD: 7.2). All data were collected through a systematic chart review of subjects, including data on tic symptoms and the course of their development; complications and developmental histories; family histories; medical and psychological examinations; treatment; severity and outcome. A check of the data showed that the mean age at onset was 6.9 years (SD: 2.7). An analysis of the progression of the symptoms revealed that 'generalized tics' afflicting the entire body were found in 64.1% of subjects and Coprolalia was found in 50%. The main complications were obsessive-compulsive symptoms (OCS) in 62.5% of patients and attention deficit hyperactivity disorder (ADHD) in 17.2%. Of their parents, 7.0% had tic disorders except TS and 1.6% had TS. Contrary to results from previous studies of TS, our study revealed that at least the incidence of Coprolalia in TS patients in Japan is not lower than in Western countries. However, the frequency of familial cases seemed to be lower than previously reported for Western patients. Outcome was fairly related with 'generalized tics,' OCS, aggressiveness and ADHD.
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Differences in clinical characteristics between Tourette syndrome patients with and without ‘generalized tics' or Coprolalia
Psychiatry and clinical neurosciences, 1997Co-Authors: Yukiko Kano, Masataka Ohta, Yoko NagaiAbstract:The purpose of this study is to examine whether there are differences in clinical characteristics between Tourette syndrome (TS) patients with and without 'generalized tics' (GT) which involve the entire body, and/or Coprolalia. Subjects were 64 patients (55 males and 9 females, mean age, 17.4 +/- 7.2 years) who visited Tokyo University's outpatient clinic of neuropsychiatry from 1974 to 1993 and who met criteria for Tourette's disorder of DSM-III-R. Data on clinical characteristics, including tic symptoms and courses of their development, complications and developmental histories, treatment and severity, were collected by systematic chart review of all subjects. Tourette syndrome patients with 'generalized tics' tended to show multiple complex vocal tics more frequently than TS patients without GT. Tourette syndrome patients with Coprolalia tended to show significantly higher rates of copropraxia, echolalia, and 'cleaning/washing' compulsion than did the TS patients without Coprolalia. Tourette syndrome patients with both GT and Coprolalia were classified as the severest group in terms of tic symptoms and social impairment. Tourette syndrome patients who had neither of these morbidities were classified into the mildest group in all aspects. Generalized tics and Coprolalia seemed to indicate the severest end of the TS spectrum and seemed to be related with a need of intensive treatment.