Psychiatr Clin North Am
· 2025 Mar · PMID 39880512
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This study describes our systematic literature review documenting outcomes associated with persistent tic disorders (PTDs) and summarizes 15 articles comparing health care use between individuals with PTDs and a comparis...This study describes our systematic literature review documenting outcomes associated with persistent tic disorders (PTDs) and summarizes 15 articles comparing health care use between individuals with PTDs and a comparison group without PTDs. Only 2 studies included adults and only one study stratified findings by sociodemographic characteristics, precluding conclusions on health care disparities. Most children with PTDs had access to routine care, similar to children without PTDs, but needed and used more specialty health care, including mental health services, compared to children without PTDs. Improving identification and management of PTDs in primary care settings may improve health care access for individuals with PTDs.
Katz TC, Khan TR, Chaponis O
… +1 more, Tomczak KK
Psychiatr Clin North Am
· 2025 Mar · PMID 39880511
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Repetitive behaviors are the hallmark of many neuropsychiatric disorders, including Tourette syndrome (TS), obsessive-compulsive disorder (OCD), and autism spectrum disorder (ASD). Tics, compulsions, and stereotypies may...Repetitive behaviors are the hallmark of many neuropsychiatric disorders, including Tourette syndrome (TS), obsessive-compulsive disorder (OCD), and autism spectrum disorder (ASD). Tics, compulsions, and stereotypies may appear similar and can be difficult to disentangle. This review addresses similarities and differences between these behaviors including clinical presentations, neuroimaging, genetics, and treatment paradigms in order to clarify the relationship between these disorders. The extensive genetic and neurocircuitry-based similarities raise the possibility that in some cases TS and OCD may represent a single neuropsychiatric entity, such as Tourettic OCD, that lies along the impulsive-compulsive spectrum.
Psychiatr Clin North Am
· 2025 Mar · PMID 39880510
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Functional tic-like behaviors (FTLBs) are a manifestation of functional neurologic disorder that can be mistaken for neurodevelopmental tic disorders like Tourette syndrome. Much information was gained about FTLBs becaus...Functional tic-like behaviors (FTLBs) are a manifestation of functional neurologic disorder that can be mistaken for neurodevelopmental tic disorders like Tourette syndrome. Much information was gained about FTLBs because of an outbreak of FTLBs spreading among adolescents and young adults via social media during the coronavirus disease 2019 pandemic. In comparison to neurodevelopmental tic disorders, FTLBs have an older age of onset, more abrupt symptom onset, and more complex tics as well as other features that would be atypical of Tourette syndrome. Although they do not respond well to standard treatment for neurodevelopmental tics, they are treatable with appropriate behavioral therapy.
Psychiatr Clin North Am
· 2025 Mar · PMID 39880509
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The underlying pathophysiology of tics in Tourette syndrome is a topic of major scientific interest. To date, there is an absence of consensus among researchers regarding the precise anatomic location responsible for tic...The underlying pathophysiology of tics in Tourette syndrome is a topic of major scientific interest. To date, there is an absence of consensus among researchers regarding the precise anatomic location responsible for tics. The goal of this article is to review the current understanding of these brain circuits and data supporting specific anatomic regions. In summary, current scientific evidence supports the likelihood of multiple areas of abnormality within cortico-basal ganglia-thalamocortical (CBGTC) circuitry or their connected brain regions. A reasonable anatomic hypothesis is that a disruption anywhere within specific circuitry can ultimately lead to the development of a tic disorder.
Psychiatr Clin North Am
· 2025 Mar · PMID 39880508
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Research conducted since the turn of the millennium has shown that the quality of life in patients with Tourette syndrome is affected by various health-related factors. The condition's chronic nature, along with its soci...Research conducted since the turn of the millennium has shown that the quality of life in patients with Tourette syndrome is affected by various health-related factors. The condition's chronic nature, along with its social and emotional implications, can significantly diminish the overall quality of life. Both core symptoms-motor and vocal tics-and associated comorbidities can contribute to functional impairments and reduced well-being. However, individual experiences vary widely, with some patients reporting relatively high levels of satisfaction and adaptation. Comprehensive care addressing both symptom management and psychological support is crucial for improving the quality of life for individuals with Tourette syndrome.
Psychiatr Clin North Am
· 2025 Mar · PMID 39880507
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Mindfulness-based interventions have demonstrated efficacy for a wide range of clinical concerns and populations. Mindfulness-based Intervention for Tics (MBIT) is a recently developed brief, online group intervention fo...Mindfulness-based interventions have demonstrated efficacy for a wide range of clinical concerns and populations. Mindfulness-based Intervention for Tics (MBIT) is a recently developed brief, online group intervention for adults with tics. Preliminary evidence suggests that MBIT is feasible, acceptable, and safe. Symptomatic improvements compare favorably with those associated with Comprehensive Behavioral Intervention for Tics, the first-line behavioral treatment for tics. Additional research is necessary to confirm these findings, identify mediators and moderators, directly compare MBIT to existing treatments, and expand the intervention to children and adolescents.
Psychiatr Clin North Am
· 2025 Mar · PMID 39880506
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This review explores the genetic basis of Tourette syndrome (TS), a complex neuropsychiatric disorder characterized by motor and vocal tics. Family, twin, and molecular genetic studies provide strong evidence for a genet...This review explores the genetic basis of Tourette syndrome (TS), a complex neuropsychiatric disorder characterized by motor and vocal tics. Family, twin, and molecular genetic studies provide strong evidence for a genetic component in TS, with heritability estimates ranging from 50% to 80%. The genetic architecture of TS is complex, involving both common variants with small effects and rare variants with larger effects. Genetic studies have identified candidate genes and chromosomal regions associated with TS risk, implicating biological pathways related to neurodevelopment, neurotransmission, and synaptic function. The article also discusses the clinical implications of these findings and future research directions.
Psychiatr Clin North Am
· 2024 Dec · PMID 39505456
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There has been tremendous interest in utilizing digital interventions to assist in the treatment of anxiety disorders. Anxiety disorders are widely prevalent and often characterized by avoidance, intolerance of uncertain...There has been tremendous interest in utilizing digital interventions to assist in the treatment of anxiety disorders. Anxiety disorders are widely prevalent and often characterized by avoidance, intolerance of uncertainty, interpersonal concerns, and worry. Digital mental health interventions, given their flexibility, may be particularly suited to this population. The authors review the literature on the use of videoconference, virtual reality, website self-help, and mobile applications in the treatment of anxiety disorders. Empirical evidence, advantages, and disadvantages of each format are considered. Additionally, we identify clinical and social challenges unique to the use of these technologies for intervention purposes.
Psychiatr Clin North Am
· 2024 Dec · PMID 39505455
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Brief, nonpharmacological interventions for anxiety are often defined as no more than 10 sessions or 50% contact time of a full intervention. Brief interventions can be of high or low intensity, depending on the type and...Brief, nonpharmacological interventions for anxiety are often defined as no more than 10 sessions or 50% contact time of a full intervention. Brief interventions can be of high or low intensity, depending on the type and extent of therapist support provided, and may be concentrated. There is evidence to support the use of brief cognitive-behavioral interventions for anxiety in mental health clinics, primary care, and schools, and internet delivery can be a cost-effective alternative to standard formats. Research to identify cases requiring longer and/or more intense intervention is needed to inform stepped-care approaches to improving treatment access.
Psychiatr Clin North Am
· 2024 Dec · PMID 39505454
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Theoretic models of anxiety disorders have emphasized the impact of caregiving on the development and maintenance of childhood anxiety. Familial factors demonstrate a reciprocal relationship with child anxiety, including...Theoretic models of anxiety disorders have emphasized the impact of caregiving on the development and maintenance of childhood anxiety. Familial factors demonstrate a reciprocal relationship with child anxiety, including family stressors, parenting control, and family accommodation. The inclusion of parents in intervention for youth anxiety has demonstrated a superior outcome in several studies and is recommended as an area to evaluate when child anxiety is presented for assessment and treatment. This review examines familial variables in their contribution to clinical levels of anxiety in youth, focusing on genetic, family environment, and parental behaviors and recommendations for prevention and treatment intervention.
Psychiatr Clin North Am
· 2024 Dec · PMID 39505453
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Understanding the cultural and social aspects of anxiety disorders is necessary to ensure the design and implementation of effective, evidence-based methods for diagnosis, prevention, and treatment among diverse populati...Understanding the cultural and social aspects of anxiety disorders is necessary to ensure the design and implementation of effective, evidence-based methods for diagnosis, prevention, and treatment among diverse populations, particularly those who are minoritized, marginalized, and traditionally underserved. This article describes variations in anxiety disorder prevalence and the association between sociocultural characteristics and stressors known to increase risk for anxiety. The ways sociocultural context impacts anxiety phenomenology and expression is explored. Then, the literature examining differential help-seeking and service utilization among diverse populations is reviewed followed by a summary of culturally responsive, evidence-based practices for anxiety disorders.
Psychiatr Clin North Am
· 2024 Dec · PMID 39505452
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Anxiety is the most common co-occurring mental health condition across the lifespan for autistic people. The authors summarize the extant research on prevalence, correlates and predictors, measurement, and treatment of a...Anxiety is the most common co-occurring mental health condition across the lifespan for autistic people. The authors summarize the extant research on prevalence, correlates and predictors, measurement, and treatment of anxiety disorders in autistic people, which has rapidly expanded in the past decade. In addition to addressing gaps within each of these areas, the authors propose that there is a need for future work to center autistic perspectives, employ longitudinal designs, and expand the focus to include autistic adults and those with co-occurring intellectual disability.
Psychiatr Clin North Am
· 2024 Dec · PMID 39505451
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Contrary to ageist stereotypes, anxiety disorders are less common in older compared with younger adults. However, anxiety is often under-recognized and undertreated in this population. Anxiety disorders affect around 1 i...Contrary to ageist stereotypes, anxiety disorders are less common in older compared with younger adults. However, anxiety is often under-recognized and undertreated in this population. Anxiety disorders affect around 1 in 10 older adults, are unremitting, and are associated with a range of negative outcomes, including increased risk of depression, cognitive and functional decline, physical health problems, increased healthcare use, and suicide. This article summarizes the epidemiology and risk factors of anxiety in later life, explores variations in symptom presentation compared with younger adults, and outlines recommendations for assessment and treatment.
Psychiatr Clin North Am
· 2024 Dec · PMID 39505450
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Anxiety disorders are common in children and adolescents, with many youths experiencing functional impairment in multiple domains because of these conditions. Biologic and cognitive-behavioral models provide a basis for...Anxiety disorders are common in children and adolescents, with many youths experiencing functional impairment in multiple domains because of these conditions. Biologic and cognitive-behavioral models provide a basis for the development and maintenance of these disorders. Cognitive behavioral therapy (CBT) with exposures and selective serotonin reuptake inhibitors or serotonin and norepinephrine reuptake inhibitors are empirically supported treatments for childhood anxiety disorders. Exposures are a key component of CBT treatment and a case vignette demonstrates how to tailor exposures to the unique fears of the child.
Psychiatr Clin North Am
· 2024 Dec · PMID 39505449
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This article reviews acceptance and commitment therapy (ACT) for anxiety disorders, obsessive-compulsive disorder (OCD), trichotillomania, excoriation disorder, hoarding, and body dysmorphic disorder (BDD). Measurement o...This article reviews acceptance and commitment therapy (ACT) for anxiety disorders, obsessive-compulsive disorder (OCD), trichotillomania, excoriation disorder, hoarding, and body dysmorphic disorder (BDD). Measurement of psychological inflexibility and its relationship to pathology is reviewed. Outcome work in all disorders listed is reviewed with results supporting ACT for anxiety disorders, OCD, and trichotillomania, but there is limited evidence for excoriation disorder, hoarding, and BDD. Future research should focus on processes of change in addition to outcomes.
Psychiatr Clin North Am
· 2024 Dec · PMID 39505448
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Anxiety disorders are the most common psychiatric illness and include disorders such as generalized anxiety disorder (GAD), panic disorder (PD), and social anxiety disorder (SAD). Psychotherapy and pharmacotherapy are bo...Anxiety disorders are the most common psychiatric illness and include disorders such as generalized anxiety disorder (GAD), panic disorder (PD), and social anxiety disorder (SAD). Psychotherapy and pharmacotherapy are both effective treatments for anxiety disorders, with efficacy between 60% and 85%. Selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors are first-line pharmacologic treatment for GAD, PD, and SAD. Recommendations for treating pediatric and geriatric populations vary slightly, but first-line treatments remain the same. Recent advancements in the treatment of anxiety disorders are limited although research has discovered novel pathways, which may lead to additional treatment options in the future.
Psychiatr Clin North Am
· 2024 Dec · PMID 39505447
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Cognitive behavioral therapy (CBT) is the front-line psychological intervention for the treatment of anxiety disorders. It is based on the cognitive behavioral model of anxiety disorders, which conceptualizes anxiety as...Cognitive behavioral therapy (CBT) is the front-line psychological intervention for the treatment of anxiety disorders. It is based on the cognitive behavioral model of anxiety disorders, which conceptualizes anxiety as caused by a pattern of maladaptive cognitive appraisals and avoidance behaviors that perpetuate pathologic fears. CBT includes core components that are relevant across anxiety disorders, including psychoeducation, cognitive restructuring, exposure therapy, and relapse prevention. CBT has a strong evidence base supporting its short-term and long-term efficacy and effectiveness. A case vignette is provided to illustrate the application of CBT principles. Clinical complexities, clinical recommendations, and future research directions are discussed.
Psychiatr Clin North Am
· 2024 Dec · PMID 39505446
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This article provides an overview of evidence-based assessment (EBA) of anxiety disorders in children and adolescents. First, this article provides an overview of using clinician-rated scales in the diagnostic process. S...This article provides an overview of evidence-based assessment (EBA) of anxiety disorders in children and adolescents. First, this article provides an overview of using clinician-rated scales in the diagnostic process. Second, this article reviews the clinical utility of clinician-rated measures, and parent-report and youth-report measures to characterize anxiety severity and monitor treatment response in clinical practice. Additionally, rating scales that capture clinical constructs that are relevant in anxiety disorders-such as accommodation and avoidance behaviors-are succinctly reviewed. Finally, the article concludes with recommendations for conducting an EBA for anxiety disorders in children and adolescents.