Symptom severity, impairment and health outcomes in patients with Functional Tic Like Behaviours
Lindsay Berg1, Tamara Pringsheim2, Davide Martino3
1University of Calgary, 2Mathison Centre, 3Department of Clinical Neurosciences, University of Calgary
Objective:
To quantitatively understand symptom severity, impairment, and health outcomes of patients with functional tic-like behaviours (FTLB) compared to Tourette Syndrome (TS) and healthy controls (HC).
Background:
Functional tic-like behaviors (FTLB) are a previously rare form of functional movement disorder that rose in incidence during the COVID-19 pandemic. Patients report significant disruptions in daily functioning.
Design/Methods:
As part of a larger data set, patients aged 11-25 years with FTLB (n= 34) were age and sex-matched to TS (n= 21), and healthy controls (HC) (n=21). Groups completed online self-report measures and a clinical neuropsychiatric interview that investigated quality of life, disability, loneliness, suicidality, depression, anxiety, social interaction anxiety, social phobia, current and peak tic-severity, and family functioning. Two-tailed group differences were Bonferroni corrected.
Results:
Compared to HC and TS, FTLB patients endure higher levels of total disability (p=.037), self-care disability (p=.019), disability related to participation in life activities such as school and work (p=.013), depression (p=.011), and suicidality (p<.001). 61.8% of FTLB patients reported school absence that ranged up to 65% of the time (Mean=20.88%, SD=22.25). FTLB had higher current phonic tic severity (p=.048), and peak motor and phonic tic severity (p<.001; p<.001) than TS. FTLB experience lower quality of life in the physical, psychological, and environmental domains (p=.015; p=.031; p=.042) and significantly higher social interaction anxiety (p=.004), social phobia (p<.001), and loneliness (p=.038) compared to HC. TS and FTLB reported similar levels of tic related impairment, anxiety, and social anxiety/phobia. Family functioning was not significantly different between groups.
Conclusions:
FTLB are a highly disabling disorder that severely impacts quality of life, social and adaptive functioning, and mental health. Comparable levels of social anxiety, loneliness, and tic related impairment in TS and FTLB may be due to social apprehension in response to common negative reactions to tics and tic-like behaviors.