Papers by Andrea Eugenio Cavanna
Neurological Sciences, 2022
Background Little is known about the perceived impact of the COVID-19 pandemic and subsequent loc... more Background Little is known about the perceived impact of the COVID-19 pandemic and subsequent lockdown measures on young patients with tic disorders. Previous studies focused on clinician and parent ratings of tic severity, whereas the only international self-report data are available for adult populations. We present the first findings from a case–control study on children and adolescents with tics during lockdown in Italy. Methods We surveyed 49 patients aged 6–18 years and 245 matched controls with a newly developed questionnaire covering socio-demographic and clinical data, as well as lockdown-related changes to daily life activities. Results About half (53.2%) of the Italian school-age patients who took part in our survey experienced changes in tic severity during lockdown. Perceived increases in tic severity (29.8%) were reported more often than decreases (23.4%). Analogous trends were reported for perceived restlessness and, more significantly, irritability, whereas changes i...
Background: Tourette syndrome (TS) is a neuropsychiatric disorder characterized by the chronic pr... more Background: Tourette syndrome (TS) is a neuropsychiatric disorder characterized by the chronic presence of multiple motor tics and at least one vocal/phonic tic since childhood. Tics typically change and vary in both intensity and severity over time, with remission and exacerbation common. In the vast majority of patients, tic expression is characteristically accompanied by discomforting bodily sensations, known as sensory phenomena or premonitory urges. Methods: We reviewed the existing literature on premonitory urges associated with the sense of voluntariness of action in TS. Results: Although the wish to move is perceived by the patient as involuntary, the decision to release the tic is often perceived by the patient as a voluntary capitulation to the subjective urge. Most patients with TS can exert a degree of control over the urge and constantly try to inhibit the movement. Based on these features, it has been suggested that tics performed in response to an urge to move should ...
Aims Gilles de la Tourette syndrome, originally described by Georges Gilles de la Tourette in 188... more Aims Gilles de la Tourette syndrome, originally described by Georges Gilles de la Tourette in 1885, is a developmental neuropsychiatric disorder characterised by multiple motor and vocal tics, usually presenting with a waxing and waning course over time. Complex tic-related symptoms, such as forced touching, self-injurious behaviours, echolalia/echopraxia, palilalia/palipraxia, and coprophenomena, have been included in the classical clinical picture. Moreover, associated psychopathology is quite common, especially obsessive-compulsive disorder, attention-deficit and hyperactivity disorder, anxiety and mood disorders. Converging evidence from epidemiological, phenomenological, neuroanatomical and genetic studies suggests that certain psychopathological features are not integral to the syndrome, whereas others seem to be genetically linked. However, controversy has traditionally characterised our understanding of the links between the behavioural problems and Gilles de la Tourette syn...
Official Journal of the Italian Society of Psychopathology, 2007
Summary Objective The clinical picture of Alzheimer's disease (AD) and other forms of degener... more Summary Objective The clinical picture of Alzheimer's disease (AD) and other forms of degenerative de- mentia is characterized by cognitive and neuropsychological dysfunction and progres- sive loss of reflective consciousness (RC), sometimes referred to as self-awareness. However, limited knowledge is currently available concerning the specific pattern of impairment in RC in different stages and subtypes of dementia. The aim of this study was to investigate RC in a population of patients with degenerative dementia, with special attention being focused on the relationship between alteration of RC and the natural history/neuropsychiatric profile of the disease.
M. et al. Features and pharmacotherapy of treatment-resistant depression: an observational study ... more M. et al. Features and pharmacotherapy of treatment-resistant depression: an observational study on hospitalized patients.
Neurological Sciences, 2020
Background The association of stereotypies and tics is not rare in children with severe autism sp... more Background The association of stereotypies and tics is not rare in children with severe autism spectrum disorder (ASD). The differential diagnosis between stereotypies and tics in this patient population can be difficult; however, it could be clinically relevant because of treatment implications. Methods A total of 108 video recordings of repetitive behaviors in young patients with stereotypies in the context of ASD were reviewed by a movement disorders expert and a trainee, in order to assess the prevalence of possible co-morbid tics. The Modified Rush Videotape Rating Scale (MRVS) was used to rate tic frequency and severity. Results Out of 27 patients with stereotypies (24 males; mean age 14 years), 18 (67%) reported possible tics. The most frequently observed tics were eye blinking, shoulder shrugging, neck bending, staring, and throat clearing. The mean MRVS score was 5, indicating mild tic severity. The only significant difference between patients with tics and patients without...
Cognitive Neuropsychiatry, 2020
What do ancient Stoicism and cognitive behavioural therapy have in common? As shown by Scottish p... more What do ancient Stoicism and cognitive behavioural therapy have in common? As shown by Scottish psychotherapist Donald Robertson, they might well share the very core principles. The new edition of ...
Neurological Sciences, 2021
Background Movement disorders have been described in the context of different types of encephalit... more Background Movement disorders have been described in the context of different types of encephalitis. Among hyperkinetic manifestations, tics have sporadically been reported in cases of encephalitis resulting from a range of aetiologies. Objective This review aimed to assess the prevalence and characteristics of tics in patients with encephalitis. Methods We conducted a systematic literature review of original studies on the major scientific databases, according to the standards outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results In addition to the established association between tics and encephalitis lethargica, our literature search identified reports of tics in patients with immune-mediated pathologies (including autoimmune encephalitides affecting the N-methyl-d-aspartate receptor, voltage-gated potassium channels, and glycine receptors) and infective processes (ranging from relatively common viral pathogens, such as her...
Cognitive Neuropsychiatry, 2020
Introduction. Converging evidence from both clinical and experimental studies has shown that Tour... more Introduction. Converging evidence from both clinical and experimental studies has shown that Tourette syndrome (TS) is not a unitary condition, but a cluster of multiple phenotypes, which encompass both tics and specific behavioural and cognitive symptoms (mainly attention-deficit and hyperactivity disorder and obsessive-compulsive disorder). Methods. We conducted a narrative review of the recent literature on the cognitive neuropsychiatry of TS. Results. Although clinical research has shown that TS is not associated with cognitive deficits per se, the findings of recent studies have suggested the presence of subtle alterations in specific cognitive functions. A promising line of research on imitative behaviour could provide a common background for the alterations in executive control and social cognition observed in TS. Two different (but not mutually exclusive) neurocognitive theories have recently suggested that TS could originate from altered perception-action binding and social decision-making dysfunction, respectively. Conclusions. Since the presence of behavioural co-morbidities influences individualised treatment approaches, it is likely that a more precise characterisation of TS phenotypes, including cognitive aspects, will result in improved levels of care for patients with tic disorders.
Neuroscience & Biobehavioral Reviews, 2020
Link to publication on Research at Birmingham portal General rights Unless a licence is specified... more Link to publication on Research at Birmingham portal General rights Unless a licence is specified above, all rights (including copyright and moral rights) in this document are retained by the authors and/or the copyright holders. The express permission of the copyright holder must be obtained for any use of this material other than for purposes permitted by law. • Users may freely distribute the URL that is used to identify this publication. • Users may download and/or print one copy of the publication from the University of Birmingham research portal for the purpose of private study or non-commercial research. • User may use extracts from the document in line with the concept of 'fair dealing' under the Copyright, Designs and Patents Act 1988 (?) • Users may not further distribute the material nor use it for the purposes of commercial gain. Where a licence is displayed above, please note the terms and conditions of the licence govern your use of this document. When citing, please reference the published version. Take down policy While the University of Birmingham exercises care and attention in making items available there are rare occasions when an item has been uploaded in error or has been deemed to be commercially or otherwise sensitive.
Cephalalgia Reports, 2020
Aim:To systematically review the available literature on the prevalence and clinical characterist... more Aim:To systematically review the available literature on the prevalence and clinical characteristics of headache in patients with Tourette syndrome (TS), a neurodevelopmental condition characterized by the chronic presence of motor and vocal tics.Design:We conducted a systematic literature review of original studies using three clinical databases (Medline, EMBASE and PsycInfo), according to the standards outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Outcome measures included both tic severity and tic frequency.Results:Our systematic literature review identified six studies on the prevalence and characteristics of headache in patients with TS (data on paediatric patients were available from five studies and data on adult patients from four studies). The proportion of patients with TS who had a diagnosis of headache ranged from 29% to 62%. Migraine was the most commonly investigated headache disorder in this patient population. The find...
Future Neurology, 2020
Aim: Correctly diagnosing repetitive behaviors in patients with Tourette syndrome (TS) can be cha... more Aim: Correctly diagnosing repetitive behaviors in patients with Tourette syndrome (TS) can be challenging. The differential diagnosis between tics and stereotypies is of particular importance, because of treatment implications. Methods: We assessed the prevalence and clinical characteristics of stereotypies in a large sample of adult patients with TS attending a specialist clinic. Results: Mild stereotypies were reported by 21/148 patients (14.2%). Patients with stereotypies were significantly more likely to have a comorbid diagnosis of Asperger syndrome, attention-deficit and hyperactivity disorder, and obsessive-compulsive disorder, compared with patients without stereotypies. Multiple linear regression analysis revealed that the presence of Asperger syndrome significantly predicted stereotypy severity. Conclusion: Stereotypies are not rare in adults with TS and other neurodevelopmental conditions, especially Asperger syndrome.
Neurological Sciences, 2020
Background Tourette syndrome (TS) and persistent motor/vocal tic disorders are neurodevelopmental... more Background Tourette syndrome (TS) and persistent motor/vocal tic disorders are neurodevelopmental conditions characterised by the chronic presence of motor and/or vocal tics. Patients with TS often present with co-morbid disorders, especially attention-deficit and hyperactivity disorder (which tends to improve after childhood), and obsessive-compulsive disorder (which can persist in adulthood). We set out to explore pharmacotherapy for tics in adult patients with TS and persistent motor/vocal tic disorders, as well as its relationship with the presence of co-morbid conditions. Methods We retrospectively reviewed the clinical characteristics and pharmacotherapy of 192 adult patients with TS (n = 187), persistent motor tic disorder (n = 3) and persistent vocal tic disorder (n = 2) attending a specialist clinic in the UK. Results Anti-dopaminergic medications (n = 65) and alpha-2-agonists (n = 50) were the most commonly prescribed pharmacotherapy for tic management. A sub-group analysi...
Journal of the Neurological Sciences, 2020
This is a PDF file of an article that has undergone enhancements after acceptance, such as the ad... more This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
Neurological Sciences, 2019
Background Tourette syndrome (TS) is a neurodevelopmental condition characterized by the presence... more Background Tourette syndrome (TS) is a neurodevelopmental condition characterized by the presence of multiple motor and phonic tics, often associated with co-morbid behavioural problems. Tics can be modulated by environmental factors and are characteristically exacerbated by psychological stress, among other factors. This observation has led to the development of specific behavioural treatment strategies, including relaxation therapy. Objective This review aimed to assess the efficacy of relaxation therapy to control or reduce tic symptoms in patients with TS. Methods We conducted a systematic literature review of original studies on the major scientific databases, including Medline, EMBASE, and PsycInfo, according to the standards outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Outcomes measures included both tic severity and tic frequency. Results Our literature search identified three controlled trials, with a total number o...
Archives of Medicine and Health Sciences, 2019
In 1986, the eminent British neurologist MacDonald Critchley (1900-1997) published his considerat... more In 1986, the eminent British neurologist MacDonald Critchley (1900-1997) published his considerations about the name of Gilles de la Tourette syndrome: "The malady of Gilles de la Tourette: What a compelling and grandiloquent choice of words! As a matter of fact, it is a fragment of poetry with its iambus following a dactyl. More than that, it is a musical theme which reverberates in one's imagery. Little wonder that the eponym fixates itself in the mind of every student at the outset of his career in neurology, there to remain throughout his life like a limpet." [1] Critchley was indeed correct in extracting two ancient Greek poetry meters from the euphonic and exotic-sounding eponym [Figure 1]. Critchley's words might have been inspired by Guilly's previous remarks on the name of Gilles de la Tourette in his contribution to Critchley's festschrift: [2] "Gilles de la Tourette: What an attractive surname! One that evokes a figure out of Watteau rather than the pitiful disease (…) to which his name remains attached." "Gilles de la Tourette syndrome" arguably resonates in the ears of clinicians as the name of the most complex and challenging tic disorder, and in the hearts of the patients who suffer from it as the name of the chronic condition, they started feeling sieged by in their early life. [3] It has been reported that the mother of a young patient with tics once told the American psychiatrist and expert on Gilles de la Tourette syndrome Arthur K. Shapiro (1923-1995) "What a pretty name for such a terrible disease." [4] Nevertheless, in his recent biography of Georges Gilles de la Tourette, French physician, and historian Olivier Walusinski cannot help but asking "Had Gilles de la Tourette been named Martin, or Leblanc or Guinon, would the eponym have been created?" [5] Although Gilles de la Tourette described his syndrome in 1885, the resurgence of his posthumous fame is relatively
Adolescent Health, Medicine and Therapeutics, 2019
Tourette syndrome (TS) is a complex neurodevelopmental disorder characterized by multiple motor a... more Tourette syndrome (TS) is a complex neurodevelopmental disorder characterized by multiple motor and vocal tics, which commonly presents with multiple behavioral problems, including co-morbid attention-deficit and hyperactivity disorder and obsessivecompulsive disorder. Both tics and co-morbid conditions have been shown to potentially affect patients' health-related quality of life. While TS typically presents in childhood, its manifestations peak in severity during adolescence, a critical period in which affected individuals are exposed to potential stigma from peers. Physical and behavioral manifestations can also contribute to stigma, which subsequently leads to poorer health outcomes, discrimination, and a reduced willingness to seek help. The available evidence suggests that young patients with TS can experience reduced social acceptance from peers and difficulties establishing relationships. There is also evidence that some health care professionals share the unhelpful belief that young patients with TS should be disciplined in order to correct their disruptive behavior, based on the erroneous assumption that tics can be consciously controlled. Studies focussed on self-perception in patients with TS have yielded inconsistent results, with some studies showing problems in the domains of self-concept and self-esteem. Feelings of isolation, loneliness, and experiences of bullying have been reported more consistently. Interventions are required to reduce misconceptions about the condition and thus reduce stigma through targeted education and behavioral interventions. A multi-faceted approach that focuses on educating children, adults, and educators about TS would be beneficial to help alleviate stigma. This can be combined with self-advocacy and tailored psychological therapies for young patients with TS. The present paper reviews the current literature on stigma and self-perception in adolescents with TS in order to inform clinical decisions about management strategies and possible interventions to improve health-related quality of life.
The British Journal of Psychiatry, 2019
Uploads
Papers by Andrea Eugenio Cavanna