Tourette Syndrome Essay Example for Free

Tourette Syndrome Essay Tourette syndrome (TS) is a chronic, familial, neurobiological disorder with its   onset in childhood and is marked by presence of involuntary motor movements and sounds, known as motor and vocal tics respectively (Bagheri, Kerbeshian Burd, 1999). According to Lingui-Systems (1999, cited in Prestia, 2003), approximately 1 in every 2,500 individuals suffer from TS, with boys being diagnosed more frequently than girls. Tourettes syndrome also known as Gilles de la Tourette syndrome (after its discoverer Georges Gilles de la Tourette, a French neurologist), can be considered to be the most complex and severe manifestation of the spectrum of tic disorders (Kwak Jankovic, 2002). Etiology and Pathogenesis The exact cause of TS is not known. TS is supposed to have a multifactorial etiology with, genetic and environmental factors playing an important role in its development. Concordance rate of about 60% in monozygotic twins and 10% in dizygotic twins suggest genetic basis behind TS (Bagheri et al, 1999). The mode of transmission of Tourettes syndrome is controversial. Though the exact patho-physiological mechanism underlying the disease has yet not been discovered, abnormalities in basal ganglia (shown in figure 1) and frontal cortex have been implicated in the pathogenesis of Tourettes syndrome (Bagheri et al). Abnormality in secretion of neuro-transmitters especially dopamine is also thought to be associated with TS (Bagheri et al). Figure1. Brain Structures Involved in Tourette Syndrome Source: John Henkel, J. (2006). Food and Drug Administration. Retrieved on 21 April 2007 from http://en.wikipedia.org/wiki/Image:Brain_structure.gif Symptoms Tourettes syndrome follows a fluctuating course in most children. Symptoms   usually appear at about 6-7 years of age.   Many factors like anxiety, stress, substance abuse etc can intensify tics. Presence of tics (both motor and vocal) is characteristic of TS. According to American Psychiatric Association’s Diagnostic and Statistical manual of mental disorders, fourth edition- text revision. (DSM-IV-TR, 2000), tics are defined as sudden, rapid, purposeless, repetitive, non-rhythmic, stereotyped movements or vocalizations. Tics in TS are not constantly present (except in extremely severe cases) and occur on a background of normal motor activity (Kwak Jankovic, 2002). This disorder usually begins with simple tics which progress over time into more complex ones.   Different types of simple and complex tics as described by Bagheri et al (1999) which can be seen in patients with TS have been enumerated in table 1. Besides TS, tics can be seen associated with other neurologic disorders like (encephalitis, Huntington’s disease etc). These secondary tics, not associated with Tourette syndrome are commonly referred to as tourettism ((Bagheri et al, 1999). Table 1.Common Types of Tics Seen in Patients with Tourette Syndrome. SIMPLE TICS COMPLEX TICS Motor tics Vocal or phonic tics Motor tics Vocal or phonic tics Eye blinking Throat clearing Flapping arms Talking to oneself Sticking tongue out Sniffing Facial grimacing Assuming different intonations Head turning Barking Adjusting or picking at clothing Coprolalia: blurting out obscene or socially inappropriate words or phrases Jerking of head or shoulders Coughing Complex touching movements Echolalia:   involuntary repetition of the words of others Muscle tensing Yelling Jumping Palilalia: involuntary repetition of ones own words Flexing fingers Hiccupping Shaking feet Kicking Belching Poking and pinching Producing animal sounds Copropraxia: involuntary performance of obscene gestures Kissing self or others Spitting Source: Bagheri, M.M. Kerbeshian, J., Burd, L. (1999). Recognition and management of Tourette’s Syndrome and tic disorders. American Family Physician, 59 (8). Retrieved on 21 April from http://www.aafp.org/afp/990415ap/2263.html Motor tics Motor tics can be described as brief movements which occur due to   involuntary muscle contraction. Motor tics can be simple or complex in nature (see table 1). Tics usually occur as an involuntary movement or as a response to an involuntary urge to perform the movement (Kwak Jankovic, 2002). These involuntary movements are often perceived as voluntary by the patient and he tries to suppress them. Suppression of tics results in building up of an inner tension or a feeling of discomfort. This leads a further burst of tics which is relieved after performance of the movement (Kwak Jankovic, 2002). Vocal tics Vocal or phonic tics represent involuntary sounds produced due to contraction of   nasal or oro-pharyngeal muscles (Kwak Jankovic, 2002). Like somatic motor tics, vocal tics can also be divided into simple and complex tics (shown in table 1). Coprolalia once thought to be characteristic of TS is present in about 8-25% cases (Bagheri et al, 1999). Another type of speech disturbance present in some patients is ‘blocking tics’. They are manifested by either hesitancy in starting the speech or sudden interruption in the flow of normal speech (Kwak Jankovic, 2002) Developmental stuttering is also sometimes seen in patients with TS (Kwak Jankovic, 2002). Tourette’s syndrome is often associated with other co-morbid conditions like obsessive compulsive disorder (OCD), attention deficit hyperactivity disorder (ADHD), behavior problems and learning disabilities (Prestia, 2003). Diagnosis Diagnosis of TS is usually made clinically based on recognition of tics. The Diagnostic criteria for TS as defined by American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, fourth edition- text revision. (DSM-IV-TR), 2000 is shown in table 1. Table 1. DSM-IV-TR Diagnostic Criteria for Tourettes Disorder A Presence of both motor and vocal tics at some time during the illness, although not necessarily concurrently. B The tics occur many times a day (usually in bouts) nearly every day or intermittently throughout a period of more than 1 year, and during this period there is never a tic-free period of more than 3 consecutive months. C The onset of symptoms is before the age of 18 years. D TS is diagnosed after ruling out the presence of symptoms due to direct effect of drugs of abuse or general medical conditions (e.g., Huntingtons disease or post viral encephalitis). Treatment      Ã‚  Ã‚  Treatment of TS may require a multi-disciplinary team approach involving   neurologists, psychiatrists, psychologists, social workers, occupational therapists, educators etc. (Kwak Jankovic, 2002).An algorithm for management of TS as described by Bagheri et al (1999) is shown in figure 2. Pharmacological therapy   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚     Ã‚  Ã‚  Medical therapy should aim at the treatment of most disabling symptom. Tics   (both vocal and motor) respond best to dopamine blocking drugs (Kwak Jankovic, 2002). These can include conventional neuroleptics like haloperidol and pimozide and the atypical neuroleptic agents like risperidone. Neuroleptic agents are associated with numerous side effects like sedation, weight gain, impaired academic performance, in children and extra pyramidal movement symptoms (like tardive dyskinesia). Since TS is frequently associated with other co-morbid conditions like OCD, ADHD etc, pharmacotherapy should be tailored to treat these conditions as well (Kwak Jankovic, 2002). For e.g. Central nervous system stimulants (amphetamines and dextroamphetamine) can be used for treatment of ADHD and anti-depressants (selective serotonin reuptake inhibitors) for management of OCD, if present. Injections of botulinum toxin can be used for tics isolated to one body region such as the eyes, neck, or vocal cords. Non-Pharmacologic interventions Since TS most commonly affects children in the age when they are attending school, symptoms of TS can affect their academic performance, cause inference with their social-emotional development, and impose limitations due to physical disabilities produced as a result of tics (Prestia, 2003). It is the duty of educational providers, school personnel and parents to keep these limitations in mind and to draw out an adequate plan incorporating carefully thought out interventions and adaptations, in order to enhance the success and performance of children suffering with TS, at school (Prestia, 2003). Behavior treatment and counseling can be used to promote development of social and academic skills in children and to prevent exacerbation of symptoms related to TS, by modifying their behavior (Bagheri et al, 1999). Source: Bagheri, M.M. Kerbeshian, J., Burd, L. (1999). Recognition and management of Tourette’s Syndrome and tic disorders. American Family Physician, 59 (8). Retrieved on 21 April from http://www.aafp.org/afp/990415ap/2263.html Prognosis TS is a lifelong disorder with an unpredictable course (Prestia, K. (2003). The   clinical course of TS as described by Bagheri et al (1999) is shown in figure 3.   As shown in figure 3, symptoms of TS diminish during and after adolescence in about 85% of patients. About 5 to 10 % of patients may show no improvement. Most patients with TS require medication for up to one to two years. About 15 % of patients may require long-term medication for tic control.                Figure 3. Clinical Course of Tourettes Syndrome Source: Bagheri, M.M. Kerbeshian, J., Burd, L. (1999). Recognition and management of Tourette’s Syndrome and tic disorders. American Family Physician, 59 (8). Retrieved on 21 April from   http://www.aafp.org/afp/990415ap/2263.html Conclusion TS is not an uncommon problem and can be often encountered in school children. TS is a multifactorial neurological disorder requiring an integrated treatment approach targeting at the other co-morbid conditions associated with TS, as well. Treatment must also incorporate an effective multi-disciplinary team approach aiming at treatment and recognition of underlying complex mechanisms, solving speech and language problems and promoting socio-emotional and academic development to substantially improve the quality of life and performance of individuals with TS. Article Review The article by Prestia, 2003 focuses on need of educators to understand the special academic, social-emotional, and physical needs of the children suffering from TS. Educators need to make use of simple interventions to help these children overcome their illness and achieve best possible performance at school. TS can cause significant academic, social-emotional, and physical challenges for the child as described below: Academic Challenges TS does not directly affect intelligence, and many students with TS have average or above average IQs. Still approximately 40% of individuals with TS can have learning problems. This is so as many individuals with TS have associated comorbid disorders like learning disabilities, OCD, ADHD, Asperger syndrome etc. Assistance can be provided through special education services or individualized education program (IEP) or a 504 Plan. If the student does not qualify for either, classroom teachers can make use of simple interventions and plans by using available resources and their own knowledge .For e.g. if the child is having trouble with writing, teachers can make use of alternatives like using oral assessment tests instead of written assignments, using multiple-choice questions etc. Since stress can precipitate tics, teachers should take steps to eliminate any source of stress for the student. Social-emotional Challenges Children with TS tend to have problems in interacting with and being accepted by their peers due to abnormal behavior produced as a result of motor and vocal tics. Such children may become isolated and depressed and are at risk for developing poor self-esteem and self-confidence. They are also easy targets to bullying. Educators should take steps to encourage acceptance and support of such students by their peers. Physical Challenges Underlying physical problems accompanying the disorder often go unaddressed. Educators should properly assess these problems by consulting a multi-disciplinary team (MDT) involving a physical therapist, occupational therapist, and adapted physical education teacher in order to determine the students motor strengths and areas of need. For e.g.   Impairments in sensory processing or motor planning may interfere with normal day to day non-academic activities like toileting, eating lunch, etc. Simple solutions can be offered by the MDT to facilitate independence and to prevent self-harm during the period of tic release in such children.   Ã‚  Ã‚     Ã‚  Ã‚  Ã‚  In my view this article provides helpful suggestions that can be utilized in school settings. In order to achieve optimal development and performance of these students, educators must make use of simple and carefully thought out interventions. They should find out ways to promote social-emotional development and also help them in coping with learning and physical disabilities, imposed by the tics. References American Psychiatric Association’s Diagnostic and Statistical manual of mental   disorders, fourth edition- text revision.   (2000). Retrieved on 21 April from http://www.behavenet.com/capsules/disorders/touretteTR.htm Bagheri, M.M., Kerbeshian, J., Burd, L. (1999). Recognition and management of   Tourette’s Syndrome and tic disorders. American Family Physician, 59 (8). Retrieved on 21 April from http://www.aafp.org/afp/990415ap/2263.html Kwak, C. Jankovic, J. (2002). The Neurology of a Tic: From the Point of View   of the Scientist. Retrieved on 21 April 2007 from http://www.asha.org/about/publications/leader-online/archives/2002/q3/020806a.htm Prestia, K. (2003).Tourettes syndrome: Characteristics and interventions. Intervention   in school and clinic, 39(2), 67. Retrieved on 21 April 2007 from http://proquest.umi.com/pqdweb?index=37did=443394391SrchMode=1sid=2Fmt=4VInst=PRODVType=PQDRQT=309VName=PQDTS=1176684625clientId=18091

Anne Bradstreet - Feminine but Feminist Essay -- essays research paper

As a female in a highly patriarchal society, Anne Bradstreet uses the reverse psychology technique to prove the point of her belief of unfair and unequal treatment of women in her community. Women who wrote stepped outside their appropriate sphere, and those who actually published their work frequently faced social censure. Compounding this social pressure, many women faced crushing workloads and struggled with lack of leisure for writing. Others suffered from an unequal access to education, while others were dealing with the sense of intellectual inferiority offered to them from virtually every authoritative voice, that voice usually being male. Bradstreet was raised in an influential family, receiving an extensive education with access to private tutors and the Earl of Lincoln's large library. She was part of an influential family who encouraged her writing and circulated it in manuscript with pride. That kind of private support did much to offset the possibility of public disappr oval. Bradstreet believed that women in her society were treated unfairly, and that gender should be insignificant. In her "Prologue" she addresses conflict and struggle, expressing her opinion toward women's rights, implying that gender is unimportant and male dominance is wrong. Bradstreet asserts the rights of women to learning and expression of thought, addressing broad and universal themes. The "Prologue" has a humble tone with slightly hidden surprises, containing a mut...

Murder of Roger Ackroyd

Have you read any Agatha Christie yet? Because she is extremely awesome and not boring and conventional like you might think. In fact, her 1926 novel The Murder of Roger Ackroyd was so controversial when it came out (due to a twist ending that I'm not going to reveal) that critics were divided and other mystery writers aghast. In this mystery a widow has apparently committed suicide one year after her husband's mysterious death. The town doctor confirms the death and later dines with a friend (and the wealthiest man in town), who was also close with the widow.After the doctor leaves the man's house for the evening, he is called back only to find his friend has been stabbed in the neck. And there we have the murder of Roger Ackroyd. Lucky for (almost) everyone, a strange foreigner has recently moved to the town for his retirement. He is none other than the famous Belgian detective, Hercule Poirot, and after a little coaxing from Ackroyd's niece, he takes on the case and begins investi gating the murder with the good doctor as his sidekick. There are a whole household of intriguing suspects, each of which would benefit from Ackroyd's death and every one of them seems to be hiding something.In this book, as in the other Agatha Christie novels I've read, the strength lies in the balance between a great mystery (lots of clues, red herrings, and teasing hints) and a masterful sense of character and psychology. Truly a perfect mystery. This is the first Hercule Poirot book that I've read, and although I've seen some TV adaptations of Poirot stories and had a general familiarity with his character I've been told by a friend that I would get even more out of The Murder of Roger Ackroyd if I had a little more Poirot under my belt. Which is great because I can't wait to read some more†¦

Subway Is Testing A New Rebranding Campaign - 1476 Words

Overview On August 18, 2015, longtime Subway pitchman Jared Fogle was arrested under a child pornography investigation. Quick to respond, Subway communicated to press via public comment and Twitter on their stance. Hours after the arrest, Subway made public its separation from Fogle and its disgust and lack of knowledge of the crimes committed. Because of their quick response, while they were directly tied to Fogle, most of the negative response was placed on Fogle and not Subway. Moving forward, Subway is testing a new rebranding campaign in Australia that focuses on products, rather than a pitchman. Company History: In 1965, a 17-year-old medical school student, Fred DeLuca, opened up a submarine sandwich shop in Connecticut on a $1,000 loan from a friend. By 1982, the chain had opened up its 300th location. In 1984, the Subway sandwich chain was introduced overseas and by 1990, there were more than 5,000 locations. Today, Subway has the most sandwich restaurants in the world at 37,000 locations (3). Known for their freshly baked bread and healthy options, Subway restaurants are located in schools, malls, gas stations, airports and even zoos. In 1995, the Subway began its journey towards becoming a major supporter of motorsports. In 1996, www.subway.com was launched and was featured multiple times in the movie â€Å"Happy Gilmore† (3). In 1999, an article was written about an overweight college student who lost a large amount of weight eating nothing but Subway sandwichesShow MoreRelatedStrategic Marketing Planning for Non Profit Organization9605 Words   |  39 Pagesdisciplines, nonpro fit leaders often fail to understand what marketing can and can’t do for their organizations. Consequently, they hold some strange assumptions (e.g. â€Å"Our good work will sell itself †), unrealistic expectations (e.g., demanding to be in The New York Times once a week) and arbitrary funding theories (i.e., when fundraising is down, cut the communications budget). Compounding the challenge, few nonprofit managers recognize their lack of expertise in these areas. The same people who would neverRead Morepaul hoang answers72561 Words   |  291 Pagessubordinates to gain valuable experiences. Given the culture, the new HOD might be expected to be more democratic in his/her approach to conflict management, e.g. perhaps by using forms of empowerment. Conflict may also arise if the Principal uses external recruitment to appoint the new HOD. Any conflict between subordinates will most likely to be dealt with by the HOD, i.e. conflict is resolved within the department. The new HOD will therefore need to have good interpersonal and communicationsRead MoreMarketing Management 14th Edition Test Bank Kotler Test Bank173911 Words   |  696 Pagespromoted aggressively to both companies and fans. This is an example of marketing a(n) ________. A) idea B) place C) luxury item D) event E) service Answer: D Page Ref: 5 Objective: 2 Difficulty: Moderate 9) The Malaysia, Truly Asia ad campaign that showcased Malaysias beautiful landscape and its multicultural society in order to attract tourists is an example of ________ marketing. A) event B) property C) service D) place E) idea Answer: D Page Ref: 6 Objective: 2 AACSB: Analytic