The psychopathological spectrum of Gilles de la Tourette syndrome [Lo spettro psicopatologico della sindrome di Gilles de la Tourette]

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 syndrome. The present report provides an up-to-date review of the psychopathological profile of Gilles de la Tourette syndrome, with a special emphasis on treatment implications. Methods: The authors analysed the evidence from the literature (sources: PubMed, PsycInfo) regarding Gilles de la Tourette syndrome, focusing on its clinical phenomenology and the following psychiatric comorbidities: obsessive-compulsive disorder/behaviours, attention-deficit and hyperactivity disorder, depression, and personality disorders. Results: Current evidence suggests that the psychopathological spectrum of Gilles de la Tourette syndrome may be described as follows: specific obsessive-compulsive symptoms are an integral part of the syndrome, as they are genetically related to simple and complex tics; attentional problems and hyperactivity, albeit common, seem to be genetically linked only in some cases; depression is common as well, yet multifactorial in aetiology; personality disorders have been poorly investigated, and may be related to co-morbidity issues rather than to Gilles de la Tourette syndrome per se. Finally, the possibility of a more severe psychopathological profile resulting from referral bias should always be taken in due account (Tables II, III). Conclusions: Further studies are needed to identify more precisely the phenotype not only of Gilles de la Tourette Syndrome, but also of the associated psychopathological disorders. It has increasingly been acknowledged that environmental factors, such as perinatal difficulties and streptococcal infections, can be invoked as putative patho-aetiological mechanisms for a subgroup of cases of Gilles de la Tourette syndrome. In this respect, future research examining the psychopathologies with more structured and rigorous methods, linking them to genetic, neuroimaging, neuroimmunological, and neuropsychological studies, will be fruitful in clarifying whether or not the "genetic Gilles de la Tourette syndrome" shares the same phenotype with the "environmentally driven Gilles de la Tourette syndrome".