Diagnostic criteria for 307.22 Chronic Motor or Vocal Tic Disorder  
( cautionary statement )

This disorder is characterized either by rapid, recurrent, uncontrollable movements or by vocal outbursts, but not both, that have been present nearly daily for more than a year without a period free of the problem longer than three months. These repeated uncontrollable bursts of activity or speech are called tics.

This Tic Disorder is diagnosed when either motor (Rapid, recurrent movement of the arms, legs, or other areas) or vocal (Vocalizations) grunts, abdominal ar diaphragmatic contractions. But not both - see Tourette's tics (sudden, rapid, recurrent, nonrhythmic, stereotyped motor movement or vocalization) are experienced persistently.

A. Single or multiple motor or vocal tics (i.e., sudden, rapid, recurrent, nonrhythmic, stereotyped motor movements or vocalizations), but not both, have been present at some time during the illness. 

B. The tics occur many times a day nearly every day or intermittently throughout a period of more than 1 year, and during this period there was never a tic-free period of more than 3 consecutive months. 

C. The disturbance causes marked distress or significant impairment in social, occupational, or other important areas of functioning.

D. The onset is before age 18 years. 

E. The disturbance is not due to the direct physiological effects of a substance (e.g., stimulants ) or a general medical condition (e.g., Huntington's disease or postviral encephalitis). 

F. Criteria have never been met for Tourette's Disorder .

Associated Features:

There may be other symptoms, such as mental coprolalia -sudden, intrusive, senseless thoughts of socially unacceptable or obscene words, phrases, or sentences that differ from true obsessions in that no attempt is made to ignore, suppress, or neutralize the thoughts, obsessions, and compulsions.

Differential Diagnosis:

Some disorders have similar symptoms. The clinician, therefore, in his diagnostic attempt, has to differentiate against the following disorders which need to be ruled out to establish a precise diagnosis.

Obssessive-Compulsive Disorder.
Attention-Deficit/Hyperactivity Disorder.
Asperger's Disorder.
Schizophrenia.
Tics secondary to drugs (medication or abuse).
Stereotypical Movement Disorder.
Obsessive-Compulsive Disorder.
Neurologic Medical and Drug-related Disorders Associated with Tics.
Abnormal Movements (associated with medical conditions).
Neurologic, primary and secondary.
General Medical conditions.
Drug-related tics.

Cause:

The incidence of chronic motor or vocal tic disorder is more common than the better known Tourette's Syndrome. The incidence of Chronic Motor or Vacal Tic disorder ranges from 1 to 2%. It is, however, rare compared to the common short-lived childhood tic (transient tic disorder). Tics appear to get worse during emotional stress and are absent during sleep. It is thought that chronic tics are a variant of Tourette’s Syndrome and to have an underlying genetic cause.

Prognosis for children who develop this disorder between the ages of 6 to 8 are good. Symptoms may last 4 to 6 years and then abate in early adolescence.

Treatment:

Treatment of chronic motor or vocal tic disorder depends on its severity, the distress it causes to the patient, and the effects the tics have on school or job performance. Medication and psychotherapy are used only when there is substantial interference with ordinary activities.

Counseling and Psychotherapy:

Psychotherapy General

Pharmacotherapy:

Drugs used to treat tics have a limited rate of success and a relatively high level of side effects:

Pimozide.
Risperidone.