Objective: To characterize obsessive-compulsive symptoms (OCS) in a cohort of adults TS patients with and without OCD.

Background: Tourette syndrome (TS) is a phenotypically complex disorder, with more than 90% of patients meeting criteria for comorbid psychiatric diagnoses, predominantly OCD and ADHD.¹ These comorbidities are associated with more severe symptomatology and clinical course.^2–4 However, TS patients not meeting formal criteria for OCD diagnosis still demonstrate OCS,⁵ and the pattern of OCS is distinct from OCD patients without tics.⁶ Enhanced understanding of OCS in TS will deepen insights into shared and dissociable clinical features of OCD and TS.

Method: A cohort of adult TS patients underwent assessment with Yale Global Tic Severity Score (YGTSS), Generalized Anxiety Disorder-7 (GAD-7), and Dimensional Obsessive Compulsive Scale (DOCS). The latter scale consists of 4 subscales: Contamination, Responsibility, Unacceptable Thoughts, and Symmetry.

Results: 15 adult TS patients (7 men, 8 women) participated, with mean age 39.4 years (16.6), YGTSS total tic score 21.4 (9.6) and YGTSS total score 44.2 (21.7). Mean scores for GAD-7 and DOCS were 9.8 (4.9) and 19.4 (12.3), respectively. DOCS subscale scores for Responsibility were highest (5.8 (5.0)), followed by Unacceptable Thoughts (5.1 (4.4)) and Symmetry (5.1 (4.1)); Contamination subscale scores were lowest at 2.4 (3.1). 7 patients total DOCS score exceeded 20, consistent with a diagnosis of OCD. Among the 8 without OCD, DOCS score was still elevated at 9.0 (5.0). Comparing patients with DOCS score ≥ 21 to those with score < 21, total tic score, GAD-7 score, and three of the DOCS subscales did not differ, but the Harm subscale scores significantly diverged: 9.3 (1.4) vs 1.9 (.9),p<0.001. GAD-7 correlated strongly with Unacceptable Thoughts subscale (r=.80,p<0.001) but no other DOCS subscales nor the DOCS total. Total tic score positively correlated with GAD-7 (r=.55,p=0.04) but not with DOCS total.

Conclusion: OCS are common in adults with TS, even in those without OCD. The type of OCS evident in TS differs based on comorbidities: those with concurrent OCD have more severe harm OCS, while those with more anxiety exhibit greater unacceptable thought OCS. Overall, contamination OCS are least prevalent, relative to other OCS domains. This study sheds additional light on the complex interplay between OCS and TS.

References: 1. Cohen, S. C., Leckman, J. F. & Bloch, M. H. Clinical assessment of Tourette syndrome and tic disorders. Neurosci. Biobehav. Rev. 37, 997–1007 (2013). 2. Lebowitz, E. R. et al. Tourette syndrome in youth with and without obsessive compulsive disorder and attention deficit hyperactivity disorder. Eur. Child Adolesc. Psychiatry 21, 451–457 (2012). 3. GRAD, L. R., PELCOVITZ, D., OLSON, M., MATTHEWS, M. & GRAD, G. J. Obsessive-Compulsive Symptomatology in Children with Tourette’s Syndrome. J. Am. Acad. Child Adolesc. Psychiatry 26, 69–73 (1987). 4. Bloch, M. H. et al. Adulthood outcome of tic and obsessive-compulsive symptom severity in children with Tourette syndrome. Arch. Pediatr. Adolesc. Med. 160, 65–69 (2006). 5. Hebebrand, J. et al. Rates for tic disorders and obsessive compulsive symptomatology in families of children and adolescents with Gilles de la Tourette syndrome. J. Psychiatr. Res. 31, 519–530 (1997). 6. Petter, T., Richter, M. A. & Sandor, P. Clinical Features Distinguishing Patients With Tourette’s Syndrome and Obsessive-Compulsive Disorder From Patients With Obsessive-Compulsive Disorder Without Tics. J. Clin. Psychiatry 59, 456–459 (1998).

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MDS Abstracts - https://www.mdsabstracts.org/abstract/obsessive-compulsive-characteristics-in-adult-tourette-syndrome-patients-with-and-without-ocd/