Lesson 1: Common Childhood Disorders

Description

Jonas, a middle-aged man, sought help for unrelenting tics. In his youth, the first tic developed was a eye-blinking tic, but lip-smacking, head tilting, and barking tics soon followed. In spite of these manifestations, Jonas did graduate from high school with honours. Shortly after graduation, Jonas was drafted into the US army. Although his tics were somewhat manageable during this period, he was eventually discharged from duty for medical reasons.

Shortly after, Jonas found a job, got married, and started a family. By the time Jonas was 30 years-old his symptoms included head tilting, shoulder shrugging, hitting his forehead with his hands, throat clearing, spitting, and “la, la, la, hey, hey, hey” vocalizations. He even began inserting obscenities in the middle of sentences (coprolalia) when speaking. Jonas tried a variety of treatments to help alleviate his symptoms (insulin shock therapy, electroconvulsive therapy, and drug therapy), all to no avail.

Eventually Jonas began to avoid public gatherings (such as church services, the movies) because his cursing and motor tics embarrassed him. He switched to the night shift at his job to reduce social embarrassment. Also, Jonas’s children stopped bringing their friends over to the house because of their discomfort surrounding his behaviour. Understandably, Jonas complained of isolation and depression. He requested a prefrontal lobotomy in the hope that the drastic measure would give him some relief from his symptoms. Although his request was denied, he was given a referral to a specialized treatment facility.

Diagnosis

Jonas met the required criteria for Tourette syndrome: the onset of his symptoms occurred before he was 21, he displayed multiple motor tics and at least one vocal tic, and the tics occurred regularly for more than one year. Although his depression might have beeen linked to a second disorder, it is better thought of as a consequence of his long-term suffering. His DSM diagnosis for Axis I is Tourette syndrome.

Follow-Up

Jonas was prescribed haloperidol (1mg/day) which almost completely eliminated his symptoms. His depression dissipated and he was able to participate in normal social activities again. Eighteen years later, Jonas remained almost symptom free!