DOI: 10.1097/NRL.0b013e3181a3cb82
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Issn Print: 1074-7931
Publication Date: 2009/11/01
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Excerpt
Woods DW, Piacentini JC, Walkup JT, eds. Treating Tourette Syndrome and Tic Disorders: A Guide For Practitioners. New York: The Guilford Press; 2007. ISBN-13: 978-1593854805, $38.
In 1885, the French neurologist Georges Gilles de la Tourette, describing the first 9 patients with Tourette syndrome (TS), declared, “Everything is extraordinary about this disease: its name absurd, its symptoms peculiar, its character uncertain, its cause unknown, its treatment problematic.” Since the seminal description, much has been learned about the neurobiology, genetics, and neuropharmacology of the disorder. Yet, the history of treatment approaches to TS is replete with therapies that were ill-conceived or ineffective. TS is the prototype neuropsychiatric disorder, spanning the separate disciplines of neurology and psychiatry. Effective treatment for the most severely affected individuals demands a comprehensive, multidisciplinary strategy and that is the primary theme of Treating Tourette Syndrome and Tic Disorders: A Guide for Practitioners.
The volume is divided into 13 chapters, with an emphasis on the psychiatric and psychological aspects of the disorder, and their treatment. The volume is edited by 3 founding members of a consortium established to promote psychological approaches for the evaluation and treatment of TS. Most of the 26 authors are highly regarded psychiatrists and psychologists who have contributed extensively to the field. As such, the volume contains specific chapters on assessing the behavioral and cognitive aspects of the disorder. There are sections on treatment devoted to family issues, learning and school difficulties, social functioning, and occupational impairment. As a neurologist and movement disorders specialist, grounded by training and practice in the biologic model of the disorder, I found the focus on the psychosocial elements of TS especially welcome, and valuable.
For practitioners, the volume provides a framework for understanding the impact of TS on its sufferers and families. Impulsivity, aggression, criminality, and marital strain represent critical dimensions of the disorder that many physicians are not specifically trained to assess. The book explores the effects of TS on peer relationships, scholastic performance, sibling relationships, and family dynamics, with useful suggestions about when and how to intervene.
Although the book offers itself as a guide for the health care provider in clinical practice, the presentation of information is scholarly in tone and style. There are few diagrams, summary tables, or algorithms to energize the referenced content. As a resource for practitioners, the absence of mention about the vast resources in the community and the media—educational videos, books, websites, foundations—is surprising.
The editors portray the evolving perspective on TS as a “historical battle between biologic and psychological conceptualizations,” but I was not entirely convinced that the psychological approach is not still on its quest for neurobiological validation. The chapter contains over a hundred references, many two decades old and framed in experimental psychological concepts that do not meet current standards of evidence for treatment recommendation. For the practitioner unversed in such techniques, how does one go about selecting and establishing a practical treatment plan?
Treatment approaches are listed in exhaustive detail, inclusively referenced but often without adequate critical appraisal. Sometimes the book simply restates the medical literature at face value, regardless of its scientific validity, as in, “Psychoanalytic theory provided an overarching framework for understanding the etiology of the condition.” Cited as “strong evidence” in support of function-based treatment approaches to tic suppression is the case report of a 4-year child whose coughing tic stopped when her parents stopped paying attention to it.
