Journal of the Korean Academy of Child and Adolescent Psychiatry

Korean Academy of Child and Adolescent Psychiatry (대한소아청소년정신의학회)
권호 표지
DOI QR코드

DOI QR Code

Diagnostic Hierarchy of Tic Disorders in Real-World Clinical Practice

  • Yeeji Sung (Department of Psychiatry, Seoul National University Hospital) ;
  • Soon-Beom Hong (Department of Psychiatry, Seoul National University Hospital)
  • Received : 2023.05.16
  • Accepted : 2023.07.21
  • Published : 2023.10.01
Download PDF
⟨ Previous Next ⟩

Abstract

Objectives: According to the 10th revision of the International Classification of Diseases, the main categories of tic disorders (F95.0, F95.1, and F95.2) follow a diagnostic hierarchy based on the duration and diversity of tic symptoms. The present study investigated the use of this diagnostic hierarchy in real-world clinical practice. Methods: Based on the National Health Insurance Service-National Health Information Database, the diagnosis of transient tic disorder (F95.0) made after a diagnosis of chronic motor or vocal tic disorder (F95.1) or Tourette's syndrome (F95.2) and diagnosis of chronic motor or vocal tic disorder (F95.1) made after a diagnosis of Tourette's syndrome (F95.2) were referred to as type A errors. The diagnosis of transient tic disorder (F95.0) repeated after a period of >12 months was referred to as type B error. Demographic and clinical differences according to the diagnostic error types were analyzed using analysis of variance, Student's t-tests, and chi-squared tests. Results: Most participants (96.5%) were without errors in the diagnosis of tic disorders. Higher proportions of males (p=0.005) and antipsychotic prescriptions (p<0.001) were observed in patients with type A or B diagnostic errors. A higher proportion of health insurance holders was observed among those with type A errors (p=0.027). Conclusion: Errors were absent in majority of the tic diagnoses in real-world clinical practice in terms of the diagnostic hierarchy.

Keywords

Acknowledgement

Data were obtained from the National Health Insurance Service-National Health Information Database (NHIS-NHID) (NHIS-2021-1-637), which has been created and managed by the NHIS. The authors declare no conflicts of interest with the NHIS. The authors thank Eunseo Jo (Zarathu Co., Ltd., Seoul, Republic of Korea) for statistical advice.

References

  1. World Health Organization. International statistical classification of diseases and related health problems, 10th revision. Geneva: World Health Organization;1992.
  2. Kim S, Greene DJ, Bihun EC, Koller JM, Hampton JM, Acevedo H, et al. Provisional tic disorder is not so transient. Sci Rep 2019;9:3951.
  3. Muller-Vahl KR, Sambrani T, Jakubovski E. Tic disorders revisited: introduction of the term "tic spectrum disorders". Eur Child Adolesc Psychiatry 2019;28:1129-1135. https://doi.org/10.1007/s00787-018-01272-7
  4. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington, VA: American Psychiatric Publishing;2013.
  5. Epstein JN, Loren RE. Changes in the definition of ADHD in DSM5: subtle but important. Neuropsychiatry (London) 2013;3:455-458. https://doi.org/10.2217/npy.13.59
  6. Kim S, Kim MS, You SH, Jung SY. Conducting and reporting a clinical research using Korean healthcare claims database. Korean J Fam Med 2020;41:146-152. https://doi.org/10.4082/kjfm.20.0062
  7. Lewin AB, Murphy TK, Storch EA, Conelea CA, Woods DW, Scahill LD, et al. A phenomenological investigation of women with Tourette or other chronic tic disorders. Compr Psychiatry 2012;53:525-534. https://doi.org/10.1016/j.comppsych.2011.07.004
  8. Groth C, Mol Debes N, Rask CU, Lange T, Skov L. Course of Tourette syndrome and comorbidities in a large prospective clinical study. J Am Acad Child Adolesc Psychiatry 2017;56:304-312. https://doi.org/10.1016/j.jaac.2017.01.010
  9. Garcia-Delgar B, Servera M, Coffey BJ, Lazaro L, Openneer T, Benaroya-Milshtein N, et al. Tic disorders in children and adolescents: does the clinical presentation differ in males and females? A report by the EMTICS group. Eur Child Adolesc Psychiatry 2022;31:1539-1548. https://doi.org/10.1007/s00787-021-01751-4
  10. Roessner V, Eichele H, Stern JS, Skov L, Rizzo R, Debes NM, et al. European clinical guidelines for Tourette syndrome and other tic disorders-version 2.0. Part III: pharmacological treatment. Eur Child Adolesc Psychiatry 2022;31:425-441. https://doi.org/10.1007/s00787-021-01899-z
  11. Pringsheim T, Okun MS, Muller-Vahl K, Martino D, Jankovic J, Cavanna AE, et al. Practice guideline recommendations summary: treatment of tics in people with Tourette syndrome and chronic tic disorders. Neurology 2019;92:896-906. https://doi.org/10.1212/WNL.0000000000007466
  12. Park YH, Lee YJ. Qualitative analysis of medical usage patterns of medical aid patients. J Korea Contents Assoc 2017;17:39-49. https://doi.org/10.5392/JKCA.2017.17.01.039
  13. Choi S, Lee H, Song DH, Cheon KA. Population-based epidemiology of pediatric patients with treated tic disorders from real-world evidence in Korea. J Child Adolesc Psychopharmacol 2019;29:764-772. https://doi.org/10.1089/cap.2019.0050
  14. Szejko N, Robinson S, Hartmann A, Ganos C, Debes NM, Skov L, et al. European clinical guidelines for Tourette syndrome and other tic disorders-version 2.0. Part I: assessment. Eur Child Adolesc Psychiatry 2022;31:383-402. https://doi.org/10.1007/s00787-021-01842-2
  15. Freeman RD, Fast DK, Burd L, Kerbeshian J, Robertson MM, Sandor P. An international perspective on Tourette syndrome: selected findings from 3,500 individuals in 22 countries. Dev Med Child Neurol 2000;42:436-447. https://doi.org/10.1111/j.1469-8749.2000.tb00346.x