Neurodevelopmental Disorders
Walden University
NRNP 6665
Disorders of Neurodevelopment
Icing Disorder
Tic disorder is characterized by a sudden twitch, movement, or sound that people repeat without being able to control the behavior. Tic is classified as a mental disorder in the DSM-5 (Hilt & Nussbaum, 2016).
Symptoms and Signs The DSM-5 recommends
Excessive blinking, uncontrollable movements of the legs or arms, facial grimacing, twitching, shrugging shoulders, and jerking are all signs and symptoms of tic disorders. The signs and symptoms impair one’s quality of life and communication (Dillon, 2019). The level of severity varies from simple to complex. Simple tics involve only a few muscles, whereas complex tics involve several muscles (Poh et al., 2018). If a person is anxious, excited, or stressed, their symptoms may worsen. The symptoms can appear while sleeping and evolve over time. As a person grows older, the severity of the condition changes (Poh et al., 2018).
Distinctive Diagnosis
Huntington’s chorea, hemiballismus, Wilson’s disease, and Sydenham’s chorea are all possibilities. Symptoms of various health conditions share some similarities (Karki et al., 2020). To promote accurate treatment, healthcare workers should properly diagnose tic disorders.
Incidence
Tic disorder affects 20% of all school-aged children. Patients have at least one tic per month for less than a year (Karki et al., 2020). Tics disappear after a year. Males are more likely than females to suffer from mental illnesses. The condition affects one percent of the world’s population.
Course and Development
Tic disorder develops or appears before the seventh birthday. Almost three years after the disease’s onset, parents or practitioners may recognize it (Hibberd et al., 2020). The disorders reach their peak around the age of 11 years. Despite medical interventions, 5 to 10% of patients have a worsening condition with little improvement (Hibberd et al., 2020).
The disease manifests differently in different patients. For several months, the symptoms may come and go. Tic disorders are classified into two types: simple and complex (Pringsheim et al., 2019). The mild version includes sniffing, grimacing, and throat clearing. Jumping, compulsively touching things, and repeating words or sounds are examples of complex conditions (Pringsheim et al., 2019).
Prognosis
Most teenagers are free of the tic disorder by the age of 18. Tic disorders cause severe symptoms between early childhood and mid-adolescence. After mid-adolescence, the symptoms fade (Pringsheim et al., 2019). Tics are less likely to disappear as teenagers enter adulthood, but their severity does. Adults who have tics can lead normal lives.
Tic disorders have no effect on intelligence, do not increase the risk of retardation, and have no effect on average life expectancy. One of the only risks is sudden jerking, which can be painful and cause learning difficulties in children (Pringsheim et al., 2019). Despite their childhood difficulties, people with tics see improvements in their lives in their late teens and early twenties.
Considerations Regarding Culture, Gender, and Age
Cultural diversity is critical in health care delivery. Because some patients may object to the treatment plan, treating neurodevelopmental disorders requires cultural considerations (Essoe et al., 2019). Some ethnic groups, for example, believe that mental disorders are a curse inflicted by spiritual forces rather than a medical condition. The age of a patient is critical because children will require patients to consent to treatment (Essoe et al., 2019). Care should be provided to all genders without discrimination, as this results in health inequality.
Pharmacological Treatments, Including any Adverse Reactions
Risperidone (Risperdal) and other drugs that block or reduce dopamine in the brain are used in treatment. Deep brain stimulation can help with severe tics. The use of neuroleptic medications is an evidence-based treatment option for the disorder (Abramovitch et al., 2017). Weight gain and involuntary repetitive movements are two of the most common side effects of the drugs. Pediatricians must be cautious about the medications they prescribe, keeping side effects in mind (Abramovitch et al., 2017). Tetrabenazine (Xenazine), for example, is effective but can increase the risk of depression. In other cases, parents report that their children are sleeping more than usual while on medication (Abramovitch et al., 2017). Some children may experience sleepiness, which may last for a few days.
Magnesium and Vitamin B6 supplements should be taken by children with tic disorders. Evidence-based interventions show that children with tic disorders benefit from the supplements (Karki et al., 2020).
Nonpharmacological Therapies
Tic disorder is treated with habit reversal training, a type of cognitive behavior therapy. The habit reversal training teaches a child to recognize impending tics or situations that cause the tics (Karki et al., 2020). The intervention in behavior therapy creates a competing action against the disorder. Children, for example, can be taught relaxation techniques to help relieve stress and combat tics (Hibberd et al., 2020). In other cases, a psychotherapist will be specific about the tics that each patient experiences (Hibberd et al., 2020). A child with a tic disorder that involves sniffing, for example, will be taught breathing exercises as a countermeasure. Lifestyle changes and calling someone in the case of a tic disorder can help to address the mental disorder and the disease’s outcomes (Pringsheim et al., 2019). Individuals with tic movement disorders must relieve stress.
Diagnostics and Laboratories
Tic disorder is diagnosed when a person has two or more tics, such as shrugging shoulders and blinking. At least one vocal tic, such as yelling, should be present in the patient. Another criterion is having tics nearly every day for at least a year (Essoe et al., 2019). Tics that begin before the age of 18 are another sign of tic disorder. Seizures, postviral encephalitis, and Huntington’s disease that occur in the absence of other medical complications or influence drugs indicate the possibility of tic disorder (Essoe et al., 2019). Tic disorder cannot be diagnosed using a medical or laboratory test. The diagnosis is made based on the patient’s medical history and the presence of signs and symptoms such as vocal and motor tics.
Comorbidities
Tic disorder is a neuropsychiatric disorder with numerous neuropsychiatric comorbidities. The comorbidities include attention deficit hyperactivity disorder (ADHD), obsessive-compulsive disorder (OCD), depression, migraine, sleep problems, impulse control disorder, and rage attacks (Abramovitch et al., 2017). The treatment plan for a tic disorder should address the co-occurring conditions. Aggressive treatment of the disorders is vital since comorbidities trigger adverse health outcomes that undermine the patients’ quality of life (Abramovitch et al., 2017).
ADHD is a mental condition that leads to impulsive behavior and hyperactivity. Children or adults with the condition have problems focusing on a single task at a time. OCD triggers unwanted thoughts and sensations or the desire to do something repeatedly (Karki et al., 2020). Healthcare workers have a responsibility to accurately diagnose the health conditions and rule out comorbidities (Hibberd et al., 2020). Failure to diagnose tic disorders accurately can lead to health complications of a patient.
Legal and Ethical Considerations
Legal and ethical considerations are vital in the treatment of mental conditions such as tic disorders. The first consideration is informed consent, which requires healthcare workers to provide comprehensive and accurate information about the medical condition of a patient (Schonberger, 2019). The patient could be an adult or child. In the case of a child, the parents should receive information on diagnosis and a proposed treatment plan. Patients or guardians have the autonomy to accept or reject treatment. Patient background or individual characteristics may determine the decision of a patient (Schonberger, 2019). Provision of care should be made in a respectful, caring, honest, and open atmosphere.
The patient’s information should remain confidential. According to HIPPA principles, patient information should be kept private (Stolt et al., 2018). Disclosing patient’s information can attract lawsuits. Another ethical consideration is maleficence and beneficence. Healthcare workers should use the best of their knowledge to prevent harm to a patient while looking for a patient’s best interest (Stolt et al., 2018).
Pertinent Patient Education Considerations
Patient education considerations are essential in ensuring the successful transfer of knowledge to the patient. The first consideration is the patient’s strengths and weaknesses (Brennan-Cook et al., 2020). For example, the patient may have emotional or intelligence limitations. In some cases, the patient may be stressed or fatigued, limiting the ability to understand the information. Healthcare workers can use technology to improve the absorption of information and adherence (Brennan-Cook et al., 2020). For instance, OpenNotes can help patients to remember doctor’s appointments and adhere to medications.
Involving family members in patient education improves adherence and guarantees family support. Tic disorders require family involvement since most of the patients are still under their parents or guardians. Parents should know how to support the children and adhere to the medication and psychotherapy sessions (Brennan-Cook et al., 2020). Healthcare workers should consider the patient learning styles. Some patients may understand the information well when they see videos or graphics. Nurses should use diverse strategies to convey the information. A teach-back strategy is vital to ensure a patient or guardian understands the information (Brennan-Cook et al., 2020). Comprehension will determine the adherence to medication, patient support, and psychotherapy sessions.
References
Hilt, R. J., & Nussbaum, A. M. (2016). DSM-5 pocket guide for child and adolescent mental health. American Psychiatric Association Publishing. Chapter 12, “Developmental Milestones”
Poh, W., Payne, J. M., Gulenc, A., & Efron, D. (2018). Chronic tic disorders in children with ADHD. Archives of Disease in Childhood, 103(9), 847-852.
Karki, U., Sravanti, L., Jacob, P., Sharma, E., Kommu, J. V. S., & Seshadri, S. P. (2020). Clinical Profile of Tic Disorders in Children and Adolescents from a Tertiary Care Center in India. Indian Journal of Psychological Medicine, 42(3), 262-267.
Hibberd, C., Charman, T., Bhatoa, R. S., Tekes, S., Hedderly, T., Gringras, P., & Robinson, S. (2020). Sleep difficulties in children with Tourette syndrome and chronic tic disorders: a systematic review of characteristics and associated factors. Sleep, 43(6), zsz308.
Pringsheim, T., Holler-Managan, Y., Okun, M. S., Jankovic, J., Piacentini, J., Cavanna, A. E., … & Oskoui, M. (2019). Comprehensive systematic review summary: treatment of tics in people with Tourette syndrome and chronic tic disorders. Neurology, 92(19), 907-915. – – Best Dissertation Writing Services UK
Essoe, J. K. Y., Grados, M. A., Singer, H. S., Myers, N. S., & McGuire, J. F. (2019). Evidence-based treatment of Tourette’s disorder and chronic tic disorders. Expert review of neurotherapeutics, 19(11), 1103-1115.
Abramovitch, A., Hallion, L. S., Reese, H. E., Woods, D. W., Peterson, A., Walkup, J. T., … & Wilhelm, S. (2017). Neurocognitive predictors of treatment response to randomized treatment in adults with tic disorders. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 74, 9-14.
Schonberger, D. (2019). Artificial intelligence in healthcare: a critical analysis of the legal and ethical implications. International Journal of Law and Information Technology, 27(2), 171-203.
Stolt, M., Leino-Kilpi, H., Ruokonen, M., Repo, H., & Suhonen, R. (2018). Ethics interventions for healthcare professionals and students: A systematic review. Nursing Ethics, 25(2), 133-152.
Brennan-Cook, J. (2020). Polycythemia Vera: Symptom Burden, Oncology Nurse Considerations, and Patient Education. Clinical Journal of Oncology Nursing, 24(5), 575-578.
Dillon, K. (2019, March 23). DSM-5 neurodevelopmental disorders. [Video]. YouTube. https://www.youtube.com/watch?v=Ydr9s_UwACo
