Reluctance to diagnose Tourette's?

[birchswing]

I've had my own experiences with this that I won't relate, but they always left me feeling a bit twilight-zone-like, as if there were some reason practitioners are reluctant to diagnose Tourette's.

I recently read an essay on Tourette's by Oliver Sacks on Tourette's where he wrote,

"Charcot and his pupils, who included Freud and Babinski as well as Tourette, were among the last of their profession with a combined vision of body and soul, ‘It’ and ‘I’, neurology and psychiatry. By the turn of the century, a split had occurred, into a soulless neurology and a bodiless psychology, and with this any understanding of Tourette’s disappeared. In fact, Tourette’s syndrome itself seemed to have disappeared, and was scarcely at all reported in the first half of this century. Some physicians, indeed, regarded it as ‘mythical’, a product of Tourette’s colourful imagination; most had never heard of it. "

Do you think there is any truth to a universality of practitioners under-diagnosing Tourette's? What type of doctor would ordinarily diagnose it? I understand it's neurological, but it seems that more people would tend to see psychiatrists than neurologists, and it also often goes hand-in-hand with OCD.

I just read this article in the New Yorker about the DSM 5, and it was talking about how doctors tend to ignore diagnoses and treat as they see fit:

http://www.newyorker.com/online/blogs/elements/2013/04/the-dsm-and-the-nature-of-disease.html

In the case of Tourette's, it seems like a diagnosis is somewhat important. Not that it would necessarily dictate a particular treatment but just to give clarification.

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[splik]

well most people aren't even aware that they have Tourette's (or experience tics). So they dont really need a diagnosis or treatment. It is regarded as an uncommon neuropsychiatric disorder but is probably more common than is realized or at least that's what the experts say (as they would). Tourette's is one of the only DSM disorders where you do not need functional impairment to get the dx (this was one of the few changes between DSM-IV and DSM-IV-TR)

 

[billypilgrim37]

Without comorbid OCD, anxiety, ADHD, etc., most of these kids go to neurology. From a therapeutic standpoint, tics are treated like OC and ERP is the most robust intervention.

 

[OldPsychDoc]

"If I fake it, then I don't have it".

 

[vistaril]

I've had my own experiences with this that I won't relate, but they always left me feeling a bit twilight-zone-like, as if there were some reason practitioners are reluctant to diagnose Tourette's.

I recently read an essay on Tourette's by Oliver Sacks on Tourette's where he wrote,

"Charcot and his pupils, who included Freud and Babinski as well as Tourette, were among the last of their profession with a combined vision of body and soul, ‘It’ and ‘I’, neurology and psychiatry. By the turn of the century, a split had occurred, into a soulless neurology and a bodiless psychology, and with this any understanding of Tourette’s disappeared. In fact, Tourette’s syndrome itself seemed to have disappeared, and was scarcely at all reported in the first half of this century. Some physicians, indeed, regarded it as ‘mythical’, a product of Tourette’s colourful imagination; most had never heard of it. "

Do you think there is any truth to a universality of practitioners under-diagnosing Tourette's? What type of doctor would ordinarily diagnose it?.

this is a matter for neurology....psychiatrists don't treat this any more than we treat seizure disorders.

 

[billypilgrim37]

this is a matter for neurology....psychiatrists don't treat this any more than we treat seizure disorders.

Child psychiatrists treat tics all the time. Usually when it's comorbid, but most kids won't be seeing a psychiatrist and a neurologist if they have tics + psychiatric disorder. Uncomplicated tics are more common and those wind up with neurology.

 

[birchswing]

Thanks for the thoughtful replies.

My own background with this would make the question more interesting, but this helps to understand a bit more how this is approached from a medical perspective. Suffice it to say, my own perspective from perhaps a rare experience is that the diagnosis can be very important, particularly with classroom environments.