Rapid Onset Functional Tic-Like Disorder Outbreak: A Challenging Differential Diagnosis in the COVID-19 Pandemic, 2022, Amorelli et al

Abstract

During the COVID-19 pandemic, several countries have observed an unexpected increase in the number of adolescents and young adults presenting with rapid onset functional tic-like behaviours after being exposed to social media content of others displaying a similar pattern of functional tics. Many of these patients have been referred to Movement Disorders Clinics with misdiagnoses of late-onset refractory Tourette Syndrome after failing different pharmacological treatments for tics. Tourette Syndrome is a well-known condition with clear clinical diagnostic criteria and which presents with the insidious onset of simple motor and phonic tics in a rostro-caudal evolution starting in early childhood. Clinical and demographic aspects can differentiate rapid onset functional tic-like behaviours from Tourette Syndrome, including the former having abrupt and explosive presentation of severe symptoms, later age of onset, female gender predominance, lack of suppressibility, comorbid anxiety and depression, atypical premonitory urge and history of exposure to social media content displaying tic-like behaviours. This new presentation of a functional neurological disorder may be explained in part by the relationship between social media exposure to tic-like behaviours, and maladaptive response to anxiety caused by life stressors (e.g. COVID-19 pandemic), especially in young individuals. Rapid onset functional tic-like behaviours may be considered a spreading neuropsychiatric disorder that is potentially fostered by the psychosocial impact caused by the COVID-19 pandemic.

Open access, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9275373/

 

Reefer madness level of nonsense. You gotta laugh at Tourette's being described as a well-known condition that medicine perfectly understands. I've read several times from people with Tourette's how healthcare professionals mostly get it wrong, about as wrong as autism. Superficial knowledge is a dangerous thing in the hands of people who are encouraged to be confidently wrong, especially glimpsed simply from behavior observed with excessive bias that explicitly rewards giving a wrong answer over admitting to a lack of understanding.

On illness, patients are the experts, simply because the professionals have failed to do any better. Medicine has made a lot of progress with disease but simply cannot deal with illness that doesn't have a simple obvious cause because it requires respecting the patients as equals, having knowledge they can't possibly have.

As long as medicine holds itself up a pedestal, it's unlikely to make any progress that requires being at ground level.

 

My understanding from a recent TV programme is that some report prior exposure to related social media content and others do not. There is also some suggestion of small clusters in occurring in single schools or social groups.

Though these presentations are atypical compared to more classic forms of Tourette’s, given, as @rvallee points out, Tourette’s is not necessarily well understood, are we at a point that we can not say this is not an atypical form of Tourette’s. Certainly we see in more classic forms of Tourette’s that witnessing others’ tics can trigger an individual’s own tic behaviour. So even if onset is associated with exposure to others that does not necessarily mean it is some how a copycat behaviour.

I also understand that people posting on social media is a response to the poor support for and poor understanding of people displaying these symptoms. However there is undoubtedly victim blaming involved in asserting that the cause of this condition is people with the condition posting on social media, which leaves people with the condition desperate for support, information and community then feeling guilty for reaching out to others as they are then accused as being responsible for others developing the condition.

From the little I know about this, we are in a position that we can not say if this an atypical form of Tourette’s or some form of social contagion, but suspect there are some professionals jumping the gun and asserting a social contagion model with incomplete evidence.

 

There was a documentary about this on C4 recently with Scarlett Moffat (Gogglebox).

https://www.channel4.com/programmes/britains-tourettes-mystery

 

The programme I referred to is ‘Britain’s Tourette’s Mystery - Scarlett Moffatt investigates the rise of Tourette's in Britain‘ which was shown several weeks ago on Channel 4 and is available still on All 4 (see https://www.channel4.com/programmes/britains-tourettes-mystery ), though people outside the UK may not be able to view it.

The programme, compared by a popular UK TV personality, did lean towards to social contagion idea, but did also give a voice to sufferers, some of whom questioned this.

[cross posted with @Sly Saint ]

 

Any part of the brain can be affected by a stroke or an infection. The resulting damage will give the same result as more usual diseases though not necessarily the whole of the complex. To assume it is social copying is ludicrous and a fine example of all those things that were stated dogmatically and later shown to be wrong.

"Geological processes are slow not catastrophic"

"Evolution happens by one gene mutating at a time and all change is because the new gene makes the organism more likely to reproduce"

"The immune system is the only body system which is not under the control of the brain"

As long as it is never considered they will never be proved wrong.