The Psychiatry of Paediatric Movement Disorders

Abstract

I compared the rate of psychiatric comorbidity in children with Non-tic movement disorders to children with tics and TS. In addition, this PhD explores whether children with Non-tic movement disorders have elevated rates of psychiatry compared to other hospital populations, including Emergency patients and other Neurology patients, as well as a healthy community control group. My hypothesis was that children with Non-tic movement disorders would have rates of psychiatric comorbidities that are similar to children with tics and TS.To examine this hypothesis, I recruited children between the ages of 5 and 16 years from Neurology clinics at The Children’s Hospital at Westmead, Australia, and Great Ormond Street Hospital, United Kingdom, for the following two movement disorder groups: tic movement disorder cohort (consisting of patients with tics and Tourette Syndrome, n=158) and Non-tic movement disorder cohort, (consisting of patients with all other movement disorders, n=102). An additional 137 patients were recruited for two clinical control groups: the Emergency department control cohort (n=100) and the Neurology control cohort including children with peripheral neuropathy or epilepsy (n=37). In addition, data from 10,438 British children were included as a retrospective community control. All patients were screened for psychiatric comorbidities using the Development and Wellbeing Assessment Tool (DAWBA). My primary outcome was that the difference in the rate of psychiatric comorbidity in the Non-tic cohort (39.2%) and the Tic cohort (41.8%) was not statically significant. Importantly, the rate of psychiatric comorbidity in the Non-tic cohort was more than four times the rate of psychiatric diagnosis observed in the large retrospective community cohort (9.5%) (p<0.00001). This is the largest study to date exploring psychiatry in children with paediatric dystonia (n=66) and psychiatric comorbidities occurred in 33.3% of these patients. In conclusion, this study recognises that children with non-tic movement disorders are just as vulnerable to psychiatric comorbidities as children with tics and TS. This new evidence may encourage clinicians to consider screening for psychiatric comorbidities in their movement disorder patients, therefore allowing for earlier diagnosis and treatment.