Tics, family and society
\citet{38159134} review the topic of stigma in Tourette syndrome. Evidence from 47 publications showed lower self-esteem in youth TS/CTD, who experienced more frequent bullying and other kinds of peer abuse. The community environment contributed, including school and work settings and the general public.
Knowledge of TS among teachers was assessed in a study by \citet{Sapozhnikov2023}. Differences in knowledge on TS, self-perceived understanding and use of sources of information were examined between 144 teachers of children with TS and 78 teachers of control subjects, using the pilot questionnaire Teacher Understanding of Tourette Syndrome Survey (TUTS). Teachers of children with TS had higher self-perceived understanding, more knowledge, and used more sources of information compared to the teachers in the control group.
Stacy et al. (2023) gathered information on perceptions about TS among physicians and caregivers and compared the attitudes between different specialists (neurologists, psychiatrists) and caregivers. While physicians consider pharmacotherapy even when tics are slightly bothersome, caregivers have a preference for behavioral interventions. \cite{Stacy2023}
Fletcher et al. (2023) \cite{Fletcher2023} evaluated the professional development needs of health care professionals regarding TS. As a result, healthcare workers reported urgent need to have access to evidence-based webinars and materials about TS and OCD. While 80% of participants had patients with TS and/or OCD in their practice, only 50% had any formal training in this area. As part of the TS OCD Alberta Network, a program consisting of twelve online webinars was delivered.
Diagnostic accuracy in determining tic diagnosis was explored by agroup from South Korea (Sung et al. 2023). They found that in the majority (96.5%), diagnoses of different tic disorders were made correct \cite{Sung2023}.
The International Parkinson's Disease and Movement Disorders Society Tic and Tourette Syndrome Study Group formed a subcommittee to discuss further barriers to practice guideline implementation among clinicians treating patients with tics (Martindale et al. 2023) \cite{Martindale2023}. The following barriers were identified: accessibility to specialized care, financial costs or coverage of treatment, neuropsychiatric comorbidities, treatment side effects, and stigma of the disease.
Marino et al. (2023) \cite{Marino2023} explored patients' experience of accessing support from primary care physicians in the UK. Altogether, more negative than positive experiences were reported. Main areas of frustration included lack of exploration of tics or no psychoeducation. Around 20% of participants had problems to get a referral to a specialist. When it comes to specialized care, adults were mainly seen by neurologists, while children mainly were treated by psychiatrists or pediatricians. Only 28% of patients were seen by physicians specialized in tic disorders. The average waiting time for children was 3-6 months but it was much longer for adults. One fifths of people was discharged from the clinic without further support, while 30% reported support by private healthcare.
"‘No ill will’: Ticcing on Moral Grounds" \citep*{Curtis_Wendlandt_2023}. "This chapter argues that tics are less blameworthy than other intentional actions, but that we often misconstrue them as morally salient behaviours."
\cite{Bervoets2023} et al published an interesting viewpoint following the similar lines of thought and inviting more inclusive patient based perspective.
Coleman and Melia ( 2023) investigated self-identity in females with TS using a focused semi-structured interview conducted via zoom. Five themes were established: "I'm not normal", "I just want to be me", I'm a "people pleaser", seeing oneself as an "outsider", and "it's just part of me…it's not going anywhere". The importance of work on self-esteem in the population of these patients was underlined. \cite{Coleman2023}.
An interesting topic of moral decision making in patients with TS was explored by Vicario et al. (2023). All in all, the authors found higher inclination for utilitarian solutions of moral dilemmas in patients with TS. Of note, TS individuals had more tendency to quantify something as morally wrong or right. The authors concluded that there might be neurobiological correlates of inappropriate behaviors in people with TS that could be an underlying cause of the higher utilitarian moral decision-making. \cite{Vicario2023}.