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In an important, large study of psychiatric comorbidity in TS, approximately 800 families were recruited primarily from TS specialty clinics in four different countries over a 16-year period \citep{25671412}. A total of 1374 participants with TS and 1142 family members unaffected by TS were included in the study. 86% of the TS participants had at least one psychiatric comorbidity and 72% had either OCD or ADHD. Other disorders, involving mood, anxiety or disruptive behavior, each occurred in approximately 30% of the TS participants. The genetic correlations between TS and mood was accounted for by ADHD and OCD, while ADHD alone accounted for the genetic correlations of TS with anxiety and disruptive behavior disorders. See also \citep*{Prime:Hirschtritt:2015}.  A small study of 17 male adolescents (Balottin et al., 2015) \cite{26078419}  found that the only difference between the TS subjects and 51 age- and gender-matched controls on the Minnesota Multiphasic Personality Inventory-Adolescent was that the TS subjects scored significantly higher on the Obsessiveness Content Scale. In contrast a study of 50 TS adults in Germany used a variety of instruments to measure psychological symptoms and personality traits (Trillini & Muller-Vahl). \cite{26112450}.  Comorbidities were common with 41% having OCD, 28% being depressed and 26% having ADHD. Patients with OCD had more severe tics and there was a trend for those with ADHD to have more severe tics. Only 29% of the patients had no pathological personality traits. The demand-anxious trait was the most common personality trait (measured with the Inventory of Clinical Personality Accentuations) seen in patients and was present in 39% while histrionic personality traits were not found in any of the subjects. For patients without comorbidities personality traits were comparable to what was seen in the control group. Interestingly, ADHD did not contribute to increased probability of pathological personality traits. Although quality of life was affected by both personality traits and comorbidities, personality traits had a larger impact on quality of life. A retrospective review of 1,000,000 people in the Taiwan National Health Insurance Research Database examined the association between epilepsy with TS. 1062 children and adolescents with TS were identified. A group of 3186 without TS but matched on age and sex was used as a control group.The TS group had an 18-fold increased risk of epilepsy compared to the control group and even after adjusting for comorbidities (i.e., bipolar disorder, depression, learning difficulties, autism, anxiety disorder, sleep disorder), the risk of epilepsy was still 16-fold. Although the authors raise the issue that some tics may have been mistaken for seizures, they also suggest that TS children be followed closely for the development of epilepsy.