Catatonic signs in Gilles de la Tourette syndrome

Background: Catatonia describes the clustering of specific movement and behavioral abnormalities of both the hypokinetic and hyperkinetic nature. Originally described in association with schizophrenia, catatonic signs have been reported in a wide range of neuropsychiatric conditions. Aim: In this study, we examined the phenomenologic expression and significance of catatonic signs in a nonpsychotic patient group, 55 adults with Gilles de la Tourette syndrome (GTS). Methods: The Bush-Francis Catatonia Rating Scale (BFCRS) and standardized psychometric instruments were used to assess the presence and severity of catatonic signs, motor and vocal tics, and comorbid psychopathologies. Results: The majority of the GTS patients (87%) expressed catatonic signs sufficient for its diagnosis with the BFCRS. In general, positive catatonic signs, including echophenomena, perseveration, and excitement, exceeded the more classic negative symptoms (eg, posturing and stupor). The presence of comorbid attention-deficit and hyperactivity disorder, but not tic severity, was associated with higher BFCRS scores. Conclusions: The core phenomenology of GTS includes specific behavioral and motor features of catatonia, enhancing insight into neuropathologic substrates of these conditions. Our finding of an association with attention-deficit and hyperactivity disorder suggests that catatonia expression in GTS reflects a conjunction of cognitive and motor dysregulation.