Elsevier

Biological Psychiatry

Volume 36, Issue 1, 1 July 1994, Pages 35-43
Biological Psychiatry

Original article
Enhanced stress responsivity of tourette syndrome patients undergoing lumbar puncture

https://doi.org/10.1016/0006-3223(94)90060-4Get rights and content

Abstract

Tourette's syndrome (TS) is a complex inherited neuropsychiatric disorder that is characterized by multiple motor and phonic tics. Stress-related fluctuations in symptom severity and medication responsiveness are common, and patients often report that tics are worsened by fatigue, emotional trauma, and anxiety. We examined the effects of lumbar puncture (LP) stress on plasma adrenocorticotropin (ACTH) and cortisol, urinary catecholamines, and self- and clinician ratings of anxiety in 13 medication-free TS patients and 10 normal controls, ages 17 to 41 years. The TS patients secreted significantly more ACTH than the normal controls in response to the stress of the lumbar puncture. Compared to the controls the TS patients had significantly greater postLP mean and postLP peak ACTH levels. The TS patients also excreted significantly more norepinephrine in the 20 hr preceding the lumbar puncture and reported higher levels of anxiety before and during the procedure than the controls. In addition, urinary norepinephrine excretion of the TS patients was significantly correlated with clinician ratings of tic severity. The results were not related to current levels of depression and anxiety. Taken together, these findings suggest that a subset of TS patients may be characterized by heightened reactivity of the hypothalamic-pituitary-adrenal axis and related noradrenergic sympathetic systems.

References (45)

  • R.A. Bornstein et al.

    A survey of Tourette syndrome patients and their families: The 1987 Ohio Tourette Survey

    J Neuropsychiat

    (1990)
  • R.D. Bruun et al.

    The natural history of Tourette syndrome

  • I.J. Butler et al.

    Biogenic amine metabolism in Tourette syndrome

    Ann Neurol

    (1979)
  • P.B. Chappell et al.

    Biochemical and genetic studies of Tourette's syndrome: implications for treatment and future research

  • P.B. Chappell et al.

    Neuroendocrine and behavioral effects of naloxone in Tourette syndrome

  • B. Coffey et al.

    Comorbidity, Tourette syndrome, and anxiety disorders

  • D.J. Cohen et al.

    Clonidine ameliorates Gilles de la Tourette syndrome

    Arch Gen Psychiatry

    (1980)
  • D.J. Cohen et al.

    Tourette syndrome: extending basic research to clinical care

  • M.F. Dallman et al.

    Stress, feedback, and facilitation in the hypothalamo-pituitary adrenal axis

    J Neuroendocr

    (1992)
  • W.K. Goodman et al.

    The Yale-Brown Obsessive Compulsive Scale: I. Development, use, and reliability

    Arch Gen Psychiatry

    (1989)
  • S.N. Haber et al.

    Basal ganglia peptidergic staining in Tourette syndrome: a follow-up study

  • Cited by (0)

    Supported in part by NIMH grants MH30929, MH44843, and MH49351, by NICHD Program Project Grant HD03008, and by NIH General Clinical Research Center Grant RR00125.

    Presented at the Annual Meeting of the Society for Biological Psychiatry, San Francisco, CA, May 20, 1993.

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