UNRECOGNIZED TOURETTE-SYNDROME IN ADULT PATIENTS REFERRED FOR PSYCHOGENIC TREMOR

Background: The diagnosis of Tourette syndrome may be overlooked in pa tients with severe psychopathologic disorder but mild motor manifestat ions of Tourette syndrome. Objective: To describe 4 patients with long -lasting general psychopathologic disorder and previously unrecognized mild motor and phonic ties exacerbated during adulthood by the onset of tremor; all of the patients had been referred for the evaluation of psychogenic tremor. Subjects: Four adult patients, with previous psyc hiatric diagnoses of depression (2 cases), generalized anxiety disorde r (3 cases), malingering (1 case), and conversion disorder (3 cases). Methods: Single case studies. Results: Clinical interviews disclosed t hat the 4 patients had positive family histories of Tourette syndrome, and all had mild motor and phonic tics that had started before the ag e of 18 years. On neurologic examination, 2 patients had bilateral pos tural tremor of the hands that varied in frequency, rhythmicity, and a mplitude, and the other 2 had resting tremor mimicking parkinsonism. A ll 4 patients described involuntary somatic sensations of the affected limbs, which they attempted to alleviate by executing movements. Two consistent positive placebo response was observed, but in all patients tremoric movements improved with haloperidol. Conclusions: These case s illustrate an unusual movement disorder (tremor as a ''tic equivalen t'') in adults with Tourette syndrome and emphasize that cases of the syndrome with mild tics often go unrecognized, precluding adequate tre atment.