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Le syndrome de Gilles de la Tourette (SGT), le trouble obsessionnel compulsif (TOC) et les comportements répétitifs centrés sur le corps (CRCC) sont trois troubles qui présentent de nombreuses similarités, autant d’ordre phénoménologique que neuroanatomique et fonctionnel. Toutefois, malgré une recension des écrits pointant vers un possible spectre incluant ces trois troubles, les études qui ont contrasté ceux-ci se font peu nombreuses. Étudier les processus cognitifs affectés dans chacune de ces conditions cliniques permettrait alors d’offrir une meilleure compréhension des différences et des similarités entre celles-ci. D’ailleurs, l’utilisation des potentiels évoqués comme technique d’imagerie cérébrale offre l’avantage de mesurer l’activité cérébrale avec une excellente résolution temporelle. Les composantes de potentiels évoqués permettent alors de refléter certains processus cognitifs, notamment les processus attentionnels et mnésiques, qui sont connus comme étant potentiellement affectés dans ces trois troubles. Notre objectif était donc de comparer l’amplitude de trois composantes (P200, N200 et P300) entre des groupes de participants atteints du SGT (n=24), du TOC (n=18) et des CRCC (n=16), qui ont tous été appariés à un groupe contrôle (n=59) dans une tâche de oddball visuelle cognitive. Nos résultats n’ont d’abord montré aucune différence intergroupe pour la P200 et la N200 lorsqu’on contrôle pour les symptômes anxio-dépressifs, ce qui laisse présager que les processus cognitifs reflétés par ces composantes sont intacts dans ces populations cliniques. En ce qui a trait à la composante P300, nos résultats ont montré une diminution de l’effet oddball P300 pour les groupes SGT et TOC comparativement au groupe contrôle, alors qu’un effet oddball intact a été observé pour le groupe CRCC. Les analyses de localisation de sources ont révélé des activations dans le gyrus lingual et le gyrus occipital moyen pour le groupe TOC, ce qui le distingue des deux autres groupes cliniques et du groupe contrôle. En effet, ceux-ci ont plutôt montré des activations dans le cortex cingulaire pour la génération de cet effet oddball. Ainsi, il semblerait que les groupes SGT et TOC présentent des déficits dans la mémoire de travail, tels que dégagés par les altérations de la composante P300, mais que des régions cérébrales différentes soient impliquées dans la génération de ces activations anormales. / Tourette Syndrome (TS), Obsessive-Compulsive Disorder (OCD) and Body-Focused Repetitive Behaviors (BFRB) are three disorders that share many similarities in terms of phenomenology, neuroanatomy and functionality. However, despite a literature review pointing towards a possible spectrum including these three disorders, only a few studies compared them in the same context. Studying the cognitive processes affected by these clinical conditions would provide a better understanding of their differences and similarities. Moreover, using EventRelated Potentials (ERP) as a brain imaging technique offers the advantage of measuring brain activity with excellent temporal resolution. The ERP components can then reflect specific cognitive processes, notably attentional and memory processes, which are known to be potentially affected in these three disorders. Our aim was, therefore, to compare the amplitude of three ERP components (P200, N200, and P300) across groups of participants with TS (n=24), OCD (n=18), and BFRB (n=16), all of whom were matched to a control group (n=59), in a cognitive visual oddball task. Our results initially showed no group differences for the P200 and N200 when controlling for anxiety and depressive symptoms, suggesting that the cognitive processes reflected by these components are intact in these clinical populations. Concerning the P300 component, our results showed a decrease in the P300 oddball effect for the SGT and OCD groups compared to the control group, whereas an intact oddball effect was observed for the BFRB group. Furthermore, source localization analyses revealed activations in the lingual and middle occipital gyrus for the OCD group, distinguishing it from the other two clinical groups and the control group. Indeed, these groups showed activations in the cingulate cortex to generate this oddball effect. Thus, it seems that the TS and OCD groups show deficits in working memory, as revealed by alterations in the P300 component, but those different brain regions are involved in generating these distinct activations.

Le syndrome de Gilles de la Tourette (SGT) est une condition neuropsychiatrique qui se caractérise par la présence de tics moteurs et vocaux. Au-delà des tics, le SGT s’accompagne souvent de troubles concomitants, tels que le trouble de déficit de l’attention avec ou sans hyperactivité et le trouble obsessionnel compulsif. Plusieurs études ont rapporté que les adultes atteints du SGT sont plus susceptibles de souffrir de dépression et de troubles anxieux comorbides que les personnes neurotypiques. Bien que les tics soient la caractéristique déterminante du SGT, les comorbidités engendrent de multiples conséquences psychologiques, sociales et comportementales, en plus d’avoir un impact considérable sur la qualité de vie des personnes qui en souffre. Jusqu'à présent, les études neuropsychologiques auprès de cette population ont révélé des résultats parfois conflictuels quant à leurs performances cognitives, notamment au niveau de l’inhibition, des processus moteurs et des capacités visuospatiales. Ces disparités peuvent être attribuées à divers facteurs, y compris la présence de comorbidités. L’objectif général de ce mémoire est d’apporter une meilleure compréhension du profil neuropsychologique des individus atteints du SGT, en tenant compte de la comorbidité anxiodépressive. Notre échantillon est composé de 128 participants divisés en trois groupes : un groupe SGT+ présentant une comorbidité anxieuse et/ou dépressive (n = 21), un groupe clinique SGT- sans comorbidité significative (n = 37) et un groupe contrôle neurotypique (n = 70). Ils ont été soumis à des mesures neuropsychologiques, dont le Stroop Color-Word Test (SCWT), le Purdue Pegboard Test (PPT) et la figure complexe de Rey-Osterrieth (ROCF). Concernant les capacités d’inhibition, aucune différence n'a été observée entre les groupes cliniques et les neurotypiques. Les patients SGT- et SGT+ ont tous deux montré une dextérité motrice supérieure. Toutefois, seuls les participants atteints de SGT+ ont présenté des déficits au niveau des fonctions visuoconstructives et de la mémoire non verbale. Les résultats suggèrent que les individus atteints du SGT avec une comorbidité anxiodépressive pourraient présenter des déficits supplémentaires dans certains domaines spécifiques. Néanmoins, des recherches supplémentaires axées sur ces conditions comorbides sont nécessaires pour tirer des conclusions robustes. / Tourette's syndrome (TS) is a neuropsychiatric condition characterized by the presence of motor and vocal tics. Beyond tics, TS is often accompanied by co-occurring disorders, such as attention deficit disorder with or without hyperactivity and obsessive-compulsive disorder. Several studies have reported that adults with TS are more likely to suffer from depression and comorbid anxiety disorders than neurotypical people. Although tics are the defining characteristic of TS, comorbidities have multiple psychological, social, and behavioural consequences, and they considerably impact the quality of life of those who suffer from them. So far, neuropsychological studies in this population have revealed sometimes conflicting results regarding their cognitive performance, particularly in inhibition, motor processes and visuospatial abilities. These disparities can be attributed to a variety of factors, including the presence of comorbidities. The general objective of this thesis is to provide a better understanding of the neuropsychological profile of individuals with TS, considering anxiodepressive comorbidity. Our sample consisted of 128 participants divided into three groups: a TS+ group with an anxiety and/or depressive comorbidity (n = 21), a clinical group TS- without significant comorbidity (n = 37) and a neurotypical control group (n = 70). They were subjected to neuropsychological measures, including the Stroop Color- Word Test (SCWT), the Purdue Pegboard Test (PPT), and the Rey-Osterrieth Complex Figure (ROCF). Regarding inhibition abilities, no differences were observed between clinical and neurotypical groups. Both TS- and TS+ patients showed superior motor dexterity. However, only participants with TS+ had deficits in visuoconstructive function and nonverbal memory. The results suggest that individuals with TS with an anxiodepressive comorbidity may have additional deficits in some specific areas. Nevertheless, further research focused on these comorbid conditions is needed to draw robust conclusions.

It has been suggested that psychosocial stress influences situational fluctuations of tic frequency. However, evidence from experimental studies is lacking. The current study investigated the effects of the Trier Social Stress Test (TSST-C) on tic frequency in 31 children and adolescents with tic disorders. A relaxation and a concentration situation served as control conditions. Patients were asked either to suppress their tics or to “tic freely.” Physiological measures of stress were measured throughout the experiment. The TSST-C elicited a clear stress response with elevated levels of saliva cortisol, increased heart rate, and a larger number of skin conductance responses. During relaxation and concentration, the instruction to suppress tics reduced the number of tics, whereas during stress, the number of tics was low, regardless of the given instruction. Our study suggests that the stress might result in a situational decrease of tic frequency.

Transtornos psiquiátricos têm sido descritos com maior freqüência em pacientes com Coréia de Sydenham (CS) do que em pacientes com Febre Reumática(FR) sem CS. Os objetivos desse estudo forma o de verificar: se existe uma freqüência aumentada de transtornos psiquiátricos em pacientes com FR comparados a um grupo controle; se estes transtornos psiquiátricos apresentam freqüência aumentada em grupo de pacientes com Coréia de Sydenham, a manifestação da FR no Sistema Nervoso Central, comparado ao grupo de pacientes com FR sem CS; e, por fim, verificar a relação temporal entre o início destes diversos transtornos e o início da FR. Concluiu-se que a presença de FR está associada a uma maior freqüência de transtornos psiquiátricos, mesmo na ausência de CS. O TDHA e o TT, neste estudo, foram indicados como fatores de risco para o desenvolvimento de CS em pacientes com FR. / Psychiatric disorders have been described as more frequent in Sydenham’s Chorea patients SC) than in rheumatic fever without SC (RF). The aim of this study was to investigate it the prevalence of psychiatric disorders in RF is associated with the occurrence of SC. Furthermore, age of onset of the various symptoms was determined in order to clarify the temporal relationship between the presence of psychiatric symptoms and either rheumatic fever or Sydenham’s Chorea. Using semi-structured diagnostic interviews for DSM-IV and ratings scales, the authors assessed 22 SC patients, 20 RF patients and 20 pediatric controls. Statistical Analyses were performed using Pearson chi-square (Fischer’s exact test for 2x2 tables) for comparisons of categorial variables. Comparisons of continuous variables among groups were carried out using ANOVA and the Student t-test, when only groups were analyzed. In order to establish the risk for the development of SC and OCD given to presence of other co-morbid conditions, a logistic regression was applied. The level of significance adopted was 0.05. Both the SC and RF groups showed a greater prevalence of psychiatric disorders. The SC sample showed higher frequency of major depression disorder (MDD) (x2 = 19,1, df = 2, p = 0,00007), tic disorder (TD) (x2 = 21,1, df = 2, p = 0,00001) and attention-deficit hyperactivity disorder (ADHD) (x2-21,7, df = 2, p = 0,0002). Although Obsessive-Compulsive Disorder (OCD) was not statiscally higher in the SC and RF groups, Obsessive-Compulsive Symptoms were more frequent in both RF and SC groups compared to the controls (x2 = 7,3, df = 2, p = 0,025). The age of onset for both ADHD and TD predicted the risk for development of SC. The risk of development of OCD in SC children was also associated with the age of onset of ADHD. RF seems to confer increased risk to develop neuropsychiatric disorders even in patients without SC. In this sample, ADHD and TD was an important risk factor for the occurrence of co-morbid illnesses.

Transtornos psiquiátricos têm sido descritos com maior freqüência em pacientes com Coréia de Sydenham (CS) do que em pacientes com Febre Reumática(FR) sem CS. Os objetivos desse estudo forma o de verificar: se existe uma freqüência aumentada de transtornos psiquiátricos em pacientes com FR comparados a um grupo controle; se estes transtornos psiquiátricos apresentam freqüência aumentada em grupo de pacientes com Coréia de Sydenham, a manifestação da FR no Sistema Nervoso Central, comparado ao grupo de pacientes com FR sem CS; e, por fim, verificar a relação temporal entre o início destes diversos transtornos e o início da FR. Concluiu-se que a presença de FR está associada a uma maior freqüência de transtornos psiquiátricos, mesmo na ausência de CS. O TDHA e o TT, neste estudo, foram indicados como fatores de risco para o desenvolvimento de CS em pacientes com FR. / Psychiatric disorders have been described as more frequent in Sydenham’s Chorea patients SC) than in rheumatic fever without SC (RF). The aim of this study was to investigate it the prevalence of psychiatric disorders in RF is associated with the occurrence of SC. Furthermore, age of onset of the various symptoms was determined in order to clarify the temporal relationship between the presence of psychiatric symptoms and either rheumatic fever or Sydenham’s Chorea. Using semi-structured diagnostic interviews for DSM-IV and ratings scales, the authors assessed 22 SC patients, 20 RF patients and 20 pediatric controls. Statistical Analyses were performed using Pearson chi-square (Fischer’s exact test for 2x2 tables) for comparisons of categorial variables. Comparisons of continuous variables among groups were carried out using ANOVA and the Student t-test, when only groups were analyzed. In order to establish the risk for the development of SC and OCD given to presence of other co-morbid conditions, a logistic regression was applied. The level of significance adopted was 0.05. Both the SC and RF groups showed a greater prevalence of psychiatric disorders. The SC sample showed higher frequency of major depression disorder (MDD) (x2 = 19,1, df = 2, p = 0,00007), tic disorder (TD) (x2 = 21,1, df = 2, p = 0,00001) and attention-deficit hyperactivity disorder (ADHD) (x2-21,7, df = 2, p = 0,0002). Although Obsessive-Compulsive Disorder (OCD) was not statiscally higher in the SC and RF groups, Obsessive-Compulsive Symptoms were more frequent in both RF and SC groups compared to the controls (x2 = 7,3, df = 2, p = 0,025). The age of onset for both ADHD and TD predicted the risk for development of SC. The risk of development of OCD in SC children was also associated with the age of onset of ADHD. RF seems to confer increased risk to develop neuropsychiatric disorders even in patients without SC. In this sample, ADHD and TD was an important risk factor for the occurrence of co-morbid illnesses.

In this paper we have chosen to focus on social workers and their experiences of interacting with clients with neuropsychiatric disabilities, in example persons with ADHD (Attention-Deficit/Hyperactivity Disorder), Asperger syndrome, autism and/or Tourette syndrome. The main purpose was to look into three areas: What knowledge do social workers mean that they need about neuropsychiatric disabilities and how can their needs of knowledge can be met? How do they experience the meeting with a person with neuropsychiatric disabilities? How does the cooperation function between authorities regarding persons with neuropsychiatric disabilities? Definition of the concept of disability and function from a historical perspective points out that the approach has changed over time. Previous research studies of the interaction in meeting between the client and the social worker shows that the social worker carries two faces, so called aspects. The first aspect is about help and care and the second aspect is about administrative functions. These two aspects can be difficult combining due to their differences. The processing in social work consists of three phases. The first is about the client presenting its issues, the next is about gathering background details about the client and the third phase to decide what action is the most adequate for the client. Recent studies show that persons with neuropsychiatric disabilities do not get the help and support they are in need of. This study is based on a qualitative method where we performed semi-structured interviews. We used a strategic sampling with maximum variation to get more in-depth answers from our informants. Interviews were made with six informants who were social workers who all have encountered neuropsychiatric disabilities on a daily basis. The analysis was based on an inductive driven analysis method which we have chosen to carefully describe. It shares some similarities with Grounded theory (GT), but it cannot really be considered as GT. Our results shows that the knowledge has improved due time but there still are some issues with the cooperation between sections due to the lack of knowledge of these diagnosis. With knowledge and interaction with clients our informants experienced that their approach changed. They felt more secure in their role as a social worker in meeting persons with neuropsychiatric disabilities. The prevalence of these disabilities has increased. Our informants noted that females are more noticeable than before and that the diagnosis can be performed in an earlier stage in life. / I denna uppsats har vi valt att fokusera på socialarbetare och deras upplevelser av att interagera med klienter som har neuropsykiatriska funktionsnedsättningar, exempelvis personer med ADHD (Attention-Deficit/Hyperactivity Disorder), Aspergers syndrom, autism och/eller Tourettes syndrom. Syftet  var att undersöka tre områden: Vilken kunskap anser sig socialarbetarna behöva om neuropsykiatriska funktionsnedsättningar och hur kan de tillgodose den kunskap de behöver om funktionsnedsättningarna? Hur upplever de mötet med en person med neuropsykiatriska funktionsnedsättningar? Hur fungerar samarbetet mellan olika instanser när det gäller neuropsykiatriska funktionsnedsättningar?   Definitionen av begreppet handikapp och funktion utifrån  ett historiskt perspektiv påvisar att synsättet har förändrats över tid. Tidigare forskning visar att i interaktionen i mötet mellan socialarbetaren och klienten visar att socialarbetaren bär på två ansikten, så kallade aspekter. Den första aspekten handlar om hjälp och omtanke och den andra aspekten handlar om administrativa funktioner. Dessa två aspekter kan vara svåra att kombinera I och med deras olikheter. Handläggningen i socialt arbete består av tre faser. Den första handlar om att klienten skall presentera sina problem, den andra att samla in information rörande bakgrund och den tredje fasen handlar om att bestämma vilken insats som är mest lämpad för klienten. Nyare studier visar att personer med neuropsykiatriska funktionsnedsättningar inte får den hjälp och stöd de är i behov av. Denna studie är baserad på en kvalitativ metod där vi genomförde semi-strukturerade intervjuer. Vi använde oss av ett strategiskt urval med maximal variation för att få mer djupgående svar från våra informanter. Intervjuerna gjordes med sex informanter som var socialarbetare varav alla hade kommit i kontakt med neuropsykiatriska funktionsnedsättningar på en daglig basis. Analysen grundade sig i en induktivt driven kvalitativ analys som vi har valt att beskriva noggrant. Den delar vissa likheter med Grounded Theory (GT), men den kan inte riktigt betraktas som GT. Våra resultat visar att kunskapen har ökat över tid, men att det finns svårigheter med samarbetet mellan instanser på grund av bristande kunskap om dessa diagnoser. Med kunskap och interaktion med klienter så upplever våra informanter att deras synsätt har förändrats. De känner sig mer säkra i sin roll som socialarbetare i att möta personer med neuropsykiatriska funktionsnedsättningar. Prevalensen av dessa funktionsnedsättningar har ökat. Våra informanter noterade att kvinnor är mer förekommande än tidigare och att diagnostisering kan ske i ett tidigare skede i livet.

The purpose of this thesis is to explore the diverse experiences of accessing health and social services when living with a neurological condition in Manitoba. Using a qualitative research design, I conducted 15 in-depth semi-structured interviews with adults living with a neurological condition in Manitoba. Findings demonstrated how characteristics of patients, and their service providers/systems, either predisposed them to a lack of service coordination or enabled them to successfully navigate health and social services. In the event that those factors contributed to a need or desire for coordination, participants employed strategies to improve their experience accessing services by i. pursuing knowledge to improve access, ii. actively engaging in behaviours to improve services, or iii. mentally coping with inadequate services. To conclude, practical recommendations on possible initiatives to improve the daily experiences of individuals living with neurological conditions are also provided. / October 2015

It has been suggested that psychosocial stress influences situational fluctuations of tic frequency. However, evidence from experimental studies is lacking. The current study investigated the effects of the Trier Social Stress Test (TSST-C) on tic frequency in 31 children and adolescents with tic disorders. A relaxation and a concentration situation served as control conditions. Patients were asked either to suppress their tics or to “tic freely.” Physiological measures of stress were measured throughout the experiment. The TSST-C elicited a clear stress response with elevated levels of saliva cortisol, increased heart rate, and a larger number of skin conductance responses. During relaxation and concentration, the instruction to suppress tics reduced the number of tics, whereas during stress, the number of tics was low, regardless of the given instruction. Our study suggests that the stress might result in a situational decrease of tic frequency.