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Tourette Syndrome and Human Behavior.

If David E. Comings' monumental work continues to hold up under scientific scrutiny and clinical experience, the world of medical and psychiatric science will pass through an unprecedented revolution. To understand Tourette Syndrome is to comprehend its associated behaviors including alcoholism, drug abuse, obesity, depression, panic attacks, phobias, night terrors, bedwetting, hyperactivity disorder, depression and many more neuropsychiatric disturbances.

Dr. Comings' book also redefines the role that psychotherapy and psychoanalysis can play in dealing with neuroses complexes that may only be secondary (or incidental) to disorders genetically based.

For many years, Dr. Comings was primarily involved in basic research on human chromosome structure. He was also among the first to discover that Huntington's disease is a hereditary neurological disorder. Just about then the science of genetics began to enjoy worldwide recognition. Its discoveries proved to be harbingers of the future: that many diseases are the result of defective genes.

Beginning in 1980, Dr. Comings and his psychologist wife, Brenda, began interviewing patients in the City of Hope National Medical Center at Duarte, California. Patients who came to the Genetics Clinic with what was then considered a very rare disorder, Tourette Syndrome, usually manifested their problem in uncontrollable outbursts of profanity and motor tics that included facial grimacing, jerking and shrugging. After treating more than 1,400 Tourette Syndrome patients, Dr. Comings amassed enough clinical information to suspect that a multitude of other conditions were linked to Tourette Syndrome.

The Tourette Profile

Although scientists have been writing about other aspects of Tourette Syndrome, until David E. Comings' book amassed and codified the research, most practitioners who recognized the ailment considered only the following symptoms the most significant:

Motor tics including blinking, facial grimacing, jerking and shoulder shrugging.

Vocal tics including throat clearing, spitting, barking, squeaking and humming.

Swearing in a compulsive manner which is present less than one-third of the time. Many people are surprised to learn that this symptom is not always pertinent to the diagnosis.

Because psychotherapy and psychoanalysis do not help in alleviating the agony of Tourette Syndrome, patients suffered severely because their conduct was considered willful. Many therapists counseled relatives "not to let him get away with it ..." that the victim could be forced to stop. The truth is that tics can be suppressed, but only for short periods of time. The patient is truly helpless.

Since the appearance of Tourette Syndrome and Human Behavior, the focus on Tourette as a single-symptom disease is changing. Newly recognized aspects of the disorder are wide ranging and alter present concepts of human misbehavior. All are probably genetically linked.

They include:

Short attention span (attention deficit hyperactivity disorder) begins early in life, is more common in boys and is characterized by inattention, impulsivity, and in most cases, hyperactivity, according to Dr. Comings. He notes that these characteristics appear before age 7 (retarded children are excluded from these studies).

Sometimes the symptoms start in infancy: the babies do not like to be cuddled, cry frequently, do not nap, sleep poorly, bang their heads and have temper tantrums.

Learning disorders are considered part of the ailment when a child with a normal or high IQ is two or more years behind classmates for no obvious causes such as prolonged physical or mental illness.

The condition includes dyslexia, a specific reading disability, congenital word blindness, or developmental reading disorder. There have been many theories proposed for the cause of dyslexia, including deficits in vision and vision processing or in the inner ear. Perhaps more diagnostic success will be achieved if Dr. Comings' theory of a Tourette Syndrome link is accepted.

Obsessive-Compulsive Disorders Many victims of Tourette Syndrome indulge in obsessive-compulsive behavior, touching, counting, checking, hand washing, and obsessing with perfectionism.

Sleep problems are common in children who have Tourette Syndrome. They also suffer from bedwetting, sleepwalking, sleep talking and night terrors, the author explains. Many have difficulty falling asleep and experience problems in awakening.

Obesity has been shown to have a strong genetic influence. Dr. Comings provides extensive case histories that include compulsive eating disorders with Tourette Syndrome.

Addictive behaviors including alcoholism, compulsive eating, compulsive shopping, and compulsive gambling are now suspected of being the result of genetic disorders.

Inappropriate sexual behaviors, including compulsive swearing, sexual touching, crotch touching and exhibitionism are manifestations of the problem among many patients.

Depression is common in individuals who carry a Tourette Syndrome gene, Dr. Comings reports. Tics do not always accompany the depression.

Mania and manic-depressive disorder are among the most bewildering problems with which the psychiatric profession deals. Careful administration of pharmacological drugs has proven helpful for some patients. The author believes that confronting the condition on the basis of a genetic disorder, linked to Tourette Syndroime, could lead to more successful treatment. He also cites family, twin studies and adoption studies arguing that depression and manic disorders are not learned psychological behaviors.

Because Tourette Syndrome and schizophrenia have several characteristics in common (genetics, abnormalities of the brain chemical dopamine, attention deficit, symptoms of paranoid behavior, and other less intrusive aspects) should further research be conducted to determine whether abnormalities appearing in each are relevant to disturbances of the frontal lobe and limbic system of the brain? Dr. Comings' evidence would suggest the answer is yes.

Autism is a problem that frustrates modern medicine. Not only are there no satisfactory definitions of the condition, but therapy consists of 'hit or miss' suppositions. Dr. Comings' research says autism provides important insights into understanding Tourette Syndrome, which can also mean that the autistic child's dilemma may be alleviated by medications found successful in Tourette Syndrome. Autism symptoms comprise (1) no speech or body language (2) no eye contact (3) absence of imaginative play (4) abnormal speech (5) repetitive speech (6) inability to carry on a conversation (7) narrow interest (8) stereotyped body movements (9) compulsive routines.

It is with much humility that a reviewer attempts to present a perspective of this gigantic scientific achievement. In one fascinating volume, Dr. Comings succeeds in explaining the vast range of problems that a defective gene engenders. It is a masterful production that should be read by every professional engaged in medical practice, psychiatry, nursing or special education. The book also will be invaluable for patients and their families.

Although Dr. Comings is convinced that serotonin, the brain chemical responsible for neuron activity, is central to Tourette Syndrome, he does not dismiss the value of psychotherapy and psychoanalysis in alleviating the mental problems patients suffer from dealing with the specific syndrome. Drug and behavior therapy are also high on his therapeutic list.
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Publication:Nutrition Health Review
Article Type:Book Review
Date:Jan 1, 1991
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