Hostname: page-component-8448b6f56d-c4f8m Total loading time: 0 Render date: 2024-04-18T02:05:33.380Z Has data issue: false hasContentIssue false
  • English
  • Français

Genetic and phenotypic overlap of specific obsessive-compulsive and attention-deficit/hyperactive subtypes with Tourette syndrome

Published online by Cambridge University Press:  27 June 2017

M. E. Hirschtritt ,
S. M. Darrow ,
C. Illmann ,
L. Osiecki ,
M. Grados ,
P. Sandor ,
Y. Dion ,
R. A. King ,
D. Pauls  and
C. L. Budman
...Show all authors
M. E. Hirschtritt
Affiliation:
Department of Psychiatry, University of California, San Francisco, CA, USA
S. M. Darrow
Affiliation:
Department of Psychiatry, University of California, San Francisco, CA, USA
C. Illmann
Affiliation:
Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
L. Osiecki
Affiliation:
Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
M. Grados
Affiliation:
Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
P. Sandor
Affiliation:
Department of Psychiatry, University of Toronto and University Health Network, Youthdale Treatment Centers, Toronto, Ontario, Canada
Y. Dion
Affiliation:
Department of Psychiatry, University of Montreal, Montreal, Quebec, Canada
R. A. King
Affiliation:
Yale Child Study Center, Yale University School of Medicine, New Haven, CT, USA
D. Pauls
Affiliation:
Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
C. L. Budman
Affiliation:
Department of Psychiatry, North Shore University Hospital, Northwell Health System, Manhasset, NY, USA
D. C. Cath
Affiliation:
Faculty of Social and Behavioural Sciences, Utrecht University and Altrecht Academic Anxiety Center, Utrecht and GGz Drenthe and Department of Psychiatry, University Medical Center Groningen, The Netherlands
E. Greenberg
Affiliation:
Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
G. J. Lyon
Affiliation:
Stanley Institute for Cognitive Genomics, Cold Spring Harbor Laboratory, Cold Spring Harbor, NY, USA
D. Yu
Affiliation:
Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
L. M. McGrath
Affiliation:
Department of Psychology, University of Denver, Denver, CO, USA
W. M. McMahon
Affiliation:
Department of Psychiatry, University of Utah, Salt Lake City, UT, USA
P. C. Lee
Affiliation:
Department of Behavioral Health, Tripler Army Medical Center, Honolulu, HI, USA
K. L. Delucchi
Affiliation:
Department of Psychiatry, University of California, San Francisco, CA, USA
J. M. Scharf
Affiliation:
Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA Division of Cognitive and Behavioral Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
C. A. Mathews*
Affiliation:
Department of Psychiatry, University of Florida Genetics Institute, University of Florida, Gainesville, FL, USA
*
*Address for correspondence: C. A. Mathews, M.D., Department of Psychiatry, University of Florida, 100 S. Newell Drive, L4-100, Gainesville, FL, 32610, USA. (E-mail: carolmathews@ufl.edu)
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

The unique phenotypic and genetic aspects of obsessive-compulsive (OCD) and attention-deficit/hyperactivity disorder (ADHD) among individuals with Tourette syndrome (TS) are not well characterized. Here, we examine symptom patterns and heritability of OCD and ADHD in TS families.

Method

OCD and ADHD symptom patterns were examined in TS patients and their family members (N = 3494) using exploratory factor analyses (EFA) for OCD and ADHD symptoms separately, followed by latent class analyses (LCA) of the resulting OCD and ADHD factor sum scores jointly; heritability and clinical relevance of the resulting factors and classes were assessed.

Results

EFA yielded a 2-factor model for ADHD and an 8-factor model for OCD. Both ADHD factors (inattentive and hyperactive/impulsive symptoms) were genetically related to TS, ADHD, and OCD. The doubts, contamination, need for sameness, and superstitions factors were genetically related to OCD, but not ADHD or TS; symmetry/exactness and fear-of-harm were associated with TS and OCD while hoarding was associated with ADHD and OCD. In contrast, aggressive urges were genetically associated with TS, OCD, and ADHD. LCA revealed a three-class solution: few OCD/ADHD symptoms (LC1), OCD & ADHD symptoms (LC2), and symmetry/exactness, hoarding, and ADHD symptoms (LC3). LC2 had the highest psychiatric comorbidity rates (⩾50% for all disorders).

Conclusions

Symmetry/exactness, aggressive urges, fear-of-harm, and hoarding show complex genetic relationships with TS, OCD, and ADHD, and, rather than being specific subtypes of OCD, transcend traditional diagnostic boundaries, perhaps representing an underlying vulnerability (e.g. failure of top-down cognitive control) common to all three disorders.

Keywords

Attention-deficit/hyperactivity disorderfactorsheritabilitylatent classesobsessive-compulsive disorderTourette syndrome
Type
Original Articles
Information
Psychological Medicine , Volume 48 , Issue 2 , January 2018 , pp. 279 - 293
Copyright
Copyright © Cambridge University Press 2017 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Abramovitch, A, Dar, R, Mittelman, A, Schweiger, A (2013). Don't judge a book by its cover: ADHD-like symptoms in obsessive compulsive disorder. Journal of Obsessive-Compulsive and Related Disorders 2, 53–61.Google Scholar
Abramovitch, A, Dar, R, Mittelman, A, Wilhelm, S (2015). Comorbidity between attention deficit/hyperactivity disorder and obsessive-compulsive disorder across the lifespan: a systematic and critical review. Harvard Review of Psychiatry 23, 245–262.Google Scholar
Almasy, L, Blangero, J (1998). Multipoint quantitative-trait linkage analysis in general pedigrees. American Journal of Human Genetics 62, 1198–1211.Google Scholar
Alsobrook, JP II, Pauls, DL (2002). A factor analysis of tic symptoms in Gilles de la Tourette's syndrome. American Journal of Psychiatry 159, 291–296.Google Scholar
American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders. American Psychiatric Publishing: Arlington, VA.Google Scholar
Arnsten, AF, Rubia, K (2012). Neurobiological circuits regulating attention, cognitive control, motivation, and emotion: disruptions in neurodevelopmental psychiatric disorders. Journal of the American Academy of Child and Adolescent Psychiatry 51, 356–367.CrossRefGoogle ScholarPubMed
Bloch, MH, Landeros-Weisenberger, A, Rosario, MC, Pittenger, C, Leckman, JF (2008). Meta-analysis of the symptom structure of obsessive-compulsive disorder. American Journal of Psychiatry 165, 1532–1542.Google Scholar
Cavanna, AE, Critchley, HD, Orth, M, Stern, JS, Young, MB, Robertson, MM (2011). Dissecting the Gilles de la Tourette spectrum: a factor analytic study on 639 patients. Journal of Neurology, Neurosurgery, and Psychiatry 82, 1320–1323.CrossRefGoogle Scholar
Collett, BR, Crowley, SL, Gimpel, GA, Greenson, JN (2000). The factor structure of DSM-IV attention deficit-hyperactivity symptoms: a confirmatory factor analysis of the ADHD-SRS. Journal of Psychoeducational Assessment 18, 361–373.Google Scholar
Darrow, SM, Hirschtritt, ME, Davis, LK, Illmann, C, Osiecki, L, Grados, M, Sandor, P, Dion, Y, King, R, Pauls, D, Budman, CL, Cath, DC, Greenberg, E, Lyon, GJ, Yu, D, McGrath, LM, McMahon, WM, Lee, PC, Delucchi, KL, Scharf, JM, Mathews, CA, Tourette Syndrome Association International Consortium for Genetics (2017). Identification of two heritable cross-disorder endophenotypes for Tourette syndrome. American Journal of Psychiatry 174, 387–396.CrossRefGoogle ScholarPubMed
Davis, LK, Yu, D, Keenan, CL, Gamazon, ER, Konkashbaev, AI, Derks, EM, Neale, BM, Yang, J, Lee, SH, Evans, P, Barr, CL, Bellodi, L, Benarroch, F, Berrio, GB, Bienvenu, OJ, Bloch, MH, Blom, RM, Bruun, RD, Budman, CL, Camarena, B, Campbell, D, Cappi, C, Cardona Silgado, JC, Cath, DC, Cavallini, MC, Chavira, DA, Chouinard, S, Conti, DV, Cook, EH, Coric, V, Cullen, BA, Deforce, D, Delorme, R, Dion, Y, Edlund, CK, Egberts, K, Falkai, P, Fernandez, TV, Gallagher, PJ, Garrido, H, Geller, D, Girard, SL, Grabe, HJ, Grados, MA, Greenberg, BD, Gross-Tsur, V, Haddad, S, Heiman, GA, Hemmings, SM, Hounie, AG, Illmann, C, Jankovic, J, Jenike, MA, Kennedy, JL, King, RA, Kremeyer, B, Kurlan, R, Lanzagorta, N, Leboyer, M, Leckman, JF, Lennertz, L, Liu, C, Lochner, C, Lowe, TL, Macciardi, F, McCracken, JT, McGrath, LM, Mesa Restrepo, SC, Moessner, R, Morgan, J, Muller, H, Murphy, DL, Naarden, AL, Ochoa, WC, Ophoff, RA, Osiecki, L, Pakstis, AJ, Pato, MT, Pato, CN, Piacentini, J, Pittenger, C, Pollak, Y, Rauch, SL, Renner, TJ, Reus, VI, Richter, MA, Riddle, MA, Robertson, MM, Romero, R, Rosario, MC, Rosenberg, D, Rouleau, GA, Ruhrmann, S, Ruiz-Linares, A, Sampaio, AS, Samuels, J, Sandor, P, Sheppard, B, Singer, HS, Smit, JH, Stein, DJ, Strengman, E, Tischfield, JA, Valencia Duarte, AV, Vallada, H, Van Nieuwerburgh, F, Veenstra-Vanderweele, J, Walitza, S, Wang, Y, Wendland, JR, Westenberg, HG, Shugart, YY, Miguel, EC, McMahon, W, Wagner, M, Nicolini, H, Posthuma, D, Hanna, GL, Heutink, P, Denys, D, Arnold, PD, Oostra, BA, Nestadt, G, Freimer, NB, Pauls, DL, Wray, NR, Stewart, SE, Mathews, CA, Knowles, JA, Cox, NJ, Scharf, JM (2013). Partitioning the heritability of Tourette syndrome and obsessive compulsive disorder reveals differences in genetic architecture. PLoS Genetics 9, e1003864.Google Scholar
Delucchi, KL, Katerberg, H, Stewart, SE, Denys, DA, Lochner, C, Stack, DE, den Boer, JA, van Balkom, AJ, Jenike, MA, Stein, DJ, Cath, DC, Mathews, CA (2011). Latent class analysis of the Yale-Brown Obsessive-Compulsive Scale symptoms in obsessive-compulsive disorder. Comprehensive Psychiatry 52, 334–341.CrossRefGoogle ScholarPubMed
Dumenci, L, McConaughy, SH, Achenbach, TM (2004). A hierarchical three-factor model of inattention-hyperactivity-impulsivity derived from the Attention Problems syndrome of the Teacher's Report Form. School Psychology Review 33, 287–301.Google Scholar
Eapen, V, Fox-Hiley, P, Banerjee, S, Robertson, M (2004). Clinical features and associated psychopathology in a Tourette syndrome cohort. Acta Neurologica Scandinavica 109, 255–260.CrossRefGoogle Scholar
First, MB, Spitzer, RL, Gibbon, M, Williams, JBW (1995). Structured Clinical Interview for DSM-IV Axis I Disorders-Non-Patient Edition (SCID-I/NP, version 2.0) . Biometrics Research Department, New York State Psychiatric Institute: New York.Google Scholar
Floyd, FJ, Widaman, KF (1995). Factor analysis in the development and refinement of clinical assessment instruments. Psychological Assessment 7, 286–299.CrossRefGoogle Scholar
Freitag, CM, Rohde, LA, Lempp, T, Romanos, M (2010). Phenotypic and measurement influences on heritability estimates in childhood ADHD. European Child & Adolescent Psychiatry 19, 311–323.CrossRefGoogle ScholarPubMed
Friedman-Hill, SR, Wagman, MR, Gex, SE, Pine, DS, Leibenluft, E, Ungerleider, LG (2010). What does distractibility in ADHD reveal about mechanisms for top-down attentional control? Cognition 115, 93–103.Google Scholar
Frost, RO, Steketee, G, Tolin, DF (2011). Comorbidity in hoarding disorder. Depression and Anxiety 28, 876–884.CrossRefGoogle ScholarPubMed
Fullana, MA, Vilagut, G, Mataix-Cols, D, Adroher, ND, Bruffaerts, R, Bunting, B, de Almeida, JM, Florescu, S, de Girolamo, G, de Graaf, R, Haro, JM, Kovess, V, Alonso, J (2013). Is ADHD in childhood associated with lifetime hoarding symptoms? An epidemiological study. Depression and Anxiety 30, 741–748.Google Scholar
Fyer, A, Endicott, J, Mannuzza, S, Klein, DF (1985). Schedule for Affective Disorders and Schizophrenia-Lifetime Version, Modified for the Study of Anxiety Disorders (SADS-LA) . Anxiety Disorders Clinic, New York State Psychiatric Institute: New York.Google Scholar
Grados, MA, Mathews, CA (2009). Clinical phenomenology and phenotype variability in Tourette syndrome. Journal of Psychosomatic Research 67, 491–496.Google Scholar
Hirschtritt, ME, Darrow, SM, Illmann, C, Osiecki, L, Grados, M, Sandor, P, Dion, Y, King, RA, Pauls, DL, Budman, CL, Cath, DC, Greenberg, E, Lyon, GJ, Yu, D, McGrath, LM, McMahon, WM, Lee, PC, Delucchi, KL, Scharf, JM, Mathews, CA, Tourette Syndrome Association International Consortium for Genetics (TSAICG) (2016). Social disinhibition is a heritable subphenotype of tics in Tourette syndrome. Neurology 87, 497–504.CrossRefGoogle ScholarPubMed
Hirschtritt, ME, Lee, PC, Pauls, DL, Dion, Y, Grados, MA, Illmann, C, King, RA, Sandor, P, McMahon, WM, Lyon, GJ, Cath, DC, Kurlan, R, Robertson, MM, Osiecki, L, Scharf, JM, Mathews, CA, Tourette Syndrome Association International Consortium for Genetics (2015). Lifetime prevalence, age of risk, and genetic relationships of comorbid psychiatric disorders in Tourette syndrome. JAMA Psychiatry 72, 325–333.CrossRefGoogle ScholarPubMed
Huisman-van Dijk, HM, Schoot, R, Rijkeboer, MM, Mathews, CA, Cath, DC (2016). The relationship between tics, OC, ADHD and autism symptoms: a cross-disorder symptom analysis in Gilles de la Tourette syndrome patients and family-members. Psychiatry Research 237, 138–146.CrossRefGoogle ScholarPubMed
Katerberg, H, Delucchi, KL, Stewart, SE, Lochner, C, Denys, DA, Stack, DE, Andresen, JM, Grant, JE, Kim, SW, Williams, KA, den Boer, JA, van Balkom, AJ, Smit, JH, van Oppen, P, Polman, A, Jenike, MA, Stein, DJ, Mathews, CA, Cath, DC (2010). Symptom dimensions in OCD: item-level factor analysis and heritability estimates. Behavior Genetics 40, 505–517.CrossRefGoogle ScholarPubMed
Kaufman, J, Birmaher, B, Brent, D, Rao, U, Flynn, C, Moreci, P, Williamson, D, Ryan, N (1997). Schedule for affective disorders and schizophrenia for school-age children-present and lifetime version (K-SADS-PL): initial reliability and validity data. Journal of the American Academy of Child & Adolescent Psychiatry 36, 980–988.Google Scholar
Leckman, JF, Denys, D, Simpson, HB, Mataix-Cols, D, Hollander, E, Saxena, S, Miguel, EC, Rauch, SL, Goodman, WK, Phillips, KA, Stein, DJ (2010). Obsessive-compulsive disorder: a review of the diagnostic criteria and possible subtypes and dimensional specifiers for DSM-V. Depression and Anxiety 27, 507–527.Google Scholar
Leckman, JF, Sholomskas, D, Thompson, WD, Belanger, A, Weissman, MM (1982). Best estimate of lifetime psychiatric diagnosis: a methodological study. Archives of General Psychiatry 39, 879–883.CrossRefGoogle ScholarPubMed
Lo, Y, Mendell, NR, Rubin, DB (2001). Testing the number of components in a normal mixture. Biometrika 88, 767–778.CrossRefGoogle Scholar
Loehlin, JC (2004). Goodness of Fit Indices: Latent Variable Models. Lawrence Erlbaum Associates: Mahwah, NJ.Google Scholar
Lopez-Sola, C, Fontenelle, LF, Verhulst, B, Neale, MC, Menchon, JM, Alonso, P, Harrison, BJ (2016). Distinct etiological influences on obsessive-compulsive symptom dimensions: a multivariate twin study. Depression and Anxiety 33, 179–191.CrossRefGoogle ScholarPubMed
Mathews, CA, Grados, MA (2011). Familiality of Tourette syndrome, obsessive-compulsive disorder, and attention-deficit/hyperactivity disorder: heritability analysis in a large sib-pair sample. Journal of the American Academy of Child and Adolescent Psychiatry 50, 46–54.Google Scholar
McGrath, LM, Yu, D, Marshall, C, Davis, LK, Thiruvahindrapuram, B, Li, B, Cappi, C, Gerber, G, Wolf, A, Schroeder, FA, Osiecki, L, O'Dushlaine, C, Kirby, A, Illmann, C, Haddad, S, Gallagher, P, Fagerness, JA, Barr, CL, Bellodi, L, Benarroch, F, Bienvenu, OJ, Black, DW, Bloch, MH, Bruun, RD, Budman, CL, Camarena, B, Cath, DC, Cavallini, MC, Chouinard, S, Coric, V, Cullen, B, Delorme, R, Denys, D, Derks, EM, Dion, Y, Rosario, MC, Eapen, V, Evans, P, Falkai, P, Fernandez, TV, Garrido, H, Geller, D, Grabe, HJ, Grados, MA, Greenberg, BD, Gross-Tsur, V, Grunblatt, E, Heiman, GA, Hemmings, SM, Herrera, LD, Hounie, AG, Jankovic, J, Kennedy, JL, King, RA, Kurlan, R, Lanzagorta, N, Leboyer, M, Leckman, JF, Lennertz, L, Lochner, C, Lowe, TL, Lyon, GJ, Macciardi, F, Maier, W, McCracken, JT, McMahon, W, Murphy, DL, Naarden, AL, Neale, BM, Nurmi, E, Pakstis, AJ, Pato, MT, Pato, CN, Piacentini, J, Pittenger, C, Pollak, Y, Reus, VI, Richter, MA, Riddle, M, Robertson, MM, Rosenberg, D, Rouleau, GA, Ruhrmann, S, Sampaio, AS, Samuels, J, Sandor, P, Sheppard, B, Singer, HS, Smit, JH, Stein, DJ, Tischfield, JA, Vallada, H, Veenstra-VanderWeele, J, Walitza, S, Wang, Y, Wendland, JR, Shugart, YY, Miguel, EC, Nicolini, H, Oostra, BA, Moessner, R, Wagner, M, Ruiz-Linares, A, Heutink, P, Nestadt, G, Freimer, N, Petryshen, T, Posthuma, D, Jenike, MA, Cox, NJ, Hanna, GL, Brentani, H, Scherer, SW, Arnold, PD, Stewart, SE, Mathews, CA, Knowles, JA, Cook, EH, Pauls, DL, Wang, K, Scharf, JM (2014). Copy number variation in obsessive-compulsive disorder and tourette syndrome: a cross-disorder study. Journal of the American Academy of Child and Adolescent Psychiatry 53, 910–919.CrossRefGoogle ScholarPubMed
Muthén, B, du Toit, SHC, Spisic, D (1997). Robust inference using weighted least squares and quadratic estimating equations in latent variable modeling with categorical and continuous outcomes. Psychometrika 75, 1–45.Google Scholar
Muthén, LK, Muthén, BO (1998–2012). Mplus User's Guide, 7th edn. Muthén & Muthén: Los Angeles, CA.Google Scholar
Pauls, DL, Leckman, JF, Cohen, DJ (1993). Familial relationship between Gilles de la Tourette's syndrome, attention deficit disorder, learning disabilities, speech disorders, and stuttering. Journal of the American Academy of Child and Adolescent Psychiatry 32, 1044–1050.Google Scholar
Pillow, DR, Pelham, WE Jr, Hoza, B, Molina, BS, Stultz, CH (1998). Confirmatory factor analyses examining attention deficit hyperactivity disorder symptoms and other childhood disruptive behaviors. Journal of Abnormal Child Psychology 26, 293–309.CrossRefGoogle ScholarPubMed
Polanczyk, GV, Eizirik, M, Aranovich, V, Denardin, D, da Silva, TL, da Conceicao, TV, Pianca, TG, Rohde, LA (2003). Interrater agreement for the schedule for affective disorders and schizophrenia epidemiological version for school-age children (K-SADS-E). Revista brasileira de psiquiatria (Sao Paulo, Brazil: 1999) 25, 87–90.Google Scholar
Preacher, KJ, Zhang, G, Kim, C, Mels, G (2013). Choosing the optimal number of factors in exploratory factor analysis: a model selection perspective. Multivariate Behavioral Research 48, 28–56.Google Scholar
Raykov, T, Marcoulides, GA (2006). Parameter and Model Identification: A First Course in Structural Equation Modeling. Lawrence Erlbaum Associates: Mahwah, NJ.Google Scholar
Robertson, MM, Althoff, RR, Hafez, A, Pauls, DL (2008). Principal components analysis of a large cohort with Tourette syndrome. British Journal of Psychiatry: The Journal of Mental Science 193, 31–36.Google Scholar
Schwarz, G (1978). Estimating the dimension of a model. Annals of Statistics 6, 461–464.CrossRefGoogle Scholar
Storch, EA, Murphy, TK, Geffken, GR, Soto, O, Sajid, M, Allen, P, Roberti, JW, Killiany, EM, Goodman, WK (2004). Further psychometric properties of the Tourette's Disorder Scale-Parent Rated version (TODS-PR). Child Psychiatry and Human Development 35, 107–120.Google Scholar
Tolin, DF, Villavicencio, A, Umbach, A, Kurtz, MM (2011). Neuropsychological functioning in hoarding disorder. Psychiatry Research 189, 413–418.Google Scholar
Toplak, ME, Pitch, A, Flora, DB, Iwenofu, L, Ghelani, K, Jain, U, Tannock, R (2009). The unity and diversity of inattention and hyperactivity/impulsivity in ADHD: evidence for a general factor with separable dimensions. Journal of Abnormal Child Psychology 37, 1137–1150.Google Scholar
Tourette Syndrome Association International Consortium for Genetics (1999). A complete genome screen in sib pairs affected by Gilles de la Tourette syndrome. American Journal of Human Genetics 65, 1428–1436.CrossRefGoogle Scholar
Tourette Syndrome Association International Consortium for Genetics (2007). Genome scan for Tourette disorder in affected-sibling-pair and multigenerational families. American Journal of Human Genetics 80, 265–272.Google Scholar
Wang, Z, Maia, TV, Marsh, R, Colibazzi, T, Gerber, A, Peterson, BS (2011). The neural circuits that generate tics in Tourette's syndrome. American Journal of Psychiatry 168, 1326–1337.Google Scholar
Zhang, T, Wang, J, Yang, Y, Wu, Q, Li, B, Chen, L, Yue, Q, Tang, H, Yan, C, Lui, S, Huang, X, Chan, RC, Zang, Y, He, Y, Gong, Q (2011). Abnormal small-world architecture of top-down control networks in obsessive-compulsive disorder. Journal of Psychiatry & Neuroscience: JPN 36, 23–31.CrossRefGoogle ScholarPubMed
Supplementary material: File

Hirschtritt supplementary material

Hirschtritt supplementary material 1

Download Hirschtritt supplementary material(File)
File 177.3 KB