RESIDENT: Psychiatric Co-Morbidities in Tic Disorders: Are Current Screening Instruments Suitable?
Presenting Author(s): Rachael Nicholls
Co-Author(s): Dr. Tamara Pringsheim, MD, FRCPC; Dr. Davide Martino, MD, FRCPC; Dr. Natalia Szejko, MD.
Date and time: 23 Mar 2024 from 14:00 to 14:15
Location: Hawthorn C
Learning Objectives
1. Review the epidemiology of psychiatric co-morbidities in tic disorders;
2. Evaluate the psychometric properties of four commonly used screening instruments (PHQ-9, GAD-7, ASRS, OCI) when applied to the tic disorders population; and
3. Explore whether established instrument cut-points in the general population are suitable for screening in the tic disorders population.
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Abstract
Background:
In tic disorders, attention-deficit hyperactivity disorder (ADHD), obsessive-compulsive disorder (OCD), depression, and anxiety are highly comorbid. Screening instruments for these conditions have been validated in the general population but it remains uncertain whether identical cut-points are applicable to individuals with tic disorders. This study assesses whether the established cut-points in four commonly used instruments (General Anxiety Disorder-7 [GAD-7], Patient Health Questionnaire-9 [PHQ-9], Adult ADHD Self
Report Scale [ASRS], Obsessive Compulsive Inventory [OCI]) are suitable for adults with tic disorders.
Methods:
36 adults diagnosed with tic disorders completed these screening instruments and a diagnostic psychiatric interview. Measures of diagnostic accuracy were calculated (area under the receiver- operating characteristic curve [AUC], sensitivity, specificity, positive predictive value, negative-predictive value, positive likelihood ratio, and negative likelihood ratio) for each instrument at various cut-points.
Results and conclusions:
Based on the psychiatric interview, the prevalence of anxiety, depression, OCD and ADHD were 41.7%, 16.7%, 27.8% and 63.9%, respectively. In our sample of people with tics, the established cut-point to indicate a positive screening score in the general population had the following sensitivities, specificities, and AUC: GAD-7 ≥10 (sensitivity 66.67%, specificity 71.43%, AUC 80%), PHQ-9 ≥10 (sensitivity 100.00%, specificity 40.00%, AUC 74%), ASRS ≥14 (sensitivity 82.61%, specificity 76.92%, AUC 83%), OCI ≥40 (sensitivity 70%, specificity 61.5%, AUC 81%). The best performing tools were ASRS and OCI, followed by GAD-7 and PHQ-9. Further research is needed to develop specific measurements for the assessment of comorbidities in patients with tics.