Tourette syndrome and rage attacks — a longitudinal and cross-sectional study

Introduction: Rage attacks (RA) are prevalent in patients with Tourette syndrome (TS) and affect their quality of life severely. Due to TS’s relationship with attention deficit hyperactivity disorder (ADHD) and obsessive-compulsive disorder (OCD) a genetic reason or an increased level of irritability from early in life could be hypothesized. This longitudinal study aims to examine the correlation between tic severity and comorbidities and RA at baseline and 6 years later. We hypothesize that a higher symptom load of TS and comorbidities results in more RA. Methods: We examined 314 patients with TS (age 5-19) at baseline and re-examined 227 patients 6 years later together with a matched control group using various instruments to assess severity of tics, ADHD, OCD, and presence of RA. Results: Patients experienced more RA than control subjects at both timepoints. Patients with RA at baseline had more compulsions and higher ADHD-scores at baseline than patients without RA but this difference was not seen at follow-up. Patients with RA at follow-up had higher ADHD-scores at baseline. Tic severity was worse in patients with RA at both timepoints but was lower in the group who had developed RA at T2. Conclusion: Patients with TS had significantly more RA than control subjects. The severity of compulsions and ADHD correlated with the presence of RA, and higher ADHD-scores early in life correlated with presence of RA in adolescence. This suggests that it is important to screen for the presence of RA in patients with TS – especially in patients who also have comorbid ADHD and/or OCD.