Abstract
Background
It remains unclear if individuals with Tourette syndrome (TS) or chronic tic disorder
(CTD) have an elevated risk of subsequent substance misuse.
Methods
In this population-based cohort study, we investigated the association between ICD
diagnoses of TS/CTD and substance misuse outcomes, accounting for psychiatric comorbidity
and familial factors. The cohort included all individuals living in Sweden at any
time between January 1, 1973, and December 31, 2013. Substance misuse outcomes were
defined as an ICD code of substance use–related disorder or cause of death, or as
a substance use–related criminal conviction in the nationwide registers.
Results
The cohort included 14,277,199 individuals, of whom 7832 had a TS/CTD diagnosis (76.3%
men). TS/CTD was associated with an increased risk of any subsequent substance misuse
outcomes (adjusted hazard ratio [aHR], 3.11; 95% confidence interval [CI], 2.94–3.29),
including alcohol-related disorder (aHR, 3.45; 95% CI, 3.19–3.72), drug-related disorder
(aHR, 6.84; 95% CI, 6.32–7.40), substance-related criminal convictions (aHR, 2.56;
95% CI, 2.36–2.77), and substance-related death (aHR, 2.54; 95% CI, 1.83–3.52). Excluding
psychiatric comorbidities had little effect on the magnitude of the associations,
with the exception of attention-deficit/hyperactivity disorder, which attenuated the
risk of any substance misuse outcomes (aHR, 2.00; 95% CI, 1.82–2.19). The risk of
any substance misuse outcomes in individuals with TS/CTD was substantially attenuated
but remained significant when compared with their unaffected siblings (aHR, 1.74;
95% CI, 1.53–1.97).
Conclusions
TS/CTD were associated with various types of subsequent substance misuse outcomes,
independently of psychiatric comorbidity and familial factors shared between siblings.
Screening for drug and alcohol use should become part of the standard clinical routines,
particularly in patients with comorbid attention-deficit/hyperactivity disorder.
Keywords
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References
- Diagnostic and Statistical Manual of Mental Disorders.5th ed. American Psychiatric Press, Washington, DC2013
- Population prevalence of Tourette syndrome: A systematic review and meta-analysis.Mov Disord. 2015; 30: 221-228
- Lifetime prevalence, age of risk, and genetic relationships of comorbid psychiatric disorders in Tourette syndrome.JAMA Psychiatry. 2015; 72: 325-333
- An international perspective on Tourette syndrome: Selected findings from 3500 individuals in 22 countries.Dev Med Child Neurol. 2000; 42: 436-447
- Gilles de la Tourette syndrome and disruptive behavior disorders: Prevalence, associations, and explanation of the relationships.J Neuropsychiatry Clin Neurosci. 2015; 27: 33-41
- Course of Tourette syndrome and comorbidities in a large prospective clinical study.J Am Acad Child Adolesc Psychiatry. 2017; 56: 304-312
- Age, period and cohort effects on time trends in alcohol consumption in the Swedish adult population 1979–2011.Alcohol Alcoholism. 2015; 50: 319-327
- Age, period and cohort trends in drug abuse hospitalizations within the total Swedish population (1975–2010).Drug Alcohol Depend. 2014; 134: 355-361
- Changes in mortality due to major alcohol-related diseases in four Nordic countries, France and Germany between 1980 and 2009: A comparative age–period–cohort analysis.Addiction. 2015; 110: 1443-1452
- Psychiatric comorbidities in alcohol use disorder.Lancet Psychiatry. 2019; 6: 1068-1080
- Comorbidity of substance misuse with anxiety-related and depressive disorders: A genetically informative population study of 3 million individuals in Sweden.Psychol Med. 2020; 50: 1706-1715
- Genetic factors in substance abuse based on studies of Tourette syndrome and ADHD probands and relatives. I. Drug abuse.Drug Alcohol Depend. 1994; 35: 1-16
- Genetic factors in substance abuse based on studies of Tourette syndrome and ADHD probands and relatives. II. Alcohol abuse.Drug Alcohol Depend. 1994; 35: 17-24
- Cannabinoids: Possible role in patho-physiology and therapy of Gilles de la Tourette syndrome.Acta Psychiatr Scand. 1998; 98: 502-506
- Gilles de la Tourette-Syndrom: Einfluss von nikotin, alkohol und marihuana auf die kliniche symptomatik.Nervenarzt. 1997; 68: 985-989
- The Swedish personal identity number: Possibilities and pitfalls in healthcare and medical research.Eur J Epidemiol. 2009; 24: 659-667
- External review and validation of the Swedish National Inpatient Register.BMC Public Health. 2011; 11: 450-466
- The Swedish Multi-generation Register.Methods Mol Biol. 2011; 675: 215-220
- The Swedish cause of death register.Eur J Epidemiol. 2017; 32: 765-773
- Registers of the Swedish total population and their use in medical research.Eur J Epidemiol. 2016; 31: 125-136
- Association of Tourette syndrome and chronic tic disorder with metabolic and cardiovascular disorders.JAMA Neurol. 2019; 76: 454-461
- Metabolic and cardiovascular complications in obsessive-compulsive disorder: A total population, sibling comparison study with long-term follow-up.Biol Psychiatry. 2018; 84: 324-331
- Association of Tourette syndrome and chronic tic disorders with objective indicators of educational attainment: A population-based sibling comparison study.JAMA Neurol. 2018; 75: 1098-1105
- Validity and reliability of chronic tic disorder and obsessive-compulsive disorder diagnoses in the Swedish National Patient Register.BMJ Open. 2015; 5e007520
- All in the family: Comparing siblings to test causal hypotheses regarding environmental influences on behavior.Curr Dir Psychol Sci. 2010; 19: 319-323
- Critical need for family-based, quasi-experimental designs in integrating genetic and social science research.Am J Public Health. 2013; 103: 46-55
- Fixed effects analysis of repeated measures data.Int J Epidemiol. 2014; 43: 264-269
- A comprehensive nationwide study of the incidence rate and lifetime risk for treated mental disorders.JAMA Psychiatry. 2014; 71: 573-581
- National cohort study of absolute risk and age-specific incidence of multiple adverse outcomes between adolescence and early middle age.BMC Public Health. 2015; 15: 920-930
- Comorbidity of Substance Use and Mental Disorders in Europe. European Monitoring Centre for Drugs and Drug Addiction Insights. 19. Publications Office of the European Union, Luxembourg2015
- Attention-deficit/hyperactivity disorder and substance abuse.Pediatrics. 2014; 134: e293-e301
- Genetic and environmental contributions to the association between attention deficit hyperactivity disorder and alcohol dependence in adulthood: A large population-based twin study.Am J Med Genet B Neuropsychiatr Genet. 2015; 168: 414-422
- Examining the association between attention deficit hyperactivity disorder and substance use disorders: A familial risk analysis.J Psychiatr Res. 2017; 85: 49-55
- The potential of cannabinoid-based treatments in Tourette syndrome.CNS Drugs. 2019; 33: 417-430
- Common adult psychiatric disorders in Swedish primary care where most mental health patients are treated.BMC Psychiatry. 2017; 17: 234-244
- Diagnosing comorbidity in psychiatric hospital: Challenging the validity of administrative registers.BMC Psychiatry. 2013; 13: 13-20
Article Info
Publication History
Published online: September 21, 2020
Accepted:
September 16,
2020
Received in revised form:
September 2,
2020
Received:
March 12,
2020
Identification
Copyright
© 2020 Society of Biological Psychiatry.
