New‐onset functional tics during the COVID ‐19 pandemic: Clinical characteristics of 105 cases from a single centre
Open accessAbstract
BACKGROUND AND PURPOSE: The COVID-19 pandemic has been associated amongst other things with a sharp increase in adolescents and young adults presenting acutely with functional tics. Initial reports have suggested clinically relevant differences between functional tics and neurodevelopmental tics seen in primary tic disorders such as Tourette syndrome. We aimed to provide confirmatory findings from the largest single-centre cohort to date. METHODS: In the present study we present data from 105 consecutive patients who developed functional tics during a 3-year period overlapping with the COVID-19 pandemic (April 2020-March 2023). All patients underwent a comprehensive neuropsychiatric assessment at a single specialist centre for tic disorders. RESULTS: Female adolescents and young adults accounted for 69% of our sample. Functional tics had an acute/subacute onset in most cases (75% with a peak of severity within 1 month). We found a disproportionately high frequency of complex movements (81%) and vocalizations (75%). A subset of patients (23%) had a pre-existing primary tic disorder (Tourette syndrome with functional overlay). The most common psychiatric co-morbidities were anxiety (70%) and affective disorders (40%). Moreover, 41% of patients had at least one functional neurological disorder in addition to functional tics. Exposure to tic-related social media content was reported by half of the patients. CONCLUSIONS: Our findings confirm substantial clinical differences between functional tics developed during the pandemic and neurodevelopmental tics. Both patient- and tic-related red flags support the differential diagnostic process and inform ongoing monitoring in the post-pandemic era.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
The role of stress and anxiety in precipitating and maintaining complex tic presentations has been previously reported.
“The role of stress and anxiety in precipitating and maintaining complex tic presentations has been previously reported (12, 20, 21).”
From Integrated cognitive behavioral intervention for functional tics (I-CBiT): case reports and treatment formulation (2023) · cites this paper as [20]
The Results report stress or anxiety as a psychological trigger for functional tics in 72% of patients, and the Discussion says the vast majority presented with complex functional motor or vocal tics. The paper does not establish that stress or anxiety maintained those presentations after onset. (LLM, conf=0.86)
Experimental — accuracy not yet measuredThe case series sample is reflective of the sex composition of patients who presented to the clinical practices for treatment and is largely consistent with FTLB presentations in the population, with an estimated female:male ratio of 9:1.
“While this case series sample is reflective of the sex composition of the patients who presented to our clinical practices for treatment and is largely consistent with the FTLB presentations in the population, with an estimated female:male ratio of 9:1 (20, 29, 30)”
From Integrated cognitive behavioral intervention for functional tics (I-CBiT): case reports and treatment formulation (2023) · cites this paper as [20]
The Results (Table 1) report that 72.4% of this single-centre sample were female, and the Discussion says female predominance was broadly consistent with other functional-tic case series; it reports 87% female in an international registry. Neither figure establishes the claimed 9:1 female:male ratio in the population. The source also cannot establish whether the citing authors’ sample reflects patients presenting to their own practices. (LLM, conf=0.87)
Experimental — accuracy not yet measuredMore recent reports emphasize the role of anxiety in complex tic presentations and note that FTLBs often co-exist alongside neurodevelopmental tics.
“More recent reports emphasize the role of anxiety in complex tic presentations, noting that FTLBs often co-exist alongside neurodevelopmental tics and that this dual diagnosis has increased in recent years and/or been previously underestimated (20, 22, 23).”
From Integrated cognitive behavioral intervention for functional tics (I-CBiT): case reports and treatment formulation (2023) · cites this paper as [20]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Holmes, E. A., O'Connor, R. C., Perry, V. H., Tracey, I., Wessely, S., Arseneault, L., Ballard, C., Christensen, H., Cohen Silver, R., Everall, I., et al. (2020) · The Lancet Psychiatry · doi:10.1016/s2215-0366(20)30168-1 · Cited by 5,715 · see citing works
Does time spent using social media impact mental health?: An eight year longitudinal study
Coyne, S. M., Rogers, A. A., Zurcher, J. D., Stockdale, L., & Booth, M. (2020) · Computers in Human Behavior · doi:10.1016/j.chb.2019.106160 · Cited by 701 · see citing works
Course of Tic Severity in Tourette Syndrome: The First Two Decades
Leckman, J. F., Zhang, H., Vitale, A., Lahnin, F., Lynch, K., Bondi, C., Kim, Y.-S., & Peterson, B. S. (1998) · Pediatrics · doi:10.1542/peds.102.1.14 · Cited by 685 · see citing works
Fréeman, R. D., Fast, D. K., Burd, L., et al. (2000) · Developmental Medicine & Child Neurology · doi:10.1111/j.1469-8749.2000.tb00346.x · Cited by 216 · see citing works
Coprophenomena in Tourette syndrome
Fréeman, R. D., Zinner, S. H., Müller‐Vahl, K., Fast, D. K., Burd, L. J., Kano, Y., Rothenberger, A., Roessner, V., Kerbeshian, J., & Stern, J. S. (2009) · Developmental Medicine & Child Neurology · doi:10.1111/j.1469-8749.2008.03135.x · Cited by 173 · see citing works
<scp>TikTok</scp> Tics: A Pandemic Within a Pandemic
Olvera, C., Stebbins, G. T., Goetz, C. G., & Kompoliti, K. (2021) · Movement Disorders Clinical Practice · doi:10.1002/mdc3.13316 · Cited by 158 · see citing works
Lidstone, S. C., Costa-Parke, M., Robinson, E. J., Ercoli, T., & Stone, J. (2022) · Journal of Neurology Neurosurgery & Psychiatry · doi:10.1136/jnnp-2021-328462 · Cited by 139 · see citing works
Rapid Onset Functional Tic‐Like Behaviors in Young Females During the <scp>COVID</scp>‐19 Pandemic
Pringsheim, T., Ganos, C., McGuire, J. F., Hedderly, T., Woods, D., Gilbert, D. L., Piacentini, J., Dale, R. C., & Martino, D. (2021) · Movement Disorders · doi:10.1002/mds.28778 · Cited by 133 · see citing works
Tourette Syndrome and Chronic Tic Disorders: The Clinical Spectrum Beyond Tics
Martino, D., Ganos, C., & Pringsheim, T. M. (2017) · International review of neurobiology · doi:10.1016/bs.irn.2017.05.006 · Cited by 129 · see citing works
Repetitive Behaviours in Patients with Gilles de la Tourette Syndrome: Tics, Compulsions, or Both?
Worbe, Y., Mallet, L., Golmard, J., Béhar, C., Durif, F., Jalenques, I., Damier, P., Derkinderen, P., Pollak, P., Anheim, M., et al. (2010) · PLoS ONE · doi:10.1371/journal.pone.0012959 · Cited by 127 · see citing works
The clinical features of psychogenic movement disorders resembling tics
Baizabal-Carvallo, J. F., & Jankovic, J. (2014) · Journal of Neurology, Neurosurgery & Psychiatry · doi:10.1136/jnnp-2013-305594 · Cited by 125 · see citing works
Tics and functional tic-like movements: Can we tell them apart?
Ganos, C., Martino, D., Espay, A. J., Lang, A. E., Bhatia, K. P., & Edwards, M. J. (2019) · Neurology · doi:10.1212/wnl.0000000000008372 · Cited by 124 · see citing works
COVID-19 related increase in childhood tics and tic-like attacks
Heyman, I., Liang, H., & Hedderly, T. J. (2021) · Archives of Disease in Childhood · doi:10.1136/archdischild-2021-321748 · Cited by 120 · see citing works
Stop that! It’s not Tourette’s but a new type of mass sociogenic illness.
Müller-Vahl, K. R., Pisarenko, A., Jakubovski, E., & Fremer, C. (2022) · Brain · doi:10.1093/brain/awab316 · Cited by 114 · see citing works
Tics and <scp>TikTok</scp> : Functional Tics Spread Through Social Media
Hull, M., & Parnes, M. (2021) · Movement Disorders Clinical Practice · doi:10.1002/mdc3.13267 · Cited by 108 · see citing works
A positive diagnosis of functional (psychogenic) tics
Demartini, B., Ricciardi, L., Pareés, I., Ganos, C., Bhatia, K. P., & Edwards, M. J. (2014) · European Journal of Neurology · doi:10.1111/ene.12609 · Cited by 93 · see citing works
Sensory aspects of Tourette syndrome
Cox, J. H., Seri, S., & Cavanna, A. E. (2018) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2018.03.016 · Cited by 86 · see citing works
Self-citationAn Introduction to the Clinical Phenomenology of Tourette Syndrome
Martino, D., Madhusudan, N., Zis, P., & Cavanna, A. E. (2013) · International review of neurobiology · doi:10.1016/b978-0-12-411546-0.00001-9 · Cited by 82 · see citing works
Self-citationPandemic Tic‐like Behaviors Following Social Media Consumption
Paulus, T., Bäumer, T., Verrel, J., Weißbach, A., Roessner, V., Beste, C., & Münchau, A. M. (2021) · Movement Disorders · doi:10.1002/mds.28800 · Cited by 73 · see citing works
Pringsheim, T., Ganos, C., Nilles, C., Cavanna, A. E., Gilbert, D. L., Greenberg, E., Hartmann, A., Hedderly, T., Heyman, I., Liang, H., et al. (2023) · European Journal of Neurology · doi:10.1111/ene.15672 · Cited by 72 · see citing works
Self-citation“I swear it is Tourette’s!”: on functional coprolalia and other tic-like vocalizations
Ganos, C., Edwards, M. J., & Müller-Vahl, K. (2016) · Psychiatry Research · doi:10.1016/j.psychres.2016.10.021 · Cited by 71 · see citing works
Rapid onset of functional tic‐like behaviours in young adults during the COVID‐19 pandemic
Pringsheim, T. M., & Martino, D. (2021) · European Journal of Neurology · doi:10.1111/ene.15034 · Cited by 71 · see citing works
The Phenomenology of Tics and Tic-Like Behavior in TikTok
Vera, A. G. Z., Bruce, A. B., Garris, J. F., Tochen, L. S., Bhatia, P., Lehman, R., Lopez, W. L., Wu, S. W., & Gilbert, D. L. (2022) · Pediatric Neurology · doi:10.1016/j.pediatrneurol.2022.02.003 · Cited by 68 · see citing works
Gilles de la Tourette syndrome as a paradigmatic neuropsychiatric disorder
Cavanna, A. E. (2018) · CNS Spectrums · doi:10.1017/s1092852918000834 · Cited by 67 · see citing works
Self-citationPrevalence and phenomenology of eye tics in Gilles de la Tourette syndrome
Martino, D., Cavanna, A. E., Robertson, M. M., & Orth, M. (2012) · Journal of Neurology · doi:10.1007/s00415-012-6470-1 · Cited by 63 · see citing works
Self-citationPaediatric tic-like presentations during the COVID-19 pandemic
Buts, S., Duncan, M., Owen, T., Martino, D., Pringsheim, T., Byrne, S., McWilliams, A., Murphy, T., Malik, O., Liang, H., et al. (2022) · Archives of Disease in Childhood · doi:10.1136/archdischild-2021-323002 · Cited by 60 · see citing works
Han, V. X., Kozlowska, K., Kothur, K., Lorentzos, M., Wong, W. K., Mohammad, S. S., Savage, B., Chudleigh, C., & Dale, R. C. (2022) · Journal of Paediatrics and Child Health · doi:10.1111/jpc.15932 · Cited by 60 · see citing works
The spectrum of functional tic-like behaviours: data from an international registry
Martino, D., Hedderly, T., Murphy, T., Müller‐Vahl, K. R., Dale, R. C., Gilbert, D. L., Rizzo, R., Hartmann, A., Nagy, P., Anheim, M., et al. (2023) · European Journal of Neurology · doi:10.1111/ene.15611 · Cited by 58 · see citing works
‘It's a curse!’: coprolalia in T ourette syndrome
Eddy, C. M., & Cavanna, A. E. (2013) · European Journal of Neurology · doi:10.1111/ene.12207 · Cited by 56 · see citing works
Self-citationTHE INTERRATER RELIABILITY OF THE POSITIVE AND NEGATIVE SYNDROME SCALE (PANSS)
Bentsen, H., Munkvold, O. G., Notland, T. H., Boye, B., Bjørge, H., Lersbryggen, A. B., Oskarsson, K. H., Berg-Larsen, R., & Malt, U. F. (1996) · International Journal of Methods in Psychiatric Research · doi:10.1002/(sici)1234-988x(199612)6:4 · Cited by 55 · see citing works
Frey, J., BLACK, K. J., & Malaty, I. A. (2022) · Psychology Research and Behavior Management · doi:10.2147/prbm.s359977 · Cited by 51 · see citing works
Beyond tics: movement disorders in patients with Tourette syndrome
Baizabal‐Carvallo, J. F., & Jankovic, J. J. (2021) · Journal of Neural Transmission · doi:10.1007/s00702-021-02386-0 · Cited by 43 · see citing works
Recognizing Uncommon Presentations of Psychogenic (Functional) Movement Disorders
Baizabal‐Carvallo, J. F., & Fekete, R. (2015) · Tremor and Other Hyperkinetic Movements · doi:10.5334/tohm.266 · Cited by 37 · see citing works
Martindale, J. M., & Mink, J. W. (2022) · Frontiers in Pediatrics · doi:10.3389/fped.2022.863919 · Cited by 34 · see citing works
Course of Tic Severity in Tourette Syndrome: The First Two Decades
Leckman, J. F., Zhang, H., Vitale, A., et al. (1999) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1097/00004583-199904000-00029 · Cited by 33 · see citing works
The neuropsychiatry of Gilles de la Tourette syndrome: The état de l’art
Cavanna, A. E. (2018) · Revue Neurologique · doi:10.1016/j.neurol.2018.06.006 · Cited by 32 · see citing works
Self-citationThe recent surge of functional movement disorders: social distress or greater awareness?
Nilles, C., Pringsheim, T. M., & Martino, D. (2022) · Current Opinion in Neurology · doi:10.1097/wco.0000000000001074 · Cited by 28 · see citing works
Mass social media-induced illness presenting with Tourette-like behavior
Fremer, C., Szejko, N., Pisarenko, A., Haas, M., Laudenbach, L., Wegener, C., & Müller-Vahl, K. R. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.963769 · Cited by 24 · see citing works
(2022) · PubMed Central · Cited by 20 · see citing works
Creating a Patient-Based Diagnostic Checklist for Functional Tics During the COVID-19 Pandemic
Trau, S. P., Quehl, L., Tsujimoto, T. H. M., Lin, F., & Singer, H. S. (2022) · Neurology Clinical Practice · doi:10.1212/cpj.0000000000200067 · Cited by 20 · see citing works
Nonepileptic attack disorder and functional movement disorder: A clinical continuum?
Rather, M. A., & Cavanna, A. E. (2020) · Epilepsy & Behavior · doi:10.1016/j.yebeh.2020.107028 · Cited by 18 · see citing works
Self-citationIncreased Number of Functional Tics Seen in Danish Adolescents during the COVID-19 Pandemic
Okkels, K. B., Skov, L., Klansø, S., Aaslet, L., Grejsen, J., Reenberg, A., Sørensen, C. B., & Debes, N. M. (2022) · Neuropediatrics · doi:10.1055/a-1985-6862 · Cited by 18 · see citing works
Nagy, P., Cserháti, H., Rosdy, B., Bodó, T., Hegyi, M., Szamosújvári, J., Fogarasi, D. J., & Fogarasi, A. (2022) · Ideggyógyászati szemle · doi:10.18071/isz.75.0211 · Cited by 16 · see citing works
Jack, R. H., Joseph, R. M., Coupland, C. A. C., Hall, C. L., & Hollis, C. P. (2023) · EClinicalMedicine · doi:10.1016/j.eclinm.2023.101857 · Cited by 14 · see citing works
Aggression Toward Others Misdiagnosed as Primary Tics
Kurvits, L., Mainka, T., Cavanna, A. E., Kühn, A. A., & Ganos, C. (2021) · Movement Disorders Clinical Practice · doi:10.1002/mdc3.13236 · Cited by 11 · see citing works
Self-citationNeurodevelopmental versus Functional Tics
Cavanna, A. E., Purpura, G., & Nacinovich, R. (2022) · Archives of Medicine and Health Sciences · doi:10.4103/amhs.amhs_246_22 · Cited by 8 · see citing works
Self-citationTourette Syndrome with Functional Overlay: A Case Series
Cavanna, A. E., Damodaran, L., Purpura, G., & Nacinovich, R. (2022) · Archives of Medicine and Health Sciences · doi:10.4103/amhs.amhs_247_22 · Cited by 7 · see citing works
‘Le tic’: A short story on psychogenic tics by Guy de Maupassant
Cavanna, A. E. (2022) · Revue Neurologique · doi:10.1016/j.neurol.2021.11.011 · Cited by 5 · see citing works
Self-citationPA.07 A case of "pseudo-Tourette" syndrome
Rather, M. A., & Cavanna, A. E. (2011) · Journal of Neurology Neurosurgery & Psychiatry · doi:10.1136/jnnp-2011-300504.34 · Cited by 4 · see citing works
Self-citation
Flagged first, then by citations
Research works printed but not linked: 4
- Paulus T, Bäumer T, Verrel J, et al. Pandemic tic-like behaviours fol- lowing social media consumption. Mov Disord. 2021;36:2932-2935.
- Robertson MM, Eapen V. The National Hospital Interview Schedule for the assessment of Gilles de la Tourette syndrome. Int J Methods Psychiatr Res. 1996;6:203-226.
- Rather MA, Cavanna AE. A case of "pseudo-Tourette" syndrome. J Neurol Neurosurg Psychiatry. 2011;82:e2.
- Eddy CM, Cavanna AE. 'It's a curse!': coprolalia in Tourette syn- drome. Eur J Neurol. 2013;20:1467-1470.
Cited by
Sorted by citations
Maxwell, A., Zouki, J.-J., & Eapen, V. (2023) · Frontiers in Pediatrics · doi:10.3389/fped.2023.1265123 · Cited by 18 · see citing works
- Authors
- Cavanna, A. E., Purpura, G., Riva, A., Nacinovich, R., & Seri, S.
- Affiliations
- Aston University (GB)
- University of Milano-Bicocca (IT)
- Corresponding author
- Cavanna, Andrea Eugenio
- Venue
- European Journal of Neurology
- Publisher
- Wiley
- Published
- 2023-05-26
- Volume
- 30
- Issue
- 8
- Pages
- 2411-2417
- ISSN
- 1351-5101 (ISSN-L)
- 1468-1331
- OpenAlex
- W4376573393
- Cited by
- 23
- References
- 49
- Citations by year
- 2026: 8 · 2025: 4 · 2024: 8 · 2023: 3
- FWCI
- 6.68
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- European Journal of Neurology (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- BOA (University of Milano-Bicocca) (submittedVersion, cc-by-nc)
- Aston Publications Explorer (Aston University) (submittedVersion)
- University of Birmingham Research Portal (University of Birmingham) (submittedVersion, cc-by-nc)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Obsessive-Compulsive Spectrum Disorders
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Social Sciences › Psychology › Clinical Psychology › COVID-19 and Mental Health
- Keywords
- COVID-19 pandemic, Tourette syndrome, conversion disorder, psychiatric comorbidity, anxiety, mood disorders, social media exposure, differential diagnosis, adolescents and young adults, complex movements, vocalizations
- MeSH terms
- COVID-19, Adolescent, Female, Tourette Syndrome, Humans, Tic Disorders, Tics, Young Adult, Pandemics
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
