Diagnostic Hierarchy of Tic Disorders in Real-World Clinical Practice

Area of Science:

• Neuroscience
• Psychiatry
• Clinical Diagnostics

Background:

• Tic disorders are classified under the International Classification of Diseases (ICD-10) with a diagnostic hierarchy based on symptom duration and type.
• This hierarchy categorizes disorders into transient tic disorder (F95.0), chronic motor or vocal tic disorder (F95.1), and Tourette's syndrome (F95.2).

Purpose of the Study:

• To investigate the adherence to the ICD-10 diagnostic hierarchy for tic disorders in real-world clinical settings.
• To identify demographic and clinical factors associated with diagnostic errors.

Main Methods:

• Utilized the National Health Insurance Service-National Health Information Database for patient data.
• Defined Type A errors as misclassifications between transient, chronic, and Tourette's syndrome diagnoses.
• Defined Type B errors as repeated transient tic disorder diagnoses after more than 12 months.
• Employed analysis of variance, Student's t-tests, and chi-squared tests for statistical analysis.

Main Results:

• The vast majority of participants (96.5%) received diagnoses that correctly followed the established hierarchy.
• Type A or B diagnostic errors were more prevalent in males (p=0.005) and patients prescribed antipsychotics (p<0.001).
• A higher proportion of health insurance holders was noted among those with Type A errors (p=0.027).

Conclusions:

• The diagnostic hierarchy for tic disorders is largely followed in clinical practice.
• Diagnostic errors, though infrequent, are associated with specific demographic (male) and treatment (antipsychotic use) factors.