Background History
Client is a 49 year old professional male employee working in a customer site who self-referred to occupational health seeking support. He reported intermittent neurological symptoms over a number of years and had been diagnosed 11 years earlier with Tourettes Syndrome (TS) although was apparently in denial of his diagnosis. The symptoms had worsened over the last year with increased involuntary vocal and motor tics, including tic attacks (whole body tics). He was able to suppress the tics whilst at work but later experienced increased tic activity which could be very powerul. A diagnosis of TS was confirmed by a second neurologist.
Primary Presenting Problems
- Increased involuntary vocal and motor tics
- Whole body tics
Secondary Presenting Problems
- Low self esteem
- Anger
- Feelings of isolation
- Despondency around personal and professional future
Support Received
A number of treatments were trialled with minimal/temporary effect:
- Anti-psychotics
- Anti-convulsants
- Anti-depressants
- Counselling.
Chest pain developed requiring hospitalisation for investigation with diagnosis of musculoskeletal condition secondary to the tic attacks. This was treated through Occupational Health (OH) physiotherapy. OH involvement remained ongoing, providing psychological support for employee and advice/ recommendations to line manager in relation to condition and symptom management in client's role and work environment.
A search was undertaken into alternative treatment options which were not readily known or available. Through the professional network a neuro-psychologist was sourced who agreed to support him in evidence based Habit Reversal Therapy (HRT), a self-help tic management technique which disrupts the motor pattern after it has started through use of competing responses.
Professional input throughout time of experiencing tics, diagnosis being confirmed and carrying out HRT with positive results included the following:
- Occupational Health Advisor
- Occupational Health Physician
- Occupational Health Physiotherapist
- Counsellor
- Alternative Therapist
- GP
- Neuropsychologist
- Neurologist
Outcome
A positive outcome has since been reached with improved tic management, and client publishing a professional journal article on being a TS sufferer and the impact of HRT both personally and professionally. He has written an article for Tourettes Action, delivered a talk at a TS conference and is now trained in HRT and delivering online therapy for tics and Tourettes sufferers.
The employee has kindly provided verbal consent for this case study to be submitted for the Salus Occupational Health, Safety and Return to Work Service website.