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Answer 1
  1. Chronic motor tic disorder. This patient most likely has chronic motor tic disorder, which is characterized by at least 1 motor tic (sudden, rapid, recurrent, nonrhythmic, stereotyped motor movements) that persists daily or intermittently for at least 1 year with onset prior to age 18 years.1 The patient’s eye blinking and facial grimacing are simple motor tics. Other common motor tics include shoulder shrugging, arm jerking, rubbing, and sniffing. If the patient displayed vocal tics in addition to motor tics, the appropriate diagnosis would be Tourette’s disorder. The symptoms do not appear to be significantly impairing the patient’s psychosocial functioning. Most DSM-IV-TR diagnostic categories are contingent upon symptoms causing significant impairment in social or other important areas of functioning, but tic disorders do not carry this contingency.1 Synkinesis is an involuntary movement that occurs specifically in conjunction with a voluntary motor action (eg, movement of the mouth when the person intends to raise the eyebrow).1 Repetitive motor tics do not represent normal childhood behavior.

     American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 4th ed., text revision. Washington (DC): The Association; 2000.
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