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Answer 3
  1. Tourette’s disorder. This patient most likely has Tourette’s disorder, which is characterized by at least 1 motor and 1 vocal tic (sudden, rapid, recurrent, nonrhythmic, stereotyped motor movements) that persist daily or intermittently for at least 1 year with onset prior to age 18 years.1,2 The patient’s arm jerking and head tossing are motor tics, while the throat clearing and grunting are vocal tics. Other common vocal tics include sniffing, clicking, coughing, and snorting.1 Complex tics, which can appear similar to the rituals observed in OCD (eg, locking a deadbolt repetitively), may develop in persons with Tourette’s disorder.2 The disorder is seen in approximately 1% of school-aged children and is more common in boys than in girls.2,3 There is evidence that Tourette’s disorder is genetic with a complex mode of transmission; however, some studies have suggested an autosomal dominant pattern.1 Choreiform movements, such as Sydenham’s chorea, are random, irregular, and nonstereotyped movements.1 Rett’s disorder is a severe pervasive developmental disorder that has only been reported in females.1

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

    2. Sadock BJ, Sadock VA. Synopsis of psychiatry. 9th ed. Philadelphia: Lippincott Williams & Wilkins; 2003:1246-53.

    3. Cummings JL, Mega MS. Neuropsychiatry and behavioral neuroscience. New York: Oxford University Press; 2003.

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