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Non-genetic, environmental, post-infectious, or psychosocial factors—while not causing Tourette's—can influence its severity. [26] Autoimmune processes may affect tic onset and exacerbation in some cases. In 1998, a team at the US National Institute of Mental Health proposed a hypothesis based on observation of 50 children that both obsessive–compulsive disorder (OCD) and tic disorders may arise in a subset of children as a result of a poststreptococcal autoimmune process. [3] Children who meet five diagnostic criteria are classified, according to the hypothesis, as having Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections ( PANDAS ). [41] This contentious hypothesis is the focus of clinical and laboratory research, but remains unproven. [2] [3] [42] Preliminary evidence suggest that refined sugar , caffeine , and gluten may exacerbate tics. [43]

Has been used for the symptomatic management of a variety of psychiatric illnesses † , 58 59 60 61 62 63 64 65 66 67 68 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 112 113 114 115 116 117 118 119 120 121 122 123 principally schizophrenia † , 58 59 60 61 62 63 64 65 66 67 68 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 but other agents generally are preferred. 69 70

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