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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]

Nitschke and Stewart 3 state that the oral form of Nembutal sold in 100ml bottles (sterile bottles) at a concentration of 60mg per ml (. 6 grams in a bottle) is enough to provide a peaceful death, although in some cases this can take up to 24 hours. For powdered Chinese Nembutal which is sold in higher quantities, 10grams dissolved in 50ml of water is suggested, and forum posts suggest this is a more reliable dose whilst also being easier to ingest. They recommend ceasing any other medications a few days before taking Nembutal. There is also non-sterile (green coloured) Nembutal that is concentrated 300mg per ml, in which case a 50ml sample equates to 15 grams, and is more than enough for a peaceful death. Compassion in Dying 5 recommend 6g - 9g of Nembutal. Dignitas use 15 grams of a concentrated soluble form of Nembutal that can be swallowed in a few mouthfuls. 3, 6

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