Tourette Syndrome

Question 1

Classes of medications for treating Tourette’s

Answer 1

• Dopamine antagonists (atypical antipsychotics)
• Dopamine depleters
• Centrally acting alpha agonists

Question 2

Most commonly used medications for Tourette’s in the USA in actual practice

Answer 2

• Resperidone (atypical antipsychotic)
• Clonidine (central alpha agonist)
• Aripiprazole (atypical antipsychotic)

Question 3

Diagnostic criteria for Tourette’s

Answer 3

• Multiple motor and one or more vocal tics during the illness course (but not necessarily at the same time)
• Frequency of tics many times a day, nearly every day, for more than 1 year
• No period of remission lasting more than 2 months
• Onset before 18 years of age
• Not due to substance or other medical condition

Question 4

Athetoid movements

Answer 4

Slow, irregular, writhing movements

(athetosis)

Question 5

PANDAS

Answer 5

• Pediatric autoimmune neuropsychiatric disorder associated with streptococcal infection
• Characteried by winter-spring seasonal worsening of tics
• OCD, Tourette, and tics are more common in chilren who have had sreptococcal infection in the last 3 months or multiple in the last 12 months
• Must be at least considered before starting treatment for Tourette’s

Question 6

Duration of transient tic disorders

Answer 6

Last at least 4 weeks, but not longer than 1 year

Question 7

Chronic motor or vocal tic disorders

Answer 7

May last longer than 1 year

But, there is an absence of multiple motor tics and/or motor and vocal tics occurring simultaneously

Question 8

Habit reversal training

Answer 8

Form of psychotherapy with good empirical evidence for treating tic disorders

Involves training the child to become aware of the averseive sensation, called a premonitory urge, that is relieved by tics. Then, to build a conscious response to this urge without engaging in tic behavior.

Question 9

Best pharmacotherapy choice for a patient with ADHD and tics

Answer 9

Centrally acting alpha agonists

Clonidine or guanfacine

Question 10

Most effective, evidence based atypical antipsychotic for treating tic disorders

AND, its side effects

Answer 10

Risperidone

Side effects: Weight gain, lipid abnormalities, sedation. In addition to the classic dopamine antagonist stuff.

Question 11

If all else fails, what neuroleptics are used for Tourette’s?

Answer 11

Haloperidol or pimozide

Note that if pimozide is used, there is risk of QTc prolongation, and patients must have regular ECG checks

Question 12

What are the options if a patient with ADHD develops tics on a stimulant?

Answer 12

1. Switch to atomoxetine therapy
2. Add a centrally acting alpha-2 agonist

Question 13

When patients present with anxiety-provoked tics, it is often best to. . .

Answer 13

. . . treat the anxiety and see if the tics respond

So, rather than starting a dopamine antagonist or adrenergic agonist, you might start an SSRI

Question 14

Vocal tic examples

Answer 14

• Words
• Throat clearing
• Grunting
• Squeaking