Tourette Syndrome and Other Tic Disorders 139‘antipsychotics’ – an unfortunate name that could potentially give families
the misleading impression that tics are somehow psychotic. Neuroleptics
can generally reduce tic severity by about two-thirds, although sometimes
at a price. Complete abolition of tics is often not possible without pushing
neuroleptics to levels that result in unacceptable side effects. Histori-
cally, haloperidol and pimozide have been the most widely usedtypical
neuroleptics, but concerns about adverse effects such as extra-pyramidal
symptoms have prompted some to switch toatypicalneuroleptics such as
risperidone – though atypicals can have different but equally important
adverse effects of their own, including rapid weight gain and its metabolic
complications. The dosage needs to be titrated against clinical need in
order to ensure that the child or adolescent is always treated with the
lowest possible dose compatible with adequate (rather than total) tic
control. Clonidine or guanfacine can be used instead of neuroleptics: they
cause fewer adverse effects, but their corresponding disadvantage is lower
efficacy – tic severity is generally reduced by about one-third instead of
two-thirds.
Associated obsessions and compulsions may be helped by behaviour
therapy or medication: usually a selective serotonin reuptake inhibitor
(SSRI) or clomipramine, augmented, if necessary, by a neuroleptic. When
a child or adolescent with a tic disorder also has a significant problem
with inattention and restlessness, the use of stimulants is controversial
since they may aggravate tics. However, several large trials of children
with ADHD and tics have shown on average that tics do not worsen, and
stimulants remain the most effective treatment for ADHD. Alternatives
to stimulants include clonidine, atomoxetine, guanfacine, buproprion and
tricyclics such as desipramine.
Prognosis of Tourette syndrome
Complete or partial resolution is common in late teens or early twenties.
Tourette syndrome may persist throughout adulthood, but if it does, the
severity gradually wanes.
Subject review
Leckman JF, Bloch MH. (2008) Tic disorders.In: Rutter Met al.(eds)Rut-
ter’s Child and Adolescent Psychiatry, 5th edn. Wiley-Blackwell, Chichester,
pp. 719–736.
Further reading
Bloch MH et al. (2009) Meta-analysis: Treatment of attention-
deficit/hyperactivity disorder in children with comorbid tic disorders.