Tic disorders

Antipsychotics. It was recognized some years ago that high potency typical anti-psychotics, that is, haloperidol (Haldol) and pimozide (Orap), were effective in treating OCD patients who had a comorbid tic disorder. The efficacy of these agents, however, is primarily in redncing the tics rather than the core symptoms of OCD. 

One exception is the patient with both ADHD and tic disorders such as Tourette s syndrome. High potency antipsychotics have proved quite effective in treating both vocal and motor tics. 

Castellanos FX. Stimulants and tic disorders from dogma to data. Arch Gen Psychiatry... 

Uniabeied Uses Attention-deficit hyperactivity disorder (ADHD), tic disorders... 

Unlabeled Uses Chronic motor or vocal tic disorder, Tourette s disorder... 

Tic disorders are chronic conditions that are frequently associated with difficulties in self-esteem, family life, social acceptance, or school or job performance that are directly related to the presence of motor and/or phonic tics. Although tic symptoms have been reported since antiquity, systematic study of individuals with tic disorders dates from the nineteenth century. 

In addition to tics, individuals with tic disorders may present with a broad array of behavioral difficulties including disinhibited speech or conduct, im-pulsivity, distractibility, motoric hyperactivity, and obsessive-compulsive symptoms (Leckman and Cohen, 1998). Alternatively, a sizable portion of children and adolescents with tics will be free of coexisting developmental or emotional difficulties. Scientific opinion has been divided on how broadly to conceive the spectrum of maladaptive behaviors associated with Tourette s syndrome (TS) (Comings, 1988 Shapiro et al., 1988). 

In this chapter, a presentation of the phenomenology and classification of tic disorders precedes a review of the neurobiological substrates of these conditions. The general perspective presented is that TS and related disorders are model neurobiological disorders in which to study multiple interactive genetic and environmental mechanisms that interact over the course of development. 

Several widely used diagnostic classifications currently include sections on tic disorders. These include both the classification system published by the American Psychiatric Association (1994) and the criteria by the World Health Organization (1996). A third classification system, the Classification of Tic Disorders (CTD), has been offered by the Tourette Syndrome Classification Study Group (1993). Although clear differences exist comparing these classification schemes, they are broadly congruent. 

Children with a range of developmental disorders appear to be at increased risk for tic disorders. Kurlan and colleagues (1994) reported a fourfold increase in the prevalence of tic disorders among children in special educational settings in a single school district in upstate New York. These children were not mentally retarded but did have significant learning disabilities or other physical impairments. 

Tic disorders have long been identified as stress-sensitive conditions (Silva et al., 1995). Typically,... 

McDougle, C.J., Goodman, W.K., Leckman, J.F., Barr, L.C., Henin-ger, G.R., and Price, L.H. (1993). The efficacy of fluvoxamine in obsessive compulsive disorder effects of comorbid chronic tic disorder./ Clin Psychopharmacol 13 354—358. 

Perlmutter, S.J., Leitman, S.F., Garvey, M.A., Hamburger, S., Feldman, F., Leonard, H.L., and Swedo, S.F. (1999) Therapeutic plasma exchange and intravenous immunoglobulin for obsessive-compulsive disorder and tic disorders in childhood. Lancet 354 1153-1158. 

Tourette Syndrome Classification Study Group (1993) Definitions and classification of tic disorders. Arch Neurol 50 1013-1016. 

Approximately three-quarters of children with OCD have comorbid diagnoses. These include tic disorders (24%-30%) and mood disorders, especially major depression (26%-29%). Riddle and colleagues (1990) found that 38% of children with OCD have other anxiety disorders, while Swedo (1989) more specifically identified increased rates of simple phobias (17%), overanxious disorder (16%), and separation anxiety disorder (7%). Other reported comorbidities include specific developmental disabilities, adjustment disorder with depressed mood, oppositional defiant disorder, attention-deficit hyperactivity disorder (ADHD), conduct disorder, and enuresis/encopresis (Swedo et ah, 1989b Riddle et ah, 1990). 

Not surprisingly, the rates of OCD and tic disorders in first-degree relatives of PANDAS patients are higher... 

Before discussing the postulated disease mechanisms in postinfectious OCD and tic disorders, it is necessary to review several related concepts. 

Kiessling, L.S. (1989) Tic disorders associated with evidence of invasive group A beta hemolytic streptococcal disease. Dev Med Child Neurol 31 (Suppl 59) 48. 

Risperidone Benzisoxazole 0.25-10 High 2 Bipolar disorder Conduct disorder PDD Psychotic disorders Tic disorders Frazier et ah, 1999 Findling et ah, 2000a McDougle et ah, 1997 Armenteros et ah, 1997 Lombroso et ah, 1995... 

Ziprasidone Benzisothiazolyl 25-160 Medium 20 Tic disorders Salke et ah, 2000a... 

Haloperidol Butyrophenone 0.25-15 High 2 Autistic disorder Conduct disorder Schizophrenia Tic disorders Anderson et ah, 1984 Campbell et ah, 1984 Spencer and Campbell, 1984 Shapiro et ah, 1989... 

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