Tourette s syndrome

Antipsychotic medications are indicated in the treatment of acute and chronic psychotic disorders. These include schizophrenia, schizoaffective disorder, and manic states occurring as part of a bipolar disorder or schizoaffective disorder. The co-adminstration of antipsychotic medication with antidepressants has also been shown to increase the remission rate of severe depressive episodes that are accompanied by psychotic symptoms. Antipsychotic medications are frequently used in the management of agitation associated with delirium, dementia, and toxic effects of both prescribed medications (e.g. L-dopa used in Parkinson s disease) and illicit dtugs (e.g. cocaine, amphetamines, andPCP). They are also indicated in the management of tics that result from Gilles de la Tourette s syndrome, and widely used to control the motor and behavioural manifestations of Huntington s disease. 

The Orphan Drug Act of 1983 was passed to encourage die development and marketing of products used to treat rare diseases. The act defines a rare disease as a condition affecting fewer than 200,000 individuals in die United States. The National Organization of Rare Disorders reports that there are more tiian 6000 rare disorders that affect approximately 25 million individuals. Examples of rare disorders include Tourette s syndrome, ovarian cancer, acquired immunodeficiency syndrome (AIDS), Huntington s disease, and certain forms of leukemia... 

Stimulants should be initiated at recommended starting doses and titrated up with a consistent dosing schedule to the appropriate response while minimizing side effects (Table 39-2). Generally, stimulants should not be used in patients who have glaucoma, severe hypertension or cardiovascular disease, hyperthyroidism, severe anxiety, or previous illicit or stimulant drug abuse. Further, stimulants can be used, albeit cautiously, in patients with seizure disorders, Tourette s syndrome, and motor tics.14... 

Furthermore, the presence of CB1 in the structures and pathways associated with the pathophysiology of Tourette s syndrome, and especially the functional link between CB1 and Di, D2, also argues that the endocannabinoid system may have some involvement in this disorder as well (Consroe, 1998). In addition, it has been suggested that activation of CB1 receptors, also owing to their link with the dopaminergic system, may reduce dyskinesia produced by L-DOPA in patients with Parkinson s disease (Brotsie, 1998). 

Zyprexa (Olanzapine) Bipolar disorders Gilles de la Tourette s syndrome Psychotic disorders 1.9 0.6 1996 - UK and US Once daily... 

The answer is d. (Hardman, p 420. Katzung, p 4852) Tourette s syndrome is effectively treated with haloperidol, a high-potency antipsychotic. If patients are unresponsive or do not tolerate haloperidol, they might be switched to pimozide. 

Tourette s syndrome, schizophrenia, attention deficit disorder, anxiety, pain and for the mai r other diseases [1]. 

Similar associations have been reported between dopamine D receptor variants with Tourette s syndrome, obesity (87-89), and alcohol dependence (90-93), although these findings are still the subject of debate in the literature. From the point of view of pharmacogenetics, the TaqlA polymorphism of the dopamine D receptor is associated with the development of tardive dyskinesia (88,94,95). While the results of these association studies vary (3,12), these data clarify our under-... 

Pimozide (Orap). Pimozide is probably the most potent of all antipsychotics, but it is seldom used to treat schizophrenia. Instead, pimozide is most often used to treat Tourette s syndrome. There is actually no reason why pimozide can t be used to treat psychosis and no reason why other antipsychotics are not effective in Tourette s syndrome. Pimozide was simply used first in controlled clinical trials to treat Tourette s syndrome, and the physicians who routinely treat that illness became accustomed to using it. Pimozide is only available in an oral form. The lack of an injectable form to treat agitated patients as well as the lack of availability of data from controlled trials in schizophrenia patients likely explains why it has not been used very often in the treatment of schizophrenia. 

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. 

Patients with marked anxiety, tension, and agitation, because the drug may aggravate these symptoms hypersensitivity to methylphenidate or other components of the product patients with glaucoma, motor tics, or a family history or diagnosis of Tourette s syndrome during treatment with monoamine oxidase inhibitors (MAOIs), and also within a minimum of 14 days following discontinuation of an MAOl (hypertensive crises may result). 

Antipsychotic agents are also used for a diversity of other indications like hiccups, Tourette s syndrome, aggressive behavior in children and the elderly and alcohol withdrawal syndrome. Some of them are also used in anesthesia as they can potentiate the sedative, analgesics or anesthetic effects of other agents. Antipsychotics which are mainly active by blocking dopamine activity have also an effect on chemoreceptor trigger zone and may therefore be used as anti-emetics. 

Brett PM, Curtis D, Robertson MM, Curling HM (1995) Exclusion of the 5-HTlA serotonin neuroreceptor and tryptophan oxygenase genes in a large British kindred multiply affected with Tourette s syndrome, chronic motor tics, and obsessive-compulsive behavior. Am J Psychiatry 152 437-440... 

Excluding tardive dyskinesia, which appears to be produced to the same degree and frequency by all agents except clozapine. Pimozide is used principally in the treatment of Tourette s syndrome. 

Tourette s syndrome, a heterogeneous behavioral disorder associated with motor and vocal tics of variable form and severity, can be effectively treated with haloperidol. Antipsychotics can also be employed to control disturbed behavior in senile dementia or Alzheimer s disease, since they decrease confusion, agitation, and hyperactivity. Most of these drugs also exhibit a strong antiemetic effect and can sometimes be used clinically for this purpose. 

CS329 Muller-Vahl, K. R. Cannabinoids reduce symptoms of Tourette s syndrome. Expert Opin Pharmacother 2003 4(10) 1717-1725. 

Tourette s syndrome. Administration of nicotine (either 2 mg nicotine gum or 7 mg transdermal nicotine patch) potentiated the therapeutic properties of neuroleptics in treating patients with Tourette s syndrome, and a single patch may be effective for a variable number of days. These findings suggest that transdermal nicotine could serve as an effective adjunct to neuroleptic therapy . 

Tourette s syndrome. A syndrome of facial and vocal tics with onset in childhood, progressing to generalized jerking movements in any part of the body, with echolalia and coprolalia. 

Contraindications Diagnosis orfamily history of Tourette s syndrome glaucoma history of marked agitation, anxiety, or tension motor tics use within 14 days of MAOIs... 

Blurred vision, Tourette s syndrome (marked by uncontrolled vocal outbursts, repetitive body movements, and tics), palpitations... 

Mechanism of Action A diphenylbutylpiperidine that blocks dopamine at postsynap-tic receptor sites in the brain. Therapeutic Effect Suppresses behavioral response in psychosis and decreases abnormal movements associated with Tourette s syndrome. 

Leckman, J.F., Goodman, W.K., North, W.G., Chappell, P.B., Price, L.H., Pauls, D.L., Anderson, G.M., Riddle, M.A., McSwiggan-Hardin, M., McDougle, C.J., et al. (1994) Elevated cerebrospinal fluid levels of oxytocin in obsessive-compulsive disorder. Comparison with Tourette s syndrome and healthy controls. Arch Gen Psychiatry 51 782-792. 

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). 

Inputs from ascending dopamine pathways originating in the substania nigra, pars compacta, play a crucial role in coordinating the output from the striatum (Aosaki et ah, 1994). Explicit dopamine hypotheses for Tourette s syndrome posit either an excess of dopamine or an increased sensitivity of D2 dopamine re-... 

Tourette s Syndrome is a familial disorder (Pauls et ah, 1991 Walkup et ah, 1996). Twin and family studies provide evidence that genetic factors are involved in the vertical transmission within families of a vulnerability to TS and related disorders. The concordance rate for TS among monozygotic twin pairs is 50% while the concordance of dizygotic twin pairs is about 10% (Price et ah, 1985). If co-twins with chronic motor tic... 

Anderson, G.M., Leckman, J.F., and Cohen, D.J. (1998) Neurochemical and neuropeptide systems. In Leckman, J.E and Cohen, D.J. eds. Tourette s Syndrome Tics, Obsessions, Compulsions—Developmental Psychopathology and Clinical Care. New York John Wiley and Sons, pp. 261-281. 

Chappell, P., Leckman, J., Goodman, W., Bissette, G., Pauls, D., Anderson, G., Riddle, M., Scahill, L., McDougle, C., and Cohen, D. (1996) Elevated cerebrospinal fluid corticotropin-releasing factor in Tourette s syndrome comparison to obsessive compulsive disorder and normal controls. Biol Psychiatry 39 776-783. 

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