Tourette syndrome, obsessive-compulsive disorder

Eapen, V., Robertson, M.M., Alsobrook, J.R, 2nd, and Pauls, D.L. (1997) Obsessive compulsive symptoms in Gilles de la Tourette syndrome and obsessive compulsive disorder differences by diagnosis and family history. Am Med Genet 74 432 38. 

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. 

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. 

King, R.A., Leckman, J.E, Scahill, L.D., and Cohen, D.J. (1998) Obsessive-compulsive disorder, anxiety and depression. 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. 43-62. 

Santangelo, S.L., Pauls, D.L., Goldstein, J.M., Faraone, S.V., Tsuang, M.T., and Leckman, J.F. (1994) Tourette s syndrome what are the influences of gender and comorbid obsessive-compulsive disorder J Am Acad Child Adolesc Psychiatry 33 795-804. 

Como, P.G. and Kurlan, R. (1991) An open-label trial of fluoxetine for obsessive-compulsive disorder in Gilles de la Tourette s Syndrome. Neurology 41 872-874. 

Fennig, S., Fennig, S., Pato, M., and Weitzman, A. (1994) Emergence of symptoms of Tourette s syndrome during fluvoxamine treatment of obsessive-compulsive disorder. Br J Psychiatry 164 839-841. 

Hewlett, W.A. (1993) The use of benzodiazepines in obsessive compulsive disorder and Tourette s syndrome. Psychiatr Ann 23 309-316. 

Miguel, E.C., do Rosario-Campos, M.C., Shavitt, R.G., Hounie, A.G., and Mercandante, M.T., (2001) The tic-related obsessive-compulsive disorder phenotype and treatment implications. In Cohen, D.J., Jankovic, J., Goetz, C., eds. Tourette Syndrome and Associated Disorders (Adv Neurol Yol 85). Philadelphia Lippin-cott-Williams Wilkins, pp. 43-56. 

Note Doses are provided as general guidelines only, and are not meant to be definitive. All doses must be individualized and monitored through appropriate clinical and/or laboratory means. ADHD, attention-deficit hyperactivity disorder bid, twice daily c, capsule CYP, cytochrome P450 EKG electrocardiogram FDA, Food and Drug Administration IM, intramuscular MDD, major depressive disorder OCD, obsessive-compulsive disorder PDD, pervasive developmental disorder qd, once daily qhs each bedtime qoWk, every other week t, tablet tid, three times daily TS, Tourette s syndrome WBC, white blood cell count. 

Pauls DL, Towbin KE, Leckman JF, et al Gilles de la Tourette s syndrome and obsessive-compulsive disorder evidence supporting a genetic relationship. Arch Gen Psychiatry 43 1180-1182, 1986... 

Rauch SL, Whalen PJ, Curran T, Shin LM, Coffey BJ, Savage CR, Mclnerney SC, Baer L, Jenike MA (2001) Probing striato-thalamic function in obsessive-compulsive disorder and Tourette syndrome using neuroimaging methods. Adv Neurol 55 207-224. 

A possible interaction of risperidone with tetracycline has been reported in a 15-year-old adolescent with Asperger s syndrome, Tourette s syndrome, and obsessive-compulsive disorder (274). Acute exacerbation of motor and vocal tics occurred when tetracycline 250 mg bd was introduced for acne withdrawal of tetracycline resulted in an improvement in the tics. 

It is well recognized that in vulnerable individuals, methylphenidate can induce or aggravate Tourette s syndrome, most often characterized by motor tics and occasionally vocal tics (21). Moreover, obsessive-compulsive symptoms caused by methylphenidate have also been reported (22,23). However, it is not clear whether explosive episodes associated with Tourette s syndrome are an integral part of the disorder or occur as part of a co-morbid disorder, predominantly ADHD or obsessive-compulsive disorder. In this case the explosive episodes coincided with a period of treatment with methylphenidate. In view of the extreme, sudden, discrete nature of the outbursts and the temporal relation to treatment, it was concluded that the episodes were behavioral problems caused by methylphenidate, rather than a feature of the underlying ADHD. 

A 15-year-old youth with Asperger s syndrome, Tourette s syndrome, and obsessive-compulsive disorder was stabilized on risperidone 1.5 mg bd and sertraline 100 mg od and had marked improvement in his social skills and tics, until he was given tetracycline 250 mg bd for acne. Within 2 weeks his tics were acutely exacerbated with pronounced neck jerking and guttural sounds. The sertraline was increased to 150 mg/day, but the tics did not resolve. The tetracycline was withdrawn after 1 month, and the tics improved within a few weeks. 

Antidepressants tend to provide a more sustained and continuous improvement of the symptoms of attention-deficit/hyperactivity disorder than do the stimulants and do not induce tics or other abnormal movements sometimes associated with stimulants. Indeed, desipramine and nortriptyhne may effectively treat tic disorders, either in association with the use of stimulants or in patients with both attention deficit disorder and Tourette s syndrome. Antidepressants also are leading choices in the treatment of severe anxiety disorders, including panic disorder with agoraphobia, generalized anxiety disorder, social phobia, and obsessive-compulsive disorder, as weU as for the common comorbidity of anxiety in depressive illness. Antidepressants, especially SSRIs, also are employed in the management of posttraumatic stress disorder, which is marked by anxiety, startle, painful recollection of the traumatic events, and disturbed sleep. Initially, anxious patients often tolerate nonsedating antidepressants poorly (Table 17-1), requiring slowly increased doses. Their beneficial actions typically are delayed for several weeks in anxiety disorders, just as they are in major depression. 

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). 

Tourette s syndrome (TS) is a chronic neurological disorder characterized by motor tics, involuntary verbalizations, and obsessive-compulsive behaviors. The current treatment lends itself to the use of antipsychotic agents. However, these treatments are only effective in about 70% of the treated population.84-85 Nicotine potentiates the behavioral effects of antipsychotics in a number of animal models.86 Clinical trials are under way involving patients receiving both nicotine and antipsychotic agents and appear to be promising.87 To date, there have been no studies mentioning the use of lobeline in TS. 

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