Antipsychotic-Associated Symptoms of Tourette Syndrome: A Systematic Review

Abstract

Tics can be a disturbing adverse effect of antipsychotics. Clinicians need to be particularly vigilant when initiating and modifying antipsychotic regimens.

Chlorpromazine-Induced Relapse of Tourette Syndrome in a Patient With Intellectual Disability, Attention Deficit Hyperactivity Disorder, and Schizophrenia

“…The main finding of this case report is the re-emergence of vocal and motor tics in a patient with a history of TS, soon after initiation of chlorpromazine therapy. Although it may seem paradoxical as antipsychotics are the first-line treatment for TS, several cases of antipsychotic-induced tics have been previously reported [ 5 - 10 ]. One systematic review by Kim et al identified 60 cases of antipsychotic-induced tics, with 30 cases associated with first-generation antipsychotics and 27 with second-generation antipsychotics [ 5 ].…”

“…Although it may seem paradoxical as antipsychotics are the first-line treatment for TS, several cases of antipsychotic-induced tics have been previously reported [ 5 - 10 ]. One systematic review by Kim et al identified 60 cases of antipsychotic-induced tics, with 30 cases associated with first-generation antipsychotics and 27 with second-generation antipsychotics [ 5 ]. In addition, the occurrence of vocal tics was significantly higher in the first-generation antipsychotic use as compared to second-generation antipsychotics.…”

“…Most of the cases have been reported in the context of tardive syndromes and tics appeared after long-term antipsychotic therapy. However, patients with a history of inattention, hyperactivity, and motor and vocal tics experienced relapse or exacerbation of tics relatively earlier during the course of antipsychotic therapy [ 5 ]. For example, Gualtieri and Patterson reported two cases, both aged nine years, with symptoms of inattention, hyperactivity, and aggression, who developed phonic and motor tics two weeks after initiation of haloperidol and thioridazine, respectively [ 9 ].…”

“…Considering that onset of tic relapse in our case and many others with a childhood history of tics was relatively earlier, one plausible explanation of early-onset antipsychotic-induced tic disorder may be that, at least in a subset of TS patients, antipsychotics act on an already existing hypersensitive dopaminergic system, leading to increased phasic (burst firing) dopamine release. The specificity of antipsychotics-induced tics to phasic dopamine release is further supported by the fact that tics resolved after discontinuation of antipsychotic drugs in most case reports, unlike tardive dyskinesias, which typically persist after discontinuation of antipsychotic drugs [ 5 ].…”

Clozapine-Associated Obsessive-Compulsive Symptoms and Their Management: A Systematic Review and Analysis of 107 Reported Cases

“…Many limitations come from the fact that most of our included studies are case reports/series. These include the risk of publication bias and that our included cases may not represent a random sample of patients treated with clozapine [82]. However, we used a systematic approach to including and analyzing the cases and this may have reduced some bias.…”