Obsessive-Compulsive Disorder in Tourette Syndrome

Abstract

Several lines of evidence suggest a meaningful association between obsessive-compulsive disorder and Tourette syndrome, including comorbidity, phenomenologic overlap, evidence from family and genetic studies, and the possible role of basal ganglia circuitry in both conditions. Obsessive-compulsive behaviors occur frequently in patients who have Tourette syndrome and tend to have a later onset than tics. Despite commonalities, the approaches to treating tics and obsessive-compulsive symptoms are actually quite distinct. A specialized form of cognitive behavior therapy and pharmacotherapy with a potent serotonin reuptake inhibitor are the two established first-line therapies for obsessive-compulsive disorder. An adequate trial of a serotonin reuptake inhibitor is 10 to 12 weeks in duration at doses near the upper end of the recommended range for age and weight. Cases of obsessive-compulsive disorder that do not sufficiently improve with serotonin reuptake inhibitors might benefit from adjunctive low-dose antipsychotic (eg, risperidone) medication whether or not tics are present. Warnings about an increased risk of suicidality among children and adolescents taking antidepressants for pediatric depression extend to those taking the medications for obsessive-compulsive disorder, but the risk-to-benefit ratio is more favorable in this latter population because several serotonin reuptake inhibitors have been shown to be efficacious in obsessive-compulsive disorder.

Prevalence and clinical correlates of explosive outbursts in Tourette Syndrome

“…Previous studies among clinically-referred samples suggest that approximately 25% to 70% of TS-affected individuals report problems with explosive anger and that, when present, such symptoms are a leading cause of morbidity (Budman et al, 1998; Stephens and Sandor, 1999; Budman, et al, 2000; Zhu et al, 2006; Budman et al, 2008; Cavanna et al, 2011, Kano et al, 2008, Wright et al, 2012). However, the relationship, if any, between explosive outbursts and the underlying tic diathesis has been difficult to untangle (Goodman et al, 2006; Wright et al, 2012). …”

Dopamine receptor modulation of repetitive grooming actions in the rat: Potential relevance for Tourette syndrome

“…The biological basis of Tourette syndrome is thought to overlap that of obsessive compulsive disorder (OCD), a condition which is characterized by intrusive thoughts (obsessions) and urges to repeat rigid behavioral patterns (compulsions) (Goodman et al, 2006). Although the serotonin system is most often implicated in OCD, the dopamine system may be disrupted as well (Kim et al, 2003).…”

Evidence-Based Assessment of Child Obsessive Compulsive Disorder: Recommendations for Clinical Practice and Treatment Research

“…The relevance of the distinction is magnified by the high, bidirectional association between OCD and tic disorders (including Tourette’s Disorder [TD]). Twenty to sixty percent of TD patients meet criteria for OCD, and 20–38% of children with OCD report comorbid tics (Goodman et al 2006; Pauls et al 1995; Swedo et al 1989). …”

“…Differentiating between OCD and tic disorders has significant treatment implications given differing pharmacological interventions for the two disorder (Goodman et al 2006). However, behavioral interventions for tics and compulsions draw upon the same basic techniques (e.g., extinction, reduction of reinforcement for problematic behavior; Piacentini and Chang 2006) such that some experts suggest that distinguishing between tics and compulsions is not always necessary (Mansueto and Keuler 2005).…”

“…In adults, diagnostic criteria for OCD stipulate that the person recognizes the senselessness or excessiveness of his or her thoughts or behaviors. Thus, the presence of insight may help distinguish obsessive-compulsive disorder from a psychotic process (Goodman et al 2006). However, even in adults, the degree of insight varies; limited insight is not uncommon in pediatric OCD (Lewin et al in press-a).…”