Tic Disorders

Abstract

The correct diagnostic approach to tic disorders requires accurate historical gathering, a thorough neurologic examination, and detailed definition of the patient's psychopathologic profile. Treatment should always begin with individualized psychoeducational strategies. Although pharmacologic treatments remain beneficial for most patients, cognitive-behavioral treatments have thus far shown promising efficacy. Deep brain stimulation surgery should still be limited to adult patients refractory to pharmacotherapy and cognitive-behavioral therapy.

Psychopharmacotherapy in Patients with Tics and Other Motor Disorders

“…Stress and anxiety may reduce one's ability to suppress tics. On the other hand, tic suppression highly requires attention, and it may influence other attention-demanding tasks, including learning processes and working memory (Martino and Mink 2013). Stress, fatigue, and negative feelings and frustration may increase tic severity, whereas relaxation and reduction of sympathetic tone can benefit tics temporarily.…”

“…The exact cause of tics is still unclear, but it is believed that the pathophysiology of tics is associated with altered neurotransmission, including dopaminergic, serotoninergic, and related signaling molecules such as cyclic adenosine monophosphate (cAMP). Hyperdopaminergic tone seems to be one of the most common neurochemical abnormalities for TS (Martino and Mink 2013). Some medications may worsen or trigger tics.…”

“…Adverse reactions of haloperidol and pimozide generally include extrapyramidal symptoms such as drowsiness, increased appetite, and anxiety. All first-generation antipsychotics may cause anxiety and irritability (after discontinuation), hyperprolactinemia (causing men's breast dysplasia, breast hypertrophy, irregular menses, and sexual dysfunction), hypotension, electrocardiographic changes, and weight gain (Martino and Mink 2013). Due to the side effect profile, antipsychotics have not yet been recommended as first-line medication.…”

Cervical Myelopathy as a Complication of Untreated Motor Tics: A Cautionary Tale

“…1 The severity of tics varies widely and fluctuates over time, and for the great many individuals with mild tics, education of the patient and the family regarding the natural history is all that is required. 2,3 Treatment needs to be initiated only when symptoms are bothersome or impairing to the child. In rare cases, tics may be self-injurious and lead to significant morbidity, and for this reason, they are termed "malignant."…”

Timing recalibration in childhood Tourette syndrome associated with persistent pimozide treatment

“…Tourette syndrome (TS) is one of the most common neurobehavioural disorders in childhood (see American Psychiatric Association, 1994). TS is characterised by chronic motor and phonic tics as core clinical features (Ganos & Martino, 2015;Martino & Mink, 2013) and is complicated by behavioural comorbidities (attention deficit, hyperactivity/impulsivity, obsessive-compulsive symptoms, anxiety, depression, or autistic traits) in about 90% of patients (Wright, Rickards, & Cavanna, 2012). Genetic background and environmental exposures during the prenatal period, perinatal stages and postnatal life may contribute to onset and course of TS (Hoekstra, Dietrich, Edwards, Elamin, & Martino, 2013).…”