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Tic disorder — Clinical Guidelines

Overview

Tic disorders are characterized by repetitive, involuntary movements or vocalizations that can significantly impact daily functioning. These disorders include Tourette syndrome, chronic motor or vocal tic disorder, and transient tic disorder 1.

Diagnosis

Clinical Presentation: Presence of motor and/or vocal tics lasting more than one year 1.

Exclusion of Secondary Causes: Rule out secondary causes such as drug-induced tics (e.g., methylphenidate, lamotrigine, risperidone) 1.

Psychological Evaluation: Assess for associated psychological conditions like ADHD or OCD 3 4.

Neurological Examination: To rule out other neurological disorders 1.

Management

First-Line Treatments:

- Behavioral Therapies: Habit Reversal Training (HRT) 4. - Psychosocial Support: Family and individual counseling 4.

Medications:

- Atypical Antipsychotics: Aripiprazole (5-15 mg/day) for tic reduction in conditions like autistic disorder 3. - Careful Monitoring: For potential side effects and drug-induced tics 1.

Special Populations

Pediatrics: Aripiprazole shows efficacy in children and adolescents with irritability associated with autistic disorder 3.

Comorbidities: Consider comorbid conditions like ADHD or OCD when selecting treatment approaches 3 4.

Key Recommendations

Evaluate for Drug-Induced Tics: Screen for medications like methylphenidate, lamotrigine, and risperidone that may exacerbate tic symptoms (Evidence: Moderate 1).

Utilize Behavioral Therapies: Implement Habit Reversal Training as a first-line non-pharmacological intervention (Evidence: Expert opinion 4).

Consider Atypical Antipsychotics: Use aripiprazole in pediatric populations with irritability associated with autistic disorder, monitoring closely for efficacy and side effects (Evidence: Strong 3).

References

1 Touafchia D, Montastruc F, Lapeyre-Mestre M, Rousseau V, Chebane L, Revet A. Drug-induced tics: An observational postmarketing study. Human psychopharmacology 2020. link 2 Arntz A, Ibañez C, Covarrubias T. Unexplained ocular and visual symptoms: The need for a psychosomatic approach in Ophthalmology. Archivos de la Sociedad Espanola de Oftalmologia 2019. link 3 Marcus RN, Owen R, Kamen L, Manos G, McQuade RD, Carson WH et al.. A placebo-controlled, fixed-dose study of aripiprazole in children and adolescents with irritability associated with autistic disorder. Journal of the American Academy of Child and Adolescent Psychiatry 2009. link 4 Campbell M, Schopler E, Cueva JE, Hallin A. Treatment of autistic disorder. Journal of the American Academy of Child and Adolescent Psychiatry 1996. link 5 Bishop D, Hartley J, Weir F. Why and when do some language-impaired children seem talkative? A study of initiation in conversations of children with semantic-pragmatic disorder. Journal of autism and developmental disorders 1994. link 6 Aranishi F, Hara K, Ishihara T. Purification and characterization of cathepsin H from hepatopancreas of carp Cyprinus carpio. Comparative biochemistry and physiology. B, Comparative biochemistry 1992. link90040-x) 7 Roberts H. Neurotic patients who terminate their own treatment. The British journal of psychiatry : the journal of mental science 1985. link 8 Ihanus J. Anatomical Rorschach responses of gravely psychosomatic patients. Perceptual and motor skills 1984. link 9 Bird J, Marks IM, Lindley P. Nurse therapists in psychiatry: developments, controversies and implications. The British journal of psychiatry : the journal of mental science 1979. link 10 Hartlage LC, Tollison CD. MMPI correlates of looking left or right during mental tasks. Journal of clinical psychology 1979. link35:1<92::aid-jclp2270350111>3.0.co;2-w)

Tic disorder