Overview
Secondary tic disorders are characterized by the presence of tics that are caused by a known medical condition or substance use. These tics are typically persistent and can significantly impact a patient's quality of life.Diagnosis
Tics are sudden, rapid, recurrent, non-rhythmic motor movements or vocalizations 1.
Diagnosis requires the presence of tics that are attributable to the physiological effects of a substance or another medical condition 1.
Diagnostic evaluation may include a thorough medical history, physical examination, and potentially neuroimaging or laboratory tests to rule out underlying causes 1.Management
Psychoeducation is recommended as an initial intervention for tic disorders, regardless of symptom severity 1.
Habit Reversal Training (HRT), particularly the Comprehensive Behavioral Intervention for Tics (CBIT) package, has the most evidence for efficacy 1.
Exposure and Response Prevention (ERP) is also recommended, though with a lesser degree of certainty than HRT/CBIT due to fewer studies 1.
Cognitive interventions and third-wave interventions are not recommended as stand-alone treatments 1.
Videoconference delivery of HRT/CBIT is the most evaluated novel treatment delivery format 1.Key Recommendations
Psychoeducation is recommended as an initial intervention for tic disorders 1. (Evidence: Expert opinion)
Habit Reversal Training (HRT), including Comprehensive Behavioral Intervention for Tics (CBIT), is recommended for tic disorders 1. (Evidence: Moderate)
Exposure and Response Prevention (ERP) is recommended for tic disorders, though with less certainty than HRT/CBIT 1. (Evidence: Weak)References
1 Andrén P, Jakubovski E, Murphy TL, Woitecki K, Tarnok Z, Zimmerman-Brenner S et al.. European clinical guidelines for Tourette syndrome and other tic disorders-version 2.0. Part II: psychological interventions. European child & adolescent psychiatry 2022. link