Treatment of Psychiatric Comorbidities in Tourette Syndrome

Abstract

Abstract Behavioral treatment should be recommended as initial treatment for patients with Tourette syndrome (TS) or other tic disorder and attention-deficit/hyperactivity disorder (ADHD), especially if symptoms are mild or parents refuse pharmacological treatments. Although obsessive–compulsive disorder (OCD) and TS are closely related, no clinical trials have specifically evaluated the treatment of OC symptoms in TS patients. Monotherapy with serotonin reuptake inhibitors (SRIs) or selective serotonin reuptake inhibitors (SSRIs) has been proven to be efficacious in the treatment of OCD patients, both adults and children, in the short term as well as the long term. No individual drug in these classes has demonstrated a superior efficacy to the others. However, nearly half of OCD patients do not respond completely to SSI/SSRI monotherapy, and even among the responders, few become asymptomatic. Various strategies have been proposed for OCD nonresponders: increasing doses, switching to another drug, augmentation strategies, and novel treatments. OCD patients with comorbid chronic tics or TS show a lower response rate compared to those without tics, both in term of percentage of responders and in terms of symptom reduction. An increased rate of response to antipsychotic augmentation in OCD patients with comorbid tics compared to those without has been reported in only one study. Despite the high rate and the clinical relevance of other psychiatric comorbidities (non-OCD anxiety disorders, self-injurious behaviors, and disruptive behaviors) in TS patients, only a few studies have been devoted to investigating a specific therapeutic approach in these patients.