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Questions and Answers
Transient tics occur in 1% of children.
False
Tourette syndrome occurs in about 20% of children.
False
Tics are more common in girls than boys.
False
Co-morbid OCD is less prevalent in people with tic disorders than would be expected by chance.
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The placebo effect in clinical trials of tic disorders is larger than previously thought.
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Most people with tics require pharmacological treatment.
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Behavioural interventions are less effective than antipsychotic medication in reducing tics.
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Clonidine has not been shown to reduce the severity and frequency of tics in open studies.
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Guanfacine has not been shown to be effective in the treatment of tics.
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Habit Reversal is not a recommended behavioural treatment for tics.
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Antipsychotics are always recommended as the first line of treatment for tics.
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Studies of pharmacological interventions in TS are easy to interpret.
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Pimozide has not been shown to be effective in reducing tics in clinical trials.
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Tics always persist into adulthood in individuals with Tourette syndrome.
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External factors such as stress, inactivity, and fatigue have no impact on tics.
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Haloperidol is generally well-tolerated by patients.
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Aripiprazole has not been shown to be an effective and well-tolerated treatment for children with TS.
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ECG monitoring is not necessary for pimozide and haloperidol.
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Complementary or alternative therapies have been extensively researched for their efficacy and side effects.
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Patients and their families do not need to be informed not to stop clonidine suddenly.
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The first line treatment for Tourette's Syndrome is educational and behavioral treatment.
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If Clonidine or guanfacine is poorly tolerated or not fully effective, the next step is to consider antipsychotic treatment.
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Antipsychotic treatment is always effective in treating Tourette's Syndrome.
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Older or experimental treatments are commonly used because most cases of Tourette's Syndrome are difficult to treat.
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Aripiprazole is an example of a recommended first-line treatment option for Tourette's Syndrome.
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Study Notes
Tics and Tourette Syndrome
- Transient tics occur in 5-20% of children, while Tourette syndrome (TS) affects about 1% of children, characterized by persistent motor and vocal tics.
- 65% of individuals with TS will have no tics or only mild tics by adulthood.
- Tics are more common in boys than girls, with a ratio of 2-3:1.
Detection and Treatment of Comorbidity
- Co-morbid conditions such as OCD, ADHD, depression, anxiety, and behavioral problems are more prevalent in individuals with TS.
- These comorbid conditions often cause the major impairment and should be treated first before assessing the level of disability caused by tics.
Education and Behavioral Treatments
- Education is crucial for individuals with tics, their families, and those they interact with, especially in schools.
- Behavioral interventions, such as Habit Reversal, Comprehensive Behavioral Interventions, and Exposure and Response Prevention, are effective in reducing tics.
- These treatments have similar effect sizes to antipsychotic medication.
Pharmacological Treatments
- Adrenergic α2 agonists, such as Clonidine, have been shown to reduce tic severity and frequency in open studies.
- Clonidine has a therapeutic dose of 3-5µg/kg, and the dose should be built up gradually to avoid side effects.
- Guanfacine has also been shown to be effective in treating tics and may be beneficial for individuals with comorbid ADHD.
- Antipsychotics, such as Pimozide, Haloperidol, and Risperidone, may be effective in alleviating tics, but adverse effects may outweigh beneficial effects.
- Aripiprazole is a well-tolerated and effective treatment for children with TS, with a significant decrease in serum prolactin concentration and increased body weight.
Treating Tourette's Syndrome
- First line treatment for Tourette's Syndrome is educational and behavioral treatment
- If educational and behavioral treatment is not fully effective, proceed to second line treatment
Second Line Treatment
- Second line treatment involves administering clonidine or guanfacine
- If clonidine or guanfacine is not fully effective or poorly tolerated, proceed to third line treatment
Third Line Treatment
- Third line treatment involves antipsychotic treatment with aripiprazole or risperidone
- If antipsychotic treatment is not effective, proceed to fourth line treatment
Fourth Line Treatment
- Fourth line treatment involves considering older or experimental treatments
- It is extremely rare to reach the fourth line treatment in practice, as most cases can be effectively treated with prior options
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Description
This quiz covers the basics of tics and Tourette syndrome in children, including their prevalence, definition, and characteristics. Learn about the waxing and waning of tics over time and how they are affected by external factors.
