Clinical Pearls for Tic Disorders

  • • Carefully explore the tic description to help rule out other tic- like movements (e.g. chorea, tardive dyskinesia).
  • • Highly co-morbid with ADHD, OCD, depression, and anxiety disorders.
  • • For tics, watchful waiting is often appropriate, especially when the patient is not unduly concerned about tics themselves or is not grossly functionally impaired. Where treatment is indicated, psychological therapy (habit reversal therapy and/or exposure and response prevention) is first-line.
  • • In moderate-severe Tic Disorders, or where psychological treatment fails, medication should be considered: start with an antipsychotic except in the case of co-morbid ADHD, where an alpha-2 receptor agonist should be used (clonidine or guanfacine).

Key References

• Knight T, Steeves T, Day L, Lowerison M, Jette N, Pringsheim T. Prevalence of tic disorders: a systematic review and meta-analysis. Pediatr Neurol. 2012 Aug;47(2):77-90.

  • • Weisman H, Qureshi IA, Leckman JF, Scahill L, Bloch MH. Systematic review: pharmacological treatment of tic disorders— efficacy of antipsychotic and alpha-2 adrenergic agonist agents. Neurosci Biobehav Rev. 2013 Jul;37(6):1162-71.
  • • Wile DJ, Pringsheim TM. Behavior Therapy for Tourette Syndrome: A Systematic Review and Meta-analysis. Curr Treat Options Neurol. 2013 Aug;15(4):385-95.
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