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Approaches to Treating Tourette’s Syndrome

Tourette’s syndrome is a childhood-onset condition that is diagnosed when motor and vocal tics have been present for at least 1 year. The syndrome is now viewed as a neuropsychiatry spectrum disorder in which tics are commonly associated with obsessive-compulsive symptoms that do not always meet the full diagnostic criteria for obsessive-compulsive disorder (OCD). Tourette’s has also been associated with disturbances of attention that do not always meet the full criteria for ADHD. The combination of tics, OCD, and ADHD—often called the Tourette’s syndrome triad—can be challenging to diagnose and treat. In the December 9, 2010 New England Journal of Medicine, I had a review published that discussed strategies and guidelines on diagnosing and treating Tourette’s syndrome in clinical practice settings. Tic suppression often occurs in physicians’ offices, so the most opportune time to look for tics is when patients are entering or leaving the examination room. Coexisting psychiatric conditions can be evaluated with clinical rating scales too. Management Strategies Virtually any movement or sound that the body is capable of making can be a manifestation of a tic. The most notorious tics of Tourette’s syndrome include obscene or insulting utterances (coprolalia), but these occur in less than half of all cases. When tics are mild and not disabling, education about Tourette’s and supportive counseling to strengthen self-confidence and self-esteem usually suffice. When tics are disabling, they cause social embarrassment or self-injury for which tic-suppressing therapy is indicated. Treatment options include habit-reversal treatment, a form of cognitive behavioral therapy, or pharmacotherapy. “The most opportune time to look for tics is when patients are entering or leaving the examination room.”...
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