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In Tourette's, focus on comorbidities.

NEW YORK -- Tourette's syndrome treatment should be targeted to improve comorbidity rather than on the characteristic vocal and motor tics, Dr. John T. Walkup said at a psychopharmacology update sponsored by the American Academy of Child and Adolescent Psychiatry.

"To enhance outcome, go for the comorbidity; don't go for the tics," said Dr. Walkup, who is with the department of psychiatry and behavioral sciences at Johns Hopkins University in Baltimore.

"As tics are easy to spot, doctors have a tendency to treat tics first and then stop," Dr. Walkup pointed out. "It's an impulse I would encourage

everyone to restrain."

As tics wax and wane even during treatment, doctors can get caught "chasing" tics by up-ping the dose, and adding or changing meds. Because tics wax and wane, doctors may falsely believe that the medication just delivered was responsible for the improvement, Dr. Walkup said.

Additionally, the comorbidity may not respond to tic-suppressing medications, and a few children with Tourette's actually develop anxiety or depressive disorders when they take antipsychotics, Dr. Walkup said.

Tics can present in upward of 25% of school-aged children. Tourette's syndrome is associated with several coexisting conditions, including obsessive-compulsive disorder, attention-deficit hyperactivity disorder (ADHD), anxiety and depressive disorders, and other behavioral problems, he said.

A small percentage of patients have a poor outcome from tics alone, Dr. Walkup said.

Taking a good family and social history is essential to identify genetic and environmental factors for these conditions. Children are at greater risk for specific comorbid conditions at certain ages.

As a general rule, ADHD is more likely to occur in children when they are about 5-7 years old, while anxiety tends to present between the ages of 8 and 10 years, depression between 10 and 14 years, and the classic version of bipolar disorder from age 14 years and up, Dr. Walkup said.

"If you've got a kid with a history of mild tics and who at age 9 deteriorates in his course, I'd be looking for an anxiety disorder as a potential cause of the deterioration, he said.

Many Tourette's syndrome patients also have behavioral problems, Dr. Walkup said. Since Tourette's is considered a neurologic disorder, parents inadvertently may back off from routine discipline strategies, which can result in an increase in behavior problems, he explained.

Dr. Walkup recommends parent training for child behavioral problems, including emotional outbursts.

Data are expected at the end of this year from two large studies funded by the National Institutes of Health that are evaluating behavioral strategies for tic suppression in children with Tourette's, he said.


Chicago Bureau
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Title Annotation:News; tourette syndrome
Author:Wendling, Patrice
Publication:Clinical Psychiatry News
Geographic Code:1USA
Date:Mar 1, 2007
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