- Behavioral
- Address comorbid conditions
- Modalities
- Positive reinforcement
- Cognitive Behavioral Therapy
- Habit reversal training
- Address triggers
- Targets: Address the most disabling first
- Skill deficiencies
- Behavior excesses
- Medications (General)
- Indications: Significant tic interfering with daily function
- Goal: Lowest medication dose to adequately improve function
- Precautions
- Often treatment worse than disease
- Start at the lowest dose and advance
- Observe for Extrapyramidal Effects of Neuroleptics
- Medication Maintenance
- Tourette's Syndrome requires treatment for up to 2 years
- Try slowly tapering medication when stable for 6 months
- Medications for mild to moderate Tic Disorder
-
Clonidine (Catapres)
- Start: 0.05 mg orally at bedtime
- Advance to: 0.1 mg orally three times daily
- Maximum 0.2 mg orally three times daily
-
Guanfacine (Tenex)
- Start: 0.5 mg orally at bedtime
- Advance to: 1 mg orally twice daily
- Maximum 1 mg orally three times daily
-
Topiramate (Topamax)
- Start: 25 mg orally at bedtime
- Advance to: 100 mg PO daily
- Maximum 200 mg PO daily
- Medications for severe Tic Disorder
- Precaution
- These agents are Neuroleptics with potential serious adverse effects
- Typically prescribed by psychiatry
-
Pimozide (Orap)
- Start: 0.5 mg orally at bedtime
- Advance to: 1 mg orally twice daily
- Maximum 3 mg orally twice daily
-
Risperidone (Risperdal)
- Start: 0.25 mg orally at bedtime
- Advance to: 1 mg orally twice daily
- Maximum 2 mg orally twice daily
-
Olanzapine (Zyprexa)
- Start: 1.25 mg orally at bedtime
- Advance to: 2.5 mg orally twice daily
- Maximum 5 mg orally twice daily
-
Fluphenazine (Prolixin)
- Start: 0.5 mg orally at bedtime
- Advance to: 1 mg orally three times daily
- Maximum 3 mg orally three times daily
- Medications for comorbid psychiatric conditions
-
Clonazepam (Klonopin) for comorbid Anxiety Disorder
- Start: 0.25 mg orally at bedtime
- Advance to: 0.5 mg orally three times daily
- Maximum 1 mg orally three times daily
- Medications for concurrent obsessive compulsive features