Psychopharmacotherapy of Obsessive-compulsive Symptoms within the Framework of Tourette Syndrome

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Author(s): Aribert Rothenberger , Veit Roessner*.

Journal Name: Current Neuropharmacology

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While Behavioral Therapy (BT) should be recommended as the first step in the treatment of OCD as well as TS, medication can be added for augmentation and in certain situations (e.g. family preference, BT not available or feasible) the priority may even reverse. This narrative review is given on the complexity of drug treatment in patients comorbid for obsessive-compulsive disorder (OCD) and Tourette syndrome (TS) and other tic problems. OCD with TS is a co-occuring combination of two generally delimitable, but in detail also overlapping disorders which wax and wane with time but have different courses and necessities and options of treatment. Distinct subtypes like „tic-related OCD” are questionable. Obsessive-compulsive symptoms (OCS) and tics are frequently associated (OCS in TS up to 90%, tics in OCD up to 37%). Sensory-motor phenomena like urges and just-right feelings reflect some behavioral overlap. The main additional psychopathologies are attention-deficit hyperactivity disorder (ADHD), mood problems and anxiety. Also, hair pulling disorder and skin picking disorder are related to OCD with TS. Hence, the assessment and drug treatment of its many psychopathological problems needs high clinical experience, careful planning, and ongoing evaluation/adaptation. Drugs are able to reduce clinical symptoms but cannot cure the disorders, which should be treated in parallel in their own right; i.e. for OCD serotonin reuptake inhibitors (SSRI) and for TS (tics) certain antipsychotics can be successfully prescribed. In cases of OCD with tics, when OCS respond only partially, an augmentation with antipsychotics (recommended: aripiprazole and risperidone) may improve OCS as well as tics. Also, the benzamide sulpiride, an atypical antipsychotics, may be beneficial in treating the combination of OCS, tics and anxious-depressive problems. Probably, any additional psychopathologies of OCD might attenuate the effectiveness of SSRI on OCS; on the other hand, in cases of OCD with tics, SSRI may reduce not only OCS but also stress sensitivity and emotional problems and thus leading to better selfregulatory abilities, useful to improve tic suppression. In sum, some clinical guidance can be given, but there remain many uncertainties because of a scarce data base for psychopharmacotherapy in OCD with TS.   Recently, a high quality primer on Tourette Syndrome (TS) has been published, giving a timely and comprehensive overview related to all relevant aspects of the disorder [1]. This includes the suggestion that primarily Behavior Therapy (BT) should be recommended for the treatment of both OCS/OCD and TS. BT seems to be equally effective for pure as well as tic-related OCD [2-4]. But many patients remain symptomatic after BT intervention. In this situation, medication comes into play for augmentation. Further, drug treatment may be given the priority if BT is not available, not feasible or not preferred by the family. Concerning the practically important relationship between obsessive-compulsive symptoms (OCS) and TS the present review will broaden this issue while starting with the essentials on core aspects of TS before presenting obsessive-compulsive symptoms/disorder (OCS/OCD) as comorbidities with TS. Several levels of investigation are mentioned (e.g. psychopathology, pathophysiology, psychosocial burden) and their specific meanings for psychopharmacological treatment are discussed. Finally, certain drugs are explored for their use in treatment of OCS/OCD within the framework of TS.

Keywords: obsessive-compulsive symptoms , tic disorders, drug treatment, comorbidity, SSRI, neuroleptics, associated psychopathology

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(E-pub Ahead of Print)
DOI: 10.2174/1570159X16666180828095131
Price: $95

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