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Current Neuropharmacology


ISSN (Print): 1570-159X
ISSN (Online): 1875-6190

Review Article

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

Author(s): Aribert Rothenberger and Veit Roessner*

Volume 17, Issue 8, 2019

Page: [703 - 709] Pages: 7

DOI: 10.2174/1570159X16666180828095131

Price: $65


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 with obsessive-compulsive disorder (OCD) and Tourette syndrome (TS) and other tic problems. OCD with TS is a co-occurring combination of the two generally delimitable, but in detail, also overlapping disorders which wax and wane with time but have different courses as well as 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 need 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 responds only partially, an augmentation with antipsychotics (recommended: risperidone and aripiprazole) 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 database for psychopharmacotherapy in OCD with TS.

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

Graphical Abstract
Robertson, M.M.; Eapen, V.; Singer, H.S.; Martino, D.; Scharf, J.M.; Paschou, P.; Roessner, V.; Woods, D.W.; Hariz, M.; Mathews, C.A.; Črnčec, R.; Leckman, J.F. Gilles de la Tourette syndrome. Nat. Rev. Dis. Primers, 2017, 3, 16097. [http://dx.doi. org/10.1038/nrdp.2016.97]. [PMID: 28150698].
Højgaard, D.R.M.A.; Skarphedinsson, G.; Nissen, J.B.; Hybel, K.A.; Ivarsson, T.; Thomsen, P.H. Pediatric obsessive-compulsive disorder with tic symptoms: clinical presentation and treatment outcome. Eur. Child Adolesc. Psychiatry, 2017, 26(6), 681-689. []. [PMID: 28032202].
Conelea, C.A.; Walther, M.R.; Freeman, J.B.; Garcia, A.M.; Sapyta, J.; Khanna, M.; Franklin, M. Tic-related obsessive-compulsive disorder (OCD): phenomenology and treatment outcome in the Pediatric OCD Treatment Study II. J. Am. Acad. Child Adolesc. Psychiatry, 2014, 53(12), 1308-1316. [http://dx.doi. org/10.1016/j.jaac.2014.09.014]. [PMID: 25457929].
Bennet, S.; Stark, D.; Shafran, R.; Heyman, I.; Krebs, G. Evaluation of cognitive behavior therapy for paediatric obsessive-compulsive disorder in the context of tic disorders. Behav. Ther. Exp. Psychiatry., 2015, 49, 223-229. [ jbtep.2015.03.004].
Moll, G.H.; Heinrich, H.; Gevensleben, H.; Rothenberger, A. Tic distribution and inhibitory processes in the sensorimotor circuit during adolescence: a cross-sectional TMS study. Neurosci. Lett., 2006, 403(1-2), 96-99. [ 021]. [PMID: 16690208].
Rothenberger, A.; Roessner, V. The phenomenology of attention-deficit /hyperactivity disorder in Tourette Syndrome. Tourette Syndrome; Martino, D; Leckman, J.F., Ed.; Oxford University Press: Oxford, New York, 2013, pp. 26-49. [ med/9780199796267.003.0002]
Roessner, V.; Rothenberger, A. Tic disorders. Psychiatric drugs in children and adolescents; Gerlach, M.; Warnke, M; Greenhill, L., Ed.; Springer: Wien, 2014, pp. 517-525.
Ferrao, Y.A.; de Alvarenga, P.G.; Hounie, A.G.; de Mathis, M.A.; de Rosario, M.C.; Miguel, E.C. The phenomenology of obsessive-compulsive symptoms in Tourette Syndrome. Tourette Syndrome; Martino, D; Leckman, J.F., Ed.; Oxford University Press: Oxford, New York, 2013, pp. 50-73. [ 9780199796267.003.0003]
de Vries, F.E.; Cath, D.C.; Hoogendoorn, A.W.; van Oppen, P.; Glas, G.; Veltman, D.J.; van den Heuvel, O.A.; van Balkom, A.J. Tic-related versus tic-free obsessive-compulsive disorders: clinical picture and 2-year natural course. J. Clin. Psychiatry, 2016, 77(10), e1240-e1247. []. [PMID: 27631146].
Banaschewski, T.; Woerner, W.; Rothenberger, A. Premonitory sensory phenomena and suppressibility of tics in Tourette syndrome: developmental aspects in children and adolescents. Dev. Med. Child Neurol., 2003, 45(10), 700-703. [ 1469-8749.2003.tb00873.x]. [PMID: 14515942].
Sambrani, T.; Jakubovski, E.; Müller-Vahl, K.R. New insights into clinical characteristics of Gilles de la Tourette syndrome: findings in 1032 patients from a single German center. Front. Neurosci., 2016, 10, 415. []. [PMID: 27672357].
Hirschtritt, M.W.; Lee, P.C.; Pauls, D.; Dion, Y.; Grados, M.; Illman, C.; King, R.A.; Sandor, P.; Mc Mahon, W.M.; Lyon, G.L.; Cath, D.C.; Kurlan, R.; Robertson, M.M.; Osiecki, L.; Scharf, J.M.; Mathews, C.A. Tourette Syndrome Association International Consortium for Genetics. Lifetime prevalence, age of risk, and etiology of comorbid psychiatric disorders in Tourette Syndrome. JAMA Psychiatry, 2015, 72(4), 325-333. [ jamapsychiatry.2014.2650]. [PMID: 25671412].
Rothenberger, A.; Becker, A.; Rothenberger, L.G. Core features and associated psychopathology of Tourette syndrome: Modifications by cultural aspects? Eur. Child Adolesc. Psychiatry, 2013, 22(11), 709-711. []. [PMID: 23568421].
Eddy, C.M.; Cavanna, A.E. Tourette syndrome and obsessive compulsive disorder: Compulsivity along the continuum. J. Obsessive Compuls. Relat. Disord., 2014, 3, 363-371. [ 1016/j.jocrd.2014.04.003].
Hartmann, A.; Millet, B. Repetitive movements and behaviors in neurological and psychiatric practice: Distinctions and similarities between Tourette disorder and obsessive-compulsive disorder. Rev. Neurol. (Paris), 2018, 174(4), 199-202. [ j.neurol.2018.01.364]. [PMID: 29606319].
Roessner, V.; Buse, J.; Schultze, F.; Rothenberger, A.; Becker, A. The role of obsessive-compulsive symptoms in the psychopathological profile of children with chronic tic disorder and attention-deficit hyperactivity disorder. Z. Kinder Jugendpsychiatr. Psychother., 2013, 41(3), 163-169. [ a000229]. [PMID: 23639924].
Roessner, V.; Rothenberger, A. Pharmacological treatment of tics. Tourette Syndrome; Martino, D; Leckman, J.F., Ed.; Oxford University Press: Oxford, New York, 2013, pp. 524-552. [http://]
Greenberg, E.; Tung, E.S.; Gauvin, C.; Osiecki, L.; Yang, K.G.; Curley, E.; Essa, A.; Illmann, C.; Sandor, P.; Dion, Y.; Lyon, G.J.; King, R.A.; Darrow, S.; Hirschtritt, M.E.; Budman, C.L.; Grados, M.; Pauls, D.L.; Keuthen, N.J.; Mathews, C.A.; Scharf, J.M. Prevalence and predictors of hair pulling disorder and excoriation disorder in Tourette syndrome. Eur. Child Adolesc. Psychiatry, 2018, 27(5), 569-579. []. [PMID: 29098466].
Coffey, B.J.; Miguel, E.C.; Biederman, J.; Baer, L.; Rauch, S.L.; O’Sullivan, R.L.; Savage, C.R.; Phillips, K.; Borgman, A.; Green-Leibovitz, M.I.; Moore, E.; Park, K.S.; Jenike, M.A. Tourette’s disorder with and without obsessive-compulsive disorder in adults: are they different? J. Nerv. Ment. Dis., 1998, 186(4), 201-206. []. [PMID: 9569887].
Rozenman, M.; Peris, T.S.; Gonzalez, A.; Piacentini, J. Clinical characteristics of pediatric trichotillomania: comparisons with obsessive-compulsive and tic disorders. Child Psychiatry Hum. Dev., 2016, 47(1), 124-132. []. [PMID: 25894516].
Groth, C.; Mol Debes, N.; Rask, C.U.; Lange, T.; Skov, L. Course of Tourette Syndrome and comorbidities in a large prospective clinical study. J. Am. Acad. Child Adolesc. Psychiatry, 2017, 56(4), 304-312. []. [PMID: 28335874].
Groth, C. Tourette syndrome in a longitudinal perspective. Clinical course of tics and comorbidities, coexisting psychopathologies, phenotypes and predictors. Dan. Med. J., 2018, 65(4), B5465. [PMID: 29619935].
Bloch, M. Clinical course and adult outcome in Tourette Syndrome. Tourette Syndrome; Martino, D; Leckman, J.F., Ed.; Oxford University Press: Oxford, New York, 2013, pp. 107-120. []
Naaijen, J.; Forde, N.J.; Lythgoe, D.J.; Akkermans, S.E.A.; Openneer, T.J.; Dietrich, A.; Zwiers, M.P.; Hoekstra, P.J.; Buitelaar, J.K. Fronto-striatal glutamate in children with Tourette’s disorder and attention-deficit/hyperactivity disorder. Neuroimage Clin., 2016, 13, 16-23. []. [PMID: 27909683].
Mechler, K.; Häge, A.; Schweinfurth, N.; Glennon, T.C.; Dijkhuisen, R.M.; Murphy, D.; Durston, S.; Williams, S.; Buitelaar, J.K.; Banaschewski, T.; Dittmann, R.W. TACTICS Consortium. Glutamatergic agents in the treatment of compulsivity and impulsivity in child and adolescent psychiatry: a systematic review oft he literature. Z. Kinder Jugendpsychiatr., 2018, 46, 246-263. [http://]. [PMID: 28922069].
Veale, D.; Miles, S.; Smallcombe, N.; Ghezai, H.; Goldacre, B.; Hodsoll, J. Atypical antipsychotic augmentation in SSRI treatment refractory obsessive-compulsive disorder: a systematic review and meta-analysis. BMC Psychiatry, 2014, 14, 317. [ 10.1186/s12888-014-0317-5]. [PMID: 25432131].
Dold, M.; Aigner, M.; Lanzenberger, R.; Kasper, S. Antipsychotic augmentation of serotonin reuptake inhibitors in treatment-resistant obsessive-compulsive disorder: An updated meta-analysis of double-blind, randomized, placebo-controlled trials. Int. J. Neuropsychopharmacol., 2015, 18(9)pyv047 [ ijnp/pyv047]. [PMID: 25939614].
Roessner, V.; Becker, A.; Banaschewski, T.; Rothenberger, A. Tic disorders and obsessive compulsive disorder: where is the link? J. Neural Transm. Suppl., 2005, 69(69), 69-99. [PMID: 16355604].
Whittington, C.; Pennant, M.; Kendall, T.; Glazebrook, C.; Trayner, P.; Groom, M.; Hedderly, T.; Heyman, I.; Jackson, G.; Jackson, S.; Murphy, T.; Rickards, H.; Robertson, M.; Stern, J.; Hollis, C. Practitioner review: Treatments for tourette syndrome in children and young people - a systematic review. J. Child Psychol. Psychiatry, 2016, 57(9), 988-1004. [ 12556]. [PMID: 27132945].
Yang, C.; Hao, Z.; Zhu, C.; Guo, Q.; Mu, D.; Zhang, L. Interventions for tic disorders: An overview of systematic reviews and meta analyses. Neurosci. Biobehav. Rev., 2016, 63, 239-255. [http://dx.]. [PMID: 26751711].
Roessner, V.; Schoenefeld, K.; Buse, J.; Bender, S.; Ehrlich, S.; Münchau, A. Pharmacological treatment of tic disorders and Tourette Syndrome. Neuropharmacology, 2013, 68, 143-149. [http://dx.doi. org/10.1016/j.neuropharm.2012.05.043]. [PMID: 22728760].
Cardona, F.; Rizzo, R. Treatment of psychiatric comorbidities in Tourette syndromes. Tourette Syndrome; Martino, D; Leckman, J.F., Ed.; Oxford University Press: Oxford, New York, 2013, pp. 553-582. []
Neri, V.; Cardona, F. Clinical pharmacology of comorbid obsessive-compulsive disorder in Tourette syndrome. Int. Rev. Neurobiol., 2013, 112, 391-414. []. [PMID: 24295628].
McDougle, C.J.; Goodman, W.K.; Leckman, J.F.; Barr, L.C.; Heninger, G.R.; Price, L.H. The efficacy of fluvoxamine in obsessive-compulsive disorder: effects of comorbid chronic tic disorder. J. Clin. Psychopharmacol., 1993, 13(5), 354-358. [ 10.1097/00004714-199310000-00008]. [PMID: 8227493].
Husted, D.S.; Shapira, N.A.; Murphy, T.K.; Mann, G.D.; Ward, H.E.; Goodman, W.K. Effect of comorbid tics on a clinically meaningful response to 8-week open-label trial of fluoxetine in obsessive compulsive disorder. J. Psychiatr. Res., 2007, 41(3-4), 332-337. []. [PMID: 16860338].
Geller, D.A.; Biederman, J.; Stewart, S.E.; Mullin, B.; Farrell, C.; Wagner, K.D.; Emslie, G.; Carpenter, D. Impact of comorbidity on treatment response to paroxetine in pediatric obsessive-compulsive disorder: is the use of exclusion criteria empirically supported in randomized clinical trials? J. Child Adolesc. Psychopharmacol., 2003, 13(Suppl. 1), S19-S29. [ 03322126313]. [PMID: 12880497].
Pediatric OCD treatment study (POTS) team. Cognitive-behavior therapy, sertraline, and their combination for children and adolescents with obsessive-compulsive disorder: the Pediatric OCD Treatment Study (POTS) randomized controlled trial. JAMA, 2004, 292(16), 1969-1976. []. [PMID: 15507582].
March, J.S.; Franklin, M.E.; Leonard, H.; Garcia, A.; Moore, P.; Freeman, J.; Foa, E. Tics moderate treatment outcome with sertraline but not cognitive-behavior therapy in pediatric obsessive-compulsive disorder. Biol. Psychiatry, 2007, 61(3), 344-347. [http://]. [PMID: 17241830].
McDougle, C.J.; Goodman, W.K.; Leckman, J.F.; Lee, N.C.; Heninger, G.R.; Price, L.H. Haloperidol addition in fluvoxamine-refractory obsessive-compulsive disorder. A double-blind, placebo-controlled study in patients with and without tics. Arch. Gen. Psychiatry, 1994, 51(4), 302-308. [ 1994.03950040046006]. [PMID: 8161290].
Gerasch, S.; Kanaan, A.S.; Jakubovski, E.; Müller-Vahl, K.R. Aripiprazole improves associated comorbid conditions in addition to tics in adult patients with Gilles de la Tourette Syndrome. Front. Neurosci., 2016, 10, 416. [ 00416]. [PMID: 27672358].
Wenzel, C.; Kleimann, A.; Bokemeyer, S.; Müller-Vahl, K.R. Aripiprazole for the treatment of Tourette syndrome: a case series of 100 patients. J. Clin. Psychopharmacol., 2012, 32(4), 548-550. []. [PMID: 22722499].

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