Tourette disorder and other tic disorders

A combination of motor and phonic tics is the hallmark of Tourette syndrome (TS). This complex neuropsychiatric disorder is often associated with psychiatric comorbidities such as attention-deficit hyperactivity disorder and obsessive-compulsive disorder. The first step in management is to establish the diagnosis of TS, avoiding potential diagnostic confounders (such as compulsions, stereotypies, or habits). Once a diagnosis of TS is made, a discussion with the patient and family about the level of impairment and presence or absence of comorbidities will guide the decision and choice of treatment. Not every patient with TS will need active treatment. When needed, active treatment falls into one of the following three categories: behavioral, pharmacologic, and nonpharmacologic. This chapter summarizes and reviews the evidence base supporting these treatments. It also discusses the evidence base and approach to the treatment of common psychiatric comorbidities. A treatment algorithm based on published data and expert consensus is proposed.