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Optimizing behavior therapy for youth with Tourette's disorder.

Joseph F McGuire1, Nathaniel Ginder2, Kesley Ramsey3

  • 1Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA. jfmcguire@jhmi.edu.

Neuropsychopharmacology : Official Publication of the American College of Neuropsychopharmacology
|July 13, 2020
PubMed
Summary

This study found that D-cycloserine (DCS) combined with habit reversal training (HRT) significantly reduced tic severity in youth with Tourette's Disorder (TD). DCS augmentation enhanced behavioral therapy outcomes for TD patients.

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Area of Science:

  • Neuroscience
  • Psychiatry
  • Pharmacology

Background:

  • Tourette's Disorder (TD) is a neurological condition characterized by distressing and impairing tics.
  • Current first-line behavioral therapies for TD, such as habit reversal training (HRT), may have limited efficacy for some patients.
  • There is a need for novel therapeutic strategies to improve tic reduction in Tourette's Disorder.

Purpose of the Study:

  • To investigate the efficacy of augmenting HRT with D-cycloserine (DCS) for reducing tic severity in youth with TD.
  • To evaluate DCS as a potential enhancer for behavioral interventions in Tourette's Disorder treatment.
  • To conduct a placebo-controlled, quick-win/fast-fail trial assessing DCS-augmented HRT.

Main Methods:

  • Twenty youth diagnosed with TD participated in a randomized, placebo-controlled trial.
  • Participants received a single session of HRT targeting two bothersome tics, augmented with either 50mg of DCS or a placebo.
  • Assessments of tic severity, premonitory urges, and comorbidities were conducted at baseline and one week post-treatment by masked independent evaluators.

Main Results:

  • A significant Treatment Group by Time Interaction favored DCS-augmented HRT (p < 0.01), indicating greater tic severity reduction.
  • While initial differences at the treatment visit were small (d=0.27), the DCS group showed significantly lower targeted tic severity at posttreatment (d=1.30, p < 0.001) compared to placebo.
  • These results suggest a preliminary enhancement of tic reduction when HRT is augmented with DCS.

Conclusions:

  • Augmenting habit reversal training with D-cycloserine shows preliminary efficacy in reducing tic severity in youth with Tourette's Disorder.
  • DCS may serve as a valuable adjunct to behavioral therapy for improving treatment outcomes in TD.
  • Further research is warranted to confirm these findings and explore the therapeutic potential of DCS in Tourette's Disorder management.