Tic Disorders
Tic Disorders
General and supportive measures
ICD-10 code: F95.9
DESCRIPTION
A tic is a sudden, rapid, recurrent, non-rhythmic stereotyped motor movement or vocalisation and includes the following subtypes:
- Chronic motor or vocal tic disorder.
- Transient tic disorder.
- Tourette’s disorder.
Tourette’s disorder is a chronic neuropsychiatric disorder that is characterised by both vocal and motor tics, and related somatosensory urges. It is commonly associated with a number of co-morbid conditions such as OCD, ADHD as well as disturbances of mood.
GENERAL AND SUPPORTIVE MEASURES
- Psycho-education of patient, parents, teachers and peers: to reduce the stigma and social consequences of tics and behavioural therapy.
- Supportive psychotherapy: to assist the individual to cope with the stigma/teasing, improve self-esteem and improve social skills.
- Family therapy: to assist the family in managing associated symptoms and to reduce stress.
MEDICATION TREATMENT
Medication is used when the tics impair functioning and ideally for short periods only in order to reduce severe symptoms. The natural course of tics is to 'wax and wane'.
- Risperidone, oral.
- Starting dose: 0.25 mg/day (< 20 kg) and 0.5 mg/day (> 20 kg).
- Recommended average dosage: 1 mg/day.
- Dosage range: 0.25 mg - 3 mg.
If risperidone cannot be tolerated due to side effects:
- Clonidine, oral, daily.
- Starting dose at 25 μg and titrate gradually to 3 - 5 μg/kg. Divide doses larger than 0.1mg/kg/day into 2 doses (morning and evening)
REFERRAL
- Tourette’s disorder not responding to therapy.
- Tourette’s disorder with comorbid psychiatric or medical conditions.
Standard Treatment Guidelines and Essential Medicines List for South Africa, Hospital Level, Paediatrics, 2023 Edition
Chapter 14: Child & Adolescent Psychiatry, 14.10 Tic Disorders