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Tourettes Guanfacine Not Help in DB: 24 kids DBPC 4 weeks. Kids with mild tics. No clear benefit. Neuropsychiatric effects of guanfacine in children with mild tourette syndrome: a pilot study. Cummings DD, Singer HS, Krieger M, Miller TL, Mahone EM. Clonidine & Methylphenidate Helps Tic & ADHD Patients: 136 pt DB PC four groups 16 weeks. Combo group did best with methylphenidate helping inattention and clonidine helping impulsivity and hyperactivity. Clonidine alone did as well as methylphenidate alone. 26% of clonidine drowsiness. No worsening of tics. Treatment of ADHD in children with tics: a randomized controlled trial. The Tourette's Syndrome Study Group. Neurology 2002 Feb 26;58(4):527-36 Desipramine Helps Tic & ADHD Patients: DB PC 6 week titrated up to 3.5mg/kg. Some tic patients had Tourettes. Robust effect and well tolerated. 71% vs 0% response rate with 47% decrease in symptoms. 58% vs 8% response for tics as well. MGH. A double-blind comparison of desipramine and placebo in children and adolescents with chronic tic disorder and comorbid attention-deficit/hyperactivity disorder. Spencer T, Biederman J, Coffey B, Geller D, Crawford M, Bearman SK, Tarazi R, Faraone SV. Arch Gen Psychiatry 2002 Jul;59(7):649-56 Guanfacine Helps ADHD with Tics: DB PC 34pt 8 weeks. 37% vs 8% decrease in ADHD symptoms and 31% vs 0% decrease in tics. Yale. A placebo-controlled study of guanfacine in the treatment of children with tic disorders and attention deficit hyperactivity disorder. Scahill L, Chappell PB, Kim YS, Schultz RT, Katsovich L, Shepherd E, Arnsten AF, Cohen DJ, Leckman JF. Am J Psychiatry 2001 Jul;158(7):1067-74 Rage Rx with Paroxetine: OCD, OCS, ADHD and episodic rages freq assoc with Tourettes with 30% having rage attacks. For these letter children, ADHD and OCD often comorbid with episodic rages. Rx Paroxetine (Paxil) in addition to meds already taking. Open trial with 75% decrease in rages. Start with 5-10 mg QD and increase Qweek by 5-10 mg. up to 60 mg. if necessary. 28 or 38 patients improved in open trial. Authors report neuroleptics, benzos, antidep, stim, beta-blockers, anticonvuls, mood stabilizers allreported to help. Authors favor risperidone as primary treatment. Ruth Bruun, NYU, J Clin Psychiatry 11/98 59:581-4 Abnormality: OCD have abn serotonergic systems and TS abn dopaminerigic and those with both hqave both. 56% kids with OCD have tics and 14% develop Ziprasidone Effective in Small Study: J Am Acad Child Adolesc Psychiatry 2000 Mar;39(3):292-9. 7-17yos rx 5mg to start then increased to max of 40 with average 28. 28 pt for 8 weeks. Sizeable decrease in tics. Ziprasidone treatment of children and adolescents with Tourette's syndrome: a pilot study. Sallee FR, Kurlan R, Goetz CG, Singer H, Scahill L, Law G, Dittman VM, Chappell PB. Children's Hospital Medical Center, Cincinnati, USA Quetiapine 2 Cases: Besides reports on risperidone, olanzapine, and ziprasidone being used for TS, these two were treated with quetiapine at 100 and 150mg/d with benefit. Parrage, J Amer Acad Child Adol Psych 01;40:389 Risperidone = Pimozide in DB: 50 pt, 3.8mg risperidone vs 2.9 pimozide. Most remissions with risperidone 54% vs 38%. Maybe fewer side-effects. Risperidone versus pimozide in Tourette's disorder: a comparative double-blind parallel-group study. Bruggeman R, van der Linden C, Buitelaar JK, Gericke GS, Hawkridge SM, Temlett JA. J Clin Psychiatry 2001 Jan;62(1):50-6 Mecamylamine Helped 2 Cases: 35yo woman unable tolerate transdermal nicotine or haldol. On sertraline 100/d for compulsive & depression. Mecamylamine (Inversine) 5mg/d decreased tices and anxiety and mood swings. 16yo male tics from stimulant rx. Clonidine 0.1mg TID helped but stopped. Mecamylamine helped tics and concentration. Mecamylamine for HBP and a acetylcholinergic nicotinic receptor antagonist. Biol Psych 00;48:1028 |