:
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.
Recent Advances in Understanding and Managing Tourette Syndrome