Most patients with Tourette's disorder experience an uncomfortable sensory phenomenon called the premonitory urge immediately before experiencing tics. It has been suggested that premonitory urges are associated with comorbidities such as obsessive compulsive disorder, anxiety disorders, and attention-deficit/hyperactivity disorder, although these associations have been inconsistent. Most patients experience tics as a result of the premonitory urges, and after the tics occur, most patients report that the premonitory urges are temporarily relieved. As a consequence, several studies have assessed the premonitory urge and its potential therapeutic utility. Based on the concept that the premonitory urge induces tics, behavioral treatments such as Exposure and Response Prevention and Habit Reversal Therapy have been developed. However, it is still unclear whether habituation, the main mechanism of these therapies, is directly related to their effectiveness. Moreover, the observed effects of pharmacological treatments on premonitory urges have been inconsistent.
Anxiety Disorders ; Behavior Therapy ; Comorbidity ; Drug Therapy ; Humans ; Obsessive-Compulsive Disorder ; Tics ; Tourette Syndrome

OBJECT: The purpose of this study was to investigate that infection with group A[beta] hemolytic streptococcus may associate the mechanisms that cause or exacerbate some cases of Tourette's disorder and to evaluate the treatment effect of IG therapy, comparing between IG therapy and drug therapy. METHOD: The subjects were divided into three groups composing of the groups with increasing level of ASO titer and the group with normal level of ASO titer, treating with antipsychotics. Children with infection-triggered exacerbation of Tourette's disorder were assigned treatment with IVIG (400mg/kg/daily on 5 consecutive days) or antipsychotic drugs. Symptom severity was rated at baseline, and at 4weeks, at at 8weeks after treatment by use of standard assessment scale of tics. RESULTS: 1) The motor tic score, global severity scores and overall TS impairment rating scores of YGTSS in the group with incresing level of ASO titer were related with ASO titer. 2) Immune therapy was more effective in the group with incresing level of ASO titer than antipsychotic drug therapy. CONCLUSION: These results suggest that increasing level of ASO titer, resulting from group A[beta] hemolytic streptococcal infection has affected worsening the tic symptoms in Touette's disorder and in group with increasing level of ASO titer, IVIG therapy is more effective than drug therapy.
Antipsychotic Agents ; Child ; Drug Therapy ; Humans ; Immunoglobulins, Intravenous ; Streptococcal Infections ; Streptococcus ; Tics* ; Tourette Syndrome*

Tics are brief, rapid and repetitive movement and sounds that are either simple or complex in presentation. Tics can be preceded by a premonitory urge (sensation) that decreases after tic is completed. The fourth edition of Diagnostic Statistical Manual of Mental Disorder (DSM- IV) includes diagnoses for Tourettes disorder, chronic motor or vocal tic disorder, transient tic disorder and tic disorder not otherwise specified (Table 1) according to the duration of tic symptoms and degree of complexity. The purposes of treatment of tic disorders must be set up based on the comprehensive evaluation of developmental profiles, strength, weakness, family situation, and school adaptation status. The family education must be included early in treatment process and psychosocial treatment including the cognitive behavioral therapy will be needed to develop and maintain the self-efficacy in controlling the tic symptoms. The most effective and efficient method for the reduction of tic symptoms, however, are drug treatment. The pharmacotherapy is usually one component of treatment for chronic tic disorder and Tourettes disorder. The gold standard for tic reduction is the dopaminergic receptor blocking agent (or antipsychotic agent, neuroleptics). The primary drugs are haloperidol, pimozide, and risperidone. Among theses, risperidone will be the primary choice because of its low side effect profiles, esp, neurologic side effects. In the near future, the studies on the efficacy of the olanzapine, quetiapine and ziprasidone will be more reported. As second line drugs, clionidine, guanfacine, nicotine related drugs can be considered.
Cognitive Therapy ; Diagnosis* ; Drug Therapy ; Education ; Guanfacine ; Haloperidol ; Humans ; Mental Disorders ; Nicotine ; Pimozide ; Risperidone ; Tic Disorders* ; Tics ; Tourette Syndrome

This study aims to comprehensively evaluate the clinical value of Shaoma Zhijing Granules(SZG), Changma Xifeng Tablets(CXT), and Jiuwei Xifeng Granules(JXG) in the treatment of children with tic disorder with the method of rapid health technology assessment(RHTA), which is expected to serve as a reference for medical and health decision-making and clinical rational use of drugs in children. To be specific, relevant articles were retrieved from eight databases and three clinical trial registry platforms. After the quality evaluation, rapid assessment was carried out from the dimensions of disease burden and unmet needs, technical characteristics, safety, efficacy and economy, and the results were analyzed and presented descriptively. A total of 22 articles(1 in English, 21 in Chinese) were screened out: 18 randomized controlled trials(RCTs) and 4 clinical controlled trials(CCTs). Among them, 5 were about the SZG(all RCTs) and 9 were on CXT(6 RCTs and 3 CCTs). The rest 8 focused on JXG(7 RCTs and 1 CCT). Moreover, the overall risk of bias for 94.40% RCTs was evaluated as "some concerns" and only one(5.60%) had high risk of bias. In terms of quality, the 4 CCTs scored 5-6 points(<7 points), suggesting low quality. SZG alone or in combination with tiapride has obvious advantages in improving traditional Chinese medicine syndromes and tic symptoms compared with tiapride alone, with the average daily cost of CNY 79.44-119.16. Compared with conventional western medicine or placebo, CXT alone or in combination with conventional western medicine can improve the total effective rate and alleviate tic symptoms, and the average daily cost is CNY 22.50-67.50. JXG alone or in combination with conventional western medicine can effectively relieve tic symptoms compared with conventio-nal western medicine or placebo, with the average daily cost of CNY 82.42-164.85. The adverse events related to the three Chinese patent medicines mainly occurred in the digestive, respiratory, and nervous systems, all of which were mild. In general, SZG, CXT, and JXG are effective for children with tic disorder. They have been approved to be used in this field, of which SZG was approved in 2019, with the most up-to-date research evidence and high-quality RCT in Q1 journals. However, the comparative analysis of the three was affected by many factors, which should be further clarified. Based on the large sample data available in multiple dimensions, a comprehensive comparative evaluation of the three Chinese patent medicines should be carried out, thereby highlighting the advantages and disadvantages of them and serving a reference for rational clinical use and drug supervision.
Humans ; Child ; Drugs, Chinese Herbal/therapeutic use* ; Nonprescription Drugs/therapeutic use* ; Technology Assessment, Biomedical ; Tiapride Hydrochloride/therapeutic use* ; Tics/drug therapy* ; Tic Disorders/drug therapy* ; Medicine, Chinese Traditional

Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder defined by impairing levels of inattention, disorganization, and/or hyperactivity-impulsivity. ADHD often persists into adulthood, with resultant impairments of social, academic and occupational functioning. ADHD is a very common disease during childhood and, the pooled overall prevalence of ADHD was found to be 5.29%. When screening for ADHD, clinicians should try to develop rapport with patients and their caregivers to increase the likelihood that they will follow the diagnostic process and treatment. The current drugs that have received Food and Drug Administration-approval for ADHD include stimulants (methylphenidate and dextroamphetamine) and non-stimulants (atomoxetine, guanfacine, and clonidine). Stimulants improve inattention, hyperactivity, and impulsivity in addition to decreasing disruptive behaviors and promoting academic achievement and the maintenance of appropriate friendships. In order to enhance drug compliance, the use of long-acting stimulants is increasing. Atomoxetine is a selective norepinephrine reuptake blocker, the effects of which may take 2 to 6 weeks to be noticeable. Furthermore, α2 agonists may help to improve behavioral side effects, tics, and sleep problems during stimulant or atomoxetine use. Common side effects of stimulants and atomoxetine include headache, stomachache, and loss of appetite. Routine electorcardiography before medication is not recommended unless there is a specific indication. Methylphenidate and atomoxetine are safe as first line therapies, and their side effects are well tolerated.
Appetite ; Atomoxetine Hydrochloride ; Attention Deficit Disorder with Hyperactivity ; Caregivers ; Compliance ; Drug Therapy ; Friends ; Guanfacine ; Headache ; Humans ; Impulsive Behavior ; Mass Screening ; Methylphenidate ; Neurodevelopmental Disorders ; Norepinephrine ; Prevalence ; Problem Behavior ; Tics

OBJECTIVETo observe the effect of salidroside on tic behavior and in vivo dopamine DA) and serotonin (5-HT) levels in Tourette syndrome (TS) model rats.

METHODSForty rats were randomly divided into the blank control group, the TS model group, the haloperidol-treated group (0.5 mg/kg x d(-1)), and the salidroside-treated group (50 mg/kg x d(-1)), 10 in each group. TS rat model was induced by imino-dipropio-nitrile (IDPN). Peritoneal injection of haloperidol and salidroside was started from the 4th day of modeling in the haloperidol-treated group and the salidroside-treated group respectively. Normal saline was peritoneally injected to rats in the blank control group and the TS model group respectively. Stereotyped behavior was scored, and changes of DA and 5-HT levels in blood and striatum were measured before modeling, after modeling, and after intervention.

RESULTSCompared with the blank control group, the score of the tic behavior was elevated (P < 0.01) , levels of DA and 5-HT in plasma and striatum were reduced in the model group (P < 0.01, P < 0.05). Compared with the same group after modeling, the tic behavior score decreased and plasma DA levels increased in the two treated groups after intervention (P < 0.01). 5-HT content increased in the salidroside-treated group (P < 0.01). Compared with the model group after intervention, the tic behavior score was significantly reduced (P < 0.01), and DA levels in plasma and striatum were elevated (P < 0.01, P < 0.05) in the salidroside-treated group and the haloperidol-treated group. Compared with the haloperidol-treated group, the tic behavior score increased (P < 0.01), DA levels in plasma and striatum were lowered (P < 0.01, P < 0.05), the 5-HT level increased in plasma and striatum (P < 0.01, P < 0.05) in the salidroside-treated group.

CONCLUSIONSIn the salidroside-treated group, the tic behavior was significantly reduced, and DA levels in plasma and striatum were elevated. Its mechanism might be related to regulating activities of dopamine neurons in striatum.

Animals ; Corpus Striatum ; Dopamine ; Drugs, Chinese Herbal ; pharmacology ; therapeutic use ; Glucosides ; pharmacology ; therapeutic use ; Haloperidol ; Phenols ; pharmacology ; therapeutic use ; Rats ; Serotonin ; Stereotyped Behavior ; Tics ; drug therapy ; Tourette Syndrome ; drug therapy

Attention-Deficit /Hyperactivity Disorder(ADHD), previously considered as a disease of childhood, is a disorder characterized by inattention, hyperactivity, and impulsivity. Recent studies, however, revealed that in about a half of the ADHD children the patients continue their symptoms into their adulthood, which implicates that ADHD is not a childhood disorder but a disorder that a patient has to live with for his or her life. The prevalence of ADHD is 2~6% of general population, with a male preponderance. Since ADHD usually develops in school ages, patients experience such problems as learning difficulties, maladjustment, depressive episodes, substance use, and conflicts with parents or other children. Co-morbidities, e.g. tic, anxiety conduct, and oppositional defiant disorders also exist. Although the exact etiology of ADHD remains to be elucidated, abnormalities of specific areas and pathways in the central nervous system, which is reflected by the term, ADHD-minimal brain damage or minimal brain dysfunction in the early 20th century, have been reported. Genetic factors also have to be considered. To establish the diagnosis of ADHD, the behavior of children and collateral information are required. Objective tests including intelligence, neuropsychological tests, and continuous performance test are helpful. Pharmacotherapy and family education are the most important elements in treating ADHD patients. Cognitive-behavior therapy, play therapy, and social skill training are also useful. A CNS stimulant such as methylphenidate is the most commonly prescribed drug, and the prescription of newly developed drugs, atomoxetine and modafinil, is increasing. The success of treatment depends on both medication and management of psychological and behavioral problems. Early diagnosis and intervention can improve the prognosis of the patients.
Anxiety ; Atomoxetine Hydrochloride ; Attention Deficit Disorder with Hyperactivity ; Brain ; Central Nervous System ; Child ; Diagnosis ; Drug Therapy ; Early Diagnosis ; Education ; Humans ; Impulsive Behavior ; Intelligence ; Learning ; Male ; Methylphenidate ; Neuropsychological Tests ; Parents ; Play Therapy ; Prescriptions ; Prevalence ; Prognosis ; Tics

OBJECTIVETo explore the clinical efficacy of integrative Chinese and Western medicine in treating Tourette syndrome (TS).

METHODSNinety children with TS were randomized into two groups by randomizing: digital table method: the 60 patients in the treated group were treated by Ningdong Granule (NDG) plus haloperidol, and the 30 in the control group treated by haloperidol alone. The course for both groups was 6 months. Conditions of the patients were estimated before and after treatment with Yale Global Tic Severity Scale (YGTSS), the short-term efficacy, adverse reaction of treatment were assessed at the end of treatment, and the long-term efficacy as well as the recurrent rate were evaluated half a year after the treatment was ended.

RESULTSOf the 60 patients in the treated group, the treatment on 36 was evaluated as remarkably effective, 21 as effective, and 3 as ineffective, the total effective rate being 95.0% (57/60), while of the 30 patients in the control group, the corresponding data were 9, 13, 8 and 73.3% (22/30), respectively, differences between groups in markedly effective rate and total effective rate were statistically significant (chi(2)=7.20, and chi(2)=6.85, P<0.01). The improvement on the condition of illness, motor tic and vocal tic, as well as the long-term efficacy of treatment were all better in the treated group than in the control group (P<0.05 or P<0.01). The incidence of adverse reaction and the recurrent rate in the treated group were 13.3% (8/60) and 8.3% (5/60) respectively, all were lower than those in the control group, 36.7% (11/30) and 43.3 (13/30), showing statistical significances (P<0.05 and P<0.01).

CONCLUSIONIntegrative medical treatment on TS was markedly effective in clinical practice with less adverse reaction and lower recurrent rate.

Antipsychotic Agents ; administration & dosage ; adverse effects ; Child ; Dose-Response Relationship, Drug ; Drug Administration Schedule ; Drug Therapy, Combination ; Drugs, Chinese Herbal ; administration & dosage ; adverse effects ; Female ; Haloperidol ; administration & dosage ; adverse effects ; Humans ; Integrative Medicine ; methods ; Male ; Recurrence ; Severity of Illness Index ; Tics ; drug therapy ; epidemiology ; Tourette Syndrome ; drug therapy ; Treatment Outcome