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Psychocutaneous Disorders
Published in Ayşe Serap Karadağ, Lawrence Charles Parish, Jordan V. Wang, Roxburgh's Common Skin Diseases, 2022
Kristen Russomanno, Vesna M. Petronic-Rosic
Given the lack of data to widely support pharmacologic therapies, behavioral treatment is considered the first line. Cognitive behavioral therapy, specifically habit reversal training, is effective, especially in children. Habit reversal training consists of training in self-awareness, stimulus control, competitive response, and relaxation. Its effectiveness relies on social support; therefore, the provider needs to promote both family and social support in the care of the patient.
Tics and Tourette’s syndrome
Published in Quentin Spender, Judith Barnsley, Alison Davies, Jenny Murphy, Primary Child and Adolescent Mental Health, 2019
Quentin Spender, Judith Barnsley, Alison Davies, Jenny Murphy
A recently developed treatment package titled ‘Comprehensive Behavioural Intervention for Tics’ has proved effective: a key component is habit reversal training.9 The child is taught to be aware of the urge to tic and to use a competing response; for vocal tics, for example, the child might focus on diaphragmatic breathing until the urge to vocalize subsides. This enables a child to manage the urge to tic so he doesn’t have to do it as often or intensely – empowering the child and family to feel more able to cope with the tics. It often makes a big difference to enlist the help of family members. Other potentially effective psychological treatments include: addressing situations that sustain or worsen tics, relaxation exercises, problem-solving, stress management, massed practice (doing a tic so many times that the urge to repeat it is exhausted) and guided imagery. Some young people may benefit from exposure and response prevention for obsessions or compulsions (see Chapter 39 on obsessive-compulsive disorder). Some combination of these may be offered by psychologists (or other professionals with relevant training) working in Tier 2 or Tier 3. For a vocal tic, you could try suggesting breathing with the tummy; or, for a motor tic, if the child can identify the urge to do a particular movement, he should try an alternative incompatible movement. For instance, if the tic is a forward head nod, when he feels the urge to do this, he should try to lift his head upwards instead.
Current and emerging pharmacotherapeutic strategies for Tourette syndrome
Published in Expert Opinion on Pharmacotherapy, 2022
Although the exact pathophysiology of TS is still unknown, alterations within the cortico-striato-thalamo-cortical circuits and disturbances in overall sensorimotor processing seem to play important roles [15]. Multiple neurotransmission pathways are likely to be involved in addition to dopaminergic networks [16]. The contribution of possible deficits in inhibitory control is controversial [17]. In consideration of the natural history of tics, a proportion of young patients first diagnosed with tics/TS might not require active interventions and would instead benefit from psychoeducation and watchful monitoring. For the remaining ones, available treatment options encompass behavioral interventions – mainly habit reversal training, as part of the comprehensive behavioral intervention for tics (CBIT), and exposure and response prevention – and pharmacotherapy [18–20]. Among non-pharmacological treatment strategies, CBIT is the intervention that has been investigated more thoroughly, with evidence based on large randomized controlled trials. More invasive procedures such as deep brain stimulation can be considered for severe and refractory cases [21]. The pharmacotherapeutic armamentarium for the treatment of TS encompasses first- and second-generation antidopaminergic medications, alpha-2 agonists, plus a range of pharmacological agents with less established evidence [22]. This latter group includes heterogenous compounds, ranging from presynaptic monoamine depletors to anticonvulsants, cannabinoids, and traditional Chinese therapies [23].
Aripiprazole for the treatment of Tourette syndrome
Published in Expert Review of Neurotherapeutics, 2021
Joanna H. Cox, Andrea E. Cavanna
In 2006, a case series of 11 consecutive patients with TS (7 males; age range 7–50 years) who were felt to require antidopaminergic medication and were treated with aripiprazole was published [60]. Most patients had proven refractory to treatment with other antidopaminergic drugs, and in one case, habit reversal training as well. Ten out of the 11 patients who were treated with aripiprazole improved, although to differing degrees: in 5 patients, the improvement was rated as ‘dramatic and quick’. The successful aripiprazole doses were between 10–20 mg daily and the only patient who showed no response was treated for one month with a lower dose (5 mg daily). Over the last fifteen years, the use of aripiprazole in the treatment of TS has increased considerably. We reviewed the available scientific literature evaluating the role of aripiprazole in the treatment of TS and other tic disorders in both children and adults, following to the methodology outlined in the Prisma guidelines for systematic literature reviews [61] (Figure 1).
Management of palatal myoclonic tinnitus based on clinical characteristics: a large case series study
Published in Acta Oto-Laryngologica, 2020
Jung Mee Park, Woo Jin Kim, Jae Sang Han, So Young Park, Shi Nae Park
Patients with PMT were relatively young with the mean age of less than 30 years in this study. The majority of our patients were under the age of 40, indicating that PMT has an earlier onset compared to sensorineural tinnitus [7]. Approximately 27.8% of the enrolled patients were children, adolescents, or under the age of 20, and 66.7% of these young patients were Group 1 patients who showed complete resolution of symptoms after reassurance and behavior therapy for 3 months. For many young patients, visually demonstrating the origin of their tinnitus through video clips of their soft palate contraction, and reassuring them that their symptoms are not harmful is often sufficient for complete remission. Parents of young patient with PMT should also be taught about the disease entity and be able to reassure their child when the patient complains of symptoms. Even adult patients can benefit from learning about the etiology, identifying and avoiding specific settings or psychological conditions that can trigger PMT. This is an approach similar to ‘habit reversal training’ used in a tic disorder.