Tourette patients' misbelief of a tic rebound is due to overall difficulties in reliable tic rating.

OBJECTIVE: While in clinical interviews the vast majority of patients with Tourette syndrome (TS) report about a tic rebound after voluntary tic suppression, in recent studies in children no paradoxical tic increase could be found. We hypothesized that in adult patients there is a tic rebound after tic suppression. METHODS: We investigated the tic severity, premonitory urges and influence of attention deficit hyperactivity disorder (ADHD) before, during and after tic suppression in 22 adult patients with TS using both an objective video tic rating and subjective patient ratings for tics and premonitory urges. RESULTS: According to the video rating, tic suppression resulted in a significant tic reduction, but no rebound. Patients also reported no tic rebound. They erroneously believed in an absolute tic reduction 20 and 30 min after suppression, but paradoxically felt no relative tic change. Premonitory urges remained unchanged. There was no correlation between premonitory urges and tic severity. The potency for tic inhibition did not correlate with premonitory urges and tic severity. ADHD did not influence tic inhibition. CONCLUSION: In adults with TS, there is no tic rebound after voluntary tic suppression. Patients also reported no rebound, but erroneously felt a tic reduction in the later course of the study. This misjudgement as well as patients' often reported (mis-)belief of a tic rebound may be caused by overall difficulties in reliable tic rating. Premonitory urges remained unchanged during tic suppression. Tic suppression was not influenced by attention deficits. Premonitory urges are no prerequisite of tic suppression.

Aripiprazole for the treatment of Tourette syndrome: a case series of 100 patients.

OBJECTIVE: Aripiprazole is an atypical neuroleptic with agonistic and antagonistic dopaminergic and serotonergic effects. Because preliminary data obtained from uncontrolled studies suggest that aripiprazole may be effective in the treatment of tics, we performed a retrospective study with a large group of patients with Tourette syndrome. METHODS: One hundred patients (78 men and 22 women; mean ± SD age, 27.1 years (± 11.5) years) who had been treated with daily doses of 5 to 45 mg (mean, 17.0 ± 9.6 mg) aripiprazole at our specialized Tourette syndrome outpatient clinic were included. Ninety-five patients with insufficient pretreatment (one or more neuroleptics) were switched to aripiprazole. RESULTS: Eighty-two patients exhibited a considerable reduction in tic severity. In 48 patients, effective treatment lasted for more than 12 months. Five patients reported additional beneficial effects on behavioral comorbidities such as depression, anxiety, and autoaggression. Altogether, 31 patients (31%) dropped out of the treatment owing to inefficacy (n = 7), adverse effects (n = 15: drowsiness, agitation, weight gain, and sleep disturbances), both (n = 4) or other reasons (n = 5). CONCLUSION: This is the largest case series on the treatment of tics with aripiprazole so far. Overall, our results corroborate previous data suggesting that aripiprazole is effective and safe in most patients. In particular, our data confirm effectiveness in adult patients and clarify that beneficial effects sustain. However, in contrast to previous data, in 1 of 3 of our highly selected patients, aripiprazole was ineffective or not well tolerated. Optimal dose seems to be individually different and may range from 5 to 45 mg.