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Refractory case of Tourette's syndrome treated successfully with comprehensive behavioural therapy and aripiprazole

Furlong, Y., Koonamave, R.L., Sarich, E. and Chen, W. (2021) Refractory case of Tourette's syndrome treated successfully with comprehensive behavioural therapy and aripiprazole. Journal of Paediatrics and Child Health . Early View.

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Case Report

A 13-year-old boy with Tourette's syndrome (TS) was referred by neurology team of Perth Children's Hospital to Paediatric Consultation Liaison Program for vocal and motor tics of 5-year duration with comorbid obsessive-compulsive disorder (OCD). At the time of referral, he was on fluoxetine for OCD as well as on risperidone and clonidine for his tics with limited improvement. He became socially withdrawn and his school attendance declined significantly. Having migrated from Sri Lanka at the age of 4, his language barrier and difficulties in integrating into school were major stressors and potential precipitating factors for the onset of OCD and tics, in the presence of biological vulnerability.

At the Perth Children's Hospital, the Paediatric Consultation Liaison Program multidisciplinary team's assessment confirmed the diagnosis of Tourette with comorbid OCD and psychometric testing revealed a normal IQ profile. He responded well to the individualised comprehensive package of treatments which included (i) psychoeducation, (ii) state-of-art Comprehensive Behavioural Intervention of Tics (CBIT) and (iii) rationalisation of his medication switching from risperidone to aripiprazole in combination with clonidine and fluoxetine. The patient learnt to substitute vocal tics with an individualised competing response strategy formulated with his clinical psychologist (e.g. whisper–reading) whereby he would practice reading aloud in a whisper voice. His motor tics were controlled with competing response exercises (e.g. ball bouncing). His OCD symptoms subsided in response to fluoxetine in the context of tics reduction. He returned to full-time education and his school grades improved. The quality of his life also improved as he became willing to attend school, engage with peers and participate in social gatherings and family outings.

Item Type: Journal Article
Murdoch Affiliation(s): Education
Publisher: Blackwell Publishing Inc.
Copyright: © 2021 Paediatrics and Child Health Division (The Royal Australasian College of Physicians).
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