[Changes in comorbid symptoms and subjective interference in a habit reversal therapy in children with chronic tic disorder - a pilot study]

Habit Reversal Therapy in Obsessive Compulsive Related Disorders: A Systematic Review of the Evidence and CONSORT Evaluation of Randomized Controlled Trials

Background: Habit Reversal Therapy (HRT) has long been used in the treatment of Tourette Syndrome and Tic Disorders. It has more recently been used to treat Trichotillomania and skin picking behaviors, both considered as Obsessive Compulsive Related Disorders (OCRD). Objectives: This literature review sought to establish and quality assess the existing randomized controlled trial evidence supporting the use of HRT in the DSM-5 family of OCRDs. Search Methods: EMBASE, PsycINFO, PubMed, and Cochrane databases were searched for key terms relating to each OCRD (as classified in the DSM-5), and HRT. Selection Criteria: Titles and abstracts were screened, and any literature matching pre-specified criteria were then selected to be reviewed further. Of these, 8 Randomized Controlled Trials (RCT) relating to Trichotillomania, and 2 RCTs relating to Excoriation Disorder, were extracted and reviewed against the 2010 Consolidating Standards of Reporting Trials (CONSORT) statement. Results: The review identified 10 RCTs of HRT, but these were limited to patients with a primary diagnosis of Trichotillomania or "excoriation behavior," only. There were some reports of the use of HRT in Tourette Syndrome or Tic Disorder with secondary OCD, but the OCD symptoms were not reliably reported on. Conclusion: There is a gap in the current literature regarding the use of HRT in the DSM-5 OCRDs. In those RCTs that have been reported, the quality of study methodology was questionable as evaluated by CONSORT criteria. The implications of these findings are discussed, and suggestions are made for future research.

A new treatment for children with chronic tic disorders - Resource activation

The aim of this pilot study is to evaluate the efficacy of a resource activation (RA) program as an alternative intervention for children and adolescents with tic disorders. RA interventions focus on the strengths and abilities of the patients. This is expected to improve the patients' perceptions regarding their own resources, which may indirectly result in a reduction of tic symptoms, impairment and comorbid conditions. A within-subject design with two phases (8 weeks diagnostic; 16 sessions treatment) was analyzed using multilevel modeling (n = 24). During the treatment phase, significant reductions of tics were found in clinical rating (Yale Global Tic Severity Scale; YGTSS), parent rating and video observation (motor tics). Moreover, an improvement was shown on most tic-related impairment and subjective burden (SB) ratings. No significant improvement was found regarding comorbid problems and self-esteem. Compared to the preceding diagnostic phase, a significant incremental treatment effect emerged in clinical rating of tic symptoms (YGTSS) and video observation (motor tics). This pilot study provides first hints that RA may represent an effective treatment for reducing tic symptoms, impairment and SB. However, further research is needed in order to establish RA as an effective treatment for tic disorders.

Die Wirksamkeit der Reaktionsumkehr-Behandlung bei Kindern und Jugendlichen mit chronischen Tic-Störungen

Fragestellung: Mit der vorliegenden Studie soll das Training der Reaktionsumkehr erstmals im deutschen Sprachraum mit gruppenstatistischen Ansätzen auf seine Wirksamkeit hinsichtlich mehrerer Zielgrößen bei der Behandlung von Kindern und Jugendlichen mit chronischen Tic-Störungen überprüft werden. Die Intervention wird anhand eines Trainingsmanuals operationalisiert. Methodik: Es wurden 16 Kinder/Jugendliche behandelt. Es wurden sowohl Verhaltensbeobachtungen als auch Eltern-, Selbst- und klinische Urteile zur Erfassung der Tic-Symptomatik eingesetzt. Die Wirksamkeit einer Intensivinterventionsphase wird außerdem im Vergleich zu einer Minimalinterventionsphase untersucht. Ergebnisse: Die Studie liefert erste Hinweise auf die Akzeptanz und Effektivität des neu entwickelten Therapieprogramms. Schlussfolgerungen: Das Therapieprogramm erwies sich als gut einsetzbar. Weitere Studien sind jedoch notwendig, um die Wirksamkeit der Intervention abzusichern.