Contemporary approaches to pharmacotherapy in Tourette's syndrome and obsessive-compulsive disorder

Application of Habit Reversal Training for the Treatment of Tics in Early Childhood

Habit-reversal training (HRT) has demonstrated efficacy in adults and in children above 9 years of age with tic disorders. However, less is known about the utility of this treatment with children younger than 9 years of age.This is alarming given that most children with tic disorders experience symptom onset before 9 years and that existing pharmacological treatments show modest efficacy, may have side effects, and may not be an acceptable intervention to parents. With this in mind, this case report documents the use of HRT with a 6-year-old female with pronounced and impairing motor tics. Throughout the course of the treatment (eight sessions) “Megan” showed improvement in her ability to control her symptoms. Furthermore, treatment gains and improved quality of life were maintained at follow-up. This case report suggests the utility of HRT for the treatment of tics in early childhood, with developmental considerations and the integration of family-based skills training.

Clonidine treatment increases tics in patients with Tourette syndrome: case report

Clonidine usually serves as a tic-suppressing agent in patients with Tourette syndrome. A case study is presented in which clonidine at subclinical concentrations led to an exacerbation of the tics and caused severe systemic heat sensations. Involvement of functional abnormalities of the hypothalamus in Tourette syndrome is hypothesized.

The use of traditional neuroleptics in children and adolescents

Neuroleptics are used for a wide range of neuropsychiatric conditions in children and adolescents. Although the body of evidence from controlled studies is limited, there is some information upon which to base clinical practice (McClellan & Werry, 1994). These medications can be useful in psychosis, tic disorders, severe hyperactivity, agitation, and aggression. Nonetheless, the neuroleptics can have both short-term and long-term adverse effects. Contemporary practice in child and adolescent psychiatry requires knowledge about the rational uses, dosing, and side effects of these medications. Prior to initiating a trial with a neuroleptic medication, the risks, benefits, and alternatives should be reviewed with the child and family.

Current approaches to the psychopharmacologic treatment of depression in children and adolescents

TOPIC

A review of major depressive disorder and antidepressant drug treatment in children and adolescents.

PURPOSE

This paper provides a synthesis of current information regarding diagnosis, psychobiology, psychopharmacology, and practice guidelines for psychiatric nurses involved in the treatment of depression in children and adolescents.

SOURCES

Recent journal and book publications regarding the psychopharmacological treatment of depression in children and adolescents.

CONCLUSION

Although there is far less research to guide the psychopharmacological treatment of depression in children and adolescents than there is for adults, these treatments can be safely administered and effective for some individuals in this age group.