Tourette Syndrome Treatment Essay

Tourette syndrome (TS) also referred as Tourette disorder is an inherited and chronic neurological disorder comprised of vocal and motor tics which begin during childhood (Martino & Leckman, 2013). It is characterized by repetitive eye blinking, shoulders shrugging, unusual sounds or use of offensive words. Tics are severe movements, twitches or repeated sounds made by people. The early symptoms of Tourette disorder are seen in children between the age of 3 and 9 years. It occurs in people from all community groups and males are four times likely to be affected than females. According to Roessner, Hoekstra, & Rothenberger (2011), there are three tic syndromes with respect to DSM-5 diagnostic criteria; it involves Tourette disorder, provisional disorder and chronic disorder. To be diagnosed with Tourette disorder, an individual must exhibit at least one vocal sign like throat clearing or humming and two or more motor symptoms like shoulder shrugging and blinking. One must have experienced tics for at least one year, tics have begin before 18 years and symptoms showing not due to medication or substance abuse. Chronic or persistent disorder comprise of having one or more motor experience or vocal tics and not both at the same moment. Provisional tic syndrome patient should be having vocal tics or one or more motor tics (Woods, 2008). Tics must not be present for more than 12 months and have started before age 18 years. Symptoms should not be due to drug and medicine use and the person should not have been diagnosed with chronic tic disorder or TS. Brinn's mother should specify the number of occurrences of the tics and how long the tics have lasted.

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Habit reversal training (HRT) is the most effective and evidence-based non-pharmacological intervention for management of Tourette disorder (Sadock, Sadock, & Ruiz, 2015). HRT method reduces tics frequency by 30% and free of possible side effects. HRT teaches patients on tics management as they happen in the normal life. It comprises of awareness training which allows the patients to have an ability to detect tics incidence and when in the urge of performing the act. The patient then completes the response training by developing and implementing a technique designed to avoid tics occurrence. This helps the individuals to avoid tics when in urge through the help of the approach. As stated by K.Murphy, B.Lewin, A.Storch, & Stock (2013), HRT involves social support where a psychiatrist educates the family members to always reinforce the use of HRT technique in the management of Tourette disorder in their child. It assists the child feels loved, secure and develops motivation in managing the syndrome because she has the family support.

Antipsychotic medications such as Haloperidol and Pimozide are proven to be effective in tic severity reduction. Haloperidol medics have a strong effect in blockage of dopamine receptors, therefore, reducing 78% to 91% tics under a maximum dosage of 1.0 mg (Dutta & Cavanna, 2013). The recommended dosage is 0.25 and 0.5mg per day. Haloperidol is however associated with side effects such as extrapyramidal reactions, drowsiness, neuroleptic malignant syndrome, and restlessness. Despite the side effects it is considered more effective than pimozide and other drugs. Pimozide affects levels of the chemical in the brain hence reducing motor and vocal tics in children and adolescents. It is used after haloperidol and other drugs found to be ineffective (Martino & Leckman, 2013). Pimozide is taken once every day with or without food and the recommended dosage is 1mg-2mg daily which can be increased to 10- 20 mg. common side effects of pimozide include drowsiness, constipation, headache and dry mouth.

Conclusion

Tourette disorder has no cure and the psychiatrist should explain to the child in a calm and friendly manner that the disease is common and people lead normal lives. The disease is manageable and after the age of 18 years, its severity reduces hence should accept it. The child should avoid stressful events and cooperate in taking the therapies. The parent should accept the reality and help in supporting the child avoid and manage the syndrome. The nurse should give examples of individuals who had Tourette disorder and they are living happily. Yale Global Tic Severity Scale is commonly used in rating severity of tic (V, et al., 2013). It has separate scores ranging from 0-5 for intensity, number, complexity, frequency, and interference of motor tics.

References

Dutta, N., & Cavanna, A. E. (2013). The effectiveness of habit reversal therapy in the treatment of Tourette syndrome and other chronic tic disorders: a systematic review. Functional Neurology Journal, 7-12.

K.Murphy, T., B.Lewin, A., A.Storch, E., & Stock, S. (2013). Practice Parameter for the Assessment and Treatment of Children and Adolescents With Tic Disorders. Journal of the American Academy of Child & Adolescent Psychiatry, 1341-1359.

Martino, D., & Leckman, J. F. (2013). Tourette syndrome. New York: Oxford University Press.

Roessner, V., Hoekstra, P. J., & Rothenberger, A. (2011). Tourette's disorder and other tic disorders in DSM-5: a comment. European Child & Adolescent PsychiatryJournal, 71-74.

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2015). Kaplan & Sadock's synopsis of psychiatry: behavioral sciences/clinical psychiatry. Philadelphia: Lippincott Williams & Wilkins.

V, R., K, S., J, B., S, B., S, E., & A, M. (2013). Pharmacological treatment of tic disorders and Tourette Syndrome. Neuropharmacology Journal, 143-149.

Woods, D. W. (2008). Managing Tourette syndrome: a behavioral intervention for children and adults: therapist guide. New York: Oxford University Press.