{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T01:02:30Z","timestamp":1787792550362,"version":"build-2784847793"},"reference-count":36,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2024,12,7]],"date-time":"2024-12-07T00:00:00Z","timestamp":1733529600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Brain Sciences"],"abstract":"<jats:p>Background\/Objectives: The treatment of tics and psychiatric comorbidities is crucial when they affect the patient\u2019s well-being and relationships. However, the optimal pharmacological treatment (PT) tailored to each patient\u2019s phenotype remains unclear. The primary objective of this study is to describe the clinical characteristics and treatment received for tics and psychiatric comorbidities in our cohort of children and adult patients with tic disorders. Additionally, a further aim was to quantify the severity of tics, comorbidities and overall severity, and the overall clinical changes observed during the follow-up. Methods: Retrospective descriptive study of patients with tic disorders under follow-up at our Tic Functional Unit from January 2022 to March 2024. Two independent neurologists retrospectively applied the Clinical Global Impression of Change (CGI-C) and the Clinical Global Impression of Severity (CGI-S) scales at baseline and at last assessment. Results: A total of 36 individuals were included (63.8% males, median age = 18 years, IQR 19): 94.4% with Tourette syndrome (TS), 2.8% with chronic tic disorder (CTD), and 2.8% with provisional tic disorder (PTD). A total of 86% had at least one psychiatric comorbidity, the most common being obsessive\u2013compulsive symptomatology (OCS) (52%), anxiety (52%), and attention deficit hyperactivity disorder (ADHD) (35%). At last assessment, 26 patients (72.2%) were on undergoing PT for tics and 3 were receiving additional botulinum toxin. The most used medication for tics were aripiprazole (46.2%) and clonazepam (46.2%), and for psychiatric comorbidities, SSRIs (42.9%), methylphenidate (19%), and benzodiazepines (57.1%). Overall improvement according to the CGI-C scale was mild (CGI-C 3). Children and adolescents showed greater improvement than adults (CGI-C 2 vs. 3; p = 0.005). Aripiprazole and clonazepam produced similar outcomes in reducing CGI-C. Conclusions: We observed a favorable clinical course in patients treated with aripiprazole and clonazepam, which appear to be better than that obtained with other treatments. We consider that clonazepam may be useful as a first-line monotherapy and as an adjuvant for both tics and comorbidities in selected cases.<\/jats:p>","DOI":"10.3390\/brainsci14121231","type":"journal-article","created":{"date-parts":[[2024,12,9]],"date-time":"2024-12-09T04:01:37Z","timestamp":1733716897000},"page":"1231","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Therapeutic Approach to Primary Tic Disorders and Associated Psychiatric Comorbidities"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-5387-7948","authenticated-orcid":false,"given":"Irene","family":"Berzosa-Gonzalez","sequence":"first","affiliation":[{"name":"Movement Disorder Unit, Neurology Department, Hospital de Sant Pau, 08041 Barcelona, Spain"},{"name":"Department of Medicine, Universitat Autonoma de Barcelona (UAB), 08193 Barcelona, Spain"},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red-Enfermedades Neurodegenerativas (CIBERNED), 28029 Madrid, Spain"},{"name":"Sant Pau Biomedical Research Institute (IIB-Sant Pau), 08041 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0125-7249","authenticated-orcid":false,"given":"Saul","family":"Martinez-Horta","sequence":"additional","affiliation":[{"name":"Movement Disorder Unit, Neurology Department, Hospital de Sant Pau, 08041 Barcelona, Spain"},{"name":"Department of Medicine, Universitat Autonoma de Barcelona (UAB), 08193 Barcelona, Spain"},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red-Enfermedades Neurodegenerativas (CIBERNED), 28029 Madrid, Spain"},{"name":"Sant Pau Biomedical Research Institute (IIB-Sant Pau), 08041 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jesus","family":"P\u00e9rez-P\u00e9rez","sequence":"additional","affiliation":[{"name":"Movement Disorder Unit, Neurology Department, Hospital de Sant Pau, 08041 Barcelona, Spain"},{"name":"Department of Medicine, Universitat Autonoma de Barcelona (UAB), 08193 Barcelona, Spain"},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red-Enfermedades Neurodegenerativas (CIBERNED), 28029 Madrid, Spain"},{"name":"Sant Pau Biomedical Research Institute (IIB-Sant Pau), 08041 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jaime","family":"Kulisevsky","sequence":"additional","affiliation":[{"name":"Movement Disorder Unit, Neurology Department, Hospital de Sant Pau, 08041 Barcelona, Spain"},{"name":"Department of Medicine, Universitat Autonoma de Barcelona (UAB), 08193 Barcelona, Spain"},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red-Enfermedades Neurodegenerativas (CIBERNED), 28029 Madrid, Spain"},{"name":"Sant Pau Biomedical Research Institute (IIB-Sant Pau), 08041 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3248-704X","authenticated-orcid":false,"given":"Javier","family":"Pagonabarraga","sequence":"additional","affiliation":[{"name":"Movement Disorder Unit, Neurology Department, Hospital de Sant Pau, 08041 Barcelona, Spain"},{"name":"Department of Medicine, Universitat Autonoma de Barcelona (UAB), 08193 Barcelona, Spain"},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red-Enfermedades Neurodegenerativas (CIBERNED), 28029 Madrid, Spain"},{"name":"Sant Pau Biomedical Research Institute (IIB-Sant Pau), 08041 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,12,7]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"American Psychiatric Association (2022). Diagnostic and Statistical Manual of Mental Disorders, American Psychiatric Publishing. [5th ed.]. Text Revision (DSM-5-TR).","DOI":"10.1176\/appi.books.9780890425787"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1016\/S2215-0366(14)00133-3","article-title":"A personal 35 year perspective on Gilles de la Tourette syndrome: Assessment, investigations, and management","volume":"2","author":"Robertson","year":"2015","journal-title":"Lancet Psychiatry"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1016\/S1474-4422(22)00303-9","article-title":"Tourette syndrome: Clinical features, pathophysiology, and treatment","volume":"22","author":"Johnson","year":"2022","journal-title":"Lancet Neurol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"513","DOI":"10.1097\/WCO.0000000000000356","article-title":"Tics and Tourette\u2019s: Update on pathophysiology and tic control","volume":"29","author":"Ganos","year":"2016","journal-title":"Curr. Opin. Neurol."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Liao, Y., Li, X., Jia, F., Jiang, Y., Ning, G., Li, X., Fu, C., Zhou, H., He, X., and Cai, X. (2022). The Alternation of Gray Matter Morphological Topology in Drug-Na\u00efve Tourette\u2019s Syndrome in Children. Front. Aging Neurosci., 14.","DOI":"10.3389\/fnagi.2022.873148"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"497","DOI":"10.1016\/j.jpsychores.2009.09.002","article-title":"Clinical course of Tourette syndrome","volume":"67","author":"Bloch","year":"2009","journal-title":"J. Psychosom. Res."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Eapen, V., Cavanna, A.E., and Robertson, M.M. (2016). Comorbidities, social impact, and quality of life in tourette syndrome. Front. Psychiatry, 7.","DOI":"10.3389\/fpsyt.2016.00097"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1016\/j.biopsych.2016.08.023","article-title":"Suicide in Tourette\u2019s and Chronic Tic Disorders","volume":"82","author":"Rydell","year":"2017","journal-title":"Biol. Psychiatry"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1007\/s00787-021-01842-2","article-title":"European clinical guidelines for Tourette syndrome and other tic disorders\u2014Version 2.0. Part I: Assessment","volume":"31","author":"Szejko","year":"2022","journal-title":"Eur. Child Adolesc. Psychiatry"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"325","DOI":"10.1001\/jamapsychiatry.2014.2650","article-title":"Lifetime prevalence, age of risk, and genetic relationships of comorbid psychiatric disorders in tourette syndrome","volume":"72","author":"Hirschtritt","year":"2015","journal-title":"JAMA Psychiatry"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"390","DOI":"10.1111\/ane.13155","article-title":"Effects of comorbidity on Tourette\u2019s tic severity and quality of life","volume":"140","author":"Matthijssen","year":"2019","journal-title":"Acta Neurol Scand."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"16097","DOI":"10.1038\/nrdp.2016.97","article-title":"Gilles de la Tourette syndrome","volume":"3","author":"Robertson","year":"2017","journal-title":"Nat. Rev. Dis. Prim."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1007\/s00787-011-0163-7","article-title":"European clinical guidelines for Tourette syndrome and other tic disorders. Part II: Pharmacological treatment","volume":"20","author":"Roessner","year":"2011","journal-title":"Eur. Child Adolesc. Psychiatry"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"403","DOI":"10.1007\/s00787-021-01845-z","article-title":"European clinical guidelines for Tourette syndrome and other tic disorders\u2014Version 2.0. Part II: Psychological interventions","volume":"31","author":"Jakubovski","year":"2022","journal-title":"Eur. Child Adolesc. Psychiatry"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"896","DOI":"10.1212\/WNL.0000000000007466","article-title":"Practice guideline recommendations summary: Treatment of tics in people with Tourette syndrome and chronic tic disorders","volume":"92","author":"Pringsheim","year":"2019","journal-title":"Neurology"},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Rizzo, R., Pellico, A., Silvestri, P.R., Chiarotti, F., and Cardona, F. (2018). A randomized controlled trial comparing behavioral, educational, and pharmacological treatments in youths with chronic tic disorder or Tourette syndrome. Front. Psychiatry, 9.","DOI":"10.3389\/fpsyt.2018.00100"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"425","DOI":"10.1007\/s00787-021-01899-z","article-title":"European clinical guidelines for Tourette syndrome and other tic disorders\u2014Version 2.0. Part III: Pharmacological treatment","volume":"31","author":"Roessner","year":"2022","journal-title":"Eur. Child Adolesc. Psychiatry"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"595","DOI":"10.5334\/tohm.442","article-title":"Merging the Pathophysiology and Pharmacotherapy of Tics","volume":"8","author":"Augustine","year":"2019","journal-title":"Tremor Other Hyperkinet. Mov."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1177\/070674371205700302","article-title":"Canadian Guidelines for the Evidence-Based Treatment of Tic Disorders: Pharmacotherapy","volume":"57","author":"Pringsheim","year":"2012","journal-title":"Can. J. Psychiatry"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1007\/s11910-022-01177-8","article-title":"Tourette Syndrome Treatment Updates: A Review and Discussion of the Current and Upcoming Literature","volume":"22","author":"Frey","year":"2022","journal-title":"Curr. Neurol. Neurosci. Rep."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"443","DOI":"10.1007\/s00787-021-01881-9","article-title":"European clinical guidelines for Tourette syndrome and other tic disorders\u2014Version 2.0. Part IV: Deep brain stimulation","volume":"31","author":"Szejko","year":"2022","journal-title":"Eur. Child Adolesc. Psychiatry"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Xu, W., Zhang, C., Deeb, W., Patel, B., Wu, Y., Voon, V., Okun, M.S., and Sun, B. (2020). Deep brain stimulation for Tourette\u2019s syndrome. Transl. Neurodegener., 9.","DOI":"10.1186\/s40035-020-0183-7"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1523","DOI":"10.1080\/14656566.2022.2107902","article-title":"Current and emerging pharmacotherapeutic strategies for Tourette syndrome","volume":"23","author":"Cavanna","year":"2022","journal-title":"Expert Opin. Pharmacother."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1539","DOI":"10.1007\/s00787-021-01751-4","article-title":"Tic disorders in children and adolescents: Does the clinical presentation differ in males and females? A report by the EMTICS group","volume":"31","author":"Servera","year":"2022","journal-title":"Eur. Child Adolesc. Psychiatry"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"334","DOI":"10.1016\/j.eurpsy.2014.07.003","article-title":"Influence of gender on tourette syndrome beyond adolescence","volume":"30","author":"Lichter","year":"2015","journal-title":"Eur. Psychiatry"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"764","DOI":"10.1002\/mdc3.13703","article-title":"Have We Forgotten What Tics Are? A Re-Exploration of Tic Phenomenology in Youth with Primary Tics","volume":"10","author":"Nilles","year":"2023","journal-title":"Mov. Disord. Clin. Pract."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1017\/S1092852922000074","article-title":"Sex differences in patients with Tourette syndrome","volume":"28","author":"Jankovic","year":"2023","journal-title":"CNS Spectr."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1007\/s40474-021-00231-3","article-title":"Course of Tic Disorders Over the Lifespan","volume":"8","author":"Black","year":"2021","journal-title":"Curr. Dev. Disord. Rep."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"304","DOI":"10.1016\/j.jaac.2017.01.010","article-title":"Course of Tourette Syndrome and Comorbidities in a Large Prospective Clinical Study","volume":"56","author":"Groth","year":"2017","journal-title":"J. Am. Acad. Child Adolesc. Psychiatry"},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Levine, J.L.S., Szejko, N., and Bloch, M.H. (2019). Meta-analysis: Adulthood prevalence of Tourette syndrome. Prog. Neuro-Psychopharmacol. Biol. Psychiatry, 95.","DOI":"10.1016\/j.pnpbp.2019.109675"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1176\/jnp.2009.21.1.13","article-title":"The Behavioral Spectrum of Gilles de la Tourette Syndrome","volume":"21","author":"Servo","year":"2009","journal-title":"J. Neuropsychiatry Clin. Neurosci."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"355","DOI":"10.2165\/00128072-200103050-00004","article-title":"Tourette Syndrome Clinical Characteristics and Current Management Strategies","volume":"3","author":"Kossoff","year":"2001","journal-title":"Paediatr. Drugs"},{"key":"ref_33","unstructured":"(2024, November 04). Grupo de Estudio de Trastornos del Movimiento de la SEN (GETM-SEN). Consenso Nacional Sobre el S\u00edndrome de Tourette; Espa\u00f1a: Sociedad Espa\u00f1ola de Neurolog\u00eda. Available online: https:\/\/www.sen.es\/component\/content\/category\/220-consenso-nacional-sobre-el-sindrome-de-tourette?Itemid=437."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1681","DOI":"10.1007\/s13311-020-00914-6","article-title":"Current Management of Tics and Tourette Syndrome: Behavioral, Pharmacologic, and Surgical Treatments","volume":"17","author":"Billnitzer","year":"2020","journal-title":"Neurotherapeutics"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1111\/j.1469-7610.2006.01687.x","article-title":"Psychosocial stress predicts future symptom severities in children and adolescents with Tourette syndrome and\/or obsessive-compulsive disorder","volume":"48","author":"Lin","year":"2007","journal-title":"J. Child Psychol. Psychiatry"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"913","DOI":"10.1177\/0883073819867245","article-title":"Predictors of the Clinical Course of Tourette Syndrome: A Longitudinal Study","volume":"34","author":"Groth","year":"2019","journal-title":"J. Child Neurol."}],"container-title":["Brain Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-3425\/14\/12\/1231\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T16:49:38Z","timestamp":1760114978000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-3425\/14\/12\/1231"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,12,7]]},"references-count":36,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2024,12]]}},"alternative-id":["brainsci14121231"],"URL":"https:\/\/doi.org\/10.3390\/brainsci14121231","relation":{},"ISSN":["2076-3425"],"issn-type":[{"value":"2076-3425","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,12,7]]}}}