From the Guidelines
Treatment of a nervous tic should prioritize Comprehensive Behavioral Intervention for Tics (CBIT) as the first-line approach, which has shown effectiveness in reducing tic severity by 30-50% in many patients 1.
Key Considerations
- CBIT typically requires 8-10 sessions with a trained therapist and teaches patients to recognize premonitory urges and perform competing responses to prevent the tic.
- For medication options, alpha-2 adrenergic agonists like clonidine (0.1-0.3 mg daily) or guanfacine (1-4 mg daily) are often tried first, especially in children or those with co-occurring ADHD, as they have been shown to be effective in treating ADHD and may also reduce tics 2.
- Antipsychotics such as risperidone (0.5-3 mg daily), aripiprazole (2-15 mg daily), or pimozide (1-4 mg daily) may be prescribed for more severe cases, but they carry significant side effects including weight gain and metabolic changes.
- Botulinum toxin injections can be helpful for focal motor tics, with effects lasting 3-6 months per treatment.
- Stress management techniques, adequate sleep, and avoiding stimulants like caffeine are important supportive measures as stress often exacerbates tics.
Diagnosis and Classification
- The term "habit cough" should be abandoned in favor of "tic cough," which shares the core clinical features of tics and may be seen alone or in the context of many tics in an individual with Tourette syndrome or primary school-aged children with high-functioning autism 1.
- Somatic cough disorder, previously referred to as psychogenic cough, is a somatization disorder that refers to the transfer of psychologic distress into a physical symptom, and its diagnosis should be based on the DSM-5 criteria for a somatic symptom disorder 1.
Treatment Approach
- A combination of behavioral therapy and medication should be considered for the treatment of nervous tics, with CBIT as the first-line approach and medication options tailored to the individual patient's needs and response 1.
- The treatment approach should prioritize the reduction of tic severity and improvement of quality of life, while minimizing the risk of adverse effects and considering the patient's overall health and well-being.
From the Research
Treatment Options for Nervous Tics
- Behavioral interventions are commonly used to manage tic symptoms in Tourette syndrome and other tic disorders 3
- Nonpharmacological treatment options include: + Massed practice + Relaxation training + Self-monitoring + Function-based/contingency management procedures + Habit reversal training + Exposure and response prevention + Cognitive behavior therapy 3
- Current international guidelines recommend habit reversal training, comprehensive behavioral intervention, and exposure and response prevention as first-line therapies for tics 4
Effectiveness of Behavioral Therapies
- Behaviour therapy has been shown to be an effective strategy in treating tics, with habit reversal and exposure and response prevention being recommended as first-line interventions 5
- Comprehensive behavioral intervention for tics (CBIT), habit reversal therapy (HRT), and exposure and response prevention (ERP) have been found to be effective in reducing tic symptoms 6
- A meta-analysis found a small to medium effect size for the efficacy of habit reversal training (HRT) in treating tic disorders 7
Delivery Methods for Behavioral Therapies
- Face-to-face one-on-one treatment with CBIT has been found to be highly effective 6
- Treatment by video conferencing has been found to provide similar benefits to face-to-face treatment 6
- Internet-based CBIT programs have been found to be more beneficial than wait list or psychoeducation, but effect sizes are small 6
- Internet-based ERP with minimal therapist support has been found to be effective, although effect sizes are small 6