What are the potential complications of TIC (Tic) disorders, such as akathisia, aphasia, and hyperactivity?

From the Guidelines

Tic disorders can lead to several potential complications, including akathisia, aphasia, and hyperactivity, which can significantly impact patients' quality of life. The potential complications of tic disorders, such as akathisia, aphasia, and hyperactivity, are multifaceted and can have a profound impact on patients' daily lives.

• Akathisia, characterized by an unpleasant sensation of inner restlessness and inability to remain still, can develop as a complication of tic disorders or as a side effect of medications used to treat them, particularly antipsychotics like haloperidol or risperidone 1.
• Aphasia, while not a direct complication of tic disorders themselves, may occur if tics involve speech mechanisms or if medication side effects impact language centers.
• Hyperactivity is commonly comorbid with tic disorders, especially in children with Tourette syndrome, where approximately 50-60% also have ADHD 1. Additional complications include social isolation and bullying due to visible or audible tics, academic or occupational difficulties from concentration problems, physical injuries from forceful motor tics, and psychological issues like depression and anxiety. Treatment approaches should address both the tics and these potential complications, often requiring a combination of behavioral therapy (Comprehensive Behavioral Intervention for Tics or CBIT), medication management (such as alpha-2 agonists like guanfacine 1-4mg daily or clonidine 0.1-0.4mg daily for milder cases, or antipsychotics for severe cases), and psychological support 1. Early intervention is crucial to prevent these complications from significantly impacting development and functioning. It is essential to consider the most recent and highest quality study, which suggests that a comprehensive treatment approach can help mitigate the complications associated with tic disorders 1.

From the FDA Drug Label

5.10 Motor and Verbal Tics, and Worsening of Tourette’s Syndrome

• TIC disorders may be exacerbated by methylphenidate, and patients with a history of TIC disorders should be monitored closely. The potential complications of TIC disorders include:
• Worsening of Tourette’s Syndrome
• Motor and Verbal Tics There is no direct information in the drug label that supports akathisia, aphasia, or hyperactivity as complications of TIC disorders 2.

From the Research

Potential Complications of TIC Disorders

The potential complications of TIC disorders, such as akathisia, aphasia, and hyperactivity, are significant and can have a substantial impact on an individual's quality of life.

• Akathisia is not commonly mentioned as a complication of TIC disorders in the provided studies.
• Aphasia is not mentioned at all in the provided studies as a complication of TIC disorders.
• Hyperactivity is a common comorbidity of TIC disorders, particularly in individuals with Attention Deficit Hyperactivity Disorder (ADHD) 3, 4, 5.

Comorbidities of TIC Disorders

TIC disorders often co-occur with other neuropsychological difficulties, including:

• Attention Deficit Hyperactivity Disorder (ADHD) 3, 4, 5
• Obsessive-compulsive disorder (OCD) 3
• Anxiety 3
• Mood disorder 3
• Disruptive behaviors 3
• Schizotypal traits 3
• Suicidal behavior 3
• Personality disorder 3
• Antisocial activities 3
• Sleep disorders 3

Treatment Options for TIC Disorders

Treatment options for TIC disorders include:

• Behavioral therapy 3
• Pharmacotherapy 3, 4, 6, 5
• Deep brain stimulation 3, 6
• Botulinum toxin injections 6
• Alpha-2 agonists (e.g., clonidine) 4, 5, 7
• Stimulants (e.g., methylphenidate) 4, 5
• Selective norepinephrine reuptake inhibitors (e.g., atomoxetine) 4
• Antipsychotics 4, 7