European clinical guidelines for Tourette syndrome and other tic disorders—version 2.0. Part III: pharmacological treatment

There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

Abstract

In 2011, the European Society for the Study of Tourette Syndrome (ESSTS) published the first European guidelines for Tourette Syndrome (TS). We now present an update of the part on pharmacological treatment, based on a review of new literature with special attention to other evidence-based guidelines, meta-analyses, and randomized double-blinded studies. Moreover, our revision took into consideration results of a recent survey on treatment preferences conducted among ESSTS experts. The first preference should be given to psychoeducation and to behavioral approaches, as it strengthens the patients’ self-regulatory control and thus his/her autonomy. Because behavioral approaches are not effective, available, or feasible in all patients, in a substantial number of patients pharmacological treatment is indicated, alone or in combination with behavioral therapy. The largest amount of evidence supports the use of dopamine blocking agents, preferably aripiprazole because of a more favorable profile of adverse events than first- and second-generation antipsychotics. Other agents that can be considered include tiapride, risperidone, and especially in case of co-existing attention deficit hyperactivity disorder (ADHD), clonidine and guanfacine. This view is supported by the results of our survey on medication preference among members of ESSTS, in which aripiprazole was indicated as the drug of first choice both in children and adults. In treatment resistant cases, treatment with agents with either a limited evidence base or risk of extrapyramidal adverse effects might be considered, including pimozide, haloperidol, topiramate, cannabis-based agents, and botulinum toxin injections. Overall, treatment of TS should be individualized, and decisions based on the patient’s needs and preferences, presence of co-existing conditions, latest scientific findings as well as on the physician’s preferences, experience, and local regulatory requirements.

Related collections

Most cited references 204

Record: found
Abstract: found
Article: not found

Comparative efficacy and tolerability of 15 antipsychotic drugs in schizophrenia: a multiple-treatments meta-analysis.

Stefan Leucht, Andrea Cipriani, Loukia Spineli … (2013)

The question of which antipsychotic drug should be preferred for the treatment of schizophrenia is controversial, and conventional pairwise meta-analyses cannot provide a hierarchy based on the randomised evidence. We aimed to integrate the available evidence to create hierarchies of the comparative efficacy, risk of all-cause discontinuation, and major side-effects of antipsychotic drugs. We did a Bayesian-framework, multiple-treatments meta-analysis (which uses both direct and indirect comparisons) of randomised controlled trials to compare 15 antipsychotic drugs and placebo in the acute treatment of schizophrenia. We searched the Cochrane Schizophrenia Group's specialised register, Medline, Embase, the Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov for reports published up to Sept 1, 2012. Search results were supplemented by reports from the US Food and Drug Administration website and by data requested from pharmaceutical companies. Blinded, randomised controlled trials of patients with schizophrenia or related disorders were eligible. We excluded trials done in patients with predominant negative symptoms, concomitant medical illness, or treatment resistance, and those done in stable patients. Data for seven outcomes were independently extracted by two reviewers. The primary outcome was efficacy, as measured by mean overall change in symptoms. We also examined all-cause discontinuation, weight gain, extrapyramidal side-effects, prolactin increase, QTc prolongation, and sedation. We identified 212 suitable trials, with data for 43 049 participants. All drugs were significantly more effective than placebo. The standardised mean differences with 95% credible intervals were: clozapine 0·88, 0·73-1·03; amisulpride 0·66, 0·53-0·78; olanzapine 0·59, 0·53-0·65; risperidone 0·56, 0·50-0·63; paliperidone 0·50, 0·39-0·60; zotepine 0·49, 0·31-0·66; haloperidol 0·45, 0·39-0·51; quetiapine 0·44, 0·35-0·52; aripiprazole 0·43, 0·34-0·52; sertindole 0·39, 0·26-0·52; ziprasidone 0·39, 0·30-0·49; chlorpromazine 0·38, 0·23-0·54; asenapine 0·38, 0·25-0·51; lurasidone 0·33, 0·21-0·45; and iloperidone 0·33, 0·22-0·43. Odds ratios compared with placebo for all-cause discontinuation ranged from 0·43 for the best drug (amisulpride) to 0·80 for the worst drug (haloperidol); for extrapyramidal side-effects 0·30 (clozapine) to 4·76 (haloperidol); and for sedation 1·42 (amisulpride) to 8·82 (clozapine). Standardised mean differences compared with placebo for weight gain varied from -0·09 for the best drug (haloperidol) to -0·74 for the worst drug (olanzapine), for prolactin increase 0·22 (aripiprazole) to -1·30 (paliperidone), and for QTc prolongation 0·10 (lurasidone) to -0·90 (sertindole). Efficacy outcomes did not change substantially after removal of placebo or haloperidol groups, or when dose, percentage of withdrawals, extent of blinding, pharmaceutical industry sponsorship, study duration, chronicity, and year of publication were accounted for in meta-regressions and sensitivity analyses. Antipsychotics differed substantially in side-effects, and small but robust differences were seen in efficacy. Our findings challenge the straightforward classification of antipsychotics into first-generation and second-generation groupings. Rather, hierarchies in the different domains should help clinicians to adapt the choice of antipsychotic drug to the needs of individual patients. These findings should be considered by mental health policy makers and in the revision of clinical practice guidelines. None. Copyright © 2013 Elsevier Ltd. All rights reserved.

0 comments Cited 331 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: found

Is Open Access

Comparative effects of 18 antipsychotics on metabolic function in patients with schizophrenia, predictors of metabolic dysregulation, and association with psychopathology: a systematic review and network meta-analysis

Toby Pillinger, Robert McCutcheon, Luke Vano … (2020)

Summary Background Antipsychotic treatment is associated with metabolic disturbance. However, the degree to which metabolic alterations occur in treatment with different antipsychotics is unclear. Predictors of metabolic dysregulation are poorly understood and the association between metabolic change and change in psychopathology is uncertain. We aimed to compare and rank antipsychotics on the basis of their metabolic side-effects, identify physiological and demographic predictors of antipsychotic-induced metabolic dysregulation, and investigate the relationship between change in psychotic symptoms and change in metabolic parameters with antipsychotic treatment. Methods We searched MEDLINE, EMBASE, and PsycINFO from inception until June 30, 2019. We included blinded, randomised controlled trials comparing 18 antipsychotics and placebo in acute treatment of schizophrenia. We did frequentist random-effects network meta-analyses to investigate treatment-induced changes in body weight, BMI, total cholesterol, LDL cholesterol, HDL cholesterol, triglyceride, and glucose concentrations. We did meta-regressions to examine relationships between metabolic change and age, sex, ethnicity, baseline weight, and baseline metabolic parameter level. We examined the association between metabolic change and psychopathology change by estimating the correlation between symptom severity change and metabolic parameter change. Findings Of 6532 citations, we included 100 randomised controlled trials, including 25 952 patients. Median treatment duration was 6 weeks (IQR 6–8). Mean differences for weight gain compared with placebo ranged from −0·23 kg (95% CI −0·83 to 0·36) for haloperidol to 3·01 kg (1·78 to 4·24) for clozapine; for BMI from −0·25 kg/m2 (−0·68 to 0·17) for haloperidol to 1·07 kg/m2 (0·90 to 1·25) for olanzapine; for total-cholesterol from −0·09 mmol/L (−0·24 to 0·07) for cariprazine to 0·56 mmol/L (0·26–0·86) for clozapine; for LDL cholesterol from −0·13 mmol/L (−0.21 to −0·05) for cariprazine to 0·20 mmol/L (0·14 to 0·26) for olanzapine; for HDL cholesterol from 0·05 mmol/L (0·00 to 0·10) for brexpiprazole to −0·10 mmol/L (−0·33 to 0·14) for amisulpride; for triglycerides from −0·01 mmol/L (−0·10 to 0·08) for brexpiprazole to 0·98 mmol/L (0·48 to 1·49) for clozapine; for glucose from −0·29 mmol/L (−0·55 to −0·03) for lurasidone to 1·05 mmol/L (0·41 to 1·70) for clozapine. Greater increases in glucose were predicted by higher baseline weight (p=0·0015) and male sex (p=0·0082). Non-white ethnicity was associated with greater increases in total cholesterol (p=0·040) compared with white ethnicity. Improvements in symptom severity were associated with increases in weight (r=0·36, p=0·0021), BMI (r=0·84, p<0·0001), total-cholesterol (r=0·31, p=0·047), and LDL cholesterol (r=0·42, p=0·013), and decreases in HDL cholesterol (r=–0·35, p=0·035). Interpretation Marked differences exist between antipsychotics in terms of metabolic side-effects, with olanzapine and clozapine exhibiting the worst profiles and aripiprazole, brexpiprazole, cariprazine, lurasidone, and ziprasidone the most benign profiles. Increased baseline weight, male sex, and non-white ethnicity are predictors of susceptibility to antipsychotic-induced metabolic change, and improvements in psychopathology are associated with metabolic disturbance. Treatment guidelines should be updated to reflect our findings. However, the choice of antipsychotic should be made on an individual basis, considering the clinical circumstances and preferences of patients, carers, and clinicians. Funding UK Medical Research Council, Wellcome Trust, National Institute for Health Research Oxford Health Biomedical Research Centre.

0 comments Cited 254 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: found

Lifetime Prevalence, Age of Risk, and Genetic Relationships of Comorbid Psychiatric Disorders in Tourette Syndrome

Matthew E. Hirschtritt, Paul C. Lee, David L. Pauls … (2015)

Tourette syndrome (TS) is characterized by high rates of psychiatric comorbidity; however, few studies have fully characterized these comorbidities. Furthermore, most studies have included relatively few participants (<200), and none has examined the ages of highest risk for each TS-associated comorbidity or their etiologic relationship to TS.

0 comments Cited 135 times – based on 0 reviews      Review now

Bookmark

All references

Author and article information

Contributors

Veit Roessner: veit.roessner@uniklinikum-dresden.de

Journal

Journal ID (nlm-ta): Eur Child Adolesc Psychiatry

Journal ID (iso-abbrev): Eur Child Adolesc Psychiatry

Title: European Child & Adolescent Psychiatry

Publisher: Springer Berlin Heidelberg (Berlin/Heidelberg )

ISSN (Print): 1018-8827

ISSN (Electronic): 1435-165X

Publication date (Electronic): 10 November 2021

Publication date PMC-release: 10 November 2021

Publication date (Print): 2022

Volume: 31

Issue: 3

Pages: 425-441

Affiliations

[1 ]GRID grid.4488.0, ISNI 0000 0001 2111 7257, Department of Child and Adolescent Psychiatry, , TU Dresden, ; Fetscherstrasse 74, 01307 Dresden, Germany

[2 ]GRID grid.7914.b, ISNI 0000 0004 1936 7443, Department of Biological and Medical Psychology, Faculty of Psychology, , University of Bergen, ; Bergen, Norway

[3 ]GRID grid.412008.f, ISNI 0000 0000 9753 1393, Regional Resource Center for Autism, ADHD, Tourette Syndrome and Narcolepsy Western Norway, Division of Psychiatry, , Haukeland University Hospital, ; Bergen, Norway

[4 ]GRID grid.264200.2, ISNI 0000 0000 8546 682X, Department of Neurology, , St George’s Hospital, St George’s University of London, ; London, UK

[5 ]GRID grid.411900.d, ISNI 0000 0004 0646 8325, Paediatric Department, , Herlev University Hospital, ; Herlev, Denmark

[6 ]GRID grid.8158.4, ISNI 0000 0004 1757 1969, Child and Adolescent Neurology and Psychiatry, Department of Clinical and Experimental Medicine, , University of Catania, ; Catania, Italy

[7 ]Vadaskert Child Psychiatric Hospital and Outpatient Clinic, Budapest, Hungary

[8 ]GRID grid.6572.6, ISNI 0000 0004 1936 7486, Institute of Clinical Sciences, , University of Birmingham, ; Birmingham, UK

[9 ]GRID grid.18147.3b, ISNI 0000000121724807, Child Neuropsychiatry Unit, Department of Medicine and Surgery, , University of Insubria, ; Varese, Italy

[10 ]GRID grid.6363.0, ISNI 0000 0001 2218 4662, Department of Neurology, , Charité Universitätsmedizin Berlin, ; Berlin, Germany

[11 ]GRID grid.4562.5, ISNI 0000 0001 0057 2672, Institute of Systems Motor Science, , University of Lübeck, ; Lübeck, Germany

[12 ]GRID grid.13339.3b, ISNI 0000000113287408, Department of Neurology, , Medical University of Warsaw, ; Warsaw, Poland

[13 ]GRID grid.13339.3b, ISNI 0000000113287408, Department of Bioethics, , Medical University of Warsaw, ; Warsaw, Poland

[14 ]GRID grid.47100.32, ISNI 0000000419368710, Division of Neurocritical Care and Emergency Neurology, Department of Neurology, , Yale School of Medicine, ; New Haven, CT USA

[15 ]GRID grid.4494.d, ISNI 0000 0000 9558 4598, Department of Psychiatry, , University Medical Center Groningen, Rijks Universiteit Groningen, GGZ Drenthe Mental Health Institution, ; Assen, The Netherlands

[16 ]GRID grid.10423.34, ISNI 0000 0000 9529 9877, Clinic of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, ; Hannover, Germany

[17 ]PsyQ Nijmegen, Parnassia Group, Nijmegen, The Netherlands

[18 ]TicXperts, Heteren, The Netherlands

[19 ]GRID grid.462844.8, ISNI 0000 0001 2308 1657, Department of Neurology, , Sorbonne Université, Pitié-Salpetriere Hospital, ; Paris, France

[20 ]National Reference Center for Tourette Disorder, Pitié Salpetiere Hospital, Paris, France

[21 ]GRID grid.411984.1, ISNI 0000 0001 0482 5331, Clinic for Child and Adolescent Psychiatry and Psychotherapy, , University Medical Center Gottingen, ; Gottingen, Germany

[22 ]GRID grid.4494.d, ISNI 0000 0000 9558 4598, Department of Child and Adolescent Psychiatry, , University of Groningen, University Medical Center Groningen, ; Groningen, Netherlands

[23 ]GRID grid.9851.5, ISNI 0000 0001 2165 4204, Division of Child and Adolescent Psychiatry, Department of Psychiatry, , Lausanne University Hospital, University of Lausanne, ; Lausanne, Switzerland

[24 ]GRID grid.466916.a, ISNI 0000 0004 0631 4836, Child and Adolescent Mental Health Centre, Mental Health Services, Capital Region of Denmark, ; Copenhagen, Denmark

Article

Publisher ID: 1899

DOI: 10.1007/s00787-021-01899-z

PMC ID: 8940878

PubMed ID: 34757514

SO-VID: b9c4b0ef-37ac-475b-947b-1fd3ad42367b

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.