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| Florida Best Practice Guidelines for Severe Tic Disorders and Tourette’s Syndrome Severe and chronic tic disorders, in particular Tourette’s Syndrome, was the focus of this expert panel. Level 0: In addition to previous Level 0s about careful assessment, it is important to note symptom duration greater than six weeks. Issues of social, educational, or physical impairment as well as contributing comorbidities need to be evaluated. Level I: Habit reversal therapy was recommended with the greatest amount of expert opinion support and safety. If severe symptoms and severe impairment were part of the picture, however, the expert panel thought that providers could use Level II options. Level II: Haloperidol, risperidone, and also aripiprazole, once emerging data is available on this agent, however, many experts felt that these two agents, risperidone and aripiprazole, would be appropriate options in patients with severe tic disorders. Level III: Options including quetiapine, olanzapine, ziprasidone, and also pimozide were included, however, the expert panel noted that safety issues related to pimozide should be considered prior to use. Level IV: Antipsychotics could be used in combination with SSRIs, clonazepam, alpha-2 agonist, and anticonvulsants, primarily based on targeting symptoms. The experts agreed that severity of the illness should drive the use of one or two agents in this condition and that habit-reversal therapy should be a mainstay in severe tic disorders. Furthermore, caregivers and patients should be aware of the expected outcomes, and that their participation in tracking and monitoring and being a part of measurement-based care would be critical in the optimal resolution or treatment of these conditions and symptoms. | Child & Adolescent » ADHD » Depression » Bipolar Disorder » Tourettes Syndrome » Aggression Adults » Schizophrenia » Bipolar Disorder | |
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