Obsessive-Compulsive Disorder and Tourette’s Syndrome Randall D. Buzan, MD Jay H. Shore, MD, MPH Christopher O’Brien, MD Christopher Schneck, MD Address University of Colorado, Department of Psychiatry, 4200 E. 9th Avenue, Denver, CO 80262, USA. E-mail: randy.buzan@ uchsc.edu Current Treatment Options in Neurology 2000, 2:125–139 Current Science Inc. ISSN 1092-8480 Copyright © 2000 by Current Science Inc. Introduction Tourette’s syndrome is the most severe illness in a spec- trum of tic disorders [1, Class I]. The Diagnostic and Sta- tistical Manual of Mental Disorders, 4th edition (DSM-IV) [2], which defines four tic disorders, requires both vocal and motor tics for the diagnosis of TS and differentiates transient tics lasting less than 1 year from chronic vocal o r mo to r tics ( Table 1) . Investigato rs have fo und O CB in 20% to 60% of patients with TS, and a recent study of 134 patients with TS found that 23% met the formal cri- teria fo r O CD [3, Class III]. Transient tics occur in 4% to 24% of schoolchildren [4••, Class III], with children between the ages of 7 and 11 years having the highest estimated prevalence (5%). In one study of the natural history of transient tic disor- der in 58 children, only 17% could be diagnosed with transient tic disorder 2 to 14 years later [4••, Class III]. Fo rty percent met the criteria fo r chro nic mo to r o r vo cal tic disorder, and 53% met the criteria for TS or tic disor- der, not otherwise specified. Forty-seven percent of patients presenting with motor and vocal tics but only 5% of patients presenting with motor tics went on to develop TS. Although it is tempting to conclude that transient tics portend development of more serious dis- orders, most tics in childhood never come to clinical attention; thus, the true prevalence and course of tics in children are not fully understood. The usual age of onset of tics ranges from 2 to 15 years, with a mean age of onset of 6 to 7 years. Seventy- five percent of patients with TS have symptoms by the age of 11 years, and the disorder appears to be two to fo ur times mo re co mmo n in boys than in girls. A review of 2400 patients suggested that 50% to 70% of patients with TS experienced facial tics as their initial symptom; vocal tics were the initial symptoms in only 12% to 37% of cases [4••, Class III]. Tics typically wax and wane in intensity and fre- quency and become more complex and varied over time as new tics are added and older ones recur. Tics may be simple, such as blinking, grimacing, coughing, snorting, blowing across the upper lip, or emitting “hawwwwk” noises, or may be more complex. Examples of complex tics include making funny facial expressions, grooming hair, hopping, stamping, picking at things, making obscene gestures (copropraxia), repeatedly saying “You bet,” repeating one’s own sentences (palilalia), and repeating others’ words and sentences (echolalia) Opinion statement Obsessive-compulsive behavior (OCB) or full-blown obsessive-compulsive disorder (OCD) afflict more than 50% of patients with Tourette’s syndrome (TS) and often are more debilitating than the tic disorder itself. Medications for OCD, including selective serotonin reuptake inhibitors (SSRIs), help patients with TS and OCD, particularly in combination with low-dose antipsychotic drugs, but seldom eliminate OCD entirely. Behavioral therapies are more effective as medications for the treatment of OCD. A combination of cognitive behavioral therapy and medication is the treatment of choice for most patients with TS and OCD.