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Systematic Review: Pharmacological Treatment of Tic Disorders - Efficacy of Antipsychotic and Alpha-2 Adrenergic Agonist Agents.

Yale Child Study Center, Yale University School of Medicine, New Haven, CT.
Neuroscience & Biobehavioral Reviews (Impact Factor: 10.28). 10/2012; 37(6). DOI: 10.1016/j.neubiorev.2012.09.008
Source: PubMed

ABSTRACT We conducted a meta-analysis of randomized, placebo-controlled trials to determine the efficacy of antipsychotic and alpha-2 agonists in the treatment of chronic tic disorders and examine moderators of treatment effect. Meta-analysis demonstrated a significant benefit of antipsychotics compared to placebo (standardized mean difference (SMD)=0.58 (95% confidence interval (CI): 0.36-0.80). Stratified subgroup analysis found no significant difference in the efficacy of the 4 antipsychotic agents tested (risperidone, pimozide, haloperidol and ziprasidone). Meta-analysis also demonstrated a benefit of alpha-2 agonists compared to placebo (SMD=0.31 (95% confidence interval CI: 0.15-0.48). Stratified subgroup analysis and meta-regression demonstrated a significant moderating effect of co-occurring ADHD. Trials which enrolled subjects with tics and ADHD demonstrated a medium-to-large effect (SMD=0.68 (95%CI: 0.36-1.01) whereas trials that excluded subjects with ADHD demonstrated a small, non-significant benefit (SMD=0.15 (95%CI: -0.06-0.36). Our findings demonstrated significant benefit of both antipsychotics and alpha-2 agonists in treating tics but suggest alpha-2 agonists may have minimal benefit in tic patients without ADHD.

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    • "Although efficacious, these medications are frequently accompanied by side effects that may limit tolerability and acceptability (Scahill et al., 2006a). Similarly, a meta-analysis of RCTs of alpha-2 agonists medications (e.g., guanfacine, clonidine) demonstrated their efficacy in reducing tic symptom severity, albeit with modest results (Weisman et al., 2012). Behavior therapy (e.g., habit reversal training, comprehensive behavioral intervention for tics) has also demonstrated efficacy in reducing tic symptom severity in RCTs for youth and adults (Piacentini et al., 2010; Himle et al., 2012; Wilhelm et al., 2012), with a meta-analysis of behavior therapy RCTs Contents lists available at ScienceDirect journal homepage: www.elsevier.com/locate/psychres "
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    • "Finally, it is worth mentioning that clonidine is effective in reducing impulsivity in other pathological conditions. This is especially the case for attention-deficit/hyperactivity disorder [83], Tourette's syndrome [84], and tic disorders [85] [86]. "
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