Peds Tics

Question 1

Epidemiology of tics
age of onset
prevalence
persistence into adulthood
genetic risk of sibling

Answer 1

mean=7
usually/must be b4 18
1% for DO
5% for transient tics
25 % persist in adulthood
increased 10-100 times
=25% risk

Question 2

Imaging in tic DO

Answer 2

loss of normal assymmetry of caudate
decreased activity in :caudate, cingulate, basalganglia
increased activity in the sensory motorregion

Question 3

Diff between PANDAS and PANS

Answer 3

Pans is pediatric acue onset neuropsychiatric syndrome

it has only OCD (no tics)

Question 4

substances “reported” but no evidence that they increase tics

Answer 4

stimulants, cocaine, SSRIs , lamotrigine

FDA consider tics a # for stimlants

Question 5

If you have tics, what are the chances of: 
ADHD
OCD
anger/rage sx
LD
ASD

Answer 5

ADHD: up to 60%
OCD: 50%
anger/rage sx: 40%
LD: 25%
ASD: x 5

Question 6

Treatment of tics beh vs meds

Answer 6

Treat if indicated 9distress, dysfunction, moderate)
if not severe, treat with behavioural therapy
#1 HRT
can also add relaxation, ABC, parent training
work with school

Consider meds if severe

Question 7

Meds for tics

Answer 7

FDA approved: haldol, pimozde
most common practice: CAR: clonidine, Aripiprazole, Risperdal
Most studied amongst AA: Risperdal

If comorbid OCD: consider AA, the OCD also actually increases response rate

If comorbid ADHD: Consider atomoxetine. consider clonidine or guanfacine. Te ADHD actually increases response rate

CAreful with ziprazidone and olanzapine dt SE

other treatments: NO