Academic journal article The Israel Journal of Psychiatry and Related Sciences

Quetiapine Treatment in a Patient with Tourette's Syndrome, Obsessive-Compulsive Disorder and Drug-Induced Mania

Academic journal article The Israel Journal of Psychiatry and Related Sciences

Quetiapine Treatment in a Patient with Tourette's Syndrome, Obsessive-Compulsive Disorder and Drug-Induced Mania

Article excerpt

Abstract: A young man with a 13 year history of Tourette disorder and obsessive-compulsive disorder developed mania on clomipramine. Quetiapine 600 mg. daily was followed by resolution of the mania and improvement of the symptoms of Tourette disorder and obsessive compulsive disorder. It seems that quetiapine may be useful in treatment of Tourette disorder with or without comorbid disorders.


Gilles de la Tourette's syndrome (TS) is the most common cause of tics (1) and is characterized by the development of multiple motor and vocal tics in childhood or early adolescence (2). Obsessive-compulsive disorder (OCD), attention deficit hyperactivity disorder (ADHD) and self-injurious behavior have been frequently described in TS (3). Other comorbid disorders include anxiety disorders, mood disorders, conduct disorders, pervasive developmental disorders, episodic discontrol with rage attacks and schizophrenia (3, 4).

Although the etiology of TS remains unknown, the hypothesis usually discussed in pathogenesis is that there is increased dopaminergic innervation in the ventral striatum (5). The most effective drugs used in treatment of tics are dopamine receptor antagonists. Due to severe adverse effects, haloperidol, pimozide and clonidine are not tolerated well. Besides typical neuroleptics, atypical neuroleptics which have fewer extrapyramidal side effects, like risperidone (6) and olanzapine (7), have also been tried and have been found to be effective. The effectiveness of clozapine, the prototype of atypical neuroleptics, is controversial (8,9). We report here the case of a young patient with Tourette's syndrome, OCD and clomipramine induced mania who was treated with quetiapine.

Case Report

A 20-year-old man was admitted to the hospital presenting with aggression, hyperactivity, euphoria and tics. He had no history of pre-, peri- or postnatal complications, significant childhood illness or trauma. His mental and motor development was normal. Stereotypic behaviors of the shy, introverted and perfectionist child started for the first time with rubbing his hair into his face and eyes when he was 7 years old. He developed bilateral eye blinking when he was 11 years old, which progressed in 4 years, including facial and shoulder tics, throat clearing, coughing. He had obsessional thoughts on different themes such as symmetry, homosexuality, cleanliness, religion and compulsive behaviors such as excessive hand washing, placing items in a symmetric layout, touching several times the place where he sat or touching and smelling the object that he picked up. His tics and obsessive-compulsive complaints had increased over the last five years and his school performance deteroriated. He was seen by a psychologist for two years but with no benefit. He was diagnosed as OCD by a psychiatrist and initially received clomipramine 75 mg. daily, which was increased to 225 mg. daily. While his tics and obsessive complaints regressed with this treatment, he started to feel cheerful. Two days before his admittance, risperidone 2 mg. daily was begun due to complaints of anxiety, hyperactivity, restlessness, excessive speaking and insomnia for four days. Dystonic movements involving his mouth and neck developed soon after initiation of risperidone therapy. In his family history, there was some stereotypic behaviors such as a shoulder twitch in a cousin and grasping hair between nails in an aunt. His neurological examination was normal except for motor tics in the form of blinking and simple oral and vocal tics like throat clearing and coughing. In a psychiatric examination, logorhea, restlessness, intensive anxiety, acceleration in associations, increase in self-confidence, impulsivity, decrease in frustration tolerance and decrease in attention were found. Extensive laboratory tests and EEG were normal. The patient was diagnosed as having mood disorder (with manic characteristics) provoked by antidepressant medicine and OCD based on a Structural Clinical Interview for DSM-IV Axis I Disorders (SCID-I) and was diagnosed as having TS based on DSM-IV (10). …

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