Psychopharmacotherapy in Patients with Tics and Other Motor Disorders

Tics are defined as involuntary, sudden, nonrhythmic, rapid movements and/or sounds, with onset in childhood or adolescence. The first-line treatment for tics is cognitive behavioral therapy, but when behavior therapy is unsuccessful and tics still cause troublesome, pharmacotherapy is recommended. α-Adrenergic agonists clonidine and guanfacine are commonly used drugs for pharmacotherapy of tics. Anti-dopaminergic drugs, i.e., antipsychotic drugs, are also effective pharmacotherapeutics for tics, with fewer adverse effects. Huntington disease (HD) is another motor disorder and a progressive autosomal dominant neurodegenerative disease characterized by progressive motor, behavioral, and cognitive decline, resulting in death within 15-20 years after disease diagnosis. There are currently no effective pharmacological agents available to stop or prevent the progression of HD. Therefore supportive and symptomatic management is still the mainstay for HD treatment. In addition to the nonpharmacologic supportive management, pharmacotherapy can be effective for motor symptoms commonly seen in HD. Psychopharmacotherapy, including typical and atypical antipsychotics, is perhaps the most commonly considered treatment of chorea and psychosis in patients with HD. In this chapter, we will review psychopharmacotherapy in the treatment of tics and HD.