Tratamentos Comportamentais para Tourette

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Behav Neurol. 2012 Nov 27. [Epub ahead of print]

Behavioural treatments for Tourette syndrome: An evidence-based review.

Frank M, Cavanna AE.

Source

The Michael Trimble Neuropsychiatry Research Group, Department of Neuropsychiatry, University of Birmingham and BSMHFT, Birmingham, UK College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.

Abstract

Tourette syndrome (TS) is a disorder characterised by multiple motor and vocal tics and is frequently associated with behavioural problems. Tics are known to be affected by internal factors such as inner tension and external factors such as the surrounding environment. A number of behavioural treatments have been suggested to treat the symptoms of TS, in addition to pharmacotherapy and surgery for the most severe cases. This review compiled all the studies investigating behavioural therapies for TS, briefly describing each technique and assessing the evidence in order to determine which of these appear to be effective. Different behavioural therapies that were used included habit reversal training (HRT), massed negative practice, supportive psychotherapy, exposure with response prevention, self-monitoring, cognitive-behavioural therapy, relaxation therapy, assertiveness training, contingency management, a tension-reduction technique and biofeedback training. Overall, HRT is the best-studied and most widely-used technique and there is sufficient experimental evidence to suggest that it is an effective treatment. Most of the other treatments, however, require further investigation to evaluate their efficacy. Specifically, evidence suggests that exposure with response prevention and self-monitoring are effective, and more research is needed to determine the therapeutic value of the other treatments. As most of the studies investigating behavioural treatments for TS are small-sample or single-case studies, larger randomised controlled trials are advocated.

Aripiprazol e pimozide em Tourette- Cada qual com suas vantagens e desvantagens

Pediatr Neurol. 2012 Dec;47(6):419-22. doi: 10.1016/j.pediatrneurol.2012.08.015.

Metabolic effects of aripiprazole and pimozide in children with tourette syndrome.

Rizzo R, Eddy CM, Calí P, Gulisano M, Cavanna AE.

Source

Section of Child Neurology and Psychiatry, Department of Pediatrics, University of Catania, Catania, Italy.

Abstract

This study assessed the metabolic effects of aripiprazole and pimozide in pediatric Tourette syndrome, a neurodevelopmental condition characterized by multiple motor and phonic tics. Patients receiving aripiprazole (n = 25) or pimozide (n = 25) were compared with medication-free patients (n = 25). Body mass index, glycemia, triglyceridemia, and cholesterolemia were monitored at baseline and 12 and 24 months after commencing treatment. The aripiprazole group demonstrated significant increases in cholesterolemia. The pimozide group demonstrated significant increases in glycemia. Both groups demonstrated elevations in triglyceridemia not significantly different from those in unmedicated control subjects. The effect of aripiprazole on cholesterol was apparent after 12 months, but leveled off during year 2 of treatment. Longitudinal studies are required to evaluate the full extent of glycemic alterations with pimozide. Both agents appear relatively safe for use in pediatric Tourette syndrome. These findings will help guide medication selection in patients with specific medical vulnerabilities.

Livro autobiográfico sobre Tourette

Repasso aqui o post do Clic Nervoso:(Clique aqui para ir ao post) , que fala do livro de Giba Carvalheira. Há alguns anos Giba, conterrâneo recifence, me mandou o livro para que eu lesse e opinasse. Lembro que o li dentro de um avião, quando ia a um congresso nos Estados Unidos. O livro é muito interessante pois mostra as agruras de um sofredor de ST e todo o seu calvário até conseguir o diagnóstico e tratamento, uma estória compartilhada pela imensa maioria dos portadores de ST que são hoje adultos ou mais velhos. Felizmente, hoje em dia a ST está mais divulgada e já não é raro que pais me procurem aos primeiros tiques de seus filhos para saberem se se trata de Tourette ou não. O diagnóstico então é feito muito mais precocemente, os pais podem ser orientados sobre a lide da ST e os pacientes tranquilizados e tratados quando necessário. Em 1998, quando eu vim para São Paulo com o objetivo de estudar a ST, ela era considerada uma doença rara. Atualmente, quase 15 anos depois, existem personagens de TV e filmes com ST, o que mostra a sua maior divulgação e reconhecimento.  No meu consultório, onde recebo pacientes com ST que vêm de todo o Brasil, chegam indicações inclusive de psicólogos! Isso me deixa feliz e aliviada. Feliz de saber que tive uma parcela de responsabilidade nessa divulgação, lançando o livro sobre ST, indo a programas de TV, jornais e rádio e dando palestras para a comunidade leiga e profissional. E fico também aliviada, pois eu sofro junto com meus pacientes quando escuto sobre suas peregrinações, tentativas frustradas de tratamento, diagnósticos errados, efeitos colaterais de medicamentos mal escolhidos, etc.
Assim, recomendo o livro de Giba para quem quiser saber um pouco de como é sofrer com a ST e que possa se inspirar a buscar tratamento.