Pharmacological Treatment of Tics

"Seignot's 1961 scientific report of a case of Tourette syndrome effectively treated with Haloperidol promoted a further 'paradigm shift' from the psychoanalytic theories to the current genetic and neurochemical theories on the aetiology and pathogenesis of Tourette syndrome. Seignot's observation was replicated throughout the world, starting with Caprini and Melotti's case report, which was published in the same year. The introduction of a pharmacological agent to control tics led to the speculation about a neurochemical substrate upon which medications work. Specifically, the unprecedented success of Haloperidol in controlling tics by blocking dopamine receptors in the brain suggested that might therefore be an excess of dopaminergic neurotransmission. American psychiatrists Arthur and Elaine Shapiro promoted the description of Tourette syndrome as a neurological disorder that by definition stood in opposition to psychoanalytic claims. The psychoanalytic perspective was successfully challenged in a book on Tourette syndrome published by the Shapiros in 1978. This paradigm shift in turn kindled interest in tracing the genetic basis of Tourette syndrome, a line of research which has flourished since the 1970s. Throughout the 1980s, studies on other first generation antidopaminergic medications, as well as alpha-2 adrenergic medications, were published, whereas in the 1990s the second generation of antidopaminergic medications were developed. During the first decade of the new millennium, Aripiprazole (sometimes referred to as 'third generation antidopaminergic medication') was first shown to be characterized by good efficacy and tolerability in the treatment of tics. More recently, a range of other medications belonging to different pharmaceutical classes have been investigated in patients with Tourette syndrome. The vast majority of these medications are pharmacological agents initially developed to treat other neuropsychiatric conditions"--