Sertraline May Be Helpful for Major Depressive Disorder in Children
CME

News Author: Laurie Barclay, MD
CME Author: Hien T. Nghiem, MD



Aug. 26, 2003 — Sertraline may be helpful in treating children with
major depressive disorder (MDD), according to the results of two
randomized, placebo-controlled trials published in the Aug. 27 issue
of The Journal of the American Medical Association. The editorialist
reviews the recent history of use of selective serotonin reuptake
inhibitors (SSRIs) for MDD in children and reminds clinicians not to
initiate treatment with paroxetine. He suggests that fluoxetine and
sertraline may be preferable.

"The efficacy, safety, and tolerability of SSRIs in the treatment of
adults with MDD are well established," write Karen D. Wagner, MD,
PhD, and colleagues from the Sertraline Pediatric Depression Study
Group. "Comparatively few data are available on the effects of SSRIs
in depressed children and adolescents."

Between December 1999 and May 2001, 376 children and adolescents
aged 6 to 17 years were enrolled in two double-blind trials
conducted at 53 centers in North America, India, Costa Rica, and
Mexico. All subjects had at least moderate severity MDD based on DSM-
IV criteria. For 10 weeks, subjects received a flexible dosage (50-
200 mg/day) of sertraline or matching placebo.

At week 10, overall mean improvement in the Children's Depression
Rating Scale-Revised (CDRS-R) was -22.84 in the sertraline group
and -20.19 in the placebo group (P = .007). Treatment response,
defined as a 40% decrease in the adjusted CDRS-R total score at
study end, occurred in 69% of the sertraline group and in 59% of the
placebo group (P = .05).

Although sertraline treatment was generally well tolerated, 17
patients receiving sertraline (9%) and five patients receiving
placebo (3%) withdrew from the study because of adverse events,
which included diarrhea, vomiting, anorexia, and agitation.

Study limitations include use of subjective rating scales, short
duration of treatment, unclear applicability of the CDRS-R to
younger patients, and treatment of most patients with doses lower
than the maximum allowed.

"Sertraline is an effective and well-tolerated short-term treatment
for children and adolescents with MDD," the authors write. "Whether
lower initial dosages in children would improve tolerability or long-
term sertraline treatment in children and adolescents would result
in maintenance of effect and an improvement of quality of life
deserves study."

Pfizer funded and supervised this study and has financial
arrangements with several of its investigators. Several authors
report additional financial arrangements with various other
pharmaceutical companies.

In an accompanying editorial, Christopher K. Varley, MD, from the
University of Washington in Seattle, agrees with the warning from
regulatory agencies not to use paroxetine in children and
adolescents.

"Prudent practice in the treatment of depressive illnesses in
children and adolescents must include careful attention to the
decision to treat a child or adolescent with medication for MDD;
clinical expertise with mental health assessment, consideration of
varied treatment modes including cognitive behavioral or
interpersonal psychotherapy, partnership with patients and their
parents, and careful attention to symptom course, particularly
emotional lability and the assessment of suicidal ideation in youth
who are treated with antidepressant medications," he writes.

JAMA. 2003;290:1033-1041, 1091-1093

Learning Objectives
Upon completion of this activity, participants will be able to:
Review the prevalence and significance of depression in children and
adolescents.
Recognize the role of SSRIs in general and the efficacy of
sertraline in particular in treating major depressive disorder in
children and adolescents.
Clinical Context
Major depressive disorder (MDD) affects 3% to 8% of children and
adolescents, according to the authors of this study. Depression may
facilitate feelings of worthlessness, low self-esteem, poor
concentration, and thoughts of suicide. Suicide is the leading cause
of death in adolescents; hence, it poses as a major healthcare
concern. Depression is one of the major risk factors associated with
suicide. Therefore, appropriate therapies, especially
psychopharmacologic treatments, are needed to combat MDD in children
and adolescents.

Although many psychotropic medications have been proven to be safe
and effective in the treatment of MDD in adults, the studies have
not yielded the same results in children and adolescents. In recent
studies, SSRIs, particularly fluoxetine and sertraline, have been
shown to be effective and safe in treating depression in children
and adolescents. Fluoxetine has already received U.S. Food and Drug
Administration (FDA) approval for the treatment of MDD in children
and adolescents. However, paroxetine, another SSRI, is not
recommended for children and adolescents due to the possibility of
increased risk of suicidal thinking and suicide attempts. Not only
is the need for appropriate medications in the treatment of MDD in
children and adolescents essential, but also careful monitoring must
be provided to ensure efficacy of the medication.

In this report, Wagner and colleagues evaluated two identically
designed, concurrently conducted 10-week international, multicenter,
randomized, double-blind, placebo-controlled trials of sertraline
vs. placebo in children and adolescents with MDD.

Study Highlights
Two trials were identically designed and concurrently conducted at
53 hospitals, general practices, and academic centers in the U.S.,
India, Canada, Costa Rica, and Mexico. Participants were aged 6 to
17 years and had met diagnostic criteria for MDD, as defined in the
Diagnostic and Statistical Manual of Mental Disorders, Fourth
Edition (DSM-IV) and by the Kiddie Schedule for Affective Disorders
and Schizophrenia for School-Age Children-Present and Lifetime
Version (K-SADS-PL). Also, for eligibility, their current episode of
major depression had to be at least 6 weeks' duration.
The trials began with a 2-week pretreatment screening period. In
addition to meeting the criteria of MDD, patients were required to
have a Children's Depression Rating Scale-Revised (CDRS-R) score of
at least 45 and a Clinical Global Impression of Severity of Illness
(CGI-S) rating of at least 4; each indicating at least moderate
severity of depression.

At the third screening visit (baseline), 376 eligible patients were
randomly assigned to double-blind treatment with sertraline (n =
189) or placebo (n = 187) for 10 weeks. Treatment was initiated at a
dosage of 25 mg/day and titrated upward to a maximum of 200 mg/day
until a satisfactory clinical response was achieved.
Primary efficacy rating scale was the CDRS-R, a 17-item, clinician-
rated instrument that measures the severity of a patient's
depression symptoms. Secondary efficacy measures included the
proportion of CDRS-R responders, defined as patients who had at
least a 40% decrease in the adjusted CDRS-R total score; scores on
the CGI-S and the Clinical Global Impression of Improvement (CGI-I).
All three scales were measured at the end of weeks 1, 2, 3, 4, 6, 8,
and 10.

Data from both studies were pooled in a combined analysis.
Sertraline-treated patients exhibited significantly greater
improvement over the course of the study than those receiving
placebo on the CDRS-R (mean change in total scores of -30.24 vs. -
25.83, respectively; P = .001), as well as on the CGI-S and CGI-I.
Significant differences in favor of sertraline were evident as early
as week 1 on the CGI-I and week 3 on the CDRS-R and the CGI-S (P
< .05).

Statistically significant improvement was noted with the sertraline-
treated patients in 5 of the 17 items of the CDRS-R: irritability,
low self-esteem, excessive weeping, listless speech, and
hypoactivity.

No statistically significant difference was noted between treatment
groups and placebo for suicidal ideation (P = .78).
There was a 10% difference in response rates observed between
sertraline and placebo groups in the CDRS-R (69% vs. 59%,
respectively), as well as in the CGI-I scores. This result indicated
that the number needed to treat to expect a difference in response
between sertraline and placebo would be 10.
Sertraline was generally well tolerated. 17 patients receiving
sertraline (9%) and five patients receiving placebo (3%)
discontinued the study due to adverse events, such as diarrhea,
vomiting, anorexia, or agitation. However, major adverse events,
including suicide attempts, were similar between the sertraline and
placebo groups.

The results from these studies support sertraline as an effective
short-term treatment for children and adolescents with MDD.
Limitations to this study include the subjectivity of the rating
scales and the relatively short duration of treatment exposure.

Pearls for Practice

MDD is a major healthcare concern in children and adolescents.
Particularly in adolescents, MDD is one of the major risk factors
for suicide.
Sertraline is effective and safe for the treatment of MDD in
children and adolescents.

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Tim Piccirillo doesn't have to search very far to find an example of
the impact teachers can have on a young person's life.
All he has to do is look in the mirror.
The 43-year-old motivational speaker from Ridgway addressed the
employees of the New Castle Area School District during an in-
service day yesterday at Cascade Park.
Piccirillo was born with Tourette's syndrome, which manifests itself
through jerking of the limbs, involuntarily facial tics and self-
abusive behavior. Piccirillo's symptoms are controlled by medication.
His illness didn't stop him from reaching his goal of being a
professional magician. That is due in no small part, he said, to
three staff members at Ridgway High School.
One was his ninth-grade typing teacher, John Lovell, who showed him
a magic trick one day in class when he pulled a half-dollar from a
typewriter. After that, Piccirillo made almost daily trips to
Lovell's house over the next two years to learn magic.
"He gave this kid something to reach out and grab onto when I had
nothing else," Piccirillo said.
He gave his first professional magic show when he was 15 and was
paid $10.
"I was overpaid," he said. "I was terrible, but I kept going."
Piccirillo's medical condition forced him to receive homeschooling
or one-on-one instruction during his junior and senior years. A
guidance counselor, Fran Grandinetti, suggested he join the touring
theater class.
Class members built sets and rehearsed plays, which they performed
at various elementary schools in the area. It was the only in-school
class Piccirillo could take.
The teacher, Bill Connelly, had him perform an opening magic act
before the curtain went up on the production.
To Piccirillo, Lovell, who remains his close friend; Grandinetti,
who is superintendent of schools and is about to retire; and
Connelly, who is now the high school principal, are what teachers
are all about.
"These guys believed in me," he said. "These guys made a difference
in my life.
"I haven't overcome anything. I've learned to deal one day at a time
because of people like you. You have the power to impact the world.
You are the most important people in the world as far as I'm
concerned."
Piccirillo went on to graduate from Clarion University in 1984 with
a bachelor of science degree in habilitative science. He worked his
way up the ladder in the mental health/mental retardation field
before becoming executive director of a center for independent
living in 1989.
Still, his goal since he was 15 years old was to become a
professional magician. In 1992, he decided to pursue that dream, and
he has gone on to work with various national stars and celebrities
in his career.
Piccirillo became a motivational speaker in 1995. He sprinkles magic
tricks throughout his presentation.
To succeed, he said, fear cannot be allowed to take control.
"Fear holds us back. As long as you continue to grow, as long as you
stretch past your comfort zone, you're going to have fear."
He advised the crowd to develop its own barometer to measure success.
"Success is a personal thing. Henry Ford had a great quote: 'Whether
you think you can or whether you think you can't, you're right.'
It's perception.
"If you have a kid like me, what are you going to do? Focus on the
kid's ability, not his disabilities. Focus on positives, not
liabilities. Focus on what you can do, not what you can't do."

(Rick Elia can be contacted at relia@n... or by calling
(724) 654-6651, extension 618.)
©New Castle News 2003

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Dutch Approve Cannabis as Prescription Drug

Mon September 1, 2003 07:17 AM ET
By Paul Gallagher

AMSTERDAM (Reuters) - The Netherlands Monday became the world's
first country to make cannabis available as a prescription drug in
pharmacies to treat cancer, HIV and multiple sclerosis patients, the
Health Ministry said.
The Netherlands is making the drug widely available to chronically
ill patients amid pressure on countries like Britain, Canada,
Australia and the United States to relax restrictions on its supply
as a medicine.
Dutch doctors will be allowed to prescribe it to treat chronic pain,
nausea and loss of appetite in cancer and HIV patients, to alleviate
MS sufferers' spasm pains and reduce physical or verbal tics in
people suffering Tourette's syndrome.
"From September 1, 2003 pharmacies can provide medicinal cannabis to
patients with a prescription from a doctor. Cannabis has a
beneficial effect for many patients," the Health Ministry said.
The Netherlands, where prostitution and the sale of cannabis in
coffee shops are regulated by the government, has a history of
pioneering social reforms. It was also the first country to legalize
euthanasia.
Two companies in the Netherlands have been given licenses to grow
special strains of cannabis in laboratory-style conditions to sell
to the Health Ministry, which in turn packages and labels the drug
in small tubs to supply to pharmacies.
As well as pharmacies, 80 hospitals and 400 doctors will be allowed
to dispense five-gram doses of SIMM18 medical marijuana for 44 euros
($48) a tub and more potent Bedrocan at 50 euros.
The Health Ministry recommends patients dilute the cannabis -- which
will be in the form of dried marijuana flowers from the hemp plant
rather than its hashish resin -- in tea or turn it into a spray.
HIV SUFFERERS WELCOME MOVE
A British drug firm pioneering cannabis spray medicine to give pain
relief for multiple sclerosis patients is hoping to launch the
product in Britain later this year.
The association of HIV patients in the Netherlands welcomed the
government's move to make cannabis available in high-street
pharmacies.
"We are glad the government recognizes that for some people it can
improve the quality of life," said Robert Witlox, managing director
of HIV Vereniging. The association has called on health insurers to
cover the cost of the drug like any other.
The government, which recognized many chronically ill people were
already buying cannabis from coffee shops, said it should only be
prescribed by doctors when conventional treatments had been
exhausted or if other drugs had side-effects.
The government said it would start distributing to pharmacies
Monday. The Health Ministry's Office of Medicinal Cannabis has a
monopoly on wholesale distribution of the drug, grown in laboratory-
style conditions to ensure medicinal purity.
The ministry estimates up to 7,000 people in the Netherlands have
used cannabis for medical reasons, buying it in coffee shops. It
said this could more than double once it was available from
pharmacies in pure medicinal form.
Cannabis has a long history of medicinal use. It was used as a
Chinese herbal remedy around 5,000 years ago, while Britain's Queen
Victoria is said to have taken cannabis tincture for menstrual
pains.
But it fell out of favor because of a lack of standardized
preparations and the development of more potent synthetic drugs.
Critics argue that it has not passed sufficient scientific scrutiny
at a time when researchers are trying to determine if it confers the
medical benefits many users claim. Some doctors say it increases the
risk of depression and schizophrenia. ($1=.9145 Euro)
http://reuters.com/newsArticle.jhtml?type=healthNews&storyID=3367251

Medicinal cannabis - which will be sold in the form of dried
marijuana flowers from the hemp plant - is being grown to order by
two official suppliers, it added, and rigorously tested for
impurities.
It will be prescribed as a painkiller for people suffering from
cancer, Aids, multiple sclerosis or Tourette's syndrome, but only if
more conventional drugs have failed or caused unwanted side effects.

----------------------------------------------------------------

Human Interest Article

"It is OK to be me," high schooler with Tourette's
Carolyn Bower
Post-Dispatch
09/06/2003


Marc Elliot greeted classmates at Clayton High School with the
confidence of a high school senior whose school feels like home.

Dazzling smile. Firm handshake. A genuine "How was your summer?"
And then Marc barked.

Seniors and teachers seemed not to notice.

Since transferring to Clayton High School his sophomore year from
Parkway Central High School, Marc, 18, has made a name for himself.
Students elected him head of the Clayton student government. He
landed a lead role in the school play. He has given speeches to
students, teachers and assistant superintendents across the region.

He has worked in hospitals, raised money for children's hospitals,
served as a counselor at a camp for children with cancer, worked at
Clayton's Shaw Park pool concession stand and helped start a car-
detailing business.

He keeps a 4.0 grade-point average and takes Advanced Placement
chemistry, Advanced Placement European history, Advanced Placement
calculus, honors physics and advanced composition. He has applied to
attend Washington University and wants to become a pediatric
surgeon.

On this day Marc quickly did what he often does when he boards an
airplane, enters a new classroom or talks with strangers.

"I'm OK," Marc told the rest of the auditorium - about 200
freshmen. "Don't worry about me. I have Tourette's syndrome."

Tourette's is a neurological disorder with symptoms such as head-
shaking, blinking, sniffing, body gestures or vocal sounds. Fewer
than 15 percent of people with Tourette's use inappropriate
language.

Just using curse words around Marc, who is among that 15 percent,
plants the suggestion deep in his brain. After hearing such words,
he often winds up using those words, over and over again.

"I don't have a lot of control over it," Marc said.

Doctors confirmed the condition when Marc was 9 years old, but he
had had symptoms since he was 5.

Marc already had had his fill of doctor's offices and hospitals. He
was born with Hirschsprung's disease, an intestinal disorder. He
spent the first six months of his life in hospitals. By the age of 4
he had had seven operations, leaving him with no large intestine and
only a small portion of a small intestine.

Iris Elliot, his mother, credits surgeries by Dr. Jessie Ternberg at
St. Louis Children's Hospital with turning Marc into a miracle
child, a poster child for a telethon to raise money for children's
hospitals.

"He never acted like a sick baby," Iris Elliot said. "We never
treated him as a person with a medical condition that needed to be
coddled. He was strong-willed and hard to discipline. We didn't want
to destroy that because that was what got him through."

Marc's doctor took to calling him "one tough bird" and gave him toy
penguins as a tribute to his resilience and charisma.

More than 100 penguins, from small crystal ones to 6-foot blow-ups,
decorate his bedroom. They come from all parts of the world,
replicas of animals who survive ice, wind and storms.

Speaking out

After 5-year-old Marc started kindergarten at Green Trails
Elementary School in the Parkway School District, he became one of
the school's fastest runners. He played Little League baseball and
soccer. He had to go to the bathroom frequently, because, he
said, "I eat and it goes out fast."

He had a quick mind, and if he had trouble focusing or deciphering
letters, he learned to solve his problem. He attended classes for
gifted students.

Marc's Tourette's symptoms, or "tics," became more apparent as he
moved into middle school and high school. Occasions of importance
such as his brother's bar mitzvah, or stress and the onset of
adolescence increased the tics and repetitive speech such as "Love
you, love you, love you."

The family tried all kinds of remedies. Hypnotism. Biofeedback.
Medication. Botox injections. Those injections, in his neck and
throat, began a year ago and seem to lessen the painful head-shaking
and shoulder-jerking.

By the time he reached Parkway Central High School and then Clayton
High, concern about how to handle Tourette's overshadowed his other
health issues.

Marc found that if he talked with teachers or other students, they
seemed to understand.

Sometimes.

Before football games, Marc would tell the opposing team that he had
Tourette's and that he made inappropriate comments.

"I can't help it more than someone who sneezes or coughs," he
said. "It bothers me more than you. I'm not trying to offend you."

Mike Musick, associate principal at Clayton and a football coach,
said: "Marc's greatest strength is he is an excellent communicator.
He doesn't let his tics get in the way."

Musick said the players, many of whom were African-American, said
fine, let's play football. Then Marc said a racial slur maybe 200
times.

The coach said other players seemed to accept Marc's condition. But
after a game, Musick heard Marc say, "I wish I wouldn't do it."

Marc fared less well on a Greyhound bus in Indianapolis. He had
boarded the bus to ride home to St. Louis from a summer camp about a
year ago. He blurted out a racial slur. The bus driver called
authorities after a passenger complained. When Marc got off the bus
to plead his case to police, he was not allowed back on the bus. The
more they asked him to stop using the language, the more agitated he
became the more obscenities spilled out. Eventually a friend drove
him home.

The episode left Marc angry, ashamed and vulnerable. It shattered
his belief that the world holds tolerance and understanding.

As days passed, Marc decided to speak out about Tourette's, his
experiences and his hope for the way things should be.

"All of us have challenges"

At a back-to-school training session for teachers in Parkway several
weeks ago, Marc talked about Tourette's syndrome, his symptoms and
the obsessive-compulsive disorder that accompanies it.

He told them things that make his mother blanch, how he was driven
sometimes to take risks, how he stuck his hand down a garbage
disposal as a child.

He told them how important it is for people to speak up for
themselves and to recognize that everyone has problems. Some people
have anxiety. Some have depression. Some have learning disabilities.
Some struggle with concern about parents getting a divorce or
relatives who are ill.

"All of us have challenges," Marc said. "Sometimes kids keep things
bottled inside. Not everybody has to go out and speak like I do, but
they should confide in someone."

Marc told the teachers how stress makes his symptoms worse. He told
them that at school he takes standardized tests outside his
classroom, not so much for him but to allow other students to
concentrate.

When Marc made inappropriate outbursts at a Home Depot two years
ago, a man tapped him on the shoulder and asked him if he had
Tourette's. When Marc replied that he did, the man said he had a
friend whose belief in Jesus had saved and cured the friend. Marc
said, "Great, I'm Jewish."

The man asked if he could pray for Marc, and Marc said sure. The man
put his hand on Marc's shoulder and prayed for him.

"I think it's great that a man I did not know would want to pray for
me," Marc said.

Marc told the teachers that he has overcome challenges with support
from his mother; his father, Bill Elliot, a financial adviser; his
brother, Brian, 22; and his brother, Justin, 10.

Marc said he admires Brian's courage in going public as a high
school sophomore about being gay. Marc also looks up to Dr.
Ternberg, someone he says saved his life and inspired him to touch
other lives.

In addition to relatives, teachers, principals, neighbors and
doctors, Marc's sense that he had to beat the odds has carried him
through.

"I had to prove that it is OK to be me," Marc said. "If I am mocked
and jeered at, I simply laugh, turn around and continue with my
life. I have just learned to let go. Life is too precious. I cannot
give up in the face of adversity. I would feel if I did, I would
have lost in some way."

"I am not crazy"

At school a few students have told teachers they are embarrassed by
Marc's outbursts, but students who know Marc seem to accept him as
one of the crowd.

Pia Luchini, 17, a senior, said: "Marc gives out positive vibes, and
people want to be with him. The effort he puts into life and giving
back to the community is a lot more than anyone else, and people
admire him for that."

At a recent dinner with Marc in the Central West End, Pia noticed
two women listening to Marc and snickering.

"I thought it was mean," Pia said.

Marc said he has experienced so much more than what his friends see.

When he made several inappropriate outbursts recently as he stood in
line to order food at McDonald's, a man in front of him turned
around and said, "What are you, retarded?"

Marc said he sometimes wonders how it would feel to be able to walk
into a movie theater or restaurant without people noticing him.

"The day I don't have to explain the Tourette's will be a special
day," he said.

A friend asked recently how Marc made it through an airport without
saying "bomb." That conversation stuck in Marc's head.

As Marc prepared to board an airplane to St. Louis recently after
visiting his brother in San Francisco, he said the "B" word. An
agent pulled Marc aside. He told her he had Tourette's. She
replied, "Don't worry, honey, I am crazy, too."

Marc said, "Ma'am, I am not crazy. I have Tourette's syndrome."

Reporter Carolyn Bower:
E-mail: cbower@p...
Phone: 314-209-1246

http://www.stltoday.com/stltoday/news/stories.nsf/News/Education/EF78
47CB34DE263A86256D990032E587?OpenDocument&Headline=%
22It+is+OK+to+be+me,%22+high+schooler+with+Tourette's

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Taking on twitching

Montreal clinic provides free treatment to reverse tics as part of
long-term study

AARON DERFEL

The Gazette
Sunday, September 07, 2003

The young computer manager couldn't stop blinking his eyes
frantically. He'd sit in a meeting and blink hundreds of times a
minute, scrunching the muscles around his eyes.
At home, he blinked while watching TV. On the road, he blinked
behind the wheel of his car. He blinked so much talking to his
girlfriend she threatened to dump him if he didn't seek treatment.
That's when the 29-year-old Montrealer sought the help of clinical
psychologist Kieron O'Connor at the Louis-H. Lafontaine Hospital.
"He has this idea that he had to invest a lot more effort into
seeing things than was normally required," O'Connor recounted. "In
his mind, he didn't want to miss anything and so he ended up
blinking that way."

Excessive eye blinking is one of many types of tics that affect as
many as half a million Quebecers. Chronic tic disorders can include
head jerks, cheek twitches, tongue clacking - even barking and
growling. In severe cases, people will scratch their faces
compulsively (a habit known as scabiomania), or pull out their hair
(trichotillomania). People suffering from bruxism will grind their
teeth to the point where they have to see a dentist.
"Chronic tics tend to be the things that the person really cannot
control at all," O'Connor explained. "If somebody has a facial tic,
it can be very distressing. They are often discriminated against in
getting jobs. They can have problems going out during social
occasions or sports activities."

Fortunately, a Montreal clinic is now providing treatment free of
charge to reverse tics as part of a long-term study. The service is
also being offered to people with Gilles de la Tourette's syndrome,
which is characterized by multiple tics and repetitive movements as
well as involuntary barking or swearing.

A common misconception about tics is that they are nervous in
nature. In a study of 90 people, O'Connor and his colleagues found
anxiety and nervousness were not sources of tics. Rather,
frustration appeared to be the cause.

"People with chronic tics and habits do seem to have a low
frustration threshold. They have problems planning activities. They
sometimes have perfectionist beliefs about the way things should be
done, which makes them adopt a kind of frustrating and tension-
producing action."

Ironically, in seeking to release that tension, they will resort to
tics, which in turn, produce more tension. With habit disorders like
severe nail biting (oncychophagia), depression can also play a role.
Psychiatrists initially hypothesized tics represented repressed
hostility - a psychoanalytic theory that has since been discredited.
Neuorleptic drugs - essentially, tranquilizers - have been used to
treat people with tics, but O'Connor recommends behaviour therapy.
First, the therapist will videotape the patient in the throes of the
tics or habit, the latter involving more destructive self-inflicted
behaviour. The patient is then shown the videotape to raise self-
awareness.

The patient is also encouraged to keep a tic diary to help pinpoint
the situations in which the behaviour is common. There are some
times of the day when the individual doesn't have tics, and at other
moments, the tics are incessant.

Finally, the therapist teaches the patient relaxation exercises to
ease tension and prevent tics. In his study, O'Connor noted
significant improvement in 65 per cent of the patients who underwent
behaviour treatment. At a two-year follow-up, 52 per cent were able
to control their tics or habits most of the time.
As for the computer manager, his frenetic eye blinking vanished
after 12 weeks of therapy. "He felt much better and was more able to
cope," O'Connor said.

O'Connor is recruiting for a second study people with chronic tic
and habit disorders as well as Tourette's syndrome. The treatment is
being offered at the Fernand-Séguin Research Centre, affiliated with
Louis-H Lafontaine Hospital.

Those interested in treatment and taking part in the study can
contact France Quevillon at (514) 251-4015, Local 3585.

aderfel@t...

© Copyright 2003 Montreal Gazette

http://www.canada.com/montreal/news/story.asp?id=97FD3F3D-1DD6-4707-
BF5E-479D42B0B057

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UNDERSTANDING Tourette Syndrome - Doctor's Guide (press release)

http://www.docguide.com/gpc.nsf/doc?
CreateDocument=&n=27&l=PE&u=/news/content.nsf/webcast/01535A591EAAA68
885256D8E005687E8?OpenDocument&c=Neurologic%20Other&count=10

Note* you will have to cut and past the above link into a new
browser for it to work.

This text-based teaching module reviews the diagnostic criteria for
Tourette
syndrome, and frequently associated behavioural disorders. ...
----------------------------------------------------------------
Note, If a link does not work, try cutting and pasting the entire
link into a new browser.
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Credits
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Paul Marshall PhD***
Tourette – Updates Moderator
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