Aripiprazole in a Patient Vulnerable to Side Effects

TO THE EDITOR: Although the involvement of infection/ inflammation
in the pathogenesis of Tourette's syndrome has been discussed,
antipsychotics are still the first choice in pharmacotherapy (1).
Haloperidol and pimozide are well-established therapies (2), but
increasing literature on this topic points out the advantages of
atypical antipsychotics, at least regarding side effects (3, 4).
Adherence to medication is a problem in Tourette's syndrome, often
because of the side effects that patients experience. In the
following, we describe a patient suffering from Tourette's syndrome
who withdrew treatment from different neuroleptics, thus leading to
severe social consequences for many years.

Ms. A, a 19-year-old patient, had suffered from motor and vocal tics
since the age of 6. Her vocal tics included grunting, snorting,
neighing, palilalia, and motor tics, such as beating and strangling
herself. Additionally, she developed compulsions of washing and
controlling. The course of her illness was chronic, not waxing and
waning. She had experienced no tic-free interval during the last 13
years. Pharmacotherapy over the last years included 300 mg/day of
tiapride, leading to an improvement of her motor tics only.
Additional therapy with 300 mg/day of sulpiride first and 400 mg/
day of amisulpride later each caused galactorrhea, without
substantial therapeutic effect. Ms. A stopped taking both
substances. Ms. A also stopped taking 4 mg/day of pimozide and later
80 mg/day of ziprasidone, each taken over several weeks; both caused
amenorrhea and had only marginal effects on the tics.

Afterward, we started treatment with 10 mg/day of aripiprazole
because of the side effect profile. In the first week, Ms. A's motor
and vocal tics showed a marked improvement; after 2 weeks, Ms. A was
nearly tic free for the first time in 13 years. Amenorrhea or
galactorrhea was not present during the next months; other side
effects, such as sedation or weight gain, did not occur. Ms. A
started working as a waiter for the first time. The compulsions were
much improved. Only a blinking tic, which exacerbated during stress,
persisted.

Aripiprazole is an antipsychotic with partial dopamine antagonism
and agonism, showing effects on serotonin 5-HT^sub 2A^ and 5-HT^sub
1A^ receptors. Its advantageous side effect profile has been
described earlier (5); however, no effects in Tourette's syndrome
have been observed. This case might encourage collecting not only
further experience with aripiprazole in the treatment of Tourette's
syndrome but in performing systematic studies in both short- and
long-term therapy.

References

1. Mller N, Riedel M, Zawta P, Gnther W, Straube A: Comorbidity of
Tourette's syndrome and schizophrenia: biological and physiological
parallels. Progr Neuropsychopharmacol Biol Psychiatry 2002; 26:1245-
1252

2. Sallee FR, Nesbitt L, Jackson C, Sine L, Sethuraman G: Relative
efficacy of haloperidol and pimozide in children and adolescents
with Tourette's disorder. Am J Psychiatry 1997; 154: 1057-1062

3. Robertson MM, Schnieden V, Lees AJ: Management of Gilles de la
Tourelle syndrome using sulpiride. Clin Neuropharmacol 1990; 13:229-
235

4. Sallee FR, Kurlan R, Goetz CH, Singer H, Scahill L, Law G,
Dittman VL, Chappell PB: Ziprasidone treatment of children and
adolescents with Tourette's syndrome: a pilot study. J Am Acad Child
Adolesc Psychiatry 2000; 39:292-299

5. McGavin JK, Goa KL: Aripiprazole. CNS Drugs 2002; 16:779-786

SANDRA DEHNING, M.D.

MICHAEL RIEDEL, M.D.

NORBERT MLLER M.D., PH.D.

Munich, Germany

Copyright American Psychiatric Association Mar 2005



Source: American Journal of Psychiatry, The





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