Patienten mit Tic-Störungen: weit bekannt, doch unterversorgt

Das Bewusstsein der Öffentlichkeit für Tic-Störungen und insbesondere für das Tourette-Syndrom ist durch zahlreiche Medienbeiträge in den letzten Jahren gestiegen. Immer wieder wird in TV- oder Printmedien jedoch lediglich von schweren Fällen des Tourette-Syndroms berichtet, die nicht dem durchschnittlichen Krankheitsverlauf entsprechen. Eine umfangreiche Aufklärung über Symptome, Verlauf, Ursachen und Behandlungsmöglichkeiten ist daher wünschenswert [1].

Abstract: Tic disorders typically start in early childhood and can be classified into provisional tic disorder (tics last <12 months) and chronic tic disorders (tics last > 12 months). The widely known chronic tic disorder Tourette’s syndrome is featuring multiple motor and vocal tics. Tics are typically waxing and waning in frequency and intensity. Concentration and relaxation might decrease tics, whereas stress and excitement might increase tics. Psychiatric comorbidities, like obsessive-compulsive disorder, ADHD, depression and anxiety are common. The etiology is multifactorial with genetic and environmental interactions leading to a dysregulation of cortico-striato-pallido-thalamo-cortical networks.

A correct diagnosis and psychoeducation are essential for patients as well as their relatives. Additional therapies are needed for patients with severe tics that cause physical impairment or great psychosocial stress. It is crucial to also treat psychiatric comorbidities. Psychotherapeutic interventions for tics include progressive muscle relaxation, habit reversal training, exposure and response prevention and comprehensive behavioral intervention for tics. First-line psychopharmacological treatment in Europe contains aripiprazole, tiapride and risperidone, which are all used off-label for tic disorders. Haloperidol remains the only approved medication for the pharmacotherapy of tics in Germany, but is rarely used due to its side effects. Cannabinoids gain interest as a new pharmacological option, but are mainly offered within the frame of studies.

Schlüsselwörter

Tic-Störungen - Tourette-Syndrom - Pharmakotherapie - Habit Reversal Training - Exposure and Response Prevention

Key Words

Tic disorder - Tourette Syndrome - pharmacotherapy - habit reversal training - exposure and response prevention

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