Begum Gulshan, Nkemjika Stanley, Olayinka Olaniyi, Olupona Tolu, Jolayemi Ayodeji
Psychiatry, Interfaith Medical Center, Brooklyn, USA.
Public Health/Epidemiology, Georgia State University, Atlanta, USA.
Cureus. 2021 Mar 25;13(3):e14111. doi: 10.7759/cureus.14111.
Antipsychotics have been documented in the literature as the most effective pharmacological treatment for tics thus far. Additionally, evidence in the literature has shown that typical and atypical antipsychotics are effective for the treatment of tic disorders in patients who are diagnosed with schizophrenia and other psychiatric illnesses. This evidence is typified as atypical antipsychotic medications, such as risperidone, aripiprazole, and olanzapine, have been documented as being effective for motor tics, particularly in Tourette's syndrome. Despite the level of evidence with regard to antipsychotics, there is no published literature on the role of clozapine-based treatment for persistent vocal tics in schizophrenia. We present a case of severe adult-onset persistent vocal tics in a schizophrenic patient who was admitted for acute psychotic exacerbation. The patient's vocal tics as well as his comorbid psychotic symptoms were not responsive to risperidone and paliperidone. The combination of risperidone with clozapine for psychosis showed improvements in his symptoms. In addition, the patient's tics showed excellent response to risperidone and clozapine combination therapy. He was subsequently discharged to the community with clozapine 125 mg twice daily and paliperidone palmitate 156 mg every 28 days. The patient was psychiatrically stable without vocalization at the time of discharge. We suggest that clozapine augmentation therapy could be an approach in treatment-resistant vocal tics among schizophrenic patients who are refractory to atypical antipsychotics.
抗精神病药物在文献中已被记载为迄今为止治疗抽动症最有效的药物治疗方法。此外，文献中的证据表明，典型和非典型抗精神病药物对诊断为精神分裂症和其他精神疾病的患者的抽动症治疗有效。这类证据的典型代表是非典型抗精神病药物，如利培酮、阿立哌唑和奥氮平，已被证明对运动性抽动有效，尤其是在妥瑞氏症中。尽管有关于抗精神病药物的证据水平，但尚无关于氯氮平为基础的治疗对精神分裂症患者持续性发声抽动作用的公开文献。我们报告一例成年起病的严重持续性发声抽动的精神分裂症患者，该患者因急性精神病性发作入院。患者的发声抽动以及共病的精神病性症状对利培酮和帕利哌酮无反应。利培酮与氯氮平联合治疗精神病症状有改善。此外，患者的抽动对利培酮和氯氮平联合治疗反应良好。随后他出院回到社区，服用氯氮平125毫克，每日两次，以及棕榈酸帕利哌酮156毫克，每28天一次。出院时患者精神状态稳定，无发声症状。我们建议，对于对非典型抗精神病药物难治的精神分裂症患者中难治性发声抽动，氯氮平强化治疗可能是一种治疗方法。
