Role of psychotherapy strategy for the management of patients with Tourette syndrome - A Bayesian network meta-analysis.

Tourette's syndrome (TS) is a complex neurodevelopmental disorder characterized by high comorbidity. Treatment with psychotherapy is highly recommended, however, there exists limited available evidence on the use and the optimal psychotherapeutic outcome is debatable. We performed a systematic search on several bibliographic databases for randomized controlled trials (RCTs) reporting the use of psychotherapy treatment in TS patients, from inception to August 1st, 2020, and without language restrictions. Outcome measures were measured by the Yale global tic severity scale (YGTSS) to determine the efficacy of psychotherapy. Data were pooled as Standard mean difference (SMD) in the Bayesian analysis of the random effect model. A total of 17 RCTs with 9 treatments and 1042 participants were included from an initial 4901 records. The primary outcome including, Comprehensive behavioral intervention (CBIT) [SMD = -1.43, 95%Credible interval (CrI): -2.39, -0.44], Exposure with response prevention (ERP) [SMD = -1.37, 95%CrI: -2.62, -0.13], Habit reversal therapy (HRT) [SMD = -0.93, 95%CrI: 1.83, -0.05], and Behavior therapy (BT) [SMD = -0.85, 95%CrI: 1.51, -0.18], were found to be significantly lower in the TS group compared with the control group (including wait-list, treatment-as-usual or other named control group). Based on the Surface under the cumulative ranking curve (SUCRA), CBIT (SUCRA value = 86.97%, 95%CrI: 44%, 100%) was found to be a suitable psychotherapeutic treatment for TS patients. High-quality RCTs on psychotherapy are needed to perform for establishing the foundation of the generation of evidence-based guidelines.