A Case Series on Complexities in Recognition and Management of Tourette Syndrome with Variable Behavioral Presentations: Comorbidity Versus Umbrella Construct

Abstract

In Tourette syndrome (TS), apart from multiple motor and vocal tics, there are often myriads of associated conditions apparently similar to attention-deficit-hyperactivity-disorder (ADHD), obsessive-compulsive-disorder (OCD), mood-and-conduct disorder, learning difficulties, etc. On the other hand, tic disorders often occur as co-morbidity with many neurodevelopmental disorders such as ADHD, OCD and mood disorders, and pharmacotherapy of these behavioral conditions may worsen the tics. So, the confusion lies whether to separately code and manage the different neurodevelopmental disorders or assume an umbrella construct of “TS-plus,” as suggested by some researchers. In this background, we share three cases of children and adolescents having multiple tics with mixed behavioral presentations of ADHD/OCD/mood disorders that created a lot of diagnostic dilemma and treatment-related complications in prior psychiatric consultations. They were finally diagnosed as “TS-plus” and managed with low-dose-risperidone-mono-pharmaco-therapy and psychological interventions. In conclusion, psychiatrists should be vigilant for Tourette-syndrome while handling children with repetitive motor behaviors along with hyperactivity, obsession-compulsion, mood-conduct, etc. Assumption of an umbrella-construct approach of “TS-plus” may be beneficial in limiting the number of diagnosis and their separate pharmacotherapy, which may worsen the clinical scenario.