Discussion
Tourette’s disorder is a well recognized condition. However the etiology
of this condition is poorly understood. In addition the occurrence of
atypical symptoms presenting as comorbidities can be misleading.
Treatments targeting such symptoms may cause marked exacerbation of the
primary pathology. In our experience the use of activating medication
such as methylphenidate for “hyperactivity” or disinhibiting
medication such as clonazepam for “anxiety” caused significant
increase in the underlying pathophysiology. Similarly the use of
traditional SSRI medications fluoxetine or fluoxetine, commonly used for
treating anxiety and obsessive-compulsive disorders proved to be of no
benefit, neither did the use of tricyclic medication clomipramine
specifically used in clinical practice for obsessive-compulsive
disorder. Empirical trial of carbamazepine proved equally unsuccessful.
Lithium has been tried previously in cases of comorbid bipolar disorder
and Tourette’s disorder with some benefit. In this particular case,
there was no evidence of a primary affective disorder, yet lithium
proved to be very successful in ameliorating motor , vocal as well as
psychological “tics”, It may have proved to be a direct benefit in
stabilizing the patient’s mood and anxiety as well.