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.