ts 文献

J Child Adolesc Psychopharmacol. 2006 Aug;16(4):505-6.

A pilot study of aripiprazole in children and adolescents with Tourette's disorder.

Yoo HK, Kim JY, Kim CY.

J Child Neurol. 2006 Apr;21(4):358.

Aripiprazole in childhood and adolescence for Tourette syndrome.

Duane DD.

Int J Neuropsychopharmacol. 2005 Sep;8(3):489-90. Epub 2005 Apr 28.

Case series on the use of aripiprazole for Tourette syndrome.

Murphy TK, Bengtson MA, Soto O, Edge PJ, Sajid MW, Shapira N, Yang M.

PMID: 15857570 [PubMed - indexed for MEDLINE]

J Child Adolesc Psychopharmacol. 2009 Dec;19(6):623-33.

Aripiprazole in children and adolescents with Tourette's disorder: an open-label safety and tolerability study.

Lyon GJ, Samar S, Jummani R, Hirsch S, Spirgel A, Goldman R, Coffey BJ.

New York University Child Study Center, New York, New York 10016, USA.

Abstract

OBJECTIVE:The aim of this study was to conduct a prospective safety and tolerability study of aripiprazole for the treatment of tics in children and adolescents with Tourette's disorder (TD).

METHOD:Eleven subjects (10 males) with TD (age 9-19 years, mean 13.36, standard deviation [SD] 3.33) who did not respond or were unable to tolerate previous tic medication were treated with aripiprazole in an open-label, flexible-dosing study over 10 weeks. Tic severity was rated using the Yale Global Tic Severity Scale (YGTSS) and the Clinical Global Impressions Scale for tics (CGI-Tics) at baseline and at follow-up.

RESULTS:The mean (+/-SD) daily dose for aripiprazole was 4.5 +/- 3.0 mg. Mean (+/-SD) YGTSS Global Severity scores reduced from 61.82 +/- 13.49 at baseline to 33.73 +/- 15.18 at end point; mean YGTSS total tic scores reduced from 28.18 +/- 7.74 at baseline to 16.73 +/- 7.54 at end point. Mean (+/-SD) CGI-Tic severity scores reduced from 4.45 +/- 0.52 (moderate-marked) at baseline to 3.18 +/- 0.60 (mild) at end point. On the CGI-Tic improvement scale, 10 (91%) subjects achieved 1 ("very much improved") or 2 ("much improved") at end point. Most common adverse effects included appetite increase and weight gain in 5 subjects, mild extrapyramidal effects in 7 subjects, and headaches and tiredness/fatigue in 7 subjects; 1 subject experienced akathisia and muscle cramps.

CONCLUSION:Aripiprazole appears to be a safe and tolerable treatment in children and adolescents with TD that appears to reduce tics; it should be further investigated as a treatment option in controlled trials.

J Child Adolesc Psychopharmacol. 2010 Aug;20(4):291-8.

Effectiveness and tolerability of aripiprazole in children and adolescents with Tourette's disorder: a pilot study in China.

Cui YH, Zheng Y, Yang YP, Liu J, Li J.

Beijing Anding Hospital, Capital Medical University, Beijing, China.

Abstract

OBJECTIVE:The primary aim of the study was to evaluate the effectiveness and tolerability of aripiprazole on motor and vocal tics in children and adolescents with Tourette's disorder (TD). The secondary aim was to assess the response of TD-associated behaviors to aripiprazole exposure.

METHODS:This was an 8-week, open-label trial with flexible dosing strategy of aripiprazole in children and adolescents with TD. A total of 72 patients, aged 6-18 years, participated in the 8-week trial. The Yale Global Tic Severity Scale (YGTSS), the Clinical Global Impressions-Tics (CGI-Tics), and the Child Behavior Checklist (CBCL) were compared at the baseline, weeks 2 and 4, and end point. The side effects of aripiprazole, electrocardiogram (ECG), and body mass index (BMI) were evaluated.

RESULTS:Over the 8-week trial, aripiprazole administration was associated with a significant decrease in total tic severity as measured by the YGTSS (50.3% reduction by week 8). The mean scores of motor tic in the YGTSS were 17.42 +/- 4.83, 12.93 +/- 3.76, 8.39 +/- 3.70, and 6.75 +/- 3.95 at baseline, weeks 2 and 4, and end point. A significant decrease in the scores was observed in week 2 compared to the baseline, and the scores continued to decrease for the remainder of the study period (degrees of freedom [df ] = 3, F = 96.02, p = 0.000). The mean phonic tic scores were 12.71 +/- 4.60, 8.53 +/- 3.26, 6.10 +/- 2.50, and 3.63 +/- 2.20 at baseline, weeks 2 and 4, and end point, respectively. A significant change was observed during week 2 compared to the baseline, and this change continued for the rest of the study period (df = 3, F = 95.16, p = 0.000). Significant improvement was also observed according to the CGI-Tics severity. The mean CGI-Tics severity score was 4.77 +/- 1.69 at baseline and decreased to 2.20 +/- 1.39 at end point (t = 10.70, p = 0.000). A significant reduction of behavior symptoms was noticed according to the CBCL and its subscales between baseline and end point. The majority of subjects tolerated aripiprazole well. The extrapyramidal symptoms (EPS) during this study were negligible. In all 21 (29.2%) of the 72 participants complained of nausea and 19 (26.4%) of them reported sedation. There was no significant difference of BMI between the two phases (df = 64, t = -0.94, p = 0.352). There were no significant changes in laboratory results. ECG monitoring revealed no significant impact on cardiac conduction by aripiprazol.

CONCLUSION:In this preliminary open-label trial, aripiprazole showed effectiveness in treating tic symptoms without causing significant weight gain or other serious side effects. Aripiprazole could be an option for TD cases that do not respond to conventional therapies. Further controlled, double-blind studies are warranted.

PMID: 20807067 [PubMed - in process]

J Clin Psychiatry. 2007 Jul;68(7):1088-93.

An open-label study of the efficacy and tolerability of aripiprazole for children and adolescents with tic disorders.

Yoo HK, Choi SH, Park S, Wang HR, Hong JP, Kim CY.

Department of Psychiatry, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea. hiyoo@amc.seoul.kr

Abstract

OBJECTIVES:This study aimed to investigate the efficacy and tolerability of aripiprazole, an atypical antipsychotic with dual agonist and antagonist actions toward dopaminergic imbalance and partial serotonin-2A receptor antagonism, for treating children and adolescents with tic disorders.

METHOD:Twenty-four outpatients aged 7 to 18 years with DSM-IV-diagnosed tic disorders were treated with aripiprazole using an open-label, flexible dosing schedule for 8 weeks from January 2005 to August 2006. The Korean versions of the Yale Global Tic Severity Scale (YGTSS), the Clinical Global Impressions-Improvement scale (CGI-I), and the CGI-Severity of Illness scale (CGI-S) scores were used to measure the drug efficacy. Side effects were assessed using an adverse effect checklist, the Extrapyramidal Symptom Rating Scale, height and weight measurements, laboratory tests, and electrocardiograms.

RESULTS:Aripiprazole was prematurely discontinued in 6 (25%) of the 24 subjects due to intolerable adverse effects. After a mean of 9.8 +/- 4.8 mg/day of aripiprazole for 8 weeks, there was a 52.8% reduction in the mean YGTSS Total Tic scores (from 26.7 +/- 5.5 to 12.6 +/- 7.6, p < .001). Nineteen patients (79.2%) showed either much improved or very much improved status according to the CGI-I. The CGI-S score was also reduced (from 5.5 +/- 0.5 to 3.0 +/- 1.4, p < .001). The initial dose of 5 mg/day aripiprazole for 2 weeks was also found to reduce tic symptoms significantly (Total Tic scores decreased from 26.7 +/- 5.5 to 17.9 +/- 8.7, p < .001). Fourteen subjects (58.3%) experienced unwanted side effects, the most common being hypersomnia (37.5%), nausea (20.8%), and headache (16.6%).

CONCLUSION:This open-label study suggests that aripiprazole is an efficacious and safe treatment for children and adolescents with tic disorders.

J Child Adolesc Psychopharmacol. 2008 Oct;18(5):509-15.

Aripiprazole in children and adolescents with Tourette disorder with and without explosive outbursts.

Budman C, Coffey BJ, Shechter R, Schrock M, Wieland N, Spirgel A, Simon E.

North Shore University Hospital-Long Island Jewish Hospital System, Manhasset, New York.

Abstract

OBJECTIVE:We conducted a retrospective, observational study of aripiprazole for the treatment of tics and/or co-morbid explosive outbursts in 37 children and adolescents with Tourette disorder (TD).

METHOD:Thirty seven children and adolescents with TD, with and without explosive outbursts, and refractory to previous treatment were treated at one of two university affiliated specialty clinics. All diagnoses were made using Diagnostic and Statistical Manual of Mental Disorders, 4th edition, Text Revision (DSM-IV-TR) criteria. Tic severity was rated using the Clinical Global Impressions Scale for tics (CGI-Tics) and frequency of explosive outbursts was assessed using the CGI-Rage; both measures were obtained at pretreatment baseline and at posttreatment follow up.

RESULTS:High rates of psychiatric co-morbidity were observed in these subjects: 31 of 37 (84%) subjects met criteria for obsessive-compulsive disorder (OCD), and 31 of 37 (84%) met criteria for attention-deficit/hyperactivity disorder (ADHD). Twenty nine of 37 (78%) subjects met criteria for intermittent explosive disorder (IED) minus criterion C; the remaining 8 subjects had TD only. Eight subjects (22%) discontinued treatment before 12 weeks due to inability to tolerate the drug. At follow up, tics reduced at a mean daily dose of 12.3 (7.50) mg in 29 of 29 (100%) subjects who completed the study, and explosive outbursts improved in 24/25 subjects (96%) who completed the study. Aripiprazole was tolerated reasonably well, although 8/37 (22%) subjects discontinued treatment; most common side effects included weight gain, akathisia, and sedation.

CONCLUSION:Aripiprazole should be investigated further as a treatment option for TD with and without co-morbid explosive outbursts.

PMID: 18928415 [PubMed - indexed for MEDLINE]

J Child Adolesc Psychopharmacol. 2008 Apr;18(2):197-205.

Aripiprazole treatment of children and adolescents with Tourette disorder or chronic tic disorder.

Seo WS, Sung HM, Sea HS, Bai DS.

Department of Neuropsychiatry, Yeungnam University, Daegu, Korea. sws3901@ynu.ac.kr

Abstract

OBJECTIVE:This study was conducted to evaluate the effectiveness of aripiprazole to reduce the severity and frequency of tic symptoms and to evaluate the additional effects of aripiprazole on weight changes in children and adolescents with Tourette disorder (TD) or chronic tic disorders.

METHODS:A 12-week, open-label trial with flexible dosing strategy of aripiprazole was performed with 15 participants, aged 7-19 years. The Yale Global Tic Severity Scale was applied and the baseline, week 3, 5, 9, and end point scores were compared. The mean body mass index (BMI) at baseline and end point were also compared.

RESULTS:Significant decreases in the scores of motor and phonic tics, global impairment, and global severity were demonstrated between baseline and week 3, and the scores continued to improve thereafter. No difference was observed between the baseline and end point BMI.

CONCLUSION:This study demonstrates that a relatively low dose of aripiprazole can be used to control tic symptoms effectively in children and adolescents with TD and chronic tic disorders without causing significant weight gain. Additional double-blind studies are needed to establish the definitive efficacy of aripiprazole in treating children and adolescents with chronic tic symptoms.

Curr Treat Options Neurol. 2010 Sep 10. [Epub ahead of print]

Treatment of Tics and Tourette Syndrome.

Singer HS.

Departments of Neurology and Pediatrics, Johns Hopkins Hospital, The David M. Rubenstein Child Health Building, Suite 2158, 200 North Wolfe Street, Baltimore, MD, 21287, USA, hsinger@jhmi.edu.

Abstract

OPINION STATEMENT: Tics come in a variety of types and frequencies; have a waxing and waning course; are exacerbated by stress, anxiety, and fatigue; and often resolve or improve in the teenage or early adult years. Tourette syndrome requires the presence of chronic, fluctuating motor and phonic tics. In addition to tics, individuals with Tourette syndrome often have a variety of comorbid conditions such as attention deficit hyperactivity disorder (ADHD), obsessive-compulsive disorder, depression and anxiety, episodic outbursts, and academic difficulties. These conditions often are a greater source of difficulty than the tics themselves. All patients with tics should be evaluated to assure proper diagnosis and to identify any associated psychopathology or academic difficulty. The treatment of tics begins with education of the patient and family, including discussions about the fundamentals of tics: their characteristics, etiology, outcomes, and available treatments. Therapy should be individualized based on the extent of impairment, available support, ability to cope, and the presence of other problems. Indications for the treatment of tics include psychosocial problems (loss of self-esteem, comments from peers, excessive worries about tics, diminished participation in activities), functional difficulties, classroom disruption, and physical discomfort. A variety of behavioral approaches can be used. Recent studies have emphasized the value of comprehensive behavioral intervention for tics (CBIT). Because habit reversal is the major component of CBIT, a cooperative patient, the presence of a premonitory urge, and a committed family are essential ingredients for success. If tic-suppressing medication is required, a two-tier approach and monotherapy are recommended. First-tier medications, notably the α-adrenergic agonists, are recommended for individuals with milder tics, especially persons with both tics and ADHD. Second-tier medications include various typical and atypical neuroleptics. Their sequence of prescription is often based on physician experience; I favor pimozide and fluphenazine. Atypical antipsychotics, such as risperidone and aripiprazole, have some advantages based on their side-effect profile and are particularly beneficial in individuals with significant co-existing behavioral issues. As will become readily apparent, however, few medications have been adequately assessed. Deep brain stimulation is an emerging therapy, but further data are required to optimize the location of electrode placement and stimulation and to determine precise indications for its implementation. Stimulant medication is effective in treating ADHD in children with tics; studies reducing concerns about its use are discussed.

PMID: 20848326 [PubMed - as supplied by publisher]

Z Kinder Jugendpsychiatr Psychother. 2010 Jul;38(4):291-8.

[Aripiprazole - a medical treatment alternative for Tourette Syndrome in childhood and adolescence]

[Article in German]

Frölich J, Starck M, Banaschewski T, Lehmkuhl G.

Klinik und Poliklinik für Psychiatrie und, Psychotherapie des Kindes- und Jugendalters, Zentralinstitut für Seelische Gesundheit, J 5, DE - 68072 Mannheim. praxis-dr-froelich@t-online.de

Abstract

OBJECTIVE:We report a case-series of seven patients with a medical history of at least two years of tic disorder treated with the partial dopamine agonist aripiprazole to illustrate its efficacy as a treatment alternative for motor and vocal tics in children and adolescents.

METHOD:A case series of five patients with Tourette Syndrome (TS) and two with chronic motor tic disorder (age range 8; 7-18; 1 year), the majority of whom had been refractory to treatment with other neuroleptics or had ceased treatment due to intolerable side effects, were treated for eight weeks with aripiprazole. Before and after treatment, parents rated the severity of motor and vocal tic symptoms on the Yale Tourette Syndrome Checklist.

RESULTS:Within eight weeks mean motor tic symptoms decreased by 66% and mean vocal tic symptoms decreased by 26%. Mean effective dosage was 14.3 mg/day (min. 5 mg, max. 30 mg). Symptoms of comorbid ADHD or Obsessive Compulsive Disorder were not significantly influenced. During medication only mild side effects were observed, e.g., abdominal pain, fatigue and increased emotional sensitivity. No patient dropped out of treatment due to side effects.

CONCLUSIONS:Aripiprazole may be an effective pharmacologic treatment alternative for individuals with chronic motor tic disorder and TS. It induces quick, significant and sustained effects with few generally mild and transient side effects, if anything. Its effectiveness, especially relative to comorbidities, should be verified in double-blind, placebo-controlled studies.

PMID: 20617499 [PubMed - indexed for MEDLINE]

Ugeskr Laeger. 2008 Jan 7;170(1):58.

[Aripiprazole for the treatment of Tourette's syndrome.]

[Article in Danish]

Stenstrøm AD, Sindø I.

Børne- og Ungdomspsykiatrisk Afdeling, Sygehuset i Kolding, DK-6000 Kolding. anne-79@stribnet.dk.

Abstract

Tourette's syndrome (TS) is a motoric disorder characterised by multiple motor and vocal tics. The treatment for patients with moderate to severe TS includes antipsychotic medication. A case report is described in which a 20 year-old male had taken antipsychotic medication since the age of five, due to TS. The initial treatment consisted of pimozide and risperidone, both of which had an unsatisfactorily efficacy on tics and side effects in the form of weight gain and sedation. The patient is now treated with aripiprazole and there is a marked reduction of tics and no side effects.

PMID: 18208720 [PubMed - indexed for MEDLINE]

Int J Neuropsychopharmacol. 2006 Dec;9(6):773-4. Epub 2006 May 31.

Aripiprazole is effective in the treatment of Tourette's disorder.

Constant EL, Borras L, Seghers A.

PMID: 16734937 [PubMed - indexed for MEDLINE]

World J Biol Psychiatry. 2006;7(2):123-5.

Aripiprazole in patients with Tourette syndrome.

Bubl E, Perlov E, Tebartz Van Elst L.

Department of Psychiatry, Albert-Ludwigs-University, Freiburg, Germany.

Abstract

The treatment of the Gilles de la Tourette syndrome (GTS) is often challenging. One reason for this is the high neuropsychiatric cormorbidity in terms of ADHD or obsessive-compulsive symptoms. Dopaminergic modulation e.g. with antidopaminergic medication is an important part of the medical therapy aimed at motor and vocal tics. We report recent experiences with treatment with aripiprazole, a novel antipsychotic agent, which not only improved motor and vocal tics but also ameliorated some behavioural symptoms of the GTS cluster. Furthermore, we discuss possible pharmacological mechanisms for the observed effects.

PMID: 16684686 [PubMed - indexed for MEDLINE]

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