A 9-year-old boy has had multiple motor tics involving the face and shoulders along with coprolalia for the past 2 years. The tics wax and wane but have never been free of symptoms for more than 3 consecutive months. Behavioral therapy has failed to control them adequately. Which drug is the most appropriate next choice for pharmacological management?

• A Methylphenidate
• B Carbamazepine
• C Fluoxetine
• D Haloperidol ✓

Explanation

Tourette disorder is defined by multiple motor tics plus at least one vocal tic lasting more than 1 year with no tic-free interval exceeding 3 months, onset before 18 years. When behavioral therapy fails, dopamine receptor antagonists such as haloperidol, risperidone or aripiprazole are first line drugs. Methylphenidate may worsen tics and is used for comorbid ADHD only after careful consideration. Fluoxetine treats comorbid OCD but not the tics themselves, and carbamazepine has no role.

Reference: Kaplan and Sadock's Synopsis of Psychiatry, 12th ed.

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