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The case highlights comorbid attention-related and obsessive-compulsive tendencies and emphasizes tic severity peaks in late childhood. Pharmacotherapy reviewed focuses on VMAT2 inhibitors as dopamine-depleting first-line options, with antipsychotics and alpha-2 adrenergic agonists as alternatives depending on comorbidity and severity.",{"@graph":69,"@context":114},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":20,"@type":76,"position":81},"https://docshare.wps.com/document/exam/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/tourette-syndrome-pharmacotherapy-and-most-appropriate-treatment/533608/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/tourette-syndrome-pharmacotherapy-and-most-appropriate-treatment/533608.png","ImageObject",300,407,{"name":92,"@type":93},"anakgang17","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-01","2026-10-10",true,{"@type":102,"interactionType":103,"userInteractionCount":24},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108],{"name":109,"@type":110,"acceptedAnswer":111},"Why aren’t the other treatment choices appropriate for this patient?","Question",{"text":112,"@type":113},"Antisense oligonucleotides are investigational for Huntington disease and don’t match this childhood-onset tic pattern. Copper chelation targets Wilson disease with prominent hepatic and specific neurologic features. Clonazepam targets myoclonus, not typical TS tics, and serotonergic drugs don’t effectively target the patient’s tics though they may help comorbid anxiety or OCD.","Answer","https://schema.org",{"og:url":83,"og:type":116,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":118,"canonical":83},"index,follow",{"doc_id":120,"site_id":62},533608,1792726880,{"code":4,"msg":5,"data":123},{"doc_id":120,"user_id":124,"nickname":92,"user_avatar":125,"doc_module":4,"category_id":19,"category_name":20,"doc_title":65,"doc_description":67,"doc_content":126,"file_id":127,"file_url":128,"file_type":129,"file_size":130,"view_count":24,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":131,"language":132,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":133,"faqs":134,"seo_title":135,"seo_description":67,"update_tm":136,"read_time":137,"preview_page_count":4},962090883568,"https://ap-avatar.wpscdn.com/davatar_a8503ba1806abce46bf441b54a3ca4cd","A 20-year-old college student comes to the office due to worsening abnormal movements.The symptoms initially started in middle school whenhe would repeatedly blink and then shrug his shoulders.The patient worked with a counselor who taught him techniques to suppress movementsfor periods of time,although these did not completely resolve them.Over the past few years,the symptoms have gradually worsened.Episodesnow occur multiple times daily,particularly around highly stressful times at school.His grades have declined,and he is embarrassed during classpresentations.The patient has no history of serious illness and takes no medications.He occasionally smokes marijuana on weekends.Familyhistory is notable for the death of his father at age 50 from a stroke.Vital signs are normal.During the examination,the patient is visibly anxious.He repeatedly blinks,clears his throat,and shrugs his shoulders.The remainder of the physical examination shows no abnormalities.Which ofthe following is the most appropriate treatment for this patient?  \n○ A.Antisense oligonucleotide therapy○ B.Copper chelation therapy○ C.GABA agonist therapy  \n○ D.Serotonin reuptake inhibition therapy○ E.VMAT2 inhibitor therapy  \nSubmit  \n☆  \nA AA  \n1 of 40  \n卡  \n三×  \n0.Z  \nMark  \n□□□□  \ntion Id:20778  \nNext  \nExit Mode  \nSettings  \nPrevious  \nTutorial  \nLab Values  \nNotes  \nText Zoom  \nCalculator  \nReverse Color  \n\n| Tourette syndrome   |  |\n| --- | --- |\n| Clinical  \u003Cbr>features   | ·Both multiple motor&≥1 vocal tics(not necessarily concurrent,>1 year)  \u003Cbr>o Motor:facial grimacing,blinking,head/neck jerking,shoulder shrugging,tongue protrusion  \u003Cbr>o Vocal:grunting,sniffing/snorting,throat clearing,barking,yelling,coprolalia(obscenities)  \u003Cbr>·Onset age\u003C18   |\n| Comorbidity   | ·Attention deficit hyperactivity disorder  \u003Cbr>·Obsessive-compulsive disorder   |\n| Treatment   | ·Education/watchful waiting if mild &nondisabling  \u003Cbr>·Behavioral therapy(habit reversal training)  \u003Cbr>·Antidopaminergic agents  \u003Cbr>o Tetrabenazine(VMAT2 inhibitor)  \u003Cbr>o Antipsychotics(receptor blockers)  \u003Cbr>·a2 Adrenergic receptor agonists   |\n| Prognosis   | ·Severity peaks at age 10-12  \u003Cbr>·Majority resolve or improve in adulthood;tics persist in one-third   |\n| VMAT2=vesicular monoamine transporter type 2.   |  |\n\nThis patient's presentation is most consistent with Tourette syndrome (TS).TS,a neurological disorder with childhood onset,is characterized bya combination of vocal (eg,throat clearing)and motor(eg,blinking,shoulder shrugging)tics.Tic severity typically peaks at age 10-12,and ticsare exacerbated by anxiety,fatigue,and psychosocial stress.When tics are severe and debilitating(eg,declining academic performance,psychosocial dysfunction),as in this patient,treatment options include behavioral suppressive therapy(eg,habit reversal training,substituting avoluntary movement incompatible with the tic)and pharmacological interventions.  \nPharmacotherapy of TS consists of:  \n·Antidopaminergic drugs:Vesicular monoamine transporter type 2 (VMAT2)inhibitors(eg,tetrabenazine)function as dopaminedepleters,whereas antipsychotic medications(eg,risperidone)block dopamine postsynaptic receptors and carry risks of parkinsonism,tardive dyskinesia,and metabolic effects.VMAT2 inhibitors are therefore increasingly preferred as initial treatment over antipsychotics.  \n·Alpha-2 adrenergic receptor agonists(eg,guanfacine,clonidine)can be considered in patients with comorbid attention deficithyperactivity disorder or behavioral symptoms.  \npsychosocial dysfunction),as in this patient,treatment options include behavioral suppressive therapy(eg,habit reversal training,substituting avoluntary movement incompatible with the tic)and pharmacological interventions.  \nPharmacotherapy of TS consists of:  \n·Antidopaminergic drugs:Vesicular monoamine transporter type 2(VMAT2)inhibitors(eg,tetrabenazine)function as dopaminedepleters,whereas antipsychotic medications(eg,risperidone)block dopamine postsynaptic recept","cbCaioAll5sbL6tP","https://ap.wps.com/l/cbCaioAll5sbL6tP","pdf",40700730,139,"English","# Educational objective\n## Clinical presentation and diagnosis\n## Treatment options and rationale\n## Answer choices and why they are incorrect","[{\"question\":\"Why aren’t the other treatment choices appropriate for this patient?\",\"answer\":\"Antisense oligonucleotides are investigational for Huntington disease and don’t match this childhood-onset tic pattern. Copper chelation targets Wilson disease with prominent hepatic and specific neurologic features. Clonazepam targets myoclonus, not typical TS tics, and serotonergic drugs don’t effectively target the patient’s tics though they may help comorbid anxiety or OCD.\"}]","Tourette syndrome - Pharmacotherapy and most appropriate treatment | PDF",1791593168,350]