Table 1.
Flow chart of pharmacological intervention up to lurasidone add-on therapy to risperidone or aripiprazole in six children/adolescents with Tourette syndrome.
| Patient | Age | Gender | Age of Onset | Psychiatric Family History | Psychiatric Comorbidity | Medical Comorbidity | Medication Attempted (Max Dose, Exposure Time) [Age at Time of Administration] | Tics | Aggressive Behavior | Obsessive Symptoms |
|---|---|---|---|---|---|---|---|---|---|---|
| Child 1 | 16 | Male | 11 | No | Yes (autistic traits) |
Yes (diabetes) |
Aripiprazole (??) | Optimal | Suboptimal | Suboptimal |
| Aripiprazole (up to 10 Mg/D, 11 months) + fluvoxamine (??, 11 months) [11 years, 7 months] | Optimal | Suboptimal | Suboptimal | |||||||
| Aripiprazole (10 Mg/D, 11 months) [12 years, 6 months] | Optimal | Suboptimal | Suboptimal | |||||||
| Aripiprazole (10 Mg/D, 3 months) + olanzapine (up to 7.5 Mg/D, 3 months) [13 years, 5 months] | Optimal | Suboptimal | Suboptimal | |||||||
| Olanzapine (10 Mg/D, 4 months) [13 years, 8 months] | Optimal | Suboptimal | Optimal | |||||||
| Olanzapine (10 Mg/D, 9 months) + topiramate (50 Mg/D, 9 months) [14 years] | Suboptimal | Suboptimal | Suboptimal | |||||||
| Olanzapine (10 Mg/D, 12 months) [14 years, 9 months] | Suboptimal | Suboptimal | Suboptimal | |||||||
| Aripiprazole (up to 15 Mg/D, 12 months) [15 years, 9 months] | Optimal | Suboptimal | Suboptimal | |||||||
| Aripiprazole (15 Mg/D, 1 month) + lurasidone (18.5 Mg/D, 1 month) [16 years, 9 months] | Optimal | Optimal | Suboptimal | |||||||
| Aripiprazole (15 Mg/D, ongoing) + lurasidone (37 Mg/D, ongoing) | Optimal | Optimal | Optimal | |||||||
| Child 2 | 12 | Male | 7 | Yes (Mother line: tics, hyperactivity, learning disability, depression, anxiety; father line: OCD, depression) |
Yes (autistic traits, hyperactivity features, borderline cognitive functioning) |
Yes (GERD) |
Risperidone (up 0.75 Mg/D, 19 months) [6 years, 7 months] | Suboptimal | Optimal | Suboptimal |
| Risperidone (1 Mg/D, 7 months) + aripiprazole (up to 6 Mg/D, 7 months) [8 years, 2 months] | Optimal | Suboptimal | Suboptimal | |||||||
| Risperidone (1 Mg/D, 12 months) + aripiprazole (6 Mg/D, 12 months) + methylphenidate (10 Mg/D, 12 months) [8 years, 9 months] | Suboptimal | Optimal | Suboptimal | |||||||
| Risperidone (up to 4 Mg/D, 17 months) + aripiprazole (up to 15 Mg/D, 17 months) + methylphenidate (10 Mg/D, 17 months) + IVIG (15 g, 17 months) [9 years, 9 months] | Optimal | Suboptimal | Suboptimal | |||||||
| Risperidone (4 Mg/D, 4 months) + aripiprazole (15 Mg/D, 4 months) + clomipramine (up to 20 Mg/D, 4 months) + VPA (up to 600 Mg/D, 4 months) + IVIG (15 g, 4 months) [11 years, 2 months] | Optimal | Suboptimal | Suboptimal | |||||||
| Risperidone (4 Mg/D, 4 months) + aripiprazole (15 Mg/D, 4 months) + fluvoxamine (up to 100 Mg/D, 4 months) + VPA (600 Mg/D, 4 months) + IVIG (15 g, 4 months) [11 years, 6 months] | Optimal | Suboptimal | Suboptimal | |||||||
| Risperidone (4 Mg/D, 3 months) + aripiprazole (15 Mg/D, 3 months) + levomepromazine (up to 100 Mg/D, 3 months) + fluvoxamine (100 Mg/D, 3 months) + VPA (600 Mg/D, 3 months) + IVIG (15 g, 3 months) [11 years, 10 months] | Optimal | Suboptimal | Suboptimal | |||||||
| Risperidone (4 Mg/D, ongoing) + lurasidone (up to 74 Mg/D, ongoing) + VPA (to 600 Mg/D, ongoing) + IVIG (15 g, ongoing) | Optimal | Optimal | Optimal | |||||||
| Child 3 | 11 | Male | ?? | No | Yes (hyperactivity features, oppositional behavior, borderline cognitive functioning) | No | Antipsychotic not better specified (??, ??) | Optimal | Suboptimal | Suboptimal |
| Risperidone (up to 5 Mg/D, at least 11 months) [10 years, 6 months] | Optimal | Suboptimal | Suboptimal | |||||||
| Risperidone (5 Mg/D, 2 months) + lurasidone (up to 74 Mg/D, 2 months) [11 years, 5 months] | Optimal | Suboptimal | Optimal | |||||||
| Risperidone (5 Mg/D, ongoing) + lurasidone (up to 148 Mg/D, ongoing) | Optimal | Optimal | Optimal | |||||||
| Child 4 | 17 | Male | ?? | No | No | No | Aripiprazole (??, ??) | Optimal | Suboptimal | Suboptimal |
| Aripiprazole (??, ??) + ziprasidone (??, ??) | Optimal | Suboptimal | Suboptimal | |||||||
| Aripiprazole (up to 8 Mg/D, ??) + quetiapine (up to 200 Mg/D, ??) | Optimal | Suboptimal | Suboptimal | |||||||
| Aripiprazole (12 Mg/D, 8 months) + haloperidol (1.5 Mg/D, 8 months) [16 years, 9 months] | Optimal | Suboptimal | Suboptimal | |||||||
| Aripiprazole (up to 24 Mg/D, 1 month) + haloperidol (up to 3 Mg/D, 1 month) + lithium sulphate PR (166 Mg/D, 1 month) [17 years, 5 months] | Optimal | Suboptimal | Suboptimal | |||||||
| Haloperidol (3 Mg/D, 20 days *) + lurasidone (74 Mg/D, 20 days) + lithium sulphate PR (166 Mg/D, 20 days) [17 years, 6 months] | Optimal | Optimal | Optimal | |||||||
| Aripiprazole (up to 30 Mg/D, ongoing) + lurasidone (74 Mg/D, ongoing) + lithium sulphate PR (166 Mg/D, ongoing) | Optimal | Optimal | Optimal | |||||||
| Child 5 | 12 | Male | ?? | Yes (mother: depression, suicide attempt; sister: mood disorder) | Yes (low mood **) | Yes (Diabetes) | Aripiprazole (10 Mg/D, 10 months) [11 years, 1 month] | Suboptimal | Optimal | Suboptimal |
| Aripiprazole (10 Mg/D, 2 months) + risperidone (4 Mg/D, 2 months) [11 years, 11 months] | Suboptimal | Optimal | Suboptimal | |||||||
| Aripiprazole (10 Mg/D, ongoing) + lurasidone (37 Mg/D, ongoing) | Suboptimal | Optimal | Optimal | |||||||
| Child 6 | 13 | Male | 9 | No | Yes (hyperactivity features, borderline cognitive functioning) | No | Antipsychotic not better specified (??, ??) | Optimal | Suboptimal | Suboptimal |
| Risperidone (6 Mg/D, 7 months) [11 years, 7 months] | Optimal | Suboptimal | Suboptimal | |||||||
| Aripiprazole (7 Mg/D, 7 months) [12 years, 2 months] | Optimal | Suboptimal | Suboptimal | |||||||
| Aripiprazole (up to 10 Mg/D, 8 months) + mirtazapine (1 Mg/D, 8 months) [12 years, 9 months] | Optimal | Suboptimal | Suboptimal | |||||||
| Aripiprazole (10 Mg/D, 1 month) + lurasidone (74 Mg/D, 1 month) [13 years, 5 months] | Optimal | Optimal | Suboptimal | |||||||
| Aripiprazole (10 Mg/D, ongoing) + lurasidone (111 Mg/D, ongoing) | Optimal | Optimal | Optimal |
Mg/D, milligrams per Day; OCD, obsessive compulsive disorder; GERD, gastroesophageal reflux disease; IVIG, intravenous immunoglobulin; VPA, valproic acid; ??, unknown; PR, prolonged release; * discontinued due to reported sedation; ** depressive symptoms were improved by lurasidone; Optimal, clinical impression of symptom improvement >50%; Suboptimal, clinical impression of symptom improvement <50%.