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Case report: Exacerbation and provocation of tics by imipramine and sulpiride

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Abstract

This paper deals with the problem of overlapping clinical effects of neurotropic agents in treating children with complex comorbidity. An 8-year-old boy suffering from a complexity of symptoms such as chronic motor tics, compulsions, phobias, anxious inhibition, and stuttering displayed the totality of Tourette's syndrome while taking imipramine. Sulpiride also enhanced motor and vocal tics. In the discussion, a review on the neurometabolic mechanisms in tic disease actually known is given, and on drugs proven to precipitate tics, which is the case in a number of neurotropic agents. Psychodynamics and famility dynamics are another issue to be regarded independently.

Résumé

Cet article traite du problème des effects cliniques d'interférences des agents neurotropes dans le traitement des enfants avec une cormorbidité complexe. Un garçon de 8 ans souffrant de symptômes complexes tels que des tics moteurs chroniques, de compulsions, de phobies, d'inhibitions anxieuses et de bégaiement, présentait la totalité du syndrome de Gilles de la Tourette tout en prenant de l'Imipramine. Le Sulpiride renforçait aussi les tics moteurs et vocaux. Dans la discussion, une revue des mécanismes neuro-métaboliques de la maladie des tics, actuellement connus est faite ainsi que des médicaments pouvant favoriser les tics ce qui est le cas pour un bon nombre d'agents neurotropes. Les données psycho-dynamiques et liées à la dynamique familiale sont une autre question qui doit être envisagée indépendamment.

Zusammenfassung

Gegenstand der Arbeit sind die sich überlappenden bzw. gegenseitig antagonisierenden klinisch-pharmakologischen Effekte neurotroper Substanzen bei der Behandlung von Kindern mit Tics, die eine Komorbidität mit anderen Symptomen wie Zwänge, Phobien oder ADHD aufweisen. Ein 8-jähiger Patient, der unter chronisch motorischen Tics, Zwangsphänomenen, Phobien, ängstlicher Gehemmtheit und Stottern litt, entwickelte unter Gabe von Imipramin das Vollbild eines Gilles-dela-Tourette-Syndroms mit starker Zunahme der Tic-Symptomatik. Auch Sulpirid aktivierte die Tics. Eine Interpretation aufgrund neurometabolischer Hypothesen und psychopharmakologischer Interaktionen bei Tic-Erkrankungen wird gegeben. Unabhängig davon wirksam werdende individuelle psycho- und familiendynamische Einflüsse werden untersucht.

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  1. RLHK Klinik für Kinder- und Jugendpsychiatrie, Hufelandstrasse 55, D-4300, Essen, Germany

    Robert Oades

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  1. Christian Eggers
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  2. Renate Schepker
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  3. Robert Oades
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Eggers, C., Schepker, R. & Oades, R. Case report: Exacerbation and provocation of tics by imipramine and sulpiride. European Child & Adolescent Psychiatry 2, 169–176 (1993). https://doi.org/10.1007/BF02125572

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