Psychiatry Tic Disorders in Children: Review Questions John W. Thatcher, MD, and William R. Marchand, MD Dr. Thatcher is a resident in psychiatry, University of Utah, Salt Lake City, UT. Dr. Marchand is acting chief of psychiatry, George E. Wahlen VAMC, and assistant professor of psychiatry, University of Utah, Salt Lake City, UT. This work was supported by the Veterans Administration VISN 19 MIRECC. Choose the single best answer for each question.
	Questions 1 and 2 refer to the following case. A 6-year-old boy presents with his mother to the pediatrician. She reports that nearly every day for the past 2 years her son has displayed episodes of sudden, rapid, nonrhythmic eye blinking during times of heightened anxiety. She also states that over the past several months her son has been making frequent repetitive nonrhythmic facial grimaces. The child is not bothered by the behavior, but the mother is concerned 1. What is this patient’s most likely diagnosis? Chronic motor tic disorder Normal childhood fidgeting Synkinesis Tourette’s disorder Click here to compare your answer. 2. What is the most appropriate treatment for this patient? Bupropion Haloperidol Reassurance and clinical monitoring Risperidone Click here to compare your answer. Questions 3 and 4 refer to the following case. A 13-year-old boy is referred by his pediatrician to a child and adolescent psychiatrist. The patient reports having various involuntary, repetitive, stereotyped movements of his arms and neck, which have occurred every day for the past 5 years. Additionally, for the past 2 years, the patient repetitively and frequently clears his throat or grunts. The patient’s pediatrician has found no laryngeal pathophysiology to suggest a medical etiology of the patient’s throat clearing. These behaviors are increasingly interfering with the patient’s ability to participate in social activities, as he feels embarrassed and ashamed by the behavior. He has no other symptoms. The patient’s father purportedly exhibited similar symptoms in adolescence. An adequate therapeutic trial of clonidine has been ineffective in suppressing the patient’s behaviors. 3. What is this patient’s most likely diagnosis? Rett’s disorder Sydenham’s chorea Tic disorder not otherwise specified Tourette’s disorder Click here to compare your answer. 4. What is the most appropriate treatment for this patient? Benztropine mesylate Haloperidol Reassurance and clinical monitoring Risperidone and behavioral interventions Click here to compare your answer.		5. What is the most common comorbid neuropsychiatric disturbance seen with Tourette’s disorder? Coprolalia Depression Encopresis Obsessive-compulsive disorder (OCD) Click here to compare your answer. Questions 6 and 7 refer to the following case. A 9-year-old girl presents for routine follow-up with her child psychiatrist. She has been treated for OCD with a combination of fluoxetine (40 mg/day) and risperidone (1.5 mg/day) for the past 3 years. Although she has had a moderate improvement in her OCD symptoms with this medication regimen, the patient’s mother has recently observed various involuntary, repetitive movements of the patient’s face, arms, and neck. The psychiatrist reasons that the patient’s movements are likely an early manifestation of Tourette’s disorder and increases the dose of risperidone to 3 mg per day. At follow-up 4 weeks later, the patient’s mother reports that the movements have increased in frequency and severity. 6. What is the most likely diagnosis of the patient’s movement symptoms? Hyperkinetic movement disorder Sydenham’s chorea Tardive tic disorder Tourette’s disorder Click here to compare your answer. 7. How should this patient be managed initially? Discontinue risperidone Increase the dose of risperidone Initiate clonazepam Reassurance and clinical monitoring Click here to compare your answer. 8. Which of the following medications would most likely cause tics in a child or adolescent? Methylphenidate Phenytoin Pramipexole Risperidone Click here to compare your answer. 9. Which of the following should be included in the diagnostic evaluation of a child with a tic disorder? Electrocardiography Electromyography Evaluation of the child’s self-esteem Magnetic resonance imaging of the brain Click here to compare your answer.
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