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Answer 4
  1. Risperidone and behavioral interventions. The patient’s symptoms are substantially interfering with his life, and interventions beyond reassurance and clinical monitoring are indicated. A combination of medication and behavioral interventions should be started. Given their lower extrapyramidal side effect profile, second-generation antipsychotics, such as risperidone, are preferred over first-generation antipsychotics (eg, haloperidol) as the treatment of choice for Tourette’s disorder.2,4 Risperidone is the best-studied second-generation antipsychotic in children and therefore is most commonly used in this population. A common behavioral intervention for Tourette’s disorder is habit reversal.2,5 Habit reversal trains the patient to increase awareness of tics and helps the patient create more socially appropriate responses to tic impulses. Clonidine is often used to treat tic disorders but is generally less effective than antipsychotic agents.2 Benztropine mesylate is not used to treat tic disorders.

    2. Sadock BJ, Sadock VA. Synopsis of psychiatry. 9th ed. Philadelphia: Lippincott Williams & Wilkins; 2003:1246-53.

    4. Shavitt RG, Hounie AG, Rosario Campos MC, Miguel EC. Tourette’s syndrome. Psychiatr Clin North Am 2006; 29:471-86.

    5. Popper CW, Gammon GD, West SA, Bailey CE. Disorders usually first diagnosed in infancy, childhood or adolescence. In: Hales RE, Yudofsky SC, editors. The American Psychiatric Publishing textbook of clinical psychiatry. 4th ed. Washington (DC): American Psychiatric Pub.; 2003.

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