As described above, OCD and tic disorders are frequently chronic, if not lifelong, conditions, and most treatments, notably drug treatment, are suspensive but not curative. Therefore, when defining a treatment plan, clinicians should be aware that they embark on a long-lasting task.
For OCD of significant severity, the initial treatment choices are cognitive-behavioural therapy or anti-obsessional medication, either alone or in combination. A recent panel of experts(7°) favoured cognitive-behavioural therapy as the initial treatment of choice, especially in milder cases without significant comorbidity, whereas presence of comorbid depression, anxiety, disruptive behaviour, or insufficient cognitive or emotional ability to co-operate in cognitive-behavioural therapy are indications for including an SRI in the initial treatment. The combination treatment might be more efficient than either one alone, and cognitive-behavioural therapy may reduce relapse rate in patients withdrawn from medication.
If tics are a common childhood problem, only a small minority of cases find their way to clinics. Given the waxing and waning nature of tic disorders, usual therapeutic practice will initially focus on careful clinical observation, along with educational and supportive interventions, and pharmacological treatments are held in reserve. The decision about whether to treat and how to treat will depend on the primary diagnosis, and the degree of interference of tics with the child's development and functioning. Most simple tics occurring in the absence of severe functioning impairment respond to a simple explanation of the mechanisms. When tics are responsible of functional impairment, pharmacotherapy can provide a substantial source of relief. However, in order not to expose the subject to excessive unwanted side-effects, pharmacological treatment should not aim at complete disappearance of tics.
Even if they are less efficacious alone, other less specific treatment modalities should not be neglected. Obsessive-compulsive and tic symptoms may have a profound impact on the inner life of subjects affected, and traditional psychotherapeutic approaches may be useful to help children and adolescents to address intrapsychic conflicts that affect or result from their illness. Some families become extensively involved in participating in compulsive rituals or reassuring obsessional worries, or on the contrary they may become mired in angry struggles with their symptomatic child. In all cases work with families on how to manage the child's symptoms and participate effectively in behavioural or pharmacological treatment is essential. The growing availability, in all countries, of patient/family lay associations on OCD and tics may be most useful to alleviate the discouragement and incomprehension created by these disorders and give access to appropriate treatment resources.
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