Complications
A community based study of 1596 children, of whom 21% had tics, found that behavioral problems were more frequent in children with tics than those without tics. The behavioral problems included obsessive-compulsive disorder, ADHD, separation anxiety, overanxious disorder, simple phobia, social phobia, agoraphobia, mania, major depression, and oppositional defiant behavior.[114]
The clinician should continuously inquire and monitor for these symptoms when managing a patient with tic disorders, as these behavioral problems may present later in the course of the disorder.
Cardiac arrhythmias have been associated with the use of antipsychotic medications as well as alpha-2-adrenergic agonists.
Patients should be screened for cardiac risk factors and an ECG may be considered.
Rarely, truncal bending tics may cause secondary thoracic spine degenerative changes.[115] These can include cervical and thoracic spine degenerative changes, retinal detachments, dental problems, and rib fractures.
Rarely, severe tics can cause neurological damage. A case report of two patients with violent and forceful cervical tics showed that over time the tic caused compressive cervical myelopathy.[116]
Potentially, this type of complication can be prevented by effectively treating such violent tics.
With the exception of tetrabenazine, these conditions are a complication of chronic use of antipsychotic medication.
They occur more frequently with the older generation (typical) antipsychotics but can occur with both typical and atypical categories.
While some symptoms may improve with discontinuation of the medications, it can be a permanent condition that only has symptomatic treatment.
This condition is a complication of using antipsychotic medication and can develop within hours to days of administration. Rapid escalation of antipsychotic dose increases the risk of this complication.
Frequently the symptoms resolve with discontinuation of the agent.
This condition is a dose-dependent complication of using antipsychotic medication and can develop within hours to days of administration.
Most frequently involves the tongue, jaw, or neck. Does not cause alteration of awareness, but is often markedly uncomfortable or painful.
More common in younger patients (second and third decade).
Treatment is the use of an anticholinergic agent (usually diphenhydramine). Intravenous administration is preferred, if possible; however, oral administration at home is also considered acceptable. More than one dose may be required.
Antipsychotic medication can usually be started again after 24 hours; however, this reaction may occur again, albeit rarely.
This condition is a dose-dependent complication of using antipsychotic medication, including tetrabenazine.
Frequently the symptoms resolve with discontinuation of the agent, but may take weeks to months to improve.
Neuroleptic malignant syndrome is a potentially life-threatening condition, characterized by fever, muscular rigidity, altered mental status, and autonomic dysfunction.
It is considered an emergency and the patient should be taken to the emergency room immediately.
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