A man comes with history of abnormal excessive blinking and grunting. He says he has no control over his symptoms, which have risen in frequency of late. This has staed affecting his social life making him depressed. Which of the following medications should be used in him?
Risperidone
Imipramine
Carbamazepine
Methylphenidate
Ans: A. Risperidone(Ref Kaplan and Sadock 11/e p1091; Niraj Ahuja 7/e p168).* This case suggests motor & vocal tics associated with Tourette's disorder.Treatment:* Pharmacotherapy - treatment of choice - Antipsychotics (haloperidol & resperidone). - DOC - Haloperidol.Other useful drugs:* Resperidone, Olanzapine, Aripiprazole.* SSRIs - Fluoxetine for co-morbid obsessive-compulsive symptoms.* Methylphenidate & Imipramine - Used in ADHD child.* Adjunct - Behavior therapy.