Quetiapine for Chronic Motor Tic Disorder

Mr. A was a 26-year-old single African American man who had been diagnosed with chronic motor tic disorder at age 7. He had symptoms of social phobia, including difficulties with public speaking and daily social interactions. His tic disorder was familial. Trials of medications since grade school included haloperidol, pimozide, clonidine, sertraline, alprazolam, propranolol, diazepam, olanzapine, and risperidone. These trials included full therapeutic doses for a sufficient duration. Risperidone was the most effective medication in relieving his symptoms but caused extensive weight gain, which led to discontinuation. The weight gain stopped after the risperidone was tapered; however, the tics reappeared. Diazepam and alprazolam exacerbated the tics. Clonidine and olanzapine were not effective in controlling the tics.

Mr. A was then given quetiapine, 25 mg/day, which was titrated to 400 mg/day over several weeks. Within a month, he reported that he could socialize with more ease and was not having any tics. For the first time ever, he was able to speak publicly without any tics or problems initiating speech. Weight gain occurred, although not as much as when he was treated with risperidone.