Treating Tics and Tourette’s Disorder

Renowned psychiatrist Barbara Coffey, MD, MS, joins Mount Sinai to lead specialized program in tics and Tourette’s Disorder

A 10 year-old boy suffers from involuntary tics including facial grimaces, coughing, and shouting out obscenities. A 17 year-old girl compulsively licks her lips, jerks her limbs, and yells loudly. As many as 20 percent of school-age children experience tics, and another 1 percent of children worldwide suffer from Tourette’s Disorder (TD) — a neuropsychiatric condition beginning in childhood that causes uncontrollable physical and vocal tics.

The Department of Psychiatry at Mount Sinai is committed to treating this debilitating disorder, which may derail development and daily functioning, leading to inability to attend school or work, problems with socialization, suicidality or even hospitalization. Recently, Barbara J. Coffey, MD, MS, joined the Department as Director of the Tics and Tourette’s Clinical and Research Program and Professor of Psychiatry. This unique specialty program is dedicated to the enhanced understanding, evaluation, and treatment of youths and adults with tics, TD, and related problems such as Obsessive-Compulsive Disorder (OCD), Attention Deficit Hyperactivity Disorder (ADHD), and other mood and anxiety disorders.

“TD is a significant public health concern,” says Dr. Coffey who is an internationally recognized scientist in the field. “While many youth experience a decrease in tics over time, approximately one-third of children with TD continue to suffer from severe symptoms in adulthood. Most patients also present with other psychiatric disorders including OCD and ADHD.”

Unfortunately, treatments for tics and TD are limited. Approved medications, such as pimozide, haloperidol, and off label agents such as the alpha agonists, can help reduce the tics and manage comorbid disorders, but their efficacy is limited and often associated with long-term side effects. To create new therapies, researchers must develop a better understanding of the cellular and molecular basis of TD.

“Making progress in uncovering the pathophysiology behind TD has been slow when compared with other psychiatric disorders,” explains Dr. Coffey. “It is imperative that we enhance our understanding of this disorder so we can develop novel treatments that will improve the lives of our patients.”

For nearly 20 years, Dr. Coffey’s research has provided valuable insights into the biological underpinnings of TD. Recently, her team published the results of two prospective case-control studies of Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcus (PANDAS), which concluded that streptococcal infection is one precipitant of acute tic and OCD exacerbations in youths with TD. These results have had a significant impact on the scientific evidence for and against the disorder, and have led to a re-definition of the nature of infection-triggered illness in youths with OCD.

Another important focus of Dr. Coffey’s work has been the role and impact of comorbid anxiety and mood disorders in TD. She was the first psychiatrist to report that separation anxiety disorder—independent of OCD—predicted greater tic severity, and that major mood disorders were a more robust predictor of functional impairment than tic severity in youths with TD.

Currently, Dr. Coffey and Vilma Gabbay, MD, MS, Associate Professor of Psychiatry and Chief of the Child and Adolescent Mood and Anxiety Disorder Program, who joined Mount Sinai in June 2012, are investigating the neurobiology of mood and anxiety disorders in TD and OCD. Their research shows that TD and comorbid OCD may involve a dysregulation of the immune system. She is also involved in a Phase III clinical trial involving a new drug that may help treat tics and TD.