Tourette's Syndrome, Attention Deficiency, Obsessive-Compulsive Disorder, Chronic Pain, and Opiate Therapy.
Tourette's Syndrome is characterized by repetitive tic-like movements of the face and sometimes the extremities with uncontrolled vocal utterances like yelps or barkings. It is often attended by obsessive-compulsive disorder (OCD). That disorder is a part of the bipolar spectrum and, therfore, Tourette's and OCD is often comorbid with attention deficiency (ADD), bipolar disorder, and chronic pain.
She suffered chronic pain following a lumbar spine operation. Her Tourette's Syndrome had been diagnosed at age 21, and she had been started on the drug, Haldol, which was somewhat effective in controlling her facial tics. Her obsessive-comopulsive disorder consisted of repetitive talking to herself and sometimes slapping her tongue in rhythm against her teeth or lower lip, exercises that, she said, would not be obvious to the casual observer. She also was a counter, repetitively counting steps in a staircase. A diagnosis of attention deficiency was made by a psychiatrist, and she was given the stimulant, Adderall, (amphetamine) at a dose of 30 mg. twice daily. She also had a history of migraine, which, she said, had diminished since she had been on Adderall (it does happen). She was also on the antidepressant, Zoloft, for anxiety and depression. She acknowledged quick mood shifts and a propensity to anger.
When she first came to me she told me that she had, on her own, increased her Adderall dosage from 30mg. twice daily to three times daily and found herself much better with that. Her psychiatrist, however, was unwilling to give her the requested dosage. I presented it. I also gave her the opiate, Oxycodone, and she reported dramatic improvement regarding her Tourette's, OCD, and ADD as well as her pain. She reported that with the Oxycodone there had been great diminution in the occasional spells of agitation and a sense of being "unettled." She reported positive feelings about the people and things in her life, uncommon previously, and also lessening of her very frequent unwarrented fears. Her tics were diminished, and her psychiatrist, she told me, was appreciative of my efforts and recongnized that the dosage of Adderall, beyond what he had wished to prescribe, was clearly benefiting her. When she reached the dose of Oxycodone 60mg. four times daily (a rather large dose) she felt a calmness that was, she said, "unbelievable." Her counting and talking to herself was much diminishe, and with Oxycodone as well as Adderall for her bipolar spectrum she has done extraordinarily well.
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