**4.7 Treatment of OCD**

Associated OCD can be more disabling than the tics themselves and may create a state of tension and anxiety that heightens tic severity. Cognitive behavioral therapy performed by a well-trained and experienced therapist can be a very effective non-pharmacological treatment for OCD. Selective serotonin reuptake inhibitors (SSRIs) are considered the firstline medications for OCD. Combination with an atypical antipsychotic may be helpful for cases resistant to an SSRI alone. DBS involving the internal capsule/nucleus accumbens is under investigation as a therapy more severe and medication-refractory cases of OCD.

The Tourette Syndrome Association (TSA) is an informative reference guide to patients, parents, and teachers, because it clearly outlines many home and school psychoeducational modifications and interventions that may be effective for children with ADHD and tics. There are local support groups in many cities that can provide information, guidance, and support.

The optimum management of patients with tics involves a comprehensive approach that focuses not only on the tics themselves, but also on neuropsychiatric comorbidities (particularly ADHD and OCD) and existing psychosocial stressors. For young patients, major goals of treatment include helping the child to develop self-confidence, personal resilience, and positive psychosocial skills. A critical goal is to reduce obstacles to successful learning and socialization. The ultimate management usually requires a spectrum of interventions that may include education, cognitive-behavioral therapies, counseling, and medications. DBS might prove to be a useful therapy for patients with severe, disabling tics, or OCD.
