Initial treatment retention to Habit Reversal Training in Tourette syndrome

Objective Tourette syndrome (TS) is a chronic neuropsychiatric movement disorder characterised by multiple motor and one or more phonic tics, plus associated behavioural problems. Specific behavioural interventions, either alone or as an adjunct to pharmacological treatment, have been shown to effectively decrease tic severity and improve health-related quality of life. Habit reversal training (HRT) is increasingly recognised as an effective behavioural intervention in the treatment of TS. However, little is known about the characteristics of patients who attend and adhere to HRT sessions, which results in inappropriate use of resources and therapist appointment times. The present study is aimed to determine the demographic (gender, age) and clinical (disease duration, tic severity, family history of tics, co-morbid behavioural problems, pharmacotherapy) characteristics of adult patients with TS who attend HRT sessions following initial referral, in order to develop recommendations for treating clinicians on the development of appropriate care pathways. Method Data regarding the demographic/clinical characteristics of a cohort of 57 patients with TS consecutively referred to HRT intervention were retrospectively reviewed. Correlation and regression analyses were used to examine associations between patients' characteristics and their attendance at HRT sessions. Results Out of the initial sample, 12/57 patients were excluded from the analysis because of inappropriate referral and/or insufficient data. About one in three patients (15/45) failed to attend HRT following referral by the treating consultant. There were no significant differences in the demographic/clinical characteristics between patients who attended HRT sessions and patients who did not. However, a trend towards statistical significance (p=0.08) was found for decreased tic severity as a predictor of poor attendance. Conclusion Our findings suggest that initial treatment retention to HRT in TS can be suboptimal. The trend towards statistical significance of tic severity as a predictor of poor attendance is of potential clinical relevance and needs further investigation in larger samples.