DISCUSSION:
The effectiveness and long-term prognosis of behavioural therapies in the index case were similar to those reported in earlier studies [10–12]. The most extensively studied behavioural treatments for tic disorders are HRT and CBiT [13,14]. Relapse prevention programs, relaxation training, function-based assessment and therapies, and psycho-educational sessions are components of CBiT. This elaborated CBiT treatment programme includes conventional HRT components with other methods recommended by understanding chronic tic disorder (CTD) [15,16]. CBiT is considered superior to pharmacotherapy in enhancing psychosocial functioning and appears to have fewer adverse effects, especially if the patient is motivated to undertake lengthy therapy. For those with CTD who want to improve their psychosocial functioning but are concerned about the side effects of pharmacotherapy, CBiT may be an alternative [17].
Good prognostic indicators include early diagnosis, the prompt intervention of parents, psychosocial support, average IQ of the child, regular follow-up, and negative family history. Females with CTD experience peak symptoms later, less age-related remission, and worse tic impairment, especially in adulthood [18]. The decision to initiate therapy is based on how disabling the child’s symptoms are to their normal development and schooling. Children responded to CBiT in trials more frequently than adults (53% vs. 38%, respectively) [16,19]. Nevertheless, given that children responded to the control treatment more than adults (psychoeducation and supportive therapy; 19% versus 7%), this may reflect factors other than the particular efficacy of CBiT in these age groups. Children as young as nine years old have participated in studies showing the effectiveness of behaviour treatment [19].
The current case significantly contributes to the scientific literature by showing that CBiT utilized as a part of an intensive outpatient program carried out via an online platform might lower tic intensity. Additionally, recent studies have demonstrated that CBiT, when administered online via videoconferencing mode, can lessen the severity of tics [20]. In a study comparing the efficacy of this method to in-person meetings (n = 18, 10 videoconferences), comparable effect sizes on tic reduction were discovered [21]. The foundation of a study protocol that compares the effectiveness of online CBiT (n = 72), psychoeducation alone (n = 72), and face-to-face CBiT (n = 16) over two years primarily involves internet-delivered CBiT [22]. Also, a small (n = 20) group of kids and teenagers participated in a waitlist-controlled voiceover Internet protocol for delivering CBiT pilot study, with promising outcomes [23]. Three children receiving remotely delivered CBiT, demonstrated clinically substantial reductions in tic frequency in an initial pilot investigation [24]. By implementing this method of treatment delivery, the potential treatment catchment areas are expanded, making CBiT more accessible to a wider range of patients who are limited by location, transportation, or cost and enabling patients to concentrate on developing and implementing their competing responses without interference from work or school [25]. About 30% of TS patients experience anxiety or depression at some point [26]. Suicidal ideas and attempts occur in about 10% of young individuals with tic disorders [27,28].
A large epidemiological cohort study from the Swedish National Patient Register found that adults with TS had a roughly four-fold greater chance of both suicide attempts and fatalities [29]. Screening for depression and anxiety symptoms is especially important in individuals with a family history of these disorders.