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.