Adult Tourette syndrome

A 30 year old male presented with complaints of sudden repetitive movements of shoulders and repetitive barking like sounds from 10years of age,excessive worrying over trivial issues accompanied by fearfulness and difficultly in breathing in crucial sitiations lasting for few mins to hours for over 2 years now,sleep disturbance,difficulty in erection while having sex with wife with decrease libido for around 6 months now...patient mentions there is no erectile problems during masturbation...on examination--motor tics and vocal tics present...on MSE..mood is anxious with somatic preoccupatio...i diagnsed this case as TOURETTE SYNDROME(childhood onset)with GAD with sexual dysfunction secondary to anxiety...HOW SHOULD I APPROACH THIS PATIENT? please suggest...

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U can manage this case by administering Tablet Risperidone 2mg (To start with, & can increase it later, depending upon the response) OD at night ; Tablet Fluoxetine as a long term anxiolytic; Tablet Clonazepam in divided doses as a short term anxiolytic. As far as sexual dysfunction is concerned, it is not organic as he is alright during masturbation. So, wait for 4-6 weeks for SSRI to work well. I am using Fluoxetine here, as it is proven and tested drug, & works well. As Anxiety subsides after 2-3 months, U can decrease the dose of Fluoxetine, as on long term, it can itself cause sexual dysfunction; Or U can taper it & change to other drugs like Bupropion or Vilazodone, which are free of sexual S/Es.

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@Dr. Sachin Arora @Dr. Santanu Bora @Dr. Utpal Bora

@Dr. Gunjesh Kumar kindly help sir

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