Biological rhythm disturbance is etiologically involved in mood disorders. Previous literature focused on studying sleep disruption in bipolar disorders (BD). However, only a few studies addressed the influence of social rhythms and occupational functioning as they may affect circadian regularity and consequently be a critical pathway to mood symptoms.

The main aim of this study was to assess biological rhythms in remitted bipolar patients and to evaluate their social rhythms and occupational functioning.

We recruited a total of 80 euthymic outpatients with BD and 80 control subjects. Biological rhythm disruptions were assessed using the Biological Rhythm Interview of Assessment in Neuropsychiatry (BRIAN), an interviewer administered questionnaire that assesses disruptions in sleep, eating patterns, social rhythms, and general activity.

Patients with BD experienced greater biological rhythm alterations than the control group (BRIAN total scores 35.26±9.21 vs. 25.84±2.68). In addition to their sleep-wake rhythm (mean scores 11.1±3.95 vs. 7.41±1.41), patients were particularly more impaired than the control group with regards to social rhythms (7.31 ± 2.57 vs. 5.24 ± 1.06) and general activity (8.9 ± 3.35 vs. 7.01 ± 1.4).

Our study indicated that patients with BD experience major disruptions in their social rhythms and occupational functioning. These alterations may lead to unstable biological rhythms and to a higher risk of mood episodes. Therefore, consolidating social rhythms and functioning appears to be a crucial step for preventing relapses in patients with BD.

No significant relationships.

In bipolar patients cognitive deficits are an important feature. Persisting neurocognitive impairment is associated with low psychosocial functioning.

The aim of this presentation is to discuss potential cognitive, clinical and treatment-dependent predictors for functional impairment in bipolar patients.

In a first study (1) at the Medical University of Vienna 43 remitted bipolar patients and 40 healthy controls were assessed testing specifically attention, memory, verbal fluency and executive functions. In a randomized controlled trial, patients were assigned to two treatment conditions as add-on to state-of-the-art pharmacotherapy: cognitive psychoeducational group therapy over 14 weeks or treatment-as-usual. At 12 months after therapy, functional impairment and severity of symptoms were assessed. In a second, ongoing study, in-patients from a defined catchment area in Vienna (12th, 13th and 23rd district) were assessed via SCIP (Purdon S. 2005. The screen for cognitive impairment in psychiatry: Administration and psychometric properties. Edmonton, Alberta, Canada: PNL Inc.). The SCIP was performed before and after cognitive remediation. The effects of treatment on functioning were measured with the clinical Global Impression Scale (CGI).

Compared to controls, bipolar patients showed lower performance in executive function, sustained attention, verbal learning and verbal fluency. Cognitive psychoeducational group therapy and attention predicted occupational functioning. In the second study, SCIP and CGI values showed improvement after treatment.

Our data support the idea that cognition affects outcome. Bipolar patients benefit from cognitive psychoeducational group therapy in the domain of occupational life. (1) Sachs G et al. Front. Psychiatry, 23 November 2020 | https://doi.org/10.3389/fpsyt.2020.530026

No significant relationships.

Bipolar disorder is a mental disorder that has one of the greatest risk of completed suicide (CS)

Determine the rate and the risk factors of CS in a cohort of Bipolar I patients followed after their first hospitalization

We choose all Bipolar I patients (DSM-IV) who were first time hospitalized in our Psychiatric unit between 1996 and 2016. We reviewed the charts of first hospitalization and recorded multiple baseline variables. In the follow-up we updated the database recording all patients who CS. We compared the different baseline variables between Bipolar patients who CS and the rest.

Of a total of 254 bipolar I patients 9 (3,5%) CS in the mean of 13 years of follow up (rate 40 times higher than General Population). The average age at CS was 41.1 years (range between 26 and 71 years old) so there was a 9 years gap on average between the first psychiatric hospitalization and suicide. CS was characterized by a violent act (8 out of 9 cases, 89 %). When we compared BP patients who CS with the rest, only history of suicide in first-degree relatives was detected as a risk factor significantly associated (P<0.01) with CS. Conversely baseline treatment with anticonvulsants (mainly valproate) was detected as a significantly (P<0.004) protective factor of CS.

1-Bipolar I patients after first hospitalization completed suicide 40 times higher than general population almost always by violent method 2-History of CS in first-degree relatives is predictor of completed suicide

No significant relationships.

Orexins are involved in the regulation of circadian rhythms which play an important role in mood regulation(1,2), and are hypothesised to be associated with major depressive disorder(3). However, scarce studies analyse their relationship with bipolar disorder (BD).

To evaluate the relationship of orexin-A and the clinical course of BD

95 BD patients were tested for serum orexin-A. The clinical course was analysed through number of depressive, manic/mixed episodes. HDRS and YMRS were used to assess severity of current episode. Statistics: Spearman correlations, U Mann-Whitney, linear regression analysis.

Mean age was 50.03 (SD=12.87) and 64.2% were women. 63.2% had BD-type I. Mean number of manic, depressive and mixed episodes was 2.32 (SD=3.07), 7.28 (SD=12.37), and 3.01 (SD=9.06), respectively. Mean age of onset was 26.09 (SD=10.50). Mean concentration of orexin-A was 21.78 pg/ml (SD=15.41), with no differences in sex, body mass index, age at onset or presence of insomnia(ICD-10). A correlation with age was observed; r=0.24 (p=0.019). No association was identified between orexin-A and severity of current episode. In relation to clinical course, no correlation was found with manic or mixed episodes. However, a negative correlation was identified between orexin-A levels and number of depressive episodes; r=-0.36 (p=0.001). When linear regression (orexin-A as dependent variable) was used to control for age, only this covariate (B=0.304) entered in the model (R2=0.067, F=6.045, p=0.015).

No relationship between orexin-A and number of manic/mixed episodes were detected. The association of orexin-A with number of depressive episodes dissappeared when age was controlled.

No significant relationships.

Bipolar disorder, especially Bipolar II subtype, is a mental disorder that has one of the greatest risk of completed suicide (CS).

Determine the rate and the risk factors of CS in a cohort of Bipolar II patients followed after their first hospitalization

We choose all Bipolar II patients (DSM-IV) who were hospitalized for first time in our Psychiatric unit between 1996 and 2016. We reviewed the charts of first hospitalization and recorded multiple baseline variables. In the follow-up we updated the database recording all patients who CS. We compared the different baseline variables between Bipolar II patients who CS and the rest

Of a total of 59 bipolar II patients 6 (10 %) CS in the mean of 13 years of follow up (rate 120 times higher than General Population). The average age at CS was 45.3 years (range between 33 and 57 years old) so there was a 2 years gap on average between the first psychiatric hospitalization and suicide. CS was characterized by a violent act (5 out of 6 cases, 83 %). When we compared BP II patients who CS with the rest, only history of previous violent suicide attempt was detected as a risk factor significantly associated (P<0.04) with CS.

Bipolar II patients CS early after their first hospitalization and at very high rate (120 times than GP) almost always by violent method. History of previous violent suicide attempt is predictor of completed suicide

No significant relationships.

Lithium is the most effective maintenance drug in Bipolar Disorder (BD), although it has a narrow therapeutic index, between 0.6 and 1.5 mEq/L; recommended doses for maintenance are 0.6-1.2 mEq/L.

To describe a clinical case of lithium intoxication and discuss relevant literature.

Clinical examination of a patient and her medical records; non-systematic PubMed review on “lithium intoxication”.

A 73-year-old woman, diagnosed with BD, stabilized on lithium monotherapy for twenty-five years, was admitted to the Emergency Room (ER) with nausea, lethargy, drowsiness, confusion, cough, and fever. A respiratory tract infection is diagnosed, based on clinical presentation, x-ray and blood analysis. Blood tests also revealed a serum lithium concentration of 2.4 mEq/L and impairment of renal function, indicating lithium intoxication; hemodialysis was initiated, with lithium discontinuation. Over weeks, renal function and general state improved, and BD treatment was reinitiated, this time with valproic acid 800mg/day. Two weeks after discharge, she was admitted again at the ER, for an episode starting in the week prior, compatible with a manic episode; olanzapine 10mg was added to the prescription. A week after, the patient is admitted again in the ER, still in a manic episode.

There are no clear indications in the literature about reinitiating lithium on someone who had an intoxication. Given that lithium brings an unparalelled quality of life to BD patients, careful consideration about reintroduction, with close monitoring, should be made, but there is a critical need of more studies and guidelines to orient clinical practice.

No significant relationships.

Bipolar Disorder (BD) is a severe recurrent disorder with a complex biogenetic and psychosocial etiology. The immune system cytokines in interaction with the CNS play a role in the pathophysiology.

To compare inflammatory cytokines between BD patients and controls during the manic episode; additionally, compare these cytokines with psychiatric symptoms and cognitive performance during follow-up.

We recruited 25 BD patients in mania with paired controls. We measured baseline IL-2, IL-4, IL-8, IL-10, GM-CSG, TNF- α, and TNF- γ in plasma. We used U-Mann-Whitney for group comparison and Spearman correlation between sub-group follow-up assessments and cytokines.

We found a significant difference in IL-6 between subjects and controls (figure 1). During the follow-up, we found a correlation with psychiatric symptoms, cognition, and cytokines during manic episodes (Table 1). Table 1. Follow-up Correlation with cytokines during a manic episode.

(+): positive correlation; (-): negative correlation. WMT: working-memory test, PST: Processing-speed test.

IL-6 was significantly different in patients with BD during a manic episode regardless of the treatment they were taking. IL-10 at manic episode was negatively correlated to general psychiatric symptoms, IL-4 positive correlated to depressive symptoms, and cognitive performance was positively correlated to TNF- α and TNF- γ at follow-up.

No significant relationships.

A 49 y.o. male patient was admitted to the male PICU with a manic episode. Upon admission he presented with mood elation, pressured speech, lack of sleep, agitation and polydipsia.

To investigate the symptom of psychogenic polydipsia in mental health patients presenting with severe mania.

The patient was assessed regularly by the psychiatric team consisting of a CT doctor and one General Adult Consultant. Appropriate psychological assessments for mania and laboratory investigations took place. There was a referral to Endocrinology for further investigation of the symptom.

The patient initially scored above 40 in the Young Mania Rating Scale (YMRS), establishing a diagnosis of mania. Upon admission he was treated with Paliperidone 9mg OD and Sodium Valproate 1gr OD. The daily dose of the sodium valproate was increased. Concerning the polydipsia, the investigations by the Endocrinology department indicated the specific weight in urine within normal range. The mental health team proceeded in a cross-titration of Paliperidone to Aripiprazole. On the 10th day since admission the management of the manic symptoms was considered satisfactory. Nevertheless, the polydipsia continued to a certain extend.

After ruling out organic and pharmacological causes of the polydipsia, the mental health team wondered about the cause of the symptom. Further investigation is required in order to clarify whether the polydipsia could actually qualify as a symptom in severe mania.

No significant relationships.

A 47 y.o. female patient was admitted to the female PICU with a manic episode. Upon admission she presented with mood elation, psychosis, pressured speech, lack of sleep and agitation.

To investigate negative prognostic factors such as the co-morbidity with a personality disorder in patients presenting with severe mania.

The patient was assessed regularly by the psychiatric team consisting of a CT doctor and one General Adult Consultant. Appropriate psychological assessments for mania and laboratory investigations took place.

The patient initially scored above 45 in the Young Mania Rating Scale (YMRS), establishing a diagnosis of severe mania. She was treated with Olanzapine titrated up to 20mg OD and augmentation with Lithium treatment. Lithium plasma levels were at 0,6. Due to the treatment resistant manic presentation a second antipsychotic agent was administered and the patient was also treated with Zuclopenthixol depot 400mg every two weeks. Clinical improvement was observed after 16 days from admission.

The clinical team wondered about the clinical challenges of the case. According to the literature having a Personality Disorder diagnosis is a negative prognostic factor for patients with mania and this is relevant to this case as well.

No significant relationships.

It has been shown in the studies that purinergic system dysfunction might have an effect on pathophysiology of bipolar disorder.

In this study, our aims were to compare uric acid levels between patient with bipolar disorder type 1 (BPD1) and healthy controls (HC) and to evaluate the validity of uric acid in predicting bipolar disorder.

Consecutive outpatients with a diagnosis of euthymic BPD-1 (n=75) and HC (n=75) were included in the study. The subjects were evaluated with Sociodemographic Data Form, Young Mani Rating Scale (YMRS), Beck Depression Scale. Serum uric acid was measured using an auto analyzer.

Serum uric acid level in BPD1 group was significantly higher than HC. Significant efficacy of uric acid value was observed in the differentiation of BPD1 and HC [Area under the curve 0.708(0.626-0.790)]. Significant efficacy of uric acid 5.4 cut off value was observed in the differentiation of BPD1 and HC [Area under the curve 0.667 (0.579-0.8754)]. Sensitivity was 50.7%, positive predictive value (PPV) was 74.5%, specificity was 82.7%, negative predictive value (NPV) was 62.6%.

Serum uric acid value is effective in detecting bipolar patients.

No significant relationships.

The influence of personality on how people deal with stressful situations has long been discussed. In bipolar disorder, these two entities seem to have a role in the outcome of the disease.

To study the relationships between coping strategies in stressful situations and personality dimensions in euthymic bipolar patients.

This is a cross-sectional, descriptive and analytical study of 30 patients followed for bipolar disorder in remission, at the psychiatric outpatient clinic at the Hédi Chaker Uuniversity Hospital in Sfax. We used a socio-demographic and clinical data sheet and the Ten Items Personality Inventory (TIPI) to evaluate personality dimensions and the Ways Of Coping Checklist (WWC) for the assessment of coping.

The mean age of the patients was 43.77 years, the sex ratio was 0.5. Bipolar I disorder was diagnosed in 93% of patients. WCC : -Coping focused on the problem : 70% of the patients. -Emotion-centered coping : 20% of patients -Coping focused on seeking social support : 10% of patients. TIPI : Conciousness was the most represented trait of personality (36.7%), agreableness (30%) and extraversion (20%). Extraversion was associated with coping focused on the problem: (p=0.015). Agreableness was associated with coping focused on seeking social support:(p=0.033).

Our study showed that conciousness is the most common trait of personality in bipolar disorder patients. The coping focused on the problem is the most frequent strategy which correlated with extraversion, so, personality dimensions appear as a target for cognitive interventions.

No significant relationships.

Bipolar disorder is presumed to involve difficulties in emotion regulation. However, little is known about the specific emotion regulation profile associated with this disorder.

To study emotion regulation in bipolar patients in remission phase and to determine the factors correlated with it.

A cross-sectional, descriptive and analytical study of 30 patients followed for bipolar disorder in remission, at the psychiatric outpatient clinic at the Hédi Chaker University Hospital in Sfax. We used a socio-demographic and clinical data sheet and the Cognitive Emotion Regulation Questionnaire (CERQ) which assesses cognitive strategies (maladaptive and adaptive) for regulating emotion.

The mean age of the patients was 43.77 years, the sex ratio was 0.5. Bipolar I disorder was diagnosed in 93% of patients. A good adherence to treatment was found in 86.7% of cases and a good social integration in 40%. The mean total score of the adaptive CERQ was 66.73 and the most used adaptive strategy was acceptation (mean score =13.87), while the mean total score of the maladaptive CERQ was 36.7 and the most used maladaptive strategy was self blame (mean score =9.47). Adaptive cognitive emotion regulation was predominant in 93.3% of patients. It was significantly correlated with good adherence to treatment (p = 0.047) and good social integration (p = 0.026).

Our patients with euthymic bipolar disorder showed a satisfying level of adaptive emotion regulation strategies. A cognitive remediation seems important to embetter this capacity and improve the income of the disease.

No significant relationships.

The exposure to child maltreatment increases the lifetime risk for many psychopathological symptoms: depression, anxiety disorders, bipolar disorder, schizophrenia, post-traumatic stress disorder, personality disorder and dissociation. Besides, adopted children, especially those with a history of institutional living before adoption, are at greater risk for a range of developmental, behavioral and attachment concerns. The case report is of a 17-year-old male, with reactive attachment disorder (RAD). He suffered child maltreatment in his family of origin before the international adoption.

The aim of this study is to present a case-report illustrating the relationship between chil maltreatment, adopted children and the reactive attachment disorder.

A bibliographic search was performed about reactive attachment disorder. Information regarding the clinical case was obtained by consulting the patient’s file.

A 17-years-old male who was adopted at age of 9 from Spain. According to reports from the orphanage, the patient suffered severe maltreatment by his family of origin, with scars on his back. The patient presents impulse control disorder, with verbal and physical heteroaggressiveness in situations of frustration, hunger and sleep. He stopped attending the institute at the age of 12, with marked isolation and reversal of the sleep-wake cycle. His treatment plan are partial hospitalization, psychotherapy and pharmacotherapy.

Both child maltreatment and adoption are risk factors for the presence of psychopathology during the lifetime. Especially during the pre-adoption process and the first years after adoption, both the family and the child should be able to use specialized Mental Health services.

No significant relationships.

The prevalence of mental disorders in children and adolescents varies between 5 and 22%, depending on the methodology, type of interview, samples and inclusion of the disability criterion. Between 4 and 6% of children and adolescents have severe mental disorders.

Reason for consultation. Current disease Milestones of psychomotor development. The presence of abnormal behaviors, delays in motor development, speech and socialization will be specified. As the child’s behavior depends to a large extent on the context, specific methods should be used to evaluate the child’s behavior at home, at school and in the clinical situation. Complementary exams: Genetic testing. Blood and urine tests, including toxics. EEG, polysomnography and evoked potentials. X-rays, CT-scans, MRI.

The essential source of medical history is clinical interviews. The semi-structured format is the most recommended by the different authors, because it allows some flexibility in the realization of the story, while providing a baseline to develop the interview (J. Diaz Atienza).

The diagnostic formulation must be individualized without assigning a categorial psychiatric diagnosis. (Doménech E et al).

The main and irreplaceable evaluation technique remains the medical history. It is important to take into account the reason for consultation and the context of both the child’s family and its ethnic, cultural and ethical characteristics. It is of the utmost importance to have and evaluate the stages of normal development and to adapt to the age that our patient has.

No significant relationships.

Psychiatric symptoms related with menstrual cycle vary from dysphoria to psychosis. There are only a few cases of menstrual psychosis reported, all characterized by acute onset, against a background of normality, brief duration, with full recovery and a circa-mensual periodicity.

We report a case of dissociative disorder, in a teenage girl, with atypical presentation and an unusual periodicity of symptoms and recoveries.

Presentation of a case of dissociative disorder, followed by a review of the similar cases described in the literature.

We are presenting a case of a 15 years old female, who presented in our Emergency Department for confusion, anxiety, negativism in verbal and non-verbal response, bradylalia and bradypsychia, insomnia for over 48 hours. The symptoms suddenly began two days before arrival in our clinic. From the patient’s personal history, we retain the following: menarche at 14 years old, irregular periods, hypermenorrhea. Patient was born premature, G=1200g, spastic diplegia, periventricular leukomalacia (MRI – 2018). Three similar episodes happened a year ago, with one month periodicity, with spontaneous remission after 5-6 days. Patient was treated with antipsychotics and benzodiazepines for the second and the third episode, but the treatment was stopped six month ago. The investigations results were normal, except for a high level of plasmatic cortisol. Patient fully recovered in the day the menses stopped.

We considered this case to be atypical due to the sudden debut and recovery and there are still some remaining questions. Is it hormonal related, menstrual related or is it exclusively a psychiatric condition?

No significant relationships.

We present the case of a boy born in 2002 who was diagnosed with 22q11.2 DS at the age of 2 years. He was referred to neurology at age 9 for “attention deficits and irritability.” At age 12 he was referred to mental health for “irritability and anxious and depressive symptoms.” The boy was erroneously discharged with a diagnosis of “only” emotional disorder without subsequent follow-up. The evolution of this case resembles the evolution of others already described in the literature.

To demonstrate the lack of knowledge of the variety of comorbid disorders in this syndrome (20 to 40% present psychotic symptoms).

Bibliographic search in the Pubmed database.

There is a partial T-cell immunodeficiency in 22q11.2DS patients confirmed by significantly reduced percentages of circulating T and helper T cells. An increased percentage of Th17 was found in adults with psychotic symptoms compared to non-psychotic adults in one article. The percentage of Th17 was related to the presence of positive psychotic symptoms. Another study says higher levels of IL-17 were found in patients with fewer symptoms. The importance of Th17 and IL-17 in the development of the hippocampus and of Th17 in the development of psychosis is highlighted. In those patients, there is a high IL-6 / IL-10 ratio in favor of a pro-inflammatory state. High levels of IL-6 are correlated with greater neurocognitive deficits and negative symptoms.

1. There is evidence for a theory of inflammation in psychosis development. 2. The 22q11.2 DS could be used as a research model.

No significant relationships.

The present aimed to examine the mental health conditions of children, ages 7-11 years, living in conditions of war and conflict conditions in two districts of a Nagorno-Karabakh, Azerbaijan.

The study surveyed teachers of 617 primary school children (mean age 8.9, SD 1.24; 50.7% female) across nine schools in Agdam and Karabakh districts.

The children were evaluated with the previously validated Azerbaijani version of the Strengths and Difficulties Questionnaire (SDQ) Teacher Form. The total difficulty and five subscale scores (emotional problems, conduct problems, hyperactivity/inattention, peer relationship problems, and prosocial behavior) were assessed.

About a third of children (32.7%) had abnormal total scores, and a fifth (21.4%) were in borderline range. The SDQ subscale scores included emotional problems (19.4%); conduct problems (20.3%), hyperactivity/inattention (12.2%), peer relationship problems (31.1%), and pro-social behavior difficulties (13.1%). Boys had higher level of difficulties than females (p<.01) with a negative correlation of children’s school performance with maternal education.

The findings of the study show that more than half of the children living in the war zone in Azerbaijan have significant mental health problems. The psychological effects of the war environments have a profund effect on child development and education and need to be revisited under the United Nations Sustainable Development Goals. These include the provision of implicit supports in terms of their emotional, behavioral, psychosocial development and education of children and protection of children from wars, conflicts, and persecution.

No significant relationships.

Cases of memory loss are rare phenomena. We present a case-study of common psychological and psychotherapy observation 14,5 years old girl with dissociative dysmnesia during 2 years. Teenager grew up in a small town near Moscow, her parents were divorced. A girl and her elder brother stay with mother. One day in New Year Holiday in January she had come to take out the trash and did not return home. When mother and her friends had found girl on the other side of town, she did not remember anything about her life and family. Goal: description the case of long observing adolescent with dissociative dysmnesia

Girl age 14,5 y.o.

Psychodiagnostics, Psychotherapy.

First period (1 months later initial episode) mother provided mane consultations to understand what has happened with daughter and what is illness. Psychiatrist made a diagnosis - dissociative dysmnesia, neurologists did not find any disturbances. Psychological diagnostics showed small gaps in knowledge, pronounced violations of autobiographical memory, decreased activity, and mood. Unusual results were obtained in projective drawing. She got to know her family and friends again, started an account on Internet, shares her stories. These 2 years she worked with individual psychotherapist with positive changes. In September 2020 she went to school, not yet caught up with program. She masters the guitar, continues to play in the theater studio, and makes plans for future.

After 2 year observation and work autobiographical memory has not restored. Girl’s personality hasn’t changed, according to the family. Her mood and communication look better.

No significant relationships.

Traditional methods of preventing the deviant behavior in adolescents are aimed at clinical variants of certain forms of deviant behavior.

The study included 160 teenagers with depression.

Study design included: Depression Test, Projective Drawing Tests, Pathoharacterological Diagnostic; Package of AUDIT tests for the diagnosis of dependent behavior.

Symptoms of depressive behavior disorder in adolescents depending on age and gender were identified: in girls aged 12-14 – autoaggression, food disorders and suicidal behavior; in boys aged 12-14 – gaming, internet addiction; in boys aged 15-18 – gambling, drug addiction and smoking. Anxiety of younger teenagers turns into a chronic anxiety-dreary depression, with frequent attacks behavioral disorders.

The use of technology makes it possible to identify informative imprinting of stereotypical behavior and the locus of the therapeutic window, provide medical and psychological support for adolescents with depressive disorders and the quality of social functioning, provide primary and secondary prevention of depression progression and the formation of dependent behavior.

No significant relationships.

A 15-year-old man who comes to the consultation referred from neurology for a poorly progressive tic disorder that is resistant to treatment. This is a patient with no relevant medical history. He has good academic performance, without symptoms of inattention, hyperactivity or impulsivity. He does not present buccophonatory tics

To Show guanfacine as a efficient treatment fot tics disorder

Case report

He has presented complex motor tics as cervical contractions that have had to receive physiotherapeutic treatment. He also presents simple ocular tics. The patient at our evaluation is on a 4 mg dose of pimozide without response. He was previously on risperidone. It was decided to start treatment with guanfacine up to 5 mg with reduction of pimozide, to 1 mg. The patient with this dose adjustment shows a notable improvement in the frequency and intensity of the tics, both cervical and ocular. The patient also refers to a feeling of being calmer and being able to face stressful situations such as being exposed to social relationships, intervening more in class without increasing their anxiety levels.

Guanfacine is a selective alpha-2a adrenergic receptor agonist that has an indication for attention deficit hyperactivity disorder. Like its precursor, clonidine, there is more and more literature that proposes this medication and others for ADHD as useful drugs in pathologies such as tic disorder. It has a safe use profile, which with progressive adjustment and hardly any side effects is placed as a treatment to take into account in this pathology.

No significant relationships.