Clozapine Response for Vocal Tics in Schizophrenic Patients: A Case Report With Literature Review

Antipsychotics have been documented in the literature as the most effective pharmacological treatment for tics thus far. Additionally, evidence in the literature has shown that typical and atypical antipsychotics are effective for the treatment of tic disorders in patients who are diagnosed with schizophrenia and other psychiatric illnesses. This evidence is typified as atypical antipsychotic medications, such as risperidone, aripiprazole, and olanzapine, have been documented as being effective for motor tics, particularly in Tourette’s syndrome. Despite the level of evidence with regard to antipsychotics, there is no published literature on the role of clozapine-based treatment for persistent vocal tics in schizophrenia. We present a case of severe adult-onset persistent vocal tics in a schizophrenic patient who was admitted for acute psychotic exacerbation. The patient's vocal tics as well as his comorbid psychotic symptoms were not responsive to risperidone and paliperidone. The combination of risperidone with clozapine for psychosis showed improvements in his symptoms. In addition, the patient’s tics showed excellent response to risperidone and clozapine combination therapy. He was subsequently discharged to the community with clozapine 125 mg twice daily and paliperidone palmitate 156 mg every 28 days. The patient was psychiatrically stable without vocalization at the time of discharge. We suggest that clozapine augmentation therapy could be an approach in treatment-resistant vocal tics among schizophrenic patients who are refractory to atypical antipsychotics.