Disorder characterised by both vocal and motor tics. More common in men, shows a genetic predisposition. Usually associated with ADHD, learning disorders and obsessive compulsive disorders (OCD). Symptoms begin before the age of 18 and causes social and occupational impairment. Diagnosis require following criteria: - Multiple motor tics (eg, blinking, grimacing). - One or more vocal tics (eg, throat clearing, grunting, coughing). - Tics present for more than 1 year. - Tics must be recurrent (many times per day and/or nearly every day). Best initial therapy is behaviour therapy (habit reversal therapy is most effective). If this therapy fails and tics are disabling, next step is pharmacological management. Antidopaminergic agents: 1. Dopamine depleting agents (eg, tetrabenzine). Preferred over dopamine blocking agents. 2. Dopamine blocking agents: Antipsychotics (eg, fluphenazine, haloperidol) mostly given in severe refractory tics. Alpha2 agonists (eg, clonidine) are also used but they are less effective.