Fig. 2

Clinical assessment of the symptoms. The time course of YGTSS, PUTS, CY-BOCS, mRS scores are depicted on (a), (b), (c), and (d) subplots, respectively. The patient was independently scored at 10 time points throughout the treatment and follow-up course (x axis) by the two first authors of the paper, and a mean score was obtained. Major interventions are marked below the x axis. The black arrows represent the four adjustments to the patient’s psychotropic regimen: 1, in addition to sertraline 200 mg/d, the patient was first prescribed risperidone 6 mg/d for 5 days, then risperidone 6 mg/d and olanzapine 10 mg/d for 5 days, and finally risperidone 6 mg/d and aripiprazole 10 mg/d for 2 days; 2, sertraline, risperidone and aripiprazole were discontinued; 3, risperidone 6 mg/d, aripiprazole 10 mg/d and sertraline 50 mg/d were re-administered for 2 weeks; and 4, aripiprazole was adjusted to 20 mg/d, fluvoxamine was prescribed at 200 mg/d, and lorazepam was prescribed at 1.5 mg/d. The blue arrows represent the three rounds of immunotherapy: 1, methylprednisolone 1000 mg/d for 5 days; 2, methylprednisolone 1000 mg/d for 5 days; and 3, immunoglobulin 22.5 g/d for 5 days and methylprednisolone 1000 mg/d for 3 days. (a) YGTSS score indicates tic severity by number, frequency, complexity, interference, and impairment. (b) PUTS: Scores for items 1–6 indicate intensity of PU; items 7–8 indicate frequency of PU; items 9–10 indicate the ability of voluntary suppression. (c) CY-BOCS score indicates the severity of obsession and compulsion. (D) mRS score indicates neurological function. YGTSS, Yale Global Tic Severity Scale; PUTS, Premonitory Urge for Tics Scale, CY-BOCS, Children's Yale-Brown Obsessive–Compulsive Scale; mRS, modified Rankin Scale; PU, premonitory urge