Psychopharmacologic Medication: What Teachers, Clinicians, and Parents Need to Know.
Psychoactive Medications and ASD. Considering Pharmacologic Intervention Why would we consider using...
-
Upload
martha-campbell -
Category
Documents
-
view
219 -
download
2
Transcript of Psychoactive Medications and ASD. Considering Pharmacologic Intervention Why would we consider using...
Considering Pharmacologic Intervention
Why would we consider using psychopharmacologic agents to treat problems in a person with Autism Spectrum Disorder (ASD)? – Treatment of core symptoms– Maladaptive behaviors sometimes seen in
ASD– Treatment of coexisting psychiatric problems
Do No Harm
• The Basic Rule of thumb when considering any treatment including medications for individuals with ASD is “first do no harm.”
• When medications have multiple potential side effects and relatively little evidence for use in the scientific literature, I have to be sure that not prescribing medication would be more harmful than prescribing medication.
• The same is true for any other intervention.
Core Symptoms of ASD
Problems with Social RelatednessProblems with LanguageProblems with fixations, repetitive
behaviors and rigidity.
Coexisting Psychiatric Problems
• ADHD• OCD• Tics/Tourette’s Disorder• Anxiety Disorders• Mood Disorders– Depressive Disorders– Bipolar Disorder
• Psychosis
Maladaptive Symptoms/Behaviors sometimes seen in ASD
There are behaviors that do not easily fit a particular psychiatric diagnosis that occur in ASD.
– Aggression– Severe tantrums and agitation– Self Injurious Behaviors– Sleep Disturbance– Rigidity– Perseveration
Stimulants
• Methylphenidate –studies listed above– Ritalin – Metadate– Concerta– Daytrana– Focalin (DextroMethylphenidate)
• Amphetamine – no know studies– Adderall– Dexedrine (DextroAmphetamine)– Vyvanse (lisdexamfetamine dimesylate)
Alpha Adrenergic Medications
Tenex (Guanfacine) – Posey, D.J. et al., 2004 retrospective study of 80 cases
Catapress (Clonidine) – Frankhauser, MP et al., 1992 9 boys placebo double blind
• Other antihypertensive are also sometimes used mostly from the Beta Blocker class– Propranolol/Inderal – Ratey, John et al., 1987
open label 8 children– Pindolol
Noradrenergic Reuptake Inhibitors
Strattera/Atomoxetine – Arnold, LE et, al., 2006 16 children
Effexor/Venflaxamine (SSRI and NRI) – Hollander, E et al., 2000 retrospective study of adults with ASD
Cymbalta/Duloxetine (SSRI and NRI) – no research that I know of
Antidepressants
Serotonin MedicationsProzac – see aboveZoloft – none knownLuvox –see aboveCelexa – on going
studiesLexapro – study
completed not published
Paxil – no known study
Wellbutrin – no known studies
Trazadone – no known studies
• Tricyclic Antidepressants– Clomipramine – see
studies above– Disimpramine – see
studies above– Imipramine –
Campbell, et al., 1971 10 children single blind
– Nortriptyline – no known studies
– Amitrityline – no known studies
• Remeron – no know studies
Antipsychotics/Neuroleptics
• Risperdal -FDA approved for use in people with ASD studies above
• Abilify –FDA approved for use in people with ASD • Zyprexa – Kemner, C et al., 2002 25 children open label
with some improvement• Seroquel – Hardan, A. Y. et al., 2005 retrospective study
in children with PDD• Geodon –Malone, R et al., 2007 open label 12
adolescents• Mellaril – I know there are early studies but generally
not used given side effects• Clozaril – a few studies none particularly conclusive
AntiConvulsants
Depakote – Hollander, E et al., 2006 13 double blind study
Lamictal – Belsito, K.M. et al., 2004 28 children placebo double blind
Tegretol- no known studiesTrileptal – studies on goingTopamax – Canitano, R 2005 open label for
weight gain from nueroleptics
Anticholinesterase Inhibitors and
NMDA antagonists
Aricept (donepezil)- Chez, M et al., 2003 43 children double blind placebo
Namenda (memantine) – Owley, T et al., 2006 14 children open label study
Symmetrel (amantadine) – King, BH et al., 2001 39 children double blind clinicians saw improvement but parents did not
Razadyne (galantamine) – R. Nicholson, MD et al., 2006 13 children open label trial
Other Pharmacologic Interventions for ASD Core
Symptoms with some Promising Evidence
Oxytocin – Hollander et al., 2003 15 adults with autism
Vancomycin- Sandler et al., 2000 10 children open study blinded video evaluation 8 children improved
Minocycline- being studied National Institute of Health Clinical Centers funded by the NIMH
D-Cyclosporine –Posey et al., 2004 2 week single blind placebo treatment with 10 subjects NMDA agonist
Vitamin C- Dolske et al., 1993 decreasing stereotyped behaviors in a 30 week double blind study with 18 children
Cyanocobalamine (B-12) - James et al., 2004Cypropheptadine- S. Akhondzadeh, PhD et al., 2004 Rapamycin
Continued
Arbaclofen – a GABA agonistN-Acetylcysteine – antioxidant/decreased
glutamate nuerotransmissionPropranolol – help with fluency in language