Patients need a clinician who is aware of what changes medicines can bring about in a patient's ability to function and who knows that ADHD is not a disorder in which one medicine or one dosing schedule suits all.
Children who were given donepezil during the initial six weeks showed a significant improvement in their Childhood Autism Rating Scale (CARS), compared to children who received a placebo.
Test results were encouraging. For example, subjects performed significantly better on the Clinical Global Impression Scale after they had received the medium and high doses of D-cycloserine than they had at the start of the study. Subjects performed significantly better on the social withdrawal subscale of the Aberrant Behavior Checklist after they had gotten the highest dose of D-cycloserine than they had at the start of the study (see chart). In four of 10 subjects, social improvement was clinically meaningful. One of these four subjects was 5-year-old "Greg." Greg had been in individual speech therapy and in group social skills training with a speech and language therapist for two years. The therapist was not informed about Greg's participation in the D-cycloserine study. Nonetheless, she noted marked improvement in his attention, spontaneous use of language, and initiation of social interaction while he was on D-cycloserine.
Antibiotics effectively killing pathogens would induce dead cells and processes that act against dead cells and fragments thereof. Such "bits and pieces" of cellular debris, especially if from a pathogen stimulate cytokines production. Her proposal is that these responsive children have an immune-tolerance towards and chronic-infection by a specific pathogen (Clostridium or Pertussis, for example). They do not have such tolerance towards most pathogens. When the antibiotic-induced pulse of cytokines occurs, the child's immune system is sufficiently activated so as to override, at least for a few days or slightly longer, the child's more deeply embedded infection towards which he or she has a mild genetic and/or acquired immune impairment and at least some degree of immune tolerance.
A major finding in the research reported here was that individuals with cognitive disabilities who were receiving anti-libidinal medication were similar on most variables to those who were not receiving anti-libidinal medication or any medication at all, and also to those who had committed non-sexual offences against other people.
The D2 receptor is the common target of antipsychotic drugs. The density of dopamine D2 receptors is elevated in post-mortem schizophrenia tissues as well as in schizophrenia patients.
Otitis media is the most common reason for medical office visits in childhood. It is estimated that 62% of children will have had at least one episode of OM by their first birthday, and more than 80% will have had an attack by 3 years of age.
Aripiprazole has produced significant core symptom changes. Improved sociability; increased self-awareness; reduced rigidity, anxiety, and irritability; and reduced preoccupation with circumscribed esoteric interests are among the effects noted.
Objective: To study the usage, efficacy, and side effects patterns of atypical neuroleptics (atypicals) in adolescents and young adults with developmental disabilities (DDs) (mental retardation).
The increased reliance on atypical antipsychotics may be the result of increasingly limited resources for mental health services for children... drugs may be substituted for other safer, but more expensive options, such as behavioral therapy.
Considers the receptor binding profile and pharmacological properties, indications, side effects, clinical applications and trials of atypical neuroleptics in comparison to the classical neuroleptic haloperidol in adolescent schizophrenia.
An alert is issued today calling attention to the fact that thousands of people with autism were treated with fenfluramine, a drug now suspected of causing serious heart problems. The drug has not been used frequently for autism since the 1990s and many people with autism who took this drug, their families, and their current health care providers, remain unaware that they should consult their physicians about possible risks.
If atypical neuroleptics are found to be significantly helpful for the most disruptive disorders in these children, it is unlikely that parents and caretakers will forgo their benefits based on worries about a possible, distant risk.
Autistic disorder (autism) is a childhood-onset disorder characterized by marked impairments in social interaction, communication and behavior. Aggression is a frequent reason for psychiatric referral in this population. As such, the clinician needs to be knowledgeable regarding aggression assessment and treatment. This article will provide an overview of treatment modalities, with emphasis on the future direction of interventions targeting aggression in children with autism.
A combination of treatments may be effective in treating symptoms and behaviors that make it hard for individuals with autism to function. These may include psychosocial and pharmacological interventions.
We judged that the patient's transfer to a specialist autistic unit constituted a therapeutic procedure, which would ordinarily have required informed discussion.
Discusses frequency of antipsychotic polypharmacy; pharmacologic rationale for combining antipsychotics; evidence for efficacy of combining antipsychotic drugs for the treatment of schizophrenia.
For many Autistic individuals, medications play a major role in helping to control the typical Autistic behaviors. They are not the only method of treatment which should be considered by a parent or a physician.
Covert medication... sounds like a coercive remnant from our disreputable past, a reminder that institutional practices are still alive and well in the 21st century.
Educational and behavioural approaches remain the mainstay of treatment for children and adolescents with autism, but there is evidence that adjunctive medication may be effective. Atypical antipsychotics have been investigated in the treatment of Tourette syndrome and early-onset schizophrenia.
Wrongly diagnosed as being schizophrenic when she really had autism spectrum disorder, the successful Warrnambool academic and author Wendy Lawson suffered the misery of 25 painful years of inappropriate medication.
Divalproex sodium may be beneficial to patients with autism spectrum disorders, particularly those with associated features of aggression, impulsivity and mood lability as well as a history of seizure disorders or EEG abnormalities.
People who use anti-psychotic drugs should carefully watch out for side effects, doctors warned. Diabetes, obesity and high cholesterol have been linked to anti-psychotic drug users.
Cholecystokinin is a peptide neurotransmitter that modulates hypothalamic-pituitary-adrenal axis activity and may be involved in fear or anxiety states. Arginine vasopressin also modulates HPA axis activity and may play a role in fear conditioning.
The most common and typical tardive stereotypies are the repetitive oral facial and lingual movements that resemble chewing, lip smacking, tongue protrusion ('fly-catching') or lateral tongue movements in the floor of the mouth (Bon-Bon sign).
In the absence of an adequate neurobiological model for autism, drugs should be chosen to target specific symptom clusters, such as inattentiveness and hyperactivity, obsessive-compulsive features, and aggression or self-injury.
Antifungal therapy has been claimed to be effective in polysymptomatic patients with diffuse symptoms from multiple body systems and even well defined diseases, traditionally not related to fungi. Hypersensitivity to fungus proteins and mycotoxins has been proposed as the cause. We conducted a 4-week randomized, double-blind, placebo-controlled study in 116 individuals selected by a 7-item questionnaire to determine whether the antifungal agent nystatin given orally was superior to placebo. At the onset of the study, the patients were free to select either their regular diet or a sugar- and yeast-free diet, which resulted in four different subgroups: nystatin + diet (ND); placebo + diet (PD); nystatin (N); and placebo (P). Nystatin was significantly better than placebo in reduction of the overall symptom score (P < 0.003). In six of the 45 individually recorded symptoms, the improvement was significant (P < 0.01). All three active treatment groups reduced their overall symptom scores significantly (P < 0.0001), while the placebo regimen had no effect (P = 0.83). The benefit of diet was significant within both the nystatin (ND > N) and the placebo groups (PD > P). Nystatin is superior to placebo in reducing localized and systemic symptoms in individuals with presumed fungus hypersensitivity as selected by a 7-item questionnaire. This superiority is probably enhanced even further by a sugar- and yeast-free diet.
Generally speaking, no conclusions could be made about the effectivenss of one class of drug over another, or for the treatment of specific comorbidity.
DM blocks the NMDA (N-methyl-D-aspartate) type receptor in the brain which has an accessary binding site for Gly.
Behavioural and psychotherapeutic strategies are often the wisest first therapeutic intervention for this age group. Psychotropic medications may be required, but should be used cautiously in young children, while additional studies are being conducted.
The basic principles of assessing risk versus benefit and using a blind evaluation should be used with all types of medications which are used to improve a child's behavior and/or language development.
Dystonia is a neurological disorder that interferes with normal motor control, causing involuntary writhing, twisting movements.
Dr. Linday first conceived the idea that treatment with famotidine (Pepcid®) might be helpful for children with autistic spectrum disorders in 1993. Subjects (patients) were active in the research studies from 1996 through 1998.
Galantamine seems to be not only effective in treating Alzheimer's disease but may also be also moderately effective in the short term treatment of irritability in children with autistic disorder.
Pharmacotherapy of autistic disorder and other PDD's currently involves the treatment of target symptoms including hyperactivity, inattention, interfering repetitive thoughts and behavior, and aggression toward self, others, or the environment.
Stimulant medication is then presented as one component of a treatment plan that includes behavioral modification and environmental adjustments. With this approach 60-90% of children respond to therapy.
The subject of this thesis is the platelet hyperserotonemia of autism. Since
Schain & Freedman's (1961) finding of an elevation of whole blood serotonin in
individuals with autism and other severe developmental disorders, a body of research
has been conducted to clarify this phenomenon. Despite the many studies published, several major issues still need clarification: How can the group differences of platelet serotonin levels be characterized? Is the hyperserotonemia confined to the more
severe subjects with so-called Kanner's autism or can it also be found in the other
autism spectrum disorders, as Asperger's disorder or pervasive developmental
disorder not otherwise specified (PDD-NOS)? How specific is the platelet serotonin
elevation for autism as compared to other developmental disorders as mental
retardation? Can clinical correlates be identified in the autism spectrum group? How
do the genetics of the serotonergic system relate to these probable clinical correlates
and hyperserotonemia? What is the exact mechanism causing the elevation of
serotonin? Are platelet factors involved or is it merely a consequence of an increased
serotonin production in the gastrointestinal tract? Can platelet serotonin levels be
used in the prediction of drug effect?
The present study was dedicated to investigate the influence of Methylphenidate (MPH) on cortical processing of children who were diagnosed with different subtypes of Attention Deficit Hyperactivity Disorder (ADHD). As all of the previous studies investigating power differences in different frequency bands have been using EEG, mostly with a relatively small number of electrodes our aim was to obtain new aspects using high density magnetoencephalography (MEG).... Main effects induced by medication were found in frontal regions. Theta band activity increased over the left hemisphere after MPH application. This finding contradicts EEG results of several groups who found lower levels of Theta power after MPH application. As relative Theta correlates with D2 test improvement we conclude that MEG provide complementary and therefore important new insights to ADHD.
Research is constantly providing us with new information about the brain and the nature of mental illnesses and, consequently, more effective treatments.
Grapefruit interacts with many cholesterol-lowering drugs, antihistamines, psychiatric medications, and others. In some cases, the results are fatal.
Reviews the dietary restrictions that should be observed when a patient is receiving monoamine oxidase inhibitor (MAOI) therapy
A brief overview of the most common medications used in the UK for the treatment of ADHD.
Inclusion in this appendix does not mean that a particular medication is recommended for these disorders; in fact, some of these medications, such as the old-line neuroleptics, are very much out of favor with reputable physicians.
The most robust and well-replicated neurobiological abnormality in autism is an elevation of whole blood serotonin found in over 30 % of the patients.
Metabolic complications, including obesity, hyperglycemia, insulin resistance, type 2 diabetes, diabetic ketoacidosis, and dyslipidemia, have been observed in association with some, but not all, atypical antipsychotics.
In spite of the lack of comparative data, we now have new treatments, more choices and greater opportunities to help our patients achieve seizure reduction and seizure freedom than ever before, hopefully with as few side-effects as possible.
Autism is characterized by impaired social interaction, abnormal language development, repetitive patterns of behavior, and serious behavioral problems such as self-injurious behavior, aggression, and tantrums. Although second-generation antipsychotics do not seem to improve social interaction and communication in children with autism, they do appear to dampen the repetitive behavior patterns, Christopher McDougle, M.D., chair of psychiatry at Indiana University, and colleagues reported in the June American Journal of Psychiatry.
Specifically, risperidone was found effective for the treatment of repetitive behaviors and aggression towards self, others and property. Social relationships, language and sensory response did not improve.
Given that psychotropic agents are often pre-scribed for extended periods, frequently in children and adolescents, it is best to err on the side of safety and to probe specifically for side effects in randomized clinical trials.
Attentional Difficulties, Fright, Tantrum, Panic Disorder, Rage Attacks, Anxiety, Bipolar disorder, OCD, Psychosis, Social Withdrawal
U.S. advisers on Wednesday called for new information about psychiatric and heart risks on the labels of attention deficit drugs but stopped short of recommending the strongest possible warning, saying they did not want to frighten patients or parents from effective treatment. The panel of pediatric experts reviewed reports of heart problems and psychotic behavior such as hallucinations in children who took the medicines, which include Novartis AG's Ritalin and Shire Plc's Adderall.
Consult your doctor? Make that: Consult your fellow patients. On a growing number of Weblogs—interactive Web sites better known as blogs—patients are advising one another about which medications to take and which to avoid. These self-styled experts may not have medical degrees, but they do wield growing influence among pharma's end customers, not least because they talk frankly about the experience of using medications.
Buspirone, a serotonin 5-HT-1A agonist, may be useful in the treatment of children with pervasive developmental disorder and autism. In this study ,the pharmacokinetics of buspirone were studied in 21 children with autism. Patients 2-3 years of age were given 2.5 mg and patients 4-6 years of age were given 5 mg. The authors found a mean peak serum concentration of 1,141±748 pg/mL, with a time to maximum concentration of 0.8 hours. Elimination half-life was 1.6±0.3 hours. Peak concentrations of the primary metabolite (1-pyrimidinylpiperazine) were 4.5-fold higher than the corresponding buspirone concentration. Girls had significantly higher peak buspirone concentrations and a lower metabolite/parent drug ratio. The authors concluded from these data that buspirone is rapidly absorbed and eliminated in young children, with peak plasma concentrations similar to that observed in older children receiving higher doses.
If clinicians are to use psychotropic medications in children and adolescents, it is important to study medication effects and response directly in children and adolescents.
Information on Haloperidol, SSRI's, Fenfluramine, Naltrexone, Clonidine.
In many ways, the brain has been the pharmaceutical industry's worst case scenario, the ultimate scientific black box.
A summary of the pharmacogenomic tests that are available now and in the near future and describes how these tests can help optimize dosing regimens, reduce adverse events, and improve clinical outcomes.
In many cases the indication of a pharmacological treatment is obvious due to impairment in different areas such as work capacity, leisure, family and social life.
The SSRI's are not devoid of unwanted effects. Most disturbing are sexual inhibition and weight gain, specially in the long term treatment. At this moment these drugs should be the first choices in the treatment of Social Phobia.
If those who hold power in the decision process are held accountable for the unwanted risks they impose upon others, both the use of neuroleptics and its inevitable iatrogenesis would probably be reduced.
Becoming an adult for most people means being recognised as capable of giving or withholding consent. If you have been diagnosed as severely learning disabled, however, you will not be seen as capable of that - at least in relation to medical treatment. That is in contrast with the choice and autonomy for people with learning disabilities emphasised in Community Care legislation and meant to govern the conduct of registered care homes for this population. However, that same legislation also lays down the obligation for registered care homes to follow all instructions from doctors. Overriding or failing to carry out medical advice could get a care home closed.
Physicians treating autism-spectrum children ought to order *thorough* immune-panel and other lab tests before prescribing steroid pharmaceuticals.
Whereas Prednisone therapy may be indicated for *some* autism spectrum children, an increasing amount of immunologic and
infection-related evidence indicates that some autism-spectrum children are likely to be harmed by Prednisone therapy
To date, prednisone appears to be one of the only medications that has a high rate of success in treating the underlying cause of speech loss or lack of speech in autism.
Summarizes the information presented on drugs in preclinical and clinical development, including AWD 131-138, DP-valproate,
harkoseride, LY300164, NPS 1776, NW 1015, pregabalin, remacemide, retigabine, rufinamide and valrocemide.
Of the individuals with autism, 35% had another comorbid psychiatric disorder. An overall prevalence rate of 10% for hypothyroidism was also identified and 35% of people with autism and no other psychiatric diagnosis were on neuroleptics.
The catastrophe of widespread and expanding medically-produced disease has failed to alarm psychiatry into taking stock of the determinants of the catastrophe - indeed the existence and magnitude of the tragedy is barely recognised within psychiatry.
It is possible, without causing behavioural deterioration, to reduce antipsychotic medication when used purely for the management of behavioural disorder in individuals with mental retardation.
One of the important things about psychiatric (in particular) medications is that they should always be the choice of the person taking them, whether to take them or not. They should never be the choice of parents, teachers, or doctors.
Indexes by trade name, generic name, Canadian name, appearance, treatments, use to counteract side effects of other medications.
Although this study revealed a modest therapeutic effect of Lofexidine in the acute management of autistic children in some subjects make it clear that its role in the management of these symptoms in children with autistic disorder may be limited.
Neurochemical factors play a major role in autism. The findings also provide the rationale for psychopharmacotherapy in individuals with autism.
This review is intended to provide an update of recent advances in psychopharmacology to support evidence-based prescription of psychotropic medications for autism spectrum disorders.
No medication is available that effectively treats the core social and communication deficits that define autism. As we shall illustrate in the following sections, that is not the case for restricted, repetitive behaviors. Nonetheless, current drug therapies have been termed palliative treatments, and behavioral interventions remain the mainstay of treatment. Thus, it is critical to focus on target symptoms or behaviors commonly associated with autism (e.g., aggression, anxiety) when discussing use of psychotropic agents.
Psychotropic medications are drugs prescribed to stabilize or improve mood, mental status, or behavior. In other words, they are medications used to modify emotions or behavior.
The severity of a specific behavioral dimension in autism (repetitive behaviors) parallels the sensitivity of the 5-HT 1d receptor, as manifest by sumatriptan elicited GH response.
A study finds that a medication now used to treat children with attention-deficit hyperactivity disorder shows promise against autism. Dr. David J. Posey of the Indiana University School of Medicine and colleagues in the Research Units on Pediatric Psychopharmacology conducted a trial comparing three different doses of methylphenidate (Ritalin) and a placebo in their effect on children with autism. Autistic children exhibit some signs of ADHD, including hyperactivity, distractibility and impulsiveness. The team found that in the 58 children who completed the crossover phase methylphenidate was consistently more effective than the placebo.
Shifts in treatment assessment philosophy; outcomes relevant to the treatment of psychosis; responses to typical and atypical agents; how atypical agents compare in their effects on negative, affective, behavioral
and cognitive symptoms.
In most cases symptoms of autism begin in early infancy. However, a subset of children appears to develop normally until a clear deterioration is observed. Many parents of children with "regressive"-onset autism have noted antecedent antibiotic exposure followed by chronic diarrhea. We speculated that, in a subgroup of children, disruption of indigenous gut flora might promote colonization by one or more neurotoxin-producing bacteria, contributing, at least in part, to their autistic symptomatology. To help test this hypothesis, 11 children with regressive-onset autism were recruited for an intervention trial using a minimally absorbed oral antibiotic. Entry criteria included antecedent broad-spectrum antimicrobial exposure followed by chronic persistent diarrhea, deterioration of previously acquired skills, and then autistic features. Short-term improvement was noted using multiple pre- and post-therapy evaluations. These included coded, paired videotapes scored by a clinical psychologist blinded to treatment status; these noted improvement in 8 of 10 children studied. Unfortunately, these gains had largely waned at follow-up. Although the protocol used is not suggested as useful therapy, these results indicate that a possible gut flora-brain connection warrants further investigation, as it might lead to greater pathophysiologic insight and meaningful prevention or treatment in a subset of children with autism.
Multiple studies now demonstrate that autism is medically characterized, in part, by immune system dysregulation, including evidence of neuroglial activation and gastrointestinal inflammation. This neuroglial process has further been characterized as neuroinflammation. In addition, a subset of autistic children exhibit higher than average levels of androgens. Spironolactone is an aldosterone antagonist and potassium-sparing diuretic with a desirable safety profile. It possesses potent anti-inflammatory and immune modifying properties that might make it an excellent medical intervention for autism spectrum disorders. Furthermore, spironolactone demonstrates substantial anti-androgen properties that might further enhance its appeal in autism, particularly in a definable subset of hyperandrogenic autistic children. One case report is briefly reviewed demonstrating objective clinical improvements in an autistic child after spironolactone administration. Additional research in controlled trials is now needed to further define the risks and benefits of spironolactone use in children with autism.
Stimulant medications in low doses can be very effective and make the children and adolescents more likely to benefit from an appropriate teaching and emotional climate, and realistic expectations.
Contains aids related to safeguards and for providing the student, family, and staff with appropriate information on the effects and monitoring of various psychopharmacological drugs used to treat child and adolescent psycho-behavioral problems.
Ohio State University Medical Center is one of 12 sites nationally studying an investigational medication for treating children with autism and gastrointestinal problems. The medication is an oral dose of human immunoglobulin, which contains antibodies to antigens that are thought to overstimulate the immune system and activate an autoimmune response. Some experts believe that the gastrointestinal problems and immune reactions may even be a cause or aggravator of autistic symptoms in some children.
ADHD has a biological basis; in other words, it's not just willful, disobedient behavior. These children can be successfully treated with medication and behavior therapy, lifting a great emotional stone from the backs of harassed parents.
Behavioural and emotional difficulties have consistently been shown to be two to three times more common in persons with learning disabilities than in the rest of the population.
A systematic review of randomized controlled trials of the use of atypical antipsychotics and selective serotonin reuptake inhibitors in the treatment of behavioural problems associated with pervasive developmental disorders is reported. A search through both published and unpublished literature, including contacting drug companies and known experts in the field was undertaken. Six trials met the criteria for inclusion in the review. They largely suffer from methodological weaknesses; only two trials had satisfactory methodological quality. The heterogeneity in outcome measurements prevented from conducting a meta-analysis. There is yet no coherent body of data concerning the effects of these medications across all sub-classifications of pervasive developmental disorders, across all age categories, and concerning their medium- and long-term effects, and their effects on quality of life. Atypical antipsychotics and selective serotonin reuptake inhibitors may be of benefit for behavioural problems associated with pervasive developmental disorders. Risperidone has been the best studied among these medications. Atypical antipsychotics appear to have a low risk of extrapyramidal symptoms during short-term treatment. The reviewed trials cannot provide data on the use of selective serotonin reuptake inhibitors in the treatment of children with pervasive developmental disorders. No firm conclusions for clinical practice can be drawn. Larger, well-conducted randomized controlled trials with long-term follow-up are needed.
This article reviews the use of atypical antipsychotics in autistic disorder, with particular focus on behaviour, cognition and physical well-being.
A syndrome involving dysfunctional, involuntary movements associated with long-term, chronic use of neuroleptic medications, such as Haldol, Prolixin, and Thorazine.
Classic tardive dyskinesia most commonly appears as repetitive, somewhat rhythmical involuntary movements (such as) tongue thrusting, lip smacking, lip pursing, grimacing and chewing movements, rocking of the trunk, etc.
Acta paedopsychiatrica, 34:298-307, 1968
Discusses abusive treatment and some of its results.
The current talk focused on the use of divalproex in borderline personality disorder and autism, 2 disorders with high levels of impulsivity.
Aggression, irritability, repetitive phenomena, or hyperactivity can interfere with the education and treatment of patients with autism... (we) show how to target maladaptive behaviors in patients of all ages with autism.
Professor of Psychiatry Dr. Robert Hendren, discusses the etiology of ADHD and effective treatments for the disorder in all ages.
There are many products which should be considered for particular situations but because of the huge variability of individual responses and the variations in dosages required it is impossible to predict outcomes.
People with autism have benefited from medication to control symptoms such as anxiety or self-injury, aggressive behaviour, hyperactivity, seizures, depression, or extreme anxiety.
People with ASD's often have the added handicap of mental illness, albeit anxiety states, depression or obsessions. Though medication does not appear to help the core handicaps of autism, it can often help with this additional handicap.
Seven independent studies are reviewed involving a total of 91 autistic schizophrenic children who had been given psychedelic drugs for therapeutic and/or experimental purposes.
In children and adolescents, SSRIs have been used in the treatment of depression, OCD, anxiety and panic disorders, eating disorders, ADHD, Tourette's, trichotillomania, mental retardation, Prader-Willi syndrome, Lesch-Nyhan syndrome, enuresis and autism.
Medications are frequently used in the management of aggression, and current psychopharmacologic treatment strategies involve treating aggression as part of each particular syndrome. Acute management focuses on calming the agitated patient, whereas chronic management aims to reduce the frequency and intensity of episodes of agitation. Long-term treatment is directed toward the underlying disorder. Additional adjunctive medications may be necessary when standard therapeutic approaches are ineffective.