Autism medical therapy: Difference between revisions
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****'''Children 5-16 years of age and >20 kg''' | ****'''Children 5-16 years of age and >20 kg''' | ||
*****Preferred regimen (1): [[risperidone]] 0.5 mg PO qd for 4 days, then 1 mg PO qd for 14 days (gradually increase the dose in increments of 0.5 mg/d for 2 weeks interval till maximum 0.5 to 3 mg/d) | *****Preferred regimen (1): [[risperidone]] 0.5 mg PO qd for 4 days, then 1 mg PO qd for 14 days (gradually increase the dose in increments of 0.5 mg/d for 2 weeks interval till maximum 0.5 to 3 mg/d) | ||
Note: Short term side effects of [[risperidone]] are [[weight gain]], [[drowsiness]], and [[hyperglycemia]]. | '''Note''': Short term side effects of [[risperidone]] are [[weight gain]], [[drowsiness]], and [[hyperglycemia]]. | ||
::*1.1.1.2 [[Aripiprazole]] | ::*1.1.1.2 [[Aripiprazole]] | ||
:::*Preferred regimen (1): [[aripiprazole]] 2 mg PO qd for 7 days, then 5 mg PO qd (gradually increase the dose in increments of 5 mg/d for 7 days interval till maximum 15 mg/d) (Specific population e.g. '''children 6-17 years of age''') | :::*Preferred regimen (1): [[aripiprazole]] 2 mg PO qd for 7 days, then 5 mg PO qd (gradually increase the dose in increments of 5 mg/d for 7 days interval till maximum 15 mg/d) (Specific population e.g. '''children 6-17 years of age''') | ||
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::***Preferred regimen (1): [[haloperidol]] 0.5-15 mg PO per day divided in 2-3 doses (maximum 15 mg/day) | ::***Preferred regimen (1): [[haloperidol]] 0.5-15 mg PO per day divided in 2-3 doses (maximum 15 mg/day) | ||
* 1.2 [[Selective serotonin reuptake inhibitor|Selective serotonin reuptake inhibitors]] ([[Selective serotonin reuptake inhibitor|SSRIs]])<ref name="pharmacotherapy">{{cite journal |journal= Expert Opin Pharmacother |year=2007 |volume=8 |issue=11 |pages=1579–603 |title= The status of pharmacotherapy for autism spectrum disorders |author= Myers SM |doi=10.1517/14656566.8.11.1579 |pmid=17685878}}</ref> | * 1.2 [[Selective serotonin reuptake inhibitor|Selective serotonin reuptake inhibitors]] ([[Selective serotonin reuptake inhibitor|SSRIs]])<ref name="pharmacotherapy">{{cite journal |journal= Expert Opin Pharmacother |year=2007 |volume=8 |issue=11 |pages=1579–603 |title= The status of pharmacotherapy for autism spectrum disorders |author= Myers SM |doi=10.1517/14656566.8.11.1579 |pmid=17685878}}</ref> | ||
** 1.2.1 [[ | ** 1.2.1 [[Fluoxetine]] | ||
*** Preferred regimen (1): | *** '''Children >5 years and adolescents''' | ||
**** Preferred regimen (1): [[fluoxetine]] 2.5 mg PO qd for 7 days (gradually increase the dose in increments of 0.3-0.5 mg/kg/d for 7 days interval till maximum 00.8 mg/kg/day) | |||
** 1.2.2 | |||
'''Note''': One of the most important side effects of [[Selective serotonin reuptake inhibitor|SSRIs]] in children with ASD is [[Suicide|suicidal]] impulses. | '''Note''': One of the most important side effects of [[Selective serotonin reuptake inhibitor|SSRIs]] in children with ASD is [[Suicide|suicidal]] impulses. | ||
* 1.3 [[Dopamine antagonist|Dopamine blockers]] | * 1.3 [[Dopamine antagonist|Dopamine blockers]] | ||
Revision as of 22:01, 1 April 2018
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Many medications are used to treat problems associated with ASD.[1] More than half of U.S. children diagnosed with ASD are prescribed psychoactive drugs or anticonvulsants, with the most common drug classes being antidepressants, stimulants, and antipsychotics.[2] Aside from antipsychotics,[3] there is scant reliable research about the effectiveness or safety of drug treatments for adolescents and adults with ASD.[4] A person with ASD may respond atypically to medications, the medications can have adverse effects, and no known medication relieves autism's core symptoms of social and communication impairments.[5][6]
Medical Therapy
- There is no pharmacologic medical therapy to completely cure autism spectrum disorder. However, pharmacologic medical therapy is recommended among patients with autism spectrum disorder to relieve common autistic symptoms such as seizures, sleep disturbances, irritability, and hyperactivity.[7][8]
- Medical therapy must be accompanied by behavioral therapies to be more effective.
- Risperidone and aripiprazole are approved by FDA to control irritability for children.[9]
- Other drugs might be used to improve symptoms of autism. However, drugs must be prescribed on a trial basis to check their efficacy and safety.
1 Medications
- 1.1 Antipsychotics
- 1.1.1 Atypical antipsychotics
- 1.1.1.1 Risperidone
- Children 5-16 years of age and 15-20 kg
- Preferred regimen (1): risperidone 0.25 mg PO qd for 4 days, then 0.5 mg PO qd for 14 days (gradually increase the dose in increments of 0.25 mg/d for 2 weeks interval till maximum 0.5 to 3 mg/d)
- Children 5-16 years of age and >20 kg
- Preferred regimen (1): risperidone 0.5 mg PO qd for 4 days, then 1 mg PO qd for 14 days (gradually increase the dose in increments of 0.5 mg/d for 2 weeks interval till maximum 0.5 to 3 mg/d)
- Children 5-16 years of age and 15-20 kg
- 1.1.1.1 Risperidone
- 1.1.1 Atypical antipsychotics
Note: Short term side effects of risperidone are weight gain, drowsiness, and hyperglycemia.
- 1.1.1.2 Aripiprazole
- Preferred regimen (1): aripiprazole 2 mg PO qd for 7 days, then 5 mg PO qd (gradually increase the dose in increments of 5 mg/d for 7 days interval till maximum 15 mg/d) (Specific population e.g. children 6-17 years of age)
- 1.1.2 Typical antipsychotics
- 1.1.2.1 Haloperidol
- Children 3-12 years of age and 15-40 kg
- Preferred regimen (1): haloperidol 0.5 mg PO per day divided in 2-3 doses (gradually increase the dose in increments of 0.5 mg/d for 7 days interval till maximum 0.05 to 0.075 mg/kg/day)
- Children >40 kg and adolescents
- Preferred regimen (1): haloperidol 0.5-15 mg PO per day divided in 2-3 doses (maximum 15 mg/day)
- Children 3-12 years of age and 15-40 kg
- 1.1.2.1 Haloperidol
- 1.2 Selective serotonin reuptake inhibitors (SSRIs)[10]
- 1.2.1 Fluoxetine
- Children >5 years and adolescents
- Preferred regimen (1): fluoxetine 2.5 mg PO qd for 7 days (gradually increase the dose in increments of 0.3-0.5 mg/kg/d for 7 days interval till maximum 00.8 mg/kg/day)
- Children >5 years and adolescents
- 1.2.2
- 1.2.1 Fluoxetine
Note: One of the most important side effects of SSRIs in children with ASD is suicidal impulses.
- 1.3 Dopamine blockers
- 1.4 Tricyclic antidepressant
- 1.4.1 Clomipramine
- Preferred regimen (1): risperidone (Specific population e.g. children 5-16 years of age)
- 1.4.1 Clomipramine
- 1.5 Psychostimulant
- 1.5.1 Methylphenidate
- Preferred regimen (1): risperidone (Specific population e.g. children 5-16 years of age)
- 1.5.1 Methylphenidate
- 1.6 Anticonvulsants
2 Supplements
- Supplements might be used to alleviate the symptoms of autism.
- 2.1 High dose pyridoxine (vitamin B6) and magnesium (HPDM)
Note: Side effect of high dose of pyridoxine is peripheral neuropathy in adults.
Note: Side effects of high doses of magnesium are bradycardia, weakened reflexes, and seizures.
- 2.2 Dimethylglycine (DMG)
- It is used to improve speech and reduce autistic behaviors.
Note: Side effects of high doses of vitamin C are kidney stones and diarrhea.
- 2.4 Probiotics
- 2.5 Melatonin
- It is used to manage sleep problems in developmental disorders.
Note: Side effects of melatonin are drowsiness, headache, dizziness, nausea, and an increase in seizure frequency among susceptible children.[11]
- 2.6 Several other supplements have been hypothesized to relieve autism symptoms which include carnosine, cyproheptadine, D-cycloserine, folic acid, glutathione, metallothionein promoters, oxytocin, polyunsaturated fatty acids (PUFA) such as omega-3 or omega-6 fatty acids, tryptophan, tyrosine, thiamine (see Chelation therapy), vitamin B12, and zinc.[7][11]
3 Diets
- There is no scientific evidence indicating effectiveness of different diets in patients with ASD. However, many testimonials can be found describing benefits of such diets in autism-related symptoms, notably social engagement and verbal skills.[14][15]
- 3.1 Diet low in gluten and casein is promoted in children with ASD.[16]
- 3.2 Elimination diets targeting salicylates, food dyes, yeast, and simple sugars might be helpful in patients with ASD.[17]
4 Hyperbaric Oxygen Therapy
5 Stem Cell Therapy
- Mesenchymal stem cells and cord blood CD34+ cells[20]
- It have been proposed to treat autism.
References
- ↑ Leskovec TJ, Rowles BM, Findling RL (2008). "Pharmacological treatment options for autism spectrum disorders in children and adolescents". Harv Rev Psychiatry. 16 (2): 97–112. doi:10.1080/10673220802075852. PMID 18415882.
- ↑ Oswald DP, Sonenklar NA (2007). "Medication use among children with autism spectrum disorders". J Child Adolesc Psychopharmacol. 17 (3): 348–55. doi:10.1089/cap.2006.17303. PMID 17630868.
- ↑ Posey DJ, Stigler KA, Erickson CA, McDougle CJ (2008). "Antipsychotics in the treatment of autism". J Clin Invest. 118 (1): 6–14. doi:10.1172/JCI32483. PMID 18172517.
- ↑ Lack of research on drug treatments:
- Angley M, Young R, Ellis D, Chan W, McKinnon R (2007). "Children and autism—part 1—recognition and pharmacological management" (PDF). Aust Fam Physician. 36 (9): 741–4. PMID 17915375.
- Broadstock M, Doughty C, Eggleston M (2007). "Systematic review of the effectiveness of pharmacological treatments for adolescents and adults with autism spectrum disorder". Autism. 11 (4): 335–48. doi:10.1177/1362361307078132. PMID 17656398.
- ↑ Template:Cite paper
- ↑ Buitelaar JK (2003). "Why have drug treatments been so disappointing?". Novartis Found Symp. 251: 235–44, discussion 245–9, 281–97. doi:10.1002/0470869380.ch14. PMID 14521196.
- ↑ 7.0 7.1 7.2 Levy SE, Hyman SL (2005). "Novel treatments for autistic spectrum disorders". Ment Retard Dev Disabil Res Rev. 11 (2): 131–42. doi:10.1002/mrdd.20062. PMID 15977319.
- ↑ Schreibman L (2005). "Critical evaluation of issues in autism" (PDF). The Science and Fiction of Autism. Harvard University Press. ISBN 0674019318.
- ↑ Chavez B, Chavez-Brown M, Sopko MA Jr, Rey JA (2007). "Atypical antipsychotics in children with pervasive developmental disorders". Pediatr Drugs. 9 (4): 249–66. PMID 17705564.
- ↑ Myers SM (2007). "The status of pharmacotherapy for autism spectrum disorders". Expert Opin Pharmacother. 8 (11): 1579–603. doi:10.1517/14656566.8.11.1579. PMID 17685878.
- ↑ 11.0 11.1 11.2 Angley M, Semple S, Hewton C, Paterson F, McKinnon R (2007). "Children and autism—part 2—management with complementary medicines and dietary interventions" (PDF). Aust Fam Physician. 36 (10): 827–30. PMID 17925903.
- ↑ Francis K (2005). "Autism interventions: a critical update" (PDF). Dev Med Child Neurol. 47 (7): 493–9. PMID 15991872.
- ↑ Herbert JD, Sharp IR, Gaudiano BA (2002). "Separating fact from fiction in the etiology and treatment of autism: a scientific review of the evidence". S ci Rev Ment Health Pract. 1 (1): 23–43.
- ↑ Dominick KC, Davis NO, Lainhart J, Tager-Flusberg H, Folstein S (2007). "Atypical behaviors in children with autism and children with a history of language impairment". Res Dev Disabil. 28 (2): 145–62. doi:10.1016/j.ridd.2006.02.003. PMID 16581226.
- ↑ Erickson CA, Stigler KA, Corkins MR, Posey DJ, Fitzgerald JF, McDougle CJ (2005). "Gastrointestinal factors in autistic disorder: a critical review". J Autism Dev Disord. 35 (6): 713–27. doi:10.1007/s10803-005-0019-4. PMID 16267642.
- ↑ Reichelt KL, Knivsberg A-M, Lind G, Nødland M (1991). "Probable etiology and possible treatment of childhood autism". Brain Dysfunct. 4: 308–19.
- ↑ Christison GW, Ivany K (2006). "Elimination diets in autism spectrum disorders: any wheat amidst the chaff?". J Dev Behav Pediatr. 27 (2 Suppl 2): S162–71. PMID 16685183.
- ↑ Rossignol DA (2007). "Hyperbaric oxygen therapy might improve certain pathophysiological findings in autism". Med Hypotheses. 68 (6): 1208–27. doi:10.1016/j.mehy.2006.09.064. PMID 17141962.
- ↑ Schechtman MA (2007). "Scientifically unsupported therapies in the treatment of young children with autism spectrum disorders" (PDF). Pediatr Ann. 36 (8): 497–8, 500–2, 504–5. PMID 17849608.
- ↑ Ichim TE, Solano F, Glenn E; et al. (2007). "Stem cell therapy for autism". J Transl Med. 5 (30). doi:10.1186/1479-5876-5-30. PMID 17597540.