Transcript Drugs Used to Treat Autism and their Effectiveness

Drugs Used in Autism and
Other Neurological diseases
Introduction
Autistic Disorders
Autism is a complex developmental disability
appears during the first three years of life
a neurological disorder that affects social
interaction and communication skills It is not a
mental illness
Children and adults with autism have
difficulties in social interactions, and leisure or
play activities
In some cases, aggressive and/or self-injurious
behaviors might be present
Symptoms of children with autism
Communication
Social relationships
 Avoid eye contact
 Act as if deaf
 Develop language, then
abruptly stop talking
 Act as if unaware of the
coming and going of others
 Are inaccessible, as if in a
shell
Fail to seek comfort
 Fail to develop
relationships with peers
Exploration of Environment
Remain fixated on a single item or activity
Are intensely preoccupied with a single subject, activity or
gesture
 Show distress over change
 Insist on routine & Lack fear
Causes of Autism Spectrum
Disorders
• No specific known cause
• Neurobiological disorder
• Autism has a genetic compound but suggest
that environmental influences play a role as
well
• Autism runs in families, but not in a clearcut way
Etiology: Genetic Evidence
she wont ask about etiology
• Strong evidence for genetic
component, but nature of the
component is unknown
• Doesn’t look like a single gene
• Monozygotic twin !!!!
Etiology: Neurotransmitters
• Serotonin
• Some studies have found higher levels in
children with ASD
• Opioids
Display properties similar to morphine
insensitivity to pain, reduced socialization
Some studies have found higher levels in
children with ASD
Etiology: Vaccines
• Vaccines
– Thimerosal - Preservative used in
MMR vaccine used to contain
mercury
Assessment
Coordinated, multi-disciplinary approach
• Psychologist
• Speech Therapist
• Occupational Therapist
• Physical Therapist
• Educators
• Physicians
Autism therapies
• No single treatment is best, and
treatment is typically tailored to the
child's needs.
• Treatments fall into two major
categories: educational
interventions and medical
management
Treatment of Autism
Educational
interventions
Medical
management
Advice the parents
• Incorporate a balance of low -stress, highpleasure activities
• Include “stress-free” time in the schedule.
• Speak in a calm, relaxed voice
• Give facts in an unemotional tone of voice
• Reassure the child about the sequence of
events
• Find opportunities to build-up/ compliment the
student
• Arrange schedule from left to right or from top
to bottom listing the things to do. Because they
love the routine.
• Music therapy and robota are new.
Increase opportunities to engage in
activities of high interests
• Allow individual work
• Includes singing, movement to music, and
playing instruments.
• Schedule for activities individual enjoys
– computer
– reading
– Drawing
• There is something
called floor time in
which the family has a
time to communicate
together on the floor
playing with him/her.
Treatment - Medical
• Children with autism commonly have
dysfunctions of the following systems:
– Digestive
– Immune
– Excretory (liver, kidneys, systems that rid
body of toxins/wastes)
• When these systems are treated, the autism
also seems to be treated and behavior
improves
• Not everyone with an autism spectrum
disorder has the same symptoms, and not all
symptoms can be treated with drugs
• Drugs are intended to address specific
symptoms including behavioral issues,
anxiety or depression, mood swings (bipolar
disorder), obsessive compulsive disorder,
attention issues and hyperactivity.
The drugs most commonly
used in autism
* Antipsychotics
* Antidepressants
* Stimulants
* Opiate Antagonists
* Benzodiazepines
* Alpha-2-NoradrenergicAgonists
* Beta-Blockers
Treating Anxiety and Depression
• Selective serotonin reuptake inhibitors (SSRIs) are
prescribed for anxiety, depression, and/or obsessivecompulsive disorder. Of these only
fluoxetine (Prozac) has been approved by the FDA
for both OCD and depression in children age 7 and
older.
• Sertraline (Zoloft)
don’t study any names between brackets as above.
Treating Behavioral Problems
• Medications are often used to treat behavioral
problems, such as aggression, self-injurious
behavior,
• Antipsychotic medications (
dopamine activity
in the brain)
• Older antipsychotic medications such as
haloperidol in treating serious behavioral problems
• Some of the newer "atypical" antipsychotics may
be a better choice, particularly for children.
Risperdone(Risperdal), Olanzapine (Zyprexa)
Treating Seizures
• One in four people with ASD also have a
seizure disorder
• they are treated with anticonvulsants such
as carbamazepine (Tegretol), valproic acid
(Depakote), lamotrigine (Lamictal)
• Carbamazepine, valproic acid, and
lamotrigine are mood stabilizers.
Treating Inattention and
Hyperactivity
• Stimulant medications such as
methylphenidate (Ritalin) used safely and
effectively in attention deficit hyperactivity
disorder ADHD for children with autism
• These medications may decrease
impulsivity and hyperactivity in some
children, especially those higher functioning
children
Atypical Antipsychotics
Risperidone
• Block D2 and serotonin receptors
• Risperidone is approved by the Food and Drug
Administration (FDA) for treating symptomatic
irritability in autistic children and adolescents
• More useful in children suffering from severe and
chronic autism
• Most adverse effects: weigh gain , drowsiness, and
high blood sugar
Typical Antipsychotics
Haloperidol
• Blocks postsynaptic dopamine receptors
(D2)
• Improves withdrawal, hyperactivity,
deviant speech ‫كالم غير مفهوم‬
• Side effects;
 weight gain, parkinsonism,
Sedation (dose dependent)
Tricylcic antidepressants
Clomipramine‫م‬
‫همممممم‬
• Sedative, reduces aggression
• Relieves many of the symptoms of autism
• Patients' ability to interact with others is
much improved
• Improves obsessive-compulsive behaviors
‫مهمممممم‬
Selective Serotonin Re-uptake Inhibitors
– Fluoxetine
• Blocks serotonin re-uptake
• Improves language, cognition, mood,
compulsive symptoms
• Possible decrease in appetite, restlessness,
anorexia, insomnia
• Children are less responsive
Atypical antidepressants
Venlafaxine
• Is a potent inhibitor of serotonin reuptake and at
higher doses is an inhibitor of NE reuptake
• Improves attention and communication
• Decreases hyperactivity
• Side effects; nausea, headache,
BP, HR
Stimulants
Methyl phenidate
– A psychostimulant similar to amphetamine
– It is one of the most prescribed drug in
children with attention deficient hyperactivity
disorders (ADHD) ‫مهممم‬
– Decreases hyperactivity associated with ASD
– Acts as dopamine and norepinephrin reuptake
inhibitor which increase the level of these
neurotransmitters in the brain.
Opiate Antagonists
Naltrexone
– Block the activity of endogenous opiate
system in the CNS
– Less aggression, less hyperactivity, more
sociability, more communication
– Side effects; mild sedation and GI upset
Sedative hypnotics
– diazepam (Valium) and lorazepam (Ativan).
– Potentiate the action of the inhibitory
neurotransmitter GABA to stabilize and
decrease firing of neurons
– Treat explosiveness and aggression which
accompanies autism
– Side effects; sedation, tolerance and
dependence
Alpha-2-Noradrenergic Agonist
Clonidine control release of neurotransmitter ‫مهممممة‬
– Pre-synaptic receptor agonist
– Decrease NE neurotransmission
– Improvement in hyperactivity, inattention,
irritability and inappropriate speech
– Side effects; sedation, decrease in blood
pressure and tolerance to therapeutic effects
Beta-Blockers
• Propanolol
– Affects the noradrenergic
transmission
– Decrease impulsive and aggressive
behavior ‫االندفاع والعدوانية‬
– Decrease in self-injurious behaviour
– Side effects: drop in BP and
bradycardia
Vitamins and nutritional
supplements
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•
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Pyridoxine (vitamin B6)
Magnesium
Vitamin C
Immune System Support
Insomnia: Melatonin