Autism atypical antipsychotics

The conventional antipsychotics have little effect on the negative psychotic symptoms such as autism, stupor and emotional withdrawal. The so-called atypical antipsychotics, or second-generation antipsychotics, like the heterocyclic compound risperidone, the benzamide sulpiride and several diben-zepines of which clozapine is the best known, have a broader spectrum which means that they also have an effect on the negative psychotic symptoms. Most share a common attribute of working on serotonin receptors as well as dopamine receptors. They have a low risk of extrapyramidal side effects. 

The preliminary findings of a relationship between serotonin S-HTja receptor genotype and atypical antipsychotic responsiveness in schizophrenia warrant replication and could be extended to children and adolescents with autism. Investigation along these lines has been included in the (National Institute of Mental Health (NIMH)-sponsored multicenter study of risperidone in autism (Arnold et ah, 2000). 

Posey, D.J., and McDougle, C.J. (in press) Atypical antipsychotics in autism and other pervasive developmental disorders. In Hollander, E. and Delaney, K., eds. Diagnosis and Treatment of Autism, New York Marcel Dekker. 

There have been numerous trials of use of the atypical antipsychotics in patients with developmental disabilities, but most of these trials were uncontrolled open-labeled studies or case reports (Aman and Madrid, 1999). Findings were reported for 86 adults and 1 child with prominent self-injury. The reports of adults assessed clozapine (1 report) and risperidone (4 reports). Improvement was observed for a majority of participants in all of these trials. The patients presented with a multitude of conditions, ranging from nonspecific MR and associated behavior problems, to pervasive developmental disorders (including autism), to various psychiatric disorders, including schizophrenia and manic disorder. Self-injury appeared to respond to treatment regardless of concomitant condition. In the only clozapine report with a child (who had autistic disorder), a mean dose of 283 mg/day caused a transient reduction in self-injury. 

No formal, prospective, long-term efficacy or safety studies of either typical or atypical antipsychotics in children and adolescents with schizophrenia have been conducted (166, 167). However, reports of the long-term treatment of children and adolescents with conduct disorder (181, 182), autism (183), and Tourette s disorder (184) with either haloperidol or thioridazine suggest that the tolerability of these medications in children and adolescents is comparable with that in adults. 

Other atypical antipsychotics commonly prescribed for treatment of autism include olanzapine, quetiapine, ziprasidone, and clozapine (Oswald and Sonenklar, 2007). Placebo-controlled trials of these agents in ASD populations have not been reported, with the exception of a small pilot study of olanzapine in which three of six children treated with olanzepine were rated as responders, compared to one of five in the placebo group (Hollander et al., 2006b). Open-label studies (reviewed by... 

In the final chapter, an expert pharmacologist. Dr. Terrell Gibbs presents a comprehensive review of pharmacotherapies in autism. He details their results from clinical trials, their effectiveness, and their role in the treatment of autistic behaviors. Special emphasis is given to the atypical antipsychotic drug risperidone that is frequently effective for ameliorating symptoms of irritability, hyperactivity, social withdrawal, and stereotypic, repetitive behavior in autism. 

Drug treatment of childhood psychosis and other behavioral disorders of children is confused by diagnostic inconsistencies and a paucity of controlled trials. Antipsychotics can benefit children with disorders characterized by features that occur in adult psychoses, mania, autism, or Tourette s syndrome. Low doses of the more potent or modem atypical agents usually are preferred in an attempt to avoid interference with daytime activities or performance in school. Attention deficit disorder, with or without hyperactivity, responds poorly to antipsychotic agents, but... 

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