Neurological or psychiatric symptoms

Although the etiology of autism is not understood, the defining or core symptoms of autistic disorder are considered to be impaired social interaction, impaired verbal and nonverbal communication, and restrictive, repetitive patterns of behavior. In addition, most patients with a primary diagnosis of autism exhibit other neurological or psychiatric symptoms, which may include seizures, sleep disorders, anxiety, panic attacks, attention deficit/hyperactivity, self-injury, and cognitive impairment (Simonoff et ah, 2008). It is not known to what extent these comorbidities reflect the primary pathology of autism and to what extent they represent unrelated vulnerabilities that are exacerbated by the impaired social interaction and communication that is characteristic of the disorder. 

FIGURE 32-2. Treatment algorithm for Alzheimer s disease. A. Cognitive treatment. B. Treatment of psychiatric or behavioral symptoms. AD, Alzheimer s disease MMSE, Mini Mental Status Examination NINCDS-ADRDA National Institute of Neurological and Communicative Disorders and Stroke/Alzheimer s Disease and Related Disorders Association. (From Faulkner JD, Bartlett J, Hicks P. Alzheimer s disease. In DiPiro JT, Talbert RL, Yee GC, et al, (eds.) Pharmacotherapy A Pathophysiologic Approach. 6th ed. New York McGraw-Hill 2005 1164, with permission.)... 

In serious cases, virtually all the symptoms in Table 9-3 appear, especially uncontrollable laughter or crying, mood disturbances, cognitive and perceptual abnormalities, sleep disturbances, and impulsive or silly acts. These symptoms constitute the classic description of manganese madness. Psychiatric symptoms usually precede neurological symptoms, although neurological symptoms... 

C. Chronic neuroiogic sequeiae can result from chronic exposure or a sublethal acute exposure. A wide spectrum of neurologic and psychiatric problems may occur that may be reversible (months to years) or irreversible. These include agitation, delirium, dementia, psychoneurotic symptoms, psychosis, visual disturbances, vertigo, aphasia, ataxia, peripheral neuropathies, myoclonic jerking, tremors, and seizures. 

A complete medical history and physical examination by a pediatrician or primary care provider should have been completed since the onset of symptoms or within the past year. Chronic medical illnesses such as asthma, cancer, diabetes mellitus, and neurologic disorders increase the risk for psychiatric disorders, par-... 

Adverse effects Amantadine s side effects are mainly associated with the CNS. Minor neurologic symptoms include insomnia, dizziness, and ataxia. More serious side effects have been reported (for example, hallucinations, seizures). The drug should be employed cautiously in patients with psychiatric problems, cerebral atherosclerosis, renal impairment, or epilepsy. Rimantadine causes fewer CNS reactions since it does not efficiently cross the blood-brain barrier. Amantadine and rimantadine should be used with caution in pregnant and nursing mothers, because they have been found to be embryotoxic and teratogenic in rats. 

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