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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 Autism: Statistics Initially thought to be 1/1,000 Autism is 3-4 times more in boys than girls It has no racial, ethnic or social boundaries Family income, lifestyle, and educational levels do not affect the chance of autism’s occurrence 50% of children diagnosed with autism will remain mute throughout their lives 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 • 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 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 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) • Clomipramine (Anafranil) • increased risk of suicidal thinking or attempts in children and adolescents taking antidepressants 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) Treating Inattention and Hyperactivity • Stimulant medications such as methylphenidate (Ritalin) used safely and effectively in attention deficit hyperactivity disorder 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 • Side effects; weight gain, parkinsonism, Sedation (dose dependent) Tricylcic antidepressants Clomipramine • Sedative, reduces aggression • Relieves many of the symptoms of autism • Patients' ability to interact with others is much improved • Improves obsessive-compulsive behaviors 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) –Decreases hyperactivity associated with ASD 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 – 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 • • • • • Pyridoxine (vitamin B6) Magnesium Vitamin C Immune System Support Insomnia: Melatonin