Drugs Used in Autism and Other Neurological diseases

Introduction

Autistic DisordersAutism is a complex developmental disability appears during the first three years of lifea 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

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 activityAre intensely preoccupied with a single subject, activity or gesture Show distress over change Insist on routine & Lack fear

Avoid eye contact Act as if deaf Develop language, then abruptly stop talking

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 clear-cut way

Etiology: Genetic Evidenceshe 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• OpioidsDisplay properties similar to morphineinsensitivity to pain, reduced socializationSome studies have found higher levels in

children with ASD

Etiology: Vaccines

• Vaccines

– Thimerosal - Preservative used in MMR vaccine used to contain mercury

AssessmentCoordinated, 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, high-pleasure 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 obsessive-compulsive 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

• 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

Risperidone

Typical Antipsychotics

• Blocks postsynaptic dopamine receptors (D2)

• Improves withdrawal, hyperactivity, deviant speech مفهوم غير كالم

• Side effects; weight gain, parkinsonism, Sedation (dose dependent)

Haloperidol

Tricylcic antidepressants

• Sedative, reduces aggression

• Relieves many of the symptoms of autism

• Patients' ability to interact with others is much improved

• Improves obsessive-compulsive behaviors مهمممممم

Clomipramineمهمممممم

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

• 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

Venlafaxine

Stimulants

– 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.

Methyl phenidate

Opiate Antagonists

– 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

Naltrexone

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

– 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

Clonidine control release of neurotransmitter مهممممة

Beta-Blockers• Propanolol

– Affects the noradrenergic transmission

– Decrease impulsive and aggressive behavior والعدوانية االندفاع

– 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