AS: Meds & Psychosis

<body topmargin=0 leftmargin=0 marginheight=0 marginwidth=0><script type="text/javascript" src="http://hb.lycos.com/hb.js"></script> <script type="text/javascript" src="http://ratings.lycos.com/ratings/lycosRating.js.php"></script> <script type="text/javascript"><![CDATA[//><!]]></script> <script type="text/javascript" src="http://scripts.lycos.com/catman/init.js"></script> <script type="text/javascript" src="http://members.tripod.com/adm/ad/code-start.js"></script> <script type="text/javascript" src="http://members.tripod.com/adm/ad/code-middle.js"></script> <script type="text/javascript" src="http://members.tripod.com/adm/ad/code-end.js"></script> <noscript> <img src="http://members.tripod.com/adm/img/common/ot_noscript.gif?rand=765212" alt="" width="1" height="1" />  <iframe frameborder="0" marginwidth="0" marginheight="0" scrolling="no" width="728" height="90" src="http://ad.yieldmanager.com/st?ad_type=iframe&ad_size=728x90&section=209094"></iframe>  </noscript> <table cellpadding=0 cellspacing=0 border=0><tr> <td valign="top" colspan=2 height=125 BGCOLOR="#996699" TEXT="#080000" bgproperties="fixed" background="0d4467d1erlcll.gif"> <div> <FONT SIZE="5" COLOR="#FFFFFF" FACE="Arial" ><B>Healthmood.com </b></FONT><B>     </b><B>|     </b><A HREF="index.htm" TARGET="_top" TITLE="Healthmood.com "><U><B>home</b></U></A></div> <div> <A HREF="id126.htm" TARGET="_top" TITLE="What is Asperger Syndrome"><U>What is Asperger Syndrome</U></A>   |   <A HREF="id106.htm" TARGET="_top" TITLE="Asperger Characteristics"><U>Asperger Characteristics</U></A>   |   <A HREF="id108.htm" TARGET="_top" TITLE="7 Characteristics of AS Treatment Techn"><U>7 Characteristics of AS & Treatment Techniques</U></A>   |   <A HREF="id107.htm" TARGET="_top" TITLE="Asperger and Nonverbal Learning Disorder"><U>Asperger and Nonverbal Learning Disorder (NLD)</U></A>   |   <A HREF="id109.htm" TARGET="_top" TITLE="AS Thoughts for Management in School"><U>AS & Thoughts for Management in School</U></A>   |   <B>AS: Meds & Psychosis</b>   |   <A HREF="id113.htm" TARGET="_top" TITLE="AS Adulthood"><U>AS & Adulthood</U></A>   |   <A HREF="id105.htm" TARGET="_top" TITLE="Asperger Syndrome Case Study"><U>Asperger Syndrome Case Study</U></A>   |   <A HREF="id111.htm" TARGET="_top" TITLE="Asperger Online sources"><U>Asperger On-line sources</U></A>   |   <A HREF="id112.htm" TARGET="_top" TITLE="AS References"><U>AS References</U></A></div> <div> </div> </td> </tr><tr> <td valign="top" width=190 BGCOLOR="#FFFFFF" TEXT="#080000"> <div> <A HREF="id84.htm" TARGET="_top" TITLE="Occupational Therapy"><U><B>Occupational Therapy</b></U></A></div> <div> <A HREF="id104.htm" TARGET="_top" TITLE="Asperger Syndrome"><U><B>Asperger Syndrome</b></U></A></div> <div> <A HREF="id106.htm" TARGET="_top" TITLE="Asperger Characteristics"><U><B>Asperger Characteristics</b></U></A></div> <div> <A HREF="id105.htm" TARGET="_top" TITLE="Asperger Syndrome Case Study"><U><B>Asperger Syndrome Case Study</b></U></A></div> <div> <A HREF="id108.htm" TARGET="_top" TITLE="7 Characteristics of AS Treatment Techn"><U><B>7 Characteristics of AS & Treatment Techniques</b></U></A></div> <div> <A HREF="id107.htm" TARGET="_top" TITLE="Asperger and Nonverbal Learning Disorder"><U><B>Asperger and Nonverbal Learning Disorder (NLD)</b></U></A></div> <div> <A HREF="id109.htm" TARGET="_top" TITLE="AS Thoughts for Management in School"><U><B>AS & Thoughts for Management in School</b></U></A></div> <bR> </td> <td valign="top" height=355 BGCOLOR="#FFFFFF" TEXT="#080000"> <div> AS: Meds & Psychosis</div> <bR> <div> <B>Psychosis and Asperger </b><FONT SIZE="4" COLOR="#000000" FACE="Arial" ><B>Syndrome</b></FONT></div> <bR> <div> <B>Although often children with Asperger do exhibit psychosis like behaviors, there is not a support of research to indicate a correlation. Rather psychotic like behaviors may be a side effect of medications</b></div> <bR> <div> <TABLE BORDER="2" CELLPADDING="1" CELLSPACING="1" WIDTH="535" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ALL" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=TOP HEIGHT= 20 WIDTH="525"><div> <B>Psychosis and Asperger </b><B>Syndrome</b></div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 368 WIDTH="525"><div> <B>Behaviors observed by a parent </b></div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Talks to herself </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Make odd faces as she talks.  It seems as if she is actually talking to "someone".   </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Talks to objects and to her self in the mirror. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">The conversations are two sided. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Laughs to her self a lot. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Imagination is very odd.  </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Thinks people are in her closet.   </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">She thinks the clouds in the sky have eyes and can see her. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">She makes up words, one of which is "keeker". </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">She will say this when questioned with what she ate for lunch, dinner, ect...</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">From her description he is a man who wears all black and is the source to her bad behavior. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">"Please make the voices stop". </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Leg pain story: My daughter complained of leg pains. One doctor said that it was here psychosis. After her meds were changes, her leg pains went away. </div> </tD> </tR> </TABLE></div> <bR> <div> THE USE OF MEDICATION FOR PEOPLE WITH AUTISM</div> <div> Overview</div> <bR> <div> <IMG BORDER="0" SRC="Symb075c00b700dc00000000.gif" HEIGHT="15" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">The use of any form of medication with people with autism is a contentious issue. </div> <bR> <div> <IMG BORDER="0" SRC="Symb075c00b700dc00000000.gif" HEIGHT="15" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Autism may be the result of many different causes and a variety of biological abnormalities may underlie the psychological and behavioral irregularities. It is, therefore, impossible to be dogmatic about which medication will or will not be effective for a given individual. </div> <bR> <div> <IMG BORDER="0" SRC="Symb075c00b700dc00000000.gif" HEIGHT="15" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">There is, as yet, <B>no medication</b>, which has been shown to be helpful for all people with autism. </div> <bR> <bR> <div> <B>Principles which must be considered before powerful drugs are employed</b></div> <bR> <div> <B>Side Effects:</b> </div> <div> Must be on the alert for any change in behavior or function which may occur. </div> <bR> <div> <B>Dosage and Compliance with Instructions</b>: </div> <div> A higher dose may not necessarily result in a greater activity.</div> <bR> <bR> <div> <B>Specific Meds</b></div> <div> <B>Drugs acting upon the Dopaminergic system</b></div> <div> <B>1) Chlorpromazine (Largactil) and thioridazine (Melleril)</b></div> <bR> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">The neuroleptic drugs such as chlorpromazine (Largactil) and thioridazine (Melleril) are examples of a vast array of drugs, which act upon the dopaminergic systems. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">These medications were developed initially for their action against psychiatric disorders such as schizophrenia and, in such situations, they have proven to be extremely useful and helpful to the patients. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">They act by partially blocking transmission by dopamine and so for schizophrenia, where excess dopaminergic transmission is involved, their use is logical. Their use in autism is less easy to justify and the benefits difficult to demonstrate. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">It may be that in autism dopaminergic transmission is, in any case, already diminished and the use of such medications which reduce it further, is illogical. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">There may be occasions when the use of these medications can be justified. For example, at times when the behavior is particularly disruptive they may serve to quiet the person down but, in autism, the results are not always sufficient to justify their use. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">With such drugs there exist very real problems of side effects. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">These may be of the "extra-pyramidal" type in which there are a variety of uncontrollable movements such as inability to keep still or shakiness or even, in some cases a catatonic rigidity. Such side effects will usually be controlled with the use of further drugs such as orphenadrine (Disipal). There is a much greater danger when these neuroleptic medications are used for prolonged periods of time. </div> <bR> <div> <B>Effects known as "Dyskinesias" may develop and these may be permanent</b>. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">The precise mechanism of these side effects is not known but the uncontrolled movements, particularly the protrusion of the tongue and characteristic body movements may only be controlled by the use of increased doses of the drug. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">When people have been treated with these drugs for some time, attempts to reduce the doses are hampered by the emergence of these symptoms. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">On account of their potentially serious side effects it is difficult to justify the continued use of such medications. The fact that they don't actually help the autism should preclude their use except for short periods of time when absolutely necessary. </div> <bR> <div> <B>2) Haloperidol (Serenace, Haldol) and sulpiride (Dolmatil)</b></div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">A group of rather atypical neuroleptics whose use is more justifiable. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">The effect of drugs such as haloperidol (Serenace, Haldol) and sulpiride (Dolmatil) will vary with the concentration employed. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">At low doses they actually stimulate dopaminergic transmission but at higher dosages they inhibit it. Certain authors report beneficial results at these lower dosages but the appropriate dose would have to be determined for each particular subject. </div> <bR> <div> <B>Drugs acting upon the Serotonergic System</b></div> <bR> <div> <B>1) </b><B>Antidepressants/ Clomipramine (Anafranil) or Fluoxetine (Prozac)</b></div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">When the nerve ending releases serotonin, much of it is re-absorbed and used again.</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Many "anti-depressive" drugs act be preventing or inhibiting this re-uptake with the result that more serotonin remains in the gap to stimulate the receiving nerve ending. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Such drugs will, therefore act to effectively increase transmission in these systems. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">There will, at the same time, be a diminution of the amount of serotonin released by the terminal and this may result in a net decrease in transmission between the terminals. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">It is, therefore, extremely difficult to predict whether or not the use of anti depressive drugs will be of benefit or make the autism worse. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Certainly, with some people medications such as Clomipramine (Anafranil) or Fluoxetine (Prozac) are beneficial in reducing aggression and depression but they may exacerbate the situation.</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">It is also apparent that the effects of such medications may take several weeks before becoming apparent. </div> <bR> <div> <B>Drugs Affecting the GABA system</b></div> <div> <B>Diazepam (Valium)</b></div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Drugs such as the diazepam (Valium) act by stimulating the GABA systems and are generally used to reduce anxiety levels. At first sight they would, therefore, seem appropriate for people with autism. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">One of the effects of such medications is to inhibit transmission in the dopaminergic systems and this transmission may, in any case, be reduced. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">A study of the results using such medications would appear to support the view that they are of little benefit. This is not to say that they have no use in particular emergency situations but they do not seem to ameliorate the autism in any way. </div> <bR> <div> <B>Drugs Affecting the Noradrenergic System/Beta Blockers</b></div> <div> <B>Amphetamines</b></div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">The group of drugs collectively known as the "Beta Blockers" is usually used to reduce blood pressure but they can have effects within the brain as well. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">They are often used to reduce the effects of "stress" and so have been employed, particularly in the USA, to help people with autism.</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Although it is difficult to find evidence for measurable improvements it may be that their use could be considered. There may, however, be other sound reasons why the use of such drugs should not be encouraged.</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Drugs such as amphetamines, which stimulate this system, have been applied to control hyperactivity and inattentiveness. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Any improvements in these target symptoms were minimal and they were accompanied by increases in stereotypic behaviors. </div> <bR> <div> <B>Drugs which inhibit the Opioid system</b></div> <bR> <div> 1) Anti-morphine" medication such as naltrexone</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">The opioid excess theory of autism proposes that, for some reason or other, there are, in people with autism, elevated levels of the body's own opioid compounds (known as endorphins). </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">The use of "anti-morphine" medication such as naltrexone would, on theoretical grounds, be appropriate. Naltrexone is one of those drugs, referred to earlier, in which the dose is critical and in the early experiments the doses used was much too high and no benefits were observed. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">More recent trials, using very much lower doses, have demonstrated beneficial results in terms of sociability and a reduction in self-injurious behavior in a proportion of people with autism. Clinical trials are still in progress - the jury is still out. </div> <bR> <div> 2) Lithium</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">As with some of the other drugs, Lithium compounds were first used to control some of the symptoms of Schizophrenia and was later tested for people with autism. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Reports seem to indicate a potential use in some instances where aggression is a problem particularly when accompanied by stereotypic or hyperactive behaviors. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">In addition, Lithium may have a use in smoothing out the mood swings or cyclic fluctuation in behavior, which are exhibited by some people with autism. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Individuals vary considerably in their responses to lithium. In particular the doses required may vary hugely so that it is usually necessary for the physician to monitor the amount of lithium in the blood in order to ascertain the ideal quantities for each patient. </div> <bR> <div> 3) Carbamazepine</div> <div> * Carbamezapine (Tegretol) has numerous effects but is normally prescribed to control epilepsy. <FONT SIZE="2" COLOR="#000000" FACE="Arial" >It also appears to smooth out the cyclic mood swings described above and should be considered where this is a problem. </FONT></div> <bR> <bR> <div> <B>Mary M. Muoio, MS OT, Post-MS GRN</b></div> <div> e-mail at mary@healthmood.com</div> <bR> </td> </tr></table></body>