Childhood Disintegrative Disorder Medication
- Author: Bettina E Bernstein, DO; Chief Editor: Caroly Pataki, MD more...
Medications in various classes, including atypical antipsychotics, stimulants, and anticonvulsants, have been used to treat a wide range of behavioral and mood problems that may occur in children with childhood disintegrative disorder.
Risperidone and haloperidol have been approved by the US Food and Drug Administration for irritability associated with autistic disorders. If neuroleptic medications are used, neuroleptic malignant syndrome (NMS) is a significant risk. Patients should be monitored for NMS symptoms.
Monitoring for atypical antipsychotics should also include screening for metabolic syndrome, new-onset diabetes, or diabetic ketoacidosis, both through physical examination (including waist circumference, blood pressure, and proportion of weight to height) and through laboratory studies (eg, serum glucose and, when indicated, hemoglobin A1c [HbA1c]).
Risperidone is an atypical antipsychotic agent indicated for irritability associated with autistic disorder in children and adolescents aged 5-16 years. Risperidone binds to dopamine D1-receptor and has 20 times lower affinity than typical antipsychotics for the 5-HT2-receptor. Risperidone improves negative symptoms of psychoses. The incidence of extrapyramidal adverse effects is lower with risperidone than with conventional antipsychotics.
Haloperidol blocks postsynaptic mesolimbic dopaminergic D1 and D2 receptors in the brain. It also decreases hypothalamic and hypophyseal hormones.
Aripiprazole is hypothesized to work differently from other antipsychotics; it is thought to be a partial dopamine (D2) and serotonin (5HT1A) agonist that antagonizes serotonin (5HT2A). Aripiprazole is available as a tablet, oral disintegrating tablet, oral solution, or intramuscular injection. Injection is indicated for agitation associated with schizophrenia or bipolar disorder, manic or mixed.
Quetiapine is a newer antipsychotic drug used for long-term management of schizophrenia and is indicated in adults for schizophrenia, depressive episodes associated with bipolar disorder, and acute manic episodes associated with bipolar I disorder as either monotherapy or adjunctive therapy to lithium or divalproex. This agent is available in tablet form and may act by antagonizing dopamine and serotonin effects. Quetiapine's improvements over earlier antipsychotics include fewer anticholinergic effects and less dystonia, parkinsonism, and tardive dyskinesia.
Ziprasidone intramuscular (IM) injection is indicated for acute agitation in patients with schizophrenia in whom treatment with ziprasidone is appropriate and who need IM antipsychotic medication for rapid control of the agitation.
This agent antagonizes dopamine D2, D3, 5HT2A, 5HT2C, 5HT1A, 5HT1D, is alpha1-adrenergic, and has a moderate antagonistic effect for histamine H1. Ziprasidone moderately inhibits reuptake of serotonin and norepinephrine. This drug is available as a tablet and IM injection.
Children who present with markedly impaired attention may improve when treated with very low doses of stimulants or nonstimulants (eg, methylphenidate, atomoxetine), and they should show signs of improvement within 4 weeks if these agents are tolerated and effective. The dosages are much lower than those usually used to treat attention-deficit/hyperactivity disorder (ADHD). During pharmacotherapy, the clinician must monitor and be vigilant for signs of adverse reactions, including insomnia, crying spells, anorexia, weight loss, and frank or worsening psychosis.
Atomoxetine inhibits the reuptake of norepinephrine with little to no activity at other receptor sites or neuronal reuptake pumps.
These agents prevent seizure recurrence and terminate clinical and electrical seizure activity. These agents are used when seizure control is an issue. Valproic acid or valproate is used along with an atypical antipsychotics (especially risperidone). The patient should be closely monitored for abnormal levels of ammonia, which are generally accompanied by alterations in mental status (often nonspecific slowing) and abnormalities of liver function.
Considered the drug of first choice for primary generalized epilepsy, valproate has a very wide spectrum and is effective in most seizure types, including myoclonic seizures. It has multiple mechanisms of anticonvulsant effects, including increasing gamma-aminobutyric acid (GABA) levels in brain, as well as T-type calcium channel activity. The extended-release (ER) formulation allows for once-a-day administration.
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