Politte Laura C, McDougle Christopher J
Department of Psychiatry and Pediatrics, Lurie Center for Autism, Massachusetts General Hospital, MassGeneral Hospital for Children, Harvard Medical School, Lexington, MA, 02421, USA,
Psychopharmacology (Berl). 2014 Mar;231(6):1023-36. doi: 10.1007/s00213-013-3068-y. Epub 2013 Apr 4.
Autism and related pervasive developmental disorders (PDD) are characterized by impairments in social interaction and communication, restricted interests, and repetitive and stereotyped patterns of behavior. Individuals with PDD frequently display irritability and disruptive behaviors including tantrums, self-injurious behavior, and aggression. Atypical antipsychotics are currently the most efficacious pharmacological interventions available for treatment of irritability associated with PDD.
This article aims to review the body of literature pertaining to the use of atypical antipsychotics in the treatment of patients with PDD.
A PubMed literature search was conducted using the following key words: autism, pervasive developmental disorders, atypical antipsychotics, risperidone, aripiprazole, quetiapine, ziprasidone, olanzapine, clozapine, paliperidone, iloperidone, asenapine, and lurasidone. Search terms were limited to English language, human subjects, and publication from 1999 to present. Relevant references from identified articles were also reviewed.
The efficacy and tolerability of risperidone and aripiprazole for the treatment of irritability in autism have been established with multi-site, randomized, controlled trials. Studies supporting the use of other atypical antipsychotics are either limited in scope or less robust in their findings, though newer agents such as ziprasidone and paliperidone show promise.
Atypical antipsychotics are currently first-line pharmacological agents for the treatment of irritability and associated behaviors in children with PDD. Further placebo-controlled studies are warranted to characterize the efficacy and tolerability of the majority of these medications. There is also a need for the development of novel, targeted drugs with more favorable long-term side effect profiles.
自闭症及相关广泛性发育障碍（PDD）的特征是社交互动和沟通受损、兴趣受限以及行为重复和刻板。患有PDD的个体经常表现出易怒和破坏性行为，包括发脾气、自伤行为和攻击行为。非典型抗精神病药物是目前可用于治疗与PDD相关易怒症状的最有效药物干预措施。
本文旨在综述有关非典型抗精神病药物用于治疗PDD患者的文献。
使用以下关键词在PubMed数据库中进行文献检索：自闭症、广泛性发育障碍、非典型抗精神病药物、利培酮、阿立哌唑、喹硫平、齐拉西酮、奥氮平、氯氮平、帕利哌酮、伊潘立酮、阿塞那平、鲁拉西酮。检索词限于英文、人类受试者以及1999年至今发表的文献。对已识别文章中的相关参考文献也进行了综述。
利培酮和阿立哌唑治疗自闭症易怒症状的疗效和耐受性已通过多中心、随机、对照试验得到证实。支持使用其他非典型抗精神病药物的研究要么范围有限，要么研究结果不太可靠，不过齐拉西酮和帕利哌酮等新型药物显示出前景。
非典型抗精神病药物目前是治疗PDD儿童易怒及相关行为的一线药物。有必要进行进一步的安慰剂对照研究，以明确这些药物中大多数的疗效和耐受性。还需要开发具有更有利长期副作用特征的新型靶向药物。
