Wink Logan K, Pedapati Ernest V, Horn Paul S, McDougle Christopher J, Erickson Craig A
1 Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine , Cincinnati, Ohio.
2 Lurie Center for Autism , Departments of Psychiatry and Pediatrics, Massachusetts General Hospital and MassGeneral Hospital for Children, Harvard Medical School , Boston, Massachusetts.
J Child Adolesc Psychopharmacol. 2017 Feb;27(1):91-94. doi: 10.1089/cap.2015.0123. Epub 2015 Oct 14.
The purpose of this study was to explore the use of multiple antipsychotic medications in patients with autism spectrum disorder (ASD) by reviewing the longitudinal medication management of 1100 patients consecutively treated for behavioral symptoms associated with ASD at a tertiary care specialty clinic.
We identified all patients with ASD treated with daily doses of two or more antipsychotics for at least two visits at our clinic. For each patient meeting inclusion criteria, diagnostic and demographic data were collected. To evaluate clinical need and effectiveness of antipsychotic medications in this sample, we reviewed symptoms targeted with each antipsychotic medication and concomitant medications prescribed. Clinical Global Impressions-Severity (CGI-S) and Clinical Global Impressions-Improvement (CGI-I) scale ratings had been completed at the time of each visit, and the duration of treatment with antipsychotic medications was determined. To evaluate the safety and tolerability of antipsychotic medication use in ASD, we reviewed reported adverse effects and calculated body mass index (BMI) change with treatment.
Seventy patients met the inclusion criteria (6.4% of our sample). The majority of patients were moderately to severely ill Caucasian males, as determined by baseline mean CGI-S of 4.7 (SD = 0.8), and were diagnosed with autistic disorder and comorbid intellectual disability. The mean age was 15.1 years (SD = 10.9), the primary targeted symptoms were agitation/irritability, physical aggression, and self-injury. The majority of patients remained on two or more antipsychotics for >1 year. In this population, patients demonstrated greater symptomatic improvement and generally tolerated treatment without significant adverse effects.
The use of two or more antipsychotic medications may be increasingly common in patients with ASD. This retrospective study demonstrates that this treatment approach may be of some clinical benefit, and is generally well tolerated. Prospective studies focusing on the efficacy and safety of concomitant antipsychotic medication usage in ASD should be considered.
本研究旨在通过回顾在一家三级医疗专科诊所连续接受治疗的1100例患有与自闭症谱系障碍（ASD）相关行为症状的患者的纵向药物管理情况，探讨多种抗精神病药物在ASD患者中的使用情况。
我们确定了所有在我们诊所接受每日剂量两种或更多抗精神病药物治疗且至少就诊两次的ASD患者。对于每例符合纳入标准的患者，收集诊断和人口统计学数据。为了评估该样本中抗精神病药物的临床需求和有效性，我们回顾了每种抗精神病药物所针对的症状以及所开具的伴随药物。每次就诊时均已完成临床总体印象-严重程度（CGI-S）和临床总体印象-改善（CGI-I）量表评分，并确定了抗精神病药物的治疗持续时间。为了评估抗精神病药物在ASD中的安全性和耐受性，我们回顾了报告的不良反应并计算了治疗期间的体重指数（BMI）变化。
70例患者符合纳入标准（占我们样本的6.4%）。根据基线平均CGI-S为4.7（标准差=0.8）确定，大多数患者为中度至重度患病的白种男性，且被诊断为自闭症障碍并伴有智力残疾。平均年龄为15.1岁（标准差=10.9），主要针对的症状为激越/易激惹、身体攻击和自我伤害。大多数患者持续使用两种或更多抗精神病药物超过1年。在这一人群中，患者症状改善更明显，且总体耐受治疗，无明显不良反应。
在ASD患者中使用两种或更多抗精神病药物可能越来越普遍。这项回顾性研究表明，这种治疗方法可能具有一定的临床益处，且总体耐受性良好。应考虑开展针对ASD患者联合使用抗精神病药物的疗效和安全性的前瞻性研究。
