Hellings Jessica A, Arnold L Eugene, Han Joan C
a Kansas City Regional Center of Missouri Department of Mental Health , University of Missouri-Kansas City , Kansas City , MO , USA.
b Department of Psychiatry , The Ohio State University Nisonger Center , Columbus , OH , USA.
Expert Opin Pharmacother. 2017 Apr;18(6):581-588. doi: 10.1080/14656566.2017.1308483.
Drug development and repurposing are urgently needed for individuals with autism spectrum disorders (ASD) and psychiatric comorbidity, which often presents as aggression and self-injury. Areas covered: We review dopamine antagonists, including classical and atypical, as well as unconventional antipsychotics in ASD. The older antipsychotic loxapine is discussed in terms of preliminary albeit limited evidence in ASD. Emerging promise of amitriptyline in ASD is discussed, together with promising BDNF effects of loxapine and amitriptyline. Expert opinion: In ASD, pharmacotherapy and specifically dopamine antagonist drugs are often prescribed for challenging behaviors including aggression. The novel antipsychotics risperidone and aripiprazole have received most study in ASD and are FDA-approved for irritability in children with ASD over age 5 years; individuals with ASD are prone to weight gain, Type II diabetes and associated side effects. Low dose loxapine has properties of classical and novel antipsychotics but importantly appears more weight neutral, and with promising use in adolescents and adults with ASD. Amitriptyline appears effective in ASD for irritability, aggression, gastrointestinal problems, and insomnia, in children, adolescents and adults however our adult data on amitriptyline in ASD is still in preparation for publication. Both loxapine and amitriptyline may stimulate BDNF; further studies are warranted.
对于患有自闭症谱系障碍（ASD）且伴有精神疾病合并症（常表现为攻击行为和自我伤害）的个体而言，药物研发和重新利用迫在眉睫。涵盖领域：我们综述了多巴胺拮抗剂，包括经典和非典型的，以及ASD中的非传统抗精神病药物。讨论了较老的抗精神病药物洛沙平在ASD中的初步证据，尽管证据有限。还讨论了阿米替林在ASD中的新前景，以及洛沙平和阿米替林对脑源性神经营养因子（BDNF）的有益作用。专家意见：在ASD中，药物治疗尤其是多巴胺拮抗剂药物常用于治疗包括攻击行为在内的具有挑战性的行为。新型抗精神病药物利培酮和阿立哌唑在ASD中得到了最多的研究，并且已获得美国食品药品监督管理局（FDA）批准用于治疗5岁以上ASD儿童的易激惹症状；ASD个体容易出现体重增加、II型糖尿病及相关副作用。低剂量洛沙平具有经典和新型抗精神病药物的特性，但重要的是其对体重的影响似乎更为中性，有望用于患有ASD的青少年和成年人。阿米替林在治疗儿童、青少年和成年人ASD的易激惹、攻击行为、胃肠道问题和失眠方面似乎有效，不过我们关于阿米替林在成人ASD中的数据仍在准备发表。洛沙平和阿米替林都可能刺激BDNF；有必要进行进一步研究。
