McLennan John D
Children's Hospital of Eastern Ontario-Research Institute, Ottawa, Ontario.
Department of Pediatrics, University of Calgary, Alberta.
J Can Acad Child Adolesc Psychiatry. 2019 Nov;28(3):141-146. Epub 2019 Nov 1.
Vlad, not his real name, a 15 year old boy with an autism spectrum disorder and intellectual disability, was referred for psychiatric consultation due to aggression and other behavioural problems. He presented for initial psychiatric consultation on five psychotropic medications with associated severe obesity. A systematic deprescribing and cross-tapering plan was implemented, removing all five psychotropic medications (which included olanzapine and quetiapine) and introducing ziprasidone. These changes were associated with a 44.8kg weight loss with no behavioral deterioration and overall lower rates of aggression. Vlad's case may typify important deficiencies in the service system which create a context that allows for aggressive psychotropic polypharmacy without apparent concomitant increase in sophistication of behavioral management design and support, while also tolerating substantial treatment adverse effects (e.g., medication induced severe obesity) within a member of a vulnerable population (e.g., a youth with developmental disability in care). Suggestions to address some of these contextual factors are outlined.
弗拉德（这不是他的真名）是一名15岁的男孩，患有自闭症谱系障碍和智力残疾，因攻击性行为及其他行为问题而被转介进行精神科会诊。他初次进行精神科会诊时正在服用五种精神药物，且伴有严重肥胖症。于是实施了一项系统的减药和交叉递减计划，停用了所有五种精神药物（包括奥氮平和喹硫平），并引入了齐拉西酮。这些改变使他体重减轻了44.8公斤，行为没有恶化，攻击行为的总体发生率也有所降低。弗拉德的案例可能代表了服务系统中的一些重要缺陷，这些缺陷营造了一种环境，使得在没有明显相应增加行为管理设计和支持复杂性的情况下，激进地使用多种精神药物成为可能，同时还容忍了弱势群体（如接受照料的发育障碍青年）中的成员出现大量治疗副作用（如药物引起的严重肥胖）。文中概述了应对其中一些背景因素的建议。
