From the Department of Psychology, New York State Institute for Basic Research, Staten Island.
Pediatric Cardiology, Boston Children's Health Physicians, Middletown, NY.
J Clin Psychopharmacol. 2020 Mar/Apr;40(2):122-129. doi: 10.1097/JCP.0000000000001175.
PURPOSE/BACKGROUND: Individuals with autism spectrum disorders present with social communication deficits and a rigid adherence to sameness. Along with these symptoms, many individuals also present with severe challenging behaviors that place themselves as well as their families and communities at risk for injury. For these individuals, new and effective treatments are acutely needed. Propranolol has been used worldwide for over 50 years. Its primary indication is for hypertension, but there is evidence that, at higher doses, propranolol inhibits rage and anger through its effects on the central nervous system. This effect has been demonstrated in a variety of neuropsychiatric disorders.
METHODS/PROCEDURES: Here, we present 46 retrospective analyses of clinical cases that were followed by a psychiatrist. Propranolol was prescribed as an add-on to the patients' existing medications. The doses ranged from 120 to 960 mg per day (mean = 462 mg).
FINDINGS/RESULTS: Thirty-nine (85%) of 46 patients were found to be much improved or very much improved on the physician-rated Clinical Global Impression Improvement scale. There were few side effects noted, with only 2 subjects unable to tolerate the propranolol.
IMPLICATIONS/CONCLUSIONS: It appears that high-dose propranolol can be given safely with minimal adverse cardiovascular problems, provided that close clinical monitoring is maintained. A more rigorous clinical trial is needed to elucidate and verify its clinical utility, clinical practice parameters, and the effects of propranolol as a monotherapy versus as an add-on to the patient's existing medication regimen.
目的/背景：自闭症谱系障碍患者存在社交沟通障碍和对一致性的刻板坚持。除了这些症状，许多患者还存在严重的挑战性行为，使他们自己以及他们的家庭和社区面临受伤的风险。对于这些患者来说，迫切需要新的、有效的治疗方法。普萘洛尔在全球已经使用了 50 多年。其主要适应证是高血压，但有证据表明，在较高剂量下，普萘洛尔通过其对中枢神经系统的作用抑制愤怒和愤怒。这种作用已在各种神经精神疾病中得到证实。
方法/程序：在这里，我们呈现了 46 例经精神科医生随访的临床病例的回顾性分析。普萘洛尔被开为患者现有药物的附加治疗。剂量范围为每天 120 至 960 毫克（平均值为 462 毫克）。
发现/结果：在医生评定的临床总体印象改善量表上，46 例患者中有 39 例（85%）被发现明显改善或非常明显改善。注意到很少有副作用，只有 2 名患者不能耐受普萘洛尔。
意义/结论：似乎可以安全地给予高剂量普萘洛尔，而心血管不良问题很少，只要保持密切的临床监测。需要进行更严格的临床试验，以阐明和验证其临床实用性、临床实践参数，以及普萘洛尔作为单一疗法与作为患者现有药物治疗方案的附加治疗的效果。
