Interdepartmental Program "Autism 0-90", "G. Martino" University Hospital, University of Messina, Italy.
Interdepartmental Program "Autism 0-90", "G. Martino" University Hospital, University of Messina, Italy.
Prog Neuropsychopharmacol Biol Psychiatry. 2021 Aug 30;110:110326. doi: 10.1016/j.pnpbp.2021.110326. Epub 2021 Apr 20.
Autism Spectrum Disorder (ASD) is a severe and lifelong neurodevelopmental disorder, with high social costs and a dramatic burden on the quality of life of patients and family members. Despite its high prevalence, reaching 1/54 children and 1/45 adults in the United States, no pharmacological treatment is still directed to core symptoms of ASD, encompassing social and communication deficits, repetitive behaviors, restricted interests, and abnormal sensory processing. The purpose of this review is to provide an overview of the state-of-the-art of psychopharmacological therapy available today for ASD in children and adolescents, in order to foster best practices and to organize new strategies for future research. To date, atypical antipsychotics such as risperidone and aripiprazole represent the first line of intervention for hyperactivity, impulsivity, agitation, temper outbursts or aggression towards self or others. Tricyclic antidepressants are less prescribed because of uncertain efficacy and important side effects. SSRIs, especially fluoxetine and sertraline, may be effective in treating repetitive behaviors (anxiety and obsessive-compulsive symptoms) and irritability/agitation, while mirtazapine is more helpful with sleep problems. Low doses of buspirone have shown some efficacy on restrictive and repetitive behaviors in combination with behavioral interventions. Stimulants, and to a lesser extent atomoxetine, are effective in reducing hyperactivity, inattention and impulsivity also in comorbid ASD-ADHD, although with somewhat lower efficacy and greater incidence of side effects compared to idiopathic ADHD. Clonidine and guanfacine display some efficacy on hyperactivity and stereotypic behaviors. For several other drugs, case reports and open-label studies suggest possible efficacy, but no randomized controlled trial has yet been performed. Research in the pediatric psychopharmacology of ASD is still faced with at least two major hurdles: (a) Great interindividual variability in clinical response and side effect sensitivity is observed in the ASD population. This low level of predictability would benefit from symptom-specific treatment algorithms and from biomarkers to support drug choice; (b) To this date, no psychoactive drug appears to directly ameliorate core autism symptoms, although some indirect improvement has been reported with several drugs, once the comorbid target symptom is abated.
自闭症谱系障碍（ASD）是一种严重的、终身性的神经发育障碍，其社会成本高昂，严重影响患者和家庭成员的生活质量。尽管 ASD 的患病率很高，在美国达到每 54 名儿童和每 45 名成人中就有 1 人患病，但仍没有针对 ASD 核心症状（包括社交和沟通障碍、重复行为、兴趣受限和异常感觉处理）的药物治疗方法。本综述旨在概述目前可用于儿童和青少年 ASD 的精神药理学治疗方法，以促进最佳实践并为未来的研究制定新策略。迄今为止，利培酮和阿立哌唑等非典型抗精神病药是治疗多动、冲动、激越、对自己或他人发脾气或攻击行为的一线干预药物。三环类抗抑郁药的应用较少，因为其疗效不确定且副作用较大。SSRIs，尤其是氟西汀和舍曲林，可能对治疗重复行为（焦虑和强迫症状）和易怒/激越有效，而米氮平对睡眠问题更有帮助。小剂量丁螺环酮与行为干预相结合，对限制和重复行为显示出一定疗效。兴奋剂，以及在较小程度上的托莫西汀，在 ASD 合并 ADHD 中有效减少多动、注意力不集中和冲动，尽管与特发性 ADHD 相比，其疗效较低，副作用发生率较高。可乐定和胍法辛对多动和刻板行为显示出一定疗效。对于其他几种药物，病例报告和开放标签研究表明可能有效，但尚未进行随机对照试验。ASD 儿科精神药理学研究仍面临至少两个主要障碍：（a）ASD 人群中观察到临床反应和副作用敏感性的个体间差异很大。这种低预测性将受益于针对特定症状的治疗算法和支持药物选择的生物标志物；（b）迄今为止，没有精神活性药物似乎可以直接改善核心自闭症症状，尽管一些药物在减轻共病靶症状后报告了一些间接改善。
