Keles Gizem, Rajakumar Augustine, Wilson Crystal M
Behavioral Health, Lake Erie College of Osteopathic Medicine, Bradenton, USA.
Academic Research Services, BayCare Health System, Tampa, USA.
Cureus. 2025 Aug 16;17(8):e90262. doi: 10.7759/cureus.90262. eCollection 2025 Aug.
This case report discusses an eight-year-old boy diagnosed with autism spectrum disorder (ASD), attention-deficit/hyperactivity disorder (ADHD), and disruptive mood dysregulation disorder (DMDD), who required two separate psychiatric hospitalizations within a four-month period due to severe aggression and self-harming behaviors. The patient was initially admitted involuntarily under the Florida Mental Health Act of 1971 after exhibiting violent behavior toward family members and significant self-harm. During his first hospitalization, which lasted 25 days, he demonstrated a limited response to multiple combination interventions, including stimulants, α-agonists, and antipsychotics such as risperidone and olanzapine. Paliperidone, an atypical antipsychotic typically used in adolescents for schizophrenia, was titrated up to 3 mg/day, resulting in significant improvement in irritability and aggression with no immediate adverse effects. Four months after discharge, the patient was readmitted for similar behaviors, including aggression toward teachers and renewed self-harm. Despite adherence to his prescribed medications during the interim period, his symptoms returned abruptly, one week prior to readmission. During this second hospitalization, lasting 16 days, the dose of paliperidone was increased to 3 mg twice daily, based on the Florida Best Practice Psychotherapeutic Medication Guidelines for Children and Adolescents, leading to rapid resolution of aggressive episodes. The patient tolerated the dosage adjustment without significant side effects, though weight gain remained a concern. This case highlights paliperidone's potential utility in managing severe behavioral dysregulation in pediatric patients with ASD when first-line therapies fail. It also underscores the importance of careful monitoring for metabolic side effects in this vulnerable population. Further research is needed to establish age-specific dosing guidelines and long-term safety profiles for children under 12 years of age.
本病例报告讨论了一名8岁男孩，他被诊断患有自闭症谱系障碍（ASD）、注意力缺陷多动障碍（ADHD）和破坏性心境失调障碍（DMDD），由于严重的攻击行为和自我伤害行为，在四个月内需要两次单独的精神病院住院治疗。该患者最初根据1971年的《佛罗里达州心理健康法》非自愿入院，此前他对家庭成员表现出暴力行为并严重自我伤害。在他的第一次住院期间，持续了25天，他对多种联合干预措施反应有限，这些措施包括兴奋剂、α-激动剂以及抗精神病药物如利培酮和奥氮平。帕利哌酮是一种非典型抗精神病药物，通常用于青少年治疗精神分裂症，滴定至3毫克/天，结果易怒和攻击行为有显著改善，且无即时不良反应。出院四个月后，患者因类似行为再次入院，包括对教师的攻击行为和再次出现的自我伤害行为。尽管在中间期坚持服用规定药物，但他的症状在再次入院前一周突然复发。在这次持续16天的第二次住院期间，根据《佛罗里达州儿童和青少年最佳实践心理治疗药物指南》，帕利哌酮的剂量增加到每日两次，每次3毫克，导致攻击发作迅速缓解。患者耐受了剂量调整，没有明显副作用，不过体重增加仍是一个问题。本病例突出了帕利哌酮在一线治疗失败时，对患有ASD的儿科患者严重行为失调的潜在治疗作用。它还强调了对这一脆弱人群仔细监测代谢副作用的重要性。需要进一步研究以建立12岁以下儿童的年龄特异性给药指南和长期安全性概况。
