Master slide
Download
1 / 69

Master Slide - PowerPoint PPT Presentation


  • 281 Views
  • Updated On :

Master Slide. Current Trends in the Pharmacological Treatment of Autism . Alexander Kolevzon, MD Peter Della Bella, MD David Grodberg, MD Charles Cartwright, MD. Symptom Domains and Associated Features of ASD. Social Phobia. Social Impairment. EEG Abnormalities. ADHD Symptoms.

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'Master Slide' - Lucy


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
Master slide l.jpg

Master Slide

Current Trends in the

Pharmacological Treatment of Autism

Alexander Kolevzon, MD

Peter Della Bella, MD

David Grodberg, MD

Charles Cartwright, MD


Symptom domains and associated features of asd l.jpg
Symptom Domains and Associated Features of ASD

Social Phobia

Social Impairment

EEG Abnormalities

ADHD Symptoms

Asperger’s syndrome

AUTISM

Impulsivity/

Aggression

Speech/

Communication Deficits

Repetitive Behaviors

Obsessive Compulsive Disorder

Expressive/Receptive Language Disorders


Peter della bella md director of clinical programs premier healthcare l.jpg

Treating Agitation and Aggressionin People with ASDs

Peter Della Bella, MDDirector of Clinical ProgramsPremier HealthCare


Adhd symptoms and autism spectrum disorders co occurrence phenomenology and treatment l.jpg
ADHD Symptoms and Autism Spectrum Disorders: Co-Occurrence, Phenomenology, and Treatment

David Grodberg, M.D.

Seaver Autism Center


The treatment of anxiety and repetitive behaviors in autism spectrum disorders l.jpg
The Treatment of Anxiety and Repetitive Behaviors in Autism Spectrum Disorders

Alex Kolevzon, M.D.

Clinical Director, Seaver Autism Center


Future directions targeting novel neurotransmitter and hormonal systems in autism l.jpg

Future Spectrum DisordersDirectionsTargetingNovel Neurotransmitter and Hormonal SystemsIn Autism

Charles Cartwright, MD

Director, YAI Autism Center


Master slide7 l.jpg

Master Slide Spectrum Disorders

Agitation and Aggression

Peter Della Bella, MD


What is agitation l.jpg

What is Agitation? Spectrum Disorders

An inability to cope

causing distress…

and losing control

Precursors: Irritability, anxiety, fatigue…

The worry: add a trigger and…


What is aggression l.jpg

What is Aggression? Spectrum Disorders

(Latin) Attack

Premeditated vs. loss of impulse control



Roots of irritability agitation the fight or flight response l.jpg

Roots of Irritability & Agitation Spectrum Disorders- the Fight or Flight Response

Sources: Babble.com; Brain-trainer.com; quantumlearningblog


Roots of agitation and aggression l.jpg

Roots of Agitation and Aggression Spectrum Disorders

ATTACK

loss of control

agitated

coping

irritated

c a l m


Roots of agitation and aggression13 l.jpg

Roots of Agitation and Aggression Spectrum Disorders

  • Survival instinct

    (“Boxed into a corner”)

  • Pain/physical discomfort

    (sensory integration)

  • Psychic discomfort

    (stress, change, frustration)


Roots of agitation and aggression14 l.jpg

Roots of Agitation and Aggression Spectrum Disorders

ATTACK

agitated

irritated

c a l m


Roots of agitation and aggression15 l.jpg

Roots of Agitation and Aggression Spectrum Disorders

stress, discomfort, pain

ATTACK

agitated

c a l m / irritated


Roots of agitation and aggression16 l.jpg

Roots of Agitation and Aggression Spectrum Disorders

stress, discomfort, pain

ATTACK

agitated

c a l m / irritated

cultural, behavioral, “medical” factors


What do you do l.jpg

What do you do? Spectrum Disorders

  • Survival instinct…….. take care of the threat

  • Treat sources of physical discomfort, side effects… proper medical evaluation sensory integration principles

  • Treat sources of psychic discomfort…..

    soften the blow of change address stress (sleep, food, downtime, fun)


Roots of agitation and aggression18 l.jpg

Roots of Agitation and Aggression Spectrum Disorders

ATTACK

agitated

Irritated

c a l m


When do you use meds l.jpg

When do you use meds? Spectrum Disorders

  • When there are underlying biological factors. Let the

    symptoms guide you!

    • Anxiety Disorder

    • Depression

    • ADHD

    • Psychosis

    • Seizure

  • Otherwise, MEDICATION IS A LAST RESORT


  • Fda approved for autism l.jpg

    FDA approved for autism… Spectrum Disorders

    risperidone

    aripiprazole


    So what do we use l.jpg

    So what do we use? Spectrum Disorders



    Master slide23 l.jpg

    Master Slide Spectrum Disorders

    Attention Deficit and Hyperactivity

    David Grodberg, MD


    Adhd symptoms in asd l.jpg
    ADHD SYMPTOMS IN ASD Spectrum Disorders

    • DSM-IV TR prohibits diagnosis of ADHD and ASD in the same individual

    • Clinic based surveys indicate that Sx c/w ADHD present in 41-78% of children with ASD


    Adhd symptoms in asd25 l.jpg
    ADHD SYMPTOMS IN ASD Spectrum Disorders

    • Asperger’s Disorder, PDD-NOS who meet full criteria for ADHD

    • Autistic Disorder with ADHD-like symptoms, which are part of core features of autism

    • Autistic Disorder with increased motor activity, impulsivity, inattention


    Adhd symptoms in asd26 l.jpg
    ADHD SYMPTOMS IN ASD Spectrum Disorders

    • Inattention to social stimuli but good sustained focus on interests or objects. NOT ADHD.

    • Hyperactivity as a manifestation of motor stereotypy, social anxiety, agitation, or medication side effects. NOT ADHD


    Treatment of adhd symptoms in asd l.jpg
    TREATMENT OF ADHD SYMPTOMS IN ASD Spectrum Disorders

    • Strongest evidence: methylphenidate

      • 2 placebo-controlled trials

      • retrospective and prospective effectiveness study


    Methylphenidate l.jpg
    Methylphenidate Spectrum Disorders

    Increases NE and DA by blocking reuptake


    Methylphenidate29 l.jpg
    Methylphenidate Spectrum Disorders

    ASD+ADHD tolerated stimulants generally well

    ASD+ADHD had dysphoria and obsessionality

    - initiate methylphenidate in ASD at lower dose and increase dose slowly with frequent monitoring for side effects


    Treatment of adhd symptoms in asd30 l.jpg
    TREATMENT OF ADHD SYMPTOMS IN ASD Spectrum Disorders

    • Moderate Level Evidence: guanfacine

      • chart review study

      • small open-label trial

    • Moderate Level Evidence: atomoxetine

      • small open label study

      • small placebo controlled study


    Guanfacine l.jpg
    Guanfacine Spectrum Disorders

    Alpha 2A agonist. Enhances prefrontal cortical function


    Atomoxetine l.jpg
    Atomoxetine Spectrum Disorders

    Increases NE and DA in prefrontal cortex.


    Treatment of adhd symptoms in asd33 l.jpg
    TREATMENT OF ADHD SYMPTOMS IN ASD Spectrum Disorders

    • Weak Support: clonidine, donepezil

      • very small studies


    Clonidine l.jpg
    Clonidine Spectrum Disorders

    Nonselective alpha2 agonist. More sedating/hypotensive.


    Donepezil l.jpg
    Donepezil Spectrum Disorders

    Acetyl Cholinesterase inhibitor


    Summary l.jpg
    SUMMARY Spectrum Disorders

    • Children with ADHD symptoms and ASD are difficult to treat

    • stimulants (methylphenidate), atomoxetine, alpha-agonists are effective

    • SSRIs and atypical neuroleptics are used to address other types of symptoms


    Clinical pearls l.jpg
    CLINICAL PEARLS Spectrum Disorders

    • If a child with ADHD is referred with poor response to meds and/or significant side effects (anxiety, stereotypy, aggression) - look for evidence of previously unrecognized ASD

    • If a stimulant is helpful but side effects of anxiety emerge, can switch to atomoxetine or add SSRI.

    • Monitor closely for behavioral disinhibition

      • hyperactivity, impulsivity, new odd/disorganized behavior, SI.


    Master slide38 l.jpg

    Master Slide Spectrum Disorders

    Anxiety and Repetitive Behaviors

    Alexander Kolevzon, MD


    Repetitive behaviors l.jpg

    Repetitive Behaviors Spectrum Disorders

    A preoccupation with stereotyped and restricted patterns of interest

    Inflexibility in adhering to routines and rituals

    Stereotyped and repetitive motor mannerisms

    Persistent preoccupation with parts of objects

    Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV)


    Repetitive behaviors40 l.jpg

    Higher Order Spectrum Disorders (compulsive)

    Insistence on sameness

    Ritualistic behavior

    Circumscribed interests &

    preoccupation

    Repetitive Behaviors

    Lower Order (motor/sensory)

    Repetitive self-injury

    Motor stereotypies

    Sniffing/mouthing objects

    Touching

    Tapping

    Rubbing


    Repetitive behaviors41 l.jpg

    Higher Order Spectrum Disorders (compulsive)

    Obsessions

    Repetitive Behaviors

    Lower Order (motor/sensory)

    Hoarding

    Anagnostou et al, 2005


    Serotonin system l.jpg
    Serotonin System Spectrum Disorders

    • Critical to neurodevelopment

    • Directs neuronal growth,

      proliferation, differentiation

    • Widely expressed in

      emotional centers of

      brain


    Emotional center of brain l.jpg

    Emotional Center of Brain Spectrum Disorders


    Serotonin pathways l.jpg

    Serotonin Pathways Spectrum Disorders


    Serotonin system in autism l.jpg
    Serotonin System in Autism Spectrum Disorders


    Serotonin reuptake inhibitors l.jpg

    Serotonin Reuptake Inhibitors Spectrum Disorders


    Serotonergic medications l.jpg

    Serotonergic Spectrum Disorders Medications


    Serotonergic medications48 l.jpg
    Serotonergic Spectrum Disorders Medications


    Study of fluoxetine in autism sofia l.jpg
    Study of Spectrum DisordersFluoxetine in Autism (SOFIA)

    N=158


    Atypical antipsychotics risperidone l.jpg

    Atypical Antipsychotics - Spectrum DisordersRisperidone

    McDougle et al, 2005


    Atypical antipsychotics abilify l.jpg

    Atypical Antipsychotics – Spectrum DisordersAbilify

    Marcus et al, 2009


    Novel therapeutics oxytocin l.jpg

    Novel Therapeutics - Spectrum DisordersOxytocin

    Widely distributed in Central Nervous System; especially emotional centers

    Peripheral release is important for delivery and lactation

    Central release is important for social cognition (recognition and memory); trust; social attachment; maternal bonding


    Iv oxytocin challenge l.jpg

    • need to know Spectrum Disorders

    • repeating

    • ordering

    • need to tell

    • self-injury

    • touching

    IV Oxytocin Challenge

    Hollander et al, 2003


    Master slide54 l.jpg

    Master Slide Spectrum Disorders

    Future Directions

    Charles Cartwright, MD



    The glutamate system l.jpg
    The Glutamate System Approval for the Treatment of Autism


    Slide57 l.jpg

    Machado-Vieira et al, 2009 Approval for the Treatment of Autism


    Glutamate modulating treatments l.jpg
    Glutamate Modulating Treatments Approval for the Treatment of Autism


    D cycloserine l.jpg
    D-Cycloserine Approval for the Treatment of Autism


    D cycloserine in the treatment of autism l.jpg
    D-Cycloserine in the Treatment of Autism Approval for the Treatment of Autism

    Posey et al, 2004


    Riluzole l.jpg
    Riluzole Approval for the Treatment of Autism


    Riluzole in the treatment of ocd l.jpg
    Riluzole in the Treatment of OCD Approval for the Treatment of Autism

    Coric et al, 2005


    N acetylcysteine l.jpg
    N-acetylcysteine Approval for the Treatment of Autism


    N acetylcysteine in the treatment of trichotillomania l.jpg
    N-acetylcysteine in the Treatment of Trichotillomania Approval for the Treatment of Autism

    Grant et al, 2009


    Treatments that involve hormones l.jpg
    Treatments that involve Hormones Approval for the Treatment of Autism


    Oxytocin l.jpg
    Oxytocin Approval for the Treatment of Autism


    Slide67 l.jpg

    Andari et al, 2010 Approval for the Treatment of Autism


    Caution l.jpg
    Caution Approval for the Treatment of Autism

    Demonstrate Safety and Efficacy


    Master slide69 l.jpg

    Master Slide Approval for the Treatment of Autism

    THANK YOU