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Salazar de Pablo G, Pastor Jordá C, Vaquerizo-Serrano J, Moreno C, Cabras A, Arango C, Hernández P, Veenstra-VanderWeele J, Simonoff E, Fusar-Poli P, Santosh P, Cortese S, Parellada M. Systematic Review and Meta-analysis: Efficacy of Pharmacological Interventions for Irritability and Emotional Dysregulation in Autism Spectrum Disorder and Predictors of Response. J Am Acad Child Adolesc Psychiatry 2023; 62:151-168. [PMID: 35470032 DOI: 10.1016/j.jaac.2022.03.033] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 02/13/2022] [Accepted: 04/14/2022] [Indexed: 02/01/2023]
Abstract
OBJECTIVE Emotional dysregulation and irritability are common in individuals with autism spectrum disorder (ASD). We conducted the first meta-analysis assessing the efficacy of a broad range of pharmacological interventions for emotional dysregulation and irritability in ASD and predictors of response. METHOD Following a preregistered protocol (PROSPERO: CRD42021235779), we systematically searched multiple databases until January 1, 2021. We included placebo-controlled randomized controlled trials (RCTs) and evaluated the efficacy of pharmacological interventions and predictors of response for emotional dysregulation and irritability. We assessed heterogeneity using Q statistics and publication bias. We conducted subanalyses and meta-regressions to identify predictors of response. The primary effect size was the standardized mean difference. Quality of studies was assessed using the Cochrane Risk of Bias Tool (RoB2). RESULTS A total of 2,856 individuals with ASD in 45 studies were included, among which 26.7% of RCTs had a high risk of bias. Compared to placebo, antipsychotics (standardized mean difference = 1.028, 95% CI = 0.824-1.232) and medications used to treat attention-deficit/hyperactivity disorder (ADHD) (0.471, 0.061-0.881) were significantly better than placebo in improving emotional dysregulation and irritability, whereas evidence of efficacy was not found for other drug classes (p > .05). Within individual medications, evidence of efficacy was found for aripiprazole (1.179, 0.838-1.520) and risperidone (1.074, 0.818-1.331). Increased rates of comorbid epilepsy (β = -0.049, p = .026) were associated with a lower efficacy. CONCLUSION Some pharmacological interventions (particularly risperidone and aripiprazole) have proved efficacy for short-term treatment of emotional dysregulation and irritability in ASD and should be considered within a multimodal treatment plan, taking into account also the tolerability profile and families' preferences.
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Affiliation(s)
- Gonzalo Salazar de Pablo
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, United Kingdom; Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, School of Medicine, Universidad Complutense, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), CIBERSAM, Madrid, Spain; Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, United Kingdom
| | - Carolina Pastor Jordá
- University of Pittsburgh Medical Center, Pittsburgh, the Western Psychiatric Institute and Clinic, Pittsburgh, Pennsylvania, and Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Julio Vaquerizo-Serrano
- Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, School of Medicine, Universidad Complutense, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), CIBERSAM, Madrid, Spain; Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, United Kingdom
| | - Carmen Moreno
- Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, School of Medicine, Universidad Complutense, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), CIBERSAM, Madrid, Spain
| | | | - Celso Arango
- Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, School of Medicine, Universidad Complutense, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), CIBERSAM, Madrid, Spain
| | - Patricia Hernández
- Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, School of Medicine, Universidad Complutense, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), CIBERSAM, Madrid, Spain
| | | | - Emily Simonoff
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, United Kingdom
| | - Paolo Fusar-Poli
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, United Kingdom; University of Pavia, Italy, and OASIS service, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Paramala Santosh
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, United Kingdom
| | - Samuele Cortese
- Centre for Innovation in Mental Health, Academic Unit of Psychology, Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, United Kingdom, the New York University Child Study Center, New York, Solent NHS Trust, and the Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, United Kingdom
| | - Mara Parellada
- Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, School of Medicine, Universidad Complutense, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), CIBERSAM, Madrid, Spain.
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Ricci V, Ceci F, Di Carlo F, Lalli A, Ciavoni L, Mosca A, Sepede G, Salone A, Quattrone D, Fraticelli S, Maina G, Martinotti G. Cannabis use disorder and dissociation: A report from a prospective first-episode psychosis study. Drug Alcohol Depend 2021; 229:109118. [PMID: 34688166 DOI: 10.1016/j.drugalcdep.2021.109118] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 09/25/2021] [Accepted: 09/28/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Cannabis is the most used recreational drug worldwide. Its use can increase the risk of developing psychotic disorders and exacerbate their course. However, the relationship between cannabis use and dissociative symptoms has been scarcely investigated. AIMS To examine differences in psychotic and dissociative symptoms, and in functioning in first-episode psychotic patients (FEPp) using cannabis compared with those not using cannabis. METHODS Between January 2014 and December 2019, seventy FEPp with cannabis use disorder (N = 35) and without it (N = 35) were recruited in psychiatric inpatient facilities in the Italian regions of Lazio and Piemonte. All subjects were assessed at FEP, after 4 and 8 months, using the Positive and Negative Syndrome Scale (PANSS), the Global Assessment of Functioning (GAF) scale and the Dissociative Experiences Scale - II (DES-II). Detailed information on the pattern of cannabis and other substance use were collected. RESULTS FEP using cannabis showed higher levels of positive symptomatology, dissociative experiences and worse functioning than their non-user counterpart, despite a comparable antipsychotic treatment. At an eight-month prospective evaluation, FEP using cannabis still showed higher levels of positive symptomatology and dissociation. Moreover, global functioning worsened over time in FEPp using cannabis, whereas it improved those not using it. DISCUSSION Our findings suggest that a greater degree of dissociation and positive symptoms at FEPp and their persistence over time may characterise cannabis-associated psychosis. Both these factors might explain the overall functioning worsening over time that we observed in the cannabis-user group compared to the functioning improvement in the non-user group.
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Affiliation(s)
- V Ricci
- San Luigi Gonzaga University Hospital, Regione Gonzole, 10, 10043, Orbassano, Turin, Italy
| | - F Ceci
- Department of Neuroscience, Imaging, Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Via dei Vestini, 33, 66100, Chieti, Italy.
| | - F Di Carlo
- Department of Neuroscience, Imaging, Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Via dei Vestini, 33, 66100, Chieti, Italy
| | - A Lalli
- Department of Neuroscience, Imaging, Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Via dei Vestini, 33, 66100, Chieti, Italy
| | - L Ciavoni
- Department of Neuroscience, Imaging, Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Via dei Vestini, 33, 66100, Chieti, Italy
| | - A Mosca
- Department of Neuroscience, Imaging, Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Via dei Vestini, 33, 66100, Chieti, Italy
| | - G Sepede
- Department of Neuroscience, Imaging, Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Via dei Vestini, 33, 66100, Chieti, Italy
| | - A Salone
- Department of Neuroscience, Imaging, Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Via dei Vestini, 33, 66100, Chieti, Italy
| | - D Quattrone
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, Memory Ln, London SE5 8AF, UK; National Institute for Health Research (NIHR) Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, King's College London, De Crespigny Park, Denmark Hill, London SE5 8AF, UK; Medical Faculty Mannheim, Central Institute of Mental Health, University of Heidelberg, Square J5, 68159 Mannheim, Germany
| | - S Fraticelli
- DSM PIPSM ASL ROMA 1, Via Plinio, 31, 00193 Roma
| | - G Maina
- San Luigi Gonzaga University Hospital, Regione Gonzole, 10, 10043, Orbassano, Turin, Italy; Rita Levi Montalcini Department of Neurosciences, University of Turin, Italy
| | - G Martinotti
- Department of Neuroscience, Imaging, Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Via dei Vestini, 33, 66100, Chieti, Italy; Department of Clinical and Pharmaceutical Sciences, University of Hertfordshire, Hatfield, Hertfordshire AL10 9AB, UK
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Pham A, Lee JY, Miller CWT. Acute Extrapyramidal Side Effects from Smoked Haloperidol. Case Rep Psychiatry 2021; 2021:4177263. [PMID: 34635875 PMCID: PMC8502104 DOI: 10.1155/2021/4177263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 09/27/2021] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Haloperidol is a dopamine receptor antagonist used to treat patients with psychotic disorders. Especially at high doses, haloperidol carries a higher risk of extrapyramidal symptoms (EPS) compared to second-generation antipsychotics. Few cases of haloperidol misuse are found in the medical literature. Case Presentation. We describe a patient with schizophrenia who smoked marijuana mixed with crushed haloperidol tablets. After the smoking of cannabis and haloperidol, the patient presented to the emergency department (ED) with suicidal ideation, psychosis, and acute dystonia. With the administration of intramuscular diphenhydramine at the ED, the dystonia resolved in less than an hour. To our knowledge, this is the first report on haloperidol misuse by smoking. CONCLUSION Clinicians should be aware that patients might misuse prescribed antipsychotics via unconventional routes, potentially combined with other substances.
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Affiliation(s)
- Angeline Pham
- Department of Psychiatry, University of Maryland Medical Center, USA
| | - Joo-Young Lee
- Department of Psychiatry, University of Maryland Medical Center, USA
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