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London EB, Zimmerman-Bier BL, Yoo JH, Gaffney JW. High-Dose Propranolol for Severe and Chronic Aggression in Autism Spectrum Disorder: A Pilot, Double-Blind, Placebo-Controlled, Randomized Crossover Study. J Clin Psychopharmacol 2024:00004714-990000000-00280. [PMID: 39174017 DOI: 10.1097/jcp.0000000000001895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/24/2024]
Abstract
BACKGROUND Despite the use of behavioral interventions and psychotropic medications, many individuals with autism spectrum disorder (ASD) who engage in severe aggression remain refractory to conventional treatment. Propranolol, a beta-blocker, has accumulated much anecdotal evidence as a promising option. However, well-designed studies are rare, and the apprehension about cardiovascular side effects from large doses continues to exist. PURPOSE The aims of this study were (1) to demonstrate the feasibility of treating aggression with high-dose propranolol using telehealth study visits and (2) to document cardiac safety. METHODS This study utilized a randomized, double-blind, placebo-controlled, crossover design. Dosing was titrated up in a flexible but stepwise fashion until therapeutic response was obtained or up to 200 mg tid. Following washout, those who were assigned propranolol were crossed over to placebo and vice versa. Six participants between the ages 12-19 participated. The primary outcome measures were the final Clinical Global Impression Improvement Scale (CGI-I) and the ABC-C/I scores at 200 mg tid. RESULTS The CGI-I indicated a 50% reduction in symptoms in the propranolol phase, while the ABC-I indicated a 37% reduction in comparison to placebo. The effect sizes ( r ) for the CGI-I and the ABC-C/I were large, -0.74 and 0.64, respectively. The average blood pressure was 122/68 during the placebo phase and 109/72 during the propranolol phase. All Holter monitor exams were unremarkable. CONCLUSION These results suggest that propranolol is an effective option in decreasing aggression in individuals with ASD. As this was a small study, a larger clinical trial is needed.
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Affiliation(s)
- Eric B London
- From the New York State Institute for Basic Research, Department of Psychology, Staten Island, NY
| | - Barbie L Zimmerman-Bier
- Rutgers University Robert Wood Johnson Medical School and the Children's Health Institute, New Brunswick, NJ
| | - J Helen Yoo
- From the New York State Institute for Basic Research, Department of Psychology, Staten Island, NY
| | - Joseph W Gaffney
- Rutgers University Robert Wood Johnson Medical School and the Children's Health Institute, New Brunswick, NJ
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Lee M, Lee S, Sohn JW, Kim KW, Choi HJ. Assessment Methods for Problematic Eating Behaviors in Children and Adolescents With Autism Spectrum Disorder. Soa Chongsonyon Chongsin Uihak 2024; 35:57-65. [PMID: 38204745 PMCID: PMC10774564 DOI: 10.5765/jkacap.230065] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 11/25/2023] [Accepted: 11/27/2023] [Indexed: 01/12/2024] Open
Abstract
Autism spectrum disorder (ASD) can be associated with eating problems. However, currently, there is a lack of established guidelines for assessing and addressing eating behaviors in individuals with ASD. This gap in research exists due to the challenges associated with using traditional assessment methods, which may lead to discrepancies in responses and unintentional potential biases from caregivers. In this review, we provided a comprehensive overview of various eating behaviors commonly observed in individuals with ASD. These behaviors include 1) food neophobia, 2) selective eating, 3) binge eating, 4) food avoidance, 5) chewing and swallowing problems, 6) pica, 7) rumination, 8) rituals, and 9) problematic behaviors. Furthermore, we provide a perspective of utilizing digital tools: 1) augmentative and alternative communication; 2) ecological momentary assessment; and 3) video analysis, behavioral analysis, and facial expression analysis. This review explores existing assessment methods and suggests novel assessment aiding together.
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Affiliation(s)
- Miji Lee
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Korea
| | - Seolha Lee
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Korea
| | - Jong-Woo Sohn
- Department of Biological Sciences, Korea Advanced Institute of Science and Technology, Daejeon, Korea
| | - Ki Woo Kim
- Division of Physiology, Departments of Oral Biology and Applied Life Science, BK21 Four, Yonsei University College of Dentistry, Seoul, Korea
| | - Hyung Jin Choi
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Korea
- Department of Anatomy and Cell Biology, Seoul National University College of Medicine, Seoul, Korea
- Neuroscience Research Institute, Seoul National University College of Medicine, Seoul, Korea
- Wide River Institute of Immunology, Seoul National University, Hongcheon, Korea
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3
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Phichaya P, Wararat C, Somchai C, Oraporn D, Palisara T, Witchaya B, Jariya C. Folate Receptor Alpha Autoantibodies in Children with Autism Spectrum Disorder. Biomarkers 2022; 27:715-719. [DOI: 10.1080/1354750x.2022.2125579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Affiliation(s)
- Phunsawat Phichaya
- Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University,
| | - Chiangjong Wararat
- Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University,
| | | | | | - Thommachot Palisara
- Department of Psychiatry, Faculty of Medicine Ramathibodi Hospital, Mahidol University
| | - Butdawong Witchaya
- Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University,
| | - Chuthapisith Jariya
- Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University,
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Sakdalan J, Maxwell Y. The application of adapted dialectical behaviour therapy concepts and skills in the treatment of adults with autistic spectrum disorder who display challenging or offending behaviours. ADVANCES IN AUTISM 2022. [DOI: 10.1108/aia-01-2022-0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
Despite some advances in the assessment and treatment of autism spectrum disorder (ASD), there remains a paucity of intervention and research literature in treating adults with ASD. There is growing evidence supporting a relationship between the core features of ASD and emotion dysregulation. There is an overlap between ASD and borderline personality disorder (BPD) characteristics such as emotional dysregulation, sensory issues and social skills deficits. This paper aims to explore the applications of dialectical behaviour therapy (DBT) concepts and skills in treating ASD individuals who display challenging or offending behaviours. The similarities in characteristics between ASD and BPD and the core issue of emotion dysregulation hold promise in the utility of DBT with ASD.
Design/methodology/approach
This is a conceptual paper that includes a case vignette.
Findings
A DBT-informed treatment approach using the adaptations and reconceptualization, i.e. risky mind–wise mind outlined in this paper, can be considered promising in addressing issues for ASD individuals, particularly those with challenging and/or offending behaviours. DBT incorporates different elements of applied behaviour analysis, cognitive behavioural therapy, mindfulness skills, sensory-based treatments, psychosocial interventions and emotion regulation skills, which makes it a more cohesive and integrated approach to treatment. The authors assert that DBT can be considered a more integrated, strengths-based, habilitative and trauma-informed approach which can be promising in its application to address challenging behaviours or offending in ASD individuals.
Research limitations/implications
It is recommended that research be carried out to evaluate the effectiveness of adapted DBT programs in treating ASD individuals presenting with challenging and/or offending behaviours. Future research can focus on evaluating the effectiveness of the different DBT concepts and skills and the different DBT modules to determine which components of the program are particularly useful for this client group.
Practical implications
Treatment manuals have already been developed for clients with intellectual disability and developmental disabilities who exhibit challenging and/or offending behaviour; hence, it is recommended that modifications be made to make it more applicable and appropriate for ASD individuals. Modifications should address ASD-specific issues (e.g. black and white thinking, cognitive rigidity, sensory issues, impaired theory of mind, emotion dysregulation issues, social skills deficits and anxiety issues). The use of DBT has much wider implications regarding addressing comorbid mental health conditions and personality issues in this client group.
Originality/value
There are limited psychological interventions that prove to be useful for individuals with ASD with complex presentations and challenging or offending behaviours. This paper discusses the application of adapted DBT concepts and skills that appear to be promising in the treatment of this client group.
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Duclot F, Kabbaj M. Epigenetics of Aggression. Curr Top Behav Neurosci 2021; 54:283-310. [PMID: 34595741 DOI: 10.1007/7854_2021_252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Aggression is a complex behavioral trait modulated by both genetic and environmental influences on gene expression. By controlling gene expression in a reversible yet potentially lasting manner in response to environmental stimulation, epigenetic mechanisms represent prime candidates in explaining both individual differences in aggression and the development of elevated aggressive behaviors following life adversity. In this manuscript, we review the evidence for an epigenetic basis in the development and expression of aggression in both humans and related preclinical animal models. In particular, we discuss reports linking DNA methylation, histone post-translational modifications, as well as non-coding RNA, to the regulation of a variety of genes implicated in the neurobiology of aggression including neuropeptides, the serotoninergic and dopaminergic systems, and stress response related systems. While clinical reports do reveal interesting patterns of DNA methylation underlying individual differences and experience-induced aggressive behaviors, they do, in general, face the challenge of linking peripheral observations to central nervous system regulations. Preclinical studies, on the other hand, provide detailed mechanistic insights into the epigenetic reprogramming of gene expression following life adversities. Although the functional link to aggression remains unclear in most, these studies together do highlight the involvement of epigenetic events driven by DNA methylation, histone modifications, and non-coding RNA in the neuroadaptations underlying the development and expression of aggression.
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Affiliation(s)
- Florian Duclot
- Department of Biomedical Sciences and Program in Neuroscience, Florida State University, Tallahassee, FL, USA.
| | - Mohamed Kabbaj
- Department of Biomedical Sciences and Program in Neuroscience, Florida State University, Tallahassee, FL, USA.
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Igarashi K, Kuchiiwa T, Kuchiiwa S, Iwai H, Tomita K, Sato T. Kamishoyosan (a Japanese traditional herbal formula), which effectively reduces the aggressive biting behavior of male and female mice, and potential regulation through increase of Tph1, Tph2, and Esr2 mRNA levels. Brain Res 2021; 1768:147580. [PMID: 34260963 DOI: 10.1016/j.brainres.2021.147580] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 06/23/2021] [Accepted: 07/06/2021] [Indexed: 01/29/2023]
Abstract
Kamishoyosan (KSS), a Japanese traditional herbal formula, is used to treat symptoms related to the autonomic nervous system in men and women; it is especially known for improving the symptoms of irritability (e.g., bad temper and persistent anger). Although clinical and ethological studies of KSS have been conducted, its efficacy in reducing irritability remains to be validated. In the present study, male and female ddY-strain mice were isolation-reared for 8 weeks (from the third postnatal week) to induce pathologically aggressive biting behavior (ABB), which was used as an indicator of irritability. The ABB of mice toward metal rods was measured using the Aggressive Response Meter. An intraperitoneal administration of KSS (100 mg/kg) effectively reduced ABB in male and female mice at 2 h after the administration; however, this effect was canceled by prior administration of WAY-100635 [a 5-hydroxytryptoamine (5-HT)-1A receptor antagonist; 0.5 mg/kg] and bicuculline (a type-A gamma-aminobutyric acid receptor antagonist; 1.0 mg/kg). Additionally, tamoxifen, ICI-182780, and G-15 (all estrogen receptor antagonists) inhibited the action of KSS in a dose-dependent manner. Furthermore, gene expression of tryptophan hydroxylase (Tph) 1 and Tph2 were increased and 5-HT immunofluorescence was slightly increased in the dorsal raphe nucleus (DRN) of isolation-reared mice administered with KSS. Collectively, these results indicate that KSS effectively reduces ABB in isolation-reared male and female mice through stimulation of 5-HT production in the DRN. Our findings also suggest that gene expression of estrogen receptor (Esr) 2 increased in the DRN might be associated with the reduction of ABB.
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Affiliation(s)
- Kento Igarashi
- Department of Applied Pharmacology, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima 890-8544, Japan
| | - Toshiko Kuchiiwa
- Department of Clinical Psychology, Graduate School of Human Science, Kagoshima Immaculate Herat University, 2365 Amatatsu-Cho, Satsuma-Sendai 895-0011, Japan; Department of Morphological Science, Field of Neurology, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima 890-8544, Japan
| | - Satoshi Kuchiiwa
- Department of Morphological Science, Field of Neurology, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima 890-8544, Japan
| | - Haruki Iwai
- Department of Oral Anatomy and Cell Biology, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima 890-8544, Japan
| | - Kazuo Tomita
- Department of Applied Pharmacology, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima 890-8544, Japan
| | - Tomoaki Sato
- Department of Applied Pharmacology, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima 890-8544, Japan.
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Herpers PCM, Neumann JEC, Staal WG. Treatment Refractory Internalizing Behaviour Across Disorders: An Aetiological Model for Severe Emotion Dysregulation in Adolescence. Child Psychiatry Hum Dev 2021; 52:515-532. [PMID: 32748274 PMCID: PMC8113221 DOI: 10.1007/s10578-020-01036-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 05/28/2020] [Accepted: 07/21/2020] [Indexed: 12/17/2022]
Abstract
Auto-aggressive behaviour, especially treatment refractory suicidality in adolescents with psychiatric disorders, may be challenging to clinicians. In search of therapeutic possibilities, we have integrated current opinions regarding causality and interdependency of suicidality and auto-aggressive behaviour across disorders within the HiTOP framework. We propose a developmental model regarding these unsettling behaviours in youths that may help to guide future directions for research and interventions. We argue that the interdependent development of biologic factors, attachment, moral reasoning and emotion regulation in an overprotective environment may lead to social anxiety and later during development to emotion dysregulation and severe internalizing behaviour disorders. To optimize treatment efficacy for both internalizing and externalizing behaviour, we emphasize the importance transdiagnostic interventions, such as addressing non-compliance, restoration of trust between parents and their child, and limitation of avoidance behaviour. These may be seen as higher order interventions within the HiTOP framework.
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Affiliation(s)
- Pierre C M Herpers
- Karakter Child and Adolescent Psychiatry, University Centre, Reinier Postlaan 12, Nijmegen, 6525 GC, The Netherlands.
- Department of Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Kapittelweg 29, Nijmegen, 6525 EN, The Netherlands.
| | - Josephine E C Neumann
- Karakter Child and Adolescent Psychiatry, University Centre, Reinier Postlaan 12, Nijmegen, 6525 GC, The Netherlands
| | - Wouter G Staal
- Karakter Child and Adolescent Psychiatry, University Centre, Reinier Postlaan 12, Nijmegen, 6525 GC, The Netherlands
- Department of Psychiatry, Radboud University Medical Centre, Geert Grooteplein 10, Nijmegen, 6525 GA, The Netherlands
- Faculty of Social Sciences, Leiden Institute for Brain and Cognition, Postzone C2-5, P.O. Box 9600, Leiden, 2300 RC, The Netherlands
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Abstract
BACKGROUND Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by markedly impaired social interaction, impaired communication, and restricted/repetitive patterns of behavior, interests, and activities. In addition to challenges caused by core symptoms, maladaptive behaviors such as aggression can be associated with ASD and can further disrupt functioning and quality of life. For adults with ASD, these behaviors can portend adverse outcomes (e.g., harm to others or to the individual with ASD, hindering of employment opportunities, criminal justice system involvement). This article reviews the scientific literature to provide an update on evidence-based interventions for aggression in adults with ASD. METHOD A search of the electronic databases CINAHL, EMBASE, and PsycINFO was conducted using relevant search terms. After reviewing titles, abstracts, full-length articles, and reference lists, 70 articles were identified and reviewed. RESULTS The strongest (controlled trial) evidence suggests beneficial effects of risperidone, propranolol, fluvoxamine, vigorous aerobic exercise, and dextromethorphan/quinidine for treating aggression in adults with ASD, with lower levels of evidence supporting behavioral interventions, multisensory environments, yokukansan, and other treatments. CONCLUSIONS Additional randomized, controlled trials using consistent methodology that adequately addresses sources of bias are needed to determine which treatments are reliably effective in addressing aggression in adults with ASD. In the meantime, considering efficacy and adverse effect/long-term risk profiles, a practical approach could start with functional assessment-informed behavioral interventions along with encouragement of regular, vigorous aerobic exercise to target aggression in adults with ASD, with pharmacotherapy employed if these interventions are unavailable or inadequate based on symptom acuity.
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Affiliation(s)
- David S. Im
- From the University of Michigan Hospital, Department of Psychiatry, University of Michigan Medical School
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9
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The Safety and Effectiveness of High-Dose Propranolol as a Treatment for Challenging Behaviors in Individuals With Autism Spectrum Disorders. J Clin Psychopharmacol 2020; 40:122-129. [PMID: 32134849 DOI: 10.1097/jcp.0000000000001175] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
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.
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10
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Lucock ZR, Sharp RA, Jones RSP. Behavior-Analytic Approaches to Working with People with Intellectual and Developmental Disabilities who Develop Dementia: a Review of the Literature. Behav Anal Pract 2018; 12:255-264. [PMID: 30918792 DOI: 10.1007/s40617-018-0270-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Behavior analysis has made contributions in the development of evidence-based interventions for people with intellectual and developmental disabilities (IDD), and there is a growing evidence base for behavior-analytic interventions for older adults with dementia. As there is an increased number of adults with IDD living to old age, and an increased prevalence of comorbid dementia in people with IDD, a review of the behavior-analytic contributions with this population is warranted. We searched Web of Science and PsycInfo and manually reviewed the last 20 years of five behavioral journals. Six behavior-analytic studies with people with IDD and dementia were identified, and all but one were published outside of core behavior-analytic journals. These articles were analyzed in terms of Baer, Wolf, and Risley's (Journal of Applied Behavior Analysis, 1, 91-97, 1968) seven dimensions of applied behavior analysis (ABA). The possible explanations and implications of these findings are discussed with consideration of the unique features of a comorbid diagnosis of IDD and dementia that may make it appropriate for increased focus in behavior-analytic research and practice.
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Affiliation(s)
- Zoe R Lucock
- 1School of Psychology, Bangor University, Bangor, Wales UK
| | | | - Robert S P Jones
- 1School of Psychology, Bangor University, Bangor, Wales UK.,2North Wales Clinical Psychology Programme, Bangor University, Bangor, Wales UK
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Takahashi A, Flanigan ME, McEwen BS, Russo SJ. Aggression, Social Stress, and the Immune System in Humans and Animal Models. Front Behav Neurosci 2018; 12:56. [PMID: 29623033 PMCID: PMC5874490 DOI: 10.3389/fnbeh.2018.00056] [Citation(s) in RCA: 125] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 03/06/2018] [Indexed: 01/25/2023] Open
Abstract
Social stress can lead to the development of psychological problems ranging from exaggerated anxiety and depression to antisocial and violence-related behaviors. Increasing evidence suggests that the immune system is involved in responses to social stress in adulthood. For example, human studies show that individuals with high aggression traits display heightened inflammatory cytokine levels and dysregulated immune responses such as slower wound healing. Similar findings have been observed in patients with depression, and comorbidity of depression and aggression was correlated with stronger immune dysregulation. Therefore, dysregulation of the immune system may be one of the mediators of social stress that produces aggression and/or depression. Similar to humans, aggressive animals also show increased levels of several proinflammatory cytokines, however, unlike humans these animals are more protected from infectious organisms and have faster wound healing than animals with low aggression. On the other hand, subordinate animals that receive repeated social defeat stress have been shown to develop escalated and dysregulated immune responses such as glucocorticoid insensitivity in monocytes. In this review we synthesize the current evidence in humans, non-human primates, and rodents to show a role for the immune system in responses to social stress leading to psychiatric problems such as aggression or depression. We argue that while depression and aggression represent two fundamentally different behavioral and physiological responses to social stress, it is possible that some overlapped, as well as distinct, pattern of immune signaling may underlie both of them. We also argue the necessity of studying animal models of maladaptive aggression induced by social stress (i.e., social isolation) for understanding neuro-immune mechanism of aggression, which may be relevant to human aggression.
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Affiliation(s)
- Aki Takahashi
- Laboratory of Behavioral Neuroendocrinology, University of Tsukuba, Tsukuba, Japan.,Fishberg Department of Neuroscience and Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States.,Laboratory of Neuroendocrinology, The Rockefeller University, New York, NY, United States
| | - Meghan E Flanigan
- Fishberg Department of Neuroscience and Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Bruce S McEwen
- Laboratory of Neuroendocrinology, The Rockefeller University, New York, NY, United States
| | - Scott J Russo
- Fishberg Department of Neuroscience and Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States
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Keefer A, White SW, Vasa RA, Reaven J. Psychosocial interventions for internalizing disorders in youth and adults with ASD. Int Rev Psychiatry 2018. [PMID: 29537895 DOI: 10.1080/09540261.2018.1432575] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Internalizing disorders are common in individuals with ASD. Psychosocial interventions targeting these disorders in the ASD population have burgeoned in the last decade. Cognitive-behavioural therapy, modified for ASD, is the most frequently investigated model, although other interventions, including behaviour therapy, third-wave interventions, models targeting transdiagnostic constructs, and alternative interventions and treatment delivery methods are now emerging. This review provides a summary of the efficacy of these interventions in treating internalizing disorders in youth and adults with ASD. The barriers to accessing these treatments, which are experienced by many individuals with ASD and their families, as well as future research directions, are also discussed.
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Affiliation(s)
- Amy Keefer
- a Center for Autism and Related Disorders , Kennedy Krieger Institute , Baltimore , MD , USA.,b Department of Psychiatry and Behavioral Sciences , Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Susan W White
- c Department of Psychology , Virginia Tech , Blacksburg , VA , USA
| | - Roma A Vasa
- a Center for Autism and Related Disorders , Kennedy Krieger Institute , Baltimore , MD , USA.,b Department of Psychiatry and Behavioral Sciences , Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Judy Reaven
- d Department of Psychiatry , University of Colorado Anschutz Medical Campus , Aurora , CO , USA
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van Schalkwyk GI, Lewis AS, Beyer C, Johnson J, van Rensburg S, Bloch MH. Efficacy of antipsychotics for irritability and aggression in children: a meta-analysis. Expert Rev Neurother 2017; 17:1045-1053. [PMID: 28847182 DOI: 10.1080/14737175.2017.1371012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Aggression and irritability in children occur across a range of diagnoses, and are associated with both economic cost and negative psychosocial outcomes. Antipsychotics are frequently prescribed in these cases. METHODS A random effects meta-analysis of 14 random controlled trials was conducted. Overall effect sizes for antipsychotics for irritability and aggression were extracted. Subgroup analyses were conducted according to diagnostic indication, specific medication and degree of sedation. Meta-regression examined effects of antipsychotic dose. RESULTS Overall, antipsychotics were effective in reducing aggression and irritability (SMD = 0.74, 95% confidence interval [CI] 0.57-0.92, z = 8.4, p < 0.0001). In stratified subgroup analysis, individual antipsychotic agents did not differ in efficacy (χ2 = 1.1, df = 3, p = 0.78). However, aripiprazole and risperidone demonstrated significant benefit over placebo. Antipsychotic efficacy did not differ significantly based on diagnostic indication (χ2 = 4.2, df = 4, p = 0.39). Meta-regression showed no overall dose effect. CONCLUSIONS Clinical data supports the efficacy of risperidone and aripiprazole for aggression and irritability across diagnoses, with insufficient data available for other agents. Available data does not support a difference in efficacy based on underlying diagnosis, choice of agent, or its degree of sedation.
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Affiliation(s)
| | - Alan S Lewis
- b Department of Psychiatry , Yale University , New Haven , CT , USA
| | - Chad Beyer
- a Child Study Center , Yale University , New Haven , CT , USA
| | - Jessica Johnson
- a Child Study Center , Yale University , New Haven , CT , USA
| | - Samuel van Rensburg
- c School of Nursing , Fairfield University School of Nursing , Fairfield , CT , USA
| | - Michael H Bloch
- a Child Study Center , Yale University , New Haven , CT , USA.,b Department of Psychiatry , Yale University , New Haven , CT , USA
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Collier-Meek MA, Sanetti LMH, Fallon LM. INCORPORATING APPLIED BEHAVIOR ANALYSIS TO ASSESS AND SUPPORT EDUCATORS’ TREATMENT INTEGRITY. PSYCHOLOGY IN THE SCHOOLS 2017. [DOI: 10.1002/pits.22001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Jobski K, Höfer J, Hoffmann F, Bachmann C. Use of psychotropic drugs in patients with autism spectrum disorders: a systematic review. Acta Psychiatr Scand 2017; 135:8-28. [PMID: 27624381 DOI: 10.1111/acps.12644] [Citation(s) in RCA: 125] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/22/2016] [Indexed: 12/28/2022]
Abstract
OBJECTIVE The objective of this review was to examine prevalence and patterns of psychopharmacotherapy in individuals with autism spectrum disorder (ASD). METHOD A systematic literature search in PubMed, CINAHL, and PsycINFO was performed, including articles published up to November 18, 2015. RESULTS A total of 47 studies (data collection: 1976-2012), encompassing >300 000 individuals with ASD, were included. The prevalence of psychopharmacotherapy ranged from 2.7% to 80% (median (overall): 45.7%; median (children): 41.9%; median (adults): 61.5%), with psychotropic polypharmacy occurring in 5.4-54% (median: 23.0%). Regarding drug classes, antipsychotics were most frequently used, followed by attention-deficit/hyperactivity disorder (ADHD) medication and antidepressants. Both older age and psychiatric comorbidity were associated with higher prevalences of psychopharmacotherapy and psychotropic polypharmacy. There were no time trends in psychopharmacotherapy prevalence observable. CONCLUSION Despite a lack of pharmacological treatment options for ASD core symptoms, the prevalence of psychopharmacotherapy and polypharmacy in ASD patients is considerable, which is probably due to the treatment of non-core ASD symptoms and psychiatric comorbidities. While there is some evidence for the use of antipsychotics and ADHD medication for these indications, the use of antidepressants should be limited to selected cases.
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Affiliation(s)
- K Jobski
- Department of Health Services Research, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - J Höfer
- Department of Health Services Research, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - F Hoffmann
- Department of Health Services Research, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - C Bachmann
- Faculty of Medicine, Philipps University Marburg, Marburg, Germany
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16
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Singh R, Turner RC, Nguyen L, Motwani K, Swatek M, Lucke-Wold BP. Pediatric Traumatic Brain Injury and Autism: Elucidating Shared Mechanisms. Behav Neurol 2016; 2016:8781725. [PMID: 28074078 PMCID: PMC5198096 DOI: 10.1155/2016/8781725] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2016] [Accepted: 11/23/2016] [Indexed: 02/08/2023] Open
Abstract
Pediatric traumatic brain injury (TBI) and autism spectrum disorder (ASD) are two serious conditions that affect youth. Recent data, both preclinical and clinical, show that pediatric TBI and ASD share not only similar symptoms but also some of the same biologic mechanisms that cause these symptoms. Prominent symptoms for both disorders include gastrointestinal problems, learning difficulties, seizures, and sensory processing disruption. In this review, we highlight some of these shared mechanisms in order to discuss potential treatment options that might be applied for each condition. We discuss potential therapeutic and pharmacologic options as well as potential novel drug targets. Furthermore, we highlight advances in understanding of brain circuitry that is being propelled by improved imaging modalities. Going forward, advanced imaging will help in diagnosis and treatment planning strategies for pediatric patients. Lessons from each field can be applied to design better and more rigorous trials that can be used to improve guidelines for pediatric patients suffering from TBI or ASD.
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Affiliation(s)
- Rahul Singh
- Department of Neurosurgery, West Virginia University School of Medicine, Morgantown, WV 26505, USA
| | - Ryan C. Turner
- Department of Neurosurgery, West Virginia University School of Medicine, Morgantown, WV 26505, USA
| | - Linda Nguyen
- Department of Basic Pharmaceutical Sciences, West Virginia University School of Medicine, Morgantown, WV 26505, USA
| | - Kartik Motwani
- Department of Medical Sciences, University of Florida School of Medicine, Gainesville, FL 32611, USA
| | - Michelle Swatek
- Department of Psychology, North Carolina State University, Raleigh, NC 27695, USA
| | - Brandon P. Lucke-Wold
- Department of Neurosurgery, West Virginia University School of Medicine, Morgantown, WV 26505, USA
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17
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Frye RE, Delhey L, Slattery J, Tippett M, Wynne R, Rose S, Kahler SG, Bennuri SC, Melnyk S, Sequeira JM, Quadros E. Blocking and Binding Folate Receptor Alpha Autoantibodies Identify Novel Autism Spectrum Disorder Subgroups. Front Neurosci 2016; 10:80. [PMID: 27013943 PMCID: PMC4783401 DOI: 10.3389/fnins.2016.00080] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 02/18/2016] [Indexed: 11/23/2022] Open
Abstract
Folate receptor α (FRα) autoantibodies (FRAAs) are prevalent in autism spectrum disorder (ASD). They disrupt the transportation of folate across the blood-brain barrier by binding to the FRα. Children with ASD and FRAAs have been reported to respond well to treatment with a form of folate known as folinic acid, suggesting that they may be an important ASD subgroup to identify and treat. There has been no investigation of whether they manifest unique behavioral and physiological characteristics. Thus, in this study we measured both blocking and binding FRAAs, physiological measurements including indices of redox and methylation metabolism and inflammation as well as serum folate and B12 concentrations and measurements of development and behavior in 94 children with ASD. Children positive for the binding FRAA were found to have higher serum B12 levels as compared to those negative for binding FRAAs while children positive for the blocking FRAA were found to have relatively better redox metabolism and inflammation markers as compared to those negative for blocking FRAAs. In addition, ASD children positive for the blocking FRAA demonstrated better communication on the Vineland Adaptive Behavior Scale, stereotyped behavior on the Aberrant Behavioral Checklist and mannerisms on the Social Responsiveness Scale. This study suggests that FRAAs are associated with specific physiological and behavioral characteristics in children with ASD and provides support for the notion that these biomarkers may be useful for subgrouping children with ASD, especially with respect to targeted treatments.
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Affiliation(s)
- Richard E Frye
- Department of Pediatrics, Arkansas Children's Hospital Research Institute, University of Arkansas for Medical Sciences Little Rock, AR, USA
| | - Leanna Delhey
- Department of Pediatrics, Arkansas Children's Hospital Research Institute, University of Arkansas for Medical Sciences Little Rock, AR, USA
| | - John Slattery
- Department of Pediatrics, Arkansas Children's Hospital Research Institute, University of Arkansas for Medical Sciences Little Rock, AR, USA
| | - Marie Tippett
- Department of Pediatrics, Arkansas Children's Hospital Research Institute, University of Arkansas for Medical Sciences Little Rock, AR, USA
| | - Rebecca Wynne
- Department of Pediatrics, Arkansas Children's Hospital Research Institute, University of Arkansas for Medical Sciences Little Rock, AR, USA
| | - Shannon Rose
- Department of Pediatrics, Arkansas Children's Hospital Research Institute, University of Arkansas for Medical Sciences Little Rock, AR, USA
| | - Stephen G Kahler
- Department of Pediatrics, Arkansas Children's Hospital Research Institute, University of Arkansas for Medical Sciences Little Rock, AR, USA
| | - Sirish C Bennuri
- Department of Pediatrics, Arkansas Children's Hospital Research Institute, University of Arkansas for Medical Sciences Little Rock, AR, USA
| | - Stepan Melnyk
- Department of Pediatrics, Arkansas Children's Hospital Research Institute, University of Arkansas for Medical Sciences Little Rock, AR, USA
| | - Jeffrey M Sequeira
- Department of Medicine, State University of New York-Downstate Medical Center Brooklyn, NY, USA
| | - Edward Quadros
- Department of Medicine, State University of New York-Downstate Medical Center Brooklyn, NY, USA
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18
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McGuire K, Fung LK, Hagopian L, Vasa RA, Mahajan R, Bernal P, Silberman AE, Wolfe A, Coury DL, Hardan AY, Veenstra-VanderWeele J, Whitaker AH. Irritability and Problem Behavior in Autism Spectrum Disorder: A Practice Pathway for Pediatric Primary Care. Pediatrics 2016; 137 Suppl 2:S136-48. [PMID: 26908469 DOI: 10.1542/peds.2015-2851l] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/09/2015] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Pediatric primary care providers (PCPs) caring for patients with autism spectrum disorder (ASD) often encounter irritability (vocal or motoric outbursts expressive of anger, frustration, or distress) and problem behavior (directed acts of aggression toward other people, self, or property). The Autism Intervention Research Network on Physical Health and Autism Speaks Autism Treatment Network charged a multidisciplinary workgroup with developing a practice pathway to assist PCPs in the evaluation and treatment of irritability and problem behavior (I/PB). METHODS The workgroup reviewed the literature on the evaluation and treatment of contributory factors for I/PB in ASD. The workgroup then achieved consensus on the content and sequence of each step in the pathway. RESULTS The practice pathway is designed to help the PCP generate individualized treatment plans based on contributing factors identified in each patient. These factors may include medical conditions, which the PCP is in a key position to address; functional communication challenges that can be addressed at school or at home; psychosocial stressors that may be ameliorated; inadvertent reinforcement of I/PB; and co-occurring psychiatric conditions that can be treated. The pathway provides guidance on psychotropic medication use, when indicated, within an individualized treatment plan. In addition to guidance on assessment, referral, and initial treatment, the pathway includes monitoring of treatment response and periodic reassessment. CONCLUSIONS The pediatric PCP caring for the patient with ASD is in a unique position to help generate an individualized treatment plan that targets factors contributing to I/PB and to implement this plan in collaboration with parents, schools, and other providers.
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Affiliation(s)
- Kelly McGuire
- Department of Psychiatry, Columbia University Medical Center and New York State Psychiatric Institute, New York, New York; Center for Autism and Developmental Disorders, Maine Behavioral Healthcare, South Portland, Maine
| | - Lawrence K Fung
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
| | | | - Roma A Vasa
- Psychiatry, Kennedy Krieger Institute, and Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Rajneesh Mahajan
- Psychiatry, Kennedy Krieger Institute, and Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Pilar Bernal
- Psychiatry, Children's Health Council, Palo Alto, California
| | - Anna E Silberman
- Department of Psychiatry, Columbia University Medical Center and New York State Psychiatric Institute, New York, New York
| | - Audrey Wolfe
- MassGeneral Hospital for Children, Boston, Massachusetts
| | | | - Antonio Y Hardan
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
| | - Jeremy Veenstra-VanderWeele
- Department of Psychiatry, Columbia University Medical Center and New York State Psychiatric Institute, New York, New York; New York Presbyterian Hospital Center for Autism and the Developing Brain, White Plains, New York
| | - Agnes H Whitaker
- Department of Psychiatry, Columbia University Medical Center and New York State Psychiatric Institute, New York, New York;
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