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Duis J, van Wattum PJ, Scheimann A, Salehi P, Brokamp E, Fairbrother L, Childers A, Shelton AR, Bingham NC, Shoemaker AH, Miller JL. A multidisciplinary approach to the clinical management of Prader-Willi syndrome. Mol Genet Genomic Med 2019; 7:e514. [PMID: 30697974 PMCID: PMC6418440 DOI: 10.1002/mgg3.514] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 10/16/2018] [Accepted: 10/22/2018] [Indexed: 12/14/2022] Open
Abstract
Background Prader–Willi syndrome (PWS) is a complex neuroendocrine disorder affecting approximately 1/15,000–1/30,000 people. Unmet medical needs of individuals with PWS make it a rare disease that models the importance of multidisciplinary approaches to care with collaboration between academic centers, medical homes, industry, and parent organizations. Multidisciplinary clinics support comprehensive, patient‐centered care for individuals with complex genetic disorders and their families. Value comes from improved communication and focuses on quality family‐centered care. Methods Interviews with medical professionals, scientists, managed care experts, parents, and individuals with PWS were conducted from July 1 to December 1, 2016. Review of the literature was used to provide support. Results Data are presented based on consensus from these interviews by specialty focusing on unique aspects of care, research, and management. We have also defined the Center of Excellence beyond the multidisciplinary clinic. Conclusion Establishment of clinics motivates collaboration to provide evidence‐based new standards of care, increases the knowledge base including through randomized controlled trials, and offers an additional resource for the community. They have a role in global telemedicine, including to rural areas with few resources, and create opportunities for clinical work to inform basic and translational research. As a care team, we are currently charged with understanding the molecular basis of PWS beyond the known genetic cause; developing appropriate clinical outcome measures and biomarkers; bringing new therapies to change the natural history of disease; improving daily patient struggles, access to care, and caregiver burden; and decreasing healthcare load. Based on experience to date with a PWS multidisciplinary clinic, we propose a design for this approach and emphasize the development of “Centers of Excellence.” We highlight the dearth of evidence for management approaches creating huge gaps in care practices as a means to illustrate the importance of the collaborative environment and translational approaches.
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Affiliation(s)
- Jessica Duis
- Division of Medical Genetics and Genomic Medicine, Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Pieter J van Wattum
- Department of Psychiatry, Child Study Center, Yale School of Medicine, New Haven, Connecticut.,Clifford Beers Clinic, New Haven, Connecticut
| | - Ann Scheimann
- Pediatric Gastroenterology, Johns Hopkins Children's Center, Baltimore, Maryland
| | - Parisa Salehi
- Division of Endocrinology and Diabetes, Seattle Children's, University of Washington, Seattle, Washington
| | - Elly Brokamp
- Division of Medical Genetics and Genomic Medicine, Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Laura Fairbrother
- Division of Medical Genetics and Genomic Medicine, Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Anna Childers
- Division of Medical Genetics and Genomic Medicine, Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Althea Robinson Shelton
- Neuro-Sleep Division, Department of Neurology, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Nathan C Bingham
- Division of Pediatric Endocrinology, Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Ashley H Shoemaker
- Division of Pediatric Endocrinology, Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Jennifer L Miller
- Pediatric Endocrinology, University of Florida, Gainesville, Florida
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Mooney LN, Dominick KC, Erickson CA. Psychopharmacology of neurobehavioral disorders. HANDBOOK OF CLINICAL NEUROLOGY 2019; 165:383-390. [PMID: 31727225 DOI: 10.1016/b978-0-444-64012-3.00023-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
At times psychotropic drug use is required to address behavioral and other interfering symptoms that accompany neurobehavioral disorders. We review such prescribing practice in autism spectrum disorder, fragile X syndrome, and Prader-Willi syndrome.
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Affiliation(s)
- Lindsey N Mooney
- Department of Psychiatry, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Kelli C Dominick
- Department of Psychiatry, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Craig A Erickson
- Department of Psychiatry, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.
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Bonnot O, Cohen D, Thuilleaux D, Consoli A, Cabal S, Tauber M. Psychotropic treatments in Prader-Willi syndrome: a critical review of published literature. Eur J Pediatr 2016; 175:9-18. [PMID: 26584571 DOI: 10.1007/s00431-015-2670-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 11/04/2015] [Accepted: 11/12/2015] [Indexed: 12/31/2022]
Abstract
UNLABELLED Prader-Willi syndrome (PWS) is a rare genetic syndrome. The phenotype includes moderate to intellectual disability, dysmorphia, obesity, and behavioral disturbances (e.g., hetero and self-injurious behaviors, hyperphagia, psychosis). Psychotropic medications are widely prescribed in PWS for symptomatic control. We conducted a systematic review of published literature to examine psychotropic medications used in PWS. MEDLINE was searched to identify articles published between January 1967 and December 2014 using key words related to pharmacological treatments and PWS. Articles with original data were included based on a standardized four-step selection process. The identification of studies led to 241 records. All selected articles were evaluated for case descriptions (PWS and behavioral signs) and treatment (type, titration, efficiency, and side effects). Overall, 102 patients were included in these studies. Treatment involved risperidone (three reports, n = 11 patients), fluoxetine (five/n = 6), naltrexone (two/n = 2), topiramate (two/n = 16), fluvoxamine (one/n = 1), mazindol (one/n = 2), N-acetyl cysteine (one/n = 35), rimonabant (one/n = 15), and fenfluramine (one/n = 15). CONCLUSION We identified promising treatment effects with topiramate for self-injury and impulsive/aggressive behaviors, risperidone for psychotic symptoms associated with uniparental disomy (UPD), and N-acetyl cysteine for skin picking. The pharmacological approach of behavioral impairment in PWS has been poorly investigated to date. Further randomized controlled studies are warranted. WHAT IS KNOWN Behavioral disturbances in Prader-Willi syndrome including aggressive reactions, skin picking, and hyperphagia might be very difficult to manage. Antipsychotic drugs are widely prescribed, but weight gain and increased appetite are their major side effects. WHAT IS NEW Topiramate might be efficient for self-injury and impulsive/aggressive behaviors, N-acetyl cysteine is apromising treatment for skin picking and Antidepressants are indicated for OCD symptoms. Risperidone is indicated in case of psychotic symptoms mainly associated with uniparental disomy.
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Affiliation(s)
- O Bonnot
- Child and Adolescent Psychiatry Department, LPL-University Hospital Nantes and GDR 3557, Psychiatric Institute, 7 quai Moncousu, Nantes, F-44 000, France.
| | - D Cohen
- Child and Adolescent Psychiatry Department, Groupe Hospitalier Pitie Salpetriere, APHP, Paris & Centre for Rare Diseases with Psychiatric Symptoms, APHP, 47 boulevard de l'hôpital, Paris, 75013, France.
| | - D Thuilleaux
- Rare Disease with Psychiatric Symptoms Department, Hôpital Mari, APHP, Route de la Corniche, Hendaye, 64700, France.
| | - A Consoli
- Child and Adolescent Psychiatry Department, Groupe Hospitalier Pitie Salpetriere, APHP, Paris & Centre for Rare Diseases with Psychiatric Symptoms, APHP, 47 boulevard de l'hôpital, Paris, 75013, France.
| | - S Cabal
- Child and Adolescent Psychiatry Department, CHU de Toulouse, Toulouse, France.
| | - M Tauber
- Pediatric Department, University Hospital Toulouse & Rare Disease Center for Prader Willi Syndrome, CHU de Toulouse, Toulouse, France.
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La Malfa G, Lassi S, Bertelli M, Castellani A. Reviewing the use of antipsychotic drugs in people with intellectual disability. Hum Psychopharmacol 2006; 21:73-89. [PMID: 16378330 DOI: 10.1002/hup.748] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Antipsychotics are the most widely prescribed drugs in people with intellectual disability even if schizophrenia and other psychotic disorders do not affect more than 3% of such population. Many authors outline the lack of studies on the efficacy of antipsychotics on schizophrenia or other psychotic disorders in people with intellectual disability. MATERIALS AND METHODS The aim of the present study is to review all evidences resulting from international trials selected by Medline, and compare efficacy and side effects of different antipsychotics in people with both intellectual disability and psychotic disorders and/or behavioural disorders. RESULTS 195 studies were identified; 117 concern traditional antipychotics while 78 new generation ones. If we consider the type of studies, it results that only the 12.8% of all production is represented by meta-analyses, systematic reviews, and randomised and not controlled trials. CONCLUSIONS Randomised controlled trials and systematic reviews would be the golden standard for therapeutical studies; unfortunately they are really few in this field. It is anyway significative that all the studies reported focus on the use of antipsychotics in people with intellectual disability presenting behavioural problems. To increase the validity of these studies it is recommendable to proceed only with well-designed studies, possibly double-blind versus placebo or other medications. There is need to define precise inclusion criteria, precise symptomatological or behavioural targets and adaptative ability assessment, using valid and reliable diagnostic instruments.
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Affiliation(s)
- Giampaolo La Malfa
- Italian Society for the study of Mental Retardation, Department of Neurological and Psychiatric Sciences, Psychiatry Unit, University of Florence, Hospital of Careggi, Florence, Italy.
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Bays HE. Current and investigational antiobesity agents and obesity therapeutic treatment targets. ACTA ACUST UNITED AC 2004; 12:1197-211. [PMID: 15340100 DOI: 10.1038/oby.2004.151] [Citation(s) in RCA: 144] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Public health efforts and current antiobesity agents have not controlled the increasing epidemic of obesity. Investigational antiobesity agents consist of 1) central nervous system agents that affect neurotransmitters or neural ion channels, including antidepressants (bupropion), selective serotonin 2c receptor agonists, antiseizure agents (topiramate, zonisamide), some dopamine antagonists, and cannabinoid-1 receptor antagonists (rimonabant); 2) leptin/insulin/central nervous system pathway agents, including leptin analogues, leptin transport and/or leptin receptor promoters, ciliary neurotrophic factor (Axokine), neuropeptide Y and agouti-related peptide antagonists, proopiomelanocortin and cocaine and amphetamine regulated transcript promoters, alpha-melanocyte-stimulating hormone analogues, melanocortin-4 receptor agonists, and agents that affect insulin metabolism/activity, which include protein-tyrosine phosphatase-1B inhibitors, peroxisome proliferator activated receptor-gamma receptor antagonists, short-acting bromocriptine (ergoset), somatostatin agonists (octreotide), and adiponectin; 3) gastrointestinal-neural pathway agents, including those that increase cholecystokinin activity, increase glucagon-like peptide-1 activity (extendin 4, liraglutide, dipeptidyl peptidase IV inhibitors), and increase protein YY3-36 activity and those that decrease ghrelin activity, as well as amylin analogues (pramlintide); 4) agents that may increase resting metabolic rate ("selective" beta-3 stimulators/agonist, uncoupling protein homologues, and thyroid receptor agonists); and 5) other more diverse agents, including melanin concentrating hormone antagonists, phytostanol analogues, functional oils, P57, amylase inhibitors, growth hormone fragments, synthetic analogues of dehydroepiandrosterone sulfate, antagonists of adipocyte 11B-hydroxysteroid dehydrogenase type 1 activity, corticotropin-releasing hormone agonists, inhibitors of fatty acid synthesis, carboxypeptidase inhibitors, indanones/indanols, aminosterols, and other gastrointestinal lipase inhibitors (ATL962). Finally, an emerging concept is that the development of antiobesity agents must not only reduce fat mass (adiposity) but must also correct fat dysfunction (adiposopathy).
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Affiliation(s)
- Harold E Bays
- FACP Louisville Metabolic and Atherosclerosis Research Center, 3288 Illinois Ave., Louisville, KY 40213, USA.
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Abstract
Although people with intellectual disabilities are at increased risk for psychiatric disorders, the type and rate of these problems differ between those with different causes for their retardation. In this paper, we review behavioural and psychiatric problems in persons with Prader-Willi syndrome, a disorder caused by a paternally derived deletion at chromosome 15(q11-q13) in about 70% of affected patients, and by maternal uniparental disomy in the majority of the remaining patients. In addition to the syndrome's characteristic hyperphagia and food seeking, individuals with Prader-Willi syndrome also have increased risks of nonfood, compulsive behaviours. These include skin picking, which is highly prevalent, as well as more variable rates of hoarding, redoing and concerns with symmetry, exactness, cleanliness, ordering and arranging. Relative to others with mental retardation, persons with Prader-Willi syndrome are at a marked increased risk for developing full-blown, obsessive-compulsive disorder. In addition, many people with Prader-Willi syndrome show increased rates of tantrums, oppositionality and aggression. Recent findings suggest that they also have an increased risk of psychotic disorder or affective illness with a psychotic component, especially young adult patients and those with the maternal uniparental disomy as opposed to paternal deletion. Dietary approaches include a reduced-calorie diet and increased physical activity, as well as close supervision around food and keeping food locked away. To date, neither CNS stimulants nor anorectic agents have been effective in treating hyperphagia, in part because hyperphagia in Prader-Willi syndrome is attributed to decreased satiation as opposed to increased hunger. Treatment for compulsivity and maladaptive behaviours include: behavioural programming; a structured, predictable routine; extra help with transitions; family support; and pharmacotherapy. Although formal drug studies have yet to be conducted, SSRIs have been effective in reducing skin picking, compulsivity and aggressive episodes in some individuals with Prader-Willi syndrome. Atypical antipsychotics have also proven helpful in persons with psychotic features or extreme aggression and impulsivity. Largely on the basis of case studies, the risks and benefits of these and other drugs in Prader-Willi syndrome are reviewed. Drug trials that move beyond case studies and that assess the relative efficacy of behavioural treatments alone or in combination with pharmacotherapy are sorely needed.
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Affiliation(s)
- Elisabeth Dykens
- University of California Los Angeles, Los Angeles, California 90024, USA
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Abstract
Obesity accelerates morbidity and mortality and has been described by the World Health Organization (WHO) as an epidemic in many industrialised nations [101,102]. Diet, exercise and lifestyle recommendations have proven to be mostly ineffective in adequately preventing or treating the progression of this public health disease. Existing drug treatment is limited by the scarce number of safe and well-tolerated drugs with proven long-term efficacy in maintaining weight loss. Numerous anti-obesity drugs in development have promise. Yet, despite that obesity is the single most common nutritional problem in many developed nations and despite the devastating health consequences of this unchecked epidemic, investigational anti-obesity drugs face unique and significant challenges due to past and current experiences with anti-obesity drugs. It is anticipated that new anti-obesity drugs for this serious, multifaceted metabolic disease will become as safe and effective and as medically accepted as the treatment of other metabolic disorders such as hypertension, dyslipidaemia or Type 2 diabetes mellitus. This may be particularly important, given that these metabolic disorders may be largely due to or exacerbated by obesity itself.
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Affiliation(s)
- Harold Bays
- L-MARC Research Center, Louisville, Kentucky 40213, USA
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