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[Pharmacological treatments in patients with pervasive developmental disorders: A review].
Encephale. 2014 Apr; 40(2):188-96.E

Abstract

BACKGROUND

Pervasive developmental disorders (PDD) are neurodevelepmental disorders that are characterized by severe deficits in socialisation and communication, and the existence of repetitive and stereotyped interests and behaviours. It is estimated more than 60/100,000 children are suffering from PDD. Comorbid disorders are common in people with PDD, including intellectual deficiency, symptoms of attention deficit-hyperactivity, aggression and disruption, and pervasive repetitive behaviours or thoughts. These symptoms have a negative impact on the outcome and quality of life of the patients and their caregivers. The first-line management of comorbid disorders in PDD is behavioural intervention, but sometimes this is not sufficient, and the use of pharmacological treatment is needed.

METHOD

We conducted a review of studies of medical treatments used in patients with PDD to establish which treatments show good evidence of efficacy in PDD. We used the Medline database and the following keywords "pervasive development disorders" or "autism spectrum disorders" or "autistic disorder" and "therapy" or "treatment".

RESULTS

The treatments that showed the best efficacy on irritability in well-designed studies are second generation antipsychotics, risperidone and aripiprazole. Some studies indicate that haloperidol is efficient as well, but the very high frequency of extra-pyramidal effects limits its use. Methylphenidate has shown some efficacy on impulsivity and hyperactivity in randomised placebo-controlled studies. First data concerning atomoxetine are promising but better-designed studies are needed. Selective serotonin re-uptake inhibitors: fluvoxamine and fluoxetine have shown some efficacy in the treatment of serious and pervasive repetitive behaviours. Alpha-adrenergic treatments, clonidine and guanfacine, can help in the management of disruptive behaviours in patients with PDD. Data concerning naltrexone are contradictory, indeed many case reports of its efficacy on aggressive (mostly auto-aggressive) behaviours are reported in the literature, but well-designed studies do not find any improvement in patients treated with naltrexone compared with patients treated with placebo. First data concerning ocytocin are promising, indeed, if they were to be confirmed, that would be the first treatment efficient on the core symptoms of PDD.

Authors+Show Affiliations

Service hospitalo-universitaire, centre hospitalier Sainte-Anne, 7, rue Cabanis, 75014 Paris, France; Pôle de psychiatrie générale de Rouen-rive-Droite, centre hospitalier du Rouvray, 76300 Sotteville-les-Rouen, France. Electronic address: laurenebeherec@hotmail.com.Centre de ressource autisme de Haute-Normandie, centre hospitalier du Rouvray, 76300 Sotteville-les-Rouen, France.Centre de ressource autisme de Haute-Normandie, centre hospitalier du Rouvray, 76300 Sotteville-les-Rouen, France.Psychiatrie de l'enfant et de l'adolescent, pôle Femme-Mère-Enfant, CHU Charles-Nicolle, 76031 Rouen, France.Pôle de psychiatrie générale de Rouen-rive-Droite, centre hospitalier du Rouvray, 76300 Sotteville-les-Rouen, France; Unité 614 de l'Inserm, université de Rouen, faculté de médecine et pharmacie, 22, boulevard Gambetta, 76183 Rouen cedex, France.Pôle de psychiatrie générale de Rouen-rive-Droite, centre hospitalier du Rouvray, 76300 Sotteville-les-Rouen, France; Centre de ressource autisme de Haute-Normandie, centre hospitalier du Rouvray, 76300 Sotteville-les-Rouen, France; Unité 614 de l'Inserm, université de Rouen, faculté de médecine et pharmacie, 22, boulevard Gambetta, 76183 Rouen cedex, France.

Pub Type(s)

English Abstract
Journal Article
Review

Language

fre

PubMed ID

24369879

Citation

Béhérec, L, et al. "[Pharmacological Treatments in Patients With Pervasive Developmental Disorders: a Review]." L'Encephale, vol. 40, no. 2, 2014, pp. 188-96.
Béhérec L, Quilici G, Rosier A, et al. [Pharmacological treatments in patients with pervasive developmental disorders: A review]. Encephale. 2014;40(2):188-96.
Béhérec, L., Quilici, G., Rosier, A., Gerardin, P., Campion, D., & Guillin, O. (2014). [Pharmacological treatments in patients with pervasive developmental disorders: A review]. L'Encephale, 40(2), 188-96. https://doi.org/10.1016/j.encep.2012.01.014
Béhérec L, et al. [Pharmacological Treatments in Patients With Pervasive Developmental Disorders: a Review]. Encephale. 2014;40(2):188-96. PubMed PMID: 24369879.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - [Pharmacological treatments in patients with pervasive developmental disorders: A review]. AU - Béhérec,L, AU - Quilici,G, AU - Rosier,A, AU - Gerardin,P, AU - Campion,D, AU - Guillin,O, Y1 - 2013/12/23/ PY - 2011/01/28/received PY - 2011/09/30/accepted PY - 2013/12/28/entrez PY - 2013/12/29/pubmed PY - 2014/12/15/medline KW - Autism spectrum disorders KW - Autistic disorder KW - Pervasive development disorders KW - Review KW - Revue de la littérature KW - Therapy KW - Thérapie KW - Treatment KW - Trouble autistique KW - Troubles envahissants du développement (TED) KW - Troubles liés à l’autisme SP - 188 EP - 96 JF - L'Encephale JO - Encephale VL - 40 IS - 2 N2 - BACKGROUND: Pervasive developmental disorders (PDD) are neurodevelepmental disorders that are characterized by severe deficits in socialisation and communication, and the existence of repetitive and stereotyped interests and behaviours. It is estimated more than 60/100,000 children are suffering from PDD. Comorbid disorders are common in people with PDD, including intellectual deficiency, symptoms of attention deficit-hyperactivity, aggression and disruption, and pervasive repetitive behaviours or thoughts. These symptoms have a negative impact on the outcome and quality of life of the patients and their caregivers. The first-line management of comorbid disorders in PDD is behavioural intervention, but sometimes this is not sufficient, and the use of pharmacological treatment is needed. METHOD: We conducted a review of studies of medical treatments used in patients with PDD to establish which treatments show good evidence of efficacy in PDD. We used the Medline database and the following keywords "pervasive development disorders" or "autism spectrum disorders" or "autistic disorder" and "therapy" or "treatment". RESULTS: The treatments that showed the best efficacy on irritability in well-designed studies are second generation antipsychotics, risperidone and aripiprazole. Some studies indicate that haloperidol is efficient as well, but the very high frequency of extra-pyramidal effects limits its use. Methylphenidate has shown some efficacy on impulsivity and hyperactivity in randomised placebo-controlled studies. First data concerning atomoxetine are promising but better-designed studies are needed. Selective serotonin re-uptake inhibitors: fluvoxamine and fluoxetine have shown some efficacy in the treatment of serious and pervasive repetitive behaviours. Alpha-adrenergic treatments, clonidine and guanfacine, can help in the management of disruptive behaviours in patients with PDD. Data concerning naltrexone are contradictory, indeed many case reports of its efficacy on aggressive (mostly auto-aggressive) behaviours are reported in the literature, but well-designed studies do not find any improvement in patients treated with naltrexone compared with patients treated with placebo. First data concerning ocytocin are promising, indeed, if they were to be confirmed, that would be the first treatment efficient on the core symptoms of PDD. SN - 0013-7006 UR - https://www.unboundmedicine.com/medline/citation/24369879/[Pharmacological_treatments_in_patients_with_pervasive_developmental_disorders:_A_review]_ DB - PRIME DP - Unbound Medicine ER -