Practice Based Learning: Management of agitation in Autism Spectrum Disorder

 

 

 

Presented by Mohammed Shahnawaz MD (PGY1)

Objectives:

  • Elucidate Autism Spectrum Disorder (ASD) characteristics and prevalence of aggression
  • Discuss options for relieving agitation and aggression
  • Inform ourselves about pharmaceutical options to reduce aggressive behavior
  • Explore future study opportunities

ASD:

  • DSM-V Diagnostic Criteria
  • Persistent deficits in social interaction in multiple settings
  • Restricted repetitive behavior, interests or activities
  • Impairment in function
  • Present in early developmental period
  • Diagnostic tools include Autism behavior checklist and Checklist for Autism in Toddlers (CHAT)

Aggression in ASD:

  • Aggression is a common manifestation in ASD
  • Difficult to provide care
  • Prevalence:
    • 53% of patients in Mazurek et al.
    • 68% of patients directed agitation toward caregiver in Kanne et al.
  • Communication barrier for patients and caregivers

Treatment options:

  • Benzodiazepines:
    • Lorazepam (Ativan)
      • Onset via IV: 2-3 minutes
      • Duration: 6-8 hours
  • Typical antipsychotics:
    • Haloperidol  (Haldol)
      • Onset of action IV: seconds-minutes
      • Duration: 4-6 hours
  • Atypical antipsychotics:
    • Olanzapine (Zyprexa)
      • Onset via IM: 15-45 minutes
      • Duration: 2-4 hours

Recommendations:

  • Olanzapine can be considered for long term use in ASD
  • Risperidone has been shown to be statistically significant in reducing symptoms
  • Behavioral and educational therapy with family involvement is still crucial in long-term management and first line

References:

Shea S, Tet al. Risperidone in the treatment of disruptive behavioral symptoms in children with autistic and other pervasive developmental disorders. Pediatrics. 2004 Nov;114(5):e634-41.

Fido A, Al-Saad S. Olanzapine in the treatment of behavioral problems associated with autism: an open-label trial in Kuwait. Med Princ Pract. 2008;17(5):415-8.

Mazurek, et al. Prevalence and correlates of aggression in children and adolescents with autism spectrum disorders. PsycEXTRA Dataset (2013): n. pag. Web. 18 July 2017.

Kanne SM, Mazurek MO. Aggression in children and adolescents with ASD:
prevalence and risk factors. J Autism Dev Disord. 2011 Jul;41(7):926-37.

Khan SS, Mican LM. A naturalistic evaluation of intramuscular ziprasidone versus intramuscular olanzapine for the management of acute agitation and aggression in children and adolescents. J Child Adolesc Psychopharmacol. 2006 Dec;16(6):671-7.

Scanlon PJ, Faxon DP, Audet AM, et al. ACC/AHA guidelines for coronary angiography: executive summary and recommendations. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Coronary Angiography) developed in collaboration with the Society for Cardiac Angiography and Interventions. Circulation. 1999 May 4;99(17):2345-57.

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