1. Drugs Used in Autism and Other Neurological diseases

2. Introduction

3. Autistic Disorders  Autism is a complex developmental disability  appears during the first three years of life  a neurological disorder that affects social interaction and communication skills It is not a mental illness  Children and adults with autism have difficulties in social interactions, and leisure or play activities  In some cases, aggressive and/or self-injurious behaviors might be present

4. Symptoms of children with autism CommunicationSocial relationships  Act as if unaware of the coming and going of others  Are inaccessible, as if in a shell Fail to seek comfort  Fail to develop relationships with peers Exploration of Environment  Remain fixated on a single item or activity  Are intensely preoccupied with a single subject, activity or gesture  Show distress over change  Insist on routine & Lack fear  Avoid eye contact  Act as if deaf  Develop language, then abruptly stop talking

5. Causes of Autism Spectrum Disorders No specific known cause Neurobiological disorder Autism has a genetic compound but suggest that environmental influences play a role as well Autism runs in families, but not in a clear- cut way

6. Etiology: Genetic Evidence she wont ask about etiology Strong evidence for genetic component, but nature of the component is unknown Doesn’t look like a single gene Monozygotic twin !!!!

7. Etiology: Neurotransmitters Serotonin Some studies have found higher levels in children with ASD Opioids Display properties similar to morphine insensitivity to pain, reduced socialization Some studies have found higher levels in children with ASD

8. Etiology: Vaccines Vaccines –Thimerosal - Preservative used in MMR vaccine used to contain mercury

9. Assessment  Coordinated, multi-disciplinary approach Psychologist Speech Therapist Occupational Therapist Physical Therapist Educators Physicians

10. Autism therapies No single treatment is best, and treatment is typically tailored to the child's needs. Treatments fall into two major categories: educational interventions and medical management

11. Treatment of Autism Educational interventions Medical management

12. Advice the parents Incorporate a balance of low -stress, high- pleasure activities Include “stress-free” time in the schedule. Speak in a calm, relaxed voice Give facts in an unemotional tone of voice Reassure the child about the sequence of events Find opportunities to build-up/ compliment the student

13. Arrange schedule from left to right or from top to bottom listing the things to do. Because they love the routine. Music therapy and robota are new.

14. Increase opportunities to engage in activities of high interests Allow individual work Includes singing, movement to music, and playing instruments. Schedule for activities individual enjoys –computer –reading –Drawing

15. There is something called floor time in which the family has a time to communicate together on the floor playing with him/her.

16. Treatment - Medical Children with autism commonly have dysfunctions of the following systems: –Digestive –Immune –Excretory (liver, kidneys, systems that rid body of toxins/wastes) When these systems are treated, the autism also seems to be treated and behavior improves

17. Not everyone with an autism spectrum disorder has the same symptoms, and not all symptoms can be treated with drugs Drugs are intended to address specific symptoms including behavioral issues, anxiety or depression, mood swings (bipolar disorder), obsessive compulsive disorder, attention issues and hyperactivity.

18. The drugs most commonly used in autism * Antipsychotics * Antidepressants * Stimulants * Opiate Antagonists * Benzodiazepines * Alpha-2-NoradrenergicAgonists * Beta-Blockers

19. Treating Anxiety and Depression Selective serotonin reuptake inhibitors (SSRIs) are prescribed for anxiety, depression, and/or obsessive- compulsive disorder. Of these only fluoxetine (Prozac) has been approved by the FDA for both OCD and depression in children age 7 and older. Sertraline (Zoloft) don’t study any names between brackets as above.

20. Treating Behavioral Problems Medications are often used to treat behavioral problems, such as aggression, self-injurious behavior, Antipsychotic medications ( dopamine activity in the brain) Older antipsychotic medications such as haloperidol in treating serious behavioral problems Some of the newer "atypical" antipsychotics may be a better choice, particularly for children. Risperdone(Risperdal), Olanzapine (Zyprexa)

21. Treating Seizures One in four people with ASD also have a seizure disorder they are treated with anticonvulsants such as carbamazepine (Tegretol), valproic acid (Depakote), lamotrigine (Lamictal) Carbamazepine, valproic acid, and lamotrigine are mood stabilizers.

22. Treating Inattention and Hyperactivity Stimulant medications such as methylphenidate (Ritalin) used safely and effectively in attention deficit hyperactivity disorder ADHD for children with autism These medications may decrease impulsivity and hyperactivity in some children, especially those higher functioning children

23. Atypical Antipsychotics Block D2 and serotonin receptors Risperidone is approved by the Food and Drug Administration (FDA) for treating symptomatic irritability in autistic children and adolescents More useful in children suffering from severe and chronic autism Most adverse effects: weigh gain, drowsiness, and high blood sugar Risperidone

24. Typical Antipsychotics Blocks postsynaptic dopamine receptors (D2) Improves withdrawal, hyperactivity, deviant speech كلام غير مفهوم Side effects;  weight gain, parkinsonism,  Sedation (dose dependent) Haloperidol

25. Tricylcic antidepressants Sedative, reduces aggression Relieves many of the symptoms of autism Patients' ability to interact with others is much improved Improves obsessive-compulsive behaviors مهمممممم Clomipramine مهمممممم

26. Selective Serotonin Re-uptake Inhibit ors –Fluoxetine Blocks serotonin re-uptake Improves language, cognition, mood, compulsive symptoms Possible decrease in appetite, restlessness, anorexia, insomnia Children are less responsive

27. Atypical antidepressants Is a potent inhibitor of serotonin reuptake and at higher doses is an inhibitor of NE reuptake Improves attention and communication Decreases hyperactivity Side effects; nausea, headache, BP, HR Venlafaxine

28. Stimulants –A psychostimulant similar to amphetamine – It is one of the most prescribed drug in children with attention deficient hyperactivity disorders (ADHD) مهممم –Decreases hyperactivity associated with ASD –Acts as dopamine and norepinephrin reuptake inhibitor which increase the level of these neurotransmitters in the brain. Methyl phenidate

29. Opiate Antagonists –Block the activity of endogenous opiate system in the CNS – Less aggression, less hyperactivity, more sociability, more communication –Side effects; mild sedation and GI upset Naltrexone

30. Sedative hypnotics –diazepam (Valium) and lorazepam (Ativan). –Potentiate the action of the inhibitory neurotransmitter GABA to stabilize and decrease firing of neurons –Treat explosiveness and aggression which accompanies autism –Side effects; sedation, tolerance and dependence

31. Alpha-2-Noradrenergic Agonist –Pre-synaptic receptor agonist –Decrease NE neurotransmission –Improvement in hyperactivity, inattention, irritability and inappropriate speech –Side effects; sedation, decrease in blood pressure and tolerance to therapeutic effects Clonidine control release of neurotransmitter مهممممة

32. Beta-Blockers Propanolol –Affects the noradrenergic transmission –Decrease impulsive and aggressive behavior الاندفاع والعدوانية –Decrease in self-injurious behaviour –Side effects: drop in BP and bradycardia

33. Vitamins and nutritional supplements Pyridoxine (vitamin B6) Magnesium Vitamin C Immune System Support Insomnia: Melatonin