ABSTRACT

BACKGROUND: Treatment of the complications arising from Prenatal Alcohol Exposure (PAE) has largely been focused on psychosocial and environmental approaches. Research on the use of medications, especially psychotropic medications, has lagged behind. OBJECTIVES: This systematic review sought to investigate psychotropic medication related findings and outcomes in those diagnosed with Fetal Alcohol Spectrum Disorder (FASD). METHODS: Comprehensive searches were conducted in seven major databases (Medline/ PubMed, Scopus, Web of Knowledge, Embase, PsycINFO, Cochrane Library, and PsycARTICLES) up to February 2017. Key search terms with synonyms were mapped on these databases. There were no timeline restrictions and no grey literature searches. Two reviewers independently assessed 25 studies that met the inclusion criteria. Most studies were reviews of treatment and retrospective case series. RESULTS: Two crossover randomized trials were reported, and the findings were not amenable to meta-analysis. Several conditions (depression, agitation, seizures, and outburst) combined with the most frequent presentation, ADHD, to represent the rationale for prescribing psychotropic medications. Second-generation antipsychotics were found to improve social skills, but the paucity of data limited the extent of clinical guidance necessary for the field. CONCLUSIONS: The systematic review showed that there are some clinical evidence displaying the validity of psychopharmacological interventions in people with FASD, which varies across the spectrum of disease severity, age, and gender. There is a need for more clinical evidencebased studies in addition to clinical expert opinions to substantiate an optimal ground for individualized management of FASD.The study protocol for this review was registered in PROSPERO with registration number CRD42016045703.

Although dysfunctional anger is not a Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition, Text Revision [DSM-IV-TR]) diagnosis, it sometimes presents as a primary clinical complaint and as a comorbid feature in a subset of adults with attention-deficit/hyperactivity disorder (ADHD). No known studies have examined electroencephalographic (EEG) profiles in adults with comorbid dysfunctional anger and ADHD (ADHD + anger). Resting EEG was recorded in 14 ADHD + anger adults (11 males) and 14 controls. Relative power was assessed at standard frequencies, as was frontal absolute α power asymmetry. A modest increase was noted in β1 power in the ADHD + anger group. Unexpectedly, relatively decreased left (or increased right) frontocortical activity (α assessed) was noted in the ADHD + anger group, which was also characterized by a more diffuse θ/β ratio scalp distribution. Nonmedicated ADHD + anger adults exhibited modest resting cortical hyperarousal, consistent with the findings in a subset of children with ADHD characterized by anger-associated problems. The unexpected frontal α asymmetry may reflect enhanced activity of frontal inhibitory mechanisms.

Psychotropic medication treatment of individuals who have experienced prenatal alcohol exposure (PAE) has lagged behind psychosocial interventions. Multiple psychotropic medications are often prescribed for those diagnosed with a range of neurodevelopmental disabilities and impairments of PAE Treatment algorithm for fetal alcohol spectrum disorder (FASD)

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