ObjectiveRisperidone long-acting injection (RLAI) was shown to be an alternative option in adult patients, but there is not available data in child and adolescents about this medication. The aim of this study is to evaluate the safety and efficiency profile of RLAI in a group of adolescents.MethodsEleven cases with conduct disorder and severe aggressive behaviors were initiated treatment with risperidone oral form. All cases were then shifted to RLAI 25 mg injection in each 15 days due to poor compliance to oral risperidone treatment. Efficiency of treatment included indicators of clinical severity and improvement, which were evaluated by Clinical Global Impression-Severity (CGI-S) and Improvement (CGI-I). Safety evaluation was performed by using Extrapyramidal Symptoms Rating Scale, and by monitoring body weight. Follow-up visits were done at the treatment initiation, and 8th, 16th, and 24th weeks of first injection.ResultsStudy included 9 girls, and 2 boys, with a mean age of 14.9±1.0 years. The CGI-S scores decreased from 6.6±0.5 at the beginning to 2.2±1.1 at the last visit (p<0.001), which is a very significant decrease through better clinical level. The CGI-I scores were also improved significantly from 2.4±0.5 to 1.9±0.5 at 24th week (p=0.001). Safety parameters were also showed favorable results, which there was no significant weight gain (p=0.076), and well-tolerated extrapyramidal adverse effects.ConclusionOur results showed that RLAI is an efficient and safe medication option in the treatment of psychiatric disorders and severe behavioral problems in adolescents with low-compliance to oral treatment in our cases.
ÖZETOtistik Spektrum Bozukluğu (OSB) yaşamın ilk üç yılı içinde ortaya çıkan, sosyal etkileşim, sözel ve sözel olmayan iletişim sorunlarıyla ve tekrarlayıcı ve kısıtlı ilgi ve davranışlar ile kendini gösteren nöropsiki-yatrik bir bozukluktur. OSB olan hastaların öfke nöbetleri, saldırganlığı, hiperaktivitesi ve stereotipileri için farmakolojik girişimler gerekebilmektedir. Amerikan Gıda ve İlaç Dairesi (FDA) aripiprazolün OSB olan çocuk ve ergenlerin öfke nöbeti tedavisinde kullanılmasına onay vermesi ile birlikte bu ilacın OSB olan çocuk ve gençlerde kullanımına ilişkin bir ilgi artışı olmuştur. Aripiprazol, dopamin D2, serotonin 5-HT1A reseptörlerinin parsiyel agonisti ve 5-HT2A reseptörlerinin antagonistidir. Aripiprazolün parsiyel agonist olması nedeniyle ekstrapiramidal yan etkilere, hareket bozukluklarına ve metabolik sorunlara karşı koruyucu bir etkisinin olabileceği düşünülmüş, ancak çocuk ve ergenlerde kullanım sıklığının artışı ile birlikte bu yan etkilerle ilgili olgu sunumlarında bir artış olmuştur. Bununla birlikte yazın bilgileri gözden geçirildiğin-de OSB olan beş yaş altındaki çocukların aripiprazol kullanımı ve akut distoni arasındaki ilişki ile ilgili bilgilerin kısıtlı olduğu görülmüştür. Bu yazıda, düşük dozda aripiprazol tedavisi sırasında distoni gelişen ve Naranjo'nun ilaç yan etki olasılığı skalasına göre bu yan etkilerin kuvvetli olasılıkla aripiprazole bağlı olduğu belirlenen beş yaş altında OSB olan iki olgu sunulmuştur. Pharmacologic interventions may be needed for the treatment of temper tantrums, aggression, hyperactivity, and stereotypes in children with ASD. The approval of aripiprazole by the United States Food and Drug Administration (USFDA) for the treatment of temper tantrums in children and adolescents with ASD has gained increased interest for the use in these patients. Aripiprazole is a partial agonist for the dopamine D2, serotonin 5-HT1A receptors, and an antagonist for 5HT2A receptors. Because aripiprazole is a partial agonist, it has been is speculated that aripiprazole has a protective effect for extrapyramidal side effects, movement disorders, and metabolic problems. But the increased use in children and adolescents is associated with an increase in the number of case reports related with such problems. Nevertheless, our review of the literature uncovered limited data regarding the association between acute dystonia and aripiprazole use in ASD children under five years of age is. In this paper, we present two cases of autistic spectrum disorder children with ages under 5 years that developed acute dystonia taking aripiprazole.
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