Лекарственная терапия расстройств аутистического спектра у детей: опыт зарубежных психофармакологов ⁵⁶⁰⁹

Ключевые слова: лекарственная терапия, аутизм, психофармакология

Тип: научная статья

За последние десятилетия число детей, страдающих расстройствами аутистического спектра (РАС), возрастает в катастрофических масштабах. Если около 30-ти лет назад частота встречаемости аутизма равнялась 1 на 10 000 (1), то в настоящее время исследования поражают выявляемыми данными: 1 на 110 детей в США [4], 1% общей популяции [32], 50 – 100 на 10 000 у наших авторов [3]. Роль улучшившейся диагностики аутизма не превышает 1/3 от общего увеличения его случаев [16]. Споры о том, целесообразна ли психофармакотерапия у детей с РАС, продолжаются. Если отечественная психиатрическая школа считает её необходимой и оправданной в большинстве случаев [1, 2, 3], то за рубежом существуют различные мнения на этот счёт. Тем не менее, от 35 до 50% детей с аутизмом в США и Канаде получают как минимум один психотропный препарат, а 50–70% – различные БАДы и «альтернативные» методы лечения [4]. У 74% детей используются новые, не одобренные FDA, препараты и средства [63].

1. Башина В.М., Симашкова Н.В. Аутизм в детстве // В.М. Башина. Лечение и реабилитация. – М.: – Медицина, 1999. – С. 171 206.
2. Козловская Г.В., Калинина М.А., Горюнова А.В., Проселкова М.Е. Опыт применения рисполепта при лечении раннего детского аутизма и шизофрении у детей // Психиатрия и психофармакотерапия. – Приложения. – Т. 1/N. – 2/2000.
3. Симашкова Н.В. Эффективная фармакотерапия и реабилитация больных с расстройствами аутистического спектра // Неврология и психиатрия. – 2011. – № 3. – С. 14-22.
4. Anagnostou E., Hansen Rl. Medical treatment overview: traditional and novel psychopharmacological and complementary and alternative medications // Curr Opin Pediatr. 2011 Dec; 23(6): 621-7.
5. Andari E., Duhamel J.R., Zolla T., et al. Promoting social behavior with oxytocin in high functioning autism spectrum disorder // Proc Natl Acad Sci USA. 2010 Mar 2; 107(9): 4389-94.
6. Anderson L.T., Campbell M., Adams P., et al. The effects of haloperidol on discrimination learning and behavioral symptoms in autistic children // J Autism Dev Disord. 1989 Jan; 19(2): 227-39.
7. Baghdadli A., Gounier V., Aussilloux G. Review of psychopharmacological treatments in adolescents and adults with autistic disorders. // Encephale. 2002 May-June; 28(3Pt1): 248-54.
8. Banaschewski T., Poustka L., Holtmann M. Autism and ADHD across the life span. Differential diagnoses or comordidity? // Nervenarzt. 2011 May; 82(5): 573-80.
9. Barnard L., Young A.H., Pearson J., et al. A systematic review of the use of atypical antipsychotics in autism //J Psychopharmacol. 2002 Mar 16(1): 93-101.
10. Bradstreet J.J., Smith S., Granpeesheh D. et al. Spironolactone might be a desirable immunologic and hormonal intervention in autism spectrum disorders // Med Hypotheses. 2007; 68(5): 979-87.
11. Branford D., Bhaumik S., Naik B. Selective serotonin re-uptake inyibitors for the treatment of perseverative and maladaptive behaviors of people with intellectual disability // J Intellect Disabil Res. 1998 Aug; 42(Pt40:301-6.
12. Chabrol H., Bonnet D., Roge B. Psychopharmacology of autism // Encephale. 1996 May-June; 22(3):197-203.
13. Chanizadeh A. Atomoxetine for Treating ADHD symptoms in Autism: a Systematic Review // J Atten Disord. 2012 Apr 27 (Epub ahead of print).
14. Charnsil C. Efficacy of atomoxetine in children with severe autistic disorders and symptoms of ADHD: an open-label study // J Atten Disord. 2011 Nov; 15(8): 684-9.
15. Chez M.G., Guido-Estrada N. Immune therapy in autism: historical experience and future directions with immunomodulatory therapy // Neurotheraputics. 2010 Jul; 7(3): 293-301.
16. Coo H., Quellette-Kuntz H., Lloyd J.E., et al. Trends in autism prevalence: diagnostic substitution revisited // J Autism Dev Disord. 2008 Jul; 38(6): 1036-46.
17. DeLong GR, Ritch CR, Busch S. Fluoxetine response in children with autistic spectrum disorders: correlation with familial major affective disorder and intellectual achievtment // Dev Med Child Neurol. 2002 Oct 44(10):652-9.
18. Dollfus S., Petit M., Menard J.F., et al. Amisulpride versus bromocriptine in infantile autism: a controlled crossover comparative study of two drugs with opposite effects on dopaminergic function // J Autism Dev Disord. 1992 Mar; 22(1): 47-60.
19. Elbe D., Lalani Z. Review of the pharmacotherapy of irritability of autism // J Can Acad Child Adolesc Psychiatry. 2012 May; 21(2): 130-46.
20. Fink H., Taylor M.A., Chaziuddin N. Catatonia in autistic spectrum disorders: a medical treatment algorithm // Int Rev Neurobiol.2006; 72: 233-44.
21. Frye R.E., Huffman L.C., Elliott G.R. Tetrahydrobiopterin as a novel therapeutic intrvtntion for autism // Neurotheraputics. 2010 Jul; 7(3): 241-9.
22. Frye R.E., Sreenivasula S., Adams J.B. Traditional and non-traditional treatments for autism spectrum disorders with seizures: an on-line survey. BMC Pediatr. 2011 May 18; 11-37.
23. Garcia-Penas J.J. Antiepileptic drugs in the treatment of autistic regression syndrome // Rev Neurol. 2005 Jan 15; 40 Suppl 1: s 173-6.
24. Goiness P., Van de Water J. The immune system`s role in the biology of autism // Curr Opin Neurol. 2010 Apr; 23(2): 111-7.
25. Gralton E.J., james D.H., Lindsey M.P. Antipsychotic medication, psychiatric diagnosis and children with intellectual disability // J Intellect Disabil Res. 1998 Feb; 42(Pt1): 49-57.
26. Green J.J., Hollander E. Autism and oxytocin: new developments in translational approaches to therapeutics // Neurotheraputics. 2010 Jul; 7(3): 250-7.
27. Guastella A.J., Einfeld S.L., Gray R.M. et al. Intranasal oxytocin improves emotion recognition for youth with autism spectrum disorder // Biol Psychiatry. 2010 Apr 1; 6797): 692-4.
28. Hjiej H., Doyen C., Couprie C., Kaye K., et al. Substitutive and dietic approaches in childhood autistic disorder: interests and limits // Encephale. 2008 Oct; 34(5): 496-503.
29. Hollander E., Chaplin W., Soorya L., et al. Divalproex sodium vs placebo for the treatment of irritability in children and adolescents with autism spectrum disorders // Neuropsychopharmacology. 2010 Mar; 35(4): 990-8.
30. Huffman L.S., Sutcliffe T.L., Tanner I.S., et al. Management of symptoms in children with autism spectrum disorders: a comprehensive review of pharmacologic and complementary – alternative medicine treatments // J Dev Behav Pediatr. 2011 Jan; 32 (1): 56-68.
31. James S., Montgomery P., Williams K. Omega-3 fatty acids supplementation for autism spectrum disorders (ASD) // Cochrane Database Syst Rev. 2011 Nov 9; (11): CD 007992.
32. Janusonis S. Origin of the blood hyperserotoninemia of autism // Theor Biol Med Model. 2008 Mar; 3(1): 355-62.
33. Jorgensen O.S. Psychopharmacological treatment of psychotic children. A survey // Acta Psychiatr Scand. 1979 Feb; 59 (2):229-38.
34. Kakooza-Mwesige A., Wachtel L.E., Dhosshe D.M. Catatonia in autism: implications across the life span // Eur Child Adolesc Psychiatry. 2008 Sep; 17(6):327-35.
35. Kaplan G., McCracken J.T. Psychopharmacology of autism spectrum disorders // Pediatr Clin North Am. 2012 Feb; 59:175-87.
36. King C.R. A novel embryological theory of autism causation involving endogenous biochemicals capable of initiating cellular gene transcription: a possible link between twelve autism risk factors and the autism “epidemic”// Med Hypotheses. 2011 May; 76(5): 653-60.
37. Krishnaswami S., McPheeters M.L., Veenstra-Vanderweele J. A systematic review of secretin for children with autism spectrum disorders // Pediatrics. 2011 May; 127 (5): e 1322-5.
38. Leventhal B.L., Cook E.V. Jr, Morford M., et al. Clinical and neurochemical effects of fenfluramine in children with autism // J Neuropsychiatry Clin Neurosci. 1993 Summer; 5(3): 307-15.
39. Linday L.A. Oral famotidine: a potential treatment for children with autism // Med Hypotheses. 1997 May; 48(5): 381-6.
40. Linday L.A., Tsiouris J.A., Cohen I.L., et al. Famotidine treatment for children with autistic spectrum disorders: pilot research using single subject research design // J Neurol Transm. 2001; 108(5): 593-611.
41. Luby J., Mrakotsky C., Stalets M.M., et al. Risperidone in preschool children with autism spectrum disorders: an investigation of safety and efficacy // J Child Adolesc Psychopharmacol. 2006 Oct; 16(5): 575-87.
42. Marrosu F., Marrozu G., Rachel M.G., et al. Paradoxical reactions elicited by diazepam in children with classic autism // Funet Neurol. 1987 Jul-Sep; 2(3): 355-61.
43. Matarazzo E.B. Treatment of late onset autism as a a consequence of probable autoimmune processes related to chronic bacterial infection // World J Biol Psychiatry. 2002 Jul; 3(3): 162-6.
44. McCracken J.T. Safety issues with drug therapies for autism spectrum disorder // J Clin Psychiatry. 2005; 66 Suppl. 10: 32-7.
45. McDougle C.L., Brodkin E.S., Naylor S.T., et al. Sertraline in adults with pervasive developmental disorders: a prospective open-label investigation // J Clin Psychopharmacol. 1998 Feb; 18(1): 62-6.
46. McDougle C.L., Kresch L.E., Posey D.G. Repetetive thoughts and behavior in pervasive developmental disorders: treatment with serotonin reuptake inhibitors // J Autism Dev Disord. 2000 Oct; 30(5): 427-35.
47. McDougle C.L., Kem D.L., Posey D.G. Case series: use of ziprasidone for maladaptive symptoms in youth with autism // J Am Acad Child Adolesc Psychiatry. 2002 Aug; 41(8): 921-7.
48. McKinney C., Renk K. Atypical antipsychotic medications in the management of disruptive behaviors in children: safety guidelines and recommendations // Clin Psychol Rev. 2011 Apr; 31(3): 465-71.
49. McPheeters M.L., Warren Z., Sathe N. A systematic review of medical treatments for children with autism spectrum disorders // Pediatrics. 2011 vol. 127 №5 May 1: e 1312-1321.
50. Millward C., Ferriter M., Calver S., et al. Gluten– and casein– free diet for autistic spectrum disorders // Cochrane Database Syst Rev. 2008 Apr 16(2): CD 003498.
51. Ming X., Julu P.O., Brimacombe M., et al. Reduced cardiac parasympathetic activity in children with autism // Brain Dev. – 2005. – vol. 5. – 486-93.
52. Modi M.E., Young L.J. The oxytocin system in drug discovery for autism: animal models and novel therapeutic strategies // Horm Behav. 2012 Mar; 61 (3): 340-50.
53. Moscal J.R., Burqdorf J. A novel NMDA receptor glycine-syte partial agonist GLYX- 13 has therapeutic potential for the treatment of autism // Neurosci Biobehav Rev. 2011 Oct; 35(9): 1982-8.
54. Newcomer J.W. Second-generation (atypical) antipsycotics and metabolic effects: a comprehensive literature review // CNS Drugs. 2005; 19 suppl. 1: 1-93.
55. Niederhofer H., Staffen W., Mair A. Galantamine might be effective in treating autistic disorder // BMJ. 2002 Dec 14; 325 (7377): 1422.
56. Posey D.J., Walsh K.H., Wilson G.A., et al. Risperidone in the treatment of two very young children with autism // J Child Adolesc Psychopharmacol. 1999; 9 (4): 273-6.
57. Posey D.J., McDougle C.J. The pharmacotherapy of target symptoms associated with autistic disorder and other pervasive developmental disorders // Harv Pev psychiatry. 2000 Jul-Aug; 8(2): 45-63.
58. Posey D.J., Puntney J.I., Sasher T.M., et al. Guanfacine treatment of hyperactivity and inattention in pervasive developmental disorders: a retrospective analysis of 80 cases // J Child Adolesc Psychopharmacol. 2004 Summer; 14(2): 233-41
59. Posey D.J., Erickson C.A., McDougle C.J. Developing drugs for core social and communication impairment in autism // Child Adolesc Psychiatr Clin N Am. 2008 Oct; 17(4): 787.
60. Poustka L., Banaschewski T., Poustka F. Psychopharmacology of autism spectrum disorders // Nervenarzt. 2011 May; 82(5): 582-9.
61. Rajapakse T., Pringsheim T. Pharmacotheraputics of Tourette syndrome and stereotypes in autism // Semin Pediatr Neurol. 2010 Dec; 17(4): 254-60.
62. Realmuto G.M., August G.J., Garfinkel B.D. Clinical effect of buspirone in autistic children // J Clin Psychopharmacol. 1989 Apr; 9(2): 122 5.
63. Robb A.S. Managing irritability and aggression in autism spectrum disorders in children and adolescents//Dev Disabil Res Rev 2010; 16(3): 258-64.
64. Rossignol D.A. Novel and emerging treatments for autism spectrum disorder: a systematic review // Ann Clin Psychiatry. 2009 Oct-Dec; 21(4): 213-36.
65. Rossignol D.A., Frye R.E. Melatonin in autism spectrum disorders: a systematic review and meta-analysis // Dev Med Child Neurol. 2011 Sep; 53(9): 783-92.
66. Possignol D.A., Frye R.E. Mitochondrial dysfunction in autism spectrum disorders: a systematic review and meta-analysis // Mol Psychiatry. 2012 Mar; 17(3): 290-314.
67. Rothenberger A. Psychopharmacological treatment of self-injurious behavior in individuals with autism // Acta Paedopsychiatr. 1993; 56(2): 99-103.
68. Rugino T.A., Samsock T.C. Levetiracetam in autistic children: an open-label study // J Dev behave Pediatr. 2002 Aug; 23(4): 22-30.
69. Shattock P., Whiteley P. Biochemical aspects in autism spectrum disorders: updating the opioid-excess theory and presenting new opportunities for biomedical intervention // Expert Opin Theor Targets. 2002 Apr; 6(2): 175-183.
70. Sloman L. Use of medication in pervasive developmental disorders // Psychiatr Clin North Am. 1991 Mar; 14(1): 165-82.
71. Stachnik J.M., Nunn-Thompson C. Use of atypical antipsychotics in the treatment of autistic disorder // Ann Pharmacother. 2007 Apr; 41(4): 626-34.
72. Wei H., Dobkin C., Sheikh F.M., et al. the therapeutic effect of memantine through the stimulanion of synapse formation and dendritic spine maturation in autism and fragile X syndrome // PLoS One. 2012; 7(5): e 36981.
73. White S.W., Oswald D., Ollendick T., et al. Anxiety in children and adolescents with autism spectrum disorders // Clin Psychol Rev. 2009 Apr; 29(3): 216-229.
74. Zuddas A., Di Martino A., Muglia P., et al. Long-term risperidone for pervasive developmental disorder: efficacy, tolerability, and discontinuation // J Child Adolesc Psychopharmacol. 2000 Summer; 10(2): 79-90.