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SPECIAL ISSUE: PSYCHOPHARMACOLOGY AND PSYCHOSOMATIC RESEARCH |
From the University of Michigan Medical School; and Developmental Disorders Clinic, Child and Adolescent Psychiatric Hospital, University of Michigan Medical Center (L.Y.T.), Ann Arbor, MI.
Address reprint requests to: Luke Y. Tsai, MD, Child and Adolescent Psychiatric Hospital, University of Michigan Medical Center, 1500 E. Medical Center Dr., Ann Arbor, MI 48109-0390.
Autism is a neurobiological disorder. The core clinical features of autism include impairment in social interaction, impairments in verbal and nonverbal communication, and restricted, repetitive, and stereotyped patterns of behavior, interests, and activities. Autism often has coexisting neuropsychiatric disorders, including seizure disorders, attention deficit hyperactivity disorder, affective disorders, anxiety disorder, obsessive-compulsive disorder, and Tourette disorder. No etiology-based treatment modality has been developed to cure individuals with autism. However, comprehensive intervention, including parental counseling, behavior modification, special education in a highly structured environment, sensory integration training, speech therapy, social skill training, and medication, has demonstrated significant treatment effects in many individuals with autism. Findings from preliminary studies of major neurotransmitters and other neurochemical agents strongly suggest that neurochemical factors play a major role in autism. The findings also provide the rationale for psychopharmacotherapy in individuals with autism. This article reviews studies of neurochemical systems and related psychopharmacological research in autism and related neuropsychiatric disorders. Clinical indications for pharmacotherapy are described, and uses of various medications are suggested. This article also discusses new avenues of investigation that may lead to the development of more effective medication treatments in persons with autism.
Key Words: autism • neuropsychiatric disorders • neurotransmitters • psychopharmacotherapy
Abbreviations: BE = ß-endorphin; CMI = clomipramine; CSF =cerebrospinal fluid; HVA = homovanillic acid; OCD =obsessive-compulsive disorder; R-BH4 =6R-L-erythro-5,6,7,8-tetrahydrobiopterin; 5-HT =5-hydroxytryptamine (serotonin).
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