ASD is commonly associated with a host of challenging behaviours. Pharmacotherapy is indicated if psycho-social and educational interventions fail. Atypical antipsychotics have the strongest evidence-base so far, with both risperidone and aripiprazole are FDA-approved. Unfortunately, their use is fraught with metabolic and neuro-hormonal side effects. Here, authors report on a case of ASD/mild ID with behavioural dyscontrol that failed multiple psychotropic trials and ultimately responded favourably to agomelatine monotherapy. This was achieved with excellent tolerability. This might open new venues in such complicated cases. 

Agomelatine Monotherapy for Autism-A Case Report.

Cyproheptadine has a unique pharmacologic portfolio that speaks to the idea of a pluripotent molecule beyond an antiallergic agent which can expand its therapeutic potential to address a multitude of psychiatric indications. Here, authors touch on the topic with focused literature review of extant evidence.

/pdf/cyproheptadine-a-psychopharmacological-treasure-trove-3e8i3pjhf5.pdf

Cyproheptadine: a psychopharmacological treasure trove?

Copyright © maladaptive challenging behaviors. Pharmacotherapy is indicated once psychosocial and educational interventions (eg, Lovaas' applied behavior analysis) prove ineffective, inadequate, or inaccessible. A sound evidence-base supports the use of atypical antipsychotics to address these behavioral facets. This is reflected in Food and Drug Administration approval of both risperidone (5–16 years) and aripiprazole (6–17 years) to tackle severe irritability (self-injury, tantrums, and aggression). Unfortunately, these agents are plaguedwith heinous neurohormonal and cardiometabolic (diabesity) adverse effects, in this population who are at a heightened vulnerability by virtue of neurodisability and young age. These problem behaviors could interfere with acquisition of more functional and adaptive behaviors, add to caregivers' distress, and are a primary reason for referral to a child psychiatrist. These include, inter alia, attention-deficit/hyperactivity disorder symptom profile, severe irritability, aberrant sleeping and eating patterns, inappropriate sexuality, and comorbid anxiety, mood disorders, catatonia, or tics. There is then a pressing need to explore agents that are both efficacious and tolerable. Here, we report a case of essential ASD and moderate intellectual disability with a severe behavioral component that failed multiple psychotropic trials either for ineffectiveness or poor tolerability issues. Interestingly, the case has ultimately responded favorably to the atypical antidepressant, tianeptine at 25 mg/d with great tolerability. Response was well sustained over a 30-week duration at the time of writing up this report. Tianeptine is uniquely a selective serotonin reuptake enhancer antidepressant. It additionally enhances extracellular dopamine in nucleus accumbens and is a μ opiate agonist, hence possessing an abuse potential. It has also been demonstrated to normalize stress-induced glutamate excitotoxicity in

Mahmoud Ali

Papers

A Case of Prepubertal Low-Functioning Autism With Behavioral Decompensation Favorably Responding to Tianeptine.