fluvoxamine and Child-Development-Disorders--Pervasive

Autism spectrum disorders (ASD) are characterised by abnormalities in social interaction and communication skills, as well as stereotypic behaviours and restricted activities and interests. Selective serotonin reuptake inhibitors (SSRIs) are prescribed for the treatment of conditions often comorbid with ASD such as depression, anxiety and obsessive-compulsive behaviours.. To determine if treatment with an SSRI:1. improves the core features of autism (social interaction, communication and behavioural problems);2. improves other non-core aspects of behaviour or function such as self-injurious behaviour;3. improves the quality of life of adults or children and their carers;4. has short- and long-term effects on outcome;5. causes harm.. We searched the following databases up until March 2013: CENTRAL, Ovid MEDLINE, Embase, CINAHL, PsycINFO, ERIC and Sociological Abstracts. We also searched ClinicalTrials.gov and the International Clinical Trials Registry Platform (ICTRP). This was supplemented by searching reference lists and contacting known experts in the field.. Randomised controlled trials (RCTs) of any dose of oral SSRI compared with placebo, in people with ASD.. Two authors independently selected studies for inclusion, extracted data and appraised each study's risk of bias.. Nine RCTs with a total of 320 participants were included. Four SSRIs were evaluated: fluoxetine (three studies), fluvoxamine (two studies), fenfluramine (two studies) and citalopram (two studies). Five studies included only children and four studies included only adults. Varying inclusion criteria were used with regard to diagnostic criteria and intelligence quotient of participants. Eighteen different outcome measures were reported. Although more than one study reported data for Clinical Global Impression (CGI) and obsessive-compulsive behaviour (OCB), different tool types or components of these outcomes were used in each study. As such, data were unsuitable for meta-analysis, except for one outcome (proportion improvement). One large, high-quality study in children showed no evidence of positive effect of citalopram. Three small studies in adults showed positive outcomes for CGI and OCB; one study showed improvements in aggression, and another in anxiety.. There is no evidence of effect of SSRIs in children and emerging evidence of harm. There is limited evidence of the effectiveness of SSRIs in adults from small studies in which risk of bias is unclear.

Topics: Adult; Age Factors; Autistic Disorder; Child; Child Development Disorders, Pervasive; Citalopram; Fenfluramine; Fluoxetine; Fluvoxamine; Humans; Obsessive-Compulsive Disorder; Randomized Controlled Trials as Topic; Selective Serotonin Reuptake Inhibitors

A systematic review of randomized controlled trials of the use of atypical antipsychotics and selective serotonin reuptake inhibitors in the treatment of behavioural problems associated with pervasive developmental disorders is reported. A search through both published and unpublished literature, including contacting drug companies and known experts in the field was undertaken. Six trials met the criteria for inclusion in the review. They largely suffer from methodological weaknesses; only two trials had satisfactory methodological quality. The heterogeneity in outcome measurements prevented from conducting a meta-analysis. There is yet no coherent body of data concerning the effects of these medications across all sub-classifications of pervasive developmental disorders, across all age categories, and concerning their medium- and long-term effects, and their effects on quality of life. Atypical antipsychotics and selective serotonin reuptake inhibitors may be of benefit for behavioural problems associated with pervasive developmental disorders. Risperidone has been the best studied among these medications. Atypical antipsychotics appear to have a low risk of extrapyramidal symptoms during short-term treatment. The reviewed trials cannot provide data on the use of selective serotonin reuptake inhibitors in the treatment of children with pervasive developmental disorders. No firm conclusions for clinical practice can be drawn. Larger, well-conducted randomized controlled trials with long-term follow-up are needed.

Topics: Adolescent; Antipsychotic Agents; Child; Child Behavior Disorders; Child Development Disorders, Pervasive; Cross-Over Studies; Double-Blind Method; Fluoxetine; Fluvoxamine; Humans; Randomized Controlled Trials as Topic; Reproducibility of Results; Risperidone; Selective Serotonin Reuptake Inhibitors; Time Factors; Treatment Outcome

We recently encountered a patient with pervasive developmental disorder not otherwise specified (PDDNOS), in whom complication by social anxiety disorder (SAD) was diagnosed at age 19, and who responded well to fluvoxamine therapy. The patient was a 19-year, 10-month-old male. He first visited our department at the age of 11 years and 3 months with the chief complaint of maladaptive behavior at school, when he was diagnosed as having PDDNOS. He was subsequently managed as an outpatient, with symptomatic alleviation in response to treatment. Recently, he visited our department again with the chief complaint of phobia of eye contact with other people. Based on the diagnosis of PDDNOS complicated by SAD, fluvoxamine therapy was initiated, which resulted in alleviation of the phobia against his own glance. Our experience with this case suggests that treatment with selective serotonin reuptake inhibitors can be effective in patients with PDDNOS complicated by SAD. Further study of patients with PDD associated with SAD, including evaluation of drug therapy, in additional cases is warranted.

Topics: Adult; Anxiety Disorders; Child; Child Development Disorders, Pervasive; Fluvoxamine; Humans; Male; Psychiatric Status Rating Scales; Selective Serotonin Reuptake Inhibitors; Social Behavior Disorders; Treatment Outcome; Young Adult

Pediatric populations, including those with autistic disorder or other pervasive developmental disorders, increasingly are being prescribed selective serotonin reuptake inhibitors (SSRIs). Little is known about the age-related brain pharmacokinetics of SSRIs; there is a lack of data regarding optimal dosing of medications for children. The authors used fluorine magnetic resonance spectroscopy ((19)F MRS) to evaluate age effects on whole-brain concentrations of fluvoxamine and fluoxetine in children taking SSRIs.. Twenty-one pediatric subjects with diagnoses of autistic disorder or other pervasive developmental disorders, 6-15 years old and stabilized with a consistent dose of fluvoxamine or fluoxetine, were recruited for the study; 16 successfully completed the imaging protocol. Whole-brain drug levels in this group were compared to similarly acquired data from 28 adults.. A significant relationship between dose and brain drug concentration was observed for both drugs across the age range studied. Brain fluvoxamine concentration in the children was lower, consistent with a lower dose/body mass drug prescription; when brain concentration was adjusted for dose/mass, age effects were no longer significant. Brain fluoxetine concentration was similar between age groups; no significant age effects on brain fluoxetine drug levels remained after adjustment for dose/mass. Observations of brain fluoxetine bioavailability and elimination half-life also were similar between age groups.. These findings suggest that fluvoxamine or fluoxetine prescriptions adjusted for dose/mass are an acceptable treatment approach for medicating children with autistic disorder or other pervasive developmental disorders. It must be determined whether these findings can be generalized to other pediatric populations.

Topics: Adolescent; Adult; Age Factors; Autistic Disorder; Brain; Brain Chemistry; Child; Child Development Disorders, Pervasive; Depressive Disorder; Dose-Response Relationship, Drug; Fluorine; Fluoxetine; Fluvoxamine; Half-Life; Humans; Magnetic Resonance Spectroscopy; Middle Aged; Obsessive-Compulsive Disorder; Panic Disorder; Selective Serotonin Reuptake Inhibitors

Recent reports suggest that selective serotonin reuptake inhibitors (SSRIs) are useful in the treatment of individuals with autism and other pervasive developmental disorders. We report on a single case study of the use of fluvoxamine with a 7-year-old Caucasian girl with severe pervasive developmental disorder. Our findings indicate that fluvoxamine was significantly effective in reducing stereotypical, repetitive behaviors, anxiety, and aggression and in improving prelinguistic and social behaviors. Our results indicate that the use of the SSRIs as a platform for the long-term habilitation of these children should be considered, but further studies are required to establish the efficiency of fluvoxamine for the treatment of children with autism.

Topics: Child; Child Development Disorders, Pervasive; Female; Fluvoxamine; Humans; Selective Serotonin Reuptake Inhibitors; Severity of Illness Index