A symptom-based approach to treatment of psychosis in autism spectrum disorder

Bell, Victoria; Dunne, Henry; Zacharia, Tharun; Brooker, Katrina; Shergill, Sukhi

doi:10.1192/bjo.2017.2

Cited by 8 publications

(6 citation statements)

References 16 publications

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“…Clinical monitoring enabled the proper detection and management of these effects without severe consequences. Seven patients (5.7%) discontinued treatment due to adverse effects (Beebani et al, 2022; Bell et al, 2018; Estay et al, 2018; Grubisha et al, 2014; Scala et al, 2023; Skarpathiotakis and Westreich, 2005; Watchel et al, 2015 ) . Scala et al (2023) and Bell et al (2018) reported cases where clozapine exacerbated obsessive-compulsive symptoms despite alleviating psychiatric symptoms, leading to treatment interruption.…”

Section: Resultsmentioning

confidence: 99%

Exploring clozapine use in severe psychiatric symptoms associated with autism spectrum disorder: A scoping review

da Rosa,

Bezerra,

Rohde

et al. 2024

J Psychopharmacol

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Background: Patients with autism spectrum disorder (ASD) may experience severe psychiatric symptoms, often unresponsive to conventional pharmacological therapies, highlighting the need for more effective alternatives. Aims: This study aims to map and synthesize evidence on the use of clozapine as a therapeutic option for managing severe psychiatric symptomatology co-occurring with ASD. Methods: We conducted a scoping review on multiple sources following the JBI guidelines. The search strategy was inclusive, targeting both peer-reviewed publications and gray literature presenting empirical data on the use of clozapine therapy for patients with ASD accompanied by comorbid psychiatric symptoms. Two independent evaluators performed the selection of studies, data extraction, and critical appraisal. Results: The review included 46 studies, encompassing 122 ASD individuals who received clozapine therapy. The sources of evidence comprise 31 case reports, 8 case series, 6 retrospective observational studies, and 1 quasi-experimental prospective study. The tables present the findings along with a narrative summary. Clozapine treatment demonstrated benefits in four groups of severe and treatment-resistant psychiatric symptoms in ASD patients: disruptive behaviors, psychotic symptoms, catatonia, and mood symptoms. Although side effects were common, tolerability was generally satisfactory. However, severe adverse events, such as seizures, moderate neutropenia, and myocarditis, underscore the need for intensive clinical monitoring. Conclusions: While clozapine shows promise as a pharmacological intervention for severe psychopathologies in ASD, more rigorous clinical studies are required to elucidate its efficacy and safety in this population. The limited robustness of the evidence calls for caution, signaling an early research stage into this topic.

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Section: Resultsmentioning

confidence: 99%

Exploring clozapine use in severe psychiatric symptoms associated with autism spectrum disorder: A scoping review

da Rosa,

Bezerra,

Rohde

et al. 2024

J Psychopharmacol

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“…Autism Spectrum Disorder (ASD), defined by the Diagnostic and Treatment Manual for Mental Disorders, Fifth Edition (DSM-5), is characterized by persistent deficits in social communication interaction and restricted-repetitive patterns of behavior, interests or activities. A specific subtype of ASD is linked to comorbid psychosis, showing positive symptoms of delusion, hallucination, thought disorder, mania and depression and negative symptoms of psychosis appear to share many features with ASD [177]. Cognitive deficits including mental deterioration, are associated with social and communication difficulties that involve components of cognition, communication and social understanding [178].…”

Section: Autism Spectrum Disordermentioning

confidence: 99%

Immune Influencers in Action: Metabolites and Enzymes of the Tryptophan-Kynurenine Metabolic Pathway

et al. 2021

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The tryptophan (TRP)-kynurenine (KYN) metabolic pathway is a main player of TRP metabolism through which more than 95% of TRP is catabolized. The pathway is activated by acute and chronic immune responses leading to a wide range of illnesses including cancer, immune diseases, neurodegenerative diseases and psychiatric disorders. The presence of positive feedback loops facilitates amplifying the immune responses vice versa. The TRP-KYN pathway synthesizes multifarious metabolites including oxidants, antioxidants, neurotoxins, neuroprotectants and immunomodulators. The immunomodulators are known to facilitate the immune system towards a tolerogenic state, resulting in chronic low-grade inflammation (LGI) that is commonly present in obesity, poor nutrition, exposer to chemicals or allergens, prodromal stage of various illnesses and chronic diseases. KYN, kynurenic acid, xanthurenic acid and cinnabarinic acid are aryl hydrocarbon receptor ligands that serve as immunomodulators. Furthermore, TRP-KYN pathway enzymes are known to be activated by the stress hormone cortisol and inflammatory cytokines, and genotypic variants were observed to contribute to inflammation and thus various diseases. The tryptophan 2,3-dioxygenase, the indoleamine 2,3-dioxygenases and the kynurenine-3-monooxygenase are main enzymes in the pathway. This review article discusses the TRP-KYN pathway with special emphasis on its interaction with the immune system and the tolerogenic shift towards chronic LGI and overviews the major symptoms, pro- and anti-inflammatory cytokines and toxic and protective KYNs to explore the linkage between chronic LGI, KYNs, and major psychiatric disorders, including depressive disorder, bipolar disorder, substance use disorder, post-traumatic stress disorder, schizophrenia and autism spectrum disorder.

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“…Autism Spectrum Disorder (ASD), defined by the Diagnostic and Treatment Manual for Mental Disorders, Fifth Edition (DSM-5), is characterized by persistent deficits in social communication interaction and restricted-repetitive patterns of behavior, interests, or activities. A specific subtype of ASD is linked to comorbid psychosis, showing positive symptoms of delusion, hallucination, thought disorder, mania and depression and negative symptoms of psychosis appear to share many features with ASD [176]. Cognitive deficits including mental retardation, are associated with social and communication difficulties that involve components of cognition, communication, and social understanding [177].…”

Section: Autism Spectrum Disordermentioning

confidence: 99%

Immune Influencers in Action: Metabolites and Enzymes of the Tryptophan-Kynurenine Metabolic Pathway

Tanaka¹,

Tóth²,

Polyák³

et al. 2021

Preprint

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The tryptophan (TRP)-kynurenine (KYN) metabolic pathway is a main player of TRP metabolism through which more than 95% of TRP is catabolized. The pathway is activated by acute and chronic immune responses leading to a wide range of illnesses including cancer, immune diseases, neurodegenerative diseases, and psychiatric disorders. The TRP-KYN pathway synthesizes multifarious metabolites including oxidants, antioxidants, neurotoxins, neuroprotectants, and immunomodulators. The immunomodulators are known to facilitate the immune system towards a tolerogenic state, resulting in chronic low-grade inflammation (LGI) that is commonly present in obesity, poor nutrition, exposer to chemicals or allergens, prodromal stage of various illnesses, and chronic diseases. KYN, kynurenic acid, xanthurenic acid, and cinnabarinic acid are aryl hydrocarbon receptor ligands that serve as immunomodulators. Furthermore, TRP-KYN pathway enzymes are known to be activated by the stress hormone cortisol and inflammatory cytokines, and genotypic variants were observed to contribute to inflammation and thus various diseases. The tryptophan 2,3-dioxygenase, the indoleamine 2, 3-oxygenases, and the kynurenine-3-monooxygenase are main enzymes in the pathway. This review article discusses the TRP-KYN pathway with special emphasis on its interaction with the immune system and the tolerogenic shift towards chronic LGI and overviews the major symptoms, pro- and anti-inflammatory cytokines, and toxic and protective KYNs to explore the linkage between chronic LGI, KYNs, and major psychiatric, including depressive disorder, bipolar disorder, substance use disorder, post-traumatic stress disorder, schizophrenia, and autism spectrum disorder.

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A symptom-based approach to treatment of psychosis in autism spectrum disorder

Cited by 8 publications

References 16 publications

Exploring clozapine use in severe psychiatric symptoms associated with autism spectrum disorder: A scoping review

Exploring clozapine use in severe psychiatric symptoms associated with autism spectrum disorder: A scoping review

Immune Influencers in Action: Metabolites and Enzymes of the Tryptophan-Kynurenine Metabolic Pathway

Immune Influencers in Action: Metabolites and Enzymes of the Tryptophan-Kynurenine Metabolic Pathway

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