背景:自闭症谱系障碍(ASD)是一种持续的神经发育障碍,通常与注意力缺陷/多动障碍(ADHD)和行为相关疾病同时发生。虽然行为疗法是治疗ASD核心症状的一线选择,有时需要药物治疗来治疗急性问题,如激动和攻击性行为。最近的指南建议使用抗精神病药减少ASD患者的精神运动躁动。然而,因为患有ASD的儿童通常是耐药的,替代疗法通常是合理的。文献报道表明,静脉注射丙戊酸盐(IV-VPA)可有效减少精神病患者的躁动,与常规治疗相比,不良事件发生频率较低。然而,由于相关发现有时不一致,在临床精神病学的背景下,IV-VPA尚未被批准。我们旨在提高对儿科患者急诊精神病治疗的IV-VPA治疗选择的认识。方法:我们报告了一个患有复杂神经发育疾病的11岁男孩的案例,该男孩经历了精神病发作并具有严重的攻击性和破坏性行为,并成功接受了IV-VPA治疗。此外,我们提供了有关该主题的最新文献综述。结论:在我们的案例中,一线治疗被证明是无效的。相反,IV-VPA导致安全和迅速的临床成功,这与其他报告一致。根据我们的文献综述,IV-VPA可以非常有效,并降低在急诊精神病学中使用高剂量标准药物经常发生的不良事件的风险。
Background: Autism spectrum disorder (ASD) is a persistent
neurodevelopmental disorder frequently co-occurring with attention-deficit/hyperactivity disorder (
ADHD) and behavior-related disorders. While behavioral therapy is the first-line option to manage the core symptoms of ASD, pharmacological therapy is sometimes needed to treat acute problems, such as agitation and aggressive behaviors. Recent guidelines recommend the use of neuroleptics to reduce psychomotor agitation in patients with ASD. However, as
children with ASD are often drug-resistant, alternative treatments are often justified. Reports from the literature have indicated that intravenous valproate (IV-VPA) can be effective in reducing agitation in psychiatric patients, with a lower frequency of adverse events compared to conventional treatments. However, as the related findings are occasionally inconsistent, IV-VPA is not yet an approved option in the context of clinical psychiatry. We aim to improve knowledge of the IV-VPA treatment option for emergency psychiatric treatment in pediatric patients. Methods: We report the
case of an 11-year-old boy suffering from a complex
neurodevelopmental condition who experienced a psychotic episode with severe aggressive and disruptive behaviors and was successfully treated with IV-VPA. Furthermore, we provide an updated literature review on this topic. Conclusion: In our
case, first-line therapies proved to be ineffective. To the contrary, IV-VPA led to safe and prompt clinical success, which is in line with other reports. Based on our literature review, IV-VPA can be highly effective and reduces the risk of adverse events that frequently occur with the use of high-dose standard medications in emergency psychiatry.