Care Across the Lifespan Il
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Collapse Subdiscussion Emilia Egwim
8:33amDec 21 at 8:33am
Discussion for Comprehensive Focused Soap Psychiatric Evaluation
Hello Lovelyne
Great presentation; I really enjoy reading your presentation about your patient Joey which is very informative. Autism Spectrum disorder is a neurodevelopmental disorder that is associated with tenacious predicaments in social communication and interaction in addition with limited, continual model of behaviors. According to study by Fitzpatrick et al; indicated that aggression behavior are noted to be increased in individual with ASD than when compared with other neurodevelopmental impairments (2016). This aggressive behavioral issues has been indicated by studies to relate with obstructive consequences for children diagnosed with ASD and their care providers resulting in reduced quality of life, heightened stress levels and decreased accessibility of educational and social adaptation/acceptance. Studies indicated that establishing effective therapeutic and pharmacological intervention approach for treatment as well as preventing aggressive behavior is imperative for reaching to better outcomes for individual with ASD. The patient in this case presentation had history of ASD and endorses aggression and self-injuries behaviors which have been indicated by various studies to associated with ASD and other manifestation including hyperactive, impulsive, inattentive behavior, unusual mood or emotional reaction.
To answer your question “ Is Risperidone FDA approved for patients with Autism”
Based on various studies, Risperidone and aripiprazole are approved by FDA and recommended for treatment of schizophrenia and bipolar for adult and adolescent including children with Autism Spectrum disorder around age 5 to 16 years. The Risperidone an antipsychotic medication was recommended to treat the aggression, irritability and mood swings associated with ASD. According to study; Risperidone has been effecting in treating symptoms of aggression and irritability between the age of 5 and 6 years distinctly that is associated with ASD, however, there’s no FDA approved medication for treatment of core sign and symptoms of ASD (Alayouf et al, 2021). There have been several controversy surrounding the use of Risperidone in which several clinician trials conducted reported that the medication was effective for the agitation, aggression and irritability often observed in autism patient, but was less effective in treating the core symptoms of Autism and other argument including the undesirable side effects that are associated with the medication and most significant of which is weight gain from an increased appetite. Other several medication as well as off-label prescription has been indicated to be effective such as treatment with SSRIs, CNS stimulants, NMDA-receptor antagonists, and including other agents (LeClerc & Easley, 2015). I completely agree with this medication because is FDA approved and several evidenced based studies has proved its efficacy.
Should patient start one psychotropic medication at a time?
It is important to avoid taking more than one psychotropic medication at a time especially when treating children or adolescent due to increased risk for complication including drug interactions, medication side effects, and metabolic disorder without improving outcomes. Although antipsychotic medication such as Risperidone and aripiprazole has been proven by FDA for treatment of ASD, however, antipsychotic may cause more harm than good especially when taking more than one antipsychotic medication at a time in a long time. It will predispose patient to high risk for numerous serious and debilitating side effects and the higher the dose the more the complication occurs. The patient in this case presentation is a child and will benefit more on one psychotropic except in the case of a failed trials of monotherapy occurred and a second antipsychotic medication may be added to assist in cross-taper to monotherapy.
Would you consider an additional diagnosis or diagnoses for this patient?
I would consider another additional diagnosis for this patient such as anxiety disorder. According to study, anxiety is among the common most comorbid disorders in ASD which have been indicated that approximately 40–45% of youth with ASD have a comorbid generalized anxiety disorder and roughly around 11–84% of children with ASD endorses anxiety that resulted in deficits in adaptive and functional abilities including social skills and planning (Stavropoulos, Bolourian & Blacher, 2018). This patient in this case study presentation can be diagnose with generalized anxiety disorder due to patient stating that he has no friends and has problem concentrating or focusing in class due the noise which can result in increased anxiety causing him to act out in school.
Do you believe that the implementation of psychotherapy will benefit this patient?
This patient will benefit with the implementation of psychotherapy especially cognitive behavioral therapy which will assist the patient in learning connection between thoughts, feelings, and behaviors. Studies has recommended that the best treated option for the core sign and symptoms of ASD is psychosocial therapies, such as applied behavior analysis, although some medication has shown effective in the treatment of associated behavioral symptoms as well as some benefits in some of the core symptoms of autism, However, is has been indicated by several evidenced based studies that effects of psychotropic medication are maximize by psychotherapy. This patient will benefit more with psychotherapy that include individual, groups and family therapy.
Should Joey see an endocrinologist to address possible hormonal changes affecting patient’s mood?
It is advisable to let patient see an endocrinologist to rule out other medical symptoms that can mimic psychiatric symptoms. Like you mentioned in your presentation, some certain brain disorders can contribute to psychiatric behaviors and if not identify might be left untreated resulting in a serious impairment and preventing patient from attaining to basic needs.
References
Alsayouf, H. A., Talo, H., Biddappa, M. L., & De Los Reyes, E. (2021). Risperidone or Aripiprazole Can Resolve Autism Core Signs and Symptoms in Young Children: Case Study. Children (Basel, Switzerland), 8(5), 318. https://doi.org/10.3390/children8050318
Fitzpatrick, S. E., Srivorakiat, L., Wink, L. K., Pedapati, E. V., & Erickson, C. A. (2016). Aggression in autism spectrum disorder: presentation and treatment options. Neuropsychiatric disease and treatment, 12, 1525–1538. https://doi.org/10.2147/NDT.S84585
LeClerc, S., & Easley, D. (2015). Pharmacological therapies for autism spectrum disorder: a review. P & T: a peer-reviewed journal for formulary management, 40(6), 389–397.
Stavropoulos, K. K., Bolourian, Y., & Blacher, J. (2018). Differential Diagnosis of Autism Spectrum Disorder and Post Traumatic Stress Disorder: Two Clinical Cases. Journal of clinical medicine, 7(4), 71. https://doi.org/10.3390/jcm7040071
