6.22 The Combination of Kampo and Western Antipsychotic Drugs Were Effective for 20 Cases in Child Psychiatric Outpatients

Abstract

Kampo is the Japanese herbal traditional medicine formula, with a root from ancient China, that is used for irritation, mood swing, and agitation in Japan. Ninety percent of Japanese doctors have an experience of prescribing Kampo, and 80% of doctors have combined Kampo and a Western antipsychotic drug (WAD). The indication of atypical WAD is for the irritability and agitation with autism spectrum disorder (ASD), and Kampo is used for peripheral symptoms in the child and adolescent psychiatric patient. For now, risperidone and aripiprazole are the only choices under the Japanese health insurance system to treat children with ASD. This retrospective case series report was conducted in 20 children who received Kampo and a WAD, from April 1, 2017 to December 31, 2020, at our child and adolescent psychiatric outpatient clinic. Their ages ranged from 7 to 19 years. Their age, gender, IQ test (Wechsler Intelligence Scale for Children–Fourth Edition [WISC-4], Tanaka-Binet-5 test, Kyoto Scale of Psychological Development), the severity that DSM-5 defines on the initial examination and the end of this research (none = Level 0, mild = Level 1, moderate = Level 2, severe = Level 3), dropouts, side effects, and the number of medications were surveyed. The average age was 12.2 years (7-19). The ratio of males to females was 19:1. The average IQ was 69.4 (22-143). There were no side effects from Kampo. Seven children had a blood test, and their average serum potassium level was 4.0 mEq/l (3.5-4.4). In addition, 0.5 (25%) of them had any type of drug and food allergies, 6 (30%) had febrile convulsion, abnormality of EEG, and epilepsy, and 3 (15%) had any severe physical disabilities. The initial diagnosis (maximum 2) was 11 (55%) with pervasive developmental disorder and ASD, 9 (45%) with ADHD, 2 (10%) with ODD, 12 (60%) with intellectual disability containing below average IQ (BAIQ), 14 (70%) had continued combined medicine, 5 (25%) had dropped out of the child and adolescent psychiatric outpatient clinic, 6 (30%) had taken multiple WADs. The average Kampo dose per day was 4.6 g (1 package is 2.5 g). The average administration duration was 14.4 month (2-41). The price of a risperidone tablet (2 mg) is $0.40 USD, aripiprazole (3 mg) is $0.60 USD, and Kampo is $0.34 to $0.16 USD per 1 package. The average severity level according to the DSM-5 on the initial examination was 1.95 (1-3). The average severity at the end of this research was 1.17 (0-3). The combination of Kampo and WADs might alleviate the severity of children in the child and adolescent psychiatric outpatient.