Functional Vomiting Treated Successfully with Aripiprazole in a Child with Autism Spectrum Disorder

Abstract

[Author Affiliation]Burak Acikel. 1 Department of Child and Adolescent Psychiatry, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey.Ahmet Yar. 2 Child and Adolescent Psychiatry Clinic, Konya Training and Research Hospital, Konya, Turkey.Sabri Herguner. 1 Department of Child and Adolescent Psychiatry, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey.Address correspondence to: Sabri Herguner, MD, Meram Tip Fakultesi, Cocuk ve Ergen Psikiyatrisi AD, 42090, Konya, Turkey, E-mail: herguners@yahoo.comTo The Editor:Autism spectrum disorder (ASD) is defined by deficits in social communication and interaction, as well as by restricted and repetitive patterns of behaviors and activities. In addition to these core symptoms, children with ASD may present with medical conditions, including gastrointestinal dysfunctions. Several studies showed that children with ASD had higher rates of gastrointestinal problems than typically developing controls, such as constipation, diarrhea, bloating, reflux, and vomiting (Kang et al. 2014).Functional vomiting (FV) is defined as vomiting in the absence of gastrointestinal or central nervous system or metabolic diseases. Several pharmacological agents, such as antipsychotics (e.g., chlorpromazine) (Ozdemir et al. 2014), and antidepressants (e.g., mirtazapine) (Coskun and Alyanak 2011) have been reported to be efficient in management of FV. In this report, we describe a child with ASD who had frequent episodes of vomiting that improved after aripiprazole administration.Case ReportA 6-year-old boy with a diagnosis of ASD was referred to our outpatient clinic because of his disruptive behaviors, including hyperactivity, temper tantrums, and irritability. According to his parents, he had also had frequent vomiting episodes, occurring once or twice every day for the past 3 years. His physical examination and diagnostic tests, including endoscopy, were unremarkable. He was diagnosed as having functional vomiting by his gastroenterologist. Risperidone 0.5 mg was initiated for his disruptive behaviors, and the dose was titrated up to 1 mg/day, but no improvement was observed during a 3 month period. Then it was decided to change risperidone to aripiprazole, and the dose was increased to 5 mg/day for a 1 month period. According to the patient's parents, his hyperactivity and irritability did not improve; however, his vomiting episodes remitted completely. He was on this regime for 6 months, and during this time he did not experience any vomiting episode. Six months later, his parents stopped aripiprazole by themselves, as the boy's disruptive behaviors did not improve significantly. However, his vomiting episodes recurred after cessation of aripiprazole. Subsequently, his parents restarted aripiprazole 1 mg/day, and the patient was free of vomiting for 3 months.DiscussionIn this report, we described a patient with ASD who had frequent vomiting episodes and had a marked and rapid improvement following aripiprazole. …