Treatment Of Behavioral Symptoms Research Articles

The effect of cannabidiol in the treatment of behavioral symptoms in children and adolescents with autism: an integrative review

Objective: to conduct an integrative review which seeks to analyze the effects of cannabidiol in children and adolescents with Autism Spectrum Disorder (ASD). Method: an integrative review was conducted following several methodological steps, including identifying the topic and formulating the research question using the PICO strategy. The guiding question was: "What is the effect of Cannabidiol (CBD) in the treatment of autism spectrum disorder (ASD) in children and adolescents?" Inclusion criteria were defined for selecting relevant articles, followed by the search and selection of articles in scientific databases Portal Capes and PubMed, with no use of search filters. The studies were evaluated and analyzed; the results were then interpreted. Finally, the integrative review consolidated knowledge about the possible effects of CBD as an intervention for ASD. Conclusion: the integrative review highlights the possible effects of cannabidiol (CBD) in the treatment of autism, showing significant improvement of symptoms with minimal side effects. Although still not widely disseminated, CBD appears to be a functional therapy for ASD.

Long-Term Safety and Sustained Efficacy of ZYN002 Cannabidiol Transdermal Gel in the Treatment of Behavioral Symptoms in Children and Adolescents With Fragile X Syndrome (ZYN2-CL-017)

Long-Term Safety and Sustained Efficacy of ZYN002 Cannabidiol Transdermal Gel in the Treatment of Behavioral Symptoms in Children and Adolescents With Fragile X Syndrome (ZYN2-CL-017)

Disruptions and Adaptations in End-of-Life Care Delivery for Homebound Patients During COVID-19

The initial COVID-19 pandemic surge in New York City caused widespread delays and disruption in end-of-life services. This study examined the impact of disruptions among homebound adults in an HBPC practice who died between March-June 2020. Through an in-depth mixed-methods chart review, we identified 113 patient deaths (mean age: 87, 73% female, 67% with dementia). Forty-nine (43%) of deaths occurred in April 2020. Through a content analysis of clinician notes, we identified key COVID-related themes, including a shift to intensive phone-based care and to a lesser degree, telehealth; delays in hospice referrals and admissions; and an increase in treatment for behavioral symptoms. Our analysis also demonstrated the central role of family and paid caregivers in coordinating care, and efforts by patients, caregivers and providers to avoid hospital admissions. These findings demonstrate the importance of care coordination across medical, home and community partners to support end-of-life care in emergencies and beyond.

Neuropsychiatric Symptoms Exacerbate the Cognitive Impairments in Patients With Late-Life Depression.

Background: Neuropsychiatric symptoms (NPS) and cognitive impairments are both common in patients with late-life depression (LLD). However, the relationship between NPS and cognitive functions in LLD patients remains unclear. The current study aims to explore the effects of NPS on cognitive impairments in LLD patients.Methods: Two hundred and sixty-two LLD patients and 141 normal controls (NC) were recruited. Exploratory factor analysis was used to extract factors from the Neuropsychiatric Inventory (NPI). Correlation, mediation, and moderation analyses were used to explore whether NPS exacerbated the cognitive impairments in LLD and whether NPS exhibited different effects on cognitive impairments in acute-state LLD (aLLD) and recovery-state LLD (rLLD).Results: Three main factors were extracted from the NPI, including emotional, behavioral, and psychotic factors. The patients with LLD exhibited worse cognition and higher NPI scores, and the scores of NPI-total and three extracted factors were negatively associated with cognitive scores. The mediation analyses exhibited that NPI-total and behavioral factor scores increase the difference in cognition scores between LLD and NC groups. The mediation analyses exhibited that behavioral factor score played a greater effect on impairing MMSE in the rLLD group than in the aLLD group. Additionally, behavioral factor score was in a trend to be negatively associated with Mini-Mental State Examination (MMSE) score changes at a one-year follow-up (p = 0.051).Conclusions: NPS, especially behavioral symptoms, exacerbate cognitive impairments in LLD and may contribute to residual cognitive impairment in rLLD patients. Early intervention for behavioral symptoms in LLD patients may be beneficial to their long-term clinical prognosis.

Palmitato de Paliperidona num Adulto com Síndrome de Asperger

A síndrome de Asperger éuma perturbação caraterizada pelo compromisso da interação social e um padrão de comportamentos estereotipados. Estes incluem comportamentos repetitivos, irritabilidade, agressividade, hiperatividade e desatenção. O tratamento dos sintomas comportamentais constitui um desafio, com escassos estudos acerca da eficácia das diferentes abordagens terapêuticas. Este artigo é a primeira descrição do uso bem‑sucedido de palmitato de paliperidona mensal no tratamento de sintomas comportamentais num adulto com síndrome de Asperger.

Effects of Psychotropic Medication on Cognition, Caregiver Burden, and Neuropsychiatric Symptoms in Alzheimer's Disease over 12 Months: Results from a Prospective Registry of Dementia in Austria (PRODEM).

Behavioral and psychological symptoms of dementia are common in Alzheimer's disease (AD) and associated with a more rapid decline in cognitive function. Psychotropic substances are frequently used in AD, but we lack conclusive evidence of their efficacy in this setting. SSRI and trazodone were reported to have positive effects on cognition. Based on the prospective registry of dementia in Austria (PRODEM), we investigated the effects of psychotropic substances on cognition, behavioral symptoms, and caregiver burden (CB) in patients with AD, followed up prospectively over a 12-month period. We used the Mini-Mental State Examination (MMSE), the Neuropsychiatric Inventory (NPI), and the Zarit caregiver burden interview. The study cohort consisted of 309 patients. Patients taking no psychotropic drugs (NO) or those undergoing consistent monotherapy with a psychotropic drug for 12 months were analyzed further (NO 101 patients, SSRI 22, trazodone 8, atypical neuroleptics or benzodiazepines (ANL/BZD) 18). Additionally, the subgroup of patients who started taking any of the substances during the study period were analyzed further to determine the effects before versus six months after the start of medication. MMSE, NPI, and CB at baseline and during follow-up did not differ between the groups. MMSE and CB declined over 12 months in the overall group (MMSE: 21.2±4 versus 19.7±5, p = 0.001 and CB 20.3±12 versus 24.7±14.2, p = 0.007), but no statistically significant changes were registered within groups over 12 months. When trazodone was started, only NPI improved significantly after 6 months (33.4±18 versus 18.9±22.7, p < 0.01). ANL/BZD or SSRI, when started, did not alter MMSE, NPI, or CB. SSRI had no beneficial effect on cognition. We conclude that trazodone might be helpful in the treatment of behavioral symptoms.

Open-Label Trial of Medical Marijuana for the Treatment of Behavioral Symptoms in Older Adults With Alzheimer's Dementia

Open-Label Trial of Medical Marijuana for the Treatment of Behavioral Symptoms in Older Adults With Alzheimer's Dementia

Treatment of behavioral symptoms and unsettled relationships in clinically complex residents in the long-term care facility

PurposeMultifactorial etiology of behavioral symptoms (BS) and unsettled relationships (UR) in long-term care facility (LTCF) residents, who are characterized by comorbidity of somatic and mental diseases, makes the treatment process particularly difficult. The main goal of this study was to analyze a line of pharmacological and non-pharmacological treatment of clinically complex LTCF residents presenting BS and UR.MethodsThis was a cross-sectional study of 301 LTCF residents with the use of interRAI-LTCF questionnaire. Descriptive statistics provided frequencies of pharmacological and non-pharmacological interventions in residents presenting BS and UR. Logistic regression models identified potential factors associated with administering antipsychotics, sedatives and antidepressants.ResultsWe found that residents with BS had a higher chance of being prescribed antipsychotics (OR 3.06; CI 1.59–5.86; p < 0.001). They were at greater risk of using sedatives only when BS were associated with older age or depression symptoms. However, BS associated with depression did not increase chance of using antidepressants. The UR had no impact on the use of psychotropic drugs. Moreover, staff’s frustration in caring for residents with BS was associated with reduced risk of prescribing sedatives (OR 0.10; CI 0.02–0.68; p < 0.02). In contrast to pharmacotherapy, the non-pharmacological interventions were rarely applied.ConclusionsLTCF residents manifesting BS were more frequently treated with antipsychotics and sedatives compared to antidepressants, even when BS were associated with depression. The multifactorial etiology of BS and UR in a clinically complex LTCF resident requires recognition of the causes of BS and UR for an appropriate treatment to be applied.

Does N-acetylcysteine improve behaviour in children with autism?: A mixed-methods analysis of the effects of N-acetylcysteine

ABSTRACT Background: Traditional treatment for the behavioural symptoms in autism spectrum disorder (ASD) remains unsatisfactory. There is an urgent need for new, biologically relevant therapies that target both the core and comorbid symptoms that children may experience. This article builds on research previously published by the authors. Method: We report a mixed-methods analysis from a 24-week double-blind randomised controlled trial of adjunctive N-acetylcysteine (NAC) for the treatment of behavioural symptoms in ASD. Ninety-eight children between the ages of 3 and 9 years, diagnosed with ASD, participated in the study. Outcome measures included parents' assessment reports (obtained before, during, and after the trial), clinicians' observations, and the researchers' detailed case notes. Thematic analysis of textual data (n = 85) was carried out, followed by an evaluation of differences in the frequency with which changes in behaviour were qualitatively reported. Results: Compared with placebo, the parents of the group that received NAC reported improved calmness, decreased aggression and agitation, and greater improvements in verbal communication. Conclusions: These results support the usefulness of NAC for treating potentially disruptive behaviour (e.g., aggression and hyperactivity) in children with ASD and provide a novel finding: potentially improved verbal communication following NAC treatment. This paper supports the utility of a mixed-methods analysis for detecting latent signals in clinical trials.

Disruptive behaviour's treatment with paliperidone in autistic disorder: Review and case report

IntroductionAutistic disorder (AD) is a neuropsychiatric disorder that often presents significant disruptive symptoms such as irritability, aggression and self-injury in addition to impairment of social skills and communication. These symptoms interfere both individuals with AD and their families and social environment.ObjectiveShow paliperidone effect in behavioural symptoms in AD.MethodsLiterature review about behavioural symptoms in AD and paliperidone effect in its treatment, followed by a case report of clinical improvement after treatment with paliperidone in a patient with autism. Agitation subscale Aberrant Behavior Checklist (ABC-I) scores was compared prior and 4 weeks after paliperidone treatment, and clinical improvement was assessed with Clinical Global Impression-Improvement Scale (CGI-I).ResultsAlthough risperidone has been one of the most studied atypical antipsychotic to treat this symptoms, its use should be limited in order to avoid extrapyramidal and metabolic symptoms. Paliperidone – the major metabolite of risperidone – has shown effectiveness in the treatment of behavioral symptoms in patients with autism, even in subjects with a prior ineffective trial of risperidone. Our patient, 21-years-old male with AD and significant disruptive symptoms was treated with paliperidone 9 mg/day. We observed a 20-points reduction in ABC-I scores 4 weeks later, with most significant improvement in items like auto-agression, heteroaggressivity, irritability and slams. CGI-I scores showed a much better improvement, and no significant adverse effects appeared.ConclusionsPaliperidone is an effective and safe treatment in behavioral symptoms associated to AD, with reduction in ABC-I subscale scores. More studies are needed to confirm our data.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Paliperidone Use in Behavioural Symptoms in Patients with Intellectual Disabilities

Introduction Behavioural symptoms are the first reason of psychiatric assessment in patients with intellectual disabilities (ID), and also the most frequent cause of psychopharmacological treatment. Different rates of prevalence of these symptoms appear in literature data (10-60%). Paliperidone has shown effectiveness in the treatment of behavioural symptoms in patients with autism and asperger syndrome, with significant reduction in ABC-I subscale scores. Conclusions Objectives: Study paliperidone effect in behavioural symptoms' improvement in patients with intellectual disabilities of diverse etiology. Methods 10 outpatients with intellectual disabilities and behavioral symptoms were selected and treated with paliperidone. Sociodemographic and clinical data (type of intellectual disability, previous antipsychotic and paliperidone dose) were registered. Agitation subscale Aberrant Behavior Checklist (ABC-I) scores were compared prior and 4 weeks after psychopharmacological treatment change. Otherwise we assessed clinical improvement with Clinical Global Impression-Improvement (CGI-I). Results All patients were similar in clinical and sociodemographic characteristics. Paliperidone mean dose was 8,4 mg/day (3-18 mg/day), changing from risperidone (44,4%), olanzapine (44,4%) and levomepromacine (11,1%). Mean reduction in ABC-I scores with paliperidone treatment was 6,2 points [with most significant improvement in items like irritability (1,2 points), aggressions (1,1 points) and slams (0,9 points)]. CGI-I scores showed a much better improvement in 60% patients, mildly betterin 30% patients and slightly better in 10% patients. No significant adverse effects leaded to treatment discontinuation. Conclusions 1. Paliperidone is an effective and safe treatment in behavioral symptoms associated to intellectual disabilities. 2. Paliperidone treatment reduces ABC-I subscale scores, with most significant improvement in irritability and aggressions.

When Addiction Co-Occurs With Traumatic Brain Injury

When Addiction Co-Occurs With Traumatic Brain Injury

Impaired Social Interaction in Autism Spectrum Disorders

Autism spectrum disorders (ASD) are characterized by impairment in social reciprocity, disturbances in language and communication, restricted interests and repetitive behaviors of various types, as defined by the DSM-IV [1]. Currently, no drug has been consistently proven to be effective for the core social and communication impairment so central to the PDDs. Pharmacotherapy in ASD lacks a solid, reliable neurobiological basis and at present it is mainly directed at the socalled associated behavioral symptoms, with limited relevance to core symptoms. Atypical neuroleptics, especially risperidone, have been shown to be useful in the treatment of behavioral symptoms in ASD. Recent trials with SSRIs did not show remarkable results, in spite of their promising potential role [2,3]. Research is now directed at evaluating novel treatments and combined behavioral and pharmacologic treatments, since behavioral interventions are the mainstay of the early treatment of autism. Abnormal functional connectivity, which affects the delivery of afferent signals, may be involved in the pathophysiology of ASD [4]. Alternatively, individuals with ASD may be more vulnerable to oxidative stress due to deficit antioxidant defense mechanisms [5]. Polyunsaturated fatty acids, arachidonic acid (ARA) and Docosahexaenoic acid (DHA) play key roles in brain network maturation. ARA is important for signal transduction [6]. Therefore, it is clear that supplements containing antioxidants that are related to lipid peroxidation may be beneficial for individuals with ASD [7]. Previous double-blind randomized placebo-controlled studies have helped to validate the efficacy of DHA or eicosapentaenoic Acid (EPA) plus small doses of ARA (42 or 40 mg/day) in reducing behavioral problems in Attention-Deficit/Hyperactive Disorders (AD/HD) [8] and learning difficulties (LD) [9]. However, there are few studies that have examined the effects of larger doses of ARA added to DHA on the core behavioral and social impairments of ASD with double-blind, randomized, placebo-controlled designs. We therefore examined the effect of supplementation with large doses of ARA added to DHA (240 mg/day) in individuals with ASD (n=13) in a double-blind, placebocontrolled trial, followed by an open-label treatment. Daily doses of ARA and DHA were 240 mg/day. Four participants aged 6-10 years received one-half of the daily doses of the supplementation (for a total of 120 mg ARA and 120 mg DHA per day). Previous studies of supplementation with PUFAs, ARA doses were 40 mg/day [9] or 42 mg/day [8]. ARA doses used in this study were 120 or 240 mg/day, and our supplementation included thus larger doses of ARA compared to these previous studies.

The Efficacy and Safety of Newer Anticonvulsants in Patients with Dementia

Anticonvulsants are a class of medications that have received considerable interest as possible treatments in patients with behavioural disturbances in dementia. The role of these medications for such a use remains controversial. The current paper reviews the published evidence surrounding the safety and efficacy (i.e. as a behavioural and cognitive treatment) of newer anticonvulsants in patients with dementia. A MEDLINE, International Pharmaceutical Abstracts, PsycINFO and clinicaltrials.gov search through to December 2011 was conducted for anticonvulsants that have received regulatory approval since 1996. Studies reporting behavioural or cognitive outcomes in patients with dementia were included. Nine trials involving only four medications met selection criteria and were included: levetiracetam (n = 4), oxcarbazepine (n = 1), topiramate (n = 2) and zonisamide (n = 2). Levetiracetam may have a role in the treatment of behavioural symptoms in dementia but study limitations substantially hinder the strength of such a recommendation. Oxcarbazepine and topiramate, based on limited data, do not appear to be effective treatments of behavioural symptoms in dementia. A lack of trials do not allow for conclusions to be made regarding zonisamide. From a cognitive standpoint, levetiracetam was the anticonvulsant most examined in patients with dementia, it appears to have less deleterious effects than some anticonvulsants. Limited data are available on the safety of these medications in elderly patients; however, studies completed thus far have demonstrated some adverse events that are more common or problematic with the use of these drugs in this patient population (i.e. somnolence, dizziness, hyponatraemia, weight loss).

Antipsychotics Do Not Have To Be Used “Off Label” in Dementia

).A class of drugs that is underused for treatment of behavioralsymptoms of dementia is antidepressants. There are 2 reasons for thissituation: the first is that antidepressants arenot consideredeffective,and the second is that depression is difficult to diagnose in residentswith advanced dementia. I would like to propose that both of thesereasons are not valid and that antidepressants would be preferable toantipsychotics in residents without psychotic symptoms whosebehavioral symptoms cannot be controlled by nonpharmacologicalstrategies.There is an overwhelming amount of evidence indicating thatdepression is one of the most important factors related to behavioralsymptoms of dementia. Two depression scales were used in thesestudies: the Cornell Scale for Depression in Dementia

Traitement pharmacologique des comportements problématiques associés aux troubles du spectre autistique : revue de la littérature

Global Management of autistic people primarily requires behavioral and educational therapy. There is actually no psychopharmacological agent that is efficient on the core symptoms of autism, especially the social and communicative impairments. However psychotropic medications are widely prescribed in this population and as mush as one out two people with autism receives at least one medication. In this population, medications are mainly directed at the frequently associated behavioral symptoms such as aggression toward self or others, tantrums, hyperactivity, severe repetitive behaviors. The goal of this article is to provide a review of the existing controlled studies in this area. The presented studies aim the following therapeutic classes: atypical antipsychotics, selective serotonin reuptake inhibitors (SSRI), psychostimulants and antiepileptics. The studies and their main results in terms of efficiency and safety are presented in tables. Atypical antipsychotics, especially risperidone and aripiprazole have been shown to be useful in the treatment of behavioral symptoms. SSRI seem to have limited interest for the management of repetitive behaviors. Stimulants can help in case of hyperactivity and attention deficit associated with Autism spectrum disorders. Antiepileptics show promising results, but the best indications for this class are not clear. For sleep disturbances, melatonin can be a safe and efficient option. Challenging behaviors requires careful investigation to understand their origin in order to provide the specific management. The first answer should be environmental and educational. Somatic or mental diseases should be carefully assessed. Medication use in this vulnerable population should carefully evaluate the benefit/risk balance. Medications should be prescribed at the minimum dose for the minimum duration.

The study protocol of a blinded randomised-controlled cross-over trial of lavender oil as a treatment of behavioural symptoms in dementia

BackgroundThe agitated behaviours that accompany dementia (e.g. pacing, aggression, calling out) are stressful to both nursing home residents and their carers and are difficult to treat. Increasingly more attention is being paid to alternative interventions that are associated with fewer risks than pharmacology. Lavandula angustifolia (lavender) has been thought, for centuries, to have soothing properties, but the existing evidence is limited and shows mixed results. The aim of the current study is to test the effectiveness of topically applied pure lavender oil in reducing actual counts of challenging behaviours in nursing home residents.Methods/DesignWe will use a blinded repeated measures design with random cross-over between lavender oil and placebo oil. Persons with moderate to severe dementia and associated behavioural problems living in aged care facilities will be included in the study. Consented, willing participants will be assigned in random order to lavender or placebo blocks for one week then switched to the other condition for the following week. In each week the oils will be applied on three days with at least a two-day wash out period between conditions. Trained observers will note presence of target behaviours and predominant type of affect displayed during the 30 minutes before and the 60 minutes after application of the oil. Nursing staff will apply 1 ml of 30% high strength essential lavender oil to reduce the risk of missing a true effect through under-dosing. The placebo will comprise of jojoba oil only. The oils will be identical in appearance and texture, but can easily be identified by smell. For blinding purposes, all staff involved in applying the oil or observing the resident will apply a masking cream containing a mixture of lavender and other essential oils to their upper lip. In addition, nursing staff will wear a nose clip during the few minutes it takes to massage the oil to the resident's forearms.DiscussionIf our results show that the use of lavender oil is effective in reducing challenging behaviours in individuals with dementia, it will potentially provide a safer intervention rather than reliance on pharmacology alone. The study's findings will translate easily to other countries and cultures.Trial RegistrationAustralian New Zealand Clinical Trials Registry - ACTRN 12609000569202

Aiming to Improve Care of Older Adults: an Innovative Faculty Development Workshop

Internists care for older adults and teach geriatrics to trainees, but they often feel ill-prepared for these tasks. The aims of our 1-day Continuing Medical Education workshop were to improve the knowledge and self-perceived competence of general internists in their care of older adults and to increase their geriatrics teaching for learners. Two internal medicine training programs encompassing University, Veterans Affairs, and a community-based hospital in Portland, OR, USA. Course faculty identified gaps in assessment of cognition, function, and decisional capacity; managing care transitions; and treatment of behavioral symptoms. To address these gaps, our workshop provided geriatric content discussions followed by small group role plays to apply newly learned content. Forty teaching faculty participated. Participants completed 13-item multiple-choice pre- and post-workshop geriatric knowledge tests, pre- and post-workshop surveys of self-perceived competence to care for older adults, and completed an open-ended 'commitment to change' prompt after the intervention. Knowledge scores improved following the intervention (61% to 72%, p < .0001), as did self-perceived competence (11 of 14 items significant). Seventy-one percent of participants reported success in meeting their commitment to change goals. A 1-day intervention improved teaching faculty knowledge and self-perceived competence to care for older patients and led to self-perceived changes in teaching behaviors.

Risperidone versus haloperidol in children and adolescents with AD

The aim of the study was to compare safety, efficacy and tolerability of risperidone with haloperidol in the treatment of Autistic Disorder (AD). This study was designed as a double-blind, prospective, for a 12-week period. A total of 30 subjects, between the ages of 8 and 18 with AD based on DSM IV criteria, were included in the study. Behavioral Rating Scales were performed by the investigators and the parents. Safety assessment included vital signs, electrocardiogram, electroencephalogram, adverse events, laboratory tests, extrapyramidal symptoms and the side effects. Both treatments were applied in a once daily dosage regimen of 0.01-0.08 mg/kg/day. The reduction from baseline in Ritvo-Freeman Real Life Rating Scale (RF-RLRS), sensory motor (subscale I) and language (subscale V) scores were significant in risperidone group (P < 0.05). Compared to haloperidol, risperidone led to a significantly greater reduction in the Aberrant Behavior Checklist (ABC) and Turgay DSM-IV Pervasive Developmental Disorder (PDD) scale scores (P < 0.05 and P < 0.01). There was a greater increase of prolactin in the risperidone group, while alanine amino transferase (ALT) had further increased in the haloperidol group. Sensory motor behaviors (subscale I) and language at the end of the 12th week, RF-RLRS sensory motor and language subscale scores decreased in the risperidone group further than the other group (P < 0.05). Risperidone was found to be more effective than haloperidol in the treatment of behavioral symptoms, impulsivity, language skills, and impaired social relations in children with AD. These results demonstrated that both drugs were safe and well tolerated in the treatment of AD.

Long-Acting Injectable Risperidone for Control of Agitation in Dementia

Article AbstractBecause this piece does not have an abstract, we have provided for your benefit the first 3 sentences of the full text.Sir: There are now many studies showing the effectiveness of risperidone in controlling agitation in patients with dementia, and it has a relatively benign adverse effect profile. Atypical antipsychotic agents are moderately effective in the treatment of behavioral symptoms in patients with dementia.1 Failure to adhere to a prescribed medication regimen by patients with psychosis is one of the most frustrating problems faced by mental health care providers, because of the high risk of relapse associated with that situation.†‹