Psychopharmacology in autism

Results of recent studies in pharmacotherapy in autism are presented. Haloperidol, fenfluramine and naltrexone have been the most extensively studied drugs in systematic research. Haloperidol appeared to decrease levels of hyperactivity, stereotypies, emotional lability but also abnormal object relations and social withdrawal. However, the therapeutic effect was generally modest and long term administration was associated with dyskinesias in autistic children. The frequent hyperserotonemia in autism has suggested the use of fenfluramine, an antiserotoninergic agent. Although the initial reports were optimistic, more recent carefully designed studies often failed to show that fenfluramine was superior to placebo. Naltrexone, a potent opiate antagonist, was explored following the opioid hypothesis based on the similarity between autistic symptomatology and abnormal behaviors observed in opiate addicts and in laboratory animals administered opiates and on the abnormalities of endogenous opioids that exit in a subgroup of autistic children. However, the current studies do not concur and no definite conclusions can be made of the efficacy of naltrexone at present time. Low doses of amisulpride which have been shown to improve negative symptoms in schizophrenia and serotoninergic antidepressants, which have proven effective in repetitive and ritualized behaviors, have recently began to be evaluated in controlled studies. At present time, no medication has shown to alter the course or the symptoms of autism, but some seem to be effective in reducing severe aberrant behaviors.