Psychopharmacology in the Pediatric Oncology and Bone Marrow Transplant Units: Antipsychotic Medications Palliate Symptoms in Children with Cancer
psycho-oncology; liaison; olanzapine; risperidone
Objectives: The present study characterized the psychiatric diagnoses and symptoms that led to the administration of antipsychotic medications in children and adolescents with cancer, and to evaluate the benefits and tolerability of these drugs in a large hospital-based pediatric hematology-oncology practice. Methods: Efficacy and adverse effects of two second-generation antipsychotics were retrospectively analyzed in 43 patients 2.9-19.6 (mean 12.1) years of age. The Clinical Global Impression-Severity (CGI-S) Scale and Improvement (CGI-I) Scale were used to evaluate psychiatric symptom severity before and following treatment, while the incidence of side effects and drug-drug interactions were collected from medical records. Results: Olanzapine was administered to 58% of patients and risperidone to 42%; the choice of drug was at the discretion of the treating psychiatrist. The common psychiatric diagnoses among these patients included adjustment disorder (37%) and medication-induced psychiatric disorders (23%). The most common psychiatric-medical symptoms included irritability/agitation (79%) and depressed mood (74%). CGI-S improved significantly (p < 0.001) between assessments, with no statistically significant difference between olanzapine- and risperidone-treated patients. CGI-I scores at reassessment indicated superiority of olanzapine as compared with risperidone. Adverse effects of treatment were mild. Conclusions: Olanzapine and risperidone can be well tolerated and ameliorate severe psychiatric-medical symptoms in children and adolescents with cancer. The potential palliative benefits of these second-generation antipsychotics (e.g., rapid onset of action, antiemesis, sedation, and appetite stimulation) increase the utility of their use in children treated in oncology and bone marrow transplant units.
Peled O; Lavan O; Stein J; Vinograd I; Yahel A; Valevski A; Weizman A; Kimmel-Tamir E; Apter A; Fennig S; Yaniv I; Bernfeld Y; Benaroya-Milshtein N
Journal of Child and Adolescent Psychopharmacology
2020
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1089/cap.2019.0164" target="_blank" rel="noreferrer noopener">10.1089/cap.2019.0164</a>
The opiate hypothesis in autism and self-injury
Pain Measurement; Analgesics; Pain; Pain Threshold; Naloxone; Naltrexone; Autistic disorder; Self-Injurious behavior; Opioid; Autism; Self Mutiliation
The opiate hypothesis maintains that patients engage in self-injurious behavior (SIB) either because they are partially analgesic (pathologically altered pain threshold) or because SIB supplies a "fix" for an addicted endogenous opiate system. The finding that opiate antogonists attenuate SIB is the strongest evidence for the opiate hypothesis. Most of the patients who had been administered opiate receptor antagonists for treatment of self-injurious behavior also had autistic disorder. Initial studies with naloxone, an injectable opiate blocker, reported positive effects in 8 (with robust effects in 6) of the 10 patients treated. Positive results were reported in studies with orally administered naltrexone in 38 of 45 autistic patients, including 24 of those 28 with SIB. Generally, the effective dose range for naltrexone is 0.5-1.5 mg/kg, but patients with high-frequency SIB typically responded best to the higher doses. Although the findings suggest a role of opiates in SIB, the database is very small and the studies vary widely in dimensions of dose, duration and method of observation, experimental controls, duration of treatment, and the age, gender, and diagnosis of patients treated. At this time, opiate blockers appear to be the only treatment option for some SIB patients who fail to respond to other treatments. It is unclear whether these treatments would help autistic patients who do not exhibit SIB or whether they would help nonautistic patients who demonstrate SIB, including individuals with Lesch-Nyhan disease, phenylketonuria, border-line personality, or major depression.
1990
Sandman CA
Journal Of Child And Adolescent Psychopharmacology
1990
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1089/cap.1990.1.237" target="_blank" rel="noreferrer">10.1089/cap.1990.1.237</a>