Elevated concentrations of blood serotonin have been documented in autistic children and mentally retarded adults. Antiserotonergic pharmacotherapy has been partially effective in treating a subgroup of children with autistic disorder. Therefore, the possibility is raised that an antiserotonergic treatment may be of value to adult psychiatric patients with a history of pervasive developmental disorder. Two such cases are described where the patients underwent psychiatric and neuropsychological examination before and after treatment with risperidone, a potent 5-HT2 antagonist with additional D2 antagonistic properties. Particular improvements were documented in both patients, despite long histories of cognitive compromise and high likelihood of damage to the central nervous system.
References
1.
LotterV.Follow-up studies. In: RutterM., SchoplerE., eds. Autism: a reappraisal of concepts and treatment.New York: Plenum Press,1978.
2.
GillbergC.Outcome in autism and autistic-like conditions.J Am Acad Child Adolesc Psychiatry1991; 30: 375–382.
3.
Diagnostic and statistical manual of mental disorders (third edition revised).Washington DC: American Psychiatric Press,1987.
4.
FisherW., BurdL., KerbeshianJ.Comparisons of DSM-III defined pervasive developmental disorders.J Am Acad Child Adolesc Psychiatry1987; 26: 704710.
5.
MesarosR.A., DonnellanA.M.Issues in individualized placements for students with autism. In: CohenD.J., DonnellanA.M., PaulR., eds. Handbook of autism and pervasive developmental disorders.Toronto: John Wiley & Sons,1987.
6.
MarcusL.M., SchoplerE.Working with families: a developmental perspective. In: CohenD.J., DonnellanA.M., PaulR., eds. Handbook of autism and pervasive developmental disorders.Toronto: John Wiley & Sons,1987.
7.
AmmanM.G., KernR.A.Review of fenfluramine in the treatment of the developmental disabilities.J Am Acad Child Adolesc Psychiatry1989; 28: 549–565.
8.
AspergerH.Die “autistischen psychopathen” im kindesalter.Archive für Psychiatrie und Nervenkrankheiten1944; 117: 76–136.
9.
AspergerH.Zur differentialdiagnose des kinlichen Autismus.Acta Paedopsychiatr1968; 35: 136–145.
10.
AspergerH.Problems of infantile autism.Communication1979; 13: 45–52.
11.
DarrG.C., WordenF.G.Case report twenty-eight years after an infantile autistic disorder.Am J Orthopsychiatry1951; 21: 559–569.
12.
ReiserD.E., BrownJ.L.Patterns of later development in children with infantile psychosis.J Am Acad Child Psychiatry1964; 3: 650–667.
13.
WolffS., ChickJ.Schizoid personality in childhood: a controlled follow-up study.Psychol Med1980; 10: 85–100.
14.
WingL.Asperger's syndrome: a clinical account.Psychol Med1981; 11: 115–129.
15.
PettyL.X., OrnitzE.M., MichelmanJ.D.Autistic children who become schizophrenic.Arch Gen Psychiatry1984; 41: 129–135.
16.
KomotoJ., UsuiS., HirataJ.Infantile autism and affective disorder.J Autism Dev Disord1984; 14: 81–84.
17.
GillbergC.Asperger's syndrome and recurrent psychosis — a case study.J Autism Dev Disord1985; 15: 389–397.
18.
SzatmariP., BartolucciG., FinlaysonA.A vote for Asperger's syndrome.J Autism Dev Disord1986; 16: 515–517.
19.
ClarkeD.J., LittlejohnsC.S., CorbettJ.A.Pervasive developmental disorders and psychoses in adult life.Br J Psychiatry1989; 155: 692–699.
20.
GellerE., RitvoE.R., FreemanB.J.Preliminary observations on the effect of fenfluramine on blood serotonin and symptoms in three autistic boys.N Engl J Med1982; 307: 165–169.
21.
RitvoE.R., YuwilerA., GellerE.Effects of L-dopa in autism.J Autism Child Schizophr1971; 1: 190–205.
22.
SchainR.J., FreedmanD.X.Studies on 5-hydroxyindole metabolism in autistic and other mentally retarded children.J Pediatr1961; 58: 315–318.
23.
RitvoE.R., YuwilerA., GellerE.Increased blood serotonin and platelets in early infantile autism.Arch Gen Psychiatry1970; 23: 566–572.
24.
YuwilerA., RitvoE.R., BaldD.Examination of circadian rhythmicity of blood serotonin and platelets in autistic and non-autistic children.J Autism Child Schizophr1971; 1: 421–435.
25.
YuwilerA., RitvoE.R., GellerE.Uptake and efflux of serotonin from platelets of autistic and non-autistic children.J Autism Child Schizophr1975; 5: 83–98.
26.
CampbellM., FriedmanE., GreenW.H.Blood serotonin in schizophrenic children: a preliminary study.Int Pharmacopsychiatry1975; 10: 213–221.
27.
TakahashiS., KanaiH., MiyamotoY.Reassessment of elevated serotonin levels in blood platelets in early infantile autism.J Autism Child Schizophr1976; 6: 317–326.
28.
HanleyH.G., StahlS.M., FreedmanD.X.Hyperserotonemia and amine metabolites in autistic and retarded children.Arch Gen Psychiatry1977; 34: 521–531.
29.
HoshinoY., KumashiroH., KanekoM.Serum serotonin free tryptophan, plasma cyclic AMP levels in autistic children.Fukushima J Med Sci1979; 26: 79–91.
30.
HoshinoY., YamamotoT., KanekoM.Blood serotonin and free tryptophan concentration in autistic children.Neuropsychobiology1984; 11: 22–27.
31.
AndersonG.M., FreedmanD.X., CohenD.J.Whole blood serotonin in autistic and normal subjects.J Child Psychol Psychiatry1987; 28: 885–900.
32.
PivenJ., TsaiG., NehmeE.Platelet serotonin, a possible marker for familial autism.J Autism Dev Disord1991; 21: 51–59.
33.
SlomanL.The use of medication in pervasive developmental disorder.Pediatr Clin North Am1991; 7: 831–843.
34.
PiggottL.R., GdowskiC.L., VillanuevaD.Side effects of fenfluramine in autistic children.J Am Acad Child Psychiatry1986; 25: 287–289.
HarveyJ.A.Neurotoxic action of halogenated amphetamines.Ann NY Acad Sci1978; 305: 289–304.
37.
GualtieriC.T., RandallE.W., PattersonD.R.The medical treatment of autistic people. In: SchoplerE., MesibovG.B., eds. Neurobiological issues in autism.New York: Plenum Press,1987.
38.
JanssenP.A.J., NiemegeersC.J.E., AwoutersF.H.L.Risperidone (R64766), a new antipsychotic with serotonin-S2 and dopamine-D2 antagonistic properties.J Pharmacol Exp Ther1988; 244: 685–693.
39.
LeysenJ.E., GommerenW., EensA.Biochemical profile of risperidone, a new antipsychotic.J Pharmacol Exp Ther1988; 247: 661–670.
40.
ChouinardG., JonesB., RemingtonG.A Canadian multicenter placebo-controlled study of fixed doses of risperidone and haloperidol in the treatment of chronic schizophrenia.J Clin Psychopharmacol1993; 13: 25–40.
41.
RooseK., GeldersY.G., HeylenS.Risperidone (R64766) in psychotic patients: A first clinical therapeutic exploration.Acta Psychiatr Belg1988; 88: 233–241.
42.
MesottenF., SuyE., PietquinM.Therapeutic effect and safety of increasing doses of risperidone (R64766) in psychotic patients.Psychopharmacology1989; 99: 445–449.
43.
CastelaoJ.F., FerreiraL., GeldersY.G.The efficacy of the D2 and 5-HT2 antagonist risperidone (R64766) in the treatment of chronic psychosis: an open dose finding study.Schizophr Res1989; 2: 411–415.
44.
MecoG., BediniL., BonifatiV.Risperidone in the treatment of chronic schizophrenia with tardive dyskinesia.Curr Ther Res1989; 46: 876–883.,
45.
BersaniG., BressaG.M., MecoG.Combined serotonin-5-HT2 and dopamine-D2 antagonism in schizophrenia: clinical, extrapyramidal and neuroendocrine response in a preliminary study with risperidone.Hum Psychopharmacol1990; 5: 225–231.
46.
GeldersY.G.Thymosthenic agents, a novel approach in the treatment of schizophrenia.Br J Psychiatry1989; 1155: 33–36.
47.
GeldersY.G., HeylenS.L.E., Vanden BusscheG.Pilot clinical investigation of risperidone in the treatment of psychotic patients.Psychopharmacopsychiatry1990; 23: 206–211.
48.
WechslerD.Wechsler Adult Intelligence Scale: revised manual.San Antonio TX: The Psychological Corporation,1981.
