WORKSHOP: Role of Guanfacine XR in the Management of Aggressive Behaviors in Adults with Neuro Developmental Disorders
Evaluate the session
Presenting Author(s): Dr. Prajjita Bardoloi Co-Author(s): Dr. Ade Orimalade
Date and time: 25 Mar 2023 from 13:50 to 14:10
Location: Hawthorn A Learning Objectives
- Learning about complex behavioral problems in patients with Neurodevelopmental disorders;
- Management of aggression in individuals with Neurodevelopmental disorders - behavioral and Medication management;
- Use of Guanfacine XR to manage aggressive behaviors in Neurodevelopmental disorders.
Abstract
Neurodevelopmental Disorders (NDD) are a group of developmental disorders which are associated with high rates of comorbid psychiatric and behavioral problems. This leads to increased need for crisis interventions, ER visits, care giver burnout and increased pressure on the health care system. These patients often end up with polypharmacy of multiple psychotropic medications and complexities secondary to the associated side effects. In this presentation we will discuss about role of Guanfacine XR in managing aggressive behaviors in this vulnerable group of patients as well as Neuro Developmental disorders and the comorbid diagnosis and challenges. This includes:
- Neurobiology of aggression;
- Current management approaches;
- Case presentations – Treatment of NDD patients with aggression using Guanfacine XR;
- Future steps- Study – Use of Guanfacine XR to treat aggression in patients with Neurodevelopmental disorders.
Literature References
- The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR), Psychiatry.org - DSM
- Straub, L., Bateman, B. T., Hernandez-Diaz, S., York, C., Lester, B., Wisner, K. L., McDougle, C. J., Pennell, P. B., Gray, K. J., Zhu, Y., Suarez, E. A., Mogun, H., & Huybrechts, K. F. (2022). Neurodevelopmental Disorders Among Publicly or Privately Insured Children in the United States. JAMA psychiatry, 79(3), 232–242. https://doi.org/10.1001/jamapsychiatry.2021.3815
- Durbin, A., Balogh, R., Lin, E., Wilton, A. S., Selick, A., Dobranowski, K. M., & Lunsky, Y. (2019). Repeat Emergency Department Visits for Individuals With Intellectual and Developmental Disabilities and Psychiatric Disorders. American journal on intellectual and developmental disabilities, 124(3), 206–219. https://doi.org/10.1352/1944-7558-124.3.206
- Peter Sturmey-Treatment interventions for people with aggressive behaviour and intellectual disability - 42.p65 (choiceforum.org)
- Hosking, F. J., Carey, I. M., DeWilde, S., Harris, T., Beighton, C., & Cook, D. G. (2017). Preventable Emergency Hospital Admissions Among Adults with Intellectual Disability in England. Annals of family medicine, 15(5), 462–470. https://doi.org/10.1370/afm.2104
- Valdovinos, M.G. Psychotropic Medication in Intellectual and Developmental Disabilities: Patterns of Use and Recommendations for Monitoring Effects. Curr Dev Disord Rep 6, 195–201 (2019). https://doi.org/10.1007/s40474-019-00179-5
- Deb, S., & Unwin, G. L. (2007). Psychotropic medication for behaviour problems in people with intellectual disability: a review of the current literature. Current opinion in psychiatry, 20(5), 461–466. https://doi.org/10.1097/YCO.0b013e3282ab9952
- Matson, J. L., & Dempsey, T. (2008). Autism Spectrum Disorders: Pharmacotherapy for Challenging Behaviors. Journal of Developmental and Physical Disabilities, 20(2), 175–191. https://doi-org
- Mohiuddin, S., & Ghaziuddin, M. (2013). Psychopharmacology of autism spectrum disorders: a selective review. Autism : the international journal of research and practice, 17(6), 645–654. https://doi.org/10.1177/1362361312453776
- Siever L. J. (2008). Neurobiology of aggression and violence. The American journal of psychiatry, 165(4), 429–442. https://doi.org/10.1176/appi.ajp.2008.07111774
- Tyrer, P., Oliver-Africano, P. C., Ahmed, Z., Bouras, N., Cooray, S., Deb, S., Murphy, D., Hare, M., Meade, M., Reece, B., Kramo, K., Bhaumik, S., Harley, D., Regan, A., Thomas, D., Rao, B., North, B., Eliahoo, J., Karatela, S., Soni, A., … Crawford, M. (2008). Risperidone, haloperidol, and placebo in the treatment of aggressive challenging behaviour in patients with intellectual disability: a randomised controlled trial. Lancet (London, England), 371(9606), 57–63. https://doi.org/10.1016/S0140-6736(08)60072-0
- Tsiouris, J. A., Kim, S. Y., Brown, W. T., Pettinger, J., & Cohen, I. L. (2013). Prevalence of psychotropic drug use in adults with intellectual disability: positive and negative findings from a large scale study. Journal of autism and developmental disorders, 43(3), 719–731. https://doi.org/10.1007/s10803-012-1617-6
- Glover, G., Bernard, S., Branford, D., Holland, A., & Strydom, A. (2014). Use of medication for challenging behaviour in people with intellectual disability. The British journal of psychiatry : the journal of mental science, 205(1), 6–7. https://doi.org/10.1192/bjp.bp.113.141267
- McCracken, J. T., McGough, J., Shah, B., Cronin, P., Hong, D., Aman, M. G., Arnold, L. E., Lindsay, R., Nash, P., Hollway, J., McDougle, C. J., Posey, D., Swiezy, N., Kohn, A., Scahill, L., Martin, A., Koenig, K., Volkmar, F., Carroll, D., Lancor, A., … Research Units on Pediatric Psychopharmacology Autism Network (2002). Risperidone in children with autism and serious behavioral problems. The New England journal of medicine, 347(5), 314–321. https://doi.org/10.1056/NEJMoa013171
- Research Units on Pediatric Psychopharmacology Autism Network (2005). Risperidone treatment of autistic disorder: longer-term benefits and blinded discontinuation after 6 months. The American journal of psychiatry, 162(7), 1361–1369. https://doi.org/10.1176/appi.ajp.162.7.1361
- Owen, R., Sikich, L., Marcus, R. N., Corey-Lisle, P., Manos, G., McQuade, R. D., Carson, W. H., & Findling, R. L. (2009). Aripiprazole in the treatment of irritability in children and adolescents with autistic disorder. Pediatrics, 124(6), 1533–1540. https://doi.org/10.1542/peds.2008-3782
- McQuire, C., Hassiotis, A., Harrison, B., & Pilling, S. (2015). Pharmacological interventions for challenging behaviour in children with intellectual disabilities: a systematic review and meta-analysis. BMC psychiatry, 15, 303. https://doi.org/10.1186/s12888-015-0688-2
- Ray, W. A., Stein, C. M., Murray, K. T., Fuchs, D. C., Patrick, S. W., Daugherty, J., Hall, K., & Cooper, W. O. (2019). Association of Antipsychotic Treatment With Risk of Unexpected Death Among Children and Youths. JAMA psychiatry, 76(2), 162–171. https://doi.org/10.1001/jamapsychiatry.2018.3421
- Tsiouris, J. A., Kim, S. Y., Brown, W. T., Pettinger, J., & Cohen, I. L. (2013). Prevalence of psychotropic drug use in adults with intellectual disability: positive and negative findings from a large scale study. Journal of autism and developmental disorders, 43(3), 719–731. https://doi.org/10.1007/s10803-012-1617-6
- Robertson, J., Emerson, E., Gregory, N., Hatton, C., Kessissoglou, S., & Hallam, A. (2000). Receipt of psychotropic medication by people with intellectual disability in residential settings. Journal of intellectual disability research : JIDR, 44 ( Pt 6), 666–676. https://doi.org/10.1046/j.1365-2788.2000.00307.x
- Giovannitti, J. A., Jr, Thoms, S. M., & Crawford, J. J. (2015). Alpha-2 adrenergic receptor agonists: a review of current clinical applications. Anesthesia progress, 62(1), 31–39. https://doi.org/10.2344/0003-3006-62.1.31
- Arnsten, A. F., Steere, J. C., & Hunt, R. D. (1996). The contribution of α2-noradrenergic mechanisms to prefrontal cortical cognitive function: potential significance for attention-deficit hyperactivity disorder. Archives of General Psychiatry, 53(5), 448-455.
- Arnsten, A. F., & Jin, L. E. (2012). Guanfacine for the treatment of cognitive disorders: a century of discoveries at Yale. The Yale journal of biology and medicine, 85(1), 45–58.
- Arnsten A. F. T. (2020). Guanfacine's mechanism of action in treating prefrontal cortical disorders: Successful translation across species. Neurobiology of learning and memory, 176, 107327. https://doi.org/10.1016/j.nlm.2020.107327
- Castro-Alamancos, M. A., & Calcagnotto, M. E. (2001). High-pass filtering of corticothalamic activity by neuromodulators released in the thalamus during arousal: in vitro and in vivo. Journal of neurophysiology, 85(4), 1489–1497. https://doi.org/10.1152/jn.2001.85.4.1489
- Hoffmann M. (2013). The human frontal lobes and frontal network systems: an evolutionary, clinical, and treatment perspective. ISRN neurology, 2013, 892459. https://doi.org/10.1155/2013/892459
- Bardoloi, Prajjita & Report, Case. (2020). Enhancement of Function of the Prefrontal Cortex to Improve Symptoms of Schizophrenia. Acta Scientific Neurology. 3. 2582-1121. 10.31080/ASNE.2020.03.0183.
Back
Add to Calendar