ABSTRACT
O transtorno autista e o grupo de condições relacionadas definidas como transtornos invasivos do desenvolvimento são transtornos de neurodesenvolvimento crônicos que começam na infância precoce e afetam um número significativo de crianças e suas famílias. Ainda que as causas e muito da fisiopatologia do transtorno sejam desconhecidas, em anos recentes, vários tratamentos medicamentosos disponíveis têm sido identificados como contendo a promessa de aliviar alguns dos comportamentos mal-adaptativos mais comprometedores associados aos transtornos invasivos do desenvolvimento. No entanto, esses tratamentos não enfocam os sintomas nucleares da enfermidade e, geralmente, seus efeitos colaterais excedem os benefícios. Portanto, há uma necessidade substancial de novas medicações que sejam mais seguras e mais eficazes em tratar os sintomas comportamentais do autismo. O objetivo desta revisão é o de destacar as farmacoterapias correntes disponíveis e aquelas emergentes e que tenham potencial de melhorar as opções de tratamento de pacientes com transtornos invasivos do desenvolvimento.
Subject(s)
Humans , Antidepressive Agents/therapeutic use , Antipsychotic Agents/therapeutic use , Autistic Disorder/drug therapy , Clinical Trials as Topic , Clozapine/therapeutic use , Placebos , Risperidone/therapeutic useABSTRACT
OBJECTIVES: To evaluate the efficacy and safety of guanfacine in children with attention-deficit hyperactivity disorder (ADHD) and tic disorders. MATERIAL AND METHOD: Twenty-five medication-free subjects (23 males and 2 females), aged 7-16 (mean = 10.6 +/- 2.0) years participated in an 8-week open-label guanfacine study. Subjects were recruited from a specialty clinic for children with tic disorders over a four-year period. Eligibility criteria included presence of ADHD (any type), a tic disorder (any type), and being medication free for two weeks. Outcome measures included the Hyperactivity Index of the Conners Parent Questionnaire, the teacher-rated ADHD Rating Scale, and the Yale Global Tic Severity Scale (YGTSS). RESULTS: All subjects met criteria for ADHD (combined type N = 22; predominantly inattentive type N = 3) and a tic disorder (Tourette's Disorder N = 20; chronic motor tic disorder N = 5). At an average dose of 2.0 +/- 0.6 mg/ day, guanfacine was associated with mean improvement of 27% on the Hyperactivity Index (N = 25; t = 4.61; p < 0.001), 32% on the total score of the teacher-rated ADHD Scale (N = 19; t = 5.27; p < 0.001), and 39% on the total tic severity scale (N = 19; t = 4.17; p < 0.001). Mild and statistically insignificant decreases in blood pressure and pulse were observed in the sample as a whole. Five subjects had endpoint systolic blood pressure below 1 SD from their age and gender norms. CONCLUSION: Results of this open-label study add to the growing data base on the safety and efficacy of guanfacine in children with ADHD and tic disorders.