RESUMO
The relationship between autism spectrum disorders and mitochondrial dysfunction, including mitochondrial myopathies and other mitochondrial diseases, is an area of ongoing research. All autism spectrum disorders are known to be heritable, via genetic and/or epigenetic mechanisms, but specific modes of inheritance are not well characterized. Nevertheless, autism spectrum disorders have been linked to many specific genes associated with mitochondrial function, especially to genes involved in mitochondrial tRNA and the electron transport chain, both particularly vulnerable to point mutations, and clinical research also supports a relationship between the two pathologies. Although only a small minority of patients with autism have a mitochondrial disease, many patients with mitochondrial myopathies have autism spectrum disorder symptoms, and these symptoms may be the presenting symptoms, which presents a diagnostic challenge for clinicians. The authors report the case of a 15-year-old boy with a history of autism spectrum disorder and neurocardiogenic syncope, admitted to the inpatient unit for self-injury, whose young mother, age 35, was discovered to suffer from mitochondrial myopathy, dysautonomia, neurocardiogenic syncope, Ehler-Danlos syndrome, and other uncommon multisystem pathologies likely related to mitochondrial dysfunction. This case illustrates the need for a high index of suspicion for mitochondrial disease in patients with autism, as they have two orders of magnitude greater risk for such diseases than the general population. The literature shows that mitochondrial disease is underdiagnosed in autism spectrum disorder patients and should not be viewed as a "zebra" (i.e., an obscure diagnosis that is made when a more common explanation is more likely).
RESUMO
Objective. This study evaluates changes in use of antidepressants in children and adolescents after the US Food and Drug Administration black box warning for increased risk of suicide.Method. A retrospective chart review was completed for children and adolescents (ages 4-17) who were diagnosed with depressive or anxiety disorders in an outpatient clinic and offered a trial of antidepressants between September 2003 and February 2004 (before the black box warning) and between January 2005 and June 2005 (after the black box warning). Statistical analyses were performed with the SPSS version 17 and R package version 2.9.1. Univariate analysis was conducted using the Fisher's Exact test.Results. The odds ratio calculated for the different groups suggests that in all the groups, the proportion of acceptance of antidepressant use was greater before the black box warning as compared to after the black box warning (odds ratio>1). It was also found that upon combining the age groups after the warning and comparing them, based on the diagnoses, there was a greater degree of refusal of antidepressant therapy when a diagnosis of anxiety disorder was made as compared to a diagnosis of depressive disorder (p=0.017).Conclusion. There has been a decrease in the use of antidepressant therapy in children and adolescents following the US Food and Drug Administration black box warning for risk of suicide. A limitation of this study is that reasons for refusal of antidepressent therapy by parents or guardians of children and adolescents were not collected; therefore, there is no certainty that the black box warning was the primary reason for refusal.