|
Anxiety , aggressive behaviours , social participation , language development in young children |
2.5-5.0mg in young children ( 2-6 years )
10-100mg in older children and adolescents
|
Diarrhoea , loss of appetite , hyperhidrosis , activation ( restlessness , mood changes , disinhibited behaviours ) and tremor . |
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Up to 200mg per day in adults |
Methylphenidate |
Central nervous system stimulant |
Non-competitively blocks the reuptake of dopamine and noradrenaline |
ADHD |
Typically 10-60mg per day , depending on the preparation and dosing frequency |
Decreased appetite , nausea , headaches , hypertension , irritability and insomnia |
Clonidine |
Alpha-2 adrenergic receptor agonist |
Stimulates presynaptic and postsynaptic alpha-2 adrenergic receptors in the prefrontal cortex |
Hyperactivity , overstimulation , attention / concentration problems and aggression , sleep disturbances |
Initial dose 0.025mg / day in children and titrate to maximum dose of 0.4mg / day in older children and adults |
Sedation , postural hypotension , nausea , constipation , bradycardia , xerostomia |
Guanfacine |
Alpha-2 adrenergic receptor agonist |
Stimulates presynaptic and postsynaptic alpha-2 adrenergic receptors in the prefrontal cortex |
Hyperactivity , frustration intolerance , hyperarousal |
Initial dose of 0.5mg / day and titrate up to a maximum dose of 4mg / day in adults |
Less sedation than clonidine , nausea , constipation , bradycardia , xerostomia |
Risperidone |
Secondgeneration antipsychotic |
Blocks dopamine D2 receptors in the prefrontal cortex and nucleus accumbens
Serotonin and norepinephrine reuptake inhibition
|
Irritability , aggression , self-injury , social impairment , stereotypic behaviours , psychosis and hyperactivity |
0.5-3mg / day based on weight
Available in long-acting injection
|
Weight changes , metabolic changes , sedation , extrapyramidal symptoms , Parkinsonian features , hyperprolactinemia |
Aripiprazole |
Secondgeneration antipsychotic |
Blocks dopamine D2 , D3 and 5-HT1A ( serotonin ) receptors
Antagonist at the 5-HT2A receptor
|
Irritability , aggression , agitation , self-injurious behaviours , sleep problems , severe anxiety |
2-15mg / day based on weight and age Increase in weight , somnolence ( dose-response relationship ) and extrapyramidal symptoms |
Melatonin Biogenic amine / endogenous hormone |
Activates melatonin receptors ML1 / ML2 , leading to inhibition of adenylate cyclase and the cAMP signal transduction pathway |
Sleep disturbances |
Initial low dose of 1mg in young children and titrating up as needed ; maximum dose typically 10mg |
Daytime drowsiness , headache , dizziness , nausea |
Activation of phospholipase C |
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Source : Protic DD et al 2022 8 |
Figure 9 . Prader-Willi syndrome . |
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Jack ’ s language is also delayed , and |
high-pitched screaming , Jack rocking |
On examination , Jack has a |
testing with routine cytogenetic |
diagnosis of ASD requiring substan- |
he uses mostly single words . His par- |
his body back and forth repeatedly , |
slightly long face and a high arched |
studies and screening for FXS and |
tial support . Genetic testing docu- |
ents have also noted delayed fine |
and frequent biting and chewing of |
palate . He has an increased carry- |
for developmental assessment . |
mented a triplet repeat of over 200 , |
motor skills , with Jack needing help |
his clothes and fingers . There are fre- |
ing angle around his elbow . The |
This demonstrates moderate global |
confirming a diagnosis of FXS full |
with dressing , eating and other fine |
quent tantrums that are difficult to |
remainder of the examination is |
developmental delay and impaired |
mutation . |
motor skills . |
control . Both the pregnancy and birth |
normal . |
reciprocal communication and |
Treatment is initiated with |
His parents report a history of |
were normal with no complications . |
Jack is referred for genetic |
socialisation , with a DSM-5 TR |
both non-pharmacological and |