Management of Aggressive Behaviors in Neurodevelopmental Disorders - Role of α 2 Agonists
Prajjita Sarma Bardoloi*
Clinical Lecturer, Department of Psychiatry, University of Alberta, Canada
*Corresponding Author: Prajjita Sarma Bardoloi, Clinical Lecturer, Department of Psychiatry, University of Alberta, Canada.
November 28, 2022; Published: January 20, 2022
Neurodevelopmental Disorders (NDD) are associated with high rates of comorbid behavioral problems leading to increased need for crisis interventions, ER visits and health care spending. These patients often end up with polypharmacy of multiple psychotropic medications and complexities secondary to the associated side effects, which may often be irreversible. Not having a proper guideline also makes it difficult for physicians to select appropriate medications. Due to underlying sympathetic over activity, many of this group of patients can get easily dysregulated, making it difficult for their caregivers to care for them. A common practice of pharmacological management of behavioral problems in NDD is to use antipsychotics and other psychotropic medications, often without any primary psychiatric disorder. Much less attention has been given to medications like α 2 agonists. Researches in the past couple of decades have found these medications much effective in behavioral management, with added benefit of lower long term side effects.
Keywords: Aggressive Behaviors; Neurodevelopmental Disorders; α 2 Agonists
- The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR).
- Straub L., et al. “Neurodevelopmental Disorders Among Publicly or Privately Insured Children in the United States”. JAMA Psychiatry3 (2022): 232-242.
- Durbin A., et al. “Repeat Emergency Department Visits for Individuals with Intellectual and Developmental Disabilities and Psychiatric Disorders”. American Journal on Intellectual and Developmental Disabilities3 (2019): 206-219.
- Peter Sturmey. “Treatment interventions for people with aggressive behaviour and intellectual disability.
- Hosking FJ., et al. “Preventable Emergency Hospital Admissions Among Adults with Intellectual Disability in England”. Annals of Family Medicine5 (2017): 462-470.
- Valdovinos MG. “Psychotropic Medication in Intellectual and Developmental Disabilities: Patterns of Use and Recommendations for Monitoring Effects”. Current Developmental Disorders Reports 6 (2019): 195-201.
- Deb S and Unwin GL. “Psychotropic medication for behaviour problems in people with intellectual disability: a review of the current literature”. Current Opinion in Psychiatry5 (2007): 461-466.
- Matson JL and Dempsey T. “Autism spectrum disorders: Pharmacotherapy for Challenging Behaviors”. Journal of Developmental and Physical Disabilities2 (2008): 175-191.
- Mohiuddin S and Ghaziuddin M. “Psychopharmacology of autism spectrum disorders: a selective review”. Autism: The International Journal of Research and Practice6 (2013): 645-654.
- Siever LJ. “Neurobiology of aggression and violence”. The American Journal of Psychiatry4 (2008): 429-442.
- Tyrer P., et al. “Risperidone, haloperidol, and placebo in the treatment of aggressive challenging behaviour in patients with intellectual disability: a randomised controlled trial”. Lancet (London, England)9606 (2008): 57-63.
- Tsiouris JA., et al. “Prevalence of psychotropic drug use in adults with intellectual disability: positive and negative findings from a large scale study”. Journal of Autism and Developmental Disorders3 (2014): 719-731.
- Glover G., et al. “Use of medication for challenging behaviour in people with intellectual disability”. The British Journal of Psychiatry: The Journal of Mental Science1 (2014): 6-7.
- McCracken JT., et al. “Research Units on Pediatric Psychopharmacology Autism Network. Risperidone in children with autism and serious behavioral problems”. The New England Journal of Medicine5 (2002): 314-321.
- Research Units on Pediatric Psychopharmacology Autism Network. Risperidone treatment of autistic disorder: longer-term benefits and blinded discontinuation after 6 months”. The American Journal of Psychiatry7 (2005): 1361-1369.
- Owen R., et al. “Aripiprazole in the treatment of irritability in children and adolescents with autistic disorder”. Pediatrics6 (2009): 1533-1540.
- McQuire C., et al. “Pharmacological interventions for challenging behaviour in children with intellectual disabilities: a systematic review and meta-analysis”. BMC Psychiatry 15 (2015):
- Ray WA., et al. “Association of Antipsychotic Treatment with Risk of Unexpected Death Among Children and Youths”. JAMA Psychiatry2 (2019): 162-171.
- Tsiouris JA., et al. “Prevalence of psychotropic drug use in adults with intellectual disability: positive and negative findings from a large-scale study”. Journal of Autism and Developmental Disorders3 (2013): 719-731.
- Robertson J., et al. “Receipt of psychotropic medication by people with intellectual disability in residential settings”. Journal of Intellectual Disability Research: JIDRPt6 (2000): 666-676.
- Giovannitti JA., et al. “Alpha-2 adrenergic receptor agonists: a review of current clinical applications”. Anesthesia Progress1 (2015): 31-39.
- Arnsten AF., et al. “The contribution of α2-noradrenergic mechanisms to prefrontal cortical cognitive function: potential significance for attention-deficit hyperactivity disorder”. Archives of General Psychiatry5 (1996): 448-455.
- Arnsten AF and Jin LE. “Guanfacine for the treatment of cognitive disorders: a century of discoveries at Yale”. The Yale Journal of Biology and Medicine1 (2012): 45-58.
- Arnsten AFT. “Guanfacine's mechanism of action in treating prefrontal cortical disorders: Successful translation across species”. Neurobiology of Learning and Memory 176 (2020): 107327.
- Castro-Alamancos MA and Calcagnotto ME. “High pass filtering of corticothalamic activity by neuromodulators released in the thalamus during arousal: in vitro and in vivo”. Journal of Neurophysiology4 (2001): 1489-1497.
- Hoffmann M. (2013). The human frontal lobes and frontal network systems: an evolutionary, clinical, and treatment perspective”. ISRN Neurology (2013): 892459.
- Bardoloi Prajjita and Report Case. “Enhancement of Function of the Prefrontal Cortex to Improve Symptoms of Schizophrenia”. Acta Scientific Neurology 3 (2020): 2582-1121.
- 4 (2014): 43.