自閉スペクトラム症の薬物療法:エビデンスと臨床判断の実際
DOI:
https://doi.org/10.51094/jxiv.980キーワード:
診断上の課題、 代償性適応、 併存疾患、 非定型抗精神病薬、 有害事象の管理抄録
自閉スペクトラム症(ASD)の診断において、知的障害を伴わないケースでは、高い知的能力による代償的な適応により、表面的には定型発達との区別が困難となることがある。また、発達段階による症状表現の変化や、成人期における長年の代償的適応により、基本的な特性が把握しにくい場合も多い。特に女性では、社会性の模倣や対人関係における代償的な方略の獲得により、典型的なASD特性が見えにくい傾向がある。さらに、不安障害や気分障害などの併存症が前景に立つ場合、基礎にあるASD特性の評価が困難となる。診断には複数の場面での行動観察と詳細な発達歴の聴取を丁寧に行うことが求められる。また、発達段階や性差による症状表現の違い、併存症の影響を考慮した包括的な評価が不可欠である。特に、代償的な適応を示す高機能例では、環境変化によって顕在化する困難さにも注目する必要がある。これらの多面的な評価により、より適切な診断と支援につながることが期待される。
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引用文献
American Psychiatric Association. Diagnostic and statistical manual of mental disorders, fifth edition, text revision (DSM-5-TR®). Muskin PR, Dickerman AL, Drysdale A, Holderness CC, editors. Arlington, TX: American Psychiatric Association Publishing; 2023. 1120 p.
Lord C, Brugha TS, Charman T, Cusack J, Dumas G, Frazier T, et al. Autism spectrum disorder. Nat Rev Dis Primers. 2020 Jan 16;6(1):5.
McCracken JT, Anagnostou E, Arango C, Dawson G, Farchione T, Mantua V, et al. Drug development for Autism Spectrum Disorder (ASD): Progress, challenges, and future directions. Eur Neuropsychopharmacol. 2021 Jul;48:3–31.
Bai D, Yip BHK, Windham GC, Sourander A, Francis R, Yoffe R, et al. Association of genetic and environmental factors with autism in a 5-country cohort. JAMA Psychiatry. 2019 Oct 1;76(10):1035–43.
Sasaki T, Tome S, Takei Y. Intraventricular IL-17A administration activates microglia and alters their localization in the mouse embryo cerebral cortex. Mol Brain. 2020 Jun 16;13(1):93.
久保明澄, 神谷沙羅, 樋口浩輝, 中村賢佑, 左中彩恵, 佐々木哲也. 胎生期バルプロ酸曝露と自閉スペクトラム症-発達神経毒性メカニズムと動物モデルの統合的考察. jxiv.jst.go.jp [Internet]. Available from: https://jxiv.jst.go.jp/index.php/jxiv/preprint/view/905
Sanagi T, Sasaki T, Nakagaki K, Minamimoto T, Kohsaka S, Ichinohe N. Segmented Iba1-positive processes of microglia in autism model marmosets. Front Cell Neurosci. 2019 Jul 30;13:344.
Sanaka S, Higuchi K, Nakamura K. Morikawa M, Iwata S, Sasaki T, Takei Y. Microstructural abnormalities of the cerebral cortex and autism spectrum disorders: from human pathology to animal models. Medical Science Digest. 2024 Sep;50(11):488–9.
Owen R, Sikich L, Marcus RN, Corey-Lisle P, Manos G, McQuade RD, et al. Aripiprazole in the treatment of irritability in children and adolescents with autistic disorder. Pediatrics. 2009 Dec;124(6):1533–40.
Scahill L, McDougle CJ, Aman MG, Johnson C, Handen B, Bearss K, et al. Effects of risperidone and parent training on adaptive functioning in children with pervasive developmental disorders and serious behavioral problems. J Am Acad Child Adolesc Psychiatry. 2012 Feb;51(2):136–46.
McCracken JT, McGough J, Shah B, Cronin P, Hong D, Aman MG, et al. Risperidone in children with autism and serious behavioral problems. N Engl J Med. 2002 Aug 1;347(5):314–21.
Hirsch LE, Pringsheim T. Aripiprazole for autism spectrum disorders (ASD). Cochrane Database Syst Rev. 2016 Jun 26;2016(6):CD009043.
Correll CU, Manu P, Olshanskiy V, Napolitano B, Kane JM, Malhotra AK. Cardiometabolic risk of second-generation antipsychotic medications during first-time use in children and adolescents. JAMA. 2009 Oct 28;302(16):1765–73.
Williams K, Brignell A, Randall M, Silove N, Hazell P. Selective serotonin reuptake inhibitors (SSRIs) for autism spectrum disorders (ASD). Cochrane Database Syst Rev. 2013 Aug 20;(8):CD004677.
Hollander E, Phillips A, Chaplin W, Zagursky K, Novotny S, Wasserman S, et al. A placebo controlled crossover trial of liquid fluoxetine on repetitive behaviors in childhood and adolescent autism. Neuropsychopharmacology. 2005 Mar;30(3):582–9.
Reichow B, Hume K, Barton EE, Boyd BA. Early intensive behavioral intervention (EIBI) for young children with autism spectrum disorders (ASD). Cochrane Database Syst Rev. 2018 May 9;5(10):CD009260.
Pearson DA, Santos CW, Aman MG, Arnold LE, Casat CD, Mansour R, et al. Effects of extended release methylphenidate treatment on ratings of attention-deficit/hyperactivity disorder (ADHD) and associated behavior in children with autism spectrum disorders and ADHD symptoms. J Child Adolesc Psychopharmacol. 2013 Jun;23(5):337–51.
De Hert M, Dobbelaere M, Sheridan EM, Cohen D, Correll CU. Metabolic and endocrine adverse effects of second-generation antipsychotics in children and adolescents: A systematic review of randomized, placebo controlled trials and guidelines for clinical practice. Eur Psychiatry. 2011 Apr;26(3):144–58.
Lever AG, Geurts HM. Psychiatric co-occurring symptoms and disorders in young, middle-aged, and older adults with autism spectrum disorder. J Autism Dev Disord. 2016 Jun;46(6):1916–30.
Mazefsky CA, Herrington J, Siegel M, Scarpa A, Maddox BB, Scahill L, et al. The role of emotion regulation in autism spectrum disorder. J Am Acad Child Adolesc Psychiatry. 2013 Jul;52(7):679–88.
Ji NY, Findling RL. An update on pharmacotherapy for autism spectrum disorder in children and adolescents. Curr Opin Psychiatry. 2015 Mar;28(2):91–101.
Volkmar F, Siegel M, Woodbury-Smith M, King B, McCracken J, State M, et al. Practice parameter for the assessment and treatment of children and adolescents with autism spectrum disorder. J Am Acad Child Adolesc Psychiatry. 2014 Feb;53(2):237–57.
Siegel M, Smith KA, Mazefsky C, Gabriels RL, Erickson C, Kaplan D, et al. The autism inpatient collection: methods and preliminary sample description. Mol Autism. 2015 Nov 10;6(1):61.
Hedley D, Uljarević M, Cameron L, Halder S, Richdale A, Dissanayake C. Employment programmes and interventions targeting adults with autism spectrum disorder: A systematic review of the literature. Autism. 2017 Nov;21(8):929–41.
Nicholas DB, Attridge M, Zwaigenbaum L, Clarke M. Vocational support approaches in autism spectrum disorder: a synthesis review of the literature. Autism. 2015 Feb;19(2):235–45.
Roux AM, Shattuck PT, Cooper BP, Anderson KA, Wagner M, Narendorf SC. Postsecondary employment experiences among young adults with an autism spectrum disorder. J Am Acad Child Adolesc Psychiatry. 2013 Sep;52(9):931–9.
Alvarez-Jimenez M, Priede A, Hetrick SE, Bendall S, Killackey E, Parker AG, et al. Risk factors for relapse following treatment for first episode psychosis: a systematic review and meta-analysis of longitudinal studies. Schizophr Res. 2012 Aug;139(1–3):116–28.
Baribeau DA, Doyle-Thomas KAR, Dupuis A, Iaboni A, Crosbie J, McGinn H, et al. Examining and comparing social perception abilities across childhood-onset neurodevelopmental disorders. J Am Acad Child Adolesc Psychiatry. 2015 Jun;54(6):479-86.e1.
Bishop-Fitzpatrick L, Minshew NJ, Eack SM. A systematic review of psychosocial interventions for adults with autism spectrum disorders. J Autism Dev Disord. 2013 Mar;43(3):687–94.
Croen LA, Zerbo O, Qian Y, Massolo ML, Rich S, Sidney S, et al. The health status of adults on the autism spectrum. Autism. 2015 Oct;19(7):814–23.
Hirvikoski T, Mittendorfer-Rutz E, Boman M, Larsson H, Lichtenstein P, Bölte S. Premature mortality in autism spectrum disorder. Br J Psychiatry. 2016 Mar;208(3):232–8.
Hong J, Bishop-Fitzpatrick L, Smith LE, Greenberg JS, Mailick MR. Factors associated with subjective quality of life of adults with autism spectrum disorder: Self-report versus maternal reports. J Autism Dev Disord. 2016 Apr;46(4):1368–78.
Lai M-C, Anagnostou E, Wiznitzer M, Allison C, Baron-Cohen S. Evidence-based support for autistic people across the lifespan: maximising potential, minimising barriers, and optimising the person-environment fit. Lancet Neurol. 2020 May;19(5):434–51.
Lord C, Charman T, Havdahl A, Carbone P, Anagnostou E, Boyd B, et al. The Lancet Commission on the future of care and clinical research in autism. Lancet. 2022 Jan 15;399(10321):271–334.
Mason D, McConachie H, Garland D, Petrou A, Rodgers J, Parr JR. Predictors of quality of life for autistic adults. Autism Res. 2018 Aug;11(8):1138–47.
McConachie H, Mason D, Parr JR, Garland D, Wilson C, Rodgers J. Enhancing the validity of a quality of life measure for autistic people. J Autism Dev Disord. 2018 May;48(5):1596–611.
Respect the way I need to communicate with you. In: Healthcare experiences of adults on the autism spectrum.
Piven J, Palmer P, Jacobi D, Childress D, Arndt S. Broader autism phenotype: evidence from a family history study of multiple-incidence autism families. Am J Psychiatry. 1997 Feb;154(2):185–90.
Sizoo BB, van der Gaag RJ, van den Brink W. Temperament and character as endophenotype in adults with autism spectrum disorders or attention deficit/hyperactivity disorder. Autism. 2015 May;19(4):400–8.
Levy SE, Giarelli E, Lee L-C, Schieve LA, Kirby RS, Cunniff C, et al. Autism spectrum disorder and co-occurring developmental, psychiatric, and medical conditions among children in multiple populations of the United States. J Dev Behav Pediatr. 2010 May;31(4):267–75.
Scahill L, McCracken JT, King BH, Rockhill C, Shah B, Politte L, et al. Extended-release guanfacine for hyperactivity in children with autism spectrum disorder. Am J Psychiatry. 2015 Dec;172(12):1197–206.
Systematic review: Rates and patterns of antipsychotic use in youth with autism spectrum disorders.
Arnold LE, Aman MG, Cook AM, Witwer AN, Hall KL, Thompson S, et al. Atomoxetine for hyperactivity in autism spectrum disorders: placebo-controlled crossover pilot trial. J Am Acad Child Adolesc Psychiatry. 2006 Oct;45(10):1196–205.
Aman MG, McDougle CJ, Scahill L, Handen B, Arnold LE, Johnson C, et al. Medication and parent training in children with pervasive developmental disorders and serious behavior problems: results from a randomized clinical trial. J Am Acad Child Adolesc Psychiatry. 2009 Dec;48(12):1143–54.
Cohen D, Raffin M, Canitano R, Bodeau N, Bonnot O, Périsse D, et al. Risperidone or aripiprazole in children and adolescents with autism and/or intellectual disability: A Bayesian meta-analysis of efficacy and secondary effects. Res Autism Spectr Disord. 2013 Jan;7(1):167–75.
Wong C, Odom SL, Hume KA, Cox AW, Fettig A, Kucharczyk S, et al. Evidence-based practices for children, youth, and young adults with autism spectrum disorder: A comprehensive review. J Autism Dev Disord. 2015 Jul;45(7):1951–66.
Kasari C, Kaiser A, Goods K, Nietfeld J, Mathy P, Landa R, et al. Communication interventions for minimally verbal children with autism: a sequential multiple assignment randomized trial. J Am Acad Child Adolesc Psychiatry. 2014 Jun;53(6):635–46.
Parsons L, Cordier R, Munro N, Joosten A, Speyer R. A systematic review of pragmatic language interventions for children with autism spectrum disorder. PLoS One. 2017 Apr 20;12(4):e0172242.
Locke J, Williams J, Shih W, Kasari C. Characteristics of socially successful elementary school-aged children with autism. J Child Psychol Psychiatry. 2017 Jan;58(1):94–102.
Anagnostou E, Soorya L, Brian J, Dupuis A, Mankad D, Smile S, et al. Intranasal oxytocin in the treatment of autism spectrum disorders: a review of literature and early safety and efficacy data in youth. Brain Res. 2014 Sep 11;1580:188–98.
Parker KJ, Oztan O, Libove RA, Sumiyoshi RD, Jackson LP, Karhson DS, et al. Intranasal oxytocin treatment for social deficits and biomarkers of response in children with autism. Proc Natl Acad Sci U S A. 2017 Jul 25;114(30):8119–24.
Bolognani F, Del Valle Rubido M, Squassante L, Wandel C, Derks M, Murtagh L, et al. A phase 2 clinical trial of a vasopressin V1a receptor antagonist shows improved adaptive behaviors in men with autism spectrum disorder. Sci Transl Med. 2019 May 8;11(491):eaat7838.
Hollander E, Jacob S, Jou R, McNamara N, Sikich L, Tobe R, et al. Balovaptan vs placebo for social communication in childhood autism spectrum disorder: A randomized clinical trial. JAMA Psychiatry. 2022 Aug 1;79(8):760–9.
Veenstra-VanderWeele J, Cook EH, King BH, Zarevics P, Cherubini M, Walton-Bowen K, et al. Arbaclofen in children and adolescents with autism spectrum disorder: A randomized, controlled, phase 2 trial. Neuropsychopharmacology. 2017 Jun;42(7):1390–8.
Pickles A, Le Couteur A, Leadbitter K, Salomone E, Cole-Fletcher R, Tobin H, et al. Parent-mediated social communication therapy for young children with autism (PACT): long-term follow-up of a randomised controlled trial. Lancet. Elsevier BV; 2016 Nov 19;388(10059):2501–9.
Hong MP, Erickson CA. Investigational drugs in early-stage clinical trials for autism spectrum disorder. Expert Opin Investig Drugs. 2019 Aug;28(8):709–18.
Fuentes J, Hervás A, Howlin P, (ESCAP ASD Working Party). ESCAP practice guidance for autism: a summary of evidence-based recommendations for diagnosis and treatment. Eur Child Adolesc Psychiatry. 2021 Jun;30(6):961–84.
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投稿日時: 2024-11-30 13:44:34 UTC
公開日時: 2024-12-05 00:32:50 UTC
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佐々木, 哲也
左中, 彩恵
神谷, 沙羅
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