Clinical experience with the use of low doses of chlorpromazine for the treatment of catatonic agitation in children with autism spectrum disorders

Authors

E.E. Balakireva

Mental Health Research Center, Russian Academy of Sciences, Moscow, Russian Federation

S.G. Nikitina

Mental Health Research Center, Russian Academy of Sciences, Moscow, Russian Federation

A.V. Kulikov

Mental Health Research Center, Russian Academy of Sciences, Moscow, Russian Federation

O.V. Shushpanova

Mental Health Research Center, Russian Academy of Sciences, Moscow, Russian Federation

A.A. Koval-Zaitsev

Mental Health Research Center, Russian Academy of Sciences, Moscow, Russian Federation

M.V. Ivanov

Mental Health Research Center, Russian Academy of Sciences, Moscow, Russian Federation

T.E. Blinova

Mental Health Research Center, Russian Academy of Sciences, Moscow, Russian Federation

N.S. Shalina

Mental Health Research Center, Russian Academy of Sciences, Moscow, Russian Federation

https://doi.org/10.26617/1810-3111-2024-2(123)-92-100

Journal: Siberian Herald of Psychiatry and Addiction Psychiatry. 2024; 2 (123):  92-100.

Abstract

Background. Chlorpromazine, despite almost 75 years of experience of the use in antipsychotic therapy, has not lost its importance in psychiatric practice due to the features of drug-receptor interaction and subsequent fast clinical response. Chlorpromazine is approved for the treatment of psychomotor restlessness, agitation, and anxiety, including autism spectrum disorders (ASD). Psychomotor agitation in children with ASD is described in a number of scientific schools as part of the catatonic syndrome. The use of chlorpromazine in low doses can be potentially successful in cases of catatonia with psychomotor agitation; therefore, it seems relevant to evaluate its effectiveness and the possibility of use in these conditions, taking into account the unwanted side effects of therapy. Objective: to evaluate the possibility of using chlorpromazine to relieve catatonic agitation in children with ASD. Materials and Methods. The study was carried out based on the Children's Unit (no. 7) of Federal State Budgetary Scientific Institution “Mental Health Research Center”. The study sample included patients (n=87) aged 3 to 15 years who met the inclusion criteria: diagnosis according to ICD-10 childhood autism (F84.0), atypical autism (F84.1), with the presence of psychomotor agitation in the clinical picture of the disease. Informed consent for patients' participation in the study was obtained from parents or legal representatives. Results. During therapy with chlorpromazine, a reduction in catatonic disorders was noted in the form of a decrease in the severity of catatonic symptoms on the Bush-Francis Catatonia Rating Scale (BFCRS) from moderate to mild, mainly due to decrease in the severity of hyperkinetic catatonia and reducing the symptoms of minor catatonia. A decrease in the severity of ASD on the Clinical Global Impression-Severity sub-scale (CGI-S) from severe to marked was revealed. The assessment of the general condition confirmed the improvement due to the reduction of catatonic hyperkinetic symptoms. The efficacy of the therapy and side effects according to the Clinical Global Impression-Efficacy subscale (CGI-E) were evaluated as moderate, with partial remission of symptoms and an insignificant impact of side effects on the patient’s functional status. At the same time, the features of the spectrum of receptor action determined the high prevalence of adverse events of mild severity, and therefore it was necessary to inform parents or caregivers on the duration and severity of side effects. It was necessary to monitor the patient’s somatic condition in the first days of taking the therapy. Conclusion. Thus, the use of chlorpromazine in low doses for the treatment of catatonic agitation in children with ASD was feasible and accessible. The agent was effective in the presence of the pronounced hyperkinetic component of the catatonic syndrome. Mild adverse events were quite common, which required monitoring by a doctor in the first days of taking the agent.

Keywords: chlorpromazine, autism spectrum disorder, catatonia, childhood.

Article (pdf)

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Materials  

For citation: Balakireva E.E., Nikitina S.G., Kulikov A.V., Shushpanova O.V., Koval-Zaitsev A.A., Ivanov M.V., Blinova T.E., Shalina N.S. Clinical experience with the use of low doses of chlorpromazine for the treatment of catatonic agitation in children with autism spectrum disorders. Siberian Herald of Psychiatry and Addiction Psychiatry.2024; 2 (123): 92-100. https://doi.org/10.26617/1810-3111-2024-2(123)-92-100

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