Paliperidone in an Adult Patient with Asperger Syndrome: Case Report

Asperger syndrome is a pervasive developmental disorder, in which pharmacological treatment is indicated in cases with severe behavioural or psychotic symptoms. For example, risperidone has frequently been used to treat behavioural symptoms of autism spectrum disorders, but its efficacy is limited due to the relatively high frequency of adverse effects. We report a case of Asperger syndrome with psychotic features that responded well to paliperidone, the principal metabolite of risperidone. Paliperidone at a dose of 6 mg per day was clinically effective in the treatment of both psychotic and autistic symptoms, and was generally well tolerated, probably due to its oral extended release formulation.

References

• 1 American Psychiatric Association .Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Washington, DC, American Psychiatric Association 1994
• 2 Badcock C, Crespi B. Imbalanced genomic imprinting in brain development: an evolutionary basis for the aetiology of autism.  J Evol Biol. 2006;  19 1007-1032
• 3 Gillberg C, Billstedt E. Autism and Asperger syndrome: coexistence with other clinical disorders.  Acta Psychiatr Scand. 2000;  102 321-330
• 4 Kamp-Becker I, Mattejat F, Wolf-Ostermann K. et al . The Marburg Rating Scale for Asperger's Syndrome (MBAS) – a screening instrument for high-functioning autistic disorders.  Z Kinder Jugendpsychiatr Psychother. 2005;  33 15-26
• 5 Lautenschlager M, Heinz A. Paliperidone-ER: first atypical antipsychotic with oral extended release formulation.  Expert Rev Neurother. 2008;  8 193-200
• 6 Leon J, Susce MT, Pan RM. et al . A study of genetic (CYP2D6 and ABCB1) and environmental (drug inhibitors and inducers) variables that may influence plasma risperidone levels.  Pharmacopsychiatry. 2007;  40 93-102
• 7 Lindstrom LH, Gefvert O, Hagberg G. et al . Increased dopamine synthesis rate in medial prefrontal cortex and striatum in schizophrenia indicated by L-(beta-11C) DOPA and PET.  Biol Psychiatry. 1999;  46 681-688
• 8 MacCracken JT, MacGough J, Shah B. et al . Risperidone in children with autism and serious behavioral problems.  N Engl J Med. 2002;  347 314-321
• 9 Megens AA, Awouters FH. In vivo pharmacological profile of 9-hydroxyrisperidone, the major metabolite of the novel antipsychotic risperidone.  Drug Dev Res. 1994;  33 399-412
• 10 Nieminen-von Wendt T, Metsähonkala L, Kulomäki TA. et al . Increased presynaptic dopamine function in Asperger syndrome.  NeuroReport. 2004;  15 757-760
• 11 Nieminen-von Wendt T, Salonen O, Vanhala R. et al . A quantitative controlled MRI study of the brain in 28 persons with Asperger syndrome.  Int J Circumpolar Health. 2002;  61 ((Suppl 2)) 22-35
• 12 Nopoulos PC, Ceilley JW, Gailis EA. et al . An MRI study of midbrain morphology in patients with schizophrenia: relationship to psychosis, neuroleptics, and cerebellar neural circuitry.  Biol Psychiatry. 2001;  49 13-19
• 13 Towbin KE. Strategies for pharmacological treatment of high functioning autism and Asperger syndrome.  Child Adolesc Psychiatr Clin N Am. 2003;  12 23-45
• 14 Ylisaukko-oja T, Nieminen-von Wendt T, Kempas E. et al . Genome-wide scan for loci of Asperger syndrome.  Mol Psychiatry. 2004;  9 161-168

Correspondence