Abstract
Evidence supporting the use of ziprasidone in autistic spectrum disease remains limited. A single case series of 12 patients aged 8–20 years found improvements in the areas of aggression, agitation, and irritability [1]. We present another case of autistic disorder in a young child demonstrating sustained behavioural and cognitive improvement after initiation of low-dose ziprasidone.
The patient was a 7-year-old boy who demonstrated moderately severe agitation manifested by impulsivity, irritability, hyperactivity, and intermittent nocturnal awakenings. The agitation failed sequential trials of mixed amphetamine salts, guanfacine, sertraline, and divalproex sodium. A trial of low-dose ziprasidone (10 mg nightly) resulted in a rapid and marked improvement in multiple aspects of his agitation including sleep pattern, behaviour, mood, and impulsivity. More interestingly, however, was the unexpected improvement in the patient's cognitive and language performance noted after 8 weeks treatment; this was evidenced by increased attentiveness and diminished distractibility coupled with a modest increase in language function so that the patient began to follow directions and use simple 2–3-word phrases to express desires and wishes.
The patient was rated as ‘much improved’ by both the examining physician as well as his parents using the Clinical Global Impression (CGI) scale. After 8 months continuous treatment, the patient continues to exhibit sustained behavioural and cognitive improvement without significant adverse effects.
Ziprasidone is a relatively new atypical antipsychotic medication approved for use in the US in 2002, but relatively little has been reported on its use in pervasive developmental disorders. Ziprasidone enjoys a mixed receptor profile such that it acts as an antagonist at the D2, 5HT2A, and 5HT1D receptors as well as demonstrating 5HT1A agonist effects. In addition, ziprasidone appears to inhibit synaptic reuptake of serotonin and norepinephrine and demonstrates moderate affinity for the H1 receptor [2, 3]. The improvement in attention and impulsivity may be related directly to synaptic reuptake inhibition of norepinephrine similar to novel agents developed for use in attention deficit hyperactivity disorder such as atomoxetine.
This case adds further evidence to the potential use of ziprasidone in young patients with pervasive developmental disorders characterized by behavioural disturbance. Further, it yields support to the small body of evidence for the safe and efficacious use of ziprasidone in this young age group. To our knowledge, this is the youngest child reported in the literature to date. Further studies are indicated to better characterize the emerging role of this agent in treating pervasive developmental disorder spectrum illness.
Editorial Note: ziprasidone is not currently available in Australia.