psychiatryПСИХИАТРИЯPsychiatry (Moscow) (Psikhiatriya)1683-83192618-6667FSBSI “The Mental Health Research Centre”; LLC «Publisher «MIA»10.30629/2618-6667-2024-22-5-87-93psychiatry-1252Research ArticleНАУЧНЫЕ ОБЗОРЫSCIENTIFIC REVIEWSФармакотерапия стереотипий при аутизмеPharmacotherapy of Stereotypes in Autismhttps://orcid.org/0000-0002-1821-2760АттаеваЛ. Ж.AttaevaL. Zh.

Лейла Жамаловна Аттаева, кандидат медицинских наук, врач-психиатр

Москва

Leila Zh. Attaeva, Cand. Sci. (Med.), psychiatrist

Moscow

staff1@staffmsk6.ruhttps://orcid.org/0000-0003-0176-3846МакаровИ. В.MakarovI. V.

Игорь Владимирович Макаров, доктор медицинских наук, профессор, руководитель отделения детской психиатрии; профессор кафедры, кафедра психиатрии и наркологии

Санкт-Петербург

Igor V. Makarov, Dr. Sci. (Med.), Professor, Head of Department, Department of Child Psychiatry; Professor

St. Petersburg

ppsy@list.ruГБУЗ «Психиатрическая клиническая больница № 1 имени Н.А. Алексеева Департамента здравоохранения города Москвы», филиал Психоневрологический диспансер № 1РоссияSBIH “Psychiatric Hospital no. 1 Named after N.A. Alexeev of the Department of Health of Moscow”, Neuropsychiatric clinic No. 1Russian FederationФГБУ «Национальный медицинский исследовательский центр психиатрии и неврологии им. В.М. Бехтерева» Минздрава России; ФГБОУ ВО «Северо-Западный государственный медицинский университет им. И.И. Мечникова» Минздрава РоссииРоссияV.M. Bekhterev National Medical Research Center for Psychiatry and Neurology; North-Western State Medical University named after I.I. MechnikovRussian Federation2024090120252258793Copyright © Аттаева Л.Ж., Макаров И.В., 20252025Аттаева Л.Ж., Макаров И.В.Attaeva L.Z., Makarov I.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.journalpsychiatry.com/jour/article/view/1252

Обоснование: стереотипии — это неспецифические проявления психических заболеваний различной этиологии. Стереотипии влияют на динамику и курабельность основного заболевания и требуют медикаментозной терапии. Цель исследования: анализ опубликованных работ, касающихся фармакотерапии стереотипий у лиц с аутизмом. Материалы и методы: по ключевым словам «аутизм», «расстройство аутистического спектра», «стереотипии», «stereotypic movements», «повторяющиеся действия», «привычные движения», «эффективность лечения» проведен поиск статей на английском и русском языке в базах данных MEDLINE/PubMed, Scopus, Web of Science, eLibrary за период с 2005 по 2024 г. Заключение: анализ опубликованных работ показал, что на сегодняшний день не существует специфической медикаментозной терапии стереотипий при расстройствах аутистического спектра. До сих пор непонятно, насколько целесообразна попытка редуцировать стереотипные действия с учетом существующих теорий о саморегулирующей роли повторяющегося поведения. Медикаментозное устранение стереотипий считается необходимым тогда, когда эти расстройства достигают уровня насильственности, тяжелой одержимости, препятствуют целенаправленной деятельности и осуществлению психолого-педагогической коррекции.

Background: stereotypes are non specific manifestations of mental illnesses of various etiologies. Stereotypes affect the dynamics and severity of the manifestations of the underlying disease and require drug therapy. The aim of the study is to analyze published studies on pharmacotherapy of stereotypes in people with autism. Materials and Methods: according to the keywords “autism”, “autism spectrum disorder”, “stereotypes”, “stereotypic movements”, “repetitive actions”, “habitual movements”, “treatment effectiveness”, articles in English and Russian were searched in the databases MEDLINE/PubMed, Scopus, Web of Science, eLibrary for the period from 2005 to 2024. Conclusion: an analysis of published works has shown that there is no specific drug therapy for stereotypes in autism spectrum disorders to date. It is still not clear how appropriate an attempt to reduce stereotypical actions is, taking into account existing theories about the self-regulating role of repetitive behavior. The medical elimination of stereotypes is necessary when they reach the level of violence, severe obsession, hinder purposeful activity and the implementation of psychological and pedagogical correction.

аутизмрасстройство аутистического спектрастереотипииповторяющиеся действияпривычные движенияэффективность леченияautismautism spectrum disorderstereotypesstereotypic movementsrepetitive actionshabitual movementstreatment effectivenessReferencesМукаетова-Ладинска ЕБ, Симашкова НВ, Мукаетова МС, Иванов МВ, Бокша ИС. Расстройства аутистического спектра у детей и взрослых: подходы к проблеме в разных странах. Журнал неврологии и психиатрии им. С.С. Корсакова. 2018;118(12):92-99.Mukaetova-Ladinska EB, Simashkova NV, Mukaetova MS, Ivanov MV, Boksha IS. Autism spectrum disorders in children and adults: the experience of researches from different countries. S.S. Korsakov Journal of Neurology and Psychiatry. 2018; 118(12):92-99. (In Russ.). doi: 10.17116/jnevro201811812192Maenner MJ, Shaw KA, Bakian AV, Bilder DA, Durkin MS, Esler A, Furnier SM, Hallas L, Hall-Lande J, Hudson A, Hughes MM, Patrick M, Pierce K, Poynter JN, Salinas A, Shenouda J, Vehorn A, Warren Z, Constantino JN, DiRienzo M, Fitzgerald RT, Grzybowski A, Spivey MH, Pettygrove S, Zahorodny W, Ali A, Andrews JG, Baroud T, Gutierrez J, Hewitt A, Lee LC, Lopez M, Mancilla KC, McArthur D, Schwenk YD, Washington A, Williams S, Cogswell ME. Prevalence and Characteristics of Autism Spectrum Disorder Among Children Aged 8 Years - Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2018. MMWR Surveill Summ. 2021 Dec 3;70(11):1-16. doi: 10.15585/mmwr.ss7011a1Maenner MJ, Shaw KA, Bakian AV, Bilder DA, Durkin MS, Esler A, Furnier SM, Hallas L, Hall-Lande J, Hudson A, Hughes MM, Patrick M, Pierce K, Poynter JN, Salinas A, Shenouda J, Vehorn A, Warren Z, Constantino JN, DiRienzo M, Fitzgerald RT, Grzybowski A, Spivey MH, Pettygrove S, Zahorodny W, Ali A, Andrews JG, Baroud T, Gutierrez J, Hewitt A, Lee LC, Lopez M, Mancilla KC, McArthur D, Schwenk YD, Washington A, Williams S, Cogswell ME. Prevalence and Characteristics of Autism Spectrum Disorder Among Children Aged 8 Years - Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2018. MMWR Surveill Summ. 2021 Dec 3;70(11):1-16. doi: 10.15585/mmwr.ss7011a1Zeidan J, Fombonne E, Scorah J, Ibrahim A, Durkin MS, Saxena S, Yusuf A, Shih A, Elsabbagh M. Global prevalence of autism: A systematic review update. Autism Res. 2022 May; 15(5):778-790. doi: 10.1002/aur.2696Zeidan J, Fombonne E, Scorah J, Ibrahim A, Durkin MS, Saxena S, Yusuf A, Shih A, Elsabbagh M. Global prevalence of autism: A systematic review update. Autism Res. 2022 May; 15(5):778-790. doi: 10.1002/aur.2696Макушкин ЕВ, Макаров ИВ, Пашковский ВЕ. Распространенность аутизма: конкретная и мнимая. Журнал неврологии и психиатрии им. С.С. Корсакова. 2019;119(2):80-86. doi: 10.17116/jnevro201911902180.Makushkin EV, Makarov IV, Pashkovskij VE. The prevalence of autism: concrete and imaginary. S.S. Korsakov Journal of Neurology and Psychiatry. 2019; 119(2):80-86. (In Russ.). doi: 10.17116/jnevro201911902180Казаковцев БА, Демчева НК, Яздовская АВ, Сидорюк ОВ, Николаева ТА. Психиатрическая помощь населению Российской Федерации в 2019 г. Аналитический обзор. М., 2020. 145 с.Kazakovcev BA, Demcheva NK, Yazdovskaya AV, Sidoryuk OV, Nikolaeva TA. Psychiatric care for the population of the Russian Federation in 2019. Analytical review. M., 2020. 145 s.Аттаева ЛЖ, Макаров ИВ. Стереотипии у детей. Социальная и клиническая психиатрия. 2021;31(2):79-85.Attaeva LZh, Makarov IV. Stereotypes in children. Social and clinical psychiatry. 2021;31(2):79-85. (In Russ.).Zandt F, Prior M, Kyrios M. Similarities and differences between children and adolescents with autism spectrum disorder and those with obsessive compulsive disorder: executive functioning and repetitive behaviour. Autism. 2009 Jan;13(1):43-57. doi: 10.1177/1362361308097120Zandt F, Prior M, Kyrios M. Similarities and differences between children and adolescents with autism spectrum disorder and those with obsessive compulsive disorder: executive functioning and repetitive behaviour. Autism. 2009 Jan;13(1):43-57. doi: 10.1177/1362361308097120Carrasco M, Volkmar FR, Bloch MH. Pharmacologic treatment of repetitive behaviors in autism spectrum disorders: evidence of publication bias. Pediatrics. 2012; 129(5):e1301-1310. doi: 10.1542/peds.2011-3285Carrasco M, Volkmar FR, Bloch MH. Pharmacologic treatment of repetitive behaviors in autism spectrum disorders: evidence of publication bias. Pediatrics. 2012; 129(5):e1301-1310. doi: 10.1542/peds.2011-3285Gordon CT, State RC, Nelson JE, Hamburger SD, Rapoport JL. A double-blind comparison of clomipramine, desipramine, and placebo in the treatment of autistic disorder. Arch Gen Psychiatry. 1993;50(6):441-447. doi: 10.1001/archpsyc.1993.01820180039004Gordon CT, State RC, Nelson JE, Hamburger SD, Rapoport JL. A double-blind comparison of clomipramine, desipramine, and placebo in the treatment of autistic disorder. Arch Gen Psychiatry. 1993;50(6):441-447. doi: 10.1001/archpsyc.1993.01820180039004McDougle CJ, Naylor ST, Cohen DJ, Volkmar FR, Heninger GR, Price LH. A double-blind, placebo-controlled study of fluvoxamine in adults with autistic disorder. Arch Gen Psychiatry. 1996;53(11):1001-1008. doi: 10.1001/archpsyc.1996.01830110037005McDougle CJ, Naylor ST, Cohen DJ, Volkmar FR, Heninger GR, Price LH. A double-blind, placebo-controlled study of fluvoxamine in adults with autistic disorder. Arch Gen Psychiatry. 1996;53(11):1001-1008. doi: 10.1001/archpsyc.1996.01830110037005Remington G, Sloman L, Konstantareas M, Parker K, Gow R. Clomipramine versus haloperidol in the treatment of autistic disorder: a double-blind, placebo-controlled, crossover study. J Clin Psychopharmacol. 2001;21(4):440-444. doi: 10.1097/00004714-200108000-00012Remington G, Sloman L, Konstantareas M, Parker K, Gow R. Clomipramine versus haloperidol in the treatment of autistic disorder: a double-blind, placebo-controlled, crossover study. J Clin Psychopharmacol. 2001;21(4):440-444. doi: 10.1097/00004714-200108000-00012Hollander E, Phillips A, Chaplin W, Zagursky K, Novotny S, Wasserman S, Iyengar R. A placebo controlled crossover trial of liquid fluoxetine on repetitive behaviors in childhood and adolescent autism. Neuropsychopharmacology. 2005;30(3):582-589. doi: 10.1038/sj.npp.1300627.Hollander E, Phillips A, Chaplin W, Zagursky K, Novotny S, Wasserman S, Iyengar R. A placebo controlled crossover trial of liquid fluoxetine on repetitive behaviors in childhood and adolescent autism. Neuropsychopharmacology. 2005;30(3):582-589. doi: 10.1038/sj.npp.1300627.King BH, Hollander E, Sikich L, McCracken JT, Scahill L, Bregman JD, Donnelly CL, Anagnostou E, Dukes K, Sullivan L, Hirtz D, Wagner A, Ritz L; STAART Psychopharmacology Network. Lack of efficacy of citalopram in children with autism spectrum disorders and high levels of repetitive behavior: citalopram ineffective in children with autism. Arch Gen Psychiatry. 2009;66(6):583-590. doi: 10.1001/archgenpsychiatry.2009.30King BH, Hollander E, Sikich L, McCracken JT, Scahill L, Bregman JD, Donnelly CL, Anagnostou E, Dukes K, Sullivan L, Hirtz D, Wagner A, Ritz L; STAART Psychopharmacology Network. Lack of efficacy of citalopram in children with autism spectrum disorders and high levels of repetitive behavior: citalopram ineffective in children with autism. Arch Gen Psychiatry. 2009;66(6):583-590. doi: 10.1001/archgenpsychiatry.2009.30Dichter GS. Functional magnetic resonance imaging of autism spectrum disorders. Dialogues. Clin Neurosci. 2012 Sep;14(3):319-351. doi: 10.31887/DCNS.2012.14.3/gdichterDichter GS. Functional magnetic resonance imaging of autism spectrum disorders. Dialogues. Clin Neurosci. 2012 Sep;14(3):319-351. doi: 10.31887/DCNS.2012.14.3/gdichterMcDougle CJ, Kresch LE, Posey DJ. Repetitive thoughts and behavior in pervasive developmental disorders: treatment with serotonin reuptake inhibitors. J Autism Dev Disord. 2000; 30(5):427-435. doi: 10.1023/a:1005551523657McDougle CJ, Kresch LE, Posey DJ. Repetitive thoughts and behavior in pervasive developmental disorders: treatment with serotonin reuptake inhibitors. J Autism Dev Disord. 2000; 30(5):427-435. doi: 10.1023/a:1005551523657Herscu P, Handen BL, Arnold LE, Snape MF, Bregman JD, Ginsberg L, Hendren R, Kolevzon A, Melmed R, Mintz M, Minshew N, Sikich L, Attalla A, King B, Owley T, Childress A, Chugani H, Frazier J, Cartwright C, Murphy T; Autism Speaks Autism Clinical Trials Network. The SOFIA Study: Negative Multi-center Study of Low Dose Fluoxetine on Repetitive Behaviors in Children and Adolescents with Autistic Disorder. J Autism Dev Disord. 2020; 50(9):3233-3244. doi: 10.1007/s10803-019-04120-yHerscu P, Handen BL, Arnold LE, Snape MF, Bregman JD, Ginsberg L, Hendren R, Kolevzon A, Melmed R, Mintz M, Minshew N, Sikich L, Attalla A, King B, Owley T, Childress A, Chugani H, Frazier J, Cartwright C, Murphy T; Autism Speaks Autism Clinical Trials Network. The SOFIA Study: Negative Multi-center Study of Low Dose Fluoxetine on Repetitive Behaviors in Children and Adolescents with Autistic Disorder. J Autism Dev Disord. 2020; 50(9):3233-3244. doi: 10.1007/s10803-019-04120-yCook EH Jr, Rowlett R, Jaselskis C, Leventhal BL. Fluoxetine treatment of children and adults with autistic disorder and mental retardation. J Am Acad Child Adolesc Psychiatry. 1992;31(4):739-745. doi: 10.1097/00004583-199207000-00024Cook EH Jr, Rowlett R, Jaselskis C, Leventhal BL. Fluoxetine treatment of children and adults with autistic disorder and mental retardation. J Am Acad Child Adolesc Psychiatry. 1992;31(4):739-745. doi: 10.1097/00004583-199207000-00024Carrasco M, Volkmar FR, Bloch MH. Pharmacologic treatment of repetitive behaviors in autism spectrum disorders: evidence of publication bias. Pediatrics. 2012; 129(5):e1301-1310. doi: 10.1542/peds.2011-3285Carrasco M, Volkmar FR, Bloch MH. Pharmacologic treatment of repetitive behaviors in autism spectrum disorders: evidence of publication bias. Pediatrics. 2012; 129(5):e1301-1310. doi: 10.1542/peds.2011-3285Hollander E, Phillips A, Chaplin W, Zagursky K, Novotny S, Wasserman S, Iyengar R. A placebo controlled crossover trial of liquid fluoxetine on repetitive behaviors in childhood and adolescent autism. Neuropsychopharmacology. 2005;30(3):582-589. doi: 10.1038/sj.npp.1300627Hollander E, Phillips A, Chaplin W, Zagursky K, Novotny S, Wasserman S, Iyengar R. A placebo controlled crossover trial of liquid fluoxetine on repetitive behaviors in childhood and adolescent autism. Neuropsychopharmacology. 2005;30(3):582-589. doi: 10.1038/sj.npp.1300627King BH, Hollander E, Sikich L, McCracken JT, Scahill L, Bregman JD, Donnelly CL, Anagnostou E, Dukes K, Sullivan L, Hirtz D, Wagner A, Ritz L; STAART Psychopharmacology Network. Lack of efficacy of citalopram in children with autism spectrum disorders and high levels of repetitive behavior: citalopram ineffective in children with autism. Arch Gen Psychiatry. 2009;66(6):583-590. doi: 10.1001/archgenpsychiatry.2009.30King BH, Hollander E, Sikich L, McCracken JT, Scahill L, Bregman JD, Donnelly CL, Anagnostou E, Dukes K, Sullivan L, Hirtz D, Wagner A, Ritz L; STAART Psychopharmacology Network. Lack of efficacy of citalopram in children with autism spectrum disorders and high levels of repetitive behavior: citalopram ineffective in children with autism. Arch Gen Psychiatry. 2009;66(6):583-590. doi: 10.1001/archgenpsychiatry.2009.30Miral S, Gencer O, Inal-Emiroglu FN, Baykara B, Baykara A, Dirik E. Risperidone versus haloperidol in children and adolescents with AD: a randomized, controlled, double-blind trial. Eur Child Adolesc Psychiatry. 2008 Feb;17(1):1-8. doi: 10.1007/s00787-007-0620-5Miral S, Gencer O, Inal-Emiroglu FN, Baykara B, Baykara A, Dirik E. Risperidone versus haloperidol in children and adolescents with AD: a randomized, controlled, double-blind trial. Eur Child Adolesc Psychiatry. 2008 Feb;17(1):1-8. doi: 10.1007/s00787-007-0620-5Jesner OS, Aref-Adib M, Coren E. Risperidone for autism spectrum disorder. Cochrane Database Syst Rev. 2007;2007(1):CD005040. doi: 10.1002/14651858Jesner OS, Aref-Adib M, Coren E. Risperidone for autism spectrum disorder. Cochrane Database Syst Rev. 2007;2007(1):CD005040. doi: 10.1002/14651858Marcus RN, Owen R, Kamen L, Manos G, McQuade RD, Carson WH, Aman MG. A placebo-controlled, fixed-dose study of aripiprazole in children and adolescents with irritability associated with autistic disorder. J Am Acad Child Adolesc Psychiatry. 2009;48(11):1110-1119. doi: 10.1097/CHI.0b013e3181b76658. PMID: 19797985.Marcus RN, Owen R, Kamen L, Manos G, McQuade RD, Carson WH, Aman MG. A placebo-controlled, fixed-dose study of aripiprazole in children and adolescents with irritability associated with autistic disorder. J Am Acad Child Adolesc Psychiatry. 2009;48(11):1110-1119. doi: 10.1097/CHI.0b013e3181b76658. PMID: 19797985.Amminger GP, Berger GE, Schäfer MR, Klier C, Friedrich MH, Feucht M. Omega-3 fatty acids supplementation in children with autism: a double-blind randomized, placebo-controlled pilot study. Biol Psychiatry. 2007; 61(4):551-553. doi: 10.1016/j.biopsych.2006.05.007.Amminger GP, Berger GE, Schäfer MR, Klier C, Friedrich MH, Feucht M. Omega-3 fatty acids supplementation in children with autism: a double-blind randomized, placebo-controlled pilot study. Biol Psychiatry. 2007; 61(4):551-553. doi: 10.1016/j.biopsych.2006.05.007.

The authors declare that there are no conflicts of interest present.