Arif ÖNDER, Aslı ADANIR SÜRER, Özge GİZLİ ÇOBAN, Öznur BİLAÇ, Aziz KARA

The efficiency and safety of N-acetylcysteine augmentation in the autistic children with severe irritability and aggression: six cases

Autism spectrum disorder (ASD) is characterized by deficits in social interactions and communication, and restricted and stereotypic behaviors. A growing body of evidence has identified metabolic pathways and glutamatergic neurotransmission affecting oxidative stress levels as potential targets of drug development in autism spectrum disorders. N-acetylcysteine (NAC) is an antioxidant that modulate glutamate and reduce oxidative stress, both associated with the pathophysiology of ASD. N-acetylcysteine has been identified as a potential treatment agent for irritability and self-injurious behaviors in autism. In this case report, we report six cases of autism with severe symptoms of irritability and aggression, two of them responded well to N-acetylcysteine treatment, two of them responded partially and while two did not. (Anatolian Journal of Psychiatry 2020; 21(2):218-221)

Şiddetli irritabilite ve saldırganlığı olan otistik çocuklarda Nasetilsistein augmentasyonunun etkinliği ve güvenilirliği: Altı olgu

Otizm spektrum bozukluğu (OSB) sosyal-iletişimsel alanda belirgin yetersizlikler ve sınırlı, yineleyici davranışlar ve ilgi alanları ile karakterizedir. Gittikçe artan sayıda kanıt, glutamaterjik nörotransmisyonu ve oksidatif stres düzeylerini etkileyen metabolik yolları otizm spektrum bozukluklarında ilaç gelişiminin potansiyel hedefleri olarak tanımlamıştır. N-asetilsistein (NAC), ikisi de OSB'nin patofizyolojisi ile ilişkili olarak glutamatı modüle eden ve oksidatif stresi azaltan bir antioksidandır. N-asetilsistein, otizmde irritabilite ve kendine zarar verme davranışları için potansiyel bir tedavi ajanı olarak tanımlanmıştır. Bu olgu sunumunda ağır saldırganlık ve irritabilite belirtileri olan altı otizmli hastada N-asetilsistein tedavisi sunulmuştur. Altı olgunun ikisi tedaviye iyi yanıt verirken, diğer ikisinde kısmi yanıt saptanmıştır. İki olgu ise tedaviye yanıt vermemiştir. (Anadolu Psikiyatri Derg 2020; 21(2):218-221)

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1. Naveed S, Amray A, Waqas A, Chaudhary AM, Azeem MW. Use of N-acetylcysteine in psychiatric conditions among children and adolescents: a scoping review. Cureus 2017; 9(11):e1888.

2. Dean O, Giorlando F, Berk M. N-acetylcysteine in psychiatry: current therapeutic evidence and potential mechanisms of action. J Psychiatry Neurosci JPN. 2011; 36(2):78-86.

3. Berk M, Malhi GS, Gray LJ, Dean OM. The promise of N-acetylcysteine in neuropsychiatry. Trends Pharmacol Sci 2013; 34(3):167-177. 4. Hardan AY, Fung LK, Libove RA, Obukhanych TV, Nair S, Herzenberg LA, et al. A randomized controlled pilot trial of oral N-acetylcysteine in children with autism. Biol Psychiatry 2012; 71(11):956-961.

5. Dean OM, Gray KM, Villagonzalo K-A, et al. A randomised, double blind, placebo-controlled trial of a fixed dose of N-acetyl cysteine in children with autistic disorder. Aust N Z J Psychiatry 2017; 51(3):241-249.

6. Ghanizadeh A, Moghimi-Sarani E. A randomized double blind placebo controlled clinical trial of NAcetylcysteine added to risperidone for treating autistic disorders. BMC Psychiatry 2013; 13(1):196.

7. Nikoo M, Radnia H, Farokhnia M, Mohammadi MR, Akhondzadeh S. N-acetylcysteine as an adjunctive therapy to risperidone for treatment of irritability in autism: a randomized, double-blind, placebo-controlled clinical trial of efficacy and safety. Clin Neuropharmacol 2015; 38(1):11-17.

8. Marler S, Sanders KB, Veenstra-VanderWeele J. N-acetylcysteine as treatment for self-injurious behavior in a child with autism. J Child Adolesc Psychopharmacol 2014; 24(4):231-234.

9. Ghanizadeh A, Derakhshan N. N-acetylcysteine for treatment of autism, a case report. J Res Med Sci 2012; 17(10):985-987.

10. Baker DA, Xi Z-X, Shen H, Swanson CJ, Kalivas PW. The origin and neuronal function of in vivo nonsynaptic glutamate. J Neurosci 2002; 22(20):9134-9141.

11. Comai S, Tau M, Gobbi G. The Psychopharmacology of Aggressive Behavior: A Translational Approach Part 1 Neurobiology. J Clin Psychopharmacol 2012; 32(1):83-94.