few more bits on propranolol for autism

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Open trial effects of beta-blockers on speech and

social behaviors in 8 autistic adults.

J Autism Dev

Disord. 1987 Sep;17(3):439-46.Ratey JJ, Bemporad J, Sorgi P, Bick P, Polakoff

S, O'Driscoll G, Mikkelsen E. SourceHarvard Medical School, Massachusetts

Mental Health Center.

We began open trials of beta-blockers, as adjunctive medication, in eight

consecutive autistic adults. The immediate result across all patients was a

rapid diminution in aggressivity (Ratey et al., 1987). As time on the drug

increased, subtler changes in speech and socialization emerged. While results

of open trials must be interpreted with caution, these changes were significant

and lasting. We speculate that these effects may be the result of a lessening

of the autistic individual's state of hyperarousal. As the individual becomes

less anxious, defensive and dearousing behaviors are relinquished and more

social and adaptive behaviors appear. There is a concomitant improvement in

language, though it is unclear whether lost skills are recouped or new ones

developed. Further research is indicated.

Effect of propranolol on functional

connectivity in autism spectrum disorder--a pilot study.

Brain Imaging Behav. 2010

Jun;4(2):189-97.Narayanan A, White CA, Saklayen S, Scaduto MJ, Carpenter AL,

Abduljalil A, Schmalbrock P, Beversdorf DQ.

SourceIntegrated Biomedical Sciences Graduate Program, The Ohio State University,

Columbus, OH, USA.

Abstract

A decrease in interaction between brain regions is observed in individuals with

autism spectrum disorder (ASD), which is believed to be related to restricted

neural network access in ASD. Propranolol, a beta-adrenergic antagonist, has

revealed benefit during performance of tasks involving flexibility of access to

networks, a benefit also seen in ASD. Our goal was to determine the effect of

propranolol on functional connectivity in ASD during a verbal decision making

task as compared to nadolol, thereby accounting for the potential spurious fMRI

effects due to peripheral hemodynamic effects of propranolol. Ten ASD subjects

underwent fMRI scans after administration of placebo, propranolol or nadolol,

while performing a phonological decision making task. Comparison of functional

connectivity between pre-defined ROI-pairs revealed a significant increase with

propranolol compared to nadolol, suggesting a potential imaging marker for the

cognitive effects of propranolol in ASD.

Full text

available

Treatment of Viral Encephalitis

Organic Personality Disorder and Autistic Features with Propranolol: A Case

Report

Neurorehabilitation

and Neural Repair, Vol. 9, No. 1, 41-45 (1995) G. Schmidt Department of Physical Medicine and Rehabilitation,

Brain Injury Rehabilitation Program, St. 's Hospital, Rochester, New York, L. Dombovy Department of

Neurology, University of Rochester School of Medicine and Dentistry, Rochester,

New York Kimberlee Watkins Premier

Care Neurorehabilitation Program, Bethesda General Hospital, St. Louis,

Missouri

Objective :

To observe and describe the clinical effects of propranolol in an agitated and violent patient with

postviral encephalitis organic personality disorder. Background: Cognitive and

behavioral deficits are common in patients with viral encephalitis. Meth ods to

modify behavior by a behavior program and medication have reported limited

success. Case: A sixteen-year-old girl developed progressive violent and

sexually disinhibited behavior five weeks following acute viral encephalitis

(presumed herpes sim plex encephalitis). Three weeks of high dose lorazepam

(6mg/d) failed to control her symptoms. Intensive behavioral therapy was also

ineffective and violent behavior increased during structured treatment hours.

Benzodiazepines and low dose haloperidol were ineffective over the subsequent

two weeks in a neurorehabilitation unit. Propranolol was then given (10 mg

b.i.d. to 20 mg t.i.d.) and she had a dramatic change in behavior with less violence

and less agitation after one day of treatment with propra nolol. Her short-term

memory improved. Decreased dosage of propranolol was associ ated with the

return of violent behavior. Maintenance propranolol was effective in con

trolling her symptoms and led to the resumption of her multidisciplinary

rehabilitation program. Conclusion: Violent and autistic behavior due to viral

(herpes) encephalitis may respond to propranolol.

Beta blockers in mental retardation and developmental disorders.

J Child Adolesc Psychopharmacol. 1991;1(5):361-73.Arnold LE, Aman MG.

beta-Adrenergic blockers appear to be effective in the management of

verbal aggression, physical aggression, or self-injurious behavior associated

with mental retardation and other developmental disorders. However,

methodological limitations of the available studies make it difficult to judge

the value of these treatments. Optimal doses for treating patients with mental

retardation or developmental disorders appear lower than described in the

general psychiatric literature, so low doses of beta-blockers may be preferred

in such patients with abnormal brain development. Children and adolescents with

mental retardation or developmental disorders appear to respond to particularly

low

doses (e.g., below propranolol 150 mg daily). Propranolol is recommended for

central blockade, and nadolol is recommended for peripheral blockade. Most beta

receptors in the brain (except cerebellum) seem to be beta(1) (cardiac type),

but it is not clear that central blockade is required for psychotropic effects.

Interim suggestions for empirical trials are offered, and rating scales and

other measurement approaches are discussed. Since evidence supporting the

efficacy of beta-blockers in mental retardation or developmental disorders in

children and adolescents is not definitive, the clinician is advised to

consider designing an empirical trial for each patient, utilizing pre- and

postmedication measures, when conventional treatments have been unsuccessful.