Paliperidone in the treatment of autistic spectrum disorder: case report

Paliperidone is a new atypical antipsychotic, injectable, long-term, risperidone-derived antipsychotic drug for oral use. Atypical antipsychotics act by blocking dopamine and serotonin receptors in the central nervous system and are used for the treatment of schizophrenia as prevention of their positive and negative symptoms. Based on scientific studies, paliperidone has shown superior effect compared to the others in the same class. It has commonly been assumed that the autism spectrum disorder is due to a set of specific characteristics manifested by deficits of varying degrees in the areas of communication, social interaction, including restrictive and repetitive behaviors. It tends to manifest itself in early childhood, usually at two years of age, or may only be perceived in the school setting. It is a disorder that affects more boys than girls and has its main cause turned to genetic factors. The objective of this report is to present the course and benefit of a new therapy through the use of paliperidone for the case of severe autism, refractory to the other standard medications. Patient INS, 31 years old, with severe autism spectrum disorder, diagnosed at 3 years of age when was started the treatment with infantile Dogmatil. It evolved to use of adult dogmatil, being necessary the suspension of the medication due to adverse reactions related to the reproductive system. Initiated use of Ritalin and Tofranil, with no significant improvement in the clinical and psychic-behavioral development, as well as the side effects that worsened the patient’s symptoms. In view of the clinic refractory to the medications of choice for the mentioned pathology, in march 2018 Paliperidone was prescribed, 100mg IM, monthly dose; an atypical antipsychotic, of high cost, not usually provided by the Unified Health System (SUS), as an empirical attempt to control the case. It was observed that its effects were beneficial, resulting in a decrease in headache, allergic reactions, nocturia and improvement of urinary incontinence. In addition, the seizures ceased, the aggressiveness was reduced, the sleep was improved, and the patient did not present rejection to the drug, and therefore the continuous use was indicated. Currently, the patient is followed up with another psychiatrist, monthly, in the state where she lives, which kept the medication due to the excellent results obtained

Transtorno de personalidade Borderline: apresentações clínicas e tratamentos / Borderline personality disorder: clinical presentations and treatments

O presente trabalho teve como objetivo analisar, através de uma revisão narrativa de literatura, o comportamento do Transtorno de Personalidade Borderline (TPB) através da identificação de suas características clínicas, curso e principais intervenções terapêuticas disponíveis atualmente. Indivíduos com TPB costumam apresentar oscilações do humor e impulsividade, além de uma ampla gama de transtornos associados e sintomas transitórios. Os estudos analisados evidenciaram que a presença de TPB é mais prevalente no sexo feminino e corresponde a 20% das internações psiquiátricas. Foi observado a presença de disfunções neuroendócrinas, elevações exacerbadas nos níveis de cortisol e distúrbio neurobiológico da função executiva. A terapêutica deve ser individualizada, uma vez que as manifestações dos pacientes com TPB podem variar bastante. A primeira linha de tratamento é baseada na psicoterapia, entretanto, o acréscimo da farmacoterapia à terapêutica pode gerar resultados mais satisfatórios ao tratamento. Por fim, reforça-se a necessidade de mais investigações científicas acerca do tema, dada a importância e complexidade desse problema de saúde pública, de forma a melhorar a qualidade de vida dos pacientes acometidos por essa patologia