Assignment Task: 28-Year Old Woman with Autism Needs Reassessment of her Medications
The Case:
1. A 28-year-old woman presents with her parents for a reassessment of her current medications
2. She was diagnosed at age 2, and from childhood through age 22, she attended school for students with special needs
3. She lives at home and does not leave the house much; she has limited verbal communication and is never without an adult caregiver
4. In association with her autism, the patient has had behavioral problems, including aggression (punching holes in walls) and intermittent self-injurious behavior (hitting her head against the wall)
5. She has bouts of irritability that worsen before her menstrual periods, and agitation that her father describes as more of a severe anxiety
6. She also exhibits multiple repetitive behaviors
7. Presentation during clinical interview
- The patient exhibits poor and intermittent eye contact
- She smiles when asked questions, but is unable to give coherent responses
- She is restless and fidgety while seated; after about 15 minutes she becomes agitated and her father takes her out of the room
8. Medication history
- The patient's symptoms of irritability, aggression, and self-injury have responded to risperidone
- A few years ago, she was switched to aripiprazole, which did not seem to work as well; she was then switched back to risperidone
- In the past, augmentation with quetiapine was helpful for her behaviors, but it was too sedating and was therefore discontinued
9. Current Medications
- Risperidone 2 mg in the morning and 1 mg at night
- Sertraline 12.5 mg twice per day
- Diphenhydramine 25 mg at bedtime
- Gabapentin 100 mg in the morning and 300 mg at night
- Lorazepam 1 mg three times per day
- Memantine 10 mg twice per day
Problem 1: What are the five symptom clusters in autism spectrum disorders?
Problem 2: Pick one symptom cluster that is related to this case and discuss the medication/s that have shown efficacy for treating the patient's current behaviors/symptoms.
Problem 3: Discuss at least one change you would make to the patient's current medication regimen. Be sure to provide a rationale with references to support your decision.