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Featured Clinical Topic-Psychiatry: The Role of Pharmacists in Serving Autistic Patients

22 Mar 2018 10:15 AM | MSHP Office (Administrator)

Authors:
Afreen Syeda Ziauddin, Pharm.D. Candidate 2019: St. Louis College of Pharmacy
Laura Challen, Pharm.D., MBA, BCPS, BCACP: St. Louis College of Pharmacy

The prevalence of autism has skyrocketed over the last decade. In the 1980’s, one in 2000 children was diagnosed with autism. According to the CDC, that demographic has significantly increased to one in 68 children being diagnosed with autism in the United States.1 With autism on the rise, the cost of caring for autistic patients in the United States has increased to 236 billion dollars per year.2 The increased cost of caring for autistic patients is mainly attributed to the lifetime care that is associated with autism. This can be alleviated with early diagnosis and intervention.2 With the rise of this patient population, it has been speculated what role pharmacists play in the treatment of patients on the autistic spectrum. Pharmacists are well positioned to be a valuable resource in caring for and serving the autistic patient population in both a clinical and community setting.

Autism spectrum disorder (ASD) is a rising neurodevelopmental disorder. While patients are usually diagnosed early, there are many aspects to being on the spectrum. Patients who are diagnosed with ASD usually display the social and cognitive defects associated with autism by the age of 3.3 ASD includes “core” symptoms, such as repetitive behaviors, language impairment, and lack of socialization.4 Milder forms of ASD include Asperger’s syndrome and pervasive developmental disorder (PDD). In the past, studies were performed to assess the effectiveness of certain pharmacological therapies in the treatment of core symptoms. The use of naltrexone, selective serotonin reuptake inhibitors, atypical antipsychotics, antidepressants, cholinergic agents, and oxytocin were studied in order to see their effectiveness in treating core symptoms.5 Unfortunately, these studies were deemed inconclusive, and as a result, there is currently no definitive treatment for the core symptoms of autism.5 Current pharmacological therapy is aimed at treating other aspects of autism such as: irritability, aggression, self-injury, hyperreactivity, and inattention.6 Agents, such as Risperdal® (risperidone) and Abilify® (aripiprazole), have been used in the treatment of aggression and mood, respectively.7 Despite the milestones made in treating certain symptoms of autism, the current needs of the autistic patient population and their families include the prevalence of adverse drug reactions (ADR’s), drug related problems (DRP’s) and medication adherence.7

Newer research has further reinforced the need for psychiatry specialized pharmacists. In 2014, a randomized, prospective, open label study was published by the pharmacy faculty of Chiang Mai University in Chiang Mai, Thailand. They assessed the importance of psychiatry trained pharmacists in treating autistic patients.7 The inclusion criteria of this study required participants to be between the ages of 2 to 12 years old, meet the DSM IV criteria for autism, and demonstrate at least one disruptive behavior such as irritability, aggression, self-injury, or temper tantrums. The exclusion criteria for this study included a history of head trauma or stroke, abnormal ECG results, or comorbid psychiatric disorders. Over the course of eight weeks, patients were randomized in a 1:1 ratio to either a psychiatry specialized pharmacist (PS) or a non-specialized pharmacist in assessing their currently pharmacotherapy regimen.7 The primary outcome of this study was assessing the number of patients who demonstrated at least one drug related problem (DRP). The secondary outcome assessed the mean aberrant behavior checklist (ABC-Irritability) and number of DRP’s in each group.7 The aberrant behavior checklist measures the presence of behaviors usually prevalent in autistic patients such as irritability, aggression, self-injury, and tantrums. An increase in this score directly correlates with the presence of these behaviors, while a decrease in this score indicates less prevalence of these behaviors. As a result of this study, it was found that the prevalence of DRP’s decreased by 52% in the intervention group vs. 16% in the control group. The ABC-Irritability score decreased from 26.7 + 7.2 to 9.8 + 5.6 in the interventional group vs. 24.0 + 5.7 to 17.7 + 7.9 in the control group. Potential limitations of this study include a disproportionate amount of patients taking risperidone in the control group and having a higher percentage of male patients. Despite limitations, the data suggests that PS pharmacists are a valuable resource in serving autistic patients.7 The collaboration of PS pharmacists with the healthcare team can further increase patient outcomes by potentially catching more medication errors, develop medication protocols, and even promoting positive perceptions about medications leading to increased medication adherence.7

In addition to the increasing need for PS pharmacists, community pharmacists play an equally important role. Autism not only affects patients, but also their families. Community pharmacists are well positioned to interact with patients’ families and guide caretakers. They play an increasing role in assessing the treatment of non-core symptoms of autism such as insomnia, mood, anxiety, hyperreactivity, and attention deficit disorders.4 Within the community pharmacy setting, pharmacists can also play a vital role in recommending alternative dosage forms, such as compounded products, for autistic patients. Dosage forms such as suppositories, solutions, suspensions, and tablets can be made to meet the individual needs of patients with ASD.8

The growing demographic of autistic patients has warranted the need for pharmacists to be aware and trained in serving this patient population. By doing so, pharmacists will be better positioned to work with patients, their families, and other healthcare providers in promoting optimal patient care.


References:

1. Autism Speaks. New government survey pegs autism prevalence at 1 in 45. www.autismspeaks.org/science/science-news/new-government-survey-pegs-autism-prevalence-1-45. Accessed February 19, 2018.

2. Autism Speaks. Lifetime Costs of Autism Average $1.4 Million to $2.4 Million. https://www.autismspeaks.org/science/science-news/lifetime-costs-autism-average-millions. Accessed February 19, 2018.

3. Terrie, Y. Understanding Autism: The Role of the Pharmacist in the Management of Autism. Pharmacy Times. 2007;12:53-62.

4. Autism Speaks. Symptoms of Autism. https://www.autismspeaks.org/what-autism/symptoms. Accessed February 19, 2018.

5. Bowers K, Lin P, Erickson C. Pharmacogenomic Medicine in Autism: Challenges and Opportunities. Pediatr Drugs. 2015;17:115-124.

6. Farmer C, Thurm A, Grant P. Pharmacotherapy for the Core Symptoms in Autistic Disorder: Current Status of Research. Drugs. 2013;73:303-314.

7. Wongpakaran R, Suansanae T, Tan-khum T, et al. Impact of providing specialty pharmacist intervention on reducing drug-related problems among children with autism spectrum disorder related to disruptive behavioural symptoms: A prospective randomized open-label study. J Clin Pharm Ther. 2017;42:329-335.

8. Community Pharmacy. Autism. http://communitypharmacymd.com/autism/. Accessed February 20, 2018.


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