Case Study: 28-Year Old Woman with Autism Needs Resassessment of her Medications
The Case:
- A 28-year-old woman presents with her parents for a reassessment of her current medications
- She was diagnosed at age 2, and from childhood through age 22, she attended school for students with special needs
- She lives at home and does not leave the house much; she has limited verbal communication and is never without an adult caregiver
- 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)
- She has bouts of irritability that worsen before her menstrual periods, and agitation that her father describes as more of a severe anxiety
- She also exhibits multiple repetitive behaviors
- 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
- 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
- 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
To participate in this discussion, please answer the following questions. Be sure to provide a rationale and references to support your responses.
- Discuss at least one change you would make to the patient’s medication regimen to treat her current behaviors and symptoms. Be sure to provide a rationale with references to support your decision.