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Z Kinder Jugendpsychiatr Psychother. 2018 May;46(3):246-263. doi: 10.1024/1422-4917/a000546. Epub 2017 Sep 18.

Glutamatergic Agents in the Treatment of Compulsivity and Impulsivity in Child and Adolescent Psychiatry: a Systematic Review of the Literature.

Author information

1
1 Research Group of Paediatric Psychopharmacology, Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.
2
2 Center for Diagnostics and Crisis Intervention, Department of Psychiatry and Psychotherapy, University Psychiatric Centers (UPK) Basel, University of Basel, Basel, Switzerland.
3
3 Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behavior, Radboud University, Radboud University Medical Centre and Karakter Child and Adolescent Psychiatry University Centre, Nijmegen, The Netherlands.
4
4 Biomedical MR Imaging and Spectroscopy Group, Center for Image Sciences, University Medical Center, Utrecht, The Netherlands.
5
5 Sackler Institute for Translational Neurodevelopment, Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.
6
6 Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, The Netherlands.
7
7 Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.
8
8 Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.

Abstract

OBJECTIVE:

Research has implicated glutamatergic projections between the various frontal subregions in the pathogenesis of compulsivity and impulsivity. Reducing striatal glutamate release, or antagonising the action of glutamate at its receptors, may therefore represent viable treatment strategies. Several glutamatergic agents with regulatory approval for other indications are available and may be of potential benefit in the treatment of compulsivity/impulsivity in psychiatric disorders in paediatric patients.

METHOD:

This review was performed according to PRISMA guidelines and evaluates available scientific literature concerning the use of glutamatergic agents in these patients, in order to determine their reported effectiveness/efficacy and tolerability/safety.

RESULTS:

Out of a total of 1,426 publications, 21 trials examining six glutamatergic substances in patients with obsessive-compulsive disorder, autism spectrum disorders, and attention deficit/hyperactivity disorder were included.

CONCLUSIONS:

Trial designs as well as results were heterogeneous and thus comparability was limited. Available data support the hypothesis that glutamatergic agents are of potential value in the treatment of compulsivity/impulsivity in children and adolescents. Based on the data reviewed, memantine and N-acetylcysteine suggest the best risk-benefit profile for future trials. Riluzole should primarily be further investigated in adults. Clinical research of this nature is a key element of the TACTICS Consortium project funded by the European Union (FP7).

KEYWORDS:

Glutamate; clinical trials; compulsivity; impulsivity; systematic review

PMID:
28922069
DOI:
10.1024/1422-4917/a000546
[Indexed for MEDLINE]
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