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Wednesday, 8 October 2014

Intermittent Explosive Disorder (IED) + Autism







An altogether different kind of IED, although you may not always feel so.



Many people think that childhood psychiatric disorders, including autism, are grossly over-diagnosed in the US.

This did spring to mind when I came across a reference to “intermittent explosive disorder” and autism.

Before we get into that, I received an interesting graphical presentation of ADHD in the US, from a company called Healthline; they want me to give a link on my post on Clonidine.  It shows many things including how ADHD diagnosis varies wildly by State, just as the CDC’s autism data does.  The difference is remarkable. I don’t think anybody really believes that ADHD is 3 times more prevalent in Kentucky than in Nevada.  It just shows how inconsistent the diagnosis is; perhaps you could correlate the diagnosis with the medical school attended by the doctor/psychiatrist?







Back to Intermittent Explosive Disorder

Intermittent explosive disorder (IED) is a behavioral disorder characterized by explosive outbursts of anger, often to the point of rage, that are disproportionate to the situation at hand.
  
This is pretty tame stuff to many carers of anyone with autism.  So I thought it odd that anyone bothered to diagnose autism + IED.

The question is usually where the IED is directed, to the carer or to self (Self Injurious Behavior).

So IED is a normal part of autism, but it can be treated, without recourse to the drugs psychiatrists use.  They often cause further problems.

I was curious to find out what the research says about IED in other people.  Rather surprisingly, or maybe not, the mechanism turns out to be the same.


IED in Autism

Regular readers will recall the posts all about inflammatory agents (cytokine IL-6 and histamine) that turned out to trigger the summertime raging in Monty, aged 11 with ASD.

Using Verapamil to stabilize the mast cells and so lower the level of histamine and IL-6, I made the raging and aggression go away.  It really does work.


IED in Everyone Else




"The researchers measured the inflammatory markers CRP (C Reactive Protein) and IL-6 levels in 197 physically healthy volunteer subjects. Sixty-nine of those subjects had been diagnosed with IED, 61 had been diagnosed with psychiatric disorders not involving aggression, and 67 had no psychiatric disorder.

Both CRP and IL-6 levels were higher, on average, in subjects with IED, compared to either psychiatric or normal controls. Average CRP levels, for example, were twice as high for those with IED as for normal healthy volunteers. Both markers were particularly elevated in subjects who had the most extensive histories of aggressive behaviors. Each marker independently correlated with aggression, the authors note, suggesting that "both have unique relations with aggression."

Overall, the findings reported in this new paper suggest that "medications that reduce inflammation may also drive down aggression," Coccaro said. Anti-inflammatories such as Celebrex, or even aspirin, might make a difference for those with IED. Since available treatments bring less than 50 percent of patients into remission, the authors wrote, "additional strategies for the examination and intervention of human impulsive aggression are needed."


Pass the NAC, please

Not surprisingly people with IED also tend to suffer from oxidative stress.


Background
Animal and clinical studies suggest a link between inflammation and oxidative stress. Because oxidative stress is an inherent part of inflammation, and inflammation is associated with behavioral aggression in lower mammals and humans, we hypothesized that markers of oxidative stress would be related to aggression in human subjects. In this case-control study, markers of oxidative stress and aggression were assessed in human subjects with histories of recurrent, problematic, impulsive aggressive behavior and in nonaggressive comparator subjects.
Conclusions
These data suggest a positive relationship between plasma markers of oxidative stress and aggression in human subjects. This finding adds to the complex picture of the central neuromodulatory role of aggression in human subjects.


I had one reader tell me that the most noticeable effect of the antioxidant NAC on her son with autism, was that he stopped biting her.  One less IED to defuse in her house.

ABA is also a potent tool to understand the underlying cause of aggression and SIB; but if you suffer from neuro-inflammation and oxidative stress, even ABA can do with a little extra help.






1 comment:

  1. There is an interesting potential explanation for why ADHD rates vary by state, and specifically, why rates are lower in the west where average elevation is higher. This article is about suicide but also covers ADHD in the context of discussing elevation's effects on neurotransmitters.

    https://mic.com/articles/104096/there-s-a-suicide-epidemic-in-utah-and-one-neuroscientist-thinks-he-knows-why#.TtTvMfozf

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