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Autism, PCOS, and meds

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LadyHalcyon

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Thoughts on the androgen hypothesis associated with ASD? Finishing up a report on an adolescent with Aspergers. Definitely looks like she has PCOS, has a diagnosis of endometriosis, and had a paratubal cyst removed not too long ago. She had an IUD inserted, but it's not really helping. Major problems are impulsivity, mood swings, depression, and suicidal ideation/attempts.

While researching, I discovered antiepileptic treatments "are thought" to cause endocrine distrubances and/or cause/exacerbate PCOS. Anyone familiar with this? If she does have PCOS, what are thoughts about androgen inhibiting meds and insulin sensitizing agents? Clearly I'm referring her for a medical work-up first, just curious if this is in someone's wheelhouse here.

Lastly, what meds do high fx adolescent aspy females seem to do well on? I know Prozac is a go to and I see Clonidine and Risperdal a lot. I'm undiagnosing her with adhd (she is currently on Intuniv, apparently didn't do well on a stimulant), but what about Wellbutrin, or is that going to be too much for her CNS? Although Prozac is on the more activating side...
 
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The reason you haven't gotten any good replies is that your post kinda conflates/confuses a bunch of separate issues. There is no diagnostic clarity here IMO and none of us are OB/GYN/Endocrine to comment on the PCOS aspect. (Are you invoking AED's thinking that'll be used as treatment or because the patient is on AED's?)
 

LadyHalcyon

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Oh sorry, there is a significant medical history of endometriosis and postubal cysts. It's ok, it way out there.. Just a shot in the dark. Also gender dysphoria symptoms around puberty and heuritism and pelvic pain and... And.... And...
The reason you haven't gotten any good replies is that your post kinda conflates/confuses a bunch of separate issues. There is no diagnostic clarity here IMO and none of us are OB/GYN/Endocrine to comment on the PCOS aspect. (Are you invoking AED's thinking that'll be used as treatment or because the patient is on AED's?)
 

Merovinge

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Not an REI or endocrinologist, but knowing people with PCOS, I think most of the time an OCP can be helpful when not trying to conceive and can certainly improve the pelvic pain portion of things as well as potentially help with mood (of course there is a non-zero risk of worsening mood). I don't think there is nearly good enough evidence to suggest that you should base her ASD treatment on her having PCOS.

Mood swings in a more teenager/poor affective regulation sense are pretty rare in the ASD population. I am wondering if you more mean this pt gets bothered by things that don't make sense to neuro-typical individuals and this causes others to view her as impulsive/mood swingy. We do use usually low dose SSRIs in ASD patients as this can sometimes help with anxiety, cognitive inflexibility; I generally start with Zoloft as Prozac can be activating, but if the patient has a significant depressive hx then Prozac makes complete sense. Tenex/clonidine are both used to help with impulsivity, largely because of their very minimal risk profile. Antipsychotics are NOT appropriate for ASD tx except in the setting of severe aggression to self/others.
 
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