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

Research output: Contribution to journalArticle

Konstantin Mechler, Alexander Häge, Nina Schweinfurth, Jeffrey C Glennon, Rick M Dijkhuizen, Declan Murphy, Sarah Durston, Steven Williams, Jan K Buitelaar, Tobias Banaschewski, Ralf W Dittmann, The Tactics Consortium

Original languageEnglish
Pages (from-to)246-263
JournalZEITSCHRIFT FUR KINDER UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE
Early online date18 Sep 2017
DOIs
Publication statusE-pub ahead of print - 18 Sep 2017

King's Authors

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).

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