Scott E. Hirsch, M.D.

Motor worsening and tardive dyskinesia with aripiprazole in Lewy body dementia
Boylan, Laura S; Hirsch, Scott
2009 ;2009:?-?, BMJ case reports
Aripiprazole (APZ) is a novel antipsychotic agent which does not block dopamine (DA) receptors but is rather a partial DA agonist. Thus, it has been proposed that APZ may not induce tardive dyskinesia (TD), a disfiguring and sometimes disabling and irreversible side effect of neuroleptics. Our patient had Lewy body dementia (LBD) and developed severe worsening of parkinsonism over 1 month of APZ treatment. Within days of discontinuation of APZ dramatic orobuccal dyskinesias emerged. Treatment emergent worsening of parkinsonism improved but orobuccal dyskinesias persisted unchanged until his death 8 months later. Others have reported severe extrapyramidal reactions including neuroleptic malignant syndrome and TD with APZ. APZ has been suggested as a treatment for TD but treatment benefit may reflect 'masked' dyskinesia. We conclude that, despite an attractive in vitro profile and promising animal data, APZ can induce serious extrapyramidal side effects, including TD
— id: 134468, year: 2009, vol: 2009, page: ?, stat: Journal Article,

Aripiprazole in children and adolescents with Tourette's disorder: an open-label safety and tolerability study
Lyon, Gholson J; Samar, Stephanie; Jummani, Rahil; Hirsch, Scott; Spirgel, Arie; Goldman, Rachel; Coffey, Barbara J
2009 Dec;19(6):623-633, Journal of child & adolescent psychopharmacology
OBJECTIVE: The aim of this study was to conduct a prospective safety and tolerability study of aripiprazole for the treatment of tics in children and adolescents with Tourette's disorder (TD). METHOD: Eleven subjects (10 males) with TD (age 9-19 years, mean 13.36, standard deviation [SD] 3.33) who did not respond or were unable to tolerate previous tic medication were treated with aripiprazole in an open-label, flexible-dosing study over 10 weeks. Tic severity was rated using the Yale Global Tic Severity Scale (YGTSS) and the Clinical Global Impressions Scale for tics (CGI-Tics) at baseline and at follow-up. RESULTS: The mean (+/-SD) daily dose for aripiprazole was 4.5 +/- 3.0 mg. Mean (+/-SD) YGTSS Global Severity scores reduced from 61.82 +/- 13.49 at baseline to 33.73 +/- 15.18 at end point; mean YGTSS total tic scores reduced from 28.18 +/- 7.74 at baseline to 16.73 +/- 7.54 at end point. Mean (+/-SD) CGI-Tic severity scores reduced from 4.45 +/- 0.52 (moderate-marked) at baseline to 3.18 +/- 0.60 (mild) at end point. On the CGI-Tic improvement scale, 10 (91%) subjects achieved 1 ('very much improved') or 2 ('much improved') at end point. Most common adverse effects included appetite increase and weight gain in 5 subjects, mild extrapyramidal effects in 7 subjects, and headaches and tiredness/fatigue in 7 subjects; 1 subject experienced akathisia and muscle cramps. CONCLUSION: Aripiprazole appears to be a safe and tolerable treatment in children and adolescents with TD that appears to reduce tics; it should be further investigated as a treatment option in controlled trials
— id: 105994, year: 2009, vol: 19, page: 623, stat: Journal Article,

PANDAS and paroxysms: a case of conversion disorder?
Kuluva, Joshua; Hirsch, Scott; Coffey, Barbara
2008 Feb;18(1):109-115, Journal of child & adolescent psychopharmacology
— id: 78737, year: 2008, vol: 18, page: 109, stat: Journal Article,

Mood and anxiety symptoms in an adolescent with pervasive developmental disorder not otherwise specified and moderate mental retardation
Williams, Daniel T; Hirsch, Scott; Coffey, Barbara
2007 ;17(5):721-726, Journal of child & adolescent psychopharmacology
A. is a 14-year-old boy who carries diagnoses of pervasive developmental disorder not otherwise specified (PDD-NOS) and moderate mental retardation. In addition, there are obsessive compulsive disorder symptoms such as perseveration and repetitive complex behaviors, and attention deficit hyperactivity disorder symptoms such as inattention, distractibility and fidgetiness. There is evidence of mild facial extrapyramidal symptoms. Target symptoms of primary clinical concern are anxious agitation and mood lability, apparently endogeneous in nature, consistent with mixed mood and anxiety disorders, not otherwise specified. A. appears to have features more consistent with a moderately retarded individual than the primary features of autistic spectrum disorders, in that he is eager to make relationships, relates warmly to people and can differentiate individuals. In this case, continuation of carefully monitored sequential trials of targeted combined pharmacotherapy to address the target symptoms of primary concern is indicated. Given the complexities, history reflects that it is not likely that single medications or combinations are likely to result in remission of his symptoms. However, a goal of optimization of the pharmacological regimen is reasonable. So as to target the anxious agitation, the symptom of most clinical concern, addressing mood and anxiety symptoms is indicated.
— id: 76158, year: 2007, vol: 17, page: 721, stat: Journal Article,