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Abstract
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Prenatal alcohol exposure can exert toxic effects on the fetus,leading to a wide range of physical,cognitive,and behavioral abnormalities classified as Fetal Alcohol Spectrum Disorders (FASDs).There are few studies in the literature focusing on the psychiatric outcomes of FASDs in children.This case report presents the complex treatment course of a 15-year-old female patient with FASD and highlights the challenges of managing multiple psychiatric comorbidities,including suicidal ideation,self-harm,social phobia,post-traumatic stress disorder,and aggression,along with polypharmacy interventions and frequent hospitalizations.
The patient was traumatized at an early age by her alcohol-addicted mother and placed in the care of her father by protection services at the age of 3.She was diagnosed at the age of 8 with fetal alcohol syndrome at the FASD Center Berlin,Charité, using a 'Diagnostic Guide:4-Digit Code.At the age of 9,she was placed in institutional care after her father's accident.The patient has been hospitalized 38 times in our hospital due to aggressive behaviors and self-harm.Multiple psychiatric diagnoses were established based on clinical observations, behavioral assessment,and psychological testing.Her treatment combines psychopharmacology and psychotherapy, with a focus on reducing polypharmacy and managing aggression.
Over two years,pipamperone,risperidone and promethazine were discontinued due to inefficacy or side effects.Sertraline,methylphenidate and lastly quetiapine have been used to treat flashbacks.At a dose of 40mg, methylphenidate was ineffective and exacerbated her oppositional behavior.An increase in sertraline to 150mg provided relief of anxiety.Therapeutic interventions included psychotherapy,skills training and psychoeducation.There has been significant stabilization in suicidal ideation,self-harm,and social phobia with the support of a stable therapeutic relationship.During outpatient follow-ups improved impulse control has been observed,although occasional support remains essential to sustain these gains.
This case highlights the complexity of the neurobehavioral profile of children with FASD and the difficulty of treatment. With more case reports, the development of treatment algorithms for FASD may guide clinicians and prevent polypharmacy.In conclusion, the need for various interventions and multiple hospitalizations emphasizes the importance of managing such complex cases with an advanced multidisciplinary approach.
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