Pathological demand avoidance (PDA) is a profile of autism spectrum disorder and a proposed sub-type. Characteristics ascribed to the condition include greater refusal to do what is asked of the person, even to activities the person would normally like, due to extreme levels of anxiety and lack of autonomy. Although PDA has its own traits that are separate from autism, they generally meet the diagnostic criteria by having significant impairments in social interaction and communication and presenting restricted and repetitive behaviors. Some notable differences in PDA compared to classic autism spectrum disorders are that individuals appear to be more sociable, have far better social skills and social understanding, tend to be more interested in people than objects, are more comfortable with pretend play, and tend to be more imaginative. It is not recognized by either the DSM-5 or the ICD-10 and is unlikely to be separated out now that the umbrella diagnosis of ASD has been adopted. In 2011, it was suggested that these symptoms could represent the condition oppositional defiant disorder (ODD). Elizabeth ONions and others argue that unlike ASD, “children with PDA are said to use socially manipulative avoidance strategies”; and unlike ODD, they “resort to extreme, embarrassing or age-inappropriate behaviour”.The term was proposed in 1980 by the UK child psychologist Elizabeth Ann Newson. Recognition
Pathological demand avoidance is not recognized by the DSM-5 or ICD-10, the two main classification systems for mental disorders.
In clinical trials, a similar increase in heart rate was observed in both Cleviprex and comparator arms. Dihydropyridine calcium channel blockers can produce negative inotropic effects and exacerbate heart failure. Heart failure patients should be monitored carefully. Cleviprex gives no protection against the effects of abrupt beta-blocker withdrawal. Most common adverse reactions (>2%) are headache, nausea, and vomiting. Cleviprex should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. Maintain aseptic technique while handling Cleviprex. Cleviprex contains phospholipids and can support microbial growth. Do not use if contamination is suspected. Once the stopper is punctured, use or discard within 12 hours. Drug interactions
No clinical drug interaction studies were conducted. Cleviprex does not have the potential for blocking or inducing any CYP enzymes. Storage
Cleviprex is available in ready-to-use 50- and 100-mL glass vials at a concentration of 0.5 mg/mL of clevidipine butyrate. Vials should be refrigerated at 2-8oC (36-46 °F). Cleviprex can be stored to controlled room temperature for up to 2 months. Cleviprex is photosensitive and storage in cartons protects against photodegradation. Protection from light during administration is not required. Phase III clinical trial results
Cleviprex has been evaluated in 6 Phase III clinical studies including the perioperative and emergency department/intensive care settings. These include ESCAPE-1, ESCAPE-2, ECLIPSE, and VELOCITY trials. ESCAPE-1 was a double-blind, randomized, placebo-controlled efficacy trial of 105 cardiac surgery patients.