Properties (15)
Id 029c090a-e5a6-4104-ada4-22070ce20979
Year 2022
Abstract We report the case of a 32-year-old male with autism spectrum disorder (ASD) suffering from severe misophonia. After titrating risperidone to 2 mg twice a day, the patient reported a significant reduction in his symptoms and his Amsterdam misophonia scale-revised (AMISOS-R) score dropped by from 31 to 5. Upon discharge, the patient was noted to have decreased irritability and overall improved behavior and effect. This significant symptomatic improvement was likely not explained by inpatient admission alone or other simultaneous pharmacologic treatments, as the effect was seen during an isolated titration of risperidone with other treatments remaining constant. Although, unfortunately, follow-up findings indicated that the treatment was not curative for the patient, risperidone’s potential for treating misophonia may warrant systematic investigation.
Cssclasses
  • purpleRed
Aliases
  • (Pan et al., 2022)
Import Date 08-21-2026
Zotero Note Link Generated true
Checked For Zettle Notes true
Notes Audited 2026-08-21T11:15:00
Audit Notes audited as review was done
Dv Authors Eric J. Pan, Jeremy Weleff, Akhil Anand, Brian S. Barnett,
Dv Limitations • Treatment was not curative; residual symptoms persisted at one-month follow-up. • Case report design; single patient with multiple comorbidities and concurrent medications, limiting causal attribution. • AMISOS-R has not been fully validated. • Psychogenic nonepileptic seizures could not be ruled out, adding diagnostic uncertainty to the clinical picture.
Dv Future Directions • Authors call for more research to establish efficacy of risperidone for misophonia and to elucidate underlying mechanisms.
Dv Relevance • describes a case study where Risperidone was found to improve Misophonia symptoms, although it did not fully treat it and needs clinical trials to confirm
Parent
  • Misophonia MOC

Treatment of Misophonia with Risperidone in a Patient with Autism Spectrum Disorder

Status:: #status/reviewed

Metadata

Abstract
Background/Purpose Background-
• Misophonia occurs in a fraction of individuals with ASD; triggers include repetitive sounds (chewing, pen clicking, tapping, loud breathing, lip-smacking); patients use avoidance and coping mechanisms (headphones, pillows over head).
• Misophonia posited to result from hyperconnectivity between auditory and limbic systems; primary emotion is anger (vs. fear in phonophobia), with irritation, stress, anxiety, aggravation, feeling trapped, and impatience also occurring.
• Specific sound cues believed to activate right insula, right anterior cingulate cortex, and right superior temporal cortex.
• Evidence for misophonia treatment is scarce; no controlled trials have been conducted, data largely anecdotal; case studies report mixed results for CBT, exposure and response prevention therapy, mindfulness, and SSRIs.
• A recent RCT found CBT effective for misophonia; no known RCT of pharmacological agents exists for misophonia.
• Hyperacusis shares similarities with misophonia but involves aversive reaction to everyday sounds broadly rather than specific sounds; case reports support risperidone for hyperacusis in autism, but no published reports address risperidone for misophonia in this population.


Purpose-
• Report a case of misophonia in an adult with ASD that responded to risperidone, given absence of prior literature on antipsychotic treatment of misophonia in adult ASD patients.
Participants/samples • Single case report: 32-year-old male with ASD, intellectual disability, generalized anxiety disorder, and schizoaffective disorder.
• Admitted via emergency department for acute-onset paranoia and delusions during an outpatient-initiated olanzapine taper (taper prompted by lack of efficacy for psychosis and weight gain).
Measures • Amsterdam misophonia scale-revised (AMISOS-R), 10 items, score range 0-40.
• Generalized anxiety disorder-7 (GAD-7).
• Patient health questionnaire-9 (PHQ-9).
• Neurological workup: MRI, EEG (for suspected seizure activity).
Procedures • Presentation & Assessment: Patient endorsed misophonia symptoms (negative emotional/physical reactions to eating, talking, snoring, fireworks, phone ringing) with avoidance behaviors including leaving situations, pillow-over-head, blowups with noise-makers, and guilt-laden avoidance of a loud relative. AMISOS-R baseline: 31 (severe–extreme).

• Admission Medications: Olanzapine 20 mg qhs continued; risperidone started at 1 mg, titrated to 1 mg BID with planned olanzapine cross-taper; home regimen (divalproex, pantoprazole, lisinopril-HCTZ, pravastatin, topiramate, venlafaxine XR) unchanged; gabapentin 300 mg TID added (chronic back pain).

• Hospital Course (12 days): Paranoia/behavioral outburst on psych unit → transferred to medical unit (day 7) for neurological workup (MRI/EEG negative; PNES not excluded) → olanzapine fully tapered (day 7) → risperidone increased to 2 mg BID (day 8) → retransferred to psychiatry (day 9) → discharged (day 12).

• Follow-up: ~1-month post-discharge (per mother): subsequent hospitalization ~2 months later for agitation (unrelated to misophonia) prompted risperidone increase to 2 mg AM / 3 mg qhs.
•
Results Treatment Response:
• Risperidone titration to 2 mg BID was associated with sudden, dramatic misophonia improvement , no further outbursts, patient engaged and attended all groups.
• AMISOS-R dropped from 31 → 5 (severe–extreme to subclinical) at discharge.
• Patient reported decreased irritability, increased talkativeness, and newfound tolerance of previously triggering sounds (eating, talking, roommate's snoring)

Attribution:
• Improvement occurred while all other medications remained constant; gabapentin dosage was unchanged throughout, making it an unlikely contributor.
• No prior reports of gabapentin for misophonia exist (one hyperacusis report noted).

Follow-up & Limitations:
• At one month, misophonia remained broadly improved but some irritability and sound sensitivity persisted during family meals effect was not curative.
• GAD-7 (20) and PHQ-9 (14) were collected at admission only and not used as misophonia outcome or covariate measures.
Discussion/Limits Conclusion-
• Clinical Significance: Authors identify this as the first reported case of antipsychotic treatment for misophonia in an adult with ASD. The improvement was incidental as risperidone was prescribed for psychosis, not misophonia.

• Attribution & Mechanism: The olanzapine→risperidone switch is the most parsimonious explanation for improvement; gabapentin was started concurrently but unchanged during the response period. Mechanistically, both agents antagonize D2 and 5-HT2 receptors (among others), but risperidone has stronger D2 affinity and differs from olanzapine in its binding profile at 5-HT2, H1, α1-adrenergic, and D1 receptors. How these differences produced misophonia improvement remains unclear.

• Conclusions: Risperidone appears helpful but not curative. Authors call for systematic investigation of its potential as a misophonia treatment.
Limitations:: • Treatment was not curative; residual symptoms persisted at one-month follow-up.
• Case report design; single patient with multiple comorbidities and concurrent medications, limiting causal attribution.
• AMISOS-R has not been fully validated.
• Psychogenic nonepileptic seizures could not be ruled out, adding diagnostic uncertainty to the clinical picture.
Future Directions:: • Authors call for more research to establish efficacy of risperidone for misophonia and to elucidate underlying mechanisms.
Relevance:: • describes a case study where Risperidone was found to improve Misophonia symptoms, although it did not fully treat it and needs clinical trials to confirm

Notes

key terms and concepts

my engagement notes

my questions

my comments

Bookmarks

reading notes

contextual statement

In a 2022 study, Pan attempted to report the first documented case of antipsychotic treatment for misophonia in an adult with autism spectrum disorder by describing a 32-year-old male's clinical course during risperidone titration, using the Amsterdam misophonia scale-revised (AMISOS-R), GAD-7, and PHQ-9.

summary statement

In a 2022 study, Pan reported a case of a 32-year-old male with ASD, intellectual disability, generalized anxiety disorder, and schizoaffective disorder whose severe misophonia was tracked during hospitalization while risperidone was titrated and olanzapine tapered off. They found that increasing risperidone to 2 mg twice daily produced a sudden, dramatic drop in AMISOS-R score (31 to 5) and reduced irritability and behavioral outbursts, though some symptoms persisted at one-month follow-up. From this they concluded that risperidone likely contributed to the improvement, independent of gabapentin or olanzapine, and that its potential for treating misophonia warrants systematic investigation.

Zettelkasten

Case of incidental improvement of Misophonia symptoms via Risperidone

Enter your search text in the box above

Select a result to preview