Hostname: page-component-78c5997874-fbnjt Total loading time: 0 Render date: 2024-11-16T15:08:12.213Z Has data issue: false hasContentIssue false
  • English
  • Français

Psychopharmacology of severe self-injury associated with learning disabilities

Published online by Cambridge University Press:  03 January 2018

David J. Clarke
David J. Clarke*
Affiliation:
Department of Psychiatry, Queen Elizabeth Psychiatric Hospital, Birmingham B15 2QZ
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Many sedative and antipsychotic agents have been used in the management of severe self-injury associated with learning disabilities. Their efficacy has been questioned. Recent research has identified some biological abnormalities associated with severe self-injury and allowed a more rational selection of treatment.

Method

Review of published literature, including trials, previous reviews and case reports.

Reports

There is evidence for the efficacy of opiate antagonists in the management of severe self-injury, and recent research has identified potential methods of predicting treatment response. Dopamine D1 antagonists and some agents affecting serotonin turnover may also be of benefit.

Conclusions

More rational psychopharmacological treatments for severe self-injurious behaviour may become available. Such treatments are difficult to evaluate for methodological and ethical reasons. They usually involve the clinical use of compounds for unlicensed indications, rather than trials of agents developed specifically to treat severe self-injurious behaviour. Combining psychopharmacological and psychological interventions may provide additional benefits.

Type
Review Articles
Information
The British Journal of Psychiatry , Volume 172 , Issue 5 , May 1998 , pp. 389 - 394
Copyright
Copyright © 1998 The Royal College of Psychiatrists 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Anderson, L. T. & Ernst, M. (1994) Self-injury in Lesch-Nyhan disease. Journal of Autism and Developmental Disorders, 24, 67–81.Google Scholar
Baumeister, A. A., Frye, G. R. & Schroeder, S. R. (1984) Neurochemical correlates of self-injurious behaviour. In Transitions in Mental Retardation: Advocacy, Technology and Science (eds J. L. Mulick & B. L. Mallory). pp 207–228. Norwood. NJ: Ablex.Google Scholar
Baumeister, A. A., Todd, M. E. & Sevin, J. A. (1993) Efficacy and specificity of pharmacological therapies for behavioral disorders in persons with mental retardation. Clinical Neuropharmacology, 16, 271–294.Google Scholar
Benjamin, E. & Buot-Smith, T. (1993) Naltrexone and fluoxetine in Prader-Willi syndrome. Journal of the American Academy of Child and Adolescent Psychiatry, 32, 870–873.Google Scholar
Breese, G. R., Baumeister, A. A., McCowan, T. J., et al (1984) Neonatal-6-hydroxydopamine treatment: Model of susceptibility for self-mutilation in the Lesch-Nyhan syndrome. Pharmacology and Biochemistry of Behavior, 21, 459–461.Google Scholar
Cook, E. H., Rowlett, R., Jaselskls, D. O., et al (1992) Fluoxetine treatment of children and adults with autistic disorder and mental retardation. Journal of the American Academy of Child and Adolescent Psychiatry, 31, 739–745.Google Scholar
Cooper, A. F. & Fowlle, H. C. (1973) Control of gross self-mutilation with lithium carbonate (letter). British Journal of Psychiatry, 122, 370–371.Google Scholar
Craft, M., Ismail, I. A., Krishnamurtl, D., et al (1987) Lithium in the treatment of aggression in mentally handicapped patients: a double-blind trial. British Journal of Psychiatry, 150, 685–689.Google Scholar
Deb, S. (1998) Self-injurious behaviour as part of genetic syndromes. British Journal of Psychiatry, 172, 385–388.CrossRefGoogle ScholarPubMed
Doch, B. & Budow, L. (1991) The use of fluoxetine in an adolescent with Prader-Willi syndrome. Journal of the American Academy of Child and Adolescent Psychiatry, 30, 298–302.CrossRefGoogle Scholar
Gedeye, A. (1991) Buspirone alone or with serotonergic diet reduced aggression in a developmentally disabled adult. Biological Psychiatry, 30, 88–91.Google Scholar
Goldstein, M., Kuga, S., Kusano, N., et al (1984) Dopamine agonist induced self-mutilative biting behavior in monkeys with unilateral ventral medial tegmental lesions of the brain stem: Possible pharmacological model for Lesch-Nyhan syndrome. Brain Research, 367, 114–120.Google Scholar
Jawed, S. H., Krishnan, V. H. R. & Cassidy, G. (1994) Self-injurious behaviour and the serotonin link: two case illustrations and theoretical overview, (Irish journal of Psychological Mediane, 11, 165–168.Google Scholar
King, B. H. (1993) Self-injury by people with mental retardation: A compulsive behavior hypothesis. American Journal on Mental Retardation, 98, 93–112.Google Scholar
Lang, C. & Remington, D. (1994) Treatment with propranolol of severe self-injurious behavior in a blind, deaf, retarded adolescent. Journal of the American Academy of Child and Adolescent Psychiatry, 33, 265–269.Google Scholar
Lewis, M. H., Bodfish, J. W., Powell, S. B., et al (1995) Clomipramine treatment for stereotypy and related repetitive movement disorders associated with mental retardation. American Journal on Mental Retardation, 100, 299–312.Google Scholar
Lewis, M. H., Bodfish, J. W., Powell, S. B., et al (1994) Clomipramine treatment for self-injurious behavior of individuals with mental retardation: a double-blind comparison with placebo. American Journal on Mental Retardation, 100, 654–665.Google Scholar
Lowry, M. A. & Sovner, R. (1992) Severe behaviour problems associated with rapid cycling bipolar disorder in two adults with profound mental retardation. Journal of Intellectual Disability Research, 36, 269–281.CrossRefGoogle ScholarPubMed
Lloyd, K. C., Hornyklewicz, O., Davidson, L., et al (1981) Biochemical evidence of dysfunction of brain neurotransmitters in the Lesch-Nyhan Syndrome. New England Journal of Medicine, 305, 1106–1111.Google Scholar
Markowitz, P. I. (1992) Effect of fluoxetine in the developmentally disabled: A preliminary study. Journal of Clinical Psychopharmacology, 12, 27–31.Google Scholar
Micev, V. & Lynch, D. M. (1974) Effect of lithium on disturbed severely mentally retarded patients (letter). British Journal of Psychiatry, 125, 110.Google Scholar
Nyhan, W. L., Johnson, H. G., Kaufman, I. A., et al (1980) Serotonergic approaches to the modification of behavior in the Lesch–Nyhan syndrome. Applied Reseorch in Mental Retardation, 1, 25–40.Google Scholar
Powell, S. B., Bodflsh, J. W., Parker, D., et al (1996) Self-restraint and self-injury: occurrence and motivational significance. American Journal on Mental Retardation, 101, 41–48.Google ScholarPubMed
Primrose, D. A. (1979) Treatment of self-injurious behaviour with a GABA (gamma-aminobutyric acid) analogue. Journal of Mental Deficiency Research, 23, 163–173.Google Scholar
Ratey, J. J., Sovner, R., Mikkelsen, E., et al (1989) Buspirone therapy for maladaptive behaviour and anxiety in developmentally disabled persons. Journal of Clinical Psychiatry, 50, 382–384.Google ScholarPubMed
Realmuto, G. M., August, G. J. & Garfinkel, B. D. (1989) Clinical effect of buspirone in autistic children. Journal of Clinical Psychopharmacology, 9, 122–125.Google Scholar
Ruedrlch, S. L., Grush, L. & Wilson, L. (1990) Beta adrenergic blocking medications for aggressive or self-injurious mentally retarded persons. American Journal on Mental Retardation, 95, 110–119.Google Scholar
Sandman, C. A., Hebrick, W. P., Taylor, D. V., et al (1993) Naltrexone reduces self-injury and improves learning. Experimental and Clinical Psychopharmacology, 1, 242–258.Google Scholar
Sandman, C. A., & Hebrick, W. P., (1995) Opiate mechanisms in self-injury. Mental Retardation and Developmental Disabilities Research Reviews, 1, 130–136.Google Scholar
Schroeder, S. R. & Tessel, R. (1994) Dopaminergic and serotonergic mechanisms in self-injury and aggression. In Destructive Behavior in Developmental Disabilities: Diagnosis and Treatment (eds Thompson, T. & Gray, D. B.), pp. 198–210. Thousand Oaks, CA: Sage.Google Scholar
Schroeder, S. R., Hammock, R. G., Mulick, J. A., et al (1995) Clinical trials of D1 and D2 dopamine modulating drugs and self-injury in mental retardation and developmental disability. Mental Retardation and Developmental Disabilities Research Reviews, 1, 120–129.Google Scholar
Sovner, R., Fox, C. J., Lowry, M. J., et al (1993) Fluoxetine treatment of depression and associated self-injury in two adults with mental retardation. Journal of Intellectual Disability Research, 37, 301–311.Google Scholar
Thompson, T. & Gray, D. B., (eds) (1994) Destructive behavior in Developmental Disabilities: Diagnosis and Treatment. Thousand Oaks, CA: Sage.Google Scholar
Thompson, T., Egli, M., Symons, F., et al (1994a) Neurobehavioral mechanisms of drug action in developmental disabilities. In Destructive behavior in Developmental Disabilities: Diagnosis and Treatment (eds Thompson, T. & Gray, D. B.), pp. 133–180. Thousand Oaks, CA: Sage.Google Scholar
Thompson, T., Hackenberg, T., Cerutti, D., et al (1994b) Opioid antagonist effects on self-injury in adults with mental retardation: Response form and location as determinants of medication effects. American Journal on Mental Retardation, 99, 85–102.Google Scholar
Winchel, R. M. & Stanley, M. (1991) Self-injurious behavior: a review of the behavior and biology of self-mutilation. American Journal of Psychiatry, 148, 306–317.Google Scholar
Submit a response

eLetters

No eLetters have been published for this article.