Treatment of Previously Undiagnosed Psychiatric Disorders in Persons With Developmental Disabilities Decreased or Eliminated Self-Injurious Behavior
J Clin Psychiatry 2003;64(9):1081-1090
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Background: Self-injurious behavior (SIB) is one
of the most common challenging behaviors in persons with autistic
disorder or severe/profound mental retardation. Many psychotropic
drugs have been evaluated for their effectiveness in SIB. Results
have varied, and no one psychotropic drug has been indicated for
SIB. In this prospective, open clinical study, psychotropic drugs
were used to treat the previously undiagnosed psychiatric
disorder in persons exhibiting SIB.
Method: Data were collected from 26 individuals
with mental retardation (14 males, 12 females), 7 to 45 years of
age (mean = 30.3 years), who exhibited SIB. Psychiatric diagnosis
was made according to DSM-III-R and DSM-IV criteria. The Behavior
Problem Inventory, Yudofsky's Overt Aggression Scale, repeated
direct observation, and information on use of protective devices
and Likert scales from log books were used to evaluate degree of
SIB. Most of the patients were treated with different
psychotropic drugs and behavior modification before they were
evaluated for this study, but only 7 of them carried a
psychiatric diagnosis. Data were collected between 1987 and 1997.
Results: Depressive disorders, impulse-control
disorder, and anxiety disorder were the most common final
diagnoses. Neuroleptics were discontinued in 5 patients and
tapered by 50% to 75% in 14 patients. Antidepressants were added
in 12 patients. Treatment of psychiatric disorders produced
significant (p < .001) decrease in the severity of SIB in the
26 patients, and SIB was eliminated in 12 patients. The severity
of SIB decreased to mild from a moderate, severe, or extreme
degree in 11 patients and from an extreme to a severe degree in 3
Conclusion: The most effective treatment for SIB
that is resistant to environment changes and behavior
modification in persons with developmental disabilities is the
treatment of their psychiatric disorders with the appropriate