Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0085631 (agitation)
 12,064 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Self-injury is common in mentally retarded persons and often unresponsive to pharmacotherapy. Based on the assumption that this maladaptive behavior may be related to central nervous system serotonergic imbalance or dysfunction, an open trial with a serotonin uptake inhibitor was conducted. Twenty-one severely to profoundly mentally retarded persons with aggression and self-injurious behavior were treated with 20-40 mg of fluoxetine daily. Marked improvement occurred in 13 patients, moderate in 4, mild in 2, and no improvement in 2 patients treated for a minimum of 3 months. Positive changes occurred in the areas of self-injury, agitation, emotional lability, and aggression. Only one patient required discontinuation of the medication because of anorexia and weight loss; all other patients tolerated the drug without any significant side effects. All were concurrently taking other psychotropic medications, and no adverse drug interactions were noted. Future trials will focus on more homogeneous patient samples and on the therapeutic interactions between concurrently administered psychotropic medications.
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PMID:Effect of fluoxetine on self-injurious behavior in the developmentally disabled: a preliminary study. 155 36

In vivo desensitization procedures were used successfully to manage self-injurious face slapping in a 10 yr old retarded boy. Face slapping had increased and persisted at self-injurious intensity following a surgical dental evaluation and had initially been prevented by the use of a hockey helmet. Parent's efforts to remove the helmet resulted in increased agitation, severe self-injurious behavior, and repeated efforts by the child to replace the helmet to restrain himself, or prompt adult restraint. An in vivo desensitization procedure involving increasingly extended periods without the helmet was introduced by the parents into a hierarchy of situations at home. Progress was monitored across four situations using a multiple baseline design with 6, 9, 12 and 15 month follow-up on each baseline. During treatment, self-injurious behavior was eliminated and the child developed a self-control response of wearing the helmet when agitated and spontaneously removing it when relaxed. Continued improvement was noted at 6, 9 and 12 month follow-ups. At the 15 month follow-up, no self-injurious behavior was observed and the use of the helmet was discontinued.
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PMID:In vivo desensitization in the management of self-injurious behavior. 612 48

Measurement methods from behavioral psychology were used to assess antiepileptic drug behavioral side effects in 5 individuals with mental retardation. When the suspected antiepileptic drug was altered, an 81% reduction of maladaptive behaviors occurred. Quality of life outcomes included successful community placement and termination of an aversive intervention procedure. Three cases demonstrated antiepileptic drug exacerbation of disruptive vocalizations, agitation, self-injurious behavior, and property destruction; 2 demonstrated improved aggression, but illustrated a common clinical problem. When seizure control must be maintained and a suspected antiepileptic drug cannot be reduced before a second antiepileptic drug with potential psychotropic properties is initiated, it was not possible to absolutely conclude that the first antiepileptic drug was responsible for the behavior problem. Overall, these measurement methods were instrumental in the systematic clinical evaluation of antiepileptic drug behavioral side effects in individuals unable to verbally communicate the presence of these side effects.
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PMID:Antiepileptic drug behavioral side effects in individuals with mental retardation and the use of behavioral measurement techniques. 856 87

The efficacy of the serotonin (5-HT) uptake inhibitor clomipramine in the treatment of self-injurious behavior (SIB) was tested in individuals with severe and profound mental retardation. Six of the 8 subjects who completed a double-blind, placebo-controlled crossover trial exhibited a clinically significant improvement (50% or greater reduction from placebo) in the frequency of SIB. Clomipramine treatment was also associated with improvement in SIB intensity, frequency of stereotypy and compulsions, teacher ratings of stereotypy and social withdrawal, and frequency of staff intervention required for problem behaviors. Adverse effects (seizure and tachycardia/agitation) occurred in 2 of the 8 subjects. These results represent the first controlled trial of a 5-HT uptake inhibitor in the treatment of SIB in mental retardation.
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PMID:Clomipramine treatment for self-injurious behavior of individuals with mental retardation: a double-blind comparison with placebo. 873 78

A longitudinal study of 62 individuals with profound mental retardation was conducted to determine if direct care staff can identify behavior change prior to identifying symptoms of acute illness. Results indicate that staff were able to notice changes in sluggishness prior to the onset of illness. Self-care behavior was of borderline significance and there was no significant change in eight behavior dimensions (vocalizations, peer conflict, stereotypy, aggression, self injurious behavior, restlessness, distractibility, and depression). This finding should alert physicians and caregivers to the importance of prompt response to symptoms. Reliance on behavioral observation of direct care staff is not always sensitive enough to pick up changes in health status in less restrictive residential environments.
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PMID:Do behavior changes herald physical illness in adults with mental retardation? 914 51

This single case reports an open trial of lamotrigine in the treatment of self-injurious behavior (SIB) and epilepsy in an 18-year-old female diagnosed with generalized seizure disorder, stereotypic movement disorder, and compulsive SIB in the context of profound mental retardation. Animal models of SIB suggest that the glutamate neurotransmitter systems, involved in the generation of epileptic seizures, may also have a role in the pathophysiology of SIB. Data suggesting that lamotrigine may decrease glutamate release encouraged an empirical trial of lamotrigine for treatment of SIB. After 4 weeks of treatment of lamotrigine 200 mg daily, decreases in agitation and fearfulness were clinically observed, along with a 50% reduction in the frequency of SIB as measured by standardized scales. Good seizure control was maintained throughout the trial. No significant adverse effects were observed. Positive effects persisted at 1-year follow-up. Symptoms of stereotypic movement disorder appeared unchanged. Because these findings are preliminary, no clinical recommendations for the treatment of SIB with lamotrigine can be made until controlled studies have been completed.
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PMID:Open trial lamotrigine in the treatment of self-injurious behavior in an adolescent with profound mental retardation. 923 20

Seven of 63 children (11%) treated with clobazam (CLB) for refractory epilepsy developed a severe behavior disorder. This disorder was characterized by aggressive agitation, self injurious behavior, insomnia, and incessant motor activity occurring between 10 and 55 days after initiation of drug therapy. The affected children were relatively young (mean age 6.4 years) and developmentally disabled (four were autistic and two had isolated mental retardation). The disorder occurred with a short latency after initiation of therapy and at a relatively low dosage of CLB. Serum levels of other coadministered antiepileptic drugs were unchanged by the administration of CLB. One child was taking CLB monotherapy. This behavioral deterioration required the discontinuation of CLB, after which patients returned to their previous behavior within 3 weeks. After > 3 years of follow-up all children continue to require multiple antiepileptic drugs but have not had a recurrence of this aggressive agitation. The mechanism of the behavioral change is unclear.
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PMID:Aggression in children treated with clobazam for epilepsy. 931 80

Risperidone has proven efficacy with reduced likelihood of causing extrapyramidal symptoms in the treatment of schizophrenia. Initial work suggests its utility in the management of aggression and self injury in patients with mental retardation. The use of risperidone in eight adult patients with moderate to profound mental retardation is described. Risperidone in these individuals was associated with significant reduction in aggression and self injurious behavior. Side effects were primarily those of sedation and restlessness. These cases illustrate the possible utility of risperidone in the treatment of aggression and self injury in adult patients with moderate to profound mental retardation.
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PMID:Risperidone for aggression and self-injurious behavior in adults with mental retardation. 965 34

This pilot study examined the efficacy and tolerability of olanzapine in the treatment of children, adolescents, and adults with pervasive developmental disorders (PDDs). Eight patients with principal diagnoses (DSM-IV) of autistic disorder (N = 5) or PDD not otherwise specified (N = 3) were given olanzapine in an open-label, prospective fashion for 12 weeks. Clinical ratings were obtained at baseline and at the end of weeks (EOWs) 4, 8, and 12. Seven of eight patients completed the 12-week trial, and six of the completers were deemed clinical responders as measured by ratings at the EOW 12 of "much improved" or "very much improved" on the global improvement item of the Clinical Global Impression Scale. Significant improvements in overall symptoms of autism, motor restlessness or hyperactivity, social relatedness, affectual reactions, sensory responses, language usage, self-injurious behavior, aggression, irritability or anger, anxiety, and depression were observed. Significant changes in repetitive behaviors were not observed for the group. The EOW 12 mean +/- SD daily dose of olanzapine was 7.8 +/- 4.7 mg/day. The drug was well tolerated with the most significant adverse effects noted to be increased appetite and weight gain in six patients and sedation in three. With respect to weight gain, the mean +/- SD weight for the group increased from 137.50 +/- 55.81 pounds (62.50 +/- 25.37 kilograms) at baseline to 155.94 +/- 55.13 pounds (70.88 +/- 25.06 kilograms) at EOW 12. No evidence of extrapyramidal side effects or liver function abnormalities was seen. These preliminary results suggest that olanzapine may be an effective and well tolerated drug in targeting core and related symptoms of PDDs in children, adolescents, and adults. Further studies, particularly those that are placebo-controlled and double-blinded, are indicated to better define the clinical use of olanzapine in these patient populations.
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PMID:Olanzapine treatment of children, adolescents, and adults with pervasive developmental disorders: an open-label pilot study. 1127 Sep 29

Children with autism and the related PDDs may benefit from serotonin reuptake inhibitors such as clomipramine, fluoxetine, fluvoxamine, and sertraline for targeting repetitive thoughts and behaviors, anxiety, and depressed mood. To date, however, there are few controlled studies of these agents in children with PDD, so definitive evidence is lacking. Despite preliminary results in favor of naltrexone, neuroleptic medication appears to be effective for reducing aggression, self-injurious behavior, agitation, and stereotypies. The primary drawback with traditional neuroleptics is risk of short- and long-term side effects. The newer atypical neuroleptics have the potential for benefit with fewer extrapyramidal side effects, but more study is needed to establish their efficacy and safety. Children on neuroleptic medications should be started at the lowest possible dose, with gradual increases until clinical benefit is observed. The likelihood of untoward side effects is increased if the medication dose is increased rapidly. Baseline measurement of target behaviors can be aided by using standardized scales. The presence of abnormal movements should be assessed before initiating treatment and at regular intervals during the course of treatment--including after medication withdrawal. Weight gain is emerging as a recurrent side effect with the atypical neuroleptics. Thus, weight should be monitored, and the family should be advised about a diet baseline. As with all treatments of children with severe behavioral difficulties, pharmacotherapy should be instituted in the context of an integrated treatment plan.
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PMID:Pharmacotherapy in children and adolescents with pervasive developmental disorders. 1034 30


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