Effect of divalproex sodium on aggression and self‐injurious behaviour in adults with intellectual disability: a retrospective review

Abstract

The aim of the present study was to evaluate the efficacy of divalproex sodium treatment in adults with intellectual disability, and aggressive or self-injurious behaviour. Twenty-eight adults aged between 20 and 63 years of age with severe, long-lasting behavioural problems were treated with divalproex sodium (dosage 500-4000 mg day(-1)). Clinical changes were assessed at 2-73 months into the pharmacological treatment utilizing the Clinical Global Impression Severity (CGI-S) scale, and monthly behavioural counts of aggressive and self-injurious acts. Seventy-one percent of subjects demonstrated a moderate or marked improvement on the CGI-S; another 21% demonstrated mild benefits. Among the patients for whom objective prospective behavioural counts were available, 88% showed a significant reduction in aggression and self-injurious behaviour, 46% had other psychotropic medications discontinued, and another 39% had psychotropic medications decreased. One patient had serious thrombocytopenia which required the discontinuation of divalproex sodium, and one other had vomiting and worsened aggression. The present preliminary, uncontrolled study suggests that adults with intellectual disability, and aggressive or self-injurious behaviour may respond to divalproex sodium, and that this drug is well-tolerated in the majority of subjects.

Pemoline (2-Amino-5-phenyl-1,3-oxazol-4-one)-induced Self-Injurious Behavior: A Rodent Model of Pharmacotherapeutic Efficacy

“…In the valproate challenge of pemoline-induced SIB, the beneficial effects were again consistent with the effectiveness in clinical self-injury (Ruedrich et al, 1999). However, valproate was less effective than was risperidone in the dose ranges that were evaluated.…”

“…Positive outcomes have also been described during treatment with the antiepileptic and mood-stabilizing drug valproate (Depakote) (Ruedrich et al, 1999), and preliminary trials with the antiepileptic topiramate (Topamax) have been promising (Shapira et al, 2002). However, it should be noted that these three compounds have not been studied as extensively as the older drug classes have.…”

Multidisciplinary Assessment and Treatment of Self-Injurious Behavior in Autism Spectrum Disorder and Intellectual Disability: Integration of Psychological and Biological Theory and Approach

“…Valproic acid is thought to decrease aggression and impulsivity through GABA receptor stimulation and is FDA-approved for the treatment of bipolar disorder (Czapinski et al 2005;McElroy et al 1989;West et al 1995). In an uncontrolled study of 18 individuals with ID, 11 had moderate to marked improvement in SIB, and 5 of 18 received mild benefits from valproic acid (Ruedrich et al 1999). Another study in children and adolescents with ASD that was double-blinded and placebo-controlled showed no significant difference between treatment groups for aggression (Hellings et al 2005).…”

Treatment of repeated self- injurious behaviour with naltrexone: a case report

“…Similarly topiramate, gabapentine, divalproex sodium and clonidine have been used in the treatment of self-injurious behavior with different degrees of success (12)(13)(14)(15).…”