Pharmacological interventions for self-injurious behaviour in adults with intellectual disabilities

Rana, Fareez; Görmez, Aynur; Varghese, Susan

doi:10.1002/14651858.cd009084.pub2

Cited by 27 publications

(19 citation statements)

References 56 publications

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“…Evidence of naltrexone efficacy in SIB in the heterogeneous population of intellectually disabled adults is limited with few double-blind placebo-controlled studies. As a result of limited data, for example, a recent Cochrane Review concluded that recommendations could not be made for use of naltrexone for SIB in intellectual disability (1). Notably, three of the albeit small studies suggested clinical benefits.…”

Section: Discussionmentioning

confidence: 99%

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Naltrexone for Severe Eye-Gouging in Down Syndrome

Hauptman

2016

AJP Residents' Journal

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We present the case of a profoundly intellectually disabled, nonverbal woman in her 40s with Down syndrome who experienced life-long severe self-injurious behavior (SIB), including chronic eye-gouging that resulted in blindness. She had been unsuccessfully treated for SIB with decades of polypharmacy, including neuroleptics, antidepressants, and anxiolytics, but ultimately showed complete resolution of SIB with naltrexone therapy. CASE"Ms. B" carried a diagnosis of Down syndrome. She was nonverbal, and while formal neuropsychological testing was not available, the evidence from history and clinical interview suggested profound intellectual disability. In addition to intellectual disability, the patient suffered from severe violent outbursts and SIB that had begun in early childhood. Of particular importance, her SIB took the form of chronic eye-rubbing and gauging. This symptom persisted for decades, was recalcitrant to treatment, and resulted in the patient blinding herself from chronic abrasion and infection. Aggressive and violent outbursts were common in her younger years but improved with age and neuroleptic management. She was first reported to have been seen by a psychiatric practitioner at 30 years old; however, numerous caregiver transfers and a complex psychosocial history resulted in considerable uncertainty about many historical details.At the time of presentation, Ms. B was in the care of her foster mother. Details of why she was in foster care were vague; however, it was reported to be related to her intense special care needs rather than specific issues in the household of her biological family. Her foster mother was experienced with caring for intellectually disabled individuals and was an excellent support. Ms. B received nursing assistance for medication management and activities of daily living. She lived at home with her foster mother.No specific family history of mental illness was known to providers. There was no known history of early-life trauma or neglect, though this cannot be known definitively, since the patient had undergone numerous housing and care transfers. To our knowledge, she had not been psychiatrically hospitalized, and despite chronic eyegauging SIB, there was no known history of suicidality. She carried no other primary psychiatric diagnoses. Down syndrome had been confirmed early in life by genetic testing. There was no suspicion of any history of substance use, legal history, or homelessness.At presentation, Ms. B was being treated with escitalopram (10 mg), paliperidone (3 mg daily), and buspirone (15 mg b.i.d.). The rational for this medication regimen was reported by her foster mother to be unclear. A primary concern had been aggression and self-injury. Despite long-term polypharmacy, she persisted in having constant, daily self-injurious eye rubbing and gouging that resulted in frequent infection. Aggressive behaviors, however, were well controlled on this regimen at the time, though no change in medication had occurred in recent history, and thus it is unknown wheth...

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Section: Discussionmentioning

confidence: 99%

“…Notably, three of the albeit small studies suggested clinical benefits. Safety, efficacy, dosing, and population variability in the use of naltrexone for SIB in intellectual disability requires further empirical study (1).…”

Section: Discussionmentioning

confidence: 99%

Naltrexone for Severe Eye-Gouging in Down Syndrome

Hauptman

2016

AJP Residents' Journal

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“…Two reviews contained studies with quasiexperimental methods [63,64]. Two reviews in this group did not conduct quantitative synthesis of estimates [61,62], whereas one review meta-analyzed the data for only one outcome, involving two trials [68].…”

Section: Description Of Included Studiesmentioning

confidence: 99%

“…None of the reviews that did not adopt GRADE gave a reason for that decision. In comparison with GRADEendorsed reviews, a higher proportion of those not endorsing GRADE in both complex and simple intervention review groups reported either the narrative synthesis of the data [42,50,51,61,62] or the quantitative synthesis applied to only part of the included outcomes [8,35,43,44,47e49,68].…”

Section: Grade Ratings For Separate Outcomesmentioning

confidence: 99%

“…Meanwhile, 61 outcomes had GRADE ratings for the main comparison [57] X X X X Magni [58] X Mayo-Wilson [59] X X Purgato [60] X Rana [61] X Rothbart [62] X Schoonees [63] X X Taft [64] X X X X Taylor [65] Wang [66] X X Wijkstra [67] Williams [68] in the total of the 11 GRADE-endorsed reviews of simple interventions (see Appendix C at www.jclinepi.com).…”

Section: Grade Ratings For Separate Outcomesmentioning

confidence: 99%

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