Self-injurious behaviour and the serotonin link: two case illustrations and theoretical overview

Psychopharmacology of severe self-injury associated with learning disabilities

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.