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Olanzapine for chronic, stereotypic self-injurious behaviour: a pilot study in seven adults with intellectual
M McDonough1, J Hillery, N Kennedy
1Behavioural Psychotherapy Unit, Maudsley Hospital, Denmark Hill, London, UK.
Abstract:
Dopamine one (D1) receptor supersensitvity in the corpus striatum is said to be the primary mechanism within the dopamine model proposed for chronic, refractory self-injurious behaviour (SIB), which may explain why conventional neuroleptics have proven largely ineffective. In common with other atypical antipsychotic agents, olanzapine has more affinity for the D1 receptor. The present study explored whether olanzapine could reduce rates of the stereotypic form of chronic SIB, a subtype where dopamine dysfunction is the most likely underlying mechanism. A clinical sample of seven patients with various levels of learning disability who displayed features of stereotypic SIB were assessed over a 6-week period of baseline measurement and a 15-week treatment phase during which olanzapine was added to existing medication. Both SIB and other aberrant behaviours were measured by daily nurse rating and the Self-Injury Trauma Scale (SITS). All measurements were unblind. Doses ranged from 5 to 15 mg. Out of the seven subjects, three showed a clear improvement, one showed a marginal improvement, one deteriorated, and the data was equivocal for the remaining two individuals. The means of the SITS Number and Severity Indices (NI and SI, respectively) reduced significantly from baseline during both the 5- and 10-mg treatment phases, and taking treatment as a whole, by 53% and 48%, respectively (NI: mean = 0.7 units reduction, P = 0.02; SI: mean = 0.9 units reduction, P = 0.04). The risk index also reduced, but did not reach significance. A modest reduction in mean nurse-rated SIB was not significant for either phase or for treatment as a whole. At doses above 5mg, mean scores deteriorated on balance, although two responders showed a marginal additional improvement. Olanzapine was well tolerated with one adverse event reported (somnolence) which was mild and transient. The present pilot study suggests that olanzapine can reduce stereotypic SIB. A larger trial is indicated.
Insights
Olanzapine may reduce stereotypic self-injurious behavior (SIB) in individuals with learning disabilities. This pilot study found significant reductions in SIB severity and frequency, suggesting olanzapine as a potential treatment option.
Area of Science:
- Neuroscience
- Psychiatry
- Pharmacology
Background:
- Dopamine D1 receptor supersensitivity in the corpus striatum is implicated in chronic self-injurious behavior (SIB).
- Conventional neuroleptics are often ineffective for refractory SIB.
- Olanzapine, an atypical antipsychotic, exhibits affinity for the D1 receptor.
Purpose of the Study:
- To investigate the efficacy of olanzapine in reducing stereotypic self-injurious behavior (SIB).
- To explore olanzapine's potential as a treatment for SIB subtypes linked to dopamine dysfunction.
Main Methods:
- A pilot study involving seven patients with learning disabilities and stereotypic SIB.
- A 6-week baseline measurement followed by a 15-week treatment phase with olanzapine (5-15 mg).
- SIB and aberrant behaviors were assessed using daily nurse ratings and the Self-Injury Trauma Scale (SITS).
Main Results:
- Significant reductions were observed in SITS Number and Severity Indices (NI and SI) by 53% and 48%, respectively.
- Three out of seven subjects showed clear improvement; one showed marginal improvement.
- Olanzapine was generally well-tolerated, with mild, transient somnolence reported as the only adverse event.
Conclusions:
- Olanzapine shows promise in reducing stereotypic self-injurious behavior (SIB).
- The findings support further investigation with larger clinical trials.
- Olanzapine may be a viable treatment option for specific SIB subtypes.