Violent and self-injurious behaviour in mentally handicapped patients--psychopharmacological control

Aggressive and self-destructive behaviour in mentally handicapped patients presents the psychiatrist with formidable problems, especially in the diagnosis of specific mental disorders using the criteria of current classificatory systems. Having reviewed the use of antidepressants, antianxiety agents and the wide range of oral antipsychotics previously employed, the literature describing treatment with depot neuroleptics is considered. The results of switching twenty-one patients to the depot butyrophenone haloperidol decanoate, dose range 50 to 300 mg given four-weekly over a nine month period, are described: they confirm previous observations that the "knock-on" effect of disruptive behaviour and the overall level of violence and self-injury can be considerably reduced when only some of the patients in any one ward are adequately treated.