Treatment of self-injurious behaviour with a GABA (gamma-aminobutyric acid) analogue

Self-injurious behaviour (SIB) is not uncommon in the severely subnormal. Corbett (1975) found the incidence in several reported series to vary between 3.5 per cent and almost 40 per cent, and Van Velzen (1973), in a survey of ten institutions in the Netherlands, found it present in 584 patients out of almost 2,000 (30.3 per cent). Treatment is notoriously difficult and many kinds have been tried including physical restraint, drug regimes, and electric shock aversion therapy. An account is given here of a drug trial using baclofen, a gamma-aminobutyric acid (GABA) analogue that crosses the blood brain barrier. GABA, in addition to being a muscle relaxant, is also a major inhibitor in many areas of the brain, including the cortex and basal ganglia (Callingham, 1972) andit was presumed by the author that some severely subnormal defectives have damage in these areas and hence might be deficient in this inhibitor. The trial commenced with a preliminary period during which the reactions of patients to the drug at different dose levels were observed. This was followed by a double-blind cross-over trial in patients who had already shown improvement.