Nonneuroleptic treatment of disruptive behavior in organic mental syndromes.
OBJECTIVE
To summarize the literature describing nonneuroleptic treatments of unacceptably disruptive behavior in chronically institutionalized psychiatric patients with mental retardation, autism, organic brain syndrome, and dementia.


METHODS
Relevant articles were identified from a MEDLINE search of the above diagnoses linked with "aggression" and "psychomotor agitation." Additional references were found in the bibliographies of these articles.


METHODS
The studies reviewed were limited to prospective evaluations of nonneuroleptic drug therapy of these behavior disturbances. Case reports, case series, and retrospective studies were excluded. Studies of patients with schizophrenia, affective disorders, and personality disorders were also excluded.


RESULTS
Studies of lithium, beta-blockers, carbamazepine, benzodiazepines, and buspirone were adequate for review. As a rule, these studies are hampered by poor design. The lithium studies suggest that mentally retarded patients with behavior disturbances may respond to lithium treatment. The beta-blocker studies suggest improvement in patients with mental retardation, autism, organic brain syndrome, and dementia. Neuroleptic discontinuation or a decrease in dose was possible in some patients. The carbamazepine studies were inconclusive. Carbamazepine should be reserved for patients with concomitant seizure disorders. Benzodiazepines were helpful in treating elderly demented patients. Thus far, buspirone has been evaluated in only a few, poorly designed studies and is not yet recommended for treatment of behavior disturbances.


CONCLUSIONS
Legislation has restricted the use of neuroleptics in many patients receiving long-term healthcare. Despite the questionable validity of the studies reviewed, lithium, beta-blockers, carbamazepine, and benzodiazepines may be considered as alternatives to neuroleptics in selected cases.
Smith
D A
DA
Division of Clinical Pharmacy, College of Pharmacy, University of Iowa, Iowa City 52242.
Perry
P J
PJ
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000987:Antisocial Personality Disorder / Q000188:drug therapy; D001321:Autistic Disorder / Q000188:drug therapy; D002220:Carbamazepine / Q000627:therapeutic use; D003704:Dementia / Q000188:drug therapy; D004311:Double-Blind Method; D006801:Humans; D008607:Intellectual Disability / Q000188:drug therapy; D008094:Lithium / Q000627:therapeutic use*; D019965:Neurocognitive Disorders / Q000188:drug therapy*; D011446:Prospective Studies; D014149:Tranquilizing Agents / Q000627:therapeutic use*
D000319:Adrenergic beta-Antagonists; D014149:Tranquilizing Agents; D002220:Carbamazepine; D008094:Lithium