Sertraline response in adults with mental retardation and autistic disorder.
BACKGROUND
Self-injury and aggression are common reasons for urgent psychiatric referral of persons with mental retardation and autistic spectrum disorders. Although the treatment prescribed for these problems has traditionally been neuroleptic medication, serotonin reuptake inhibitors such as sertraline may result in significant clinical improvement as well as fewer side effects.


METHODS
The authors administered sertraline in an open trial to nine consecutively admitted adult mentally retarded outpatients presenting with target behaviors of self-injury and/or aggression. Most patients (N = 6) were mildly or moderately mentally retarded by DSM-III-R criteria; five had comorbid autistic disorder. Prescribed dosages ranged from 25 mg to 150 mg daily, based on observed clinical responses. Clinical Global Impressions (CGI) ratings were made at baseline and again after sertraline treatment for at least 28 days.


RESULTS
Sertraline led to improvement in CGI ratings of overall clinical severity in eight of nine subjects; mean +/- SD improvement in CGI ratings was 2.44 points +/- 1.67. Discontinuation of the treatment was necessary in only one patient, after 18 weeks of sertraline treatment, because of agitation and worsening of self-picking. Side effects were otherwise minimal.


CONCLUSIONS
These findings from a clinical sample suggest that sertraline is promising in the treatment of self-injury and aggression. Double-blind controlled studies of sertraline and other serotonin reuptake inhibitors in the treatment of self-injury and aggression in patients with mental retardation and with autistic disorder are warranted.
Hellings
J A
JA
Department of Psychiatry, Kansas University Medical Center, Kansas City 66160, USA.
Kelley
L A
LA
Gabrielli
W F
WF
Kilgore
E
E
Shah
P
P
D015057:1-Naphthylamine / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000328:Adult; D000374:Aggression / Q000187:drug effects / Q000523:psychology; D001321:Autistic Disorder / Q000188:drug therapy* / Q000453:epidemiology / Q000523:psychology; D015897:Comorbidity; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D008607:Intellectual Disability / Q000188:drug therapy* / Q000453:epidemiology / Q000523:psychology; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D016728:Self-Injurious Behavior / Q000188:drug therapy / Q000523:psychology; D017367:Selective Serotonin Reuptake Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use; D020280:Sertraline; D012720:Severity of Illness Index; D016896:Treatment Outcome
D015057:1-Naphthylamine; D017367:Selective Serotonin Reuptake Inhibitors; D020280:Sertraline