title: The treatment of cyclical behavioral changes in women with mental disabilities.
abstract: OBJECTIVE
  This study aims to evaluate the frequency of occurrence of cyclical behavioral changes in women with mental retardation, as well as the effectiveness of several treatment modalities for this type of behavior.
  
  
  METHODS
  Retrospective chart analysis.
  
  
  METHODS
  University of Michigan clinic for reproductive healthcare of women with mental disabilities.
  
  
  METHODS
  All clinic patients of reproductive age, presenting with cyclical behavioral changes in our clinic from November 1985 to October 1992.
  
  
  METHODS
  Medical treatment of cyclical behavioral changes.
  
  
  METHODS
  Presence and documentation of cyclical behavioral changes, level of retardation, type of behavior, treatment modalities and results.
  
  
  RESULTS
  Ninety-three of 522 reproductive-age patients (18%) presented with cyclical behavioral changes. Good documentation with behavior charts was present in 46% of these records. Level of retardation among the women included: 57 (61%) severely, 12 (13%) moderately, and 1 (1%) mildly retarded. No level of retardation could be detected in 23 (25%) women. Aggressive behavior was noted in 35 (38%) women, self-mutilation in 20 (22%) a combination of both in 10 (10%) and other behavior in 28 (28%) women. Primary treatment was by physician preference. Of 46 patients who received nonsteroidal antiinflammatory drugs (NSAID), 30 (65%) showed improvement, 10 (21%) showed no improvement, and 2 patients (4%) showed worsening symptoms. Birth control pills were used in 15 patients; there were signs of improvement in 6 (40%), no improvement in 3 (20%), and worsening in 3 (20%). The use of depomedroxyprogesterone injections was successful in treating 6 of 9 patients (66%), and showed no improvement in 2 women. No statistically significant differences were found between these treatment modalities.
  
  
  CONCLUSIONS
  Cyclical behavioral changes in women with mental retardation is a common problem (18%) and may be related to pain- possibly due to menstrual cramps, since 65% of the patients responded to NSAID. If treatment with NSAID is unsuccessful, birth control pills and depomedroxyprogesterone improved behavior in 40% to 66% of patients. Documentation is a key issue.
authors.affiliation: Department of Obstetrics and Gynecology, University of Michigan Health System, Ann Arbor 48109-0276, USA.
authors.forename: E H
authors.initials: EH
authors.lastname: Quint
authors.forename: T E
authors.initials: TE
authors.lastname: Elkins
authors.forename: C A
authors.initials: CA
authors.lastname: Sorg
authors.forename: S
authors.initials: S
authors.lastname: Kope
mesh_terms: D000293:Adolescent; D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D005260:Female; D006801:Humans; D015994:Incidence; D008607:Intellectual Disability / Q000150:complications* / Q000523:psychology; D008598:Menstruation / Q000523:psychology; D011293:Premenstrual Syndrome / Q000188:drug therapy / Q000453:epidemiology / Q000523:psychology*; D012189:Retrospective Studies
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal