title: [Treatment for self-injurious behavior in mentally handicapped populations--a report from our practice].
abstract: OBJECTIVE
  Self-injurious behavior (SIB) is a common problem in individuals with intellectual disabilities, yet its clinical management remains to be established. We aimed to clarify the background factors and profiles of SIB in mentally and physically handicapped subjects and subsequently examined the efficacy of treatments attempted in our practice in order to achieve a better understanding of SIB and appro- priate interventions in these populations.
  
  
  METHODS
  We surveyed 92 mentally handicapped subjects with SIB (including 25 females and 67 males, most of whom also had physical disabilities) as outpatients or inpatients of our institution using a retrospective questionnaire com- pleted by the corresponding doctors.
  
  
  RESULTS
  Regarding psychobehavioral complications, impulsive mood swings (such as sudden rage) were more frequent than other behaviors. As to probable triggers of SIB, the patient's physical condition (17 cases) and noise or the temperature of the surrounding environment (38 cases) were identified. A total of 81 of 92 patients were given a prescription for SIB. Risperidone was the most commonly prescribed drug (75 cases), found to be effective in 38 (50.6%) cases, whereas phenothiazine antipsychotics were often more effective in patients with profound SIB. SSRIs (selective serotonin reuptake inhibitors) were applied in 20 cases, being effective in only five (25%) patients and discontinued in 11 (55%) patients due to the onset of several side effects, including overexcitement. As an additional agent for mood control, the antiepileptic topiramate was effective in 10 (76.9%) of 13 cases. Aside from medication, equipment for elbow extension was beneficial in some of the patients with profound SIB.
  
  
  CONCLUSIONS
  Pharmacological intervention is sometimes beneficial, albeit only partly. Clinicians must therefore also consider triggers and factors in the surrounding environment for the development of SIB in mentally handicapped individuals.
authors.forename: Ikumi
authors.initials: I
authors.lastname: Kimura
authors.forename: Hiroya
authors.initials: H
authors.lastname: Nishida
authors.forename: Naoto
authors.initials: N
authors.lastname: Yamaguchi
authors.forename: Mika
authors.initials: M
authors.lastname: Nagase
authors.forename: Junko
authors.initials: J
authors.lastname: Ohinata
authors.forename: Naoko
authors.initials: N
authors.lastname: Ishikawa
authors.forename: Michiko
authors.initials: M
authors.lastname: Kita
authors.forename: Katsutoshi
authors.initials: K
authors.lastname: Nakatani
authors.forename: Akira
authors.initials: A
authors.lastname: Yoneyama
authors.forename: Eiji
authors.initials: E
authors.lastname: Kitazumi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D014150:Antipsychotic Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003142:Communication; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019989:Persons with Intellectual Disabilities; D016728:Self-Injurious Behavior / Q000628:therapy*; D011795:Surveys and Questionnaires; D055815:Young Adult
chemical_list: D014150:Antipsychotic Agents