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Unusual devastating self-injurious behaviour in a patient with a severe learning disability: treatment with citalopram

  • Peter Martin (a1) and Christoph Guth (a2)
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Physicians caring for people with severe learning disabilities are frequently faced with the problem of self-injurious behaviour, which often takes a chronic course. Among neurotransmitter systems the serotonergic system in particular is thought to be involved in the initiation and maintenance of self-injurious behaviour, and pharmacological treatment with serotonin enhancers or serotonin reuptake inhibitors has been shown to reduce impulsive aggressive behaviour.

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This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
References
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BJPsych Bulletin
  • ISSN: 0955-6036
  • EISSN: 1472-1473
  • URL: /core/journals/bjpsych-bulletin
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Unusual devastating self-injurious behaviour in a patient with a severe learning disability: treatment with citalopram

  • Peter Martin (a1) and Christoph Guth (a2)
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eLetters

Self-injurious behaviour (SIB) in a person with learning disabilities

Dr Dimitrios Paschos, SpR in Psychiatry of Learning Disabilities
29 April 2005

We were interested to read Martin and Guth’s case report (PsychiatricBulletin, March 2005, 29, 108-110) of self-injurious behaviour (SIB) in a person with learning disabilities (LD) successfully treated with Citalopram. Whilst this case report was clearly not intended to be a review, we were concerned that it may unwittingly support a narrowness of approach that the authors may not have intended. It has long been established that there are multiple factors associated with SIB (McClintock et al, 2003) including physical ill-health, mental illness, epilepsy and communication and sensory difficulties.

The relationship between behaviour, environment and neurochemistry isconstantly evolving and specific to each individual (Kalachnik et al., 1998). There are thus not likely to be any simple relationships between SIB, specific receptors, neurotransmitters and pharmacotherapy. SIB must be seen as the outcome of processes in which developmental, biological andpsychosocial factors interact. Another major ongoing problem is that of definition. Although widely used without clarification, the umbrella term of SIB encompasses behaviours with sometimes little in common (Rojahn, 1994).

Progress in treating SIB needs thus both integrated approaches and more consistent terminology than has been the case hitherto. Despite previous calls for the integration of behavioural, pharmacological and other approaches they still tend in practice to be used in parallel. However, in the UK the CPA offers a way forward to improve co-ordination of treatment for SIB. This should ensure that treatment is multimodal and offers the best chance to reduce the significant distress associated with SIB.

KALACHNIK, J. E., LEVETHAL, B. L., JAMES, D. H., SOVNER, R., KASTNER,T.A., WALSH, K., WEISBLATT, S.A. & KLITZKE, M.G. (1998) Guidelines forthe use of psychotropic medication. In Psychotropic Medication and Developmental Disabilities: The International Consensus Handbook (eds S. Reiss & M. G. Amin). Columbus, OH: Ohio State University.

MCCLINTOCK, K., HALL, S. & OLIVER, C. (2003) Risk markers associated with challenging behaviours in people with intellectual disabilities: a meta-analytic study. Journal of Intellectual Disability Research 47, 405-416.

ROJAHN, J. (1994) Epidemiology and Topographic Taxonomy of Self-Injurious Behaviour. In: Destructive Behaviour in Developmental disabilities: Diagnosis and Treatment. (eds Thompson, T. & Gray, D.B.)Sage Publications Inc., Thousand Oaks, California.
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