Effects of Zuclopenthixol on Aggressive Disruptive Behavior in Adults with Mental Retardation – A 2-Year Follow-Up on a Withdrawal Study

Abstract

Introduction:

People with mental retardation often display aggressive behavior against themselves or others making care within institutions or foster families difficult. Due to a lack of viable alternatives, antipsychotics of the first and second generations are often used for long-term treatment despite the fact that only data about short-term treatment exist.

Methods:

A short-time withdrawal trial of 12 weeks (n=39) was extended at open label to 2 years. 31 patients received zuclopenthixol after the end of the withdrawal and were examined using the same instruments as in the withdrawal period (DAS, MOAS, CGI).

Results:

Patients still treated with zuclopenthixol after 2 years (n=21) benefitted, compared to the drop-outs (n=10). Analyses of time trends revealed an early effect of zuclopenthixol which could not be enhanced afterwards.

Discussion:

Zuclopenthixol proved to be safe and effective to keep a lower rate of aggressive behavior in adults with mental retardation also over a longer period of time.

Key words

mental retardation - aggression - zuclopenthixol - long-term results

• References

• 1 Ballinger BR, Ballinger CB, Reid AH et al. The psychiatric symptoms, diagnosis and care need of 100 mentally handicapped patients. Br J Psychiatry 1991; 158: 251-254
• 2 Meins W. How should mentally handicapped adults with depressive disorders be treated psychopharmacologically?. Nervenarzt 1996; 67: 216-218
• 3 Oliver C, Petty J. Self-injurious behavior in people with intellectual disability. Curr Opin Psychiaty 2002; 15: 477-481
• 4 Aman MG, Crismon ML, Frances A, ^{et al.} (eds.) Treatment of psychiatric and behavioral problems in individuals with mental retardation: An update of the Expert Consensus Guidelines. 2004. Englewood, CO: Postgraduate Institute for Medicine;
• 5 Singh I, Owino WJ. A douple-blind comparison of zuclopenthixol tablets with placebo in the treatment of mentally handicapped inpatients with associated behavioral problems. J Intellect Disabil Res 1992; 23: 541-549
• 6 Baumeister AA, Todd ME, Sevin JA. Efficacy and specificity of pharmacological therapies for behavioral disorders in persons with mental retardation. Clin Neuropharmacol 1993; 16: 271-294
• 7 Malt UF, Nystad R, Bache T et al. Efficacy of zuclopenthixol in comparison to haloperidol in the treatment of mentally retarded with behavior disorders. Br J Psychiat 1995; 166: 374-377
• 8 Izmeth M, Khan SY, Kumarjee DI et al. Zuclopenthixol decanoate in the management of behavioral disorders in mentally handicapped patients. Pharmacotherapeutica 1998; 5: 217-227
• 9 Haessler F. Psychopharmacotherapy in mentally retarded adults. Psychopharmakotherapie 1998; 5: 76-80
• 10 Haessler F, Buchmann J, Bohne S. Möglichkeiten und Grenzen der Behandlung aggressiven Verhaltens bei Menschen mit geistiger Behinderung mit Risperidon. Nervenarzt 2002; 73: 278-282
• 11 Haessler F, Glaser T, Beneke M et al. Zuclopenthixol in adults with intellectual disabilities and aggressive behaviors. Br J Psychiatry 2007; 190: 447-448
• 12 Haessler F, Glaser T, Pap AE et al. A double-blind placebo-controlled discontinuation study of Zuclopenthixol for the treatment of aggressive disruptive behaviors in adults with mental retardation – secondary parameter analyses. Pharmacopsychiatry 2008; 41: 232-239
• 13 Tyrer P, Oliver-Africana PC, Ahemd Z et al. Risperidone, haloperidol, and placebo with intellectual disability: a randomised controlled trial. Lancet 2008; 371: 57-63
• 14 Ruedrich SL, Swales TP, Rossvanes C et al. Atypical antipsychotic medication improves aggression, but not self-injurious behavior, in adults with intellectual disabilities. J Intellectual Disability Res 2007; 52: 132-140
• 15 Janowsky DS, Barnhill LJ, Davis JM. Olanzapine for self-injurious, aggressive, and disruptive behaviors in intellectually disable adults: a retrospective, open-label, naturalistic trial. J Clin Psychiatry 2003; 64: 1258-1265
• 16 Haessler F, Reis O. Pharmacotherapy of disruptive behavior in mentally retarded subjects: A review of the current literature. Dev Disabil Res Rev 2010; 16: 265-272
• 17 Deb S, Sohanpal SK, Soni R et al. The effectiveness of antipsychotic medication in the management of behavior problems in adults with intellectual disabilities. J Intellect Disabil Res 2007; 51: 766-777
• 18 Engel C, Szrama E, Hässler F. Psychopharmacological therapy in mental retardation – comparison of the years 1991 and 2005. Psychiatr Prax 2010; 37: 391
• 19 Croonenberghs J, Fegert JM, Findling RL et al., Risperidone study group . Risperidone in children with disruptive behavior disorders and subaverage intelligence: a 1-year, open-label study of 504 patients. J Am Acad Child Adolesc Psychiatry 2005; 44: 64-72
• 20 Coccaro EF, Harvey PD, Kupsaw-Lawrence E et al. Development of neuropharmacologically based behavioral assessments of impulsive aggressive behavior. J Neuropsychiat Clin Neurosci 1991; 3: 44-55
• 21 Cohen L, Tsiouris J, Flory MJ et al. A large scale study of the psychometric characteristics of the IBR modified overt aggression scale: Findings and evidence for increased self-destructive behavors in adult females with autism spectrum disorder. J Autism Dev Disord 2010; 40: 599-609
• 22 Holmes N, Shah A, Wing L. The disability assessment schedule: a brief screening device for use with mentally retarded. Psychol Med 1982; 12: 879-890
• 23 Tsakanikos E, Underwood L, Sturmey P et al. Psychometric properties of the disability assessment schedule (DAS) for behavior problems: an independent investigation. Res Dev Disabilities 2011; 32: 653-658
• 24 Ascher-Svanum H, Nyhuis AW, Faries DE et al. Clinical, functional, and economic ramifications of early nonresponse to antipsychotics in the naturalistic treatment of schizophrenia. Schizophr Bull 2008; 34: 1163-1171