Pharmacological interventions for self-injurious behaviour in adults with intellectual disabilities: Abridged republication of a Cochrane systematic review

J Psychopharmacol. 2014 Jul;28(7):624-32. doi: 10.1177/0269881114531665. Epub 2014 Apr 30.

Abstract

We aimed to determine clinical effectiveness of pharmacological interventions for self-injurious behaviour in adults with intellectual disability. We searched the following databases: CENTRAL; MEDLINE; EMBASE; PsycINFO; CINAHL; SCI; SSCI; Conference Proceedings Citation Index - Science; Conference Proceedings Citation Index - Social Science and Humanities; ZETOC; World Cat .We also searched ClinicalTrials.gov,ICTRP and the reference lists of included trials. We included randomised controlled trials that examined drug interventions versus placebo for self-injurious behaviour. We found five double-blind, placebo-controlled trials, which included a total of 50 people. Four trials compared the effects of naltrexone versus placebo and one trial clomipramine versus placebo. We did not identify any relevant placebo-controlled trials for other drugs. We presented a narrative summary, as meta-analysis was not appropriate due to differences in study designs, differences between interventions and heterogeneous outcome measures. There was weak evidence in included trials that any active drug was more effective than placebo for people with intellectual disability demonstrating self-injurious behaviour. Due to sparse data, an absence of power and statistical significance, and high risk of bias for four of the included trials, we are unable to reach any definite conclusions about the relative benefits of naltrexone or clomipramine compared to placebo.

Keywords: Self-injurious behaviour; intellectual disability; pharmacological interventions.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Clomipramine / adverse effects
  • Clomipramine / therapeutic use*
  • Humans
  • Intellectual Disability / diagnosis
  • Intellectual Disability / epidemiology
  • Intellectual Disability / psychology*
  • Naltrexone / adverse effects
  • Naltrexone / therapeutic use*
  • Narcotic Antagonists / adverse effects
  • Narcotic Antagonists / therapeutic use*
  • Persons with Mental Disabilities / psychology*
  • Risk Factors
  • Selective Serotonin Reuptake Inhibitors / adverse effects
  • Selective Serotonin Reuptake Inhibitors / therapeutic use*
  • Self-Injurious Behavior / diagnosis
  • Self-Injurious Behavior / drug therapy*
  • Self-Injurious Behavior / epidemiology
  • Self-Injurious Behavior / psychology
  • Treatment Outcome

Substances

  • Narcotic Antagonists
  • Serotonin Uptake Inhibitors
  • Naltrexone
  • Clomipramine