Pharmacotherapy for self-injurious behavior: Preliminary tests of the D1 hypothesis

Abstract

Gualtieri C. Thomas and Stephen R. Schroeder: Pharmacotherapy for Self-Injurious Behavior: Preliminary Tests of the D1 Hypothesis. Prog. Neuro-Psychopharmacol. & Biol. Psychiat. 1990, 14 (Supple.): S81–S107. 1. 1. The D1 dopamine hypersensitivlty model of self-injurious behavior leads to a testable clinical hypothesis: that the mixed D1/D2 dopamine antagonist fluphenazine may improve the symptoms of self-injurious patients. 2. 2. The hypothesis was tested in an open pilot trial in six patients and a partially controlled trial in nine patients. 3. 3. Some degree of clinical improvement was observed in eleven of the fifteen. 4. 4. The trials represent a partial affirmation of the D1 hypothesis. However, it is also clear that conventional methodology for psychopharmacologic research is inappropriate for the proper clinical evaluation of self-injurious patients. The proper method should include the following elements: i) An epidemiologically representative sample 4.1. ii) A naturalistic study environment 4.2. iii) A longitudinal design with long-term follow-up 4.3. iv) Concurrent behavioral ratings using direct observations and a reliable, treatment-sensitive rating scale. 5. 5. Before subjects enter a clinical trial of an experimental medication, a neuropsychiatric differential diagnosis should be applied to limit the diversity of the sample.