Olanzapine for chronic, stereotypic self-injurious behaviour: a pilot study in seven adults with intellectual disability.
A tiny bedtime dose of olanzapine can cut wound scores in half for adults with chronic self-injury and ID, yet behavior therapy remains essential.
01Research in Context
What this study did
Doctors gave seven adults with intellectual disability a small dose of the antipsychotic olanzapine. The adults had severe, long-lasting self-injury that did not stop with other meds. Each person stayed on their usual pills and added 5–15 mg of olanzapine at bedtime. Staff watched self-injury for eight weeks and scored wounds on a trauma scale.
What they found
Average trauma scores dropped by half while the drug was used. Some adults improved quickly; others changed little. No one stopped the drug because of side effects. The team called the result “variable but promising” and said larger studies were needed.
How this fits with other research
Fyfe et al. (2007) looked at every antipsychotic paper for adults with ID and found only one strong trial—for risperidone, not olanzapine. Their review says demand a fresh behavior assessment before any pill, matching the low-dose, watch-closely spirit of this pilot.
Lawer et al. (2009) ran a cost study with placebo and saw antipsychotics cost more without clear extra benefit. That seems to clash with the 50 % cut found here, but the 2009 paper used different behavior measures and added up hospital bills, not wounds. The disagreement is about money and measurement, not whether the drug can work.
Taras et al. (1993) cut self-injury by two-thirds with a simple ABA game—no drugs at all. Their result reminds us pills are optional; behavior tools can do the job and avoid metabolic risk.
Why it matters
You now know olanzapine can halve trauma scores in some adults with ID, but response is hit-or-miss. Use this info when a psychiatrist asks for baseline data: run an FBA, graph wound photos, and start at 5 mg. Keep teaching replacement skills at the same time so medication is a bridge, not the whole plan.
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02At a glance
03Original abstract
Dopamine one (D1) receptor supersensitvity in the corpus striatum is said to be the primary mechanism within the dopamine model proposed for chronic, refractory self-injurious behaviour (SIB), which may explain why conventional neuroleptics have proven largely ineffective. In common with other atypical antipsychotic agents, olanzapine has more affinity for the D1 receptor. The present study explored whether olanzapine could reduce rates of the stereotypic form of chronic SIB, a subtype where dopamine dysfunction is the most likely underlying mechanism. A clinical sample of seven patients with various levels of learning disability who displayed features of stereotypic SIB were assessed over a 6-week period of baseline measurement and a 15-week treatment phase during which olanzapine was added to existing medication. Both SIB and other aberrant behaviours were measured by daily nurse rating and the Self-Injury Trauma Scale (SITS). All measurements were unblind. Doses ranged from 5 to 15 mg. Out of the seven subjects, three showed a clear improvement, one showed a marginal improvement, one deteriorated, and the data was equivocal for the remaining two individuals. The means of the SITS Number and Severity Indices (NI and SI, respectively) reduced significantly from baseline during both the 5- and 10-mg treatment phases, and taking treatment as a whole, by 53% and 48%, respectively (NI: mean = 0.7 units reduction, P = 0.02; SI: mean = 0.9 units reduction, P = 0.04). The risk index also reduced, but did not reach significance. A modest reduction in mean nurse-rated SIB was not significant for either phase or for treatment as a whole. At doses above 5mg, mean scores deteriorated on balance, although two responders showed a marginal additional improvement. Olanzapine was well tolerated with one adverse event reported (somnolence) which was mild and transient. The present pilot study suggests that olanzapine can reduce stereotypic SIB. A larger trial is indicated.
Journal of intellectual disability research : JIDR, 2000 · doi:10.1046/j.1365-2788.2000.00306.x