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

Physicians caring for people with severe learning disabilities are frequently faced with the problem of selfinjurious 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. We report the case of a youngman with a severe learning disability and unusually devastating self-injurious behaviour, who was successfully treated with citalopram after neuroleptic medication had failed to be effective. Self-injurious behaviour is one of the most common forms of destructive behaviour displayed by people with developmental disabilities (Collacott et al, 1998). Selfmutilation in such cases is difficult to treat and can become a lifelong problem (Griffin et al, 1984; Schroeder et al, 1986; Murphy et al, 1993). There has been much interest in the role of serotonin (5-hydroxytryptamine, 5-HT) in aggressive behaviour and impulse control disorders, and reduced indices of 5-HT function in individuals who display such behaviour traits have been found (Swann, 2003). A recent study confirmed the presumption that serotonin reuptake inhibitors (SSRIs) can reduce impulsive aggressive behaviour (e.g. Reist et al, 2003). The effectiveness of serotonin reuptake inhibitors in the treatment of maladaptive behaviour, aggression and self-injury has also been shown in people with learning disabilities (Branford et al, 1998; Davanzo et al, 1998). We report the case of a 30-year-old man with a severe learning disability and long-standing and unusually devastating self-biting behaviour which was successfully, reproducibly and enduringly treated with citalopram after antipsychotic drugs had failed to ameliorate the behaviour.