KU study shows drug for schizophrenics may also help treat self-injuring people

LAWRENCE -- A drug that's approved for use with schizophrenics may also help children and adults who suffer from outbursts of violence or mutilate themselves. In a University of Kansas study, the drug, risperidone, reduced aggressive and self-injuring behavior by 50 percent in half of those who took it.

Twenty people participated in the study.

In all the other subjects but one, the problems were reduced by at least 25 percent, the KU researchers report in the November issue of the American Journal on Mental Retardation. The doses of risperidone the people in the trial took were low. An earlier and smaller trial in Scandinavia used higher doses than the KU trial, in tandem with other drugs.

"We are feeling pretty confident that even at low doses, risperidone can be effective in severe cases," said Steve Schroeder, who heads the KU Center on Disabilities and was the study's lead investigator.

Jessica Hellings, associate professor of psychiatry at KU Medical Center, and Jennifer Zarcone, a KU research assistant professor and psychologist, teamed with Schroeder. The results compare favorably with the effects of Haldol and Thorazine, which are often used to treat these problematic behaviors, said Schroeder.

Thorazine shows good effect in only about 10 percent of these cases, he said, and the side effects -- including uncontrollable tremors -- are worse. Weight gain appears so far to be the most common side effect for those who take risperidone, Hellings said.

Among the 20 subjects in the KU test of risperidone was a violent 13-year-old boy who threw a screaming tantrum and then punched his mother in the aisle of a grocery store when she wouldn't let him buy a doughnut. He benefited from treatment, Zarcone said, as did a 16-year-old girl who chewed her hand and wrist so badly that they looked, her mother said, like "hamburger." An adult with severe mental retardation also benefited. He had repeatedly banged his head with such force that he tore an opening in his scalp that required stitches, Hellings said. Once back home, he banged his head hard enough to reopen the wound, requiring a return to the hospital.

Those who entered the study stopped taking virtually all other medications. During different phases of the study, they sometimes received liquid risperidone and sometimes a placebo. Neither those administering the drugs nor the patients knew whether study participants were receiving the drug or the placebo.

Finally, the researchers compared the behavior of the patients when they were on and off the medication.

Since the original study, 30 more patients with these symptoms have entered the program, Schroeder said.

All 50 are highly difficult cases, say Schroeder and Hellings. Many had multiple diagnoses and were taking several drugs to regulate their behavior.

Risperidone appears to work by blocking the action of two brain chemicals important to mood regulation: serotonin and dopamine. Risperidone blocks sites on nerve cells that these brain chemicals normally occupy, Hellings said. Still, with about 100 brain chemicals, or neurotransmitters, now identified, Hellings believes that that's a coarse picture of the brain chemistry behind these behavior eruptions. She thinks it will take at least five to 10 years to determine more precisely the sequence of chemical events involved in aggressive and self-mutilating behavior. The National Institute of Child Health and Human Development provided funding of $1.25 million to support the study.

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