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  • Title: Pharmacotherapy for self-injurious behavior: preliminary tests of the D1 hypothesis.
    Author: Gualtieri CT, Schroeder SR.
    Journal: Psychopharmacol Bull; 1989; 25(3):364-71. PubMed ID: 2626514.
    Abstract:
    The D1 dopamine hypersensitivity model of self-injurious behavior leads to a testable clinical hypothesis: the mixed D1/D2 dopamine antagonist fluphenazine may improve the symptoms of self-injurious patients. The hypothesis was tested in an open pilot trial in six patients and a partially controlled trial in nine patients. Some degree of clinical improvement was observed in 11 of the 15 patients. 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: 1. An epidemiologically representative sample. 2. A naturalistic study environment. 3. A longitudinal design with long-term follow up. 4. Concurrent behavioral ratings using direct observations and a reliable, treatment-sensitive rating scale. Before subjects enter a clinical trial of an experimental medication, a neuropsychiatric differential diagnosis should be applied to limit the diversity of the sample.
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