Repetitive Behavior Disorders in People With Severe Mental Retardation

Abnormal repetitive behaviors (odd or inappropriate movements, self-injury, and compulsions)
are among the aberrant behaviors exhibited by individuals with mental retardation. However,
little is known about their pathobiology and treatments are largely unconfirmed by
controlled trials. For example, few controlled studies have examined the efficacy of
pharmacological treatment of abnormal repetitive behavior in individuals with mental
retardation.

This trial is part of a larger project designed to elucidate the neurobiological bases of
repetitive behavior disorders and to develop rational, safe, and effective pharmacological
treatments. Thus far, the project has established a pathophysiological basis for stereotyped
behavior disorder, demonstrated the role of central dopamine deficiency in stereotyped
behavior disorder, and provided evidence of the efficacy of both 5-HT uptake inhibitors and
atypical antipsychotics in treating stereotyped behaviors.

There is currently little information to guide the clinician in deciding which drug class
may be more effective for which abnormal repetitive behaviors and for which individuals.
Moreover, little work has attempted to identify variables that may predict differential
treatment response. This trial will assess the relative efficacy of an SSRI and an atypical
antipsychotic across multiple categories of abnormal repetitive behaviors.

Inclusion Criteria

- Mental retardation

- Medically stable resident of either Western Carolina Center, Morganton, NC or
Tacachale Community, Gainesville, FL

- Free of sensory deficits

- Ambulatory

- High rate of stereotyped behavior that may co-occur with self-injurious or compulsive
behaviors

Exclusion Criteria

- Poor general health

- Cardiac, hepatic, or renal abnormalities

- Seizure within 4 months prior to study entry (patients on seizure medication who have
not had a seizure within 4 months prior to study entry may participate)

- Tardive dyskinesia

- Akathisia

- Neuroleptic use within 6 months of study entry

- History of sensitivity to ergot alkaloids

- Hypertension