Drugs Offer No Benefit in Curbing Aggression, Study Finds

From the New York Times

Drugs Offer No Benefit in Curbing Aggression, Study Finds

By Benedict Carey

Published: January 4, 2008

The drugs most widely used to manage aggressive outbursts in intellectually disabled people are no more effective than placebos for most patients and may be less so, researchers report.

The finding, being published Friday, sharply challenges standard medical practice in mental health clinics and nursing homes in the United States and around the
world."

the article continues:

In the study, Dr. Peter J. Tyrer, a professor of psychiatry at Imperial College London, led a research team who assigned 86 people from ages 18 to 65 to one of three groups: one that received Risperdal; one that received another antipsychotic, the generic form of Haldol; and one that was given a placebo pill. Caregivers tracked the participants’ behavior. Many people with very low I.Q.’s are quick to anger and lash out at others, bang their heads or fists into the wall in frustration, or singe the air with obscenities when annoyed.

After a month, people in all three groups had settled down, losing their temper less often and causing less damage when they did. Yet unexpectedly, those in the placebo group improved the most, significantly more so than those on medication.

In an interview, Dr. Tyrer said there was no reason to believe that any other antipsychotic drug used for aggression, like Zyprexa from Eli Lilly or Seroquel from AstraZeneca, would be more effective. Being in the study, with all the extra attention it brought, was itself what apparently made the difference, he said. “These people tend to get so little company normally,” Dr. Tyrer said. “They’re neglected, they tend to be pushed into the background, and this extra attention has a much bigger
effect on them that it would on a person of more normal intelligence level.”

In my experience as a direct care giver and medication aide working with men and women with developmental disabilities, administering antipsychotic medication for those who exhibited aggressive behavior was very much the norm. Behavioral management techniques were attempted, though sometimes more half-heartedly than others, depending on the agencies I worked for. However, in almost all individuals displaying aggression, medication was the preferred method of managing behaviors.

I very much agree with part Dr. Tyler's statement about the people in this study getting so little company normally, that they are neglected and tend to be pushed into the background, and the extra attention from being in this study has a big effect on them. (Though I don't, as he does, believe it necessarily has anything to do with their low intelligence. This kind of attention would have a big effect on anyone.)

I'm not surprised that those who received the placebo had better outcomes than those who received the real medication. Antipsychotic drugs are powerful. They make one's head cloudy and can alter a person's reasoning skills which makes other behavior management techniques such as verbal prompts and positive reinforcement very difficult.

I'm not discounting drugs for those who truly need them, and indeed there are people with developmental disabilities who also have various mental illnesses, including psychosis, who do benefit from these kinds of drugs. But giving someone in one's care uneccesary medical treatment is called abuse.