SELF-INJURIOUS-BEHAVIOR - PATHOPHYSIOLOGY AND IMPLICATIONS FOR TREATMENT

Background: Self-injurious behavior (SIE) is a common clinical problem that affects a diverse group of patients and populations, Little is k nown about the underlying pathophysiology and pharmacologic treatment of SIE. Method: The authors selectively reviewed the clinical literatu re on SIE and related aggressive/impulsive behaviors, with the aim of formulating provisional guidelines far pharmacotherapy. Results: The s erotonergic system is most directly implicated in the pathophysiology of SIE and related behaviors. While there is no well-established ''dru g of choice'' for SIE, the identification of specific subgroups of SIE patients and associated symptoms such as psychosis permits the ration al selection of medication, Serotonin selective reuptake inhibitors, o ther serotonergic agents, antipsychotics, beta-blockers, and opiate an tagonists all play a role in the treatment of SIE. Conclusion: SIE is not a single entity and may have different pharmacologic treatments, d epending on the associated symptoms and target population. Medications that act on the serotonergic system appear to be the most promising.