Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-6bf8c574d5-86b6f Total loading time: 0 Render date: 2025-03-09T22:37:35.629Z Has data issue: false hasContentIssue false

44 - Other treatments for persistent disturbances of behaviour

from Part III - Specific treatments

Published online by Cambridge University Press:  12 May 2010

By
Peter Tyrer  and
Stephen Tyrer
Edited by
Peter Tyrer  and
Kenneth R. Silk
Peter Tyrer
Affiliation:
Imperial College London Claybrook Centre Charing Cross Campus London UK
Stephen Tyrer
Affiliation:
University of Northumbria Newcastle upon Tyne UK
Peter Tyrer
Affiliation:
Imperial College of Science, Technology and Medicine, London
Kenneth R. Silk
Affiliation:
University of Michigan, Ann Arbor
Get access

Summary

Editors' note

We were not sure where to place this chapter in this book. Persistent behavioural problems are a feature of many disorders and are discussed at length in the sections on organic disorders, alcohol and substance misuse, schizophrenia and child and adolescent psychiatry. Even when these are all taken into account, there remains a core of behavioural problems that goes beyond the specific diagnostic conditions concerned. These conditions or disorders are probably best considered in the same section as personality disorders as they are behaviours that either are persistent or almost seem to be a part of the person's repertoire. The preceding chapter is admirably comprehensive and covers all personality disorders in the official classification systems but it does not consider a group of interventions that is used frequently in psychiatry but not specifically for a particular diagnostic group, but for behaviour disturbance. A large number of interventions in this management area are for people with intellectual (learning) disability, a discipline which does not appear much elsewhere in this book, partly because, despite its importance, it has a relatively low base for evidence-based interventions.

Introduction

The treatment of persistent behavioural problems is usually lengthy, eventful and frustrating for both therapists and patients. Successful engagement requires commitment and perseverance, and although the therapist often hopes that any abnormal behaviour is a consequence of the disorder being treated by evidence-based therapies and should therefore improve pari passu with the other symptoms, all too often the behavioural difficulties persist independently.

Type
Chapter
Information
Cambridge Textbook of Effective Treatments in Psychiatry , pp. 682 - 690
Publisher: Cambridge University Press
Print publication year: 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Aarkrog, T. (1994). Borderline Adolescents 20 Years Later. Vojens: PJ Schmidt.
Ahmed, Z., Fraser, W., Kerr, M. P.et al. (2000). Reducing antipsychotic medication in people with a learning disability. British Journal of Psychiatry, 176, 42–6.Google Scholar
Alexander, R. & Cooray, S. (2003). Diagnosis of personality disorders in learning disability. British Journal of Psychiatry, 182 (Suppl. 44), S28–S31.Google Scholar
American Psychiatric Association (1994). The Diagnostic and Statistical Manual of Mental Disorders, 4th edn. Washington: American Psychiatric Association.
Jones, Bowden O., Iqbal, M. Z., Tyrer, P.et al. (2004). Prevalence of personality disorder in alcohol and drug services and associated co-morbidity. Addiction, 99, 1306–14.Google Scholar
Branford, D., Bhaumik, S. & Naik, (1998). Selective serotonin re-uptake inhibitors for the treatment of perseverative and maladaptive behaviours of people with intellectual disability. Journal of Intellectual Disability Research, 42, 301–6.Google Scholar
Browder, D. M., Bambara, L. M. & Belfiore, P. J. (1997). Using a person-centred approach in community-based institutions for adults with developmental disabilities. Journal of Behavioral Education, 7, 519–28.Google Scholar
Brylewski, J. & Duggan, L. (1999). Antipsychotic medication for challenging behaviour in people with intellectual disability: a systematic review of randomized controlled trials. Journal of Intellectual Disability Research, 43, 360–71.Google Scholar
Brylewski, J. & Duggan, L. (2004). Antipsychotic medication for challenging behaviour in people with learning disability Cochrane Database of Systematic Reviews, 3, CD000377. Oxford: Update Software Ltd.Google Scholar
Buitelaar, J. K., Gaag, R. J., Cohen-Kettenis, P. & Melman, C. T. M. (2001). A randomized controlled trial of risperidone in the treatment of aggression in hospitalized adolescents with subaverage cognitive abilities. Journal of Clinical Psychiatry, 62, 239–48.Google Scholar
Craft, M., Ismail, I. A., Krisnamurti, D.et al. (1987). Lithium in the treatment of aggression in mentally handicapped patients: a double-blind trial. British Journal of Psychiatry, 150, 685–9.Google Scholar
Deb, S., Clarke, D. & Unwin, G. (2006). Using Medication to Manage Behaviour Problems Among Adults with a Learning Disability: Quick Reference Guide. Birmingham: University of Birmingham.
Emerson, E., McGill, P. & Mansell, J. (1994). Severe Learning Disabilities and Challenging Behaviours – Designing High Quality Services. London: Chapman and Hall.
Emerson, E., Kiernan, C., Alborz, A.et al. (2001). The prevalence of challenging behaviors: a total population study. Research in Developmental Disabilities, 22, 77–93.Google Scholar
Fisher, W. W., Adelinis, J. D., Volkert, V. M., Keeney, K. M., Neidert, P. L. & Hovanetz, A. (2005). Assessing preferences for positive and negative reinforcement during treatment of destructive behavior with functional communication training. Research in Developmental Disabilities, 26, 153–68.Google Scholar
Gagiano, C., Read, S., Thorpe, L.et al. (2005). Short- and long-term efficacy and safety of risperidone in adults with disruptive behavior disorders. Psychopharmacology (Berlin), 179, 629–36.Google Scholar
Haddock, K. & Jones, R. S. (2006). Practitioner consensus in the use of cognitive behaviour therapy for individuals with a learning disability. Journal of Intellectual Disability, 10, 221–30.Google Scholar
Haessler, F., Glaser, T. & Beneke, L. J.et al. (2007). Zuclopenthixol in aggressive challenging behaviour in learning disability: discontinuation study. British Journal of Psychiatry, 190, 447–8.Google Scholar
Iwata, B. A., Dorsey, M. F., Slifer, K. J.et al. (1982). Toward a functional analysis of self injury. Analysis and Intervention in Developmental Disabilities, 2, 1–20.Google Scholar
Janowsky, D. S., Kraus, J. E., Barnhill, L. J.et al. (2003). Effects of topiramate on aggressive, self-injurious, and disruptive/destructive behaviors in the intellectually disabled: an open-label retrospective study. Journal of Clinical Psychopharmacology, 23, 500–4.Google Scholar
Janowsky, D. S., Shetty, M., Barnhill, L. J.et al. (2005). Serotonergic antidepressant effects on aggressive, self-injurious and destructive/disruptive behaviours in intellectually disabled adults: a retrospective, open-label, naturalistic trial. International Journal of Neuropsychopharmacology, 8, 37–48.Google Scholar
LaGrow, S. J. & Repp, A. C. (1984). Stereotypic responding: a review of intervention research. American Journal of Mental Deficiency Research, 88, 595–609.Google Scholar
O'Neill, R. E., Horner, R. H., Albin, R. W.et al. (1997). Functional Analysis of Problem Behavior: A Practical Assessment Guide, 2nd edn. Pacific Grove, CA: Brooks/Cole.
Oliver, P. C., Piachaud, J., Done, J.et al. (2002). Difficulties in conducting a randomised controlled trial of health service interventions in intellectual disability: implications for evidence-based practice. Journal of Intellectual Disability Research, 46, 340–5.Google Scholar
Peck Peterson, S. M., Caniglia, C., Royster, A. J.et al. (2005). Blending functional communication training and choice making to improve task engagement and decrease problem behaviour. Educational Psychology, 25, 257–74.Google Scholar
Petry, N. (2006). Contingency management treatments: a uniquely American approach, or perhaps even better suited for European drug abuse treatment? British Journal of Psychiatry, 189, 97–8.Google Scholar
Ranger, M., Barrett, B., Milosevska, K.et al. (2007). Nidotherapy in comorbid severe mental illness and personality disorder: a randomised controlled trial. British Journal of Psychiatry (submitted).Google Scholar
Rangecroft, M. E. H., Tyrer, S. P. & Berney, T. P. (1997). The use of seclusion and emergency medication in a hospital for people with learning disability. British Journal of Psychiatry, 170, 273–7.Google Scholar
Scotti, J. R., Evans, I. M., Meyer, L. H.et al. (1991). A meta-analysis of intervention research with problem behavior: treatment validity and standards of practice. American Journal on Mental Retardation, 93, 233–56.Google Scholar
Shogren, K. A., Faggella-Luby, M., Bae, S. J. & Wehmeyer, M. L. (2004). The effect of choice-making as an intervention for problem behavior: a meta-analysis. Journal of Positive Behavior Interventions, 6, 228–37.Google Scholar
Tasman, A., Riba, M. B. & Silk, K. R. (2000). The Doctor–Patient Relationship in Pharmacotherapy: Improving Treatment Effectiveness. New York: Guilford Press.
Taylor, J. L., Novaco, R. W., Gillmer, B. & Thorne, I. (2002). Cognitive-behavioural treatment of anger intensity among offenders with intellectual disabilities. Journal of Applied Research in Intellectual Disabilities, 15, 151–65.Google Scholar
Tyrer, P. (2006). Personality diatheses: a superior explanation than disorder. Psychological Medicine, (in press).Google Scholar
Tyrer, P. & Bajaj, P. (2005). Nidotherapy: making the environment do the therapeutic work. Advances in Psychiatric Treatment, 11, 232–8.Google Scholar
Tyrer, P. & Kramo, K. (2006). Nidotherapy in practice. Journal of Mental Health, 16, 117–31.Google Scholar
Tyrer, S. P., Walsh, A., Edwards, D. E.et al. (1984). Factors associated with a good response to lithium in aggressive mentally handicapped subjects. Progress in Neuropsychopharmacology and Biological Psychiatry, 8, 751–5.Google Scholar
Tyrer, S. P., Aronson, M. E. & Lauder, J. (1993). The effect of lithium on behavioural factors in aggressive mentally handicapped subjects. In Lithium in Medicine and Biology, ed. Birch, N. J., Padgham, C. & Hughes, M. S., pp. 119–25. Carnforth: Marius Press.
Tyrer, P., Mitchard, S., Methuen, C. & Ranger, M. (2003a). Treatment-rejecting and treatment-seeking personality disorders: Type R and Type S. Journal of Personality Disorders, 17, 265–70.Google Scholar
Tyrer, P., Sensky, T. & Mitchard, S. (2003b). The principles of nidotherapy in the treatment of persistent mental and personality disorders. Psychotherapy and Psychosomatics, 72, 350–6.Google Scholar
Tyrer, P., Oliver-Africano, P. C., Ahmed, Z.et al. (2007). Neuroleptics in the treatment of aggressive challenging behaviour for people with intellectual disabilities (NACHBID trial). Health Technol Ass (in press).Google Scholar
Borre, R., Vermote, R., Buttiens, M.et al. (1993). Risperidone as add-on therapy in behavioral disturbances in mental-retardation – a double-blind placebo-controlled cross-over study. Acta Psychiatrica Scandinavica, 87, 167–71.Google Scholar
Willner, P. (2005). The effectiveness of psychotherapeutic interventions for people with learning disabilities: a critical overview. Journal of Intellectual Disabilities Research, 49, 73–85.Google Scholar
Willner, P., Jones, J., Tams, R. & Green, G. (2002). A randomised controlled trial of the efficacy of a cognitive-behavioural anger management group for adults with learning disabilities. Journal of Applied Research in Intellectual Disabilities, 15, 224–35.Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×