A case of phenobarbital exacerbation of a preexisting maladaptive behavior partially suppressed by chlorpromazine and misinterpreted as chlorpromazine efficacy

doi:10.1016/0891-4222(92)90012-U

Research in Developmental Disabilities

Volume 13, Issue 4, July–August 1992, Pages 381-392

https://doi.org/10.1016/0891-4222(92)90012-U Get rights and content

Abstract

An adult female with developmental disability was prescribed chlorpromazine for the target behaviors of aggression and self-injurious behavior (SIB), and she was prescribed phenobarbital for seizures. Upon a chlorpromazine minimal effective dose reduction, target behaviors increased and dosage was returned to prior levels with the conclusion that chlorpromazine was controlling the target behaviors. Upon subsequent reduction and discontinuation of phenobarbital, however, chlorpromazine was able to be reduced with no increase in target behaviors. Ten years of behavioral data are presented to support the hypothesis that phenobarbital was exacerbating maladaptive behaviors. Given tardive dyskinesia (TD), clinicians and interdisciplinary teams should remain alert to the following client profile: (1) prescribed phenobarbital (or primidote), (2) prescribed neuroleptics, especially at high dosages, to control maladaptive behaviors, (3) failure of neuroleptic gradual minimal effective dose attempts, and (4) possible presence of behavioral procedures, especially intrusive procedures, to control maladaptive behaviors. This profile should trigger a “red flag” as to the possibility of phenobarbital behavioral side effects or exacerbation of preexisting maladaptive behaviors.

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^∗: The authors would like to thank the following individuals for valuable advice and support: Sue Paquin, Human Services Technician Senior, Faribault Regional Center (FRC); Jeff Bauernfeind, Behavior Analyst, FRC; Shirley Jacobson, Human Services Technician Senior, FRC; Bill Saufferer, Administrator, FRC; Bill Combs, Unit Director, FRC; and Dave Campbell, Program Director, FRC.

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A case of phenobarbital exacerbation of a preexisting maladaptive behavior partially suppressed by chlorpromazine and misinterpreted as chlorpromazine efficacy

Abstract

Applied Research in Mental Retardation

Journal of the American Academy of Child Psychiatry

Applied Research in Mental Retardation

Reduction of polypharmacy in epileptic patients

Archives of Neurology

Discontinuation of antiepileptic medications in patients with developmental disability and diagnosis of epilepsy

American Journal on Mental Retardation

Tardive dyskinesia

Relationship of sedative-hypnotic response to self-injurious behavior and stereotypy by mentally retarded clients

American Journal of Mental Dificiency

Anticonvulsant serum levels are useful only if the physician appropriately uses them: An assessment of the impact of providing serum level data to phy sicians

Epilepsia

Monitoring and evaluating psychotropic drug use for persons with mental retardation: A follow-up report

American Journal of Mental Retardation

Drug therapy reviews: Clinical pharmacology of antiepileptic drugs

American Journal of Hospital Pharmacy

Psychotropic medication of mentally retarded residents in community long-term care facilities

American Journal of Mental Deficiency

Withdrawal of anticonvulsant drugs in patients free of seizures for two years

New England Journal of Medicine

Newly treated childhood epilepsy: A prospective study of recurrences and side effects

Neurology

Therapeutic drug monitoring of anticonvulsants. State of the art

Clinical Pharmacokinetics

Clinical and therapeutic monitoring of epilepsy in a mental handicap unit

British Journal of Psychiatry

Package insert for chlorpromazine hydrochloride syrup, USP oral solution (concentrate) tablets, USP

A method of quantification for the evaluation of antiepileptic drug therapy

Neurology

Prescribing in a hospital for the mentally retarded

Journal of Mental Deficiency Research

Children on medication

Epilepsy

Effects of antiepileptic drugs and seizure type on operant responding in mentally retarded persons

Epilepsia