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Koyuncu Z, Ozdemir M, Karacetin G, Erdogan A
Aripiprazole and chlorpromazine combination in childhood self-mutilation: two case reports
Medications have an important role in the treatment self-mutilation, which is a common admission complaint to the child psychiatry clinics. Aripiprazole is a partial dopamine agonist, which is approved by FDA for the treatment of schizophrenia, bipolar I disorder and aggressive behavior in autism in children and adolescents. A8-year-old-girl, was admitted to the outpatient clinic of Bakirkoy Research and Training Hospital for Psychiatry, Neurology and Neurosurgery by her mother with complaints of self-mutilation such as hitting head to the wall and hitting to her face by her hand. She was interned to the inpatient clinic for diagnoses and treatment. Her mother stated that these behaviors had started 3 years ago and increased progressively. Her mother was binding her hands by arope to prevent self-mutilation. She was diagnosed as autism spectrum disorder, when she was 5 years of age and epilepsy at the age of 2 years. Her weight was 19 kg. She had oxcarbamazepine 150 mg/day, valproic acid 15 mg/day, risperidone 1.5 mg/day, and mirtazapine 15 mg/day for 2 years but did not have recovery. Her treatment was changed to valproic acid 250 mg/day, aripiprazole 2.5 mg/day and chlorpromazine 100 mg/day. Aripiprazole dose was increased by 2.5mg in every two days with a maintenance dose of 15 mg/day and valproic acid was increased to 500 mg/day in 12 days. Her self- mutilation had declined significantly by the second week of the treatment. Second case is a 5-year-old-girl, who had a weight of 12 kg. She was admitted to the same clinic as the previous patient by her father and grandmother with the same complaints that is hitting head to the wall and slapping her face by her hands. She was returned to the inpatient clinic for diagnoses and treatment. She had been mutilating herself for 2 months. She was also tied up by rope, night and day. She was born premature and diagnosed as severe developmental delay 2 years ago. Firstly, she had poor eye contact and social interaction, but her eye contact, pointing, use of gestures and facial expressions and responding to name was increased by interaction with hospital staff. She was diagnosed as reactive attachment disorder. She did not respond to risperidone 3 mg/day and haloperidol 5mg/day. Her treatment was changed to valproic acid 120 mg/day, chlorpromazine 100mg/day, and aripiprazole 2 mg/day. Aripiprazole dose was increased to 6 mg/day by increasing 2 mg in every two days. Valproic acid dose was increased to 200mg/day in the second day and chlorpromazine dose was increased to 150 mg/day on the 19th day of the treatment. Valproic acid was stopped and topiramate 15 mg/day was added on the 22nd of the treatment. Topiramate dose was increased to 25 mg/day 7 days later and then increased to 50 mg/day 7 days later. Self-mutilation disappeared by the third week of the therapy. Our two cases provide evidence for effectiveness of aripiprazole in children and adolescent with self-mutilation