Verhoeven W M, Tuinier S, van den Berg Y W, Coppus A M, Fekkes D, Pepplinkhuizen L, Thijssen J H
Vincent van Gogh Institute for Psychiatry, Venray, The Netherlands.
Pharmacopsychiatry. 1999 Jan;32(1):13-20. doi: 10.1055/s-2007-979183.
Self-injurious behavior (SIB) and stereotyped behavior (SB) are major challenges for professionals in the field of mental retardation. From animal experiments it has become obvious that these behavioral disturbances are not purposeless but may emerge secondary to restrictive environment and may serve de-arousing objectives. In mentally retarded subjects, several hypotheses have been formulated concerning the pathogenesis of SIB, particularly about the involvement of serotonin and beta-endorphin, which are supported by beneficial treatment effects of the opiate antagonist naltrexone and serotonin modulating compounds, respectively. The present study was designed to investigate basal levels of stress-hormonal and serotonergic parameters as well as plasma levels of amino-acids and the beta-carboline norharman in a group of 64 mentally retarded subjects with SB and/or SIB. Allocation to three different groups comprising 17 retarded controls, 26 subjects with mainly SIB and 21 subjects with mainly SB, was originally performed using the scores on the factors Irritability, Stereotypic Behaviour and Hyperactivity of the Aberrant Behavioral Checklist. Because of the overlapping nature of the behavioral parameters, subjects were subsequently divided into three maximally contrasting groups, viz. predominantly SIB, predominantly SB and retarded controls, each comprising 11 subjects. With respect to beta-endorphin, no differences were found either between both the original and maximally contrasting groups or in comparison to nonretarded controls. As compared to retarded controls, a tendency to lower values for total cortisol and cortisol binding globulin appeared to be present in the SIB group, whereas in the SB group a tendency toward higher levels of the major serotonin metabolite 5-HIAA was found. In the contrasting SB group, a trend toward decreased total cortisol level was observed as compared to the retarded control group. In addition, significantly lower values for norharman and tryptophan were demonstrated in the total group of mentally retarded subjects as compared to non-retarded controls. The results of the present study, yielding co-existent disturbances in stress-hormonal and monoaminergic mechanisms as well as in the metabolism of norharman, are in line with the hypothesis that mentally retarded subjects are at risk for the development of stress-related behavioral disorders such as SIB and SB.
自伤行为（SIB）和刻板行为（SB）是智力障碍领域专业人员面临的主要挑战。从动物实验中可以明显看出，这些行为障碍并非毫无目的，而是可能继发于受限环境，并可能服务于去唤醒目标。在智力障碍患者中，已经提出了几种关于SIB发病机制的假说，特别是关于血清素和β-内啡肽的参与，分别得到了阿片拮抗剂纳曲酮和血清素调节化合物有益治疗效果的支持。本研究旨在调查64名患有SB和/或SIB的智力障碍患者的应激激素和血清素能参数的基础水平，以及血浆氨基酸和β-咔啉去甲哈尔满的水平。最初根据异常行为检查表的易怒、刻板行为和多动因素得分，将其分为三个不同的组，包括17名智力障碍对照组、26名主要患有SIB的患者和21名主要患有SB的患者。由于行为参数的重叠性质，随后将受试者分为三个最大程度对比的组：主要为SIB组、主要为SB组和智力障碍对照组，每组各11名受试者。关于β-内啡肽，在原始组和最大程度对比组之间以及与非智力障碍对照组相比均未发现差异。与智力障碍对照组相比，SIB组总皮质醇和皮质醇结合球蛋白的值有降低的趋势，而在SB组中发现主要血清素代谢物5-羟吲哚乙酸水平有升高的趋势。在对比的SB组中，与智力障碍对照组相比，观察到总皮质醇水平有下降的趋势。此外，与非智力障碍对照组相比，智力障碍患者总体组中的去甲哈尔满和色氨酸值显著较低。本研究结果显示应激激素和单胺能机制以及去甲哈尔满代谢存在共同紊乱，这与智力障碍患者有发展为与应激相关的行为障碍如SIB和SB的风险这一假说相符。
