The treatment of cyclical behavioral changes in women with mental disabilities

Study Objective: This study aims to evaluate the frequency of occurrence of cyclical behavioral changes in women with mental retardation, as well as the effectiveness of several treatment modalities for this type of behavior. Design: Retrospective chart analysis. Setting: University of Michigan clinic for reproductive healthcare of women with mental disabilities. Participants: All clinic patients of reproductive age, presenting with cyclical behavioral changes in our clinic from November 1985 to October 1992. Interventions: Medical treatment of cyclical behavioral changes. Main Outcome Measures: Presence and documentation of cyclical behavioral changes, level of retardation, type of behavior, treatment modalities and results. Results: Ninety-three of 522 reproductive-age patients (18%) presented with cyclical behavioral changes. Good documentation with behavior charts was present in 46% of these records. Level of retardation among the women included: 57 (61%) severely, 12 (13%) moderately, and 1 (1%) mildly retarded. No level of retardation could be detected in 23 (25%) women. Aggressive behavior was noted in 35 (38%) women, self-mutilation in 20 (22%) a combination of both in 10 (10%) and other behavior in 28 (28%) women. Primary treatment was by physician preference. Of 46 patients who received nonsteroidal antiinflammatory drugs (NSAID), 30 (65%) showed improvement, 10 (21%) showed no improvement, and 2 patients (4%) showed worsening symptoms. Birth control pills were used in 15 patients; there were signs of improvement in 6 (40%), no improvement in 3 (20%), and worsening in 3 (20%). The use of depomedroxyprogesterone injections was successful in treating 6 of 9 patients (66%), and showed no improvement in 2 women. No statistically significant differences were found between these treatment modalities. Conclusions: Cyclical behavioral changes in women with mental retardation is a common problem (18%) and may be related to pain— possibly due to menstrual cramps, since 65% of the patients responded to NSAID. If treatment with NSAID is unsuccessful, birth control pills and depomedroxyprogesterone improved behavior in 40% to 66% of patients. Documentation is a key issue.