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NANCY C. BRAHM, PHARM. D., M.S., BCPP, is Clinical Associate Professor, Department of Pharmacy Practice; and KEVIN C. FARMER, PH. D., is Associate Professor, Department of Pharmacy Administration, College of Pharmacy, University of Oklahoma, Tulsa. ROBERT C. BROWN, M.D., is Adjunct Clinical Associate Professor, Department of Pharmacy Practice, University of Oklahoma, and Medical Director, Developmental Disabilities Services Division, Oklahoma Department of Human Services, Oklahoma City.

Address correspondence to Dr. Brahm at the College of Pharmacy, University of Oklahoma, 4502 East 41st Street, 2H17, Tulsa, OK 74135-2512 (nancy-brahm{at}ouhsc.edu).

Purpose. The use of risperidone in decreasing fecal smearing behavior as an expression of nonverbal aggression in a developmentally disabled adult is discussed. Summary. A 36-year-old Caucasian man had a history of fecal smearing when he did not get his way or was upset. The patient had profound mental retardation, had an IQ in the range of less than 20 to 25, and was nonverbal. For this patient, fecal smearing was not only a behavioral issue but also a medical concern because he was hepatitis B positive with noncarrier status. Serology also confirmed previous infection with hepatitis A. Risperidone was started at 0.5 mg twice daily. Smearing frequencies during baseline and after risperidone intervention were tracked. During the course of treatment, the risperidone dosage was increased to a total daily dose of 4 mg. The mean ± S.D. number of episodes per month decreased from 15.2 ± 3 in the pretreatment period to 6.0 ± 1.8 at 6 months and 6.7 ± 1.2 at 12 months posttreatment with risperidone. On follow-up in October 2003, fecal smearing had further decreased to the point where it was no longer formally tracked. A diagnosis of mental retardation, developmental disability, or pervasive developmental disorder increases the possibility for emotional and behavioral problems. Previous medication classes tried in the management of aggressive behaviors have not produced consistent results. Risperidone has been used in the treatment of self-abuse, aggression toward others, and violent behaviors. Conclusion. Risperidone was effective in decreasing episodes of fecal smearing as an expression of nonverbal aggression in a developmentally disabled adult. Index terms: Aggression; Antipsychotic agents; Dosage; Mental retardation; Risperidone